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Peds > General > Flashcards

General Flashcards

1
Q

When should the mother expect milk to come in abunduntly?

A

3-5 days post delivery

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2
Q

Describe physiologic jaundice:

  • why it happens
  • when it’s mostly seen
  • bilirubin levels
A

Physiologic jaundice:

  • newborn’s liver is unable to process the RBC load from the birth experience, as this was previously the job of the placenta.
  • most notable at 2-4 days. Gone by 2 weeks.
  • indirect bilirubin: 12 or less
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3
Q

Describe pathologic jaundice

  • why it happens
  • when it occurs
A

Pathologic jaundice: AKA direct hyperbilirubinemia

  • caused by sepsis, ABO incompatibility, toxoplasmosis, or occult hemorrhage
  • appears at 24 hours of life
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4
Q

When should a clinician worry about jaundice?

A

1 Major risk factor + High Bhutani score

Known FHx of inherited disorder

Presentation varies widely from typical

Infant is not responding to phototherapy

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5
Q

What are the major risk factors of jaundice? (6)

A
  • High bilirubin levels
  • Jaundice within first 24 hours
  • Gestational age 35-36 weeks
  • Previous sibling treated with phototherapy
  • Bruising
  • Exclusive breastfeeding
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6
Q

Describe breast milk jaundice:

  • when it occurs
  • bilirubin levels
  • how long it lasts
A

Breast milk jaundice: AKA indirect hyperbilirubinemia

  • occurs after 7 days of life and peaks between 2-3 weeks of life
  • indirect bilirubin: 15-17 or less
  • lasts 1+ months
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7
Q

What child characteristics puts a child at risk for abuse?

A
  • Prematurity
  • Physical / developmental disabilities
  • < 4 years old
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8
Q

What is the single most common presentation of child physical abuse?

A

Bruising

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9
Q

Bruises are rare in children of what age?

A

Less than 6 months as they are not mobile at this time.

“No cruise, no bruise”

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10
Q

What patterns of bruising in childhood are suggestive of abuse?

A
  • away from bony prominences
  • MC: head, neck, face (excluding forehead)
  • buttocks, trunk (excluding spinous processes), arms
  • large, multiple, and clustered
  • patterned
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11
Q

What is the MC cause of death from abuse?

A

Head trauma due to a direct blow and/or shaking

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12
Q

A toddler presents with posterior rib fractures and no altered mental status. Does this warrant a head CT?

A

Yes – neurologically asymptomatic kids with rib fractures, multiple fractures, facial injury, and anyone less than 6 months of age with suspicious injury require a head CT/MRI.

Additionally, all patients with neurological symptoms and with concerns of child physical abuse require a head CT/MRI.

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13
Q

An 18 month old comes in with bruising and abdominal trauma. What is your next best step in management?

A

Skeletal survey.

All children <2 years of age with concerns of physical abuse require a skeletal survey.

Skeletal surveys have little value in those >5 yo.

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14
Q

Who needs screening for occult abdominal injury and when would you consider an abdominal CT?

A

Children less than 5 years old and suspected victim of physical abuse.

Screening test – AST and ALT
- if AST or ALT >80, obtain abdominal CT.

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15
Q

Drowning is the process of experiencing respiratory impairment through submersion or immersion. Describe the difference between submersion and immersion.

A

Submersion: airway under water

Immersion: significant amount of water enters oropharynx through splashing

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16
Q

Drowning has a higher chance of having a fatal outcome before coming to the hospital under what conditions?

A

No supervision

Age <2

Under water for >5 minutes or unknown

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17
Q

What are the best preventative methods one should utilize to prevent drowning?

A

Pool fencing - BEST

Life jackets

Swim lessons (1+ yo)

Supervision

Lifeguards

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18
Q

What are the most common scenarios of drowning by age group - babies, toddlers, teens?

A

Babies - bathtubs and buckets

Toddlers - swimming pools

Teens - freshwater

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19
Q

What is first line treatment for drowning?

A

Initiate CPR (respiratory first, then cardiac) at the scene, call EMS

Prioritize respiratory support

No need to stabilize C-spine

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20
Q

Under which drowning conditions would you observe a patient for 4-8 hours? What are you looking for in those 4-8 hours?

A

Conscious with no respiratory distress

Looking for:

  • Cough, tachypnea
  • Vomiting
  • Mental status changes
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21
Q

In order for a child to be defined as having a febrile seizure, they must have what?

A

Be 6 months to 60 months (5 yo)

Have a temperature of >38 C (100 F)

No known intracranial, metabolic cause or history of afebrile convulsions

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22
Q

For a seizure to be defined as a simple febrile seizure, what characteristics must it have?

A

Lasts less than 15 min

Generalized tonic-clonic activity

No recurrence within 24hrs

No underlying neurologic disease

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23
Q

For a seizure to be defined as a complex febrile seizure, what characteristics must it have?

A

Last more than 15 mins

Focal

Recur within 24hrs

Associated with postictal neurological abnormalities

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24
Q

Under what conditions is a lumbar puncture warranted in those who have a simple febrile seizure?

A

If less than 6 months of age

If 6-12 months of age and immunizations are incomplete or unknown due to Hib or Strep. pneumo meningitis

If persistent lethargy (beyond typical post-ictal length), meningeal signs, or clinical suspicion

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25
Q

If a neonate has a fever, what diagnostic workup do you do? How would you treat?

A

Dx:

  • CBC w/ diff
  • U/A
  • CSF

Tx: Ampicillin + Gentamycin until cultures are negative for 48 hours

26
Q

When should you start checking BMI in office screenings?

A

2+ yo

27
Q

What are the very toxic substances we worry about most for poisoning?

A

Prenatal vitamin supplements – due to iron content

Antidepressants – TCAs especially

Hydrocarbons – kerosene, lamp oils

28
Q

What is considered a normal temperature in pediatrics?

A

96-100 F

29
Q

At what age can you start introducing soft pureed foods once they sit with little support and have good head/neck control?

A

4-6 months

30
Q

At what age can you introduce small soft pieces of foods that can be offered on a spoon or fork and they may start to self-feed with hands?

A

6-9 months

31
Q

At what age can kids start eating a full variety of foods, may use a spoon or fork if food is on it, may try sippy cups or small open cups; small pieces of foods the rest of the family is eating?

A

9-12 months

32
Q

At what age should the child be eating meals with families, small snacks in between, and transition to WHOLE milk and discontinue bottles/pacifiers?

A

12+ months

33
Q

Define colic

A

An otherwise healthy 2-3 month old infant who seems to be in pain, cries for > 3 hours a day, for > 3 days a week, for > 3 weeks

34
Q

Those with oppositional defiance disorder have a higher risk of what?

A

developing conduct disorder and suicide

35
Q

Diagnostic criteria for oppositional defiant disorder includes what?

A

Must have at least four of the following and must last 6 months or longer with a negative impact on functioning:

  • Angry and/or Irritable Mood
  • Vindictive at least twice within past 6 months
  • Argumentative and/or Defiant Behavior
  • Often deliberately annoys others
  • Often blames others for mistakes or misbehaviors
36
Q

What screening tools are used to diagnose oppositional defiant disorder?

A

Conners and Vanderbilt screening tools (comorbid ADHD common)

37
Q

A patient younger than 12 comes in presenting with oppositional defiant disorder. How would you treat them?

A

Cognitive behavioral therapy, peer group therapy, or family therapy.

Treat comorbid conditions.

Monitor for suicidal ideations.

Meds are NOT effective.

38
Q

Which psych disorder is associated with developing antisocial disorder in adulthood?

A

Conduct Disorder

39
Q

Diagnostic criteria for conduct disorder includes what?

A

3 of the criteria in past 12 months must be met + at least one criterion present in the past 6 months

  • Aggression to People and Animals
  • Destruction of Property
  • Serious Violations of Rules - Often stays out at night despite parental prohibitions, beginning <13 years
  • Deceitfulness or Theft
40
Q

A patient comes in with conduct disorder. How would you treat them?

A

Cognitive behavioral therapy

Peer group therapy

Family therapy

Treat comorbid disorders

Monitor for suicidal ideation

Meds NOT effective

41
Q

A patient comes in with breast engorgement. In your patient education, what do you tell the patient causes engorgement and how would you treat it?

A

Causes:

  • Intrapartum fluids
  • Increased blood flow
  • Normal postpartum fluid shift
  • Poor or infrequent feeding

Treatment:

  • Breast massage
  • Warmth before feeding & Cool compresses after feeding
  • Brief period of expression prior to feeding to soften the areola and evert the nipple
  • Reverse pressure softening
  • Anti-inflammatories
42
Q

A patient comes in with local tenderness and erythema on the L breast and a lump. She is afebrile. She notes that the pain radiates while she breastfeeds and complains of reduced milk supply. Upon further questioning, she notes that she has long sleep stretches overnight due to increased fatigue. What is the most likely diagnosis and how would you treat it?

A

Blocked Duct

Tx:

  • WARMTH and massage
  • FREQUENT BREAST EMPTYING
  • Rest
  • Change nursing positions
  • Lecithin

Follow up if not resolved within 48 hrs

43
Q

A patient comes in complaining of a white spot on her nipple. She notes it looks “creamy”. What is the most likely diagnosis and how would you treat it?

A

Bleb/Blocked nipple pore

Gentle compression
Keep the nipple well moisturized
Lecithin to prevent recurrent plugged ducts (1000 mg x4/day)
Steroid ointment to reduce inflammation (triamcinolone 0.1% Ointment, 3-4x/d)

F/U: Sterile de roofing if not resolved

44
Q

A G1P1 patient comes in with fever, chills, and body aches 2 weeks postpartum. On PE, her R breast is red, swollen, hot, and tender to the touch. What is the most likely diagnosis and how would you treat it?

A

Mastitis

Breastmilk culture to r/o MRSA

Warm compresses, continue breastfeeding, & antibiotics

45
Q

A patient comes in with mastitis for 2 months. What are you most concerned of it developing into and how would you treat it?

A

Abscess

Abscess tx:

  • antibiotics
  • drainage

Baby may continue to breastfeed/receive expressed milk so long as milk is not purulent

46
Q

A G1P1 patient comes in complaining of itchy, chapped nipples that burn when breastfeeding. On PE, you notice fissures around the base of the nipple shaft. What is the most likely diagnosis and how would you treat it?

A

Candida

Topical nystatin ointment/clotrimazole
Oral Diflucan.

Clean everything that comes in contact with breasts, milk, baby’s mouth.

If you’re treating the mom or the infant, the other has to be treated.

47
Q

A postpartum breastfeeding woman comes in complaining of her R nipple turning blue after breastfeeding or when she is exposed to cold temperatures. She notes associated pain, which lasts about 35 minutes. What is the most likely diagnosis, common causes, and how would you treat it?

A

Vasospam

Causes:

  • poor latch/suck trauma
  • baby biting
  • autoimmune diseases: Reynauds or rheumatoid arthritis

Treatment:

  • avoid the trauma, obvs
  • Keep warm
48
Q

A new mom comes in wanting to talk about breastfeeding. She asks about the benefits of breastfeeding compared to formula. In addition to talking about improved developmental outcomes and improved immune system of the baby, you also discuss reduced morbidity and mortality related to what?

A

SIDS & NEC

49
Q

What can be accurately described as providing baby’s first immunization and how?

A

Colostrum - has high concentrations of antibodies, immune modulating factors, and anti-inflammatory substances.

This protects the infant while preparing the gut for mature milk feeding.

These protective factors function without causing inflammation or tissue damage in the baby.

50
Q

How much milk is mom expected to produce and on what day?

A

Average production of 556-705 g/d on day 6 postpartum.

Onset of copious milk secretion: days 3-8 postpartum

51
Q

What is/are the diagnostic criteria of gender dysphoria in prepubescent girls?

A

Dysphoria must be present for at least 6 months

Persistent and intense distress about being a girl, states desire to be a boy or insists is a boy

Assertion that she has or will grow a penis

Rejection of urination in a sitting position

Assertion that she does not want to grow breasts or menstruate

52
Q

What is/are the diagnostic criteria of gender dysphoria in prepubescent boys?

A

Dysphoria must be present for a least 6 months

Persistent and intense distress about being a boy, states desire to be a girl or insists is a girl

Preoccupation with stereotypic female activities (cross-dressing or intense desire to participate in pass times of girls and rejection of stereotypical boy toys, games, and activities)

He will grow up to be a woman

His penis and testes are disgusting or will disappear

It would be better not to have a penis or testes

53
Q

Antidote for Cyanide

A

Cyanide: sodium nitrite

54
Q

Antidote for Iron

A

Iron: Deferoxamine

55
Q

Antidote for Severe cyanosis

A

Severe cyanosis: Methylene blue 1%

56
Q

Antidote for Acetaminophen

A

Acetaminophen: N-Acetylcysteine

57
Q

Antidote for anticholinergics

A

Anticholinergics: Physostigmine

58
Q

Antidote for Organophosphates

A

Organophosphates: Atropine or Pralidoxime

59
Q

Antidote for Benzodiazepine

A

Benzodiazepine: Flumazenil

60
Q

Antidote for Beta blockers

A

Beta Blockers: Glucagon

61
Q

Antidote for TCAs

A

TCAs: NaHCO3

62
Q

Antidote for Warfarin

A

Warfarin: Vitamin K

Peds (7 decks)

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