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Pediatrics > Last semester > Flashcards

Last semester Flashcards

1
Q 
Newborn
Infant
Toddler
Young Children
Older Children
Adolescents
A 
Newborn --> birth to 1 month
Infant --> 1 month to 1 year
Toddler --> 1 year to 2 years
Young Children --> 2 years to 5 years
Older Children --> 5 years to 12 years
Adolescents
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2
Q 
Normal gestation
Pre term infants
Post term infants
Low birth weight
Very low birth weight
A 
Normal gestation --> 38 to 42 weeks
Pre term infants --> before the end of 37th week
Post term infants --> 42 weeks
Low birth weight --> under 2500g
Very low birth weight --> under 1500g
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3
Q

Gross motor physical development of a child

When does child understand name?

A 
Newborn: flexed posture
7 mo: sits without support
1 year: stands independently 
15-18 months: walks independently and steadily
2 1/2 years: rund and jumps

Child understands name at 1 year

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4
Q

3 endocrine levels

A

Primary: gonads, thyroid gland
Secondary: anterior pituitary
Tertiary: Hypothalamus

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5
Q

Goitre - causes

A

Non-toxic:
- dietary deficiency, hashimotos, neoplasm, genetics

Toxic:
- graves, hashimotos, neoplasm, TSH-secreting pituitary gland tumor

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6
Q

In hyperthyroidism, TSH levels are…

A

…decreased

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7
Q

Calcium daily balance

A
  • 1 g Ca per day!
  • Total calcium is twice as high as ionic calcium
  • decreased ca levels –> PTH released
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8
Q

Growth hormone - IGF-1 axis

A
  • produced at anterior pituitary
  • released into blood stream
  • action via its mediator IGF-1
  • directly on traget tissue
  • ghrelin is secreted in stomach and increases the release of growth hormone
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9
Q

Puberty

  • hormones involved
  • Stages
A
  • Anterior pituitary: LH and FSH
  • LH: stimulates testes –> testosterone
  • FSH: stimulates ovaries
  • puberty starts at 11 in boys, 10 in girls (LH is a good marker for beginning)

1- Adrenarche: implement of adrenal androgen which could give some pubic/ axillary hair –> not conencted to gonadarche
2- Gonadarche: maturation of gonads

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10
Q

Window of opportunity

A
  • mini-puberty at 3-6 months of age

- increased LH and FSH levels

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11
Q

What should we ask in history taking of urinary tract?

A

ANTENATAL HISTORY:

  • amniotic fluid volume
  • alpha-fetoprotein level
  • presence of fetal distress
  • maternal drug history and diabetes

BIRTH HISTORY:

  • delivery, apgar, weight…
  • low weight –> low nephron number; high weight –> Beckwith-Wiedemann syndrome
  • number of umbilical vessels
  • weight of placenta
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12
Q

Kidneys are enlarged/ palpable with…(7)

A
  • autosomal recessive polycystic kidney disease
  • autosomal dominant polycystic kidney disease
  • tuberous sclerosis
  • multicystic dysplastic kidney
  • severly obstructed kidneys
  • renal venous thrombosis
  • renal tumor
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13
Q

Evidence of renal osteodystophy

A
  • thickened wrists
  • ricekty rosary
  • lower limb deformities
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14
Q

Red Urine can be due to:

A
  • macroscopic hematuria: the longer the contact and the more acidic the urine, the darker the color
  • certain foods (beetroot)
  • Hemoglobinuria
  • myoglobinuria
  • urate crystals
  • drugs
  • inborn errors of metabolism
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15
Q

Causes of cloudy urine

A

secondary to the presence of:

  • pyuria (white blood cells)
  • Calcium phosphate crystals
  • combination of calcium salts, uric acid, cysteine or struvite
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16
Q

What does a dipstick urine test look for: (6)

A
  • pH
  • Blood
  • Protein
  • Glucose
  • Leukocytes
  • nitrites
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17
Q

Urine pH

A
  • from 5 to 8
  • important in diagnosing renal tubular acidosis
  • important in treating and preventing urinary stones
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18
Q

Specific gravity

A
  • 1.001 to 1.035
  • reflects concentrating and diluting ability of kidney
  • reflets persons hydration status
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19
Q

Causes of false positive and false negative proteinuria

A

FALSE POSITIVE:

  • concentrated urine
  • alkaline urine
  • gross hematuria
  • dipstick was left in too long
  • contamination with secretions from urinary tract or vagina
  • contamination with antiseptics, chlorhexidine, benzalkonium

FALSE NEGATIVE:

  • diluted urine
  • acidic urine
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20
Q

GLUCOSE on urine dipstick

A
  • lower limit of detection is 4-5 mmol/l

- appears when serum glucose is >8.910 mmol/l

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21
Q

Nitrites of urine dipstick

A
  • majority of pathogenic bacteria produce nitrite

- high specificity and low sensitivity for UTI

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22
Q

Casts in urine

A
  • Hyaline casts –> in proteinuria
  • Cellular casts
  • ->RBCs (in glomerular bleeding) –> >5 RBC/mcl
  • ->WBCs (renal inflammation) –> > 10 WBC/mcl
  • ->epithelial cells
  • can be a normal finding
  • centrifugation can damage casts
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23
Q

Diagnostic tools in urinary system

A
  • Ultrasound
  • Intravenous urogram
  • voiding cysturethrogram (to detect VUR)
  • DMSA scan
  • Dynamic renography (to asses renal blood flow)
  • CT
  • MRI
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24
Q

Hematopoiesis in children

A
  • by birth, all bone marrow cavities are actively hematopoietic
  • in childhood, hematopoiesis moves to central bones
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25
Q

Causes of an increase and decrease in WBCs

Normal levels

A

Normal: 5.0-10

INCREASE:
infection, tissue necrosis, bone marrow malignancies, inflammation

DECREASE:
- infection, conditions that suppress immune system or exhaust bone marrow

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26
Q

WBCs precentages of different types

A

prcentages of total WBC count

  • Neutrophils 40-60% (elevated in bacterial infection)
  • Monocytes 2-10% (viral infectio)
  • Lymphocytes 20-40% (viral infection)
  • Eosinophils 0-5% (allergic and parasitic disorder)
  • Basophils 0-1% (systemic allergic reaction)
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27
Q

Physiologic WBC changes

A
  • newborn has high WBC count (falls within 2 weeks)

- until 8 years, lymphocytes are more dominant than neutrophils

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28
Q

Causes of increase and decrease of RBC

A

INCREASE
- congenital heart disease, chronic hypoxia, high altitudes, polycythemia vera

DECREASE
- renal disease, RBC destruction, iron deficiency, vit. B12 deficiency, blood loss, bone marrow depression

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29
Q

MCV
MCH
MCHC
RDW

A
  • Mean corpuscular volume: average size of RBCs
  • Mean corpuscular hemoglobin: average weight of Hb per RBC
  • Mean corpuscular hemoglobin concentration: average concentration of Hb (normo-, hyper- and hypochromic)
  • Red Cell Distribution Width: uniformity of RBDs
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30
Q

Hemoglobin

Causes for increase and decrease

A
  • 115-145 g/l)
  • Hgb F (fetal hemoglobin)
  • Hgb A (adult hemoglobin)

INCREASE:
- congenital heart disease, chronic hypoxia, high altitudes, polycythemia vera, fluid loss

DECREASE

  • decreased production(anemia, renal disease, iron deficiency, bone marrow depression)
  • Increased destruction (sickel cell, shperocytosis)
  • blood loss
  • fluid volume overload
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31
Q

Reticulocytes

causes of increase and decrease

A
  • immature RBC (0.5%-1.5%)

INCREASE
- anemia, chronic hemolytic anemia

DECREASE
- bone marriw failure syndrome, iron deficiency anemia, vit. B 12 anemia, folate deficiency anemia

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32
Q

Physiologic anemia of the newborn

A

at one week postnatal –> all RBC indices begin declinign to a minimum

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33
Q

Platelets

causes of increase and decrease

A
  • 150-450

INCREASE
- acute blood loss, myeloproliferative disease, polycythemia vera

DECREASE

  • decreased production (leukemias, bone marrow failure syndromes)
  • increased destruction (ITP, certain drugs)
  • Abnormal pooling (splenic sequestration, splenomegaly)
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34
Q

Lymph node exam

A
  • size: insignificant if 2cm or less
  • consistency: soft (hard –> malignancy, rubber –> lymphoma)
  • tender: no
  • Mobility: yes, should not be fused together
  • Patient’s age: 2-12 years -> always palpable head and neck
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35
Q

Examination of fontanelles

A
  • anterior fontanel closes until 1-2 y
  • posteiror fontanel closes into 2 months
  • anterior fontanel is felt for bulging (raised intracranial pressure) or depression (dehydration)
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36
Q

Macrocephaly and Microcephaly

A

Macrocephaly: OFC > 2 standard devations (SD) above the mean
Microcephaly: OFC > 2 SD below the mean
Severe Microcephaly: OFC > 5 SG below the mean

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37
Q

Meningeal signs

A
  1. Neck muscle (Nuchal) rigidity
  2. Kernig sign: pain or resistance to straightening leg from flexed position
  3. Brudzinsky signs: involuntary flexion of knees when lyign supine
  4. Lasegue sign: pain or resistance to lift extended leg
38
Q

Munich functional Deelopmental Diagnostics

–> 8 most important psychomotor functions

A
  • crawling
  • sitting down
  • walking
  • gripping
  • perception
  • speaking
  • understanding speech (from 10 mo)
  • social skills
39
Q

Iron deficiency anemia

A
  • Hb < 110g/l in children younger than 2

- Hb < 120 g/l in children older than 2

40
Q

Fe metabolism after birth

A
  • mothers Fe keeps Fe level of infant until 1 year
  • postnatal high Hb - high iron storage
  • during first 4 months Fe storage increases only 10%
  • 4-12 months: Fe storage increases 50%
41
Q

Impaired absorption of Iron

A
  • Malabsorption syndrome
  • Celiac disease
  • Prolonged diarrhea
  • Anatomic gut lesions
  • Allergic gastroenteropathy
  • intestinla parasites
  • colonisation of H. pylori
42
Q

Stages of Iron Deficiency

A

1- Prelatent Stage: decrease in ferritin, no symtpoms

  1. Latent stage: decrease of MCV, MCH, reticulocytes, ferritin
  2. Iron deficiency anemia: decrease of Hb
43
Q

Consequences of IDA in pregnant women and children

A

PREGNANT WOMEN

  • pre-eclampsia
  • abortion
  • peripartal bleeding complications
  • Premature delivery
  • low birth weight

CHILDREN

  • impaired motor development
  • impaired language development
  • psychological and behavioural effects
  • decreased physical activity
  • mild to moderate mental retardation
44
Q

Stages of IDA and their treatment

A
  • mild: Hb 110-90 g/l (1-3 mg/kg/day to normal Hb + 1-2mo)
  • moderate: 90-70 (3-5 mg(kg/day to normal Hb + 2-3 mo)
  • severe: < 70 (5-7 mg/kg/day), tapering 5-6 mo

give premature babies 1-4mg of Fe/kg to prevent

45
Q

four baby miracles after birth

A
  1. Physical growth
  2. Cognitive development
  3. Immature maturation
  4. Digestive maturation
46
Q

Celiac disease oral manifestations

A 
Enamel defects
Delayed eruption
recurrent aphthous ulcers
Cheilosis
Oral lichen planus
Atrophic glossitis
47
Q

Etiology of halithosis

A
  1. mouth (gingivitis, aphta, ulcer)
  2. Nasopharynx (tonsils, adenoids)
  3. Esophagus (GERD)
  4. Stomach (gastritis, peptic ulcer disease)
  5. Liver
  6. Other: lungs, renal, metabolic disease
48
Q

Peutz-Jager syndrome

A
  • autosomal dominant disorder characterized by the development of benign hamartomatous polyps in the GI tract and hyperpigmented macules on the lips and oromucosa
49
Q

What does parotid gland produce?

A
  • amylase
  • growth hormone
  • lipase
50
Q

Stomach functions

A
  • Chief cells: pepsinogen
  • lipase
  • Parietal cells: HCl
  • G cells: gastrin
  • D cells: somatostatine
  • horomones: ghrelin
  • mucous production

less acidic the younger the child

51
Q

Importane of HCL

A
  1. Activation of pepsinogens 1-5
  2. Protein digestion
  3. Food sterilization
52
Q

Stomach pH and pepsin relation

A

the higher the pH, the lower the pepsin activity

53
Q

Maturing of digestive system

A
  • enzyme activities develop throughout the digestive system during the first year of life
  • first 4-6 mo: infants gut is more open and antibodies from breast milk can enter
  • 6 mo: gut barrier is closed, infant produces antibodies
54
Q

Human pancreatic exocrine enzymes

A

PROTEASES
LIPASES (low during first months of life)
GLYCOSIDASES (amylase; is low at birth)
NUCLEASES

55
Q

Protein digestion

A
  1. Stomach: pepsin

2. Intestine: pancreatic proteases

56
Q

Exocrine pancreas secreted enzymes during:

A
  • fasting
  • interdigestive period
  • after eating
57
Q

Clinical symtpoms of exocrine pancreatic insufficiency

A
  • poor growth
  • diarrhea
  • lipid soluble vitamins deficiency
58
Q

Development of skeletal system

A
  • 3rd week: formation of notochord
  • 4th week: first signs of arms and legs
  • 5th to 8th week: limbs begin to extend
  • ossification of most bony nuclei of long and rouhnd bones does not complete until after birth
59
Q

Bone formation

A
  1. Intramembranous ossification: flat bones of the skull and mandible
  2. Endochondral ossification: replacement of cartilage by bone, most bones of the body
60
Q

Factors affecting bone growth

A
  • lack of calcium, protein and other nutrients
  • vitamin D needed to absorption of calcium(lack –> ricketts in childhood and osteomalacia in adults)
  • vitamin C needed for collagen synthesis (lack –> scurvy, teeth fall out, wounds do not heal)
61
Q

Gait in children

A
  • Toddler who begins to walk: wide and unstable gait
  • 18 mo: wide base narrows and more stable
  • 4 years: child can hop on one foot and arm swing occurs
  • 6 years: gait and arm swing similar to adult
62
Q

Joint hypermobility is assessed by the …

A

Beighton score

  • one point for each thumb
  • one point for each finger + 90°
  • one point for each elbow + 10°
  • one point for each knee + 10°
  • one point with straight legs
63
Q

Causes of Rickets

A
  • Vit D disorders
  • Calcium deficiency
  • Phosphorus deficiency
64
Q

10 importatn clinical features in Rickets

A
  • delayed closure of fontanelles
  • frontal bossing
  • dental hypoplasia
  • pectus carinatum
  • swelling in wrist and ankle
  • wide sutures (skull)
  • Craniotabes
  • Rachitic rosary
  • Harrison’s sulcus
  • Bowing of legs
65
Q

Spasmophilia

A
  • in malnutrition of vit D
  • development of alkalosis and hypocalcemia
  • laryngospasm, convulsions, increased neuromuscular tone
66
Q

Grading of heart murmurs

A

I°: only listening very carefully
II°: audible, only in full contact of stetoscope with chest
III°: audible at once without full contact
IV°: audible thourgh the palm
V°: audible through the forearm
VI°: hear it without stetoscope

67
Q

Innocent murmurs

A
  • only systolic
  • mostly under II°
  • not audible from back
  • vertical position decreases intensity
  • temporary
68
Q

Abnromal murmurs

A
  • systolic and diastolic
  • Mostly above II°
  • audible from back and out of heart area
  • Vertical position increases intensity
  • permanent
69
Q

Hypertension from 0-15 years (percentile)

A

over 95th percentile

70
Q

CTI equation

A

(CD+DE)/AB (must be under 50%)

71
Q

growth is controlled by

A
  • genetics
  • nutrition
  • environment
  • hormones
72
Q

Endocrine regulation of grwoth

A
  • GH
  • growth factors (IGF-1)
  • thyroid hormones
  • insulin
  • sex steroids (during puberty)
73
Q

Growth hormone - IGF-1 axis (more detailed)

A

GH –> Liver –> IGF-1 –> bone, cartilage and others

74
Q

Physical growth components

A

Infancy component: mostly nutrition
Childhood component: GH
Pubertal component: sex steoids and GH

75
Q

Target height

A

girls: Father height - 13 + mother hieght / 2
boys: mother height + 13 + father height /2

76
Q

maturation of the hypothalamic-pituitary gonadal axis in puberty

A
  • development of gonads

- increased secretion of sex steroids

77
Q

Breast milk protective effect from

A 
1- Infections
2- Allergy
3- obesity
4- High blood pressure and total blood cholesterol
5- psychological and cognitive benefits
6- Higher intelligence
7- Crohns disease and ulcerative colitis
78
Q

Recommendations on Breastfeeding

A
  • 8-12 feedigns in 24 h
  • no supplements
  • begin daily vit D drops at hosptial discharge
  • avoid routine pacifier use (no earlier than 3-4 weeks)
79
Q

Milk secretion

A
  • prolactin and oxytocin are secreted and released into the circulation
  • prolactin stimulates milk synthesis
  • oxytocin stimulates the myoepithelial cells to contract

domperidon could be given to induce mild secretion

80
Q

Composition of human milk

A
  • carbohydrates (lactose)
  • protein
  • lipids
  • vitamins (influenced by mothers diet)
  • Minerals
  • HMOs
81
Q

HMOs

A 
Glucose
Galactose
N-acetyl-glucosamine
Fucose
Sialic acid
82
Q

HMOs protective factors

A
  • healthy intestinal microbiota
  • support gut barrier
  • reduce harmful bacteria
  • promote the gut associated immune system
83
Q

Contraindications of breast feeding

A
  • baby has galactosemia
  • mother has active untreated tuberculosis
  • mother is receiving radioactive isotopes
  • mother is receiving antimetabolites, chemotherapeutic agents
  • mother is abusing drugs
  • mother is HIV positive
  • mother has herpes simplex lesions on breast
84
Q

Fatty acids in formulas

A
  • omega 6 and omega 3 is important for development of baby’s eyes, brain, nerves and immune system
85
Q

Weaning from bottle

A
  • infants are introduced to a cup at 6 months
  • begin weaning from bottle around 1 year
  • should be fully weaned by 15 months
86
Q

Complementary feeding guidelines

A
  • 6 mo: pureed, mashed and semi-solid food
  • 8 mo: “finger food”
  • 12 mo: same types of food eated by the rest of the family
87
Q

Daily nutritional needs from complementary foods

A

6-8 mo: 130 kcal
9-11 mo: 310 kcal
12-23 mo: 580 kcal

88
Q

what not to give as complementary food

A
  • no sugar/ salt
  • no whole nuts/ mushrooms
  • no juices and honey
89
Q

Gluten and milk as complementary food

A
  • gluten between 4-12 months, large quantities should be avoided
  • milk should not be used as the main drink before 11-12 months
90
Q

When can the child eat what

A 
Grain - porridge: 4-6 months
Vegetables: 4-6 months
Meat: 5-6 months
Egg: 6-7 months
Fish: 6-7 months
Fruits: 6-7 months
91
Q

Antenatal development of lungs

A
  • embryonic
  • pseudovascular
  • canalicular
  • saccular
92
Q

Postnatal development of lungs

A
  • alveolar maturation (up to 2 years)
  • microvascular maturation (up to 3 years)
  • Late alveolarization (3 years tp to adulthood)

Pediatrics (11 decks)

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