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Pediatrics: Case Files > MedU Clipp Cases 9 and 10 > Flashcards

MedU Clipp Cases 9 and 10 Flashcards

1
Q

What age is an infant expected to regain his birth weight?

A

2 weeks

  • Failure to regain Birth Weight by 3 weeks of age or continuous wieght loss after 10 days of life has been defined as Failure to Thrive
  • Adequately nourished = 6 feedings/day
  • and 6 wet diapers/day
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2
Q

What are (4) indications to initiate Breastfeeding?

A
  • Increased Alertness
  • Increased Physical Activity
  • Mouthing
  • Rooting
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3
Q

How often should an infant be feeding?

A
  • Every 1 - 3 hours for 10 - 15 minutes per breast
  • If > 4 hours between feedings –> inadequate
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4
Q

How much Vit. D should infants recieve?

A
  • 400 iU of Supplemental Oral Vitamin D beginning with the first hours of life
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5
Q

Do Formula-fed Infants need Vit. D supplementation?

A
  • Exclusive Formula-fed infants, 1 liter/day, DO NOT require Vitamin D supplementation
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6
Q

How can voiding (urinating) be used to assess Breast Milk feeding?

A
  • Newborn –> 3 - 5 voids and 3 - 5 stools / day
  • 5 - 7 days –> 4 - 6 voids and 3 - 6 stools / day
  • From day one to end of week one the number of voids and stools onlyl goes up by one
    • 5 voids –> 6 voids
    • 5 stools –> 6 stools
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7
Q

What is the definition of Lethargy in a Newborn?

A
  • A level of consciousness characterized by poor or absent eye movements
    or
  • Failure of a Child to Recognize Parents or Objects in the Environment
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8
Q

(4) DDx of Lethargy in a 2 week old?

A
  • Infection (Sepsis, Meningitis)
  • Intracranial Pathology (Hemorrhage from Trauma, Hydrocephalus, Hydranencephaly)
  • Metabolic disorder
  • Chromosomal anomaly
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9
Q

Define Seizures in a Newborn?

A
  • Different from adults
  • Newborns rarely have organized, generalized, tonic-clonic seizures
  • Often subtle
  • Manifest as jerking or horizontal deviation of the eyes
  • Blinking or Fluttering eyelids
  • Drooling
  • Sucking
  • Lip smacking
  • Tonic posturing of a Limb
  • Apnea
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10
Q

Define Jitteriness in Newborns?

A
  • Distinct from Seizure activity
  • Movements are Stimulus-sensitive
  • Generalized
  • Symmetric
  • Can be Diminshed by Gentle, Passive Flexion of the Limbs
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11
Q

Define Myoclonic Jerks in Newborns?

A
  • Brief Myoclonic jerks in and of themselves
  • Not abnormal in Infants
  • Often noted when infant is falling asleep
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12
Q

Define Clonus in Newborns?

A
  • Ankle clonus (spasmodic alternation of muscular contractions between antagonistic muscle groups caused by a Hyeractive stretch reflex from an Upper Motor Neuron Lesion
  • Up to 10 Beats
  • Disappears rapidly
  • More than 3 Beats in a child 1 - 2 months old is abnormal
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13
Q

(3) Uncommon Risks a/w Home Deliveries?

A
  • Neonatal Tetanus
  • Omphalitis (serious infection of the umbilical stump)
  • Hemorrhagic disease of the Newborn
    • No Vit. K is administered
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14
Q

(11) DDx for a Neonate w/
Poor Feeding and Decreased Activity

A
  • Congenital Hypothyroidism
  • Shaken Baby Syndrome
  • Down Syndrome
  • Sepsis
  • Congenital Adrenal Hyperplasia
  • Inborn Error of Metabolism
  • Hypoglycemia
  • Botulism (Honey)
  • Hypoxic-ischemic encephalopathy
  • Polycythemia
  • Hyperbilirubinemia
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15
Q

What is the mean fontanel size?

A
  • 2.1 cm ( 0.6 - 3.6 cm)
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16
Q

What is an Abnormally Large Fontanel Size A/w?

A
  • Skeletal Disorders (Rickets, Osteogenesis Imperfecta etc.)
  • Chromosomal Abnormalities (Down Syndrome)
  • Hypothyroidism
  • Malnutrition
  • Increased Intracranial pressure can also be a/w Large Fontanels and Splitting of the Sutures
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17
Q

What is a Small Fontanel A/w?

A
  • Premature closure of a Small fontanel
  • Microcephaly
  • Craniosynostosis
  • Hyperthyroidism
  • ~ NORMAL variant
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18
Q

What is a Sunken Fontanel A/w?

A
  • Dehydration
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19
Q

What is a Bulging Fontanel A/w?

A
  • Bulging Fontanel is Generally regarded as a sign of Increased intracranial pressure
  • Meningitis
  • Hydrocephalus
  • Subdural Hematoma
  • Lead poisoning
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20
Q

What are Upslanted Palpebral Fissures A/w?

(Eliptical openings of the eyes, the Eye Slits)

A
  • Down Syndrome
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21
Q

(6) What are the Signs of Fetal Alcohol Syndrome?

A
  • Short Palpebral Fissures
  • Thin upper lip
  • Smooth Philtrum
  • Growth Retardation
  • Microcephaly (height and weight < 10th %)
  • Cognitive deficits
22
Q

Signs and Symptoms of Congenital Hypothyrodism?

A
  • Feeding Problems
  • Large Tongue
  • Coarse Cry
  • Hypotonia
  • Large Fontanels
  • Umbilical Hernia (common but a/w Cong. Hypothyroid)
  • Jaundice
  • Mottled Skin
  • Hypothermia
23
Q

A baby with virilization would indicate a possible?

A
  • Congenital Adrenal Hyperplasia
24
Q

Signs of Smnolence and Poor feeding,
followed by Vomiting and Lethargy?

A
  • Inborn Error of Metabolism
25
Q

Low Temperature, Irritiability, Tremors, and Jitteriness
are a/w with Newborn?

A
  • Hypoglycemia
  • sometimes Asymptomatic
    • check blood sugars routinely if considered
26
Q

A Newborn with Low Sodium and High Potassium suggest?

A
  • Congential Adrenal Hyperplasia (CAH)
  • Req’s further testing, 17-OH Progesterone analysis
27
Q

Elevated Serum Ammonia in a Newborn?

A
  • Elevated in Inborn errors of Metabolism
    • Urea Cycle Disorders
      • Ornithine Transcarbamylase Deficiency (OTC)
        • X-linked
        • and Elevated Urine Orotic Acid
    • Organic Acidemias
    • Fatty Acid Oxidation Disorders
    • Ornithine Transcarbamylase Deficiency (OTC)
      • X-linked
28
Q

An infant with Hypotonia? Critical to check?

A
  • Glucose
29
Q

How are T4 and TSH changed in an Infant w/
Congenital Hypothyrodism?

A
  • Low T4
  • High TSH
30
Q

A deficiency in 21-OH in Congenital Adrenal Hyperplasia?

A
  • Decreased production of:
    • Cortisol
    • Aldosterone
  • Elevated 17-OH Progesterone
  • -> diverted to Androgen formation
  • Females –> Virilized
  • Males –> Virilization presents w/ Increased Penile Length and Darker Pigmentation of Scrotum
  • Also consider Salt-wasting form too
31
Q

(4) Hypothyroidism in Newborn caused by?
Transient Hypothyrodism?

A
  • Aplasia
  • Hypoplasia
  • Ectopic Gland (2/3 of cases)
  • Iodine Deficiency
  • Transient Hypothyoridism
    • Mother’s with
      • Autoimmune Thyroiditis
      • Grave’s Disease
32
Q

Primary Hypothyroidism vs. Secondary/Tertiary?

A
  • Primary
    • Hypothalamic-pituitary axis is functioning
  • -> High TSH
  • -> Low T4
  • Secondary/Tertiary
    • Low TSH
    • Low T4
33
Q

Treatment of Hypothyoridism in a Newborn?

A
  • Levothyroxine
    • Maintain TSH - 1 mlU/L
    • T4 - upper half of Normal range for age
  • Follow-up is Key
    • every 1 - 2 months until 1 y.o.
    • every 2 - 3 months until 3 y.o.
    • every 3 - 12 months until growth is completed
34
Q

Signs and Symptoms of Infant Botulism?

A
  • Hypotonia
  • Lethargy
  • Constipation
  • Weak cry
  • Absent Deep Tendon Reflexes
  • Can eventually lead to Respiratory Failure
35
Q

Which Test is diagnostic for an
Ornithin Transcarbamylase Deficiency?
( OTC deficiency )

A
  • Hyperammonemia
  • Elevated Urine Orotic Acid
  • X-linked condition
  • Most common Urea Cycle disorder
36
Q

Adverse reactions to Vaccines in Newborns?

A
  • Most Adverse rxns occur w/in first 24 to 48 hrs after the First Dose of Innoculation
  • Rotavirus (live virus) –> Fever in some infants (several days)
  • MMR and Varicella (live virus) –> Fever w/in 1 week
37
Q

Define Fever Without Source?

A
  • Used when a Complete history has been obtained and a Detailed physical examination performed
  • No identified Source of Child’s Fever
  • Most are Viral in origin
  • Small Percentile are Bacterial
38
Q

(8) Bacterial Infections in Newborns?

A
  • UTI
  • Meningitis
  • Sepsis
  • Pneumonia
  • Bacterial gastroenteritis
  • Osteomyelitis
  • Septic arthritis
  • Occult Bacteremia
39
Q

What are Kernig’s and Brudzinski’s Sign
used for in Neonates?

A
  • Kernig’s sign is resistance to extension of the Knee
  • Brudzinski’s sign is flexion of the hip and knee in response to flexion of the Neck by the examiner
  • Bacterial Meningitis
  • -> Lumbar Puncture
40
Q

Other Sign’s of Bacterial Meningitis?

A
  • Fever
  • Hypothermia
  • Bulging Fontanelles
  • Lethargy
  • Irritability
  • Restlessness
  • Nunchal Rigidity - Opisthotonos
  • Paroxysmal crying (crying when picked up)
  • Poor feeding
  • Vomiting
  • Diarrhea
41
Q

Risk for UTI in Infants?

A
  • Uncircumscised Male under 6 mo.
  • Any Female < 24 mo.
  • Signs and Symptoms
    • Suprapubic tenderness
    • History of UTI
    • Foul-smelling Urine
  • Temp > 39 C (102.2 F)
  • Fever > 24 hours w/out source
42
Q 
(2) Most common bacteria for Bacterial Meningitis
in Children (3 - 36 months)?
A
  • S. pneumoniae
  • N. meningitidis
43
Q

Common cause of Viral Meningitis in Children?

A
  • Enterovirus
44
Q

(4) What tests do you order for testing a child w/
Fever Without Source?

A
  • UA w/ culture
    • most likely UTI
    • Suprapubic aspiration > Bagged Urine
  • CBC w/ differential
    • “Left-shift”
  • Blood culture
  • Lumbar punture
  • Additional considder: Stool Guaiac, Fecal Leukocytes, Stool culture, CXR, Rapid Viral Resp. Pathogens, Inflammatory markers: CRP, Procalcitonin, IL-6
45
Q

Define Pyuria?

A
46
Q

What does a Positive Nitrite Test of Urine mean?

A
  • Occurs when a G- bacteria can reduce
    Urinary nitrate –> nitrite
  • E. coli
  • Klebsiella
  • Proteus spp
  • Good Sensitivity
  • Poor Specificity
47
Q

What does a Positive Leukocyte Esterase Urine test mean?

A
  • Detcts Esterases released from Broken-down Leukocytes
  • -> presence of WBCs in Urine
  • A positive Leukocyte Esterase Test alone is insufficient to make a diagnosis of UTI
48
Q

What does a Positive Nitrite and Leukocyte Esterase Test mean?

A
  • UTI
49
Q

(4) Parenteral ABX treatments of Pyelonephritis?

A
  • Ampicillin / Gentamicin
  • Ceftriaxone
    • cannot give Ca2+ meds through same IV –> precip.
    • not Pseudomonas aeruginosa
  • Piperacillin / Tazobactam
    • not optimal for enterococci
  • Ciprofloxacin
    • cost
    • adverse rxns in children, used in > 1 y.o.
50
Q

What study should be ordered after
First Episode of Pyelonephritis?

A

Renal and Bladder Ultrasound

51
Q 
When do you order a
Voiding Cystourethrogram (VCUG)?
A
  • After a Second Febrile UTI
  • Demonstrates Vesicoureteral reflux

Pediatrics: Case Files (16 decks)

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