9. Pediatrics

Question 1

Underlying cause of dec head size, small palpebral fissures, absent philtrum, and thin upper lip (vermilion border) in an infant?

Answer 1

In utero exposure to alcohol (fetal alcohol syndrome)

cognitive problems also seen

Question 2

Infants born to moms with Graves’ disease are at risk for what?

Answer 2

Thyrotoxicosis - d/t passage of maternal TSH receptor abs across the placenta –> irritability, tachy wt gain.
Methimazole + BB given to symptomatic patients (mom)

Question 3

Brief period of apnea and skin color change and unresponsiveness after girl’s toys were taken away.

Answer 3

Breath holding spell - normal in development

Reassure parents they are harmless

Question 4

What are the 3P’s of McCune-Albirght syndrome?

Answer 4

1. Precocious puberty
2. Pigmentation (cafe au lait spots)
3. Polyostotic fibrous dysplasia (multiple bone defects)

Question 5

Patients with febrile seizures should be managed how?

Answer 5

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.

Question 6

After an xray of the abdomen is performed in a patient with neonatal bilious emesis, what shoud be done?

Answer 6

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

Question 7

What is the most common GI manifestation of CF?

Answer 7

pancreatic insufficiency –> fat malabsorption, steatorrhea, failure to thrive, vit def (Vit k def –> bruising and epistaxis)

Question 8

MC congenital cyanotic heart defect in the neonatal period? After the neonatal period?

Answer 8

Neonatal period - transposition of great vessels
After neonatal period - tetralogy of fallot
Note: ASD, PDA, VSD are acyanotic

Question 9

Differentiate Klumpke palsy from Erb-Duchenne palsy

Answer 9

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.

Question 10

Given Total lymphocytes, Cd4 T cells and CD8 T cells. How can you calculate B cells?

Answer 10

Total lymphocytes minus Cd4 Tcells

Question 11

Child with palpable purpura on lower extremities, abdominal pain, arthralgias, normal platelets, and renal involvement. Dx?

Answer 11

HSP - IgA-mediated vasculitis of childhood.

Question 12

SCID labs? Tx?

Answer 12

Labs: low lymphocyte conc (T cell low and B cells) –> bacterial, viral and fungal infx
tx: Stem cell transplant

Question 13

Infant with apathy, weakness, hypotonia,large tongue, sluggish movement, abdominal bloating, and an umbilical hernia has what?

Answer 13

Congenital hypothyroidism
Infants appear normal at birth, but gradually develop these sx
Part of neonatal screening

Question 14

Why should vision screening be performed at every well-child exm in the first few years of life?

Answer 14

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.

Question 15

What are risk factors for resp distress syndrome in infants?

Answer 15

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)

Question 16

What should be suspected when a newborn chokes and coughs during the first feeding?

Answer 16

Esophageal atresia with TE fistula. Note: esophageal atresia alone is rare and would not cause sudden resp distress with feeding.

Question 17

When should vaccinations for medically stable preterm infants be administered?

Answer 17

By CHRONOLOGICAL AGE, not gestational age.

Exception is if wt should be >=2kg (4lb 6 oz) before the first hep B vaccine.

Question 18

What vaccines are safe during pregnancy?

Answer 18

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

Question 19

What should be considred in a previously health infant presenting with bulbar palsies, constipation, and hypotonia?

Answer 19

Infant botulism - EVEN IF BABY HAS NOT HAD HONEY! can be found in soil (botulism SPORES).
Tx: human-derived botulism immune globulin

Question 20

Scalp swelling limited to one cranial bone a few hours after an infant is born is classic for what?

Answer 20

Cephalohematoma - subperiosteal hemorrhage
Does not require tx and resorbs spontaneously within 2 wk to 3 mo.
There is no discoloration of the overlying scalp.

Question 21

HSP causes increased risk of what abdominal/GI complication? How does it do this?

Answer 21

Intussusception - currant jelly/bloody stools

D/t bowel wall edema and localized hemorrhage that act as lead-points for intussusception

Question 22

What does apgar assess?

Answer 22

1. muscular tone
2. resp effort
3. adequate HR
4. good reflex irritability
5. color

Question 23

Is gastroschisis or omphalocele assoc with cardiac disease, neural tube defects, or trisomy syndromes?

Answer 23

Omphalocele. have sac of peritoneum over healthy bowel.

Both require immediate surgery.

Question 24

What type of abdominal defect is a common finding in black infants? management?

Answer 24

Umbilical hernia
Generally reducible and close spontaneoulsy bf 5yo
Surgery not usually required

Question 25

Babies who are large for gestational age are at inc risk for birth injuries such as clavicular fractures. How do you manage these fractures? What do you do if there is a brachial plexus injury (Erb-Duchenne palsy)?

Answer 25

Reassurance and guidance on gentle handling. Most heal rapidly without complications.
Palsy: recovery spontaneous in a few months (PT and massage to prevent contractures)

Question 26

When does an ingested battery need to be removed vs let it pass?

Answer 26

If in esophagus - immediate endoscopic removal to prevent mucosal damage and esophageal ulceration. Likely lodged
If distal to esophagus - these pass uneventfully in 90% of cases and observe.

Question 27

A newborn with intraventricular hemorrhage (IVH) which results from bleeding into the germinal matrix is associated most significantly with what risk factor?

Answer 27

Prematurity (Low birth weight infants).
Vascular perfusion injuries have also been associated with IVH.
Transfontanel US for all newborns with predisposing RF is key.