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Peds III > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

when does physiologic jaundice start

A

at least 24 hours old

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2
Q

breast-feeding jaundice is due to

A

inadequate breast milk intake leading to decreased excretion of bilirubin

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3
Q

breast-feeding jaundice improves when

A

intake is improved

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4
Q

breast milk jaundice starts when

A

5-7 days old

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5
Q

bilirubin levels in breast milk/breast feeding jaundice

A

not very high

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6
Q

when to evaluate physiologic jaundice

A

if still present at 2-3 weeks

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7
Q

breast milk jaundice eval

A

trial of formula

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8
Q

breast feeding jaundice treatment

A

increase breast milk, monitor I and O, supplement or change to formula

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9
Q

cause of physiologic jaundice

A

increased bili production (high RBC turnover) and decreased excretion

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10
Q

when does physiologic jaundice peak

A

3-5 days

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11
Q

when does physiologic jaundice resolve

A

1-2 weeks

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12
Q

when does breast milk jaundice peak

A

< 3 weeks

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13
Q

when does breast milk jaundice resolve

A

< 3 months

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14
Q

breast milk jaundice due to

A

slow breakdown of bilirubin

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15
Q

what to evaluate in neonate with jaundice

A

CBC/diff, CMP, UA, US (look for atresia), serial HFP, blood type, Coombs, genetic analysis, viral panels, HIDA scan, biopsies

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16
Q

most common treatment for indirect hyperbilirubinemia

A

bili lights

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17
Q

intrahepatic cholestatic jaundice causes

A

hepatocyte injury (infectious, metabolic, genetic, toxic, endocrine)

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18
Q

extrahepatic cholestatic jaundice causes

A

biliary atresia, choledochal cyst, biliary sludge

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19
Q

characteristics of intrahepatic cholestasis

A

sick patient, patent bile ducts, elevated direct and total bilirubin

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20
Q

characteristics of extrahepatic cholestasis

A

asymptomatic, duct obstruction, elevated direct and total bilirubin

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21
Q

cholestasis red flags

A

failure to thrive, poor feeding, lethargy, hepatomegaly, splenomegaly, abnormal labs (direct hyperbilirubinemia, elevated LFTs, hypoglycemia, hyperammonemia)

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22
Q

red flags of advanced chronic liver disease

A

fatigue, GI bleeds, jaundice, hepatosplenomegaly, low platelets, low WBC, elevated direct bilirubin, elevated INR

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23
Q

what is infant dyschezia

A

a functional condition characterized by at least 10 minutes of straining and crying before successful or unsuccessful passage of soft stool

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24
Q

infant dyschezia population

A

otherwise healthy infant < 6 months old

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25
Q

infant dyschezia episode frequency

A

several times daily

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26
Q

infant dyschezia presentation

A

healthy infant who cries for 20-30 minutes, turns red, and screams before defecation takes place

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27
Q

infant dyschezia pathophys

A

Pt lacks coordination of 2 events required for defecation: pelvic floor relaxation and an increase in intra-abdominal pressure

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28
Q

testing/treatment/prognosis for infant dyschezia

A

no testing or treatment is necessary, generally lasts only a week or two and resolves spontaneously as child develops

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29
Q

types of hernias seen in peds

A

inguinal, umbilical, hiatal, diaphragmatic

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30
Q

ssx of hiatal hernia

A

reflex, heartburn, regurgitation

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31
Q

testing for hiatal hernia

A

UGI study with barium, EGD

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32
Q

treatment for small hiatal hernia

A

treat for GERD (H2 blockers/PPI/lifestyle for infant GERD)

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33
Q

treatment for larger hiatal hernias

A

laprascopic surgical repair: fundoplication

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34
Q

diaphragmatic hernia ssx

A

respiratory distress, poor breath sounds, scaphoid abdomen, pulmonary hypoplasia/hypertension, cardiac defects, chromosomal abnormalities

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35
Q

testing for diaphragmatic hernia

A

antenatal US, UGI study

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36
Q

diaphragmatic hernia treatment

A

surgical reduction of organs, intubation/gastric decompression, treat for ongoing GERD, pulmonary HTN

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37
Q

incarcerated hernia definition

A

irreducible hernia with viable contents, contents of hernia sack are stuck to one another by adhesions

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38
Q

incarcerated hernia aka

A

obstructed hernia

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39
Q

strangulated hernia definition

A

visceral contents of hernia become twisted or entrapped by narrow opening with compromised blood supply and ischemic/necrotic contents.

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40
Q

strangulated hernia presentation

A

painful/tender on palpation

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41
Q

sliding hernia definition

A

part of a viscus is adherent to the outside of the peritoneum forming the hernial sack beyond the hernial orifice

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42
Q

which type of hernia constitutes a medical emergency

A

strangulated

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43
Q

most childhood and congenital inguinal hernias are:

A

indirect

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44
Q

indirect hernia definition

A

enters inguinal canal at deep inguinal ring and transverses it with spermatic cord. It is lateral to the inferior epigastric vessels and can pass into scrotum or labial majora

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45
Q

direct hernia definition

A

a bulge through weakened fascia of abdominal wall located directly behind superficial inguinal ring, medial to inferior epigastric vessels. Rarely enter the scrotum

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46
Q

when do most pediatric umbilical hernias resolve spontaneously

A

within 3 years

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47
Q

what is gastroschisis

A

eviscerated bowel to the right of the umbilical cord with no covering membrane

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48
Q

what is omphalocele

A

protruding sac containing multiple organs with umbilical cord at apex

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49
Q

malrotation ssx

A

abd distention, pain, vomiting (possibly bilious), hematochezia, possibly toxic appearance

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50
Q

volvulus ssx

A

abd distention, pain, bilious vomiting, constipation, tympanitic abdomen, possibly toxic appearance

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51
Q

radiographic sign of duodenal obstruction (volvulus)

A

double bubble sign

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52
Q

what is diaphragmatic hernia

A

stomach/intestines protrude into chest cavity with displacement of lung and heart

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53
Q

where does diaphragmatic hernia usually occur

A

on the left

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54
Q

who is more likely to get inguinal hernia

A

boys

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55
Q

umbilical hernia red flags

A

red/purple, painful, enlarged, vomiting, severe pain, fever, unable to urinate

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56
Q

inguinal hernia treatment

A

manual reduction, surgery

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57
Q

umbilical hernia imaging

A

US, doppler

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58
Q

when is gastroschisis diagnosed

A

antenatal

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59
Q

gastroschisis prognosis

A

must treat surgically, but Pts do well after reduction

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60
Q

what is more emergent, malrotation or volvulus

A

volvulus

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61
Q

most common volvulus location

A

sigmoid/cecum

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62
Q

malrotation imaging

A

US, KUB, contrast film

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63
Q

volvulus imaging

A

KUB/CT

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64
Q

volvulus treatment

A

urgent/emergent surgery

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65
Q

cause of patent omphalomesenteric duct

A

duct does not dissolve during fetal development

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66
Q

consequences of patent omphalomesenteric duct

A

can leared to hernia or discharge of feces or mucus out of umbilicus

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67
Q

what is meckels diverticulum

A

most common omphalomesenteric duct remnant (ileum): ectopic gastric mucosa that still secretes acid

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68
Q

meckels diverticulum presentation

A

usually asymptomatic, may progress to painless maroon rectal bleeding or melena

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69
Q

meckels diverticulum complications

A

obstruction due to intussusception, volvulus. May get trapped in inguinal hernia

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70
Q

meckel’s diverticulum diagnosis

A

meckel scan (nuclear medicine)

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71
Q

prognosis of meckel’s diverticulum

A

good prognosis with surgical correction

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72
Q

red flags associated with IBD

A

bloody stools, nocturnal stools, abd pain, tenesmus

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73
Q

pediatric age for IBD

A

older children or teenagers

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74
Q

features of crohn’s

A

short stature, poor weight gain or weight loss, fevers, joint pain, fatigue, hair loss, anemia, elevated inflammatory markers

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75
Q

goals of crohn’s treatment

A

remission, growth

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76
Q

possible IBD etiologies

A

autoimmune, environmental, genetics

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77
Q

treatment for mild crohns

A

5-ASA, then PO glucocorticoids, +/- abx

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78
Q

treatment for moderate-severe crohns

A

PO glucocorticoids, 5-ASA, thiopurines/methotrexate, biologics

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79
Q

treatment for very severe crohns

A

admission with IV glucocorticoids, resection of affected bowel

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80
Q

cure for UC

A

colectomy (if severe and refractory to meds)

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81
Q

peds consideration with UC

A

may progress to crohns

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82
Q

UC in peds (growth, constitutional symptoms)

A

may or may not be problems

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83
Q

Rome IV constipation criteria (general)

A

at least 2 complaints for the last 3 months with ssx onset at at least 6 months old

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84
Q

what percentage of constipation is functional

A

95%

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85
Q

Rome IV criteria for constipation criteria (specific complaints)

A

straining, lump/hard stools, sensation of incomplete evacuation, sensation of anorectal obstruction, manual maneuvers to facilitate defecation, <3 BMs per week

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86
Q

peds life events risk factors for constopation

A

starting solid for the first time, during potty training, during early school, trauma, bullying

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87
Q

when to get KUB for constipation

A

eval of impaction, caliber of colon, eval of cleanout

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88
Q

KUB in peds consideration

A

balance benefits vs radiation exposure

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89
Q

when to use barium enema

A

to look for anatomical abnormalities causing constipation

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90
Q

when to get rectal biopsy

A

to evaluate for Hirschprung disease (look for ganglion nerve cells)

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91
Q

when do meckels complications occur

A

in boys age 0-2

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92
Q

encopresis definition

A

repeated passage of stool into inappropriate places by child older than 4 each month for at least 3 months

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93
Q

most common etiology of encopresis

A

constipation (overflow diarrhea)

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94
Q

conditions associated with encopresis

A

cerebral palsy, spina bifida, hx of crohns, colectomy

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95
Q

evaluation of encopresis

A

physical exam +/- KUB, enemas, psychology/counseling, parent education. Do not pressure or punish child

96
Q

constipation treatment of choice for infants

A

glycerin suppositories or lactulose syrup (if over 6 months)

97
Q

giving fiber to infants

A

contraindicated

98
Q

how much fiber do kids need

A

5 grams of fiber for each year of age

99
Q

treatment of choice for constipation in peds

A

osmotic laxatives like PEG 3350 (miralax), sorbitol containing foods

100
Q

other treatment options for constipation

A

enemas, suppositories, PT, biofeedback, counseling

101
Q

treatment for fecal impaction

A

manual disimpaction, enema, suppository, then maintenance +/- eval for underlying conditions

102
Q

complication of chronic constipation

A

dilation and loss of bowel tone

103
Q

abdominal pain red flags associated ssx

A

worsens over time, ill appearance, doesn’t want to move

104
Q

abdominal pain red flags abd PE

A

tense, distended, rigid, reduced/absent bowel sounds, involuntary guarding, tympanitic, tenderness, masses

105
Q

causes of GI malabsorption

A

celiac, pancreatic insufficiency/chronic pancreatitis, SIBO

106
Q

diarrhea timing in IBD

A

can be nocturnal

107
Q

rotavirus presentation

A

watery, green diarrhea in a baby or young child

108
Q

most common cause of infectious diarrhea in peds

A

viral acute gastroenteritis (rotavirus)

109
Q

causes of infectious diarrhea

A

rotavirus, c diff, giardia, cryptosporidium, e coli

110
Q

functional causes of diarrhea

A

diet, motility, IBS, toddler’s diarrhea, fecal impaction

111
Q

characteristics of inflammatory diarrhea

A

small volume, frequent, painful

112
Q

characteristics of steatorrhea

A

fatty, large volume, weight loss

113
Q

characteristics of exudative diarrhea

A

blood, leukocytes/pus, damaged epithelium

114
Q

causes of exudative diarrhea

A

IBD, c diff

115
Q

infectious cause of secretory diarrhea

A

e coli

116
Q

chronic diarrhea time

A

> 4 weeks

117
Q

persistent diarrhea time

A

2-3 weeks

118
Q

diarrhea definition

A

loose/watery stools 3+ times per day, >10 ml/kg/day, >200 g/day

119
Q

what is necrotizing enterocolitis

A

infection that causes necrosis of bowel

120
Q

necrotizing enterocolitis ssx

A

hypo/hyperthermia, apnea, bradycardia, hypotension, lethargy, sepsis, abd distention, bloody bowel movements, vomiting, +/- mass, abd cellulitis

121
Q

NEC imaging

A

KUB

122
Q

NEC imaging findings

A

pneumatosis intestinalis, pneumoperitoneum

123
Q

what is pneumatosis intestinalis

A

gas in the wall of the intestine

124
Q

what is pneumoperitoneum

A

free air in the abdomen

125
Q

NEC treatment

A

NPO, gastric decompression, IV fluids, broad-spectrum abx,, +/- surgery

126
Q

what percentage of NEC patients need surgery and what surgery is it

A

50%, resection of necrotic bowel

127
Q

indications for NEC surgery

A

fixed section of bowel, cellulitis

128
Q

NEC prognosis

A

10% mortality rate, high risk of postoperative complications, check for short bowel syndrome and vitamin levels

129
Q

NEC risk factors

A

prematurity, NICU stay, newborn, congenital heart disease, birth problems (ie hypoxia)

130
Q

juvenile polyps characteristics

A

usually single polyp but less than 5, painless passage of blood PR in an otherwise healthy toddler to young child

131
Q

juvenile polyps diagnosis

A

colonoscopy or flex sig with removal and biopsy

132
Q

most common juvenile polyp biopsy finding

A

benign, hamartomatous

133
Q

juvenile polyposis syndrome

A

> 5 polyps anywhere from stomach to colon with high risk of cancer, often inherited

134
Q

what is intussusception

A

telescoping of bowel

135
Q

most common intussusception cause

A

idiopathic

136
Q

most common location for intussusception

A

ileocecal

137
Q

what is the most common cause of bowel obstruction in first 2 years of life

A

intussusception

138
Q

who is more likely to get intussusception

A

males

139
Q

catch phrase for intusussecption

A

currant-jelly stools

140
Q

intussusception complications

A

incarceration of bowel, perforation, peritonitis

141
Q

what is lead point in intussusception

A

abnormality that triggered it

142
Q

common intussusception lead points

A

polyp, anatomical anomaly, foreign body, infection, IBD, lymphoma

143
Q

class intussusception presentation

A

3-12 month old with recurring spasms of pain, draws up knees and screams +/- sausage-shaped mass in upper mid abdomine

144
Q

combination of these factors lead to high sensitivity for intussusception

A

paint, lethargy, vomiting and KUB indicating intussusception

145
Q

what can be both diagnostic and therapeutic for intussusception

A

barium/air enema

146
Q

initial imaging for intussusception

A

US

147
Q

when to avoid barium in intussusception

A

if perforation is suspected

148
Q

imaging timing consideration for intussusception

A

best if within 24 hours of symptom onset

149
Q

what is sentinel pile

A

anal fissures can heal to form them

150
Q

hemorrhoids in peds consideration and ddx

A

not common in peds, consider polyp, IBD, prolapse

151
Q

most common location for Hirschsprung

A

isolated to the rectum

152
Q

what is Hirschsprung

A

aganglionic bowel

153
Q

when is Hirschsprung diagnosed and presentation

A

usually at birth: no meconium stool within 24-48 hours, vomiting, abd distention, feeding refusal, +/-explosive diarrhea, toxic appearance

154
Q

presentation when Hirschsprung is diagnosed later in life

A

constipation, thin stools, abd distention, malnutrition

155
Q

Hirschsprung typical diagnosis

A

KUB +/- barium enema showing thin rectum and dilated sigmoid

156
Q

Hirschsprung gold standard diagnosis

A

rectal biopsy (can be done if office if <3 months)

157
Q

Hirschsprung treatment and complications

A

surgery; persistent constipation, encopresis, diarrhea, surgical complications, perforation, sepsis

158
Q

timing of N/V in appendicitis

A

after onset of pain

159
Q

appendicitis considerations for very young

A

high rate of perforation, atypical presentation

160
Q

labs in appendicitis

A

elevated WBC, CRP

161
Q

what percent of JPS becomes cancer

A

50%

162
Q

type of bilirubin that is fat soluble

A

unconjugated

163
Q

type of bilirubin that is water soluble

A

conjugated

164
Q

what is unconjugated bilirubin bound to

A

mostly albumin

165
Q

conjugated bilirubin excretion

A

stool and urine (via portal circulation)

166
Q

bilirubin is a byproduct of

A

the breakdown of heme

167
Q

which test measures unconjugated bilirubin

A

indirect

168
Q

how to obtain indirect bilirubin

A

total-conjugated = unconjugated

169
Q

when level of bilirubin is high risk for kernicterus

A

> 20 mg/dl

170
Q

which kind of hyperbilirubinemia is often non-pathologic

A

indirect/unconjugated

171
Q

elevated indirect bilirubin ddx

A

physiologic, breast-feeding, breast milk, hemolytic blood disorders

172
Q

main categories of causes for elevated indirect bilirubin

A

increased hemolysis, decreased conjugation/excretion

173
Q

2 causes of pathologic unconjugated hyperbilirubinemia

A

ABO incompatability, Rh-isoimmunization

174
Q

ABO incompatibility presentation

A

usually mild hemolysis with variable course

175
Q

ABO incompatibility usually affects

A

type A or type B infants with anti A or anti IgG antibodies born to a type O mother

176
Q

ABO incompatibility treatment

A

may require transfusion for anemia

177
Q

Rh isoimmunization affects

A

Rh negative mother with an Rh positive infant

178
Q

Rh isoimmunization presentation

A

severe hemolysis +/-anemia, edema, heart failure

179
Q

Rh isoimmunization called

A

erythroblastosis fetalis

180
Q

Rh isoimmunization treatment

A

phototherapy, transfusion

181
Q

Rh isoimmunization prevention

A

prenatal screening with maternal administration of Rho D immunoglobulin

182
Q

tests for neonate with jaundice

A

CBC/diff, CMP, UA, US

183
Q

timing of testing for neonate with jaundice

A

must get serial HFP, CMP or bilirubin within 24-48 hours

184
Q

other tests to consider for neonate with jaundice

A

blood type, coombs, genetic testing, viral panels for hep and CMV, HIDA scan, biopsies

185
Q

most common treatment for indirect hyperbilirubinemia and mechanism

A

phototherapy: converts unconjugated bilirubin to water soluble form

186
Q

phototherapy consideration

A

shield eyes

187
Q

major categories of causes of neonatal cholestasis

A

intrahepatic and extrahepatic

188
Q

intrahepatic cholestasis is caused by (generally)

A

hepatocyte injury

189
Q

causes of hepatocyte injury leading to intrahepatic cholestasis

A

idiopathic, infectious, metabolic, genetic, hypothyroidism, toxic

190
Q

causes of infectious intrahepatic cholestasis

A

viruses, TORCH, sepsis, UTI

191
Q

causes of toxic intrahepatic cholestasis

A

TPN, drugs

192
Q

causes of extrahepatic cholestasis

A

biliary atresia, choledochal cyst, biliary sludge

193
Q

characteristics of intrahepatic cholestasis

A

patient is ill with patent bile ducts and elevated direct and total bilirubin

194
Q

characteristics of extrahepatic cholestasis

A

often asymptomatic with obstructed bile ducts and elevated direct and total bilirubin

195
Q

top 3 causes of neonatal cholestasis

A

extrahepatic biliary atresia, idiopathic neonatal hepatitis, infectious hepatitis

196
Q

what is biliary atresia

A

fibro-inflammatory obstruction of extrahepatic bile ducts

197
Q

ssx of biliary atresia

A

jaundice, splenomegaly, dark urine, hepatomegaly, acholic stools, pruritus

198
Q

biliary atresia surgical treatment

A

hepatoportoenterotomy

199
Q

hepatoportoenterotomy aka

A

Kasai

200
Q

biliary atresia nonsurgical adjunct treatment

A

nutrition, manage portal HTN, abx, ADEK supplementation

201
Q

prognosis of biliary atresia

A

most children will require liver transplant by 20 y/o and anti-rejection drugs plus frequent monitoring

202
Q

red flags signs of intrahepatic cholestasis

A

failure to thrive, poor feeding, lethargy, hepatosplenomegaly, hypoglycemia, elevated LFTs, direct hyperbilirubinemia, hyperammonemia

203
Q

most common form of chronic liver disease in children/teens

A

NAFLD

204
Q

most important NAFLD risk factors in peds

A

insulin resistance, central obesity

205
Q

global prevlance of NAFLD in peds

A

3-10%

206
Q

when to screen for NAFLD

A

overweight/obese, cardio/metabolic risks, ALT>80

207
Q

tests to order when assessing for NAFLD

A

CBC/diff, CMP, GGT, PT/INR, viral hep panel, A1C, lipids, US, r/o autoimmune, celiac, thyroid, EBV/CMV

208
Q

definitive NAFLD diagnosis

A

needle biopsy

209
Q

nutrition requirements depend on what factors

A

growth rate, body composition, composition of new growth, age (decreases after age 4), health status/chronic illness

210
Q

infant formula is generally based on ____

A

cow’s milk

211
Q

sole source of infant nutrition is recommended to be breast milk until what age

A

6 months

212
Q

contraindications to breast feeding

A

TB, galactosemia, HIV (relative)

213
Q

newborn feeding frequency

A

8-12 feedings per 24 hours

214
Q

older infant feeding frequency

A

7-9 feedings daily, decreases with age

215
Q

what is phenylketonuria

A

inherited error of metabolism that causes toxic levels of phenylalanine

216
Q

ssx of phenylketonuria

A

mental retardation, convulsions, behavior problems, skin rash, musty body odor

217
Q

phenylketonuria diet

A

no meat, dairy, dry beans, nuts, or eggs

218
Q

criteria for undernutrition

A

weight <5th %

219
Q

z score mild undernutrition

A

-1 to -2

220
Q

z score moderate undernutrition

A

-2 to -3

221
Q

z score severe undernutrition

A

-3 to -4

222
Q

criteria for pediatric metabolic syndrome

A

at least 10 y/o, abdominal obesity, and 2 or more of: elevated TG, low HDL, HTN

223
Q

when to screen non fasting lipids

A

9-11 y/o

224
Q

when to screen fasting lipids

A

2-8 y/o and 12-16 y/o

225
Q

weight loss recommendations for obese child < 12

A

1 lb/month

226
Q

weight loss recommendations for obese child at least 12 y/o

A

up to 2 lbs/week

227
Q

criteria for overweight

A

BMI 85-95%

228
Q

criteria for obese

A

BMI>95

229
Q

criteria for severe obesity

A

BMI >99%

230
Q

myplate guidelines

A

fruits/vegetables: 1/2 of plate, meats/proteins: 1/4 of plate each, side serving of dairy

231
Q

signs that infant is ready for foods

A

can sit with little/no support, good head control, opens mouth and leans forward when food is offered

232
Q

formula calories

A

20 kcal/oz

233
Q

newborn feedings schedule

A

2-3 oz every 2-3 hours

234
Q

feeding schedule 1-5 months

A

3-4 oz every 3-4 hours

235
Q

feeding schedule 6+ months

A

6-8 oz 4-5 times daily plus solid foods of 4 oz/meal

Peds III (2 decks)

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