CLIPP Main Flashcards
Infants born to adolescent mothers are at greater risk for :
- lower birth weight
- vertically acquired STI
- worse dev. outcome
- fetal death
NOT chromsomal abnormalities though
How do you screen for the three leading causes of death in adolescents
HEEADSSS interview (home, education, eating, activity, drug/alcohol, sex, suicide, safety)
- Accidents
- Homicide
- Suicide
Effect of maternal tobacco use during pregnancy
risk of low birth weight in fetus
Effect of cocaine use during pregnancy
vasoconstriction = placental insufficiency and low birth weight
what are the components of the apgar score?
Appearance (skin color) Pulse Grimace (reflex irritability) Activity (mm tone) Respiration
What is the Ballard score?
Uses neuromuscular and physical maturity to confirm gestational age (i.e. you’re not sure about dates)
risks for SGA newborns
- Hypoglycemia
- Hypothermia
- Polycythemia
DDx for SGA newborn with Microcephaly and Purpuric Rash
- TORCH
- FAS
- Chrom abnorm.
- Prenatal tobacco
- HIV
T/F: Erythromycin (or tertracycline,silver nitrate) admin topically to prevent gonococcal and chlamydial conjunctivitis
False. Only GONOCOCCAL.
–>Chlamydia more common but occurs 7-14 days later so neonatal prophylaxis doesnt help
brain imaging findings in congenital CMV
- intracranial calcifications
- dec # gyri/thick cortex (lissencephaly)
- enlarged ventricles
T/F: CMV infected infants have progressive hearing loss
true
T/F: CMV infected infants can expect hepatosplenomegaly and rash to resolve spontaneously within few weeks
True
t/f:Treatment of symptomatic CMV for 6 months has been demonstrated to improve audiologic and neurodevelopmental outcomes at 2 years
true
Vision screening use a chart begins at age ____, and hearing with audiometry at ____
3; 4
when should toddlers be in a forward-facing car seat in the back seat?
> 2 years old, or have outgrown wt/ht of car seat
The itch that rashes
Atopic dermatitis (eczema)
antihistamines that can be used to help with eczema in kids
nonsedating types. Loratidine, fexofenadine, cetirizine
Intoeing in toddlers is caused by ____ ____, whereas intoeing in preschool/school kids by ____ ____
toddlers: Tibial torsion. resolves~4yo
kids: Femoral anteversion (both knees and feet turn inward). Resolves~8-12yo
Misalignment of the eyes
Strabismus
Anemia screening
@ 12 months and @preschool/KG entry
and anytime there are risk factors for anemia (poor diet)
4 steps toward improving a toddlers nutrition
- Stop the bottle
- Limit eating to 3 meals and 2 snacks, stopping food and drink grazing throughout day
- No bargaining (eat @ the time-limited meals)…desserts should not be an incentive for good eating
- Gradually change diet content (introducing new foods and reducing quantity of old favorite foods)
what is weight age/height age
time when those would plot at 50th %
common side effects of stimulant meds (ADHD)
appetite suppression, insomnia
no increases in risk of substance abuse or addiction
T/F: Slipped capital femoral epiphysis most commonly occurs at onset of puberty in obese patients
true
T/F: Obesity increases risk of t1dm
false
T/F: Age is generally helpful in diff. btwn T1DM and T2DM
False
Age of initiation of screening for diabetes in children at risk
10 years of age or onset of puberty (whichever is earlier)
–>check q3 years
Who gets screened for diabetes (what are criteria for “at risk”)?
Overweight (BMI>85%) + 2 of the following:
a. FHx of T2DM in 1st/2nd degree rel
b. Native american/african american/hispanic/asian
c. signs of insulin resistance (Acanthosis, PCOS, HTN, dyslipidemia)
d. MHx GDM or DM
T/F: Most elevated BP measurements in children are errors in measurement, not true HTN
True
BP %’s (don’t confuse with BMI)
<90th: Normal
90-95: Pre-HTN
95-99: Stage 1 HTN
>99: Stage 2 HTN
T/F: Adolescent with BP 130/90 has HTN
Depends on % for their age. if <95th, its pre-HTN
Why are UTI’s in childhood one of the leading causes of HTN and renal insufficiency later in life?
Renal scarring following infection
What sx of depression is more common adults than adolescents?
Early morning waking/difficulty falling asleep
Signs associated with anorexia sequelae
- Bradycardia
- Electrolyte abnormalities
- ca/mg def can = arrythmias, neuro changes/increased reflex tone
- hyponatremia from excessive H20 intake
T/F: A pt with a bleeding disorder would have a negative ROS unless:
- systemic illness leading to DIC
- neutropenia
- thrombocytopenia
TRUE
T/F: Hypothyroidism is ass. with menorrhagia and shorter menstrual cycles
TRUE
A late-bloomer in puberty who will attain a normal adult height later than peers
Constitutional short stature
Order of puberty for girls
Breast buds, then pubic hair (by 10-11), growth spurt (12), menarche (12-13), attainment of adult height (15)
Order of puberty for boys
Growth of testicles, then pubic hair (12), growth of penis/scrotum (13-14), first ejaculations (13-14), Growth spurt (14), adult height (17)
Symptoms of vWD
Ecchymoses/bruising, epistaxis, menorrhagia, gingival bleeds, bleeds post dental procedures
Tx of vWD
Desmopressin (releases vWF stored in endothelium)
T/F: Hyperglycemia is common in LGA infants born to diabetic mothers
False…HYPOglycemia is common
clinical complications in SGA babies
Hypothermia, Hypoglycemia, Polycythemia, Hyperviscosity
path of oxygenated blood in utero
Placenta to umbilical vein. Some to liver, rest bypasses liver –Ductus Venosus –>IVC….crosses PFO to LA, goes to coronary/cerebral/UE circ. 10% of RV flows through pulm vasc, 90% through PDA to descending aorta.
What causes transient tachypnea of the newborn?
First breath results in replacement of lung fluid by air (uterine contractions squeeze it out + pulm lymphatics). Delay in this = TTN (persistent postnatal pulm edema)
How does an oxygen challenge test help differentiate btwn cardiac and respiratory causes of cyanosis?
Cardiac: oxygen will not sig. inc PaO2
Resp: oxygen will increase PaO2
T/F: Normal bilat breath sounds makes a congenital diaphragmatic hernia unlikely
True
____ is the primary anabolic hormone for fetal growth
Insulin
When should newborns be screened for hypoglycemia?
- Term infants SGA or LGA
- Late pre-term
- DM moms
Doesn’t matter if symptoms present or not, need to screen
T/F: Only symptomatic infants should be screened for hypoglycemia
False, even asympotomatic hypoglycemia has negative conseq. for long term neurodev
T/F: Insulin and glucose cross the placenta
False, only glucose does
Target glucose screen value prior to routine feeds:
> 45 mg/dL
T/F: Glucometer is used to confirm hypoglycemia
False, its only a screening test. Confirm by lab analysis of serum or plasma glucose (draw blood)
Are there CXR findings in TTN?
Yes, lungs will look “wet” i.e. perihilar streaking/densities. but no consolidations.
Pneumonia can look similar, but clinical findings will be more concerning for sepsis
The breastfed infant will typically feed on demand every 2-4 hours, feeding _____ minutes on each side
10-15/side
T/F: Infants and children <2 years should not be given OTC cough and cold products (i.e. antihistamines/decongestants)
True
T/F: Allergic rhinitis presents with fever
False, presence of fever usually decreases suspicion of allergic rhinitis
T/F: Persistent URI sxs (>10days) w/day and night cough are common in sinusitis
True
Seasonal vs perennial rhinitis
S: environmental allergens i.e. pollen
P: Indoor allergens i.e. dust/animal/mold/tobacco
White, bulging, poorly mobile tympanic membranes
AOM
T/F: Otitis media with effusion = fluid in the middle ear space with acute inflammation
False. it is WITHOUT inflammation
Which viruses can increase risk for AOM?
RSV, influenza, rhino
alter mucosal lining
Amber, non/poorly mobile, opaque, and retracted TM
OME = Otitis Media with Effusion (not AOM)
T/F: Antihistamines and decongestants are helpful in clearing otitis media with effusion
False
Audiologic eval for children 6mo-2.5years
Visual Reinforcement Audiometry (VRA)…conventional audiometry starts at >4years
Tx for OME
Tympanostomy tube placement
most accurate method of determining pt’s degree of dehydration:
Weight prior to illness - current weight
(% dehydration)
recommended volume for mild-moderate rehydration
50-100mL/kg
T/F: Bilious emesis is more commonly seen in gastroenteritis than malrotation with volvulus
False, vice versa
Obstruction below ________ is typically when emesis becomes bilious
Ligament of Treitz
Study of choice for Pyloric stenosis:
Pyloric US (NOT CT)
…if US not available, can use Upper GI contrast study (shows String Sign)
T/F: As soon as pyloric stenosis is identified, corrective surgery can be performed
False, need to to correct metabolic status (electrolytes) first
What is the metabolic (electrolyte) status in Pyloric Stenosis
Hypochloremic, Hypokalemic metabolic alkalosis