Pediatric Specific Flashcards
BRUE looks like
Cyanosis/pallor, breathing changes, marked change in tone, altered level of responsiveness
Subdural hematoma in an infant
Violent shaking, accidental trauma, rare delivery complication, often you can see retinal hemorrhage too
Non accidental head trauma
Violent shaking, throwing, blunt trauma, can have subdural hemorrhage, often there will be retinal hemorrhage
Suspicious fracture in ped
Multiple at diff stages, femur or tibia in non walking child, posterior rib fracture, skull fracture
Calorie requirement of term infant
100-120 kcal/kg/day
Daily weight gain for a term infant
20-30g/day
Neonatal acne
Neonatal cephalic pustulosis (inflammatory, due to yeast)
Vitamin D supplementation in infants
400 IU per day til 12 months
Absence of a symmetric red reflex in infants DDx
Cataracts, glaucoma, retinoblastoma, chorioretinitis
DDx for RUQ mass in infant
Hepatic neoplasm, hydronephrosis, neuroblastoma, teratoma, wilms tumour
APGAR score categories
Appearance (skin colour) Pulse (heart rate) Grimace (reflex irritability) Activity (muscle tone) Respiration
Symmetric IUGR
Head, length, weight are decrease proportionately
Asymmetric IUGR
Greater decrease in length/weight without affecting the head
Causes of asymmetric IUGR
Poor delivery of nutrition to the fetus
Primitive reflexes in infant
Rooting, sucking, Moro/startle, asymmetric tonic neck, palmar and plantar grasps, stepping
Preventing hemorrhagic disease of the newborn
Admin vitamin K at birth
Infants born to hep B positive moms should
Receive hep B Ca vine and hep b IvIg within 12 hrs of delivery
Routine newborn medications
Vitamin K, Hep B vaccination, erythromycin on the eyes
Signs of heroin withdrawal in the newborn
High pitched cry, tremulous, hypertonicity, feeding difficulty
Examples of live attenuated vaccines
MMR, varicella
After a live vaccine, when can you expect a fever?
6-14 days post immunization
Inactivated, subunit, or toxoid vaccines: when can you expect a fever post vac?
A few days later
Bacterial meningitis (gluc, protein, WBC, type, gram)
Glucose low, protein high, WBC high, PMN, + or - gram stain
Viral meningitis (gluc, protein, WBC, type, gram)
Normal glucose, normal protein, WBC high or slightly high, lymphocytes, negative gram stain
Pyelonephritis in a healthy kid is usually which organism?
E Coli
Ampicillin/gentamycin is a good choice to treat infections by which organism?
Enterococcus infection
Meropenem may be indicated for UTI if
Increasing resistance due to extended-spectrum beta-lactamases
Ciprofloxacin can be used in which cases of UTI
Complicated UTI with resistant organisms
Cephalexin (keflex) covers
EColi and other enteric gram neg rods
Nitrofurantoin cannot treat
Pyelo, only UTI
Most likely precursor infection to serious bacterial illness in kids
UTI
Left shift towards more immature WBCs (reticulocytes) can increase the likelihood that a child has
A serious bacterial illness
Pyuria defined
> 5 WBC per HPF
Nitrite test is positive when
Gram negative bacteria are present (E coli, klebsiella, proteus)
Positive leukocyte esterase indicates
Presence of WBC in the urine
Voiding cystourethrogram is recommended in a child
With abnormal ultrasound, hydronephrosis, second febrile UTI
Chest xray to rule out pneumonia if
Resp findings, and or WBC >15000
Occult bacteremia
Positive blood culture in a well appearing kid, usually wont develop into something bad
Viral meningitis is commonly caused by
Enterovirus
Rosella is caused by what virus
HHV6
Roseola treatment
Symptomatic only
HSV gingivostomatitis rash
Oral lesions that start as vesicles and evolve to ulcerations
AOM physical exam findings
Poor mobility and bulging of the tympanic membrane, with erythema
Best prevention against transmission of viral Gastroenteritis
Good hand washing
Fluid therapy for severe dehydration
Repeated NS boluses 10-20ml/kg until th patient has improved
Maintenance fluids in a dehydrated person should be
Isotonic solutions - 0.9% NS, lactated ringers, balanced electrolyte solution
ORT maintenance for mild-moderate dehydration
50-100ml/kg over 2-4 hours to correct fluid deficit
ORT with vomiting
2ml/kg for each emesis
ORT with diarrhea
10ml/kg for each loose stool
Kerinicterus is
Staining of the basal ganglia and cranial nerve nuclei by bilirubin
A patient presenting with kerinicterus on examination looks like
Abnormal tone and reflexes, choreoathetosis, tremor, paralysis, SNHL, cognitive impairment
Risk factors for bilirubin toxicity
Asphyxia, temp instability, sepsis, metabolic acidosis, albumin <3, prematurity
Pregnant ABO incompatibility can be an issue when
Mom is type O, cause anti A and anti B are predominantly IgG and can cross the placenta
ABO incompatibility and hemolysis in pregnant woman is more significant with a positive
Direct Coombs test
Physiologic jaundice has total bilirubin less than
15mg/dl
Factors contributing to physiologic jaundice of a newborn
Increased bilirubin production Deficiency of ADPGT Lack of flora to metabolize bile High B-gluc in meconium Minimal oral intake and slow passage of meconium
Breastfeeding jaundice due to
Low intake and decreased GI motility leading to retention of meconium
Breast milk jaundice is due to
B-gluc in breast milk deconjugates bilirubin in the intestinal tract
Test for jaundice being caused by hemolysis with what test
DAT (Coombs test)
Antibody positive hemolysis due to
RH incompatibility, ABO incompatibility, minor antigen incompatibility
Non hemolytic RBC breakdown jaundice of newborn
Bruising from birth trauma, hemorrhage, polycythemia, swallowed blood during delivery
Crigler Najjar syndrome
AR condition with severe unconjugated hyperbilirubinemia in the first few dace of life from lack of UDPGT (can lead to kerinicterus)
Gilbert syndrome
AR resulting in decreased enzyme function so that the conjugation of bilirubin is slowed. The hyperbilirubinemia is self resolving and intermittent.
Jaundice due to hypothyroid
Combo of decreased rate of bili conjugation, decreased gut motility, and impaired feeding
Typical BF baby feeds how often
8-12 times in 24 hours
What age can infants start to drink cows milk
12m
Major carb in breast milk
Lactose
Ethnic groups associated with G6PD def
Mediterranean and west African
Hyperbilirubinemia with G6PD deficiency occurs as a result of
Decreased bilirubin conjugation
Biliary atresia signs in infant
Jaundice, dark urine, acholic stools
Biliary atresia is treated with
Kasai procedure. Anastomoses of the intrahepatic bile ducts to a loop of intestine so bile drains directly into intestine
Cephalohematoma
Subperiosteal hemorrhage localized to one cranial bone
Caput succedaneum
Edematous swelling over the presenting position of the scalp, boggy swelling crossing the suture line
Phototherapy
Makes unconjugated bilirubin more soluble so it can be excreted in bile and urine without conjugation
Vit D supplementation in newborns
400 IU a day within days of birth
Increasing direct bilirubin at two weeks of life might be
Biliary atresia or alpha 1 antitrypsin deficiency
Cocaine effect on placenta
Causes vasoconstriction leading to placental insufficiency and low birth weight
Small for gestational age is detected at
Birth
IUGR is noted
During pregnancy
Percentile for SGA
<10th %
Cause of infant hydronephrosis
Obstrucyion at the ureteropelvic junction, multicystic kidney
Painless mass in neck, chest, abdo, usually before the age of 2. Fever, pallor, and weight loss are common.
Neuroblastoma
Wilms tumour median age of diagnosis
3 years
Breath holding spells occur during
Expiration
Tet spells are
Acute episodes of cyanosis associated with a drop in pulmonary blood flow
Most common respiratory bug that causes apnea
Respiratory syncytial virus (RSV) infection
Rapid response protocol in pediatrics
Call team, gather ppl and equipment, IV, head CT, call peds ICU for transfe
Retinal hemorrhages in infant with head trauma
Highly suggestive of abusive head trauma
Respiratory distress syndrome is due to
Deficiency of lung surfactant and delayed lung maturation
Transient tachypnea of the newborn is due to
Delayed clearance of fluid from the lungs following birth
TTN is most common in newborns born
By c section, and to diabetic mothers
CHF in a newborn is usually due to
A congenital heart defect
Symptoms of a coarctation of the aorta arise when
The ductus arteriosus closes at 1-3 days of life
Perfect APGAR score
Heart rate more than 100, resp good and infant crying, tone well flexed, coughs or sneezes, baby is completely pink
Average newborn sleep
15-18 hours per day
Average number of breast feeds per day
8-12
Tracheoesophageal fistula presents with
Copious oral secretions and choking, coughing, vomiting with feeding
Diagnosis of tracheoesophageal fistula can be confirmed by
Insertion of an NG tube which encounters resistance at the proximal esophageal pouch
Pts with fragile x syndrome life expectancy is
Normal
The most common cause of eye discharge in infants is
Congenital nasolacrimal duct obstruction (aka dacryostenosis)
Management of nasolacrimal duct obstruction in infants is with
Lacrimal sac massage with downward pressure performed several times daily to open the duct
Gonooccal eye infection most commonly presents at how old
2-5 days of life
Viral conjunctivitis presents with
Clear/mucoid discharge and red conjunctiva often associated with a viral prodrome (fever and congestion, etc)
Blood streaked stool in infant less than 6m is commonly due to (2)
Anal fissures, protein-induced allergic-proctocolitis
First line therapy for acute otitis media in children is
Amoxicillin
Treating pediatric labial agglutination
Twice daily topical estrogen cream up to 4 weeks
HIV antibody testing for infants born to infected mother
Done at 12-15 months and again at 18m if necessary
Infants born to hep B infected moms
Treated with HbIG and their first hep B immunization within 12 hours of birth, followed by later doses and testing
Which immunoglobulins can cross the placenta
IgG
Management of neonatal sepsis
Ampicillin and gentamycin plus or minus acyclovir
Osteomyelitis in kids commonly caused by what bug
Staph aureus
Treat osteomyelitis with
Vanco
Biggest risk factor for bed wetting
Family history
Milia rubra, often seen in infants, is also known as
Heat rash
Pityriasis rosea has two characteristic rash signs
Initial herald patch, followed by a most diffuse spotty rash
Rash that goes with acute rheumatic fever
Erythema marginatum
Idiopathic avascular necrosis of the femoral head in a young child is called
Legg-calve-perthes disease
When does scoliosis usually present?
Around age 10, with periods of rapid growth
When should the first well infant/postpartum visit occur?
Around the 1 week mark
What % of birth weight is normal to lose in the first week of life?
10%
What language milestone should a 1 year old meet?
Speaking a few words, 3 or more
What age can solids be introduced?
Between 4 and 6 months of age
