MTB 2 CK - Pediatrics Flashcards
once the baby is delivered what do you do next
mouth and nose is suctioned then cutting/clamping of the umbilical cord, then dried/wrapped in clean towels and placed under a warmer.
what is the normal heart rate in a baby
120-160 beats per minute
what is the respiratory rate in a newborn
40-60 breaths per minute
conjunctivitis most likely at day 1
chemical irritation
conjunctivitis at 2-7
gonorrhea
conjunctivitis after more than 7 days
chlamydia trachomatis
conjunctivitis after 3 weeks or more in newborn
herpes infection
newborns should receive what 2 types of antibiotics
erythromycin ointment or tetracycline ointment
silver nitrate solution
neisseria gonorrhea conjunctivitis tx
ceftriaxone
chlamydia conjunctivitis tx
oral erythromycin
herpes conjunctivitis tx
systemic acyclovir and topical vidarabine
give rhogram at what weeks
28-32 weeks and during delivery
what week do you check for gbs
35-37 weeks
amlodipine a/e
edema
what should be given to newborn prophylactically
single IM dose of vitamin K
hep b vaccine
but newborns with HbSAg positive mother should get hep b vaccine and HBIG
what is transient tachypnea of the newborn
when newborn passes thru vaginal canal, compression of rib cage helps in removal of fluid from lungs
newborns delivered with c-section- have excess fluid in lungs and are hypoxic
if hypoxic for more than four hours, get urine and blood culture
when should you do a csf analysis with lumbar puncture on newborn
neuro signs like irritability, lethargy, temp irregularity, and feeding problems
transient hyperbilirubinemia in newborn
infant spleen removign excesss rbc with hbF- excess breakdown of rbc- leads to physilogical release of Hb and a rise in bilirubin
subconjunctival hemorrhage in newborn
due to increased intrathoracic pressure of chest as being compressed while passing thru birth canal
tx- none
newborn skull fractures from least dangerous to worst
linear-most common
basilar- most fatal
depressed- can cause cortical injuries but no surgical intervention
caput succedaneum and cephalohematoma
do not cross suture lines
duchenne-erb paralysis presentation in newborb
cant abduct shoulder, cant externally rotate, and cant supinate
dx of ducehenne-erb palsy
clinical dx and tx with immoblization
klumpke paralysis of newborn
claw hand with horner syndrome
facial nerve plasy in newborn causes
forcep use in delivery
tx of facial nerve palsy in newborn
improvement occurs gradually over weeks to months
if no improvement then surgical repair of nerve
polyhydramnios def
too much fluid because the fetus is not swallowing
causes of polyhydramnios
werdnig hoffman syndrome
intestinal atresia
oligohydramnios
too little fluid because the fetus cant urinate
causes of oligohydramnios
prune belly- lack of abdominal muscles so cant bear down and urinate
-tx of prune belly is serial foley catheter placements but carries high risk of uti
renal agenesis- assoc with potter syndrome and incompatible with life
flat facies
where is the defect in morgagni
retrosternal or parasternal
where is the defect in bochdalek
posterolateral
omphalocele cause
failure of gi sac to retract at 10-12 weeks
gastroschisis occurs where
lateral to midline with no sac covering
umbilical hernia is highly associated with what
congenital hypothyroidism
tx of umbilical hernia
90 percent close spontaneously by age 3 but if doesn’t after age 4, then surgical intervention to prevent bowel strangulation and subsequent necrosis
wilms tumor caused by
hemihypertrophy of one kidney due to increased vascular demands
presentation of wilms tumor
constipation, n/v, abdominal pain, palpable abdominal mass, aniridia
dx of wilms tumor
abdominal ultrasound is the best initial
most accurate is the contrast enhanced ct scan
tx of wilms
nephrectomy with chemo and radiation
neuroblastoma dx
hypsarrhythmia on eeg and opsomyoclonus
hydrocele
painless swollen fluid filled sac, transilluminates
remanant of tunica vaginalis
resolve w/n 6 m.
dx with ultrasound
varicocele best initial test
Physcial exam coinciding with a bag of worms sensation
ultrasound of scrotal sac showing dilatation of pampiniform plexus
cryptorchidism tx
orchipexy to bring testicle down into scrotum after age 1 to avoid sterility
cryptorchidism increase risk of malginancy regardless of surgical intervention true or false
true
what is contraindicated in hypospadias
circumcision bc diffficulty in surgical correction then
hypospadias highly associated with what
cryptorchidism and inguinal hernia
epispadias highly associated with what
urinary incontinence; evaluate for concomitant bladder exstrophy
why does squatting help in TOF
increase in preload increases systemic circulation resistance, decreases R to left shunt, leading to increased pulmonary blood flow and increase blood oxygen sat
tx of transposition of great vessels
prostaglandin E1 to keep patent ductus arteriosisu open
nsaids/indomethacin contraindicated
two surgeries are necessary
pulsus alterans seen in what
left ventricular systolic dysfunction
pulsus bigeminus seen in what
hocm
pulsus bisferiens seen in what
AR
pulsus tardus seen in what
AS
hypoplastic left heart syndrome
left ventricular hypoplasia, mitral valve atresia, and aortic valve lesions
gray cyanosis rather than blue
precordial hyperactivity, loud second heart sound, weak pusles
truncus arteriosus
severe dyspnea, early and frequent resp infections within first few days
tx of truncus arteriosus
surgery to prevent pulmonary htn which develops within 4 months
TAPVR with obstruction
early in life with resp distress and severe cyanosis
dx of TAPVR with obstruction
chest xray shwoing pulm edema
echo is definitive
TAPVR without obstruction
1-2 years of age with right heart failure and tachypnea
tapvr without obstruction dx
CXR showing snowman or figure 8 sing
most accurate is echo- have to diagnose with this
VSD conservative tx
diuretics and digoxin otherwise larger or more symptomatic lesions require surgery
vsd and asd dx
cardiac cath is the most definitive test
but echo is less invasive and just as effective
prolong qt syndrome
hearing loss, syncope, normal vitals and exam, fm hx of sudden cardiac disease
3 sign on chest xray signifies what
coarctation of aorta
tx of coarctation of aorta
surgical resection of narrowed segment and then balloon dilation if recurrent stenosis occurrs
hyperbilirubinemia is pathological when?
appears on first day of life bilirubin increases more than 5 a day direct bilirubin is above 2 bilirubin arises above 19.5 in a term child persists after second week of life
tx of hyperbilirubinemia
blue green light helps break down bilirubin to excretable components
consider exchange transufson if bilirubin arises above 20-25
tx of Trachoesophageal fistula
surgical repair in two wteps
antibiotic coverage for anaerobes
fluid resus before surgery to prevent dehydration
string sign and olive seen seen where
pyloric stenosis
doughnut sign seen where
intusseption
best intial test for pyloric stenosis
abdominal ultrasound showing thickened pyloric sphincter
when is pyloric stenosis seen
first month of life but can be seen upto six months after birth
shoulder sign is what in pyloric stenosis
filling defect in the antrum due to prolapse of muscle inward
what is mushroom sign in pyloric stenosis
hypertrophies pylorus against the duodenum
railroad track sign in pyloric stenosis
excess mucosa in the pyloric lumen resulting in two columns of barium
best intial test for chaonal atresia
pass NG tube
most accurate: ct scan
first step in management of choanal atresia
secure airway
tx of choanal atresia
surgery to perforate the membrane and reconnect the pharynx to the nostrils
dx of duodenal atresia
abdominal xray and double bubble
first day of life
first step in management dudoenal atresia
iv fluids
tx of pyloric stenosis
replace lost volume with iv fluids, replace lost electrolytes especially potassium
NGT to decompress the bowel
surgical myotomy
CHARGE syndrome
coloboma of eye heart defects atresia of choanae retardation of growth genital defects ear anomalies
hirschsprung disease
do not pass meconium for over 48 hours or fail to pass meconium at all
extreme constipation followed by large bowel obstruction
rectal eaxm shows extremely tight sphincter; cant pass flatus
dx of hirschsprung disease
plain xray shows distended bowel loops with lack of air in rectum
contrast enema shows retention of barium for greater than 24 hours
manometry will show high pressures in the anal sphincter
mainstay of dx is full thickness biopsy revealing lack of ganglionic cells in submucosa
VACTERL syndrome
veretebral anomalies anal atresia cardivascular anomalies tef esopghaeal atresia renal anomalies limb anomalies
dx of imperforate anus
not being able to pass meconium and physical exam will reveal no anus
dudoenal atresia is associated with what
down syndrome and annular pancreas
duodenal atresia presentation
bilious vomiting within 12 hours of birth
xray shows classic double bubble sign
tx of duodenal atresia
replace lost volume with IV fluids
replace potassium
NGT to decompress the bowel
surgical duodenostomy-most common/definitive tx
birds peak appearance seen in what two situations
volvulus and achalasia
volvulus presentation
vomiting and colicky abdominal pain
multiple air fluid levels seen
first year of life
best initial therapy for volvulus is
iv fluids
endoscopic decompression
most effective tx if endoscopy fails in volvulus
surgical decompression
intussusception associated with
previous rotavirus vaccine and HSP
intussusception caused by what
polyp, hard stool, lymphoma, or even have a viral origin
intussusception presentation
bilious vomiting, currant jelly stool, and colicky abdominal pain
right quadrant sausage shaped mass can be palpated
first year of life
dx of intussusception
ultrasound will show doughnut sign or target sign
most accurate test for intussusception
barium enema both diagnostic and therapeutic
tx of intussusception
fluid resus and balancing electrolytes
NGT decompression of bowel
barium enema- must observe bc 10 percent recur w/n 24 hours
if barium enema not curative then emergent surgical intervention
norwalk virus
explosive cramping pain, epidemic, short lived 1-2 days
necrotizing enterocolitis
seen in premature infants with low birth weight, vomiting/abdominal distention, fever
dx of necrotizing enterocolitis
abdominal xray shows pneumatosis intestinalis- air within bowel wall and ct with air in the portal vein, dilated bowel loops
frank or occult blood can be seen in stool
tx of necrotizing enterocolitis
feeding discontinued
iv fluids immediately
ngt for bowel decompression
if these does not help then surgery to remove affected bowel
small left colon syndrome seen where
in infants of diabetic mothers
congenitally smaller descending colon leads to distention from constipation
tx with repeated smaller and more frequent feeds
major cardiac change seen in infants of diabetic mothers
asymmetric septal hypertrophy- bc obliteration of left ventricular lumem causing decreased cardiac output
dx with ekg and echo
tx with bb and iv fluids
CAH dx
increased 17-OH progesterone level at birth
17 alpha hydroxylase def
increase in aldosterone decrease in sex steroids and cortisol
female: normal at birth
male: pseudohermaphrodite
21 hydroxylase def
decrease in aldosterone and cortisol
increase in sex hormones
female: virilized
male: normal at birth
11 b hydroxylase def
decrease in aldosterone and cortisol increase in sex hormones girls: virilized boys: normal at birth 11-doc increased
children at what age are most susceptible to rickets
6-24 months
infants who are exclusively breast fed should be given what
vitamin d supplements at 2 months of age
tx of neonatal sepsis
gentamicin and ampicillin
cefotaxime
neonatal taxoplasmosis
chorioretinitis, hydrocephalus, mutiple ring enchancing lesions on ct
neonatal taxoplasmosis dx
elevated igM to taxoplasma- best initial
most accurate: pcr
tx for taxoplasmosis
pyrimethamine and sulfadiazine
rubella
pda, cataracts, deafness, hps, thrombocytopenia, blueberry muffin rash, and hyperbilirubinemia
dx of rubella
maternal igM along with clincal diagnosis
tx of neonatal rubella
supportive
neonatal cmv
periventricular calcifications with microencephaly, chorioretinitis, hearing loss, and petechiae
dx of cmv
best initial: urine or saliva viral titers
most accurate: urine or saliva PCR for viral DNA
tx of scarlet fever
penicillin, azithromycin, or cephalosporin
croup
barking cough, coryza, inspiratory stridor, difficulty breathing when lying down, signs of hypoxia like acessory muscle use or peripheral cyanosis
chest xray: steeple sign
dx of croup
made clinically, rarely need xray
tx of croup
mild symptoms: steroids
moderate/severe: epinephrine
tx of epiglottis
intubate the child in the OR
administer ceftriaxone for 7-10 days
rifampin given to all close contacts
what do the three stages of whooping cough present with
catarrhal stage: congestion and rhinorrhea-14 days
paroxysmal stage: severe coughing with extreme gasp for air followed by vomiting-14-30 days in duration
convalescent stage: decrease of frequency of coughing-14 days
tx of whooping cough
erythromycin or azithryomycin only in catarrhal stage
isolate child and macrolides for all close contacts
tx of diphtheria
antitoxin
pharyngitis
cervical adenopathy, petechiae, fever above 104, other URI symptoms, acute rheumatic fever and GN
dx of pharyngitis
rapid DNAse Ag detection test
tx of pharyngitis
oral pcn for ten days or macrolides if pcn allergry
what is Legg Calve Perthes disease
avascular necrosis of femoral head showing painful limp
dx of legg calve perthes
xray showing joint effusion and widening
tx of legg calve perthes
nsaid and rest
follow with surgery on both hips
