9. Pediatrics Flashcards
Underlying cause of dec head size, small palpebral fissures, absent philtrum, and thin upper lip (vermilion border) in an infant?
In utero exposure to alcohol (fetal alcohol syndrome)
cognitive problems also seen
Infants born to moms with Graves’ disease are at risk for what?
Thyrotoxicosis - d/t passage of maternal TSH receptor abs across the placenta –> irritability, tachy wt gain.
Methimazole + BB given to symptomatic patients (mom)
Brief period of apnea and skin color change and unresponsiveness after girl’s toys were taken away.
Breath holding spell - normal in development
Reassure parents they are harmless
What are the 3P’s of McCune-Albirght syndrome?
- Precocious puberty
- Pigmentation (cafe au lait spots)
- Polyostotic fibrous dysplasia (multiple bone defects)
Patients with febrile seizures should be managed how?
Treat fever with acetaminophen
Reassure parents seizures have good prognosis and dont need treatment.
Febrile seizures are common and generally harmless - dont cause brain injury.
After an xray of the abdomen is performed in a patient with neonatal bilious emesis, what shoud be done?
Neonatal bilious emesis = bowel obstruction After xray (rule out pneumoperitoneum)--> contrast enema to determine level of obstruction Microcolon = meconium ileus --> CF narrow sigmoid and dilated descending colon = hirschsprung
What is the most common GI manifestation of CF?
pancreatic insufficiency –> fat malabsorption, steatorrhea, failure to thrive, vit def (Vit k def –> bruising and epistaxis)
MC congenital cyanotic heart defect in the neonatal period? After the neonatal period?
Neonatal period - transposition of great vessels
After neonatal period - tetralogy of fallot
Note: ASD, PDA, VSD are acyanotic
Differentiate Klumpke palsy from Erb-Duchenne palsy
Klumpke - C8 and T1 injured by shoulder dystocia. Claw hand (extended wrist, absent grasp reflex, hyperextended MCP, flexed interphalangeal jts). Can cause horner synd bc sympathetic fibers run along C8 and T1
Erb - C5 and C6 injured. Waiter’s tip (extended elbow, pronated forearm, flexed wrist and fingers. Intact grasp reflex.
Given Total lymphocytes, Cd4 T cells and CD8 T cells. How can you calculate B cells?
Total lymphocytes minus Cd4 Tcells
Child with palpable purpura on lower extremities, abdominal pain, arthralgias, normal platelets, and renal involvement. Dx?
HSP - IgA-mediated vasculitis of childhood.
SCID labs? Tx?
Labs: low lymphocyte conc (T cell low and B cells) –> bacterial, viral and fungal infx
tx: Stem cell transplant
Infant with apathy, weakness, hypotonia,large tongue, sluggish movement, abdominal bloating, and an umbilical hernia has what?
Congenital hypothyroidism
Infants appear normal at birth, but gradually develop these sx
Part of neonatal screening
Why should vision screening be performed at every well-child exm in the first few years of life?
Vision development is critical during this time, and if untreated can lead to permanent vision loss. Eval for fixation and tracking. Cover uncover test to assess for strabismus.
What are risk factors for resp distress syndrome in infants?
Maternal diabetes, prematurity, male sex, perinatal asphyxia, c-section without labor.
Note: high insulin levels antagonize cortisol and block maturation of sphingomyelin (vital component of surfactant)
What should be suspected when a newborn chokes and coughs during the first feeding?
Esophageal atresia with TE fistula. Note: esophageal atresia alone is rare and would not cause sudden resp distress with feeding.
When should vaccinations for medically stable preterm infants be administered?
By CHRONOLOGICAL AGE, not gestational age.
Exception is if wt should be >=2kg (4lb 6 oz) before the first hep B vaccine.
What vaccines are safe during pregnancy?
Inactivated influenza, Tdap, Rho(D) immunoglobulin
Note: Seasonal flu vaccine is safe during EVERY trimester of pregnancy and should be admin to all preg pts as soon as its available
What should be considred in a previously health infant presenting with bulbar palsies, constipation, and hypotonia?
Infant botulism - EVEN IF BABY HAS NOT HAD HONEY! can be found in soil (botulism SPORES).
Tx: human-derived botulism immune globulin
Scalp swelling limited to one cranial bone a few hours after an infant is born is classic for what?
Cephalohematoma - subperiosteal hemorrhage
Does not require tx and resorbs spontaneously within 2 wk to 3 mo.
There is no discoloration of the overlying scalp.
HSP causes increased risk of what abdominal/GI complication? How does it do this?
Intussusception - currant jelly/bloody stools
D/t bowel wall edema and localized hemorrhage that act as lead-points for intussusception
What does apgar assess?
- muscular tone
- resp effort
- adequate HR
- good reflex irritability
- color
Is gastroschisis or omphalocele assoc with cardiac disease, neural tube defects, or trisomy syndromes?
Omphalocele. have sac of peritoneum over healthy bowel.
Both require immediate surgery.
What type of abdominal defect is a common finding in black infants? management?
Umbilical hernia
Generally reducible and close spontaneoulsy bf 5yo
Surgery not usually required
