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Pediatrics > Case Files 1 > Flashcards

Case Files 1 Flashcards

1
Q

Five things in apgar score

A

HR, Respiratory effort, muscle tone, reflex irritability (catheter in nose), and color

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2
Q

How does a child with a diaphragmatic hernia often present

A

Immediate respiratory distress, scaphoid abdomen, cyanosis, and heart sounds displaced to right side of chest

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3
Q

What does choanal atresia result in

A

Respiratory distress when a child stops crying: intubate until surgery can be completed

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4
Q

GDM when mothers fasting glucose above

A

95

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5
Q

What cause HCM from GDM

A

Glycogen deposition in myocardium

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6
Q

Why RDS from GDM

A

Inulin appears to interfere with cortisols ability to induce surfactant production

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7
Q

When do give IV glucose to IDM

A

When blood glucose less than 40 with any symptom of hypoglycemia
hypocalcemia also seen

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8
Q

Two labs for neonatal jaundice

A

Bilirubin and hematocrit

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9
Q

What kind of bilirubin is toxic to brain

A

Unconjugated (deposition into brain causes kernicterus)

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10
Q

What does end-tidal CO2 concentration (ETCO) measure

A

Non-invasive measure of bilirubin association

Tracutaneous bilirubinometer can also be used

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11
Q

4 findings suggestive of non-physiologic jaundice in newborn

A
  1. First 24-36 hours
  2. Rise > 5 in 24 hours
  3. Bili greater than 12 in healthy newborn
  4. Jaundice lasts > 2 weeks
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12
Q

Jaundice in 2nd to 3rd week of life likely

A

Breast milk jaundice

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13
Q

How does maternal phenobarbital reduce neonatal jaundice

A

Induces gluconuryl transferase

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14
Q

Defect in Crigler-Najjar

A

Severe uridine-diphosphate glucuronyslatransferase def (all newborns somewhat def)

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15
Q

Three features typical of GBS pneumonia

A

Rapid symptom onset, low WBC with left shift, and CXR show infiltrates

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16
Q

Majority of early onset neonatal sepsis occurs when

A

Within first 24 hours (def is within 6 days)

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17
Q

What is crucial for patients with suspected sepsis

A

Blood culture

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18
Q

MCC of neonatal sepsis from birth to 3 months

A

GBS

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19
Q

When do screen pregnant women for GBS

A

35-37 weeks

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20
Q

How does late onset GBS most commonly manifest

A

Bacteremia without a focus

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21
Q

Neonatal sepsis Ab tx for early vs late

A

Early: Pen and amino glycoside (gent)
Late: Vanc and 3rd gen ceph

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22
Q

Late onset neonatal infection (7-90 days) usually caused by

A

Environment (coag neg staph, E. coli)

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23
Q

Microphallus size

A

less than 2cm for neonate (

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24
Q

3 goals for intersex born baby

A
  1. Learn etiology
  2. Assign gender
  3. Intervene with surgical or other treatment
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25
Q

MCC of male pseudohermaphroditism

A

Androgen insensitivity syndrome

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26
Q

Hyper pigmentation of labial scrotal folds seen in

A

CAH

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27
Q

What is used for karyotype analysis in neonates

A

Activated lymphocytes

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28
Q

Whats elevated in the MC CAH? what helps

A

17-hydroxyprogesterone

Administration of hydrocortisone helps

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29
Q

Gonad + ovaries on US

A

True hermaphroditism

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30
Q

Androgen insensitivity syndrome

A

Blind vagina in girl with amenorrhea and no pubic hair

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31
Q

Infants born with intrauterine HSV infection suspected to have

A

Skin vesicles, chorioretinitis, microcephaly

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32
Q

Blueberry muffin rash with what

A

Congenital rubella infection

Also some CMV

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33
Q

Neonatal HSV CNS manifestations seen when

A

2-3 weeks of life

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34
Q

Congenital toxo triad

A

Hydrocephalus, intracranial calcifications, and chorioretinis

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35
Q

CMV vs toxo calcifications in baby

A

toxo: basal ganglia
CMV: periventricular w/ blue petechia on baby

36
Q

Rubella in baby

A

Blueberry muffin, cataracts, normal CT

37
Q

Tracheal esophageal malformation seen when ~4-12 month old has recurrent aspiration pneumonia

A

H type TEF

38
Q

VACTERL

A 
Vertebral anomaly
Anal imperforation
Cardiac
Tif
Renal 
Limb
39
Q

CHARGE

A 
Coloboma of eye
Heart defects
Atresia of nasal/esophagus
Retardation
Genital 
Ear
40
Q

Why hypocalcemic crisis in DiGeroge

A

Parathyroid hypoplasia

41
Q

What causes transient tachypnea of the newborn

A

Slow absorption of fetal lung fluid with resultant tachypnea, treated with supportive care
More commonly seen with C sections

42
Q

What is required to link neonate to ECMO

A

Cannulation of the carotid artery and jugular vein

43
Q

CXR of transient tachypnea of newborn

A

Perihilar streaking and fluid in the fissures

44
Q

2 causes of tachypnea of infant born to diabetic mother

A

Polycythemia and hypoglycemia

45
Q

What is aphakia

A

Absence of the lens

46
Q

Misalignment of the visual axes

A

Strabismus

Ambylopia is decrease of loss of vision caused by underuse of one eye

47
Q

Galactosemia can cause

A

congenital cataracts (also think about other metabolism errors)

48
Q

Low birthweight, PDA, and congenital cataracts likely

A

Congenial rubella

49
Q

Excessive tear production in newborn that later becomes mucupurulent likely

A

Congenital nasolacrimal duct obstruction

50
Q

Abnormal red light reflex next step

A

Consult optho

51
Q

What can clinician observe during exam to help figure out cause of FTT

A

Feeding -may give clues to maternal-child interaction bonding issues or to physical problems

52
Q

Calcifications of CMV vs Toxo

A

CMV: periventricular pattern
Toxo: Scattered throughout cortex

53
Q

When do young children often become picky eaters

A

Between 18-30 months of age, which can cause their growth rates to plateau

54
Q

Most common cause of FTT in US

A

Psychosocial or non-organic

55
Q

3 appropriate first steps for FTT

A
  1. Cheap screening tests
  2. Dietary counseling
  3. Observation of weight changes
56
Q

What can be found in unpasteurized goats milk

A

Brucellosis

57
Q

What is an ovovegetarian

A

Diets devoid of animal products but includes eggs

58
Q

Infants receiving goat’s milk as primary nutrition should get what

A

Folate and vitamin B12, also iron

59
Q

What vitamin is low in breast milk

60
Q

What def causes fontanelle fullness

61
Q

What vitamin def causes hemolytic anemia

62
Q

Galactosemia features

A

jaundice, hepatosplenomeglay, vomiting, hypoglycemia, failure to thrive, MR, inc risk of E. coli sepsis

63
Q

What is phosphate dependent rickets due to

A

Renal phosphate wasting

Low serum PO4 with normal PTH

64
Q

Stage 1 vs 2 vs 3 calcipenic rickets

A
  1. Hypocalcemia
  2. Normal Ca but low PO4 and inc Alk pos due it inc PTH
  3. Low Ca b/c PTH compensation reached its limits
65
Q

Symptoms of severe hypocalcemia

A

Seizures, tetany, poor feeding, vomiting, apnea spells, arrhythmias

66
Q

Genu valgum vs varum

A

valgum - knock kneus

vacuum - bowed legs

67
Q

Best sites to examine to look for rickets

A

Distal ulna and metaphases of the knees

68
Q

Why are premies at risk for rickets

A

80% of placental Ca and PO4 occur b/w 32-36 weeks

69
Q

Vitamin D levels in kids? Tx for def

A

> 20 normal

15-20 insuff

70
Q

Labs in Vit D def rickets

A

Low Ca and PO4, elevated alk pos and PTH

71
Q

Prominence of chostochondral junctions seen in

72
Q

Vit D in healthy kids

A

400 for up to one year

600 for healthy kids after birth

73
Q

MCC of non-nutritional rickets

A

Primary hypophosphatemia (x linked dominant) - proximal tubule kidney defect

74
Q

Sickle cell crisis prophylaxis drug

A

Hydroxyurea

75
Q

Most common cause of sickle cell aplastic crisis

A

Parvo B19 infection

76
Q

Why is sickle cell crisis + fever emergency

A

Functional asplenia predisposes patients to crisis with encapsulated bacteria

77
Q

Test to prevent strokes in SCD kids

A

Annual transcranial doppler US until pt is 16

78
Q

When should SCD kids get CBCs

A

Baseline and periodic with relic count starting at 2 months of age

79
Q

Top two causes of pneumonia in first 2 days of life? tx?

A

enterobacter and GBS

* tx Amp and gent

80
Q

Bug to think in infant with staccato cough and tachypnea and conjunctivitis? lab? tx?

A

Chlamydia, may see eosinophilia

Erythromycin

81
Q

Most prevalent viral pneumonia in the first few days of life

82
Q

Peds kids 5 and up with LRTI typically have

A

Mycoplasma

83
Q

cough and increased respiratory effort in an afebrile infant with eye discharge consistent with

A

Chlamydia

transmission typically vaginal delivery

84
Q

Fever, cough, and bilateral lymphadenopathy in young guy likely

A

Childhood TB

85
Q

most likely pneumo for neonates? toddlers? adolescents?

A

Neonates: GBS
Toddlers: RSV
Adolescents: Mycoplasma

Pediatrics (14 decks)

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