CLIPP Pediatrics

Question 1

What are the lab findings associated with post-strep GN?

Answer 1

Elevated ASO
+ streptozyme
Elevated anti-DNAase B antibodies
Low C3

Question 2

Why would you see hyponatremia in nephrotic syndrome?

Answer 2

Increased total body water leads to dilutional hyponatremia. Hyperlipidemia exacerbates this on labs

Question 3

Why are you at risk of venous thrombosis in nephrotic syndrome?

Answer 3

Urinary loss of anticoagulants
Hyperlipidemia causes platelet dysfunction
Increased fibrinogen
Increased hct means increased viscosity

Question 4

Treatment of primary nephrotic syndrome

Answer 4

Trial of corticosteroids

Sodium restriction to

Question 5

When do you give IV glucose to newborns?

Answer 5

Symptomatic hypoglycemia with blood glucose

Question 6

How can you differentiate between RDS and TTN on CXR?

Answer 6

RDS: ground glass infiltrates with air bronchograms

TTN: wet lungs but no air bronchograms or consolidation

Question 7

What bilirubin levels can you expect for physiologic jaundice of the newborn? When do levels peak?

Answer 7

Tbili

Question 8

What metabolic errors can present with jaundice?

Answer 8

Crigler-Najjar
Galactosemia
Hypothyroidism

Question 9

What pattern should be observed in the weight of a healthy newborn?

Answer 9

Can lose up to 10% of birth weight in the first 4-5 days but should regain that weight by at least 2 weeks of age

Question 10

When does biliary atresia normally present?

Answer 10

Between 3 and 6 weeks of age

Question 11

How do you differentiate between cephalohematoma and caput succedaneum?

Answer 11

Caput succedaneum crosses suture lines, cephalohematoma does not

Question 12

What should you do for female infants that presented in breech position?

Answer 12

US of hip at 4-6wks or radiograph of hip at 4mo to screen for developmental dysplasia of the hip

Question 13

What is the laboratory work up for infants with hyperbilirubinemia?

Answer 13

Maternal ABO and Rh type/screen
Infant cord blood ABO and Rh type and direct Coomb’s
G6PD screen for +fam history
Total serum bili
Direct bili in kids with acholic stools/persistent jaundice at 3 wks
CBC and retics if suspicion for hemolysis

Question 14

Tests for work up of sepsis in a newborn?

Answer 14

CBC with diff
CRP
Blood cultures
LP with Chem and cultures

Question 15

How do you define failure to thrive?

Answer 15

Failure to regain birth weight by 3 wks or continuous weight loss for 10 consecutive days

Question 16

Compare clonus in newborn to clonus in 1-2mo old

Answer 16

Up to 10 beats of clonus can be normal in newborn

More than 3 beats is abnormal in 1-2mo old

Question 17

What is the goal TSH for infants with hypothyroidism?

Answer 17

1mIU/L

Measure at 2 and 4 weeks after starting therapy and then q2mo until 1 year old, q3 until 3 years old, q12mo until an adult

Question 18

What is the 24hr urine protein and urine protein:creatinine that define nephrotic syndrome in children?

Answer 18

24hr urine protein >40mg/m^2/hr

Urine protein:creatinine >2.5

Question 19

What are the most commonly isolated organisms from blood cultures of febrile pediatric patients?

Answer 19

Strep pneumo

Then less commonly:
H flu type b (Hib)
N meningitidis
Salmonella

Question 20

What WBC essentially rules out bacteremia in pediatric patients?

Question 21

What WBC warrants CXR even without lung findings on exam?

Answer 21

> 20000

Question 22

What antibiotics would you use to treat pyelo?

Answer 22

Amp/gent - covers E. coli and enterococcus
Ceftriaxone - covers G- bacilli except pseudomonas
Pip/tazo - covers G- and pseudomonas

Cipro only in kids >1yo with complicated and resistant UTI

ORAL:
Cephalexin
Amox/clav - avoid 2/2 rxns
TMP-SMX - avoid 2/2 rxns