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Shelf exams and USMLE Step 2 > Pediatric Clerkship > Flashcards

Pediatric Clerkship Flashcards

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USMLE® Step 1 flashcards
1
Q

Normal respiratory rate for a newborn?

A

40-60

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2
Q

Normal HR for a newborn?

A

120-160

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3
Q

True or False: Apgar score predicts mortality

A

FALSE

The Apgar score delineates a quantifiable measurement for the need and effectiveness of resuscitation. However, it does not predict mortality.

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4
Q

What is the Barlow maneuver?

A

This is a newborn/infant physical exam maneuver to evaluate for developmental dysplasia of the hip (DDH).
You have the infant lying supine on the table with knees bent. You grab the femur with your thumb on the medial aspect of the thigh and your fingers on the greater trochanter. Push back towards the exam table to attempt posterior dislocation of the hip from the acetabulum.

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5
Q

True or False: Developmental dysplasia of the hip must be detected and treated early

A

True.

Failure to diagnose DDH can cause major problems requiring lengthy treatment, and can be permanently disabling.

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6
Q

What is the Ortolani maneuver?

A

This is a newborn/infant physical exam maneuver to evaluate for developmental dysplasia of the hip (DDH).

You have the infant lying supine on the table with knees bent. While you abduct, push the greater trochanter medially and forward with your fingers. You are attempting to relocate a hip that has already been in a dislocated position.

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7
Q

What is the 1-minute Apgar score evaluating? How about the 5-minute?

A

1-minute: evaluating conditions during labor and delivery

5-minute: evaluating response to resuscitative efforts

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8
Q

True or False:

Low score on the Apgar is NOT associated with future cerebral palsy

A

True

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9
Q

APGAR score?

A

Appearance, pulse, grimace, activity, respiration

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10
Q

To diagnose conjunctivitis in a newborn, you should consider when the redness and irritation begins.

At 1 day, the most likely cause is?

A

Chemical irritation

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11
Q

To diagnose conjunctivitis in a newborn, you should consider when the redness and irritation begins.

At 2-7 days, the most likely cause is?

A

Neisseria gonorrhoeae

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12
Q

To diagnose conjunctivitis in a newborn, you should consider when the redness and irritation begins.

At more than 7-21 days, the most likely cause is?

A

Chlamydia trachomatis

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13
Q

To diagnose conjunctivitis in a newborn, you should consider when the redness and irritation begins.

At 3 weeks or more, the most likely cause is?

A

Herpes simplex

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14
Q

All newborns must be given what 2 types of antibiotic drops? What is it treating?

A

Give

  1. erythromycin ointment or tetracycline ointment
  2. silver nitrate solution

To prevent ophthalmia neonatorum (most commonly caused by neisseria gonorroeae or chlamydia trachomatis

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15
Q

1 week old newborn brought to the ED after home delivery.
Parents do not believe in vaccinations.
Parents did not seek any medical attention after delivery.
Baby presents with BRBPR and lethargy.
Unequal pupils and diaper has gross red blood.

a. Cerebrovascular accident
b. Meckel’s diverticulum
c. Vitamin K deficient bleeding
d. Crohn disease

A

C. As this child received no routine newborn care, it is very likely he is suffering from a vitamin K deficiency. Newborns are at most risk as their immature livers do not utilize vitamin K to develop the appropriate clotting factors. Breast milk typically has very low levels of vitamin K. The child’s lethargy is likely from intracranial bleeding, and the bright red blood per rectum is mucosal bleeding. The child’s age precludes a diagnosis of CVA, Crohn disease, or a Meckel’s diverticulum.

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16
Q

Antibiotic eye drops/ointments are given at Day 0 of newborns to prevent ophthalmia neonatorum. If a baby is found to have conjunctivitis on Day 5 after birth, what is the likely bug and how do you treat?

A

Day 2-7 = neisseria gonorrhea

If preventative ointments failed, treat with ceftriaxone.

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17
Q

Antibiotic eye drops/ointments are given at Day 0 of newborns to prevent ophthalmia neonatorum. If a baby is found to have conjunctivitis on Day 10 after birth, what is the likely bug and how do you treat?

A

Day 7-21 = Chlamydia trachomatis

If preventative ointments failed, treat with oral erythromycin.

18
Q

Antibiotic eye drops/ointments are given at Day 0 of newborns to prevent ophthalmia neonatorum. If a baby is found to have conjunctivitis on Day 30 after birth, what is the likely bug and how do you treat?

A

Day 21+ = herpes simplex

Treat with systemic acyclovir and topical vidarabine

19
Q

How do you prevent vitamin K deficient bleeding in newborns?

A

Give a single intramuscular dose of vitamin K to newborns

20
Q

True or False: all neonates must be screened for diseases prior to discharge

A

True

21
Q

X-linked recessive disease characterized by hemolytic crises. Treatment involves reducing oxidative stress and specialized diets.

A

G6PD deficiency

22
Q

Autosomal recessive genetic disorder characterized by a deficiency in the enzyme phenylalanine hydroxylase (PAH) that leads to mental retardation.

Dx and tx?

A

Phenylketonuria (PKU)

Treat with special diet low in phenylalanine for at least the first 16 years of the patient’s life.

23
Q

a rare genetic disorder that precludes normal metabolism of galactose

dx and tx?

A

Galactosemia

Tx is to cut out all lactose-containing products

24
Q

several autosomal recessive diseases resulting in errors in steroidogenesis

dx and tx?

A

Congenital adrenal hyperplasia

Tx is to replace mineralocorticoids and glucocorticoid deficiencies and possible genital reconstructive surgery.

25
Q

a condition affecting 1 in 4,000 infants that can result in cretinism–a condition of severely stunted physical and mental growth owing to untreated congenital deficiency.

dx and tx?

A

Congenital hypothyroidism

tx is thyroid hormone replacement

26
Q

autosomal disorder causing abnormally thick mucus

dx? how to dx?

A

Cystic fibrosis

Best initial test: sweat chloride

Most accurate test: genetic analysis of CFTR gene

27
Q

True or False:

Every child gets hepatitis B vaccination and Hepatitis B immunoglobulin

A

FALSE

Every child gets a hepatitis B vaccination but only those with HBsAg-positive mothers should receive hepatitis B immunoglobulin (HBIG) in addition to the vaccine.

28
Q

True or False

Splenomegaly is a normal finding in newborns

A

True

Up to 1/3 of newborns have splenomegaly. However, if it is palpated more than 2cm below the left costal margin, it is considered to be abnormal.

29
Q

What is transient polycythemia of the newborn?

A

Hypoxia during delivery stimulated erythropoietin and causes an increase in circulating RBCs. The newborn’s first breath will increase O2 and cause a drop in erythropoietin, which in turn will lead to normalization of hemoglobin.

30
Q

What is transient tachypnea of the newborn?

A

Compression of the rib cage by passing through the mother’s vaginal canal helps to remove fluid from the lungs. Newborns who are delivered via cesarean birth may have excess fluid in the lungs and therefore be hypoxic. If tachypnea lasts more than 4 hours, it is considered sepsis and must be evaluated with blood and urine cultures. Lumbar puncture with CSF analysis and culture is done when the newborn displays neurological signs such as irritability, lethargy, temperature irregularity, and feeding problems.

31
Q

What is transient hyperbilirubinemia of the newborn?

A

Over 60% of all newborn infants are jaundiced. This is due to the infant’s spleen removing excess red blood cells that carry Hgb F. This excess breakdown of RBCs leads to a physiological release of hemoglobin and in turn a rise in bilirubin.

32
Q

Delivery-associated eye injury in newborn? Dx and tx?

A

Subconjunctival hemorrhage

Minute hemorrhages may be present in the eyes of the infant due to a rapid rise in intrathoracic pressure as the chest is compressed while passing through the birth canal. No treatment is indicated.

33
Q

What is the most common delivery-associated skull fracture in newborns? Most fatal?

A

Most common: linear fx

Most fatal: basilar fx

34
Q

True or False: Delivery-associated depressed skull fractures in newborns will generally resolve with observation and conservative management

A

FALSE

Depressed fractures can cause further cortical damage without surgical intervention.

35
Q

What are caput succedaneum and cephalohematoma? What are the differences and treatment?

A

These are delivery-associated scalp injuries of newborns.

Caput succedaneum is a swelling of the soft tissues of the scalp that DOES CROSS suture lines.

Cephalohematoma is a subperiosteal hemorrhage that DOES NOT CROSS suture lines.

Diagnosis is made clinically and improvement occurs gradually without treatment over weeks to months.

36
Q

What is shoulder dystocia? What is the problem with shoulder dystocia? Risk factors?

A

This is when the baby’s anterior shoulder gets stuck behind the mother’s pubic bone after delivery of the baby’s head.

Brachial plexus injuries are secondary to births with traction in the event of shoulder dystocia.

This is most commonly seen in macrosomic infants of diabetic mothers.

37
Q

C5-C6 brachial palsy?

Dx and tx?

A

Duchenne-Erb Paralysis

“Waiter’s tip” appearance, secondary to shoulder dystocia

The infant is unable to abduct the shoulder or externally rotate and supinate the arm.

Diagnosis is made clinically and immobilization is the best treatment.

38
Q

C7-C8 +/- T1 brachial palsy?

A

Klumpke Paralysis

“Claw hand” due to a lack of grasp reflex

Paralyzed hand with Horner syndrome (ptosis, anhydrosis, miosis)

Diagnosis is made clinically and immobilization is the best treatment.

39
Q

What is the most common newborn fracture as a result of shoulder dystocia? Best dx test? Tx?

A

Clavicular fracture.

X-ray is the best dx test. Fracture is tx with immobilization, splinting, and PT.

40
Q

What nerve palsy can be caused by forcep use in delivery?

Dx? Tx?

A

Facial nerve palsy.

Facial nerve palsy is paralysis of structures innervated by the facial nerve, caused by trauma secondary to forcep use in delivery. Diagnosis is made clinically and improvement occurs gradually over a few weeks to months. However, if no recovery is seen, then surgical nerve repair is necessary.

41
Q

What is amniotic fluid made of?

A

80% is mother’s plasma

20% is baby’s swallowing, absorbing, filtering, and urinating

42
Q

What are causes of polyhydramnios?

A

Polyhydramnios is too much fluid secondary to the fetus not swallowing. This can be caused by neurological we

Shelf exams and USMLE Step 2 (6 decks)

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