CLIPP Cases Flashcards
Things to ask in well child visit
Interval hx, development, growth, diet and social history
Calories an infant requires a day? pre term? very low birth?
100-120 for full term
130 for pre-term
150 for very low birth weight
Baby weight course
Lose some in first week, expected to gain back birth weight by 2 weeks
What is the moro reflex
Abrupt change in infants head causes symmetric abduction and extension of arms followed by abduction and sometimes cry
Solid foods start when
Cereal at 4 months (rice)
Two month vaccines
DTaP RotaV Hib IPV PCV13
When should an infants birth weight double and triple?
Double by 5 months, triple by 12 months
4 things absence of red reflex could be
Cataracts
Glaucoma
Retinoblastoma
Chorioretinitis
6 month milestones
Rolls over and sits up
Reaches for items and looks at drops items
Turns towards voices and babbles
Feeds self and demonstrates stranger recognition
1 year milestones
Stands alone
Neat pincer grasp
Says mama and dada and a few other words
Points to things and can hand things
Mass in baby for constipation
likely LUQ
What is the HHEADS interview
For young adults about all the fun/bad stuff (more comfortable questions go first)
3 big things seen in mono
fatigue, pharyngitis, and lymphadenopathy
What depression feature is more common in adolescents that adults
Early morning waking
Progression in severe anorexia
Bradycardia, electrolyte imbalances, arrhythmias, circulatory collapse, death
Girls vs Boys starting puberty
Girls b/w 8-13 years of age
Boys b/w 10-15
VWD tx
Desmopression (releases factor 8)
75% of newborn bilirubin comes from
Breakdown of hemoglobin
Manifestations of kernicterus
lose the suck reflex
become lethargic
develop hyperirritability and seizures, and
ultimately die
Physiologic jaundice of newborn def
total bilirubin level ≤ 15 mg/dL (≤ 257 μmol/L) in full-term infants who are otherwise healthy and have no other demonstrable cause for elevated bilirubin.
deficient or completely absent UDPGT causes
Crigler-Najjar syndrome
Normal breast fed baby timing
typically nurses 8–12 times in 24 hours
Day 3 and 6 after birth pee patterns
Day 3: The baby should be voiding 3-4 times a day.
Day 6: Baby should be voiding at least 6–8 times a day.
Day 3 and 6 poo patterns
Day 3: Meconium should no longer appear in the stool and bowel movements should begin to appear yellow.
Day 6 or 7: Most newborns have 3–4 stools per day, although many infants pass stool with every feeding.
A healthy-appearing infant who develops jaundice, dark urine, and acholic (pale) stools between 3 and 6 weeks of age may have
Biliary atresia
Tx is surgery
What should solely breast fed infants start on after 6 months
Iron and fluoride (if water levels are low)
Where does jaundice start on a baby
Face and moves down to trunk
When do you worry about hemolysis as a cause for jaundice in newborn
If jaundice started in the first 24 hours
Test for CAH
17-OH progesterone level
Galactosemia in baby can cause
Direct hyperbilirubinemia, vomiting, and lethargy, can lead to death
When would you stop breast feeding for a few days in breast milk jaundice? How long can breast milk jaundice persist?
16-25 mg/dL
Can last up to 12 weeks
Physiologic jaundice timeline
peaks at 3–4 days of life and generally resolves within a day or two
Things to remember to ask two week old mom
Preg history, hep B status and hearing screen, feeding history, and developmental milestones
How much vit D should breast fed babies get
400 IU
Lethargy def in children
poor or absent eye movements or as the failure of a child to recognize parents or to interact with persons or objects in the environment.
Head size in congenital hypothyroidism
Large
Most common cause of congenital hypothyroidism? PE findings?
Some kind of dysgenesis Findings: Feeding problems Decreased activity Constipation Prolonged jaundice Skin mottling Umbilical hernia
Why do most ped docs do amox instead of pen for strep throat
It tastes betters
4 Big kawasaki criteria
Fever > 5 days
Nonpurulent conjunctivitis (may have cleared prior to presentation)
Rash
Swelling and erythema of extremities
Thrombophilia on labs and sterile pyuria on UA
“sandpaper like rash” in what
Scarlett fever
Strawberry tongue with what 3 diseases
Streptococcal pharyngitis
Kawasaki disease
Toxic shock syndrome
Two kawasaki drugs
Aspirin and IVIG
Infection workup in kid
CBC w/ diff and blood culture
Bacterial meningitis Ab regimen
3rd gen cef and vanc
Only thing elevated in CSF for viral meniningitis
WBC, all others normal
Complex febrile seizure features
> 15 min, focal, more than one in 24 hours,
Febrile seizures and blanching rash likely what disease?
HHV6 or roseola
What children with a fever need to be seen immediately
Infants less than 6-8 weeks
4 peds emergencies to worry about needing to reverse immediately
(1) Hypoxemia (2) Shock (septic, hypovolemic, cardiac) (3) Hypoglycemia (4) Poisoning
First and most subtle sign of inadequate perfusion
tachycardia
Why is hypotension a late sign of shock in kids
They compensate so well
Meningitis exposure ppx
Cipro in adults
Rifampin for children
Meningitis complications
Hearing loss
Neurologic disability
Digit or limb amputations
Skin scarring
Near SIDS is also called
ALTE
Most common respiratory cause of apnea
RSV
Normal neuro findings in a 2 month old
Can fix and follow easily with their eyes;
Exhibit a meaningful smile in response to voices;
Have a strong suck; and
Are beginning to coo
What to do with suspected child physical abuse
Skeletal survey
Fractures highly suspicious of shaken baby
Posterior rib fractures
Infants with Zellweger syndrome are usually
generally hypotonic and poorly responsive.
Most consistent finding in Down’s? Other findings
Hypotonia (most consistent finding in infants with Down syndrome)
Upslanting palpebral fissures
Small ears (usually less than 34 mm at maximum dimension in a term infant)
Flattened midface
Epicanthal folds
Redundant skin on back of neck (nuchal skin)
Standard lab diagnosis for Down’s
Lymphocyte karyotype
Infants born with Down’s have an increased risk of
Hypothyroidism
Cause of fragile X
inheritance of an abnormal number of CGG repeats in the FMR1 gene
Turner syndrome PE findings
Webbed neck Low ear placement Edema of the hands and feet Hyperconvex nails, and "Shield" chest, with widely spaced nipples
Atopic triad
asthma, eczema, and allergies
Infant Seborrheic dermatitis tx
Oil to remove scale, frequent shampoo, mild topical steroids
Factors known to worsen acne lesions
Make-up (unless noncomedogenic)
Mechanical factors such as manipulation)
Occlusion, as occurs with some sports gear
Overzealous cleaning
Doxy AE
photosensitivity, dental staining in children under age 9, teratogenicity, esophagitis, and pseudotumor cerebri
Best OTC wart tx
Over-the-counter salicylic acid
3 main causes of diaper rash
- Irritant dermatitis (most common)
- Diaper candidiasis
- Bacterial infection (GAS)
Nutritional cause of diaper rash
Zinc def
