BODY SYSTEMS (things not on charts)

Question 1

surfactant

Answer 1

lining of the lungs that occurs in the 3rd trimester; premies do not have as much and that’s why they have more trouble breathing

Question 2

smaller/larger (Resp)

Answer 2

smaller lower airways and cartilage, tonsillar tissue enlarged (kids lymph on the whole is very large)

Question 3

under 6 years use these mm to breathe

Answer 3

abdominal

Question 4

we count for a full minute with children due to

Answer 4

periodic breathing

Question 5

TRUE APNEA signs

Answer 5

1. how long the pause in breathing is (generally longer than 10 secs)
2. a cyanosis (circumoral – around the mouth)
3. a bradycardia

Question 6

tracheal tug

Answer 6

kids who are having trouble breathing willl tug at their neck

Question 7

croup

Answer 7

often disease of toddlers or preschoolers
low-high temp 38.5 ish
croup can move on to epiglottitis

Question 8

epiglottitis

Answer 8

PAEDS EMERGENCY
40-41 temp
leaning forward in tripod position, tongue sticking out, pale, drooling

Question 9

RSV

Answer 9

respiratory synctial virus

babies presenting w it cough a lot and have a lot of phelgm

Question 10

CHD/cardiac problems in babies and children

Answer 10

congenital heart disease
tend to be long, skinny babies and feeding tends to be difficult bc it takes up so much of their work/energy because theyre not getting the proper oxygen supply
cant always keep up in play (children show things behaviourally)
can often have Coarctation ofthe Aorta (means narrowing of the aorta, its recommended children have a comparison of arm and leg BPs at least once during childhood)

Question 11

innocent/innocuous murmurs

Answer 11

do not have a physiological consequence, often genetic and run in families “soft murmurs”

Question 12

count apical pulse for a full minute because of

Answer 12

sinus arrhythmia

radial is not used, its not accurate

Question 13

BP assessment procedures

Answer 13

any child under 3 who has risk factors should be checked for BP at every HC visit

Question 14

risk factors for high BP

Answer 14

prematurity/birth
cardiac/renal problems
family hx
any severe disorders

Question 15

primary hyperT

Answer 15

cause is either a disease (underlying physiological reason) or how we are treating a disease*; children have a higher rate of primary hyperT than adults

Question 16

secondary hyperT

Answer 16

due to lifestyle/diet/etc

Question 17

adults vs child water percentage

Answer 17

male: 60&, female: 55%, premie: 80%

Question 18

less at risk for dehydration after age

Answer 18

2

Question 19

assessment for dehydration

Answer 19

eyes
fontanelles
voiding
skin
weight loss

Question 20

early signs: mild dehydration

Answer 20

5%

thirst, dry mouth, less urine, wt loss

Question 21

late signs: moderate dehydration

Answer 21

10%
sunken fontanelle, sunken eyes (one of the best indicators for dehydration, rapid/deep breathing (acidotic), loss of skin elasticity (done on abd, not hands)

Question 22

late signs: severe dehydration

Answer 22

15%; almost always fatal
signs of shock: rapid, weak pulse; cyanosis, cold limbs
potential for coma

Question 23

dehydration tx

Answer 23

fluid replacement (IV, replace what theyve lost over 24 hrs depending on renal/cardiac status)
NPO short term
clear fluids/electrolyte replacement
BRAT/RAB diet when introducing food back (bananas rice applesauce toast)

Question 24

visual ability at 4 months

Answer 24

20/50 - 20/80

Question 25

visual ability at 5 YEARS

Answer 25

20/20 - 20/50

Question 26

age eye colour will show (true colour)

Answer 26

at 6 months; most children born with blue eyes

Question 27

can get: strabismus

Answer 27

eye oscillates

Question 28

can also get: oculomotor dyskinesia

Answer 28

they suddenly lose control of their eye muscles (perfectly normal otherwise)

Question 29

colour blindness most common

Answer 29

red/green

x linked dx; expressed by males and carried by female

Question 30

otitis media

Answer 30

ear infections

Question 31

acute ear infx

Answer 31

dont miss, ear drum can actually rupture, screaming, fever

Question 32

chronic infx

Answer 32

subclinical and no matter what antibiotics given they just wont go awya

Question 33

outer “swimmer’s ear”

Answer 33

often most painful

infection of the ear canal

Question 34

stomach round and protruberant

Answer 34

wilm’s tumour is a renal cancer; the #1 sign of it is increased abd girth (diaper doesnt fit even though child hasnt grown much) – WILL metastasize on palpation, no one palpates abdomen, very curable even in latest stages

Question 35

pyloric stenosis

Answer 35

pyloric sphincter can become so tight that it closes off – common in infants under 6 months of age, higher incidence in first born males (vomiting is more projectile)

Question 36

projectile vomiting in anyone indicates

Answer 36

a NEURO problem (concussed, migraine)

Question 37

intusscesseption

Answer 37

in adults intestines are well-adhered, in a baby theyre not. one part of the intestine can transverse another part and cut it off; causes projectile vomiting
* cranberry jelly stool is diagnostic and not part of any other disorder; no more tests needed but does require surgery

Question 38

rate of propulsion will be increased by

Answer 38

a fever

Question 39

lower GI in neonate:

Answer 39

large intestine short, reduced epithelial lining; stools soft
on breastmilk alone stools mustard yellow and soft
children are prone to constipation

Question 40

soft tissues in children are

Answer 40

very resilient (hardly any sprains, etc)

Question 41

greenstick fractures

Answer 41

their bones are soft; a # occurs on one side/shreds the bone slightly and the other side remains intact

Question 42

common dx: congenital dislocation of hip

Answer 42

every baby tested for it at birth (click is heard if present)
lay them on their stomachs and their folds of skin on the back of legs should be symmetrical
8x more common in girls
if not treated will need hip replacements EARLY (35-40), uneven gait, etc
tx: triple diapers, follow with xrays (usually works)
if it doesnt, a Hip Spica cast used

Question 43

common dx; scoliosis

Answer 43

girls more likely to have it

Question 44

internationally adopted girls tangent:

Answer 44

35-40% of endocrine consults are from this popoulation – risk for retardation
if nutrition is very poor in the first few years, what happens is their brain is kind of “reset” which impacts later when they hit puberty (usually around the same time as other girls), they go through it very quickly and when menarche hits the estrogen cuts off the growth of long bones and these girls can end up very short, socially impacting short, and should be offered growth hormone (purely a growth issue that needs to be screened for)
puberty normally takes years (breast budding then 2-3 years for menarche)
should be monitored when they go through puberty or even before – parents should be counselled
risk factors: orphanage, low nutrition

Question 45

mongolian spots

Answer 45

darker patches of skin along the buttocks, back; NOT a sign of abuse
with time they go away, it’s the melanin containing cells that are migrating to the neural crest

Question 46

cafe au lait spots

Answer 46

little brown spots, surface looking (a small number is considered normal, ie 6-8, but a larger number is linked to a number of neurological disorders). not raised.

Question 47

dennie morgan lines (an atopic sign)

Answer 47

extra fold of skin immediately below the eyes, due toa little bit of swelling that causes the skin to fold (as the sinuses get bigger and they get older they may go away)

Question 48

rabbit nose

Answer 48

may twitch their nose like a rabbit to sniffle/clear an obstruction/nasal mucus

Question 49

allergic shiners

Answer 49

dark rings under the eyes

Question 50

allergic salute

Answer 50

children use the palm of their hand to rub the tip of their nose to itch/congestion/wipe away mucus