CLIPP Cases 2 Flashcards
Infants born to teen mom risks
Lower birth weight, higher risk of vertical transmission, poorer developmental outcomes, and higher risk of fetal death
APGAR score
Appearance (skin color) Pulse (heart rate) Grimace (reflex irritability) Activity (muscle tone) Respiration
Metabolic risks for SGA babies
Hypoglycemia, hypothermia, and polycythemia
TORCH testing
Hepatitis B- Maternal hepatitis B surface antigen (HBsAg)
Rubella- Maternal and infant rubella titer
Toxoplasma- Infant toxoplasma titer
CMV- Infant urine culture
Brain imaging of congenital CMV
- Intracranial calcifications (these appear as bright areas on CT)
- Diminished number of gyri and abnormally thick cortex (a condition known as lissencephaly or agyria-pachygyria)
- Enlarged ventricles
Use of bottles at age 2 leads to risk of
Dental cavities
2nd gen antihistamines ok for kids
loratidine (Claritin) and cetirizine (Zyrtec)
Typical anemia screening
At 12 months and again before starting school
Three core symptoms of ADHD
Inattention
Hyperactivity
Impulsivity
When should you begin to screen for DM
10 years old every 3 years
Most elevated BP in children are
Not true HTN, but errors in measurement
Labs for a fat young teenager
fasting glucose, lipid profile, AST, ALT
Things to ask a kid who passed out
Chest pain, trouble breathing, heart beating fast, LOC
Most common cause of chest pain in adolescent
Precordial catch syndrome - benign sharp pain over left sternum
3 quick things you check in orthopedic exam
Strength, muscle bulk, and range of motion
When do you give first Tdap
11-12 years old (different from Dtap given to babies)
What causes transient tachypnea of the newborn
delayed clearance of fluid from the lungs following birth
more common in IDM and c-sections
APGAR scores acts as
mechanism to record fetal-to-neonatal transition
HR and RR in first and second hour of life
First hour: 160–180 per minute, and the respiratory rate is often 60–80 per minute
2nd hour: Heart rate is usually 120–160 per minute, and the respiratory rate is usually 40–60 per minute.
Two most common cyanotic heart defects
TOF and TGA
Primary anabolic hormone for fetal growth
Insulin
Target glucose screening for babies prior to feeds
> 45
When is urine culture helpful in newborn
After 4 days old
TTN chest xray
This x-ray will show “wet” looking lungs, no consolidation, and no air bronchograms.
3 big DDH risk factors
Breech presentation, Females, family history
Majority of AE to vaccines come
24-48 hours
Live like MMR and varicella can take 7 days
Fever of unknown origin when? Vs fever without a source
Defined as a temperature greater than 38.3 C (101 F) for at least two weeks’ duration with failure to reach a diagnosis after one week of evaluation
Fever without a source when a complete H and P done and no source identified
Kernigs and Brudzinkis positive tests
Kernig’s sign is resistance to extension of the knee.
Brudzinski’s sign is flexion of the hip and knee in response to flexion of the neck by the examiner.
Good Ab for severe UTI in infant (IV)?
Ceftriaxone (or Amp/Gent)
Good oral Ab for pyelonephritis
Cephalexin
Follow up for resolved severe UTI in kid
Renal and bladder US
3 key asthma features
Airway inflammation
Mucus hyper secretion
Reversible airflow obstruction due to bronchoconstriction
What is paradoxical breathing
When force of contraction of the diaphragm exceeds ability of chest wall to expand ribcage, and chest gets drawn inward with inspiration
3 stages of pertussis
- catarrhal stage - 1 to 2 weeks of URI type symptoms
- paroxysmal stage- 4 to 6 weeks of whooping type cough
- convalescent stage- episodic cough that may persist for months
Significant asymmetry of airway highly suggestive of? Imaging?
Foreign body aspiration
Imaging: Bilateral decubitus or inspiratory/expiratory chest films
How long for a cough to be chronic
> 4 weeks
What are Dennie-Organ lines
This is the name for the infraorbital creases that appear due to intermittent edema caused by allergies.
3 things to help dx sinusitis
- nasal discharge lasting > 10 days
- Worsening after initial improvement
- high fever and purulent nasal d/c lasting more than 3 days
Characteristic wheezes of asthma
Musical or polyphonic noises that occur in a continuous fashion during respiration, usually expiratory
What is thought to cause ronchi
due to mucus/secretions in the airways.
Most specific means of determining asthma
PFT before and after bronchodilator treatment
Biphasic response of asthma exacerbation
- Early that lasts an hour, from mast cells and eosinophils
2. 2-3 hours after, infiltration that results in epithelial destruction
How old to start getting OTC cold meds
2 years
Bilateral otitis media with effusion described as
fluid in the middle ear space without signs and symptoms of acute inflammation
Denver II tests
Social, language, fine motor, and gross motor
Primary concern in viral gastroenteritis
Dehydration
Easy way to determine level of dehydration
Weight before illness and weight now (% dehydration)
UTI in infant can present with only what
Vomiting
acid/base hallmark of pyloric stenosis
A hypochloremic, hypokalemic metabolic alkalosis
3 reasons children are at a higher risk of dehydration than adults
- Greater surface area ratio
- Higher basal metabolic rate
- Higher % of body weight is water
Fluid bolus rate in kids
20 mL/kg over 60 minutes
Bicarb in DKA? Why creatinine elevated?
Low- elevated ketone acid in blood
Renal function normal, but creatinine elevated due to dehydration
Pre-illness weight formula
Current weight / [(100 - % dehydrated) x 0.01]
Maintenance fluid doses
100 mL/kg/day for the first 10 kg of body weight (x10)
50 mL/kg/day for the second 10 kg of body weight (x10)
20 mL/kg/day for each additional 1 kg of body weight
Two most common autoimmune diseases seen w/ DM 1
Thyroid and Celiac dz
How old to screen for DM II in kids with risk factors
10 years
What must always be considered in a child refusing to walk
Leukemia
Transient synovitis association with
recent URI
Bone pain in leukemia
More chronic in nature, shouldn’t be affected by position
Tests for suspected septic arthritis
X-ray, CRP, ESR, CBC and blood culture
How long and often should babies breast feed
10-30 minutes every 2 hours
Normal RR in newborns
40-60 breaths per minute
What causes hepatomegaly in kids with CHF
Decreased RBF leads to systemic congestion
Things seen in CHF infant
dyspnea with feedings diaphoresis poor growth an active precordium hepatomegaly
Aortic stenosis murmur
systolic ejection murmur followed by an early diastolic murmur of AI.
Why can VSDs be missed in newborns
There is elevated pulmonary vascular resistance
3 meds for kids chf
Furosemide, Digoxin, Enalapril or Catopril
Posterior neck tenderness seen in what kind of headache
Tension
Cushing’s triad
HTN, bradycardia, and irregular respirations
MCC of ataxia in kids
Post-infectious cerebellitis
What do cerebellar hemispheric lesions cause
ipsilateral limb abnormalities, nystagmus, tremor/dysmetria and tend to spare speech.
Infratentorial lesion features
cerebellar signs and signs of raised intracranial pressure (ICP)
Cerebellar hemispheric lesions
changes in muscle tone and DTRs, but usually lead to hypotonia and hyporeflexia.
Supratentorial lesions
focal motor and sensory abnormalities on the side opposite to the lesion.
How does HSP often present in kids
otherwise well appearing child with bruising and leg pain
Lymphadenopathy highly suggestive of lymphoma
Supraclavicular
Lab hallmark of HSP? quick description of HSP?
non-thrombocytopenia purpura
self-limited, IgA-mediated, small vessel vasculitis that typically involves the skin, GI tract, joints, and kidneys
Where can pain in PID be localized
RUQ (swelling of liver capsule)
Classic findings of TCA ingestion in kid
Agitation, cardiac manifestations (especially hypotension), dilated pupils and dry, hot skin
Most common accidental ingestion
Acetaminophen
What to get accidental drugs out of kids
Catharsis and charcoal
Weight gain in first 4 months of life
20-30 grams per day
Normal infant HR
100-160
Two types of failure to thrive
Organic (underlying disease)
Non organic
Underlying cause is inadequate calories to me metabolic needs
How much should kids eat in the first four months of life
100-110 Cal/kg/24 hours in the first 4 months of life.
Greasy stool in neonate with FTT consider?
Consider CF
hgb neonates and infants
Hgb around 16.5 at birth
11.2 around 2 months old, starts to rise around 7-9 weeks
MCC of abdominal pain in school age children
Functional abdominal pain
Two tests to check for Crohns
Upper endoscopy and colonoscopy
When is developmental screening recommended
at 9, 18 and 30 months.
Mean age of autism diagnosis
48 months
Retinopathy of prematurity characterized by
extraretinal fibrovascular proliferation
MRI findings of CP
periventricular leukomalacia and thinned corpus callosum
Two most common surgeries in SS kids
Tonsillectomy (hypertrophy) and Cholecystectomy (blurbing gallstones)
3 things that can be seen in CXR of acute chest syndrome
Multilobar infiltrates (more commonly lower and middle lobes)
Effusions
Atelectasis
peak growth of lymphoid tissues
4-6 years of age
S3 gallop indicates
Overloaded left ventricle
Most common cause of nephrotic syndrome in kids
minimal change disease
Lipid level in nephrotic syndrome
Hyperlipidemia
Hypernatremia in nephrotic syndrome due to
Volume overload
can also get pseudohypernatremia from elevated TG if blood looks milky
