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Peds > Emma Holliday > Flashcards

Emma Holliday Flashcards

1
Q

acrocyanotic
define
apgar score

A

blue hands and feet

add 1 to apgar

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2
Q

grimaces to stimulation

apgar score

A

add 1 to apgar

not full withdrawal to stim, that would be 2

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3
Q

tf

apgar guides therapy and has prognostic value

A

f

just descriptive basically

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4
Q

erb palsy
appearance
which nerve roots

A

waiter’s tip

C5-C6

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5
Q

klumpke palsy
appearance
which nerve roots

A

klumpke claw hand

C7C8T1

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6
Q

scalp edema crosses suture lines is called

vs does not cross suture lines

A

caput succedaneum

cephalo-hematoma

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7
Q

what makes up mongolian spots

A

arrested melanocytes

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8
Q

pale pink vascular macules on face or nuchal area

aka

persist or resolve?

A

(nevus simplex) salmon patch

on the face regress
on the neck may persist into adolescence

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9
Q 
firm white papules on face of newborn on day one
aka
filled with
may confuse with...
but won't because..
A

milia
filled with keratin
may confuse with neonatal acne
but won’t because acne presents later (week of life 1 or 2, not day of life 1)

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10
Q

firm yellow/white papules/pustules on an erythematous base on day of life 2
aka
filled with

A

erythema toxicum

filled with eosinophils

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11
Q 
bright red
sharply demarcated
raised lesion
in first few months of life
aka
A

hemangioma

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12
Q

tactile difference nevus simplex vs hemangioma

A

nevus simplex (salmon patch) is not palpable

hemangioma is raised, palpable, sharp borders

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13
Q

erythematous papules on face in week of life 1 or 2

aka

A

neonatal acne

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14
Q

why does neonatal acne occur

A

hormones! same as teens

circulating maternal androgens

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15
Q

biggest clue milia vs neonatal acne

A

time of presentation
milia - day 1 of life
neonatal acne - week 1 or 2 of life

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16
Q

area of alopecia with orange colored nodular skin
aka
mgmt

A

nevus sebaceous

remove before adolescence because risk of malignant transformation

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17
Q

newborn seborrheic dermatitis
aka
describe
manage

A

cradle cap
thick yellow/white oily scale on an inflammatory base

mild shampoo… eg on a soft toothbrush and scrub away… pretty easy to get rid of

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18
Q 
2 neonatal disorders screened in every state because disastrous if not caught early and contraindicate breast feeding
path
time to sx
sx
mgmt
A
  • PKU Phenylketonuria
  • deficient phenylalanine hydroxylase, phe accumulates in brain
  • sx take a few months to arise
  • developmental delay, mental retardation, vomiting, athetosis writhing muscle contractions, fair hair eyes skin, musty smell
  • low phenylalanine diet

Galactosemia

  • deficient G1p-uridyl-transferase, G1p accumulates and damages kidney liver brain
  • right at birth (galactose can cross placenta)
  • mental retardation, jaundice hyperbilirubinemia, hypoglycemia, cataracts, seizures
  • no lactose diet (no breast milk!)
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19
Q

tf

phenylalanine and lactose are present in breast milk

A

T

that’s why important to screen for PKU and Galactosemia in neonates

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20
Q

physiologic jaundice usually resolved by…

A

day of life 5

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21
Q

4 red flags for pathologic jaundice

and next best test

A

1st day of life (usually pathologic)

total bili ^12
d bili ^2

rate of rise ^5/day

get coombs for ABO Rh incompatibility
-if negative… lots of other stuff it could be…

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22
Q

does sepsis cause neonatal indirect or direct hyperbilirubinemia

A

direct

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23
Q

does galactosemia cause neonatal indirect or direct hyperbilirubinemia

A

direct

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24
Q

does hypothyroidism cause neonatal direct or indirect hyperbilirubinemia

A

direct

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25
Q

pathogenesis of dubin johnson and rotors

A

secretion… absorption… or something… get conjugated hyperbili… not a conjugation defect (that’s gilbert and crigler najar unconjugated hyperbili)

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26
Q

dubin johnson vs rotor liver color

A

dubin johnson black liver

rotor red (normal) liver

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27
Q

where does indirect bilirubin deposit in the brain in kernicterus

A

basal ganglia

cranial nerve nuclei

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28
Q

tf

phototherapy conjugates bilirubin

A

FALSE
it ionizes the unconjugated bili so that it becomes soluble and can be excreted… but does not conjugate it… whatever that means

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29
Q

diaphragmatic hernia identified prenatally
the big worry
how to manage delivery and repair

A

big worry is pulmonary hypoplasia

ECMO (extracorporeal membrane oxygenation) after delivery to support for a few days and let lungs mature… THEN operate 3-4 days after delivery…

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30
Q

drooling newborn who can’t breath think…

A

esophageal atresia

tracheo-esophageal fistula, etc

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31
Q

VACTERL

A 
Vertebral defects
Anal atresia
Cardiac defects
Tracheo-Esophageal fistula
Renal anomalies
Limb anomalies

VACTERL association has 3+ of the above

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32
Q

feeding tube coils, dianosing esophageal atresia

…what else to look for?

A

VACTERL association has 3+ of

Vertebral defects
Anal atresia
Cardiac defects
Tracheo-Esophageal fistula
Renal anomalies
Limb anomalies
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33
Q

what is the choana

A

back of the nasal passage

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34
Q

1 week old baby cyanotic with feeds but pinks with crying
think…
also look for…

A

choanal atresia (failed recanalization of nasal fossa)

CHARGE association
Coloboma (hole in an eye structure)
Heart defects
Atresia of choana
Retarded growth
GU anomalies
Ear anomalies and deafness
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35
Q

CHARGE association

A 
Coloboma (hole in an eye structure)
Heart defects
Atresia of choana
Retarded growth
GU anomalies
Ear anomalies and deafness
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36
Q

32 wk premie w dyspnea rr 80 w nasal flaring

cxr ground glass opacities, air bronchograms, atelactasis

dx
pathophys
tx

A

RDS
L:S ratio v2 prenatally

not enough surfactant to keep alveoli open

corticosteroid prenatally to stim lung maturation
O2 therapy with nasal CPAP to keep alveoli open

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37
Q

tf

theophyline for RDS

A

false
theophylline for problems with respiratory drive (central sleep apnea)

RDS is a problem of oxygenation, not respiration

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38
Q

38wk LGA infant porn by csection to mom with gestational diabetes has dyspnea and grunting

dx
pathophys
tx/prognosis

A

TTN
transient tachypnea of the newborn
cxr perihilar streaking from retained fluid in lung fissures

retained fluid from not having it expulsed during vaginal passage because delivered by c section

minimal O2 needed usually, self resolves in hours-dats

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39
Q

baby born after rupture of membranes yielded green/brown fluid

dx
next best step
complications

A

meconium aspiration syndrome

intubate and suction BEFORE typical stimulation maneuvers to prevent further aspiration into lungs

pneumonitis, pulmonary htn (lungs not expanding to decrease resistance)

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40
Q

newborn periumbilical intestinal hernia, defect lateral of midline, no sac

dx
associations
complications

A

gastroschisis
^maternal AFP prenatally

NO disease associations
(as opposed to omphalocele….big baby big tongue ear pits low glucose Beckwith Wiedemann Syndrome)

dehydration and scarring requiring resection, short gut syndrome (malnutrition etc)

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41
Q

newborn periumbilical intestinal hernia covered by sac

dx
associations

A

omphalocele

assoc w Beckwith Wiedemann Syndrome - big baby w big tongue, ear pits, low glucose, omphalocele

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42
Q

newborn umbilical hernia
(midline defect WITHOUT BOWEL present)

assoc
tx

A

assoc w Congenital Hypothyroidism

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43
Q

newborn
big tongue
umbilical hernia

think…
assoc
tx

A

congenital hypothyroidism

vs big tongue and ompalocele… and ear pits, low glucose assoc w Beckwith Wiedemann Syndrome

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44
Q

big tongue and umbilical hernia think…

not..

A

congenital hypothyroid

if big tongue and Omphalocele think beckwith wiedemann syndrome… espec if with ear pits, low glucose

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45
Q

metabolic complication of pyloric stenosis

A

hypochloremic metabolic alkalosis (because vomiting up HCL)

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46
Q

Polyhydramnios is typically caused by

A

decreased fetal swallowing or increased fetal urination

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47
Q

causes of necrotizing enterocolitis

A 
premature gut (premie)
maybe introducing food too soon
maybe formula...
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48
Q

treat necrotizing enterocolitis

A

NPO TPN abx resection of necrotic bowel

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49
Q

prune belly syndrome
define
association

A

failure of abdominal musculature to form so belly looks pruny because intestines underneath skin more easily visualized

assoc w cryptorchidism

50
Q

tf

orchopexy for cryptorchidism decreases risk of cancer

A

tish fish

does not decrease rate of cancer… but increases detection of testicular changes so id and tx faster

51
Q

newborn w ambiguous genitalia, one month later with vomiting, hyponatremia, hyperkalemia, and acidosis

dx
most common cause
most definitive test
tx

A

CAH
congenital adrenal hyperplasia
21 hydroxylase deficiency

test: 17OHP 17hydroyprogesterone level, ACTH bolus afterward

give cortisone and fludricortisone (replace cortisol and aldosterone)

52
Q

anterior midline abdominal mass and no pee in newborn… most common cause… treat

A

posterior urethral valves
(mass is distended bladder)

cath then surg

53
Q

infant complications of maternal type 1 diabetes

how to prevent

A

placental insufficiency/IUGR, congenital heart disease, neural tube defects, caudal regression syndrome, small left colon syndrome

control insulin during pregnancy, especially 1st trimester, take 4mg of folate per day

54
Q

infant complications of gestational diabetes (gimme6)

A

LGA (from fetal hyperinsulinemia), birth trauma clavicle fx BPBP risk, TTN risk because csection rates higher

hypoglycemia (from fetal hyperinsulinemia), neonatal seizures

hypocalcemia, neonatal seizures

polycythemia (big baby needs more O2 delivery so makes more EPO), renal or splenic vein thromboses

jaundice (more RBCs to break down), kernicterus

RDS (hyperinsulinemia interferes with cortisol surge prior to birth that normally stimulates lung maturation)

55
Q

treat neonatal hypoglycemia due to gestational diabetes

A

feed frequently (eg breast milk) if glucose v40, IV dextrose of glucose v20

56
Q

L:S ratio in mature vs immatuer lungs

A

mature ^2

immature v2

57
Q

risk factors for neonatal sepsis (gimme6)

A
  • prematurity
  • prolonged rupture of membranes ^18hours
  • chorioamnionitis (e.g with prolonged rupture of membranes)
  • GBS+ mom
  • intrapartum fever
  • maternal leukocytosis
58
Q

most common bugs of neonatal sepsis

empiric abx

A

GBS
Ecoli
lysteria

amp and gent til 48 hours negative cx

amp and cefotaxime if meningitis suspected

59
Q

congenital TORCH infections and treatment:

maculopapular rash on palms and soles, snuffles, periostitis

A

congenital syphilis

penicillin

60
Q

congenital TORCH infections and treatment:

hydrocephalus, intracranial calcifications, and chorioretinitis

A

congenital toxoplasmosis

sulfadiazine and leucovorin

61
Q

congenital TORCH infections and treatment:

cataracts, deafness, PDA VSD heart defects, extramedullary hematopoesis

A

congenital rubella syndrome

no treatment… so vaccinate!

62
Q

congenital TORCH infections and treatment:

microcephaly, periventricular calcifications, deafness, thrombocytopenia, petechiae

A

congenital CMV

gancyclovir… but will not prevent mental retardation

63
Q

congenital TORCH infections and treatment:

limb hypoplasia, cutaneous scars, cataracts, chorioretinitis, cortical atrophy

A

congenital varicella (an HSV)

vaccinate! baby gets IVIG against VZV if mom exposed 5 days before or 2days after delivery

64
Q

neonatal conjunctivitis: cause, complication, and treatment

DOL 1-3, red conjunctiva and tearing

DOL 3-5, purulent conjunctivitis

DOL 7-14, mucopurulent conjunctivitis and lid swelling

A

chemical conjunctivis… from silver nitrate drops… so use erythromycin instead

gonococcal conjunctivitis… can cause corneal ulceration… give topical erythromycin and IV 3rd gen cephalosporin

chlamydial conjunctivitis… can cause chlamydial PNA… give oral erythromycin

65
Q 
down syndrome complications
heart
gi
endocrine
msk
neuro
cancer
A

heart - endocardial cushon defects
gi - hirschpung, intestinal atresia, annular pancreas, imperforate anus
endocrine - hypothyroidism
msk - cervico-atlanto instability (important preop for anesthesia intubation!)
neuro - alzheimers (APP on ch21)
cancer - ALL

66
Q

why inc AD in Downs

A

APP amyloid precursor protein on chromosome 21

67
Q

omphalocele, rocker bottom feet, hammer toe, microcephaly, clenched hand
think…

A

edward syndrome
(trisomy 21)

“edward scissor hands rocker feet small head spilled intestines”

68
Q

holoprosencephaly, severe mental retardation, microcephaly, cleft lip/palate
think…

A

patau syndrome

trisomy 13

69
Q 
14yo F no breast dev, short stature, high FSH
think...
genotype...
assoc vasc and renal anomalies...
tx...
A

Turner Syndrome

XO genotype

coarcted aorta / bicuspid aortic valce

estrogen replacement for secondary sex characteristics and avoidance of osteoporosis

70
Q

18yo tall lanky boy with mild mental retardation with gynecomastia and hypogonadism

  • has what syndrome
  • increased risk for what malignancy
A

Klinefelter syndrome

increased risk of gonadal malignancy

71
Q

cafe-au-lait spots, seizures, large head

think…
inheritance pattern…

A

neurofibromatosis

autosomal dominant

72
Q

glossoptosis means

A

downward displacement and retraction of tongue

73
Q

mandibular hypoplasia, glossoptosis, cleft soft palate. with fetal alcohol syndrome or edwards syndrome is called…

A

pierre robin sequence…

74
Q

broad square face, rhot stature, self-injurious behavior, deletion on ch17 is called…

A

smith-magenis

75
Q

prader willi signs and symptoms and genetics

A

hypotonia hypogonadism hyperphagia skin picking aggression deletion on paternal ch15

76
Q

angelman syndrome signs and symptoms and genetics

A

seizures strabismus sociable with episodic laughter deletion on maternal ch15

77
Q

williams syndrome signs symptoms and genetics

A

elfin facies friendly high empathy and verbal reasoning deletion on ch7

78
Q

fragile x syndrome
population significance
genetics
sings and symptoms

A

most common cause of mental retardation in boys

CGG repeats on X chromosome with anticipation

macrocephaly, large ears, macroorchidism

79
Q

2yo M w multiple ear infections, diarrheal episodes, and pneumonias. no tonsils on exam

what dx
why no tonsils
labs

A

bruton agammaglobulinemia
x-linked, infections @ 6-9 mos

no b cells, no tonsils

no b cells on flow, low Igs

80
Q

17yo F w decreased Igs but normal number of B cells

what dx
complication

A

combined variable immunodeficiency
(acquired)

lymphoma risk because increased lymphoid tissue trying to make functional b cells

81
Q

most common B-cell defect
symptoms
complication

A

selective IgA deficiency
recurrent URIs, diarrhea
anaphylaxis if blood transfusion with IgA!!

82
Q

no thymus and no tonsils, severe lymphopenia

what dx
tx

A

SCID
x-linked and autosomal recessive forms

bone marrow transplant emergently

83
Q

child w recurrent swollen infected lymph nodes in groin and staph aureus skin abscesses

what dx
how dx

A

CGD
x-linked recessive
(staph aureus abscesses because susceptible to catalase positive organisms)

dx w nitrotetrazolium blue (yellow means they have the dz) also flow cytometry w DHR-123

84
Q

baby w severe eczema petechiae and recurrent ear infections

what dx
what Ig make up
other common presentation

A

wisckott aldrich syndrome

high IgE IgA, low IgG

often present w prolonged bleeding after circumcision
(thrombocytopenic too)

85
Q

why do newborns lose birth weight

A

they pee

86
Q

baby should regain birth weight by

double weight by

triple weight by

increase length 50% by

double length by

A

regain birth weight by 2wks

double weight by 6mos

triple weight by 12mos

increase length 50% by 1y

double length by

87
Q

contraindications for breast feeding

maternal

fetal

A

maternal - HIV, TB? chemo, radioactive iodine… alcohol…

fetal - PKU, galactossemia

88
Q

tf

maternal hepC is a contraindication to breast feeding

A

F

contraindications include
maternal - HIV, TB? chemo, radioactive iodine… alcohol…
fetal - PKU, galactossemia

89
Q

breast milk vs formula

A

breast milk

more whey, more lactose, more long chain fatty acids, less iron but better absorbed

90
Q

predominant protein in breast milk

A

whey > casein

91
Q

bone age vs time age eg around puberty parents worried about child growth

constitutional delay
familial short stature
obesity

A

constitutional delay
bone v time

familial short stature
bone = time

obesity
bone ^ time (estrogen)

92
Q

pathologic short stature

aka
tests to consider, why

A

aka falling off the growth curve at puberty

chest ct - craniopharyngioma
TFTs - hypothyroid
IgF1 - hypopituitarism
karyotype - Turners if female

93
Q

primitive reflexes

when do they go away

A 
moro
grasp
rooting
stepping
tonic neck / fencing
(all present at birth - 4-6mos)

parachute
(appears 6-8 mos and NEVER GOES AWAY)

94
Q

parachute reflex
what is it
when does it appear
when does it go away

A

baby lifted from tummy, arms go out

appears 6-8 mos and NEVER GOES AWAY

95
Q

which primitive reflex never goes away

A

parachute
(appears 6-8 mos and NEVER GOES AWAY)

grasp
rooting
stepping
tonic neck / fencing
(all present at birth - 4-6mos)
96
Q

pincer grasp at what age

A

9 mos

97
Q

gross and fine motor at 9 mos

A

sit up without support

pincer grasp

98
Q

half of speech is comprehensible at what age

A

2 years

99
Q

cooing starts at what age

A

2 mos

with social smile

100
Q

when should kids be potty trained

A

stool continence by 4 years

urinary continence by 5 years

(pathologic after.. can attain well before)

101
Q

primary vs secondary urinary incontinence in child

A

primary is never continent

secondary is recurrence after 6 mos of continence

102
Q

medical causes to rule out and how, in peds pt still incontinent of urine after 5yo

A

UTI - UA
constipation - disimpact
diabetes - check glucose

103
Q

enuresis
define
aka in peds
treat

A 
urinary incontinence
(bed-wetting = nocturnal enuresis)

behavioral reward system, pee before bed, bell-alarm pad
pharm if behavioral fails, DDAVP or imipramine

104
Q

most common cause of peds fecal incontinence

treat

A

constipation, fecal retention

disempatct, stool softeners, high fiber diet, behavioral mod eg put on pot after eat to take advantage of gastrocolic reflex

105
Q

when does baby get hepB IVIG in addition to hepB vaccine

A

when mom hepB positive

106
Q

vaccines due at 2 4 6 mos

A 
hep B
DTap
PCV
hib
IPV
rotavirus
107
Q

vaccine starting at 6 mos and yearly after

A

flu

108
Q

vaccines due at 12 mos

A

MMRV and hepA

live attenuated

109
Q

drug allergy that contraindicates MMR vaccine

A

neomycin/streptomycin allergy… because it is in vaccine…

110
Q

vaccines due before age 2

before kindergarden

at age 12

A

Dtap HepA boosters before 2

IPV last Dtap MMRV boosters before kindergarden

Tdap booster, meningococcal, HPV at age 12…. ish

111
Q

% of kids with benign heart murmurs

A

30%

112
Q

benign peds heart murmurs

A

Stills - v2/6 systolic @ lower mid-sternum

Venous hum - heard @ anterior neck, disappears when jugular vein compressed

113
Q

peds v2/6 systolic murmur @ lower mid-sternum

A

Stills

benign

114
Q

peds murmur heard @ anterior neck, disappears when jugular vein compressed

A

Venous hum

benign

115
Q

never normal heart murmur in peds

what to do if these heard

A

ANYTHING
DIASTOLIC

ANYTHING ^2/6

get an echo

116
Q

any murmur worse with inspiration is defect on what side of heart

A

R side

any murmur worse with inspiration

117
Q

bipolar mom has baby with holosytolic murmur worse on inspiration… why

what associated arrhythmia

A

ebstein anomaly from lithium

wpw wolff parkinson white arrhythmia

118
Q

when is surgery indicated for 2/6 systolic murmur caused by VSD in peds

A

if sympromatic (failure to thrive, pulmonary htn)

otherwise wait till 2yo

119
Q

what does common cardiac defect in turner syndrome look like on cxr

A

reverse 3 sign.. aortic arch looks weird

notching at inferior rib borders from increased collateral flow thru intercostal arteries

(from aortic coarctation)

120
Q

heart stuff
joint stuff
rash

think…
tx
compx

A

acute rheumatic fever

oral penicillin or erythromycin for 10 days, then prophylactic till 20 yo

mitral stenosis, then aortic or tricuspid

Peds (12 decks)

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