8 Flashcards
In infants born > 37 weeks, what is goal for daily nutrition?
100-120 kcal/kg/day
What is goal weight gain per day for infants born > 37 weeks?
20-30 g per day
When do you expect moro reflex to go away?
Moro is arm abduction followed by adduction with abrupt change in head position; should go away by 4 months
At what age should kids be able to sit in front seat of car?
13 and older
Through 6 years old, how many DtaP vaccines?
5
What vaccines are in the PediaRix combo?
HepB, DTaP, IPV
When do babies typically double their birth weight?
4-5 months
What are some causes of red reflex?
Cataracts
Glaucoma
Retinoblastoma
Chorioretinitis
What should gross motor function look like for a 6 month old?
Rolls over
Sits unsupported
No head lag when pulled to sit from supine
How does a 6 month old interact with language?
Turns towards voice and babbles (da-da-da etc)
When should a child be able to stand?
1 yr
Fine motor for 1 year old?
Developed fine pincer grasp
Kid has neuroblastoma. Prognosis?
When diagnosed in less than a year, likely regresses
Are most cases of neuroblastoma due to familial inheritance or spontaneous mutation?
SPONTANEOUS; <1% due to AD incomplete penetrance
In which childhood tumor do we look at catecholamine levels?
neuroblastoma
DDx for RUQ mass in child?
neuroblastoma, Wilms tumor (nephroblastoma), hepatic neoplasm, hydronephrosis, teratoma
Where do we see neuroblastomas?
Neck, chest, abdomen
What does the HEEADSSS mnemonic stand for?
Home Education / Employment Eating Activities Drugs Sexuality Suicide / Depression Safety / Violence
What’s the role in the cremasteric reflex on physical exam of someone you suspect has testicular torsion?
Absence of the cremasteric reflex is a sensitive but non-specific finding for testicular torsion.
Which sign is virtually pathognomonic for appendiceal torsion when tenderness is also present?
Blue dot sign; bluish discoloration in upper pole of testes where embryologic appendage of testes lives
Kid comes in with groin pain. Physical exam reveals a high-riding testicle with an absent cremasteric reflex. What is on your ddx?
Testicular torsion.
How long after torsion do you have until testes may become ischemic and compromised?
4-8 hours; time is testes
What age groups are most effected by testicular torsion?
Neonates and pubertal age
What can help distinguish epididymitis from testicular torsion?
Elevate the testes (Prehn maneuvre), if relieves pain than it is likely epididymitis
When does a direct hernia usually occur?
usually occurs due to a defect or weakness in the transversalis fascia area of the Hesselbach triangle
What makes up the edges of the Hesselbach triangle through which a direct hernia penetrates?
inferiorly by the inguinal ligament, laterally by the inferior epigastric arteries, and medially by the conjoint tendon.
A teenager comes in with painless swelling of his left testes that transilluminates with light. What is you suspect diagnosis?
Hydrocele
______ is a collection of dilated and tortuous veins in the pampiniform plexus surrounding the spermatic cord in the scrotum
Varicocele
Why do varicoceles occur more frequently on the left side?
because the left spermatic vein enters the left renal vein at a 90 degree angle, whereas the right spermatic vein drains at a more obtuse angle directly into the inferior vena cava, facilitating more continuous flow.
This testicular abnormality makes up large proportion of male infertility
Varicocele
A boy comes in with testicular pain and you suspect torsion. What helps you differentiate testicular with appendage torsion?
tenderness/pain localized to the upper pole of the testis and “blue dot sign” suggest appendiceal torsion
A man has testicular pain. What physical exam findings would suggest epididymitis as cause?
Prehn sign (relief of pain with elevation of testes), presence of cremasteric reflex (absent in torsion) and systemic signs of infection (fever, tachy) `
What are some causes of testicular torsion?
Congenital anomaly (bell clapper deformity - failure of normal posterior anchoring of the gubernaculum, epididymis, and testis), undescended testes, trauma or high intensity exercise
When surgical correction is attempted for relief of testicular torsion, what are signs that the testes is viable?
a return of color, return of Doppler flow, and arterial bleeding after incision of tunica albuginea
Can infections with gonorrhea, chlamydia and trichomonas all be asymptomatic?
YES; and they can all be treated with a single dose medication ( g = 250 mg ceftriaxone IM, c = 1 g azithromycin, t = 2 g metronidazole)
What is the most common malignancy affecting males between the ages 15 and 35?
testicular cancer
What is the most common type of testicular cancer?
germ cell tumor
What are some cardiac causes of SOB?
Congestive heart failure (CHF), coronary artery disease (CAD), dysrhythmia, pericarditis, acute myocardial infarction
What is orthopnea?
Dyspnea when lying flat
What is paroxysmal nocturnal dyspnea?
Sudden, severe shortness of breath at night that awakens a person from sleep, often with coughing and wheezing – usually HF patients
Why is cough with asthma and COPD generally worse in cold weather?
because breathing cold dry air causes constriction of the airways and obstructs air flow
What are classic physical exam findings of a patient with COPD?
Increased anteroposterior (AP) diameter of the chest Decreased diaphragmatic excursion Wheezing (often end-expiratory) Prolonged expiratory phase Distant heart sounds Diminished lung sounds
What is the GOLD standard diagnostic test for COPD?
PFTs
What do we call the total amount of air the patient can expel from the lungs after a full inspiration?
FVC
What FEV1/FVC is diagnostic of COPD?
< 70%
Does the the FEV1 impairment define the level of COPD severity?
YES; < 30% is very severe
Which cells play a role in the inflammatory and destructive processes of COPD?
Macrophages, T killer cells, and neutrophils
At what FEV1 do COPD patients typically become symptomatic?
FEV1 between 50 and 80%; this is defined as moderate
What is the sequence of medication addition for increasing severity of COPD?
1) SABA
2) SABA + LABA or LAMA
3) SABA + LABA + LAMA
4) SABA + LABA + LAMA + ICS
Which vaccines should a COPD patient recieve?
TDaP, Influenza, Pneumococcal
Treatment of COPD exacerbation?
Inhaled bronchodilators (particularly inhaled beta 2-agonists with or without anticholinergics) and oral glucocorticosteroids
Of those experiencing COPD exacerbation, which signs/sx indicate that the patient may benefit from abx?
Dyspnea, increased phlegm, change in phlegm color
Describe the mechanism for COPD induced heart failure.
chronic hypoxia (1) causes pulmonary vasoconstriction (2), which increases blood pressure in the pulmonary vessels. This elevation in blood pressure causes permanent damage to the vessel walls and leads to irreversible hypertension (3). The right heart eventually fails (4) because the pump cannot sustain flow effectively against this pressure. Right heart failure leads to an increase in preload, with peripheral edema and increased jugular venous distention.
