Pediatric Flashcards
Normal RR and HR in a newborn
RR 40-60 bpm
HR 120-160 bpm
What does APGAR stand for?
Appearance
Pulse
Grimace
Activity
Respiration
Apgar delineates a quantifiable measurement for the need and effectiveness of resuscitation; does not predict mortality.
Most common cause of conjunctivitis in a newborn at:
1 day
1 week
2 weeks
1 month
1 day: chemical irritation (silver nitrate)
2-7 days: N gonorrhea (prevent with ointments, treat with ceftriaxone)
>7 days: Chlamydia (not effectively prevented by ointments, treat with oral erythromycin)
>3 weeks: herpes (treat with systemic acyclovir and topical vidarabine)
What steps do we take to prevent ophthalmia neonatorum
2 types of antibiotic drops in each eye:
Erythromycin or tetracycline ointment
Silver nitrate solution
What causes Vit K deficiency in newborns and how do we prevent it?
Immature livers do not utilize vitamin K to develop appropriate clotting factors; E coli is not present in sufficient quantities to make enough vitamin K
To prevent VKDB a single IM dose of vitamin K is recommended
Which children should get HBIG in addition to a hepatitis B vaccine
THose with HBsAg-positive mothers
Explain transient polycythemia of the newborn
Hypoxia during delivery stimulates EPO
Splenomegaly is a normal finding
Explain transient tachypnea of the newborn
Newborns delivered via C/S may have excess fluid in the lungs and therefore by hypoxic
If tachypnea lasts more than 4 hours, it is considered sepsis and must be evaluated with blood and urine cultures
Why are over 60% of newborns jaundiced?
Infant’s spleen removing excess RBCs that carry Hgb F
What puts infants at risk for subconjunctival hemorrhage
Minute hemorrhages may be present in the eyes of the infant due to a rapid rise in ICP as the chest is compressed while passing through the birth canal
3 major types of skull fractures in the newborn
- Linear: most common
2: Depressed - Basilar: most fatal
Difference between caput succedaneum and cephalohematoma?
Caput: swelling of the soft tissues of the scalp that DOES CROSS suture lines
Cephalo: subperiosteal hemorrhage that DOES NOT CROSS suture lines
Infant unable to abduct the shoulder or externally rotate and supinate the arm
Duchenne-Erb Paralysis: C5-C6
“Waiter’s tip” appearance 2/2 shoulder dystocia
Paralyzed hand with ptosis, miosis, and anhydrosis
Klumpke Paralaysis: C7-C8 +/- T1
“Claw hand” d/t lack of grasp reflex
What is the most common cause of Facial Nerve Palsy
trauma 2/2 forcep use in delivery
surgical repair is necessary if improvement is not seen over a few weeks
Neurological Werdnig-Hoffman
Infant is unable to swallow, leading to polyhydramnios
2 types of diaphragmatic hernias
Morgagni: defect is retrosternal or parasternal
Bochdalek (most common): defect is posterolateral and commonly occurs on the left side
What is an omphalocele highly associated with?
Edwards syndrome (trisomy 18)
What is an umbilical hernia highly associated with?
Congential hypothyroidism
WAGR syndrome
Wilms tumor
Aniridia (absence of an iris)
Genitourinary malformations
mental Retardation
Syndrome results from a deletion on chromosome 11
Most common cancer in infancy
Neuroblastoma (adrenal medulla tumor)
Look for hypsarrhythmia (on EEG) and opsomyoclonus (dancing eyes dancing feet)
Look for increased VMA and metanephrines on urine collection
Remnant of the tunica vaginalis that transilluminates upon inspection
Hydrocele (usually resolves within 6 months)
What should you do if you find a varicocele?
Ultrasound the other testicle (varicocele is a bilateral disease)
Treatment is indicated for delayed growth of the testes or in those with evidence of testicular atrophy
Exercise intolerance and squatting while playing outside
pathognomonic for tetralogy of Fallot
Most common cyanotic heart defect in children
TOF: overriding aorta, pulmonary stenosis, RV hypertrophy, VSD
Associated with chromosome 22 deletions
CXR: boot-shaped heart
TOF
Only 3 holosystolic murmurs
- Mitral regurgitation
- Tricuspid regurgitation
- VSD
The most common congenital heart defect in Down Syndrome
endocardial cushion defect of atrioventricular canal
(walls separating all 4 chambers are poorly formed or absent)
CXR: egg on a string
Transposition of the Great Vessels
No oxygenation of blood can occur without a PDA, ASD, or VSD
Most common cyanotic condition in neonates vs children
Neonates = TOGV
Children = TOF
CXR: globular-shaped heart
Hypoplastic left heart syndrome
Treatment for truncus arteriosus
Surgery must be done early to prevent pulmonary hypertension
CXR: snowman or figure 8 sign
Total anomalous pulmonary venous return (TAPVR): oxygenated blood returns to the SVC
TAPVR with obstruction would just show pulmonary edema on CXR and present early in life with respiratory distress and severe cyanosis
Holosystolic murmur + FTT
VSD
Common in Down, Edwards, and Patau
3 major types of ASD
- Primum defect (concomitant mitral valve abnormalities)
- Secundum defect (most common)
- Sinus venosus defect (least common)
Look for paradoxical emboli from deep leg veins
fixed wide splitting S2
ASD
Machine-like murmur
Wide pulse pressure
Bounding pulses
PDA
Normal finding in the first 12 hours, after 24 hours it is considered pathologic
Mitral lesions radiate to…
Tricuspid/pulmonary lesions radiate to…
Aortic lesions radiate to…
Mitral = Axilla
Tricuspid/pulmonary = Back
Aortic = Neck
CXR: pear-shaped heart
pericardial effusion
CXR: “3-sign” or rib notching
coarctation of the aorta
associated with Turner Syndrome (short girl with webbed neck, shield chest, streak gonads, horseshoe kidneys, or shortened fourth metacarpal)
Hearing loss
Syncope
Normal vitals/exam
FHx of sudden cardiac death
Long QT Syndrome
When is hyperbilirubinemia considered pathologic?
- first day of life
- rises more than 5 mg/dL/day
- above 19.5 mg/dL
- direct rises above 2 mg/dL
- persists after the second week of life
Hypotonia
Seizures
Choreoathetosis
Hearing loss
Kernicterus
Choreoathetosis: occurrence of involuntary movements in combination with chorea (irregular migrating contractions) and athetosis (twisting and writhing)
Vomiting with first feeding
TEF
Likely be a history of polyhydramnios; look for recurrent aspiration pneumonia
Nonbilious projectile vomiting with “olive sign”
Pyloric stenosis (most common cause is idiopathic)
Lab changes seen with vomiting
Hypochloremic, hypokalemic metabolic alkalosis
Due to loss of hydrogen ions in the vomitus; potassium loss also worsens from aldosterone release in response to hypovolemia
Look for “string sign” on upper GI series
CHARGE Syndrome
C: coloboma of the eye (hole), CNS anomalies
H: heart defects
A: atresia of the choana (prevents breathing during feeding)
R: retardation of growth/development
G: genital and/or urinary defects (hypogonadism)
E: ear anomalies and/or deafness
Hirschsprung disease, Imperforate anus, and Duodenal atresia are associated with
Down Syndrome
VACTERL Syndrome
V: vertebral anomalies
A: anal atresia
C: CV anomalies
T: TEF
E: esophageal atresia
R: renal anomalies
L: limb anomalies
Duodenal atresia is caused by
a lack or absence of apoptosis (improper canalization of the lumen)
upper GI series showing “bird beak” appearance
Volvulus (majority being in the ileum)
Most important step for intussusception
Fluid resuscitation and balancing of electrolytes, followed by NGT decompression of the bowel
Air/Barium enema is both diagnostic and therapeutic (can be attempted 3 times before surgical intervention is required)
painless BRBPR
Meckel’s diverticulum (technetium 99 scan)
Rules of 2’s: 2% of the population, 2 feet of ileocecal valve, 2 types of tissue (gastric and pancreatic), age < 2, males 2x more affected, symptomatic in 2% of patients, 2 inches long
Abdominal XR showing air within the bowel wall
AKA pneumatosis intestinalis
Pathognomonic for necrotizing enterocolitis - seen in premature infants where the bowel undergoes necrosis and bacteria invade the intestinal wall
Unique findings in infants of diabetic mothers (IDMs)
Small Left Colon Syndrome
Cardiac Abnormalities
Renal Vein Thrombosis
Metabolic Findings and Effects
Macrosomia (all organs enlarged except for the brain)
Sugar Can Really Make Mistakes
What is common among all forms of Congenital Adrenal Hyperplasia?
Low cortisol, High ACTH, Low aldosterone
21 = relatively low BP, increased androgens
11 = increased BP, increased androgens
17 = increased BP, decreased androgens
3 main etiologies of rickets
- Vitamin D-deficient
- Vitamin D-dependent (inability to convert 25-OH to 1,25(OH)2)
- X-linked hypophosphatemic
Most common causes of neonatal sepsis
Pneumonia and Meningitis
Most common organisms: GBS, E coli, S aureus, Listeria
Treatment: Ampicillin and gentamicin (+/- cefotaxime)
Chorioretinitis, hydrocephalus, and multiple ring-enhancing lesions
Toxoplasmosis
Look for elevated IgM (PCR is most accurate test)
Treat with pyrimethamine and sulfadiazine
Rash on palms/soles, snuffles, 8th nerve palsy, and saddle nose
Syphilis
VDRL or RPR (dark field microscopy is most accurate)
Treat with penicillin
PDA, cataracts, deafness, hepatosplenomegaly, thrombocytopenia, blueberry muffin rash, hyperbilirubinemia
Rubella
Supportive care
Periventricular calcifications with microencephaly, chorioretinitis, hearing loss, and petechiae
CMV
Urine or saliva viral titers (most accurate test is PCR)
Treat with ganciclovir when signs of end organ damage are present
Best initial test for Herpes
Tzanck smear (PCR is most accurate)
Treat with acyclovir and supportive care
Week 1: shock and DIC
Week 2: vesicular skin lesions
Week 3: encephalitis
Pruritic vesicular rash that begins on the face; possible fever and malaise
Varicella
Tzanck smear showing multinucleated giant cells
Cough, Coryza, and Conjunctivitis with a Koplik spot (grayish macule on buccal surface)
Measles (rubeola)
Starts with fever and URI and progresses to rash with “slapped cheek” appearance
5th disease (parvovirus B19)
Fever and URI progressing to diffuse rash
Roseola
Fever precedes classic parotid gland swelling and possible orchitis
Mumps
Fever
Pharyngitis
Sand-paper rash over trunk and extremities
Strawberry tongue
Cervical lymphadenopathy
Scarlet Fever
Treat with penicilin, azithromycin, or cephalosporins
Severe cough
Fever
Coryza
Inspiratory stridor
CXR: steeple sign
Croup (most commonly caused by parainfluenza virus types 1 and 2; RSV is the second most common cause)
Treatment for mild croup vs moderate-severe
Mild = steroids
Moderate-severe = racemic epinephrine to prevent asphyxiation and probable tracheostomy
Croup will show hypoxia on presentation while epiglottitis is worrisome for imminent hypoxia
Hot potato voice
Fever
Drooling in a tripod position
Refusal to lie flat
Epiglottitis (due to H influenza type B)
CXR (not the right answer) would show a “thumbprint sign”
Intubate in the OR, administer ceftriaxone for 7-10 days, and give rifampin to all close contacts
Stages of Whooping cough
Form of bronchitis caused by Bordetella pertussis
*Catarrhal stage: severe congestion and rhinorrhea (14 days)
Paroxysmal stage: severe coughing episodes with inspiratory whoop followed by vomiting (14 - 30 days)
Convalescent stage: decrease of frequency of coughing (14 days)
*Erythromycin or azithromycin are only useful in the catarrhal stage
Give macrolides to all close contacts
Treatment for congenital hip dysplasia
Pavlik harness
Treatment for Legg-Calve-Perthes disease
Rest and NSAIDs
Follow with surgery on both hips: if one necroses, eventually the other one will
Treatment of SCFE
Internal fixation with pinning (don’t let them walk out of the exam room)
Poor night vision
Hypoparathyroidism
Vitamin A deficiency
Vitamin A toxicity = pseudotumor cerebri and hyperparathyroidism
Beriberi
Wernicke’s encephalopathy
Vitamin B1 (thiamine) deficiency
Angular chelosis
Stomatitis
Glossitis
Vitamin B2 (Riboflavin) deficiency
Diarrhea
Dermatitis
Dementia
Death
Vitamin B3 (Niacin) deficiency
Burning feet syndrome
Vitamin B5 (panthothenic acid) deficiency
Peripheral neuropathy
Must be given with INH
Vitamin B6 (pyridoxine) deficiency
Megaloblastic anemia
Hypersegmented neutrophils
Vitamin B9 (folate) deficiency
Megaloblastic anemia
Hypersegmented neutrophils
Peripheral neuropathy of the dorsal column tracts
Vitamin B12 (cyanocobalamin)
Echymoses
Bleeding gums
Petechiae
Vitamin C deficiency
Rickets in children
Vitamin D deficiency
Vitamin D toxicity = hypercalcemia, polyuria, polydipsia
Increased prothrombin time/INR
Mild to severe bleeding
Vitamin K deficiency
