Exam 1 Treatment

Question 1

TTN tx

Answer 1

supportive, sup O2, CPAP, self-limited course

Prevent by avoiding elective c-section <39 wks

Question 2

RDS tx

Answer 2

Mild cases may respond to CPAP

More severe require mechanical ventilation

Diuresis

No clear guidelines regarding when to administer exogenous Surfactant

Prevention- Reduce pre-term births, provide antenatal steroids

Question 3

MAS tx

Answer 3

O2 sup, CPAP/mech vent., surfactant, ECMO if severe

Suction does NOT help to prevent

Question 4

PPHN tx

Answer 4

mechanic ventilation, cardiotonic therapy, inhaled nitric oxide, ECMO

Question 5

Apnea of prematurity tx

Answer 5

usually resolves by 36-40 wks, CPAP, methylxanthine (theophylline and caffeine)

Question 6

Congenital Diaphragmatic Hernia yx

Answer 6

mech vent, treat pulm HTN, consider ECMO, surgical repair

Question 7

Tx for neonatal sepsis

Answer 7

empiric therapy for early-onset sepsis combo against G and G-

Question 8

Management of down syndrome

Answer 8

well child care, devel & behavior, audiology, vision, thyroid, neck, sleep, heme-onc (↑ risk leukemia - AML b4 1, ALL for older)
Echocardiogram, thyroid screen, audiology, dental care, diet

Question 9

Turner Syndrome tx

Answer 9

Renal US to ID anomalies, cardio (coarct of aorta), EENT (structural abnormal), endocrine (autoimmune d/o), estrogen in early teen yrs to stim secondary sex characteristics

Question 10

Positional Plagiocephaly tx

Answer 10

↑ “tummy time” while awake, repositioning in crib, sleep on backs but while away be on tummy

PT: repositioning head with neck
ROM

Helmets therapy (can start as late as 18 mo)

Question 11

Craniosynostosis tx

Answer 11

Surgical

Question 12

Lead posioning tx

Answer 12

Chelation for BLL ≥45 mcg/dL (succimer 10 mg/kg PO every 8 hours x 5 days, then every 12 hours for 14 days)

Question 13

Food protein proctocolitis tx

Answer 13

resolves within days to 2 weeks fo removing agent (if breast feeding have mom avoid milk proteins)

will resolve fully by 12 mo of age and will not have to avoid

Question 14

Food Protein Induced Enterocolitis Syndrome (EPIES) tx

Answer 14

Can be medical emergency- fluid resuscitation and anti-emetics

Long term—avoid offending food

Can outgrow after several months to years

Question 15

What is the first line therapy for allergic rxn?

Answer 15

epinephrine into lat aspect of thigh

Question 16

What is the dose of epi?

Answer 16

0. 15 mg ≤ 25 kg
1. 3 mg ≥ 25 kg

or 0.01 mg/kg (Max 0.5 mg) every 5 minutes
as needed to control symptoms

Question 17

What is second line therapy for anaphylaxis?

Answer 17

antihistamines

Question 18

How long should pt be observed in ED after allergic exn?

Answer 18

4-8 hrs or when sx fully resolved

if >1 dose epi, hypotensive, laryngeal edema, severe asthma, ingestion as trigger then admit

Question 19

Tx for GER

Answer 19

reassurance but if sx persist >18 mo refer to ped GI

Question 20

Tx for GERD

Answer 20

PPI for 8-12 wk but if no improvement after 2-4 wk or relapse after tx then d/c and refer

Question 21

Methods to prevend GER

Answer 21

thicken formula with rice cereal, consider acid suppression therapy

Question 22

Pyloric Stenosis tx

Answer 22

Correct dehydration and alkalosis

Surgical Correction with pyloromyotomy

Question 23

Malrotation tx

Answer 23

Require emergent diagnosis and repair: Ladd’s procedure

Question 24

volvulus tx

Answer 24

Surgical consultation and operative intervention are essential

Question 25

Intussusception tx

Answer 25

Fluid resuscitation Antibiotics Surgical consultation Options include air-contrast enema or exploration

Question 26

Meckel’s Diverticulum tx

Answer 26

Stabilization (may need PRBCs if significant bleed) Surgical consult

Question 27

Hirschprung’s Disease tx

Answer 27

Surgical resection of aganglionic segment Colostomy followed by endorectal pull-through at later date

Question 28

Complications of Hirschprung’s Disease

Answer 28

Hirschsprung’s associated enterocolotis Constipation Stricture Fecal incontinence

Question 29

Constipation tx

Answer 29

Assess for large volume of stool in rectum—disimpact via oral or rectal “clean out” before starting tx PEG-3350 (Mitalax) Prune juice for infants Behavioral therapy

Question 30

How long should you continue maintenance meds for constipation?

Answer 30

>2 months and should not be stopped until symptoms resolved for >1 month should continue until toilet training well established

Question 31

Encopresis tx

Answer 31

stool softeners timed sitting after meals in conj with oral laxative

Question 32

Cryptorchidism tx

Answer 32

Most descend spontaneously within 1st 3 months of life If still undescended by 4 months—likely permanent Surgery at 6 mo NO later than 9-15 mo of age Hormonal tx

Question 33

Consequences of Cryptorchidism

Answer 33

Infertility Testicular malignancy Associated hernia (usually indirect) Torsion of cryptorchid testis

Question 34

Micropenis tx

Answer 34

Most will have satisfactory sexual function Androgen Rx controversial—may limit growth potential in pre-pubertal boys

Question 35

Hypospadias tx

Answer 35

Surgical repair for all 2nd and 3rd degree to correct functional and cosmetic deformities Some boys with 1st degree may not have functional abnormality

Question 36

Non-specific vulvovaginitis tx

Answer 36

Keep area dry and aerated Decease irritants Sitz baths twice daily with 3 tablespoons of baking soda while symptomatic, may continue for prevention Distraction/redirection

Question 37

Labial Adhesions tx

Answer 37

Often resolve spontaneously Gentle traction to separate labia Hormonal cream Occasionally surgery by pediatric urologist

Question 38

Complications of Febrile Urinary Tract Infection (UTI)

Answer 38

Urosepsis Abscess formation Renal scarring

Question 39

Treatment of febrile UTI in 2-24 month old

Answer 39

Oral abx for 7-14 days Cephalosporin, Amoxicillin, Amoxicillin-clavulanate, Trimethoprim-Sulfamethoxazole

Question 40

What is recommended after febrile UTI?

Answer 40

US to ID anatomic anbnormalities

Question 41

Who is Voiding cystourethrogram (VCUG) recommended for after UTI?

Answer 41

recommended for children (not yet toilet trained) if urinary dilatation, scarring, or findings suggestive of vesicoureteral reflux or bladder outlet obstruction on ultrasound or recurrence or atypical sx

Question 42

Antibiotic Prophylaxis for VUR

Answer 42

Trimethoprim-Sulfamethoxazole 2-4 mg/kg once daily

Question 43

Enuresis Treatment

Answer 43

``` Behavioral modification limit fluid intake before bed dry bed training-wake at night to urinate bladder stretching exercises bed alarm therapy-most effective ``` pharm only if >7 yo and if other therapy unsuccessful - DDAVP