Paeds Flashcards
normal RR newborn
40-60 BrPM
normal HR newborn
120-160 bpm
things that are done for every baby
- mouth and nose suctioning
- clamping and cutting umbilical cord
- dried, wrapped–> warmer
- gentle rubbing or stimulating the heels
one minute APGAR score
during labour and delivery conditions
five minute APGAR score
response to resuscitative efforts
appearance 0 point APGAR
blue all over
appearance 1 point APGAR
blue extremities
appearance 2 point APGAR
normal all over
pulse 0 point APGAR
Asystole or less than 60
pulse 1 point APGAR
60-100bpm
pulse 2 point APGAR
greater than 100bpm
grimace 0 point APGAR
no response
grimace 1 point APGAR
grimace/ feeble cry
grimace 2 point APGAR
sneeze/cough
activity 0 point APGAR
none
activity 1 point APGAR
some flexion
activity 2 point APGAR
active movement
resp 0 point APGAR
absent
resp 1 point APGAR
weak or irregular
resp 2 point APGAR
strong
all newborns receive eye care…
- erthromycin or tetracycline ointment
- silver nitrate solution
day 1 red eye
silver nitrate
days 2-7 red eye
gonorrhoea
PREVENTABLE with ointments
Tx: ceftriaxone
days +1 week red eye
chalmydia
NOT preventable with ointments
Tx: oral erythromycin
days +3weeks red eye
herpes
Tx: acyclovir systemic
decrease mortality of vit K bleeding
IM vit K dose
national screening tests newborn USA:
- PKU
- CAH
- CF
- hypothyroidism
- beta thalassemia
- homocyteinuria
- biotinidase
- hearring test
mum is hep B positive, what does baby get?
BOTH active and passive
- active: vaccine
- passive: HBIG
3 transient conditions in the newborn
- transient polycythemia
- TTN
- transient hyperbilirubinemia
splenomegaly normal in newborns
yessssss
TTN timing
first 4 hours
if tachypnea greater than 4 hrs
SEPSIS– do blood and urine cultures, and LP if neuro/irritable
what % of newborns are jaundiced?
60%
delivery associated injuries
- subconjunctival hemorrhage
- skull fractures
- scalp injuries
- brachial
- clavicular fracture
- facial nerve palsy
- AF abnormalities
most common skull fracture during delivery
LINEAR fracture
most fata skull fracture during delivery
BASILAR fracture
caput succedaneum
CROSSES the midline
cephalohaematoma
DOES NOT cross the midline
prune belly
oligohydramnios: lack abdo muscles, unable to bear down and urinate
tx prune belly
serial foley catheter !!!! UTI risk
werdnig hoffman AF
POLY– since cannot swallow
tx for facial palsy delivery injury
NOPE
air fluid levels in chest, and bowel sounds heard in back
congenital diaphragmatic hernia
morgagni
CDH– retrosternal or parasternal
bochdalek
CDH- MORE COMMON, L side posterolateral
most common cause for elevated AFP
incorrect dating
mcc abdo mass in children
WILMS TUMOR
best initial test for wilms tumors
abdo US
most accurate test for wilms tumor
CT with contrast
tx wilms
TOTAL nephrectomy + Ctx, Rtx
most common cancer in infancy
neuroblastoma
most common extra cranial solid malignancy in infancy
neuroblastoma
PC neuroblastoma
- hypsarrhythmia EEG
- opsomyoclonus and cerebellar ataxia
- increase VMA and metanephrine on urine
varicocele imaging
ALWAYS US the OTHER testicle
when to tx varicocele
- delayed testes growth
- evidence of testicular atrophy
risk of malignancy and cryptorchidism with sx
MALIGNANCY RISK CONTINUES despite surgery
most common cyanotic heart lesion in children
TOF
most common cyanotic heart lesion in neonates
TGV
TOF a/w
chromosome 22 deletions
murmur in TOF
holosystolic in LLSB
squatting in TOF
increase preload
increase SVR
VSDs a/w
TRISOMIES
- downs
- edwards
- pataus
3 holosystolic murmurs
- MR
- TR
- VSD– thus TOF
TGV imaging
egg on string
pulsus alterans
alternating strong and weak beats
–>LV systolic dysfunction
pulsus bigeminus
two heartbeats close together followed by a longer pause
–> HOCM
pulsus bisferiens
on palpation of the pulse, a double peak per cardiac cycle can be appreciated
–> AR
HY a/w hypoplastic L heart
GG
G-gray
G-globular heart
truncus arteriosus surgery
must be completed early to prevent PUL HTN
TAPVR
no venous return between pulmonary veins and L atrium
TAPVR with obstruction PC
EARLY LIFE
- resp distress
- severe cyanosis
TAPVR without obstruction PC
AGE 1-2 years old
- RHF
- tachypnea
TAPVR with obstruction CXR
pulmonary edema
TAPVR without obstruction CXR
snowman appearance or figure 8 sign
diagnosis of TAPVR with or without obstruction
ECHO
purpose of surgery in TAPVR with obstruction
DEFINITIVE tx
purpose of surgery in TAPVR without obstruction
RESTORE proper blood flow
VSD PC
- acyanotic
- FTT
- holosystolic murmur LLSB
2 cyanotic heart lesions a/w VSD
- TOF
- Truncus arteriosus
2 cyanotic heart lesions = PDA dependent
- TGV
- HLH
most common congenital heart lesion
VSD
HY a/w ASD
fixed wide splitting S2
PC ASD ….
later in life
- dyarrhythmias
- paradoxical emboli– STROKE
PDA in first 12hrs
normal
PDA after 24hrs
PATHOLOGIC
best initial test for PDA
ECHO
most accurate test for PDA
cardiac catheterization
pear shaped heart
pericardial effusion
jug handle shaped heart
primary pulmonary artery HTN
PC
- hearing loss
- syncope
- fam Hx SCD
- normal vitals/exam
LONG QT SYNDROME
PC kernicterus
- hypotonia
- choreoathetosis
- hearing loss
- seizures
big risk with tef
aspiration pneumonia
vomiting with first feed=
TEF
4 signs of pyloric stenosis
- string sign
- shoulder sign
- mushroom sign
- railroad track sign
string sign
THIN COLUMN of barium leaking through the tightened muscle
shoulder sign
filling defect in the antrum due to prolapse of muscle inward
mushroom sign
hypertrophic pylorus against duodeum
railroad track sign
excess mucosa in pyloric lumen= 2 columns of barium
auscultation of pyloric stenosis
succussion splash
electrolyte disturbance in pyloric stenosis
hypochloraemic, hypokalaemic metabolic alkalosis
what worsens the potassium loss in pyloric stenosis?
ALDOSTERONE
choanal atresia by definition
membrane between the nostrils and the pharyngeal space, preventing breathing during feeding
feeding and choanal atresia
BLUE
crying and choanal atresia
PINK
initial step of choanal atresia
passing NG tube
most diagnostic test for choanal atresia
CT scan
first step in mgmt of choanal atresia
secure airway
CHARGE syndrome
C-coloboma and CNS abnormalities H-heart defects A-atresia choanae R-retardation growth and development G-GU defects (hypogonadism) E-ear anomalies and or deafness
respiratory distress and esophageal atresia
ONLY during feeds
initial test for esophageal atresia
CXR
timing for hirschsprungs
failure to pass meconium within 48hrs
dx of hirschsprungs
- PFA- distension
- manometry- increase pressure of anal sphincter
- full thickness bx
dx of imperforate anus
CLINICAL
wrong answers for dx of imperforate anus
- manometry
- barium
duodenal atresia=
LACK or ABSENCE of apoptosis
timing of duodenal atresia
12 hours
volvulus imaging sign
BIRD BEAK
two things a/w intussusception
- rotavirus
- HSP
triad of symptoms for intussusception
- currant jelly stools
- abdo pain with sausage like mass in RUQ
- vomiting billious
best initial test for intussusception
US– doughnut/ target sign
diagnostic and therapeutic test for intussusception
BARIUM ENEMA
most important first thing for intussusception
fluids and electros
second most common cause of infant death worldwide
GASTRO/DIARRHEA
mild case of diarrhea
oral fluids
severe case of diarrhea
IV fluids
loperamide in kids diarrhea
NO NO NO NO NO
rotavirus and adenovirus= blood?
NO NO NO NO NO NOT BLOODY
after confirmed evidence of NEC
Abx:
- vancomycin
- gentamicin
- metronidazole
big tx for NEC
IV FLUIDS, if failed
SURGERY
infant with diabetic mother– GI
small L colon syndrome
dx small left colon syndrome
barium study– congenitally smaller descending colon–> constipation
major cardiac change in infants of diabetic mothers
asymmetric septal hypertorphy
renal vein thrombosis
infants of diabetic mothers
- flank mass
- possible bruit
- hematuria
- thrombocytopenia
different types of rickets
- vit d deficient rickets
- vit d dependent rickets
- X-linked hypophosphataemic rickets
vit d dependent rickets
inability to convert 25,OH vit D to 1,25 OH vit D
dx of vit D defieicny CXR
rachitic rosary
infant exclusively breastfed it D supplements starting from
2 months of age
vit D dependent rickets labs
decrease calcium
decreased 1,25
normal phosphate
normal 25,OH
X-linked hypophosphataemic rickets
everything normal except
DECREASED PHOSPHATE
most common causes of neonatal sepsis
pneumonia
meningitis
early neonatal sepsis causes
e.coli
listeria
late neonatal sepsis causes
e.coli
GBS
diagnostic tests for sepsis
- blood and urine culture
- urinalysis
- CXR
- LP
tx of neonatal sepsis
ampicillin
gentamicin
cefotaxime (if meningitis)
best initial test for toxo
IgM
most accurate test for toxo
PCR
initial test for rubella
maternal IgM + clinical
tx for neonatal rubella
supportive
CMV best intiial test
urine or saliva viral titers
most accurate test for CMV
urine or saliva PCR for viral DNA
tx CMV with end organ damage
ganciclovir
week 1 herpes
shock and DIC
week 2 herpes
vesicular skin lesions
week 3 herpes
encephalitis
measles dx
IgM= most accurate
emergency tx of croup
racemic epinephrine
XR for croup
NEVER the right answer
hypoxia on presentation
croup
hypoxia imminent
epiglottitis
most nb for epiglottitis
intubation
CXR for whooping cough
buterfly pattern
productive cough lasting 7-10days with fever
bronchitis- clinical dx-supportive tx
painful limp + ER leg
SUFE
painful limp only
LCP
XR LCP vs SUFE
BOTH= widening of joint
LCP—-> effusions
tx LCP
= rest and NSAIDS
—> SURGERY BOTH HIPS (since if one necroses, likely that the other one will swell)
tx for SUFE
IR and pinning
burning feet syndrome
vit B5 deficiency
random add in for it A deficiency
hypoparathyroidism
thus XS= hyperparathyroidism
