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AHN 548 > AHN 548 Unit 2 > Flashcards

AHN 548 Unit 2 Flashcards

Unit 2

1
Q

What is autosomal dominance

A

mutation has occurred in 1 gene of an allelic pair and that the presence of this new gene produces enough of the changed protein to give a different phenotypic effect

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2
Q

characteristics of autosomal dominant inheritance (4)

A
  1. trait appears with equal frequency in both sexes, 2. at least 1 parent must have the trait unless a new mutation has just occurred, 3. when homozygous individual is mated to a normal individual, all offspring will carry trait. if heterozygous individual is mated to a normal individual, 50% of offspring will show trait, 4. if the trait is rare, most persons demonstrating it will be heterozygous
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3
Q

characteristics of autosomal recessive inheritance (5)

A
  1. characteristic will occur with equal frequency in both sexes. 2. for characteristic to be present, both parents must be carriers of recessive trait. 3. if both parents are homozygous for the recessive trait, all offspring will have it. 4. if both both parents are heterozygous for recessive trait, 25% of offspring will have it. 5. frequent occurrence of individuals with rare recessive characteristics, consanguity is often present
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4
Q

x linked recessive, what is it

A

occurs when gene on x chromosome undergoes mutation and the new protein formed as a result of this mutation, is incapable of producing a change in phenotype characteristic in the heterozygous state

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5
Q

x linked recessive characteristics (4)

A
  1. condition occurs more commonly in males than in females. 2. if both parents normal and an affected male is produced, it must be assumed that the mother is a carrier of the trait. 3. if father is affected and an affected male is produced, the mother must be at least heterozygous for the trait. 4. female with trait may be produced in 2 ways: may inherit a recessive gene from both her mother and father (father is affected and mother is heterozygous), may inherit recessive gene from 1 of her parents and may express the recessive characteristic as a function Lyon hypothesis
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6
Q

examples of autosomal dominant conditions and traits (11)

A

cataracts, color blindness (yellow blue), deafness, Huntington’s chorea, keloid formation, marfans syndrome, mitral valve prolapse, muscular dystrophy, pectus excavatum, von willebrand, wolff-parkinson-white syndrome

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7
Q

examples of autosomal recessive conditions (9)

A

albinism, total color blindness, cystic fibrosis, deafness, galactosemia, glaucoma, phenylketonuria, sickle cell anemia, tay Sachs disease

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8
Q

ABCDE of primary survey if trauma (what do these letters stand for)

A

airway, breathing, circulation, disability (Neuro), exposure

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9
Q

CAB meaning for patients that are apneic or have agonal breaths

A

chest compressions, open the airway, provide two rescue breaths

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10
Q

airway : primary survey

A

failure to maintain airway most common cause of preventable death; give all pts high flow 02 at 100%, apply manual stabilization of neck then apply collar

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11
Q

signs of pneumothorax

A

asymmetric breath sounds, trachael deviation, cyanosis, bradycardia

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12
Q

How to evacuate tension pneumothorax

A

insert large bore catheter over needle assembly attached to a syringe through 2nd intercostal space, midclavicular line. withdraw air

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13
Q

tx for pneumothorax and hemothorax

A

place chest tube in 4th or 5th intercostal space in anterior axillary line. insert over rib to avoid neurovascular bundle. connect to water seal

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14
Q

tx for open pneumothoraces

A

treat temporarily with petroleum gauze tapped on 3 sides to create flap

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15
Q

when does child need endotrachael intubation

A

Glasgow less than 9 (decreased loc), need for prolonged ventilation, severe head trauma, or impending operative intervention

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16
Q

airway route of choice for children

A

orotrachael intubation, no need for cervical manipulation

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17
Q

contraindication for nasotracheal intubation

A

midfacial injury

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18
Q

risk associated with use of LAM ( laryngeal mask airway

A

risk for aspiration, shouldn’t be used for prolonged definitive airway management

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19
Q

external hemorrhage control

A

direct pressure, only use hemostats on scalp

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20
Q

signs of cardiac tamponade

A

s/p penetrating or blunt injury. signs: shock, pulseless electrical activity, narrowed pulse pressure, distended neck veins, hepatomegaly, muffled heart sounds

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21
Q

diagnostic and tx for cardiac tamponade

A

ultrasound, pericardiocentesis and rapid volume infusion

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22
Q

treatment for poor perfusion

A

rapid infusion of normal saline or LR at 20ml/kg of body weight. if no improvement after 2 boluses, give 10 ml/kg of RBCs

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23
Q

assessment of Neuro deficit

A

assess pupils, level of consciousness, use AVPU or Glasgow

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24
Q

maintaining body temp in child with injuries

A

hyperthermia compromises outcomes in children with acute brain injuries

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25
Q

signs of urethral transection

A

blood at meatus or in scrotum, or displaced prostate. foley is CONTRAINDICATED

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26
Q

urine output for children with foley

A

1 ml/kg/h

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27
Q

AMPLE for obtaining history

A

allergies, medications, past medical hx/ pregnancy, last meal, events/ environment leading to injury

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28
Q

skin physical assessment for injured child

A

search for lacs, hematoma, burns, swelling, bruising, remove foreign body. ask about tetanus vaccination

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29
Q

head physical assessment for injured child

A

check for hemotympanum, clear or bloody cerebrospinal fluid leak from nares. battle sign ( hematoma over mastoid). raccoon eyes sign of basilar skull fx. look for wounds, foreign body. CT scan

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30
Q

sign of basilar skull fx.. what vaccine to give

A

raccoon eyes. consider pneumococcal vaccine

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31
Q

spine exam of injured child

A

check for spine pain with palpation. obtain xray…if child is obtunded still wait for child to awaken before clearing spine

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32
Q

seat belt sign

A

abdomen pain and tenderness with linear contusion across abdomen. increases risk of intra abdominal injury

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33
Q

x linked dominant definition

A

mutation will produce a protein when present in heterozygous state, sufficient to cause change in characteristic

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34
Q

characteristics of x linked dominant

A
  1. characteristic occurs with same frequency in males and females, 2. affected male mated to normal female will produce characteristic in 50% of offspring, 3. affected homozygous female mated to normal male will produce characteristics in all offspring, 4. heterozygous female mated to normal male will produce characteristic in 50% of offspring, 5. occasional heterozygous females may not show the dominant trait on the basis of the Lyon hypothesis
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35
Q

polygenic inheritance def and examples

A

inheritance of single phenotypic feature as a result of the effects of many genes. examples : cleft lip, club foot, meningomyelocele, dislocation of hip

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36
Q

mitosis

A

division of somatic cells

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37
Q

prophase

A

chromosome filaments shorten, thicken, and become visible. 2 long parallel spiral strands lying adjacent to one after. stands begin to unwind, nuclear membrane disappears

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38
Q

metaphase

A

2nd phase of mitosis, formation of spindle and lining up of chromosomes in pairs

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39
Q

anaphase

A

3rd phase of mitosis, centromere divides and each daughter chromatid goes to 1 of poles of the spindle

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40
Q

signs of pelvic fx

A

pain, crepitus, abnormal motion. foley insertion contraindicated

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41
Q

tx goals for acute head injury in children

A

aggressively treat hypotension to optimize cerebral perfusion, provide supplemental o2 to keep above 90%, achieve eucapnia (end tidal co2 35-45 mm hg), avoid hyperthermia, minimize painful stimuli

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42
Q

tx of choice for acute seizures in children in hospital

A

fosphenytoin or levetiracetam

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43
Q

most common head injury in children

A

traumatic brain injury

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44
Q

head injury symptoms

A

non specific, headache, dizziness, n/v, disorientation, amnesia, slowed thinking, preservation

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45
Q

AVPU

A

alert, responsive to voice, responsive to pain, unresponsive

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46
Q

Glasgow coma scale

A

score 3 to 15, under 8 indicates cns depression requiring positive pressure ventilation

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47
Q

imaging for head injury

A

CT

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48
Q

head injury differential diagnosis

A

cns infection, toxicological ingestion, inborn errors of metabolism

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49
Q

risks associated with open head injury, precautionary tx

A

risk for infection due to direct contamination. allow entry portal for streptococcus pneumoniae. give pneumococcal vaccination

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50
Q

early symptoms of acute intracranial hypertension

A

ams, headache, vision changes, vomiting, gait difficulties, pupillary abnormalities, PAPILLEDEMA, stiff neck, cranial nerve palsies, hemiparesis

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51
Q

late signs of acute intracranial hypertension

A

Cushing triad (bradycardia, hypertension, irregular respirations

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52
Q

diagnostics for acute intracranial hypertension

A

consider CT before lumbar puncture due to risk of herniation

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53
Q

ICP tx in children

A

intubate, give sedative and paralytic. maintain pco2 between 35 and 40, give mannitol. elevate HOB, keep head midline, consult neurosurgery

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54
Q

s/p concussion in children

A

no sports until symptom free at rest and with exercise without medication use. usually 1 to 2 weeks

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55
Q

superficial thickness burns

A

painful, dry, red, hypersensitive. ex:sunburn

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56
Q

superficial partial thickness burns characteristics

A

red, blister

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57
Q

deep partial thickness burn characteristic

A

pale, edematous, blanch with pressure, decreased sensitivity to pain

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58
Q

full thickness burns

A

white or black, dry, depressed, leathery, no sensation

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59
Q

deep full thickness burns

A

most severe, burn down to muscle and bone

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60
Q

compilation of severe burns

A

contracture, compartment syndrome, renal failure secondary to myoglobinuria from rhabdomyolisis

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61
Q

major burn category areas

A

hands, feet, face, eyes ears, perinuem

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62
Q

what types of burns are counted when calculating % body surface area

A

partial and full thickness. NOT superficial

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63
Q

tx for superficial and partial thickness burns

A

Pain control, saline irrigation, application of antibiotic ointment and nonadherent dressing (petroleum gauze). leave small blisters intact. drain larger blisters or leave intact, then protect with bulky dressing. reexamine in 48 hours.

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64
Q

home tx for superficial and partial thickness burns

A

cool compress, hydrocodone or oxycodone

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65
Q

oral or nasal burn/ inhalation injury actions and considerations

A

establish artificial airway. singing of oro or nasophharynx needs immediate intubation. consider toxicity from carbon monoxide, cyanide, or other combustion products. place ng tube and foley

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66
Q

fluid resuscitation for full thickness and deep burns

A

fluid needs are based on weight and percentage of BSA. parkland formula for fluid therapy is 4 mL/kg/% bsa burned for 1st 24 hours with half administered in 1st 8 hours along with maintenance rates. urine output should be 1 to 2 mL/kg/hr

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67
Q

admission for children with burns

A

burns greater than 10% BSA/ inhalation injuries/ abuse should be admitted. admission warranted for adequate pain control. burns greater than 20% or full thickness greater than 2% should be admitted to children’s center or burn center with burn specialist

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68
Q

burn prognosis

A

the greater the surface area and depth of burn the greater the risk of long term morbidity and mortality .

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69
Q

electrical burns in children: what to expect

A

children awake and alert at time of eval after electrocution, ecg not necessary. exposure to high voltage current causes “locking on” effect causing tetany. Can cause extensive nerve and muscle injury, fxs, and cardiac arrhythmias

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70
Q

heat cramps

A

brief severe cramps of skeletal or abdominal muscles following exertion. core temp is normal or slightly elevated. No lab eval indicated

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71
Q

heat exhaustion

A

pt sweats and have varying degrees of sodium and water depletion. core temp normal or slightly increased. weakness, fatigue, headache, disorientation, pallor, thirst, nausea, muscle cramps, possible shock.

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72
Q

heat stroke

A

life threatening, neuro dysfunction. same symptoms as great exhaustion but severe cns dysfunction is hallmark. incoherent/ combative. severe cases include vomiting, shivering, coma, seizures, nuchal rigidity and posturing.

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73
Q

diagnosis of heat stroke

A

rectal temp above 40.6 C (105 F)

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74
Q

severe complications of heat stroke

A

cellular hypoxia, enzyme dysfunction and disrupted cell membranes lead to global end organ derangement. may develop rhabdomyolysis, myocardial necrosis, electrolyte abnormality, acute tubular necrosis, renal failure, hepatic degeneration, acute respiratory distress, DIC

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75
Q

heat stroke differential diagnosis

A

viral gastroenteritis, sepsis, neuroleptic malignant syndrome, malignant hyperthermia, anticholinergic poisoning

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76
Q

heat cramps tx

A

get out of heat, remove clothing, rest, rehydrate with electrolyte solution

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77
Q

heat exhaustion tx

A

iv fluid rehydration

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78
Q

heat stroke tx

A

address ABCs and give o2, place monitor, rectal temp, foley and ng tube. give iv fluids isotonic crystalloid for hypotension, give diazepam for comfort, central venous pressure monitoring. active cooling (stop at 39 C or 102 F to prevent shivering) admit pt PICU

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79
Q

heat stroke labs

A

cbc, electrolytes, glucose, creatinine, pt and put, creatine kinase, liver function test, abg, urinalysis, serum calcium, magnesium and phosphate

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80
Q

prognosis for heat cramps, heat exhaustion and heat stroke

A

heat cramps and heat exhaustion: full recovery; heat stroke: risk of end organ damage…but should recover fully

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81
Q

hypothermia

A

core temp under 35 C (95 F), usually related to water submersion

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82
Q

hypothermia symptoms

A

peripheral vasoconstriction, cool mottled skin, shivering, temp falls, heart rate slows, mental status declines. severe cases mimic death: pale, cyanotic, pupils fixed or dilated, muscle rigidness , may not have palpable pulses. HR of 4 -6 beats per min may be adequate perfusion due to lowered metabolic needs in severe hypothermia. don’t call death until unresponsive after rewarmth and resuscitation efforts

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83
Q

causes of hypothermia besides cold exposure and who’s at risk

A

sepsis, metabolic derangement, ingestion, cns disorder, endocrinopathies. neopates, trauma victims, and chronically disabled most at risk.

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84
Q

labs and imaging for hypothermia

A

cbc, electrolytes, coagulation studies, glucose, and blood gas studies, cxr

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85
Q

hypothermia tx

A

may go into asystole or v give, start cpr, defibrillation and epi won’t work until pt is rewarmed. cover with blankets, warm bath immersion, watch for afterdrop (drop in temp after rewarming). extensive warming is warmed 02,warm crystalloid fluids, warm peritoneal and pleural lavage

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86
Q

hypothermia prognosis

A

may have cns anoxic injuries and lung injury

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87
Q

risk factors for submersion injury

A

epilepsy, alcohol, lack of supervision

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88
Q

submersion injury symptoms

A

cough, nasal flaring, grunting, retraction, wheezes, cyanosis. child rewarmed but remains apneic and pulseless will probably not survive or will have severe Neuro deficits

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89
Q

imaging for submersion injury

A

cxr and ct brain

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90
Q

submersion injury complications and prognosis

A

anoxia from laryngospasm or aspiration leads to irreversible cns damage after 4 to 6 minutes. protection from anoxia only occurs if child falls through ice or directly into icy water

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91
Q

options for laceration repair

A

staples, sutures, tissue adhesive (never use on highly contaminated wound like a bite)

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92
Q

laceration tx

A

give pain medication, irrigate with normal saline or tap water, debride tissue, remove foreign material, closure, antibiotic ointment, tetanus shot

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93
Q

infection from dog bites

A

dogs may carry pasteurella canis, pasteurella multocida, and streptococci staphylococci. treat with amoxicillin and clavulanic acid

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94
Q

complications of dog bites

A

scarring, infection, cns infection, septic arthritis, osteomyelitis, endocarditis, sepsis, posttraumatic stress

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95
Q

complications of cat bite

A

tenosynovitis, septic arthritis, cellulitis

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96
Q

cat scratch disease findings

A

papule, vesicle, or pustule at site of inoculation. hallmark of csd is regional lymphadenitis

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97
Q

cleaning of cat puncture wounds

A

high pressure irritation contraindicated since it may force bacteria deeper. soak in dilute providone iodine solution for 15 minutes. give tetanus shot, DO NOT close wound

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98
Q

infection from cat wound

A

p multocida is most common pathogen in cats. give first line amoxicillin and clavulanic. admit pt if infected wound is hand or foot

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99
Q

absorption rates in order

A

iv, inhalation, sublingual, IM, subq, nasal, oral, rectal, dermal

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100
Q

body burden

A

total amount of drug or toxin within body and may be useful to determine dose absorbed from ingestion

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101
Q

blood levels in poisoning

A

Don’t go by blood levels. treat symptoms

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102
Q

high risk ingestant

A

caustic solutions, hydrogen fluoride, drugs of abuse, or medications such as calcium channel blocker, opiod, hypoglycemic, and antidepressant. and also if poisoning was intentional

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103
Q

skin burn from contaminant tx

A

flood with sterile saline solution or water

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104
Q

emesis and lavage in Peds pt

A

don’t use in routine management of poisoning

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105
Q

charcoal use in peds

A

shouldn’t be used routinely, never give to those with ams who can’t protect airway. repeat 4 to 6 hours until passed through rectum. DON’T use for ingestion of heavy metals, hydrocarbons, caustic, and solvent ingestions

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106
Q

charcoal dosage peds

A

1 to 2 g/kg (max 100 g) per dose. repeat dose for slow passage agents, but DON’T repeat sorbitol or saline cathartics (would cause fluid loss and electrolyte imbalances)

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107
Q

use of cathartics in peds

A

don’t improve outcome and should be avoided

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108
Q

whole gut lavage in peds

A

orally administered, non absorbable hypertonic solution (golytely). use with poisoning with sustained release preparations, mechanical movement of items through bowel (like cocaine packets) and poisoning with substances poorly absorbed by charcoal (like lithium and iron). contraindications in those with intestinal blockage

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109
Q

alkaline diuresis for enhanced excretion

A

used for tx of salicylate toxicity and to prevent methotrexate used on substances whose pK8 is less than 7.5. sodium bicarb used. observe for hypokalemia.

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110
Q

hemodialysis for peds poison treatment

A

used when potentially life threatening toxicity is caused by dialyzable drug and cannot be treated by conservative means, or there renal failure or insufficiency, or marked hyperosmolality or severe acid base or electrolyte disturbances not responding to therapy

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111
Q

poisoning by Tylenol/paracetamol tx

A

abnormalities in liver function may not show for 72 to 96 hrs. treat with acetylcysteine (acetadote) oral or IV. get blood levels 4 hours after ingestion

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112
Q

acetylcysteine dosage for over 40kg

A

over: IV administered as loading dose of 150mg/kg administered or 15-60 minutes, followed by infusion of 50 mg/kg over 4 hours, then 100 mg/kg over 16 hours

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113
Q

alcohol/ethanol consumption in children

A

children show change in sensorium with blood levels as low 10 to 20 mg/dL and should be seen immediately. intoxication increases risk of subarachnoid hemorrhage

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114
Q

alcohol/ethanol consumption tx

A

manage hypoglycemia and acidosis. start IV drip of d5w or d10w if bg less than 60. death is usually because of resp failure. in severe cases, cerebral edema may occur

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115
Q

amphetamine acute poisoning symptoms

A

common poisoning because diet pills and it’s use in adhd medication. anxiety, hyperactivity, hyperpyrexia, diaphoresis, htn, abd cramps, n/v, and inability to void urine, hyponatremia and seizures. severe cases lead to rhabdomyolysis and toxic psychosis

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116
Q

chronic amphetamine use symptoms

A

high tolerance, hyperactivity, disorganization, and euphoria followed by exhaustion, depression, and coma lasting 2 to 3 days. psychosis

117
Q

amphetamine tx

A

benzodiazepine (lorazepam) titrated in small increments. give droperidol or haldol for extreme hallucinations or agitation. control hypertherrmia. psych treatment as well

118
Q

local anesthetics (lidocaine) poisoning symptoms

A

cns stimulation, acidosis, delirium, ataxia, shock, convulsions and death. can cause fetal death

119
Q

local anesthetic poisoning tx

A

if swallowed, clean mucous membranes, give 02. treat methemoglobinemia with methylene blue 1% over 5 to 10 minutes to relieve cyanosis. treat acidosis with sodium bicarb. treat seizures with benzos. treat bradycardia with atropine. give fat emulsion therapy for cardiac arrest

120
Q

antihistamines and cold med toxicity symptoms

A

excitement, hallucinations, delirium, ataxia, tremors, convulsions followed by cns depression, resp failure, or cardio collapse. dry mouth, fixed dilated pupils, flushed face, fever

121
Q

antihistamines and cold med toxicity tx

A

benzos (ativan) to control seizure and agitation. physostigmine to reverse symptoms. treat dysrhythmia and hypotension with normal saline and a vasopresser

122
Q

arsenic poisoning, commonly found in

A

fruit tree, insecticide, and tobacco spray. seafood exacerbates concentration.

123
Q

arsenic poisoning acute symptoms

A

abdomen pain, vomiting, watery and bloody diarrhea, cardi collapse, paresthesia, neck pain, garlic breath

124
Q

arsenic poisoning chronic symptoms

A

anorexia, generalized weakness, giddiness, colic, abdomen pain, polyneuritis, dermatitis, nail changes, alopecia, anemia

125
Q

barbiturate poisoning symptoms

A

confusion, poor coordination, coma, miotic or fixed dilated pupils, resp depression, resp acidosis, atelectasis, hypotension

126
Q

benzo poisoning symptoms

A

cns depression, lethargy without hemodynamic compromise in small amounts, large overdose can cause resp and cardiac depression

127
Q

barbiturate and benzo tx

A

maintain airway, treat hypotension, urinary alkalinization , charcoal. flumazenil for cns and resp depression

128
Q

beta blocker and calcium channel blocker toxicity symptoms

A

bradycardia, hypotension, heart block, dysrhythmia, cns depression

129
Q

beta blocker and calcium channel blocker toxicity tx

A

iv fluid (isotonic), give around for bradycardia, give calcium and glucagon . if still hypotensive give vasopressor (dopamine, norepinephrine)

130
Q

carbon monoxide poisoning symptoms

A

non specific, headache or flulike symptoms, confusion, unsteadiness, coma. permanent cardiac, liver, or cns damage may occur.

131
Q

carbon monoxide poisoning lab findings

A

proteinuria, glycosuria, elevated serum amniotransferase

132
Q

carbon monoxide poisoning tx

A

give 02 immediately (hyperbaric too)

133
Q

acids poisoning where are they found, symptoms

A

metal, toilet bowl cleaners, batteries. symptoms coagulative necrosis. burns skin and mucous membranes. hydrofluoric acid can cause penetrating burn for hours or days and cause life threatening hypocalcemia

134
Q

alkali poisoning examples and symptoms

A

more severe reaction than acid. results in liquefactive necrosis. burns skin and mucous membranes. ex. Clorox, drano, purex

135
Q

acid and alkali poisoning tx

A

emetics and lavage are CONTRAINDICATED. wash burned areas with copious amounts of warm water. irritate eye for 20 minutes. may need intubation. treat hydtofluoric burns with calcium glyconate gel or infusion

136
Q

cocaine poisoning

A

tachycardia, hyperpnea, htn, stimulation of cns followed by coma seizures, hypotension, and resp depression. may have dysrhythmias

137
Q

tx for cocaine toxicity

A

charcoal for body stuffers and whole bowel irrigation for body packers. treat seizures and agitation with lorazepam

138
Q

symptoms of overdose of cyclic antidepressants

A

sudden onset coma within 1 to 2 hours. convulsions, hypotension, dysrhythmia

139
Q

tx and diagnostic of overdose of cyclic antidepressants

A

charcoal and benzos, ecg, sodium bicarb for reverse ventricular dysrhythmia and qrs changes. physostigmine contraindicated. give dopamine or norepinephrine for hypotension

140
Q

tx for lomotil toxicity

A

pulse of monitoring, give naloxone hydrochloride for respiratory depression

141
Q

5 stages of iron toxicity

A
  1. hemorrhagic gastroenteritis (30 to 60 minutes after ingestion) associated with shock, acidosis, coagulation defects, and coma, lasts for 4 to 6 hours 2. phase of improvement, lasts 2 to 12 hours. 3. delayed shock (12 to 48 hours after ingestion) metabolic acidosis, fever, leukocytosis, coma. 4. liver damage, hepatic failure. 5. residual pyloric stenosis (4 weeks after ingestion)
142
Q

urine after iron toxicity

A

red color prior chelation, means iron over 350 mg/dL

143
Q

iron toxicity tx

A

gastric lavage and whole bowel irrigation. deferoxamine for chelating iron, contraindicated in patients with renal failure unless on dialysis. fast infusion can cause hypotension, flushing, urticaria, tachycardia and shock

144
Q

lead poisoning (plumbism) symtoms

A

vague, weakness, irritability, weight loss, vomiting, personality change, ataxia, constipation, headache, colicky abdomen pain. late manifestations: developmental delays, convulsions, coma, increased icp (medical emergency)

145
Q

lead poisoning labs and findings

A

cbc, serum ferritin. glycosuria, proteinuria, hematuria, and aminoaciduria. may have normocytic slightly hypochromic anemia. csf pressure and protein is elevated.

146
Q

lead poisoning tx

A

succimer used in asympyomatic children with blood lead over 45 mcg/dl. dimercaprol and calcium sodium edetate in symptomatic children with blood level over 70. treat encephalopathy with anticonvulsants. give diet high in calcium and phosphorus

147
Q

metatarsus adductus signs

A

Inward deviation of the forefoot. Most common foot abnormality. Angulation occurs at the base of the 5th metatarsal causing prominence of this bone. Could be caused by intrauterine positioning . associated with hip dysplasia

148
Q

metatarsus adductus tx

A

Fully flexible deformity requires no treatment, but if the deformity is rigid and cannot manipulated past the midline it is worth while to perform serial casting.

149
Q

club foot (talipes equinovarus) signs

A

Plantar flexion of the foot at the ankle joint, inversion deformity of the Heel, and medial deviation of the forefoot. associated with spine problems

150
Q

club foot tx

A

Manipulation of the foot to stretch the contracted tissues on the medial and posterior aspect followed by casting to hold the correction. Serial casting performed weekly for 6 to 8 weeks. if severe percutaneous Achilles tenotomy is performed.

151
Q

flat foot signs

A

Flat foot is normal in infants. make sure heel cord is not too short and infant has arch when sitting in non weight bearing position. rule out tarsal coalition/fusion

152
Q

flat foot tx

A

No treatment indicated unless there is calf or leg pain. Supportive shoe can be use

153
Q

talipes calcaneovalgus signs

A

Excessive dorsiflexion at the ankle and eversion of the foot. Usually due Intrauterine position

154
Q

talipes calcaneovalgus tx

A

Passive exercises common stretching the foot into a plantar flexion Should resolve by age 3 to 6 months

155
Q

cavus foot signs

A

Unusually high longitudinal arch of the foot. usually will have a claw toe as well. could be associated with poliomyelitis, diastematomyelia. will have pain

156
Q

cavus foot tx

A

othotic to realign the foot. Surgery may be necessary to lengthen the contracted extensor and flexor tendons and to release the plantar fascia and other tight plantar structures

157
Q

bunion (hallux valgus) sign

A

most common forefoot abnormality. Lateral deviation of the great toe associated with prominence over the head of the 1st metatarsal. Painful with shoe wear

158
Q

bunion tx

A

surgery after bones are completely mature in adulthood

159
Q

genu varum signs and tx

A

means bowleg. normal from infancy to age 3. associated with blount dz. may need brace or osteotomy

160
Q

genu valgum

A

means knock knee, from age 4 to 9 is normal

161
Q

tibial torsion

A

internal rotation of of tibia. normal from birth to 16 months. usually resolves spontaneously.

162
Q

femoral anteversion

A

causes toeing beyond age 2 to 3. should resolve spontaneously. encourage activities like skating

163
Q

developmental dysplasia of hip signs and diagnosis

A

will feel slipping of joint when performing ortolani sign. may also be able to easily dislocate with barlow sign. Can only abduct up to 60 °. galeazzi sign: uneven knees, lower knee is dislocated hip. will have painless limp when walking. may waddle of both hips displaced.

164
Q

hip dysplasia tx

A

can be reversible if fixed in first few weeks of life. most undergo spontaneous correction by 2 to 6 weeks of age. use pavlik harness in first few weeks of life. DON’T do forced and extreme reduction…can lead to necrosis of femoral head. if severe will need closed reduction and then spica cast.

165
Q

torticollis signs

A

occurs usually due to injury to sternocleidomastoid muscle during delivery. may follow uri or mild trauma in kids. head will tilt to the side opposite of affected muscle

166
Q

torticullis tx

A

need passive stretching in 1st year of life. surgery may be needed to release muscle.

167
Q

scoliosis signs

A

lateral curvature of spine and rotation of vertebrae. waistline asymmetry and deformity of rib cage. most common in girls (develops around age 8 to 10) and usually idiopathic.

168
Q

scoliosis signs

A

lateral curvature of spine and rotation of vertebrae. waistline asymmetry and deformity of rib cage. most common in girls (develops around age 8 to 10) and usually idiopathic.

169
Q

scoliosis tx

A

bracing can be used on curvature 20 to 40°. surgical correction needed over 40°. need rods and fusion

170
Q

marfan syndrome

A

connective tissue disorder. unusually long fingers and toes (arachnodactyly), hypermobility of joints, subluxation of ocular lenses (or other eye probs), high arched palate, possible to have scoliosis, pectus carinatum, aortic aneurysms

171
Q

marfan syndrome tx

A

supportive. manage bp. restrict physical activity. may need bracing

172
Q

osteogenesis imperfecta signs

A

genetic connective tissue dz. have multiple and recurrent fractures. may be autosomal dominant (1-5) or autosomal recessive ( 6-11). fx may happen intrauterine. may have dwarfism. blue sclerae, thin skin, hyeperextensive joints. cardio and resp probs

173
Q

osteogenesis imperfecta tx

A

surgical tx of long bones. rods placed for fx prevention. usually wheelchair bound by adulthood. biphosphates used for fx prevention

174
Q

ankle sprains signs and tx

A

happens due to forceful inversion or eversion, causing tearing of lateral or medial ligaments. tx: immobilization with splint and rest ( use crutches). may do functional rehab

175
Q

knee sprains signs and tx

A

pulling of collateral and cruciate ligaments…umcommon. tx: refer to specialist if edema present

176
Q

internal derangement of knee

A

clicking or locking of knees can be heard. get stress films

177
Q

back sprains

A

unusual in kids but may occur in trauma. cause lateral and midline pain. check differential of kidney issues, infection and tumors.

178
Q

contusions

A

muscle contraction with hematoma cause charley horse. tx: ice, compression, rest. no exercise for 5 to 7 days . may use heat after initial healing

179
Q

osteochondroma

A

most common benign bone tumor in kids. pain free mass. capped with cartilage. result from defect of growth plate and grow during childhood. near metaphyseal region of long bones. tx: should be excised if it affects function or causes deformity

180
Q

baker cyst

A

herniation of synovium of knee joint into popliteal region. self limiting. may aspirate mucinous fluid to diagnose

181
Q

ganglion cyst

A

smooth small cystic mass connected by a pedicle to the joint capsule usually on dorsum of wrist. self limiting

182
Q

legg calve perthes

A

occurs between age 4 and 8. vascular supply to proximal femur is interrupted. pain, limp. on imaging will see effusion of joint, widening of joint space. tx: protect joint by minimizing impact

183
Q

Concussion: what is is?, symptoms?

A

occurs when direct blow to body or head translates forces in to the brain, causing transient alteration of neuro function. Confusion, headache, visual disturbance, posttraumatic amnesia, balance problems

184
Q

What to do after concussion

A

don’t leave pt alone in initial hours, only do CT if pt deteriorates, symptoms resolve in 7-10 days. need physical an cognitive rest for 1 to 2 days. Don’t return to play until 24 hours asymptomatic

185
Q

Fracture of clavicle

A

caused by trauma or fall on outstreched hand, tx: pain control, apply sling and swathe. then early progressive rehab is important. no contact sports for 8-12 weeks. only surgery needed for open fractures or those with neurovascular compromise

186
Q

acromioclavicular separation

A

injury from fall on shoulder. acromioclavicular joint capsule tearing. there will be soft tissue swelling and tenderness, positive cross arm test. tx: rest and immobilization in sling with progressive rehab and return to activity in 1 to 6 weeks.

187
Q

fx of humerus

A

injury from significant fall on outstreched arm or shoulder, severe pain, swelling, and deformity. assess brachial plexus and radial nerves. apply sling for 4-6 weeks followed by return to play in 8 to 12 weeks

188
Q

acute traumatic anterior shoulder instability

A

Injury with an abducted and externally rotated arm. pt has severe pain and mechanical block to motion. some pts will spontaneously reduce but most need closed reduction. don’t need sling. may reoccur

189
Q

Rotator cuff injury

A

usually due to repetitive overuse and tissue failure. usually tendonitis and bursitis. present with pain in anterior and lateral shoulder. rehab of injury needed

190
Q

Little league shoulder

A

participate in throwing sport, overuse injury (age 11-14). pain in lateral aspect of humerus with throwing. swelling around shoulder. xray may show widening and sclerosis. tx: rest from throwing, PT for rehab

191
Q

epicondyle apophysitis/little league elbow

A

participate in throwing sport, overuse injury (age 9-12). pain in medial elbow. Tx: complete rest from throwing activities, restricted throwing for up to 6 weeks

192
Q

distal phalanx injury

A

splint for 3 to 6 weeks or until pt is pain free. surgical k wire can be used for reduction. may have nail bed injury

193
Q

distal interphalangeal injury

A

ball handling sports, forced flexion against actively extending finger. present with flexion contracture, inability to extend distal phalanx. tx: splinting for 4 weeks for fx and 6 to 8 weeks for tendon repair

194
Q

thumb injury

A

skier’s thumb, injury to ulnar collateral ligament from forced abduction of the thumb MCP. need thumb spica cast 4 to 6 weeks. need surgery if severe

195
Q

hand fxs

A

check fingers for growth plate involvement, rotation and displacement. if stable, splint for 3 to 4 weeks and buddy taped for immediate return to sports. all other should be referred to ortho surgeon. boxer fx needs hand based casting for 4 weeks

196
Q

wrist injury

A

distal and radial injuries require casting for 3 to 6 weeks in short or long arm cast, torus or buckle fxs may be placed in rigid brace for 3 to 4 weeks

197
Q

hamstring strain

A

mechanism is forced knee extension. pain with tearing or popping sensation in posterior leg, common in athletes. pain occurs with knee flexion against resistance, ice and apply compression. crutches may be needed

198
Q

jumper’s knee

A

from repetitive loading of quadriceps during running and jumping. tenderness over patellar tendon. need PT, ice and activity modification

199
Q

Osgood-Schlatter Disease

A

insidious onset of activity related anterior knee pain in teens. swelling and pain over tibial tubercle. caused by recurrent traction on tibial tubercle apophysis (growth plate). irregular ossification on xray. typically resolves spontaneously as bones mature, pain control with nsaids

200
Q

Meniscal injury

A

medial or lateral knee pain, joint line tenderness. feeling of locking or knee giving way. tx: need surgery, need 6 weeks of crutch training, return to sports in 3 to 4 months

201
Q

Red eye

A

causes: trauma, foreign body, infection, allergy, conjunctivitis

202
Q

tearing

A

in infants can be due to nasolacrimal obstruction. associated with glaucoma, photophobia and blepharospasm

203
Q

purulent discharge from eye

A

associated with bacterial conjunctivitis.

204
Q

watery discharge from eyes

A

occurs with viral conjunctivitis.

205
Q

mucoid discharge from eyes

A

allergic conjunctivitis or nasocrimal obstruction, will contain eosinophils

206
Q

photophobia

A

aversion to light, happens with corneal abrasions, foreign bodies, and iritis may squint one eye. present in infants with glaucoma, albinism, aniridia, and retinal dystrophies

207
Q

leukocoria

A

white pupil, present in retinoblastoma, retinopathy, pupillary membrane, cataracts, retinal detachment, toxocara infection and retinal dysplasia. need immediate optho consult

208
Q

refractive errors: whos at risk

A

heriditary, marfan, down syndrome.

209
Q

myopia

A

nearsightedness, objects at far distance are blurry, onset around age 8. may squint. tx: glasses

210
Q

hyperopia

A

farsightedness, hard to focus on near objects. significant can cause cross eyes (esotropia) and amblyopia

211
Q

astigmatism

A

person has two planes of focus. all objects blurred. causes amblyopia. treated with glasses

212
Q

age norms for vision testing

A

6 weeks: eye to eye contact slow follow movement, 3 months: fixing and following for 2 to 3 feet distance, 6 months: interest in objects across the room, 2 to 3 year use allen and lea symbols with familiar pictures, 4 years old: tumbling e game and tell orientation of E or snellen chart.

213
Q

visual acuity age norms

A

less than 2 vision 20/60 or beter, 3 year old 20/40-20/30, 4 year old 20/30 to 20/25, 5 and older 20/20

214
Q

absent red reflex differentials

A

cataract, large refractive error, tumor, strabismus

215
Q

removal of FB on eye

A

give topical anesthetic, remove foreign body with irrigation or cotton applicator. give ophthalmic antibiotic

216
Q

corneal abrasion

A

sudden and severe eye pain, decreased vision, tearing, eyelid edema, redness. tx: ophthalmic antibiotic ointment. no patch needed

217
Q

penetrating injury to eye

A

emergency, sudden ocular pain, vision prb, irregular pupil,

218
Q

6 cardinal positions of gaze

A

medial rectus, superior rectus, superior oblique, lateral rectus, inferior rectus, inferior oblique

219
Q

wood lamp in eye exams

A

turns epithelial defects yellow green. herpes lesions look branchlike,

220
Q

Hordeolum (Stye)

A

Patho: Staph. Localized tender, red, warm papule on upper or lower eyelid. Tx: Warm compresses. Topical
abx (bacitracin or erythromycin). If no improvement in 48 hours, consider referral for incision and drainage.

221
Q

Chalazion

A

Obstruction of meibomian glands with inflammation and granuloma formation. May follow an internal stye. Hard eyelid nodule, upper or lower, with localized redness. Minimal to no tenderness. May have distorted vision due to compression on cornea.
Tx: Eyelids crubs with baby shampoo, warm
compresses, and topical antibiotic ointment (bacitracin or EES). If doesn’t resolve, refer to
ophthalmology for incision and curettage and/or
corticosteroid injection.

222
Q

Blepharitis

A

Patho: Bacterial overgrowth (usually staphylococcus).
Meibomian gland obstruction may occur. Common chronic inflammatory condition of eyelid margins causing irritation and redness, and sometimes dry eyes, conjunctivitis, eyelid ulcerations, or eyelid scaling. Tx: Eyelid scrubs with baby shampoo, warm
compresses, and topical antibiotic ointment

223
Q

Dacrocystitis

A

Infection of the lacrimal sac. Usually unilateral. Acute: redness near tear duct, tender, swelling pain, purulent discharge expressed. Tx: systemic antibiotics. Warm
compresses. Surgical relief after acute resolution. Chronic: tearing and discharge. pus expressed. tx: surgery

224
Q

ptosis

A

eyelid drooping. need surgery for mod to severe

225
Q

viral conjunctivitis

A

caused by adenovirus, Usually bilat with copious watery discharge. Sometimes associated with URI symptoms. tx: No antibiotics needed. Secondary
bacterial conjunctivitis is not uncommon and
often sulfonamide eye drops are prescribed to
prevent. Cold compresses. Hygiene education

226
Q

bacterial conjunctivitis

A

if caused by Staphlococci, streptococci, Haemophilus,
Pseudomonas, and Moraxella: will have Copious purulent discharge and mild discomfort. self limiting in 10 to 14 days but can take Topical abx to clear in 2-3 days. If caused by Gonococcal & Trachoma (chlamydial): will have Infected genial secretions.
Copious purulent discharge. Tx: Systemic abx

227
Q

Allergic conjunctivitis

A

• Patho: Atopic. Allergic rhinitis, dermatitis, or asthma will usually co-exist. Signs: Seasonal, Itching, tearing, redness, and stringy discharge. Large cobblestone
papillae are noted on the upper tarsal conjunctiva in the vernal form. tx: Topical histamine H1-receptor antagonist or topical mast cell stabilizers are
recommended. Adding oral antihistamine may be needed

228
Q

nasoclacrimal duct obstruction

A

tearing and mucoid drainage from affected eye especially in the morning, erythema and conjunctivitis. tx: massage nasolacrimal sac to empty debris. may need surgical tx

229
Q

glaucoma

A

caused by increased ICP, can cause vision loss due to optic nerve injury and corneal scarring. signs: tearing, photophobia, corneal clouding. will have sudden eye pain. will need sx and med to decrease icp

230
Q

viral keratitis

A

painful red eye. branchlike pattern under woodlamp. caused by herpes and adenovirus affecting cornea. tx with topical antifungals. give systemic meds to newborns like acyclovir

231
Q

cataracts

A

signs: leukocoria, poor fixation, strabismus or nystagmus. abscence of red reflex. should be removed prior to six weeks of age

232
Q

retinoblastoma

A

most commonprimary intraocular malignancy of childhood. usually seen before age 3. will have leukocorria. could cause death. tx: chemoreduction and radiotherapy

233
Q

retinal detachement

A

seen in marfan syndrome. symptoms: floaters, flashing lights, loss of visual field, abnormal or absent red reflex, tx: surgical

234
Q

diabetic retinopathy

A

higher risk with type 1 and insulin dependent diabetes, , blurred vision, myopia, cataracts. tx pan retinallaser photocoagulation or vitreoretinal surgery.

235
Q

papilledema

A

increased icp, can be caused by tumor or hydrocephalus, ophthalmoscopy will reveal elevated disc and vessel tortuosity. tx: corticosteroid or carbonic anhydrase inhibitor. may need shunt

236
Q

Amblyopia

A

“lazy eye”, tx: patch good eye to strengthen bad eye

237
Q

Estropia (Cross-eyed)

A

tx with surgery between 6 months and 2 years old. accomadative may use bifocals and rehab

238
Q

Extropia (Wall-eyed)

A

tx with sx, orthoptic exercises , patching, and occasionally glasses

239
Q

Cyanotic Presentations in infants

A

Etiology: transposition of the great vessels, total anomalous pulmonary venous return, truncus arteriosus (some types), tricuspid atresia, and pulmonary atresia or critical pulmonary stenosis.
S/S: Early cyanosis often without initial respiratory distress
Testing: ABG, CXR, EKG, and Echo

240
Q

Acyanotic Presentations in infants

A

Etiology: Left-side outflow obstruction, left-to-right shunting VSD
S/S: Dependent on etiology, peripheral pulses diminished or absent
Testing: Echo

241
Q

Pulmonary HTN in infants

A

Etiology: Many. Pulmonary vascular vasoconstriction, smooth muscle development, or decreased area of exchange due to meconium aspiration syndrome, hyaline membrane disease, perinatal depression, neonatal sepsis, chronic intrauterine hypoxia, pulmonary hypoplasia etc…
S/S: Respiratory distress with poor response to O2, cyanosis, patent ductus arteriosis or foamen ovale by echo
Treatment: Ventilation, IV fluids, systemic pressors, nitric oxide, ECMO

242
Q

S1, S2, S3 and S4

A

S1- sound of AV valve closure; S2-sound of semilunar valve closure, splitting varies with respiration; S3- rapid left ventricular filling,disappears when going from supine to sitting or standing; S4- atrial contraction and increased atrial pressure, not normal, happens in noncompliant ventricle, diastolic dysfunction

243
Q

cardiac defects associated with down syndrome

A

AVSD, atrioventricular septal defect

244
Q

cardiac defects associated with turner syndrome

A

Bicuspid aortic valve, coarctation, dilated aortic root, htn

245
Q

cardiac defects associated with Noonan syndrome

A

dysplastic pulmonic valve, HCM

246
Q

cardiac defects associated with Williams-Beuren syndrome

A

supravalvular aortic stenosis, PPS, Coronary ostial stenosis

247
Q

cardiac defects associated with Marfan Syndrome

A

MVP, MR, dilated aortic root

248
Q

cardiac defects associated with fetal alcohol syndrome

A

VSD, ASD

249
Q

cardiac defects associated with MAternal rubella Loeys-Dietz Syndrome

A

PDA, PPS, Aneurysmal PDA, dilated aortic root, tortuous arteries throughout the body

250
Q

Systolic murmurs

A

MR. PASS: Mitral Regurgitation, Physiologic (also known as functional, systolic flow murmur, a heart murmur heard in the absence of cardiac abnormality), Aortic Stenosis, Systolic; MVP: Mitral Valve Prolapse

251
Q

Diastolic murmurs

A

MS. ARD: Mitral Stenosis, Aortic Regurgitation Diastolic

252
Q

Resting heart rate for < 1 month

A

80-160

253
Q

Resting heart rate for 1-3 months

A

80-200

254
Q

Resting heart rate for 2-24 months

A

70-120

255
Q

resting heart rate 2-10 years

A

60-90

256
Q

blood pressure checks in extracardiac examination

A

do BP in every extremity, low BP in lower extremities suggests coarctation of aorta

257
Q

cyanosis of extremities

A

results from increased concentration of reduced hemoglobin in blood. bluish skin color, low cardiac output, hypothermia. look for bluish mucous membranes

258
Q

clubbing of fingers and toes

A

associated with severe cyanotic congenital heart dz. appears after age 1. can occur with endocarditis, chronic liver dz, IBS, chronic pulmonary dz, and lung abscess

259
Q

edema on extracardiac exam

A

in dependent areas means elevated right BP seen with tricuspid valve pathology or heart failure

260
Q

extracardiac exam of abdomen

A

hepatomegaly is cardial sign of rt heart failure. splenomegaly may be present in pts with long standing HF and infective endocarditis. ascites feature of rt HF

261
Q

dextrocardia

A

heart on rt side of chest, severe when other organs aren’t reversed as well.

262
Q

D transposition of great arteries on CXR

A

egg on string

263
Q

tetralogy of fallot on CXR

A

boot shaped heart

264
Q

unobstructed total anomalous pulmonary venous drainage on CXR

A

Snowman

265
Q

obstructed total anomalous pulmonary venous drainage on CXR

A

small heart with congested lungs

266
Q

coarctation

A

figure 3 sign + rib notching

267
Q

Transesophageal echocardiography

A

test for heart disease, under general anesthesia

268
Q

Transthoracic echocardiogram

A

pt must be still for 30 minutes, at each transducer a beam is swept through the heart and a 2 dimensional image appears. gives info on structural detail and intracardiac blood flow and pressure gradients.

269
Q

MRI in infants

A

useful in imaging thoracic vessels to eval structure and blood flow. helpful in diagnosing MArfan, Turner and Loeys-dietz syndrome

270
Q

During ABG testing

A

Lung disease responds well to 100% 02, heart disease does not

271
Q

Cardiac cath

A

tests oximetry, shunts, cardiac output, pressures, vascular resistance

272
Q

atrial septal defect

A

opening in atrial septum permitting shunting of blood between atria, widely split S2, RV heave, ejection murmur at pulmonary area, frequently asymptomatic. Xray shows enlarged heart, ECG shows right heart deviation. tx: surgical or catheterization closure

273
Q

ventricular septal defect

A

most common congenital heart malformation, clinical features are failure to thrive, tachypnea, and diaphoresis with feeds. lt to rt shunt with normal pulmonary vascular resistance. may cause eisenmenger syndrome. tx: diuretics and systemic afterload reduction, may need sx treatment to place patch

274
Q

Atrioventricular defect

A

common in infants with down syndrome, incomplete fusion of embryonic endocardial cushions. symptoms such as failure to thrive, tachypnea, diaphoresis with feeding, recurrent bouts of pneumonia. tx: surgery is required before 1st year of life

275
Q

Patent Ductus Arteriosis

A

continuous murmur, bounding peripheral pulses. signs:failure to thrive, tachypnea, diaphoresis with feeding. lt to rt shunt, imaging will show enlarged lt atrium and ventricle, ecg may be normal. tx: indomethecin given to close PDA in preterm infants. otherwise sx needed

276
Q

pulmonary valve stenosis

A

cyanosis and high incidence of right sided HF. dilated pulmonary artery on CXR. tx: recommened for pts with systemic or suprasystemic rv pressure. done with percutaneous balloon valvuloplasty

277
Q

Coarctation of the aorta

A

absent or diminished femoral pulses, blowing systolic murmur in back or left axilla. lt ventricular enlargement on Xray. tx: surgical corrective repair

278
Q

Aortic stenosis

A

harsh systolic ejection murmur at upper right sternal border, thrill in carotid arteries, systolic click at apex, dilation of ascending aorta on CXR. tx: percutaneous balloon valvuloplasty in symptomatic patients

279
Q

Mitral Valve Prolapse

A

midsystolic click, late systolic whooping or honking murmur, overdiagnosed, symptoms: chest pain, palpitations and dizziness. common in marfan, loey-dietz, and ehlersddanslo syndroms. tx: propanolol

280
Q

tetralogy of fallot

A

hypoxemia spells during infancy, rt sided aortic arch, ejection murmur at upper left sternal border. right ventricular outflow tract obstruction. Hgb, hematocrit, and RBCs will be elevated. tx: palliative care vs total correction through open heart sx

281
Q

transposition of great arteries

A

cyanotic newborn without resp distress, more common in males, neonates usually large and profoundly cyanotic without resp distress tx: corrective surgery with arterial switch operation

282
Q

Kawasaki dz

A

leading cause of heart dz in children, manage with IVIG and high dose aspirin

283
Q

pulmonary htn

A

subtle with symtpoms of dyspnea, fatigue, chest pain and syncope. rare, progressive and often fatal dz without tx. tx:use cardic cath for data, give vasodilators like nifidepine or diltiazem. if unresponsive give prostanoids, endothelin antagonist or phosphodiesterase 5 inhibitors

284
Q

x linked recessive conditions (8)

A

color blindess (red green), diabetes insipidus, gout, hemophilia A, hemophilia B, hypothyroidism, immunodificiency, muscular dystrophy

285
Q

neural tube dz ex

A

anencephaly, spina bifida, meningomyelocele

286
Q

neural tube dz maternal testing

A

maternal serum drawn at 16 to 20 weeks gestation. if elevation over 2.5 of st deviation of the mean , do amniocentesis for AFP along with US

287
Q

false positive on neural tube

A

due to innacurate dating of of gestational age, multiplegestation, fetal demise, dying fetus, or structural abnormalities. do repeat

288
Q

trisomy 21

A

most common trisomy responsible for down syndrome,

AHN 548 (2 decks)

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