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Master Review > Pediatrics > Flashcards

Pediatrics Flashcards

1
Q

At delivery, what should a newborn baby receive?

A
  • erythromycin ophthalmic ointment

- IM vit K 1mg

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2
Q

What does erythromycin ophthalmic ointment protect a newborn from?

A
  • Neisseria gonorrhoeae ophthalmia neonatorum
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3
Q

If a newborn day 2 infant develops eye issues, what is the most likely cause?

A
  • Neisseria gonorrhea
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4
Q

What is the tx for neisseria gonorrhoeae ophthalmia neonatorum?

A
  • ceftriaxone
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5
Q

If a newborn day 7 develops eye issues, what is the most likely cause?

A
  • chlamydia trachomatis
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6
Q

What is the tx for eye issues in a newborn caused by chlamydia trachomatis?

A
  • oral erythromycin
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7
Q

Newborn baby of 21 days develops eye issues, what is the most likely cause?

A
  • herpes simplex virus
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8
Q

A 21 day old infant has herpes simplex virus. What is the tx?

A
  • systemic acyclovir and topical vidarabine
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9
Q

MOA of erythromycin

A
  • inhibits reproduction of bacteria by blocking ribosomal formation
  • specifically the 50 S unit
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10
Q

MOA of penicillins

A
  • inhibit cell fall formation
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11
Q

What the vitamin K dependent factors?

A
  • 10
  • 9
  • 7
  • 2
  • protein C
  • protein S
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12
Q

Define hemorrhagic disease of newborn

A
  • occurs after 24 hours of life
  • baby did not have vit K shot, look for a home delivery
  • healthy baby who suddenly presents with increased bleeding
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13
Q

Why do babies have low vitamin K levels?

A
  • Vitamin K does not cross the placenta
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14
Q

What are the neonatal screenings required by law?

A
  • PKU
  • congenital adrenal hyperplasia
  • biotinidase
  • beta-thalassemia
  • galactosemia–> galactase enzyme
  • TSH for hypothyroidism
  • homocysteine for homocystinuria
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15
Q

If the mother was HBsAg negative, what should you give the baby?

A
  • hep B vaccine
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16
Q

If the mother was HBsAg +, what should you give baby?

A
  • hep B vaccine AND IVIG
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17
Q

When performing a hearing test on a newborn before discharge, what are you trying to rule out?

A
  • congenital sensorineural hearing loss
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18
Q

The 1 minute APGAR score indicates?

A
  • what is going on with the baby during labor and delivery
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19
Q

The 5-minute APGAR score indicates?

A
  • the newborn’s response to therapy
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20
Q

What does APGAR stand for?

A
  • appearance
  • pulse
  • grimace
  • activity
  • respirations
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21
Q

A mass in the midline that moves with swallowing or tongue protrusion is known as?

A
  • thyroglossal duct cyst
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22
Q

What causes a thyroglossal duct cyst to form?

A
  • from the descent of the primordial thyroid gland at the base of the tongue
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23
Q

When do the intestines migrate into the abdomen?

A
  • at 10 weeks
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24
Q

How would a baby from a diabetic mother present?

A
  • large for gestation
  • plethora
  • jitteriness
  • possible complication- shoulder dystocia during delivery
  • cardiomegaly
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25
Q

Tx for an infant of a diabetic mother

A
  • glucose and small frequent meals
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26
Q

What are some abnormalities that may be seen in an infant of a diabetic mother?

A
  • hypoglycemia
  • hypocalcemia
  • hyperbilirubinemia
  • polycythemia
  • hypomagnesemia
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27
Q

Infant of a diabetic mother is associated with what abnormalities?

A
  • cardiac abnormalities, like ASD, VSD, truncus arteriosus
  • small left colon syndrome
  • increased risk of developing diabetes and childhood obesity
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28
Q

Why are infants of diabetic mothers hypoglycemic at birth?

A
  • they are used to a high glucose environment so their bodies produce more insulin. When they leave the high glucose environment, they are making more insulin than the sugar in their bodies.
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29
Q

what is the best initial test for a newborn with respiratory distress?

A
  • cxr
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30
Q

A newborn with respiratory distress should have which tests completed?

A
  • cxr
  • abg
  • blood cultures
  • glucose
  • CBC
  • cranial ultrasound
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31
Q

What is the tx for newborn respiratory distress?

A
  • oxygen
  • nasal CPAP
  • consider empirical antibiotics, if suspecting sepsis
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32
Q

If oxygen therapy does not improve the newborn’s respiratory distress, what other cause may be the issue?

A
  • cardiac related
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33
Q

How will a baby with respiratory distress syndrome present?

A
  • tachypnea
  • nasal grunting
  • intercostal retractions within hours after birth
  • premature infant
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34
Q

What would you expect to see on a cxr with an infant of respiratory distress syndrome?

A
  • ground glass appearance
  • air bronchograms
  • atelectasis
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35
Q

what is the best predictive test that a newborn will develop respiratory distress syndrome?

A
  • Lecithin-sphingomyelin ratio on amniotic fluid prior to birth
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36
Q

Tx for RDS

A
  • oxygen
  • nasal CPAP
  • exogenous surfactant (lucinactant)
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37
Q

Mechanism of surfactant

A
  • prevents collapse of the alveoli by decreasing surface tension
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38
Q

Which cells produce surfactant?

A
  • type II pneumocytes
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39
Q

When is enough surfactant produced for the fetus?

A
  • 35 weeks gestation
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40
Q

What can be used for preventing respiratory distress syndrome?

A
  • antenatal betamethasone
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41
Q

When is betamethasone most effective?

A
  • given 24 hours before delivery

- before 34 weeks gestation

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42
Q

What are possible complications of respiratory distress syndrome?

A
  • retinopathy of prematurity due to hypoxemia
  • bronchopulmonary dysplasia due to prolonged high concentration of oxygen
  • intraventricular hemorrhage
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43
Q

How can you prevent bronchopulmonary dysplasia from occurring in a newborn with respiratory distress syndrome?

A
  • by using a CPAP
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44
Q

Define transient tachypnea of the newborn

A
  • tachypnea after birth of an infant delivered by c section or rapid second stage of labor
  • most likely caused by retained lung fluid
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45
Q

What can you see on an xray in a newborn with transient tachypnea of a newborn?

A
  • air trapping
  • fluid in fissures
  • perihilar streaking
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46
Q

tx for transient tachypnea of a new born?

A
  • oxygen
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47
Q

Define meconium aspiration syndrome

A
  • newborn aspirates first stool in utero or at the first postnatal breath causing severe respiratory distress and hypoxemia
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48
Q

Meconium aspiration causes

A
  • blockage of alveoli
  • decreased gas exchange
  • irritation of airway, causing inflammation and then PNA
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49
Q

What to look for in a patient with meconium aspiration syndrome on cxr?

A
  • patchy infiltrates
  • increased AP diameter aka barrel chest
  • flattening of diaphragm
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50
Q

Tx for meconium aspiration syndrome

A
  • positive pressure ventilation
  • high frequency ventilation
  • nitric oxide therapy
  • extracorporeal membrane oxygenation
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51
Q

What are some possible meconium aspiration complications

A
  • pulmonary artery hypertension
  • air leak leading to pneumothorax
  • aspiration pneumonitis
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52
Q

How can you confirm the diagnosis of tracheoesophageal fistula?

A
  • placement of NG tube
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53
Q

A patient with tracheoesophageal fistula may also have other VACTERL abnormalities. What could those be?

A
  • vertebral defects
  • anal atresia
  • cardiac abnormalities
  • esophageal atresia
  • renal anomalies
  • limb syndrome
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54
Q

What is the differential diagnosis for double bubble seen on xray?

A
  • duodenal atresia
  • annular pancreas
  • malrotation
  • volvulus
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55
Q

A premature infant takes her first feed and begins vomiting gastric and bilious material. There is a double bubble gas shown on xray. What is the most likely diagnosis?

A
  • duodenal atresia
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56
Q

Define annular pancreas

A
  • pancreas surrounds the second part of the duodenum in a ring-like formation, potentially causing obstruction
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57
Q

What are some symptoms of annular pancreas?

A
  • polyhydramnios
  • low birth weight
  • feeding intolerance
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58
Q

What is the best initial test for suspected annular pancreas?

A
  • abdominal x-ray
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59
Q

What is the most accurate test for annular pancreas?

A
  • abdominal CT scan
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60
Q

How does annular pancreas form?

A
  • the ventral bud of the pancreas does not rotate with the duodenum during the 7th week of gestation. This causes encasing of the duodenum.
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61
Q

What are tests that need to be ordered when a newborn has jaundice within the first 24 hours of life?

A
  • total and direct bilirubin
  • blood type of infant and mother
  • direct coombs test
  • cbc
  • reticulocyte count
  • blood smear
  • U/A
  • urine culture
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62
Q

If there is prolonged jaundice for more than 2 weeks and no elevation of conjugated bilirubin, what may be the cause?

A
  • UTI
  • bilirubin conjugation abnormalities
  • hemolysis
  • intrinsic red cell membrane or enzyme defects
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63
Q

which enzyme is low in infants, which is why they cannot conjugate unconjugated bilirubin to glucose so that it can be excreted through the feces?

A
  • glucuronosyltransferase
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64
Q

If there is prolonged jaundice for more than 2 weeks and elevated conjugated bilirubin, what is the best initial test?

A
  • LFTs
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65
Q

After ordering LFTS, what should be ordered in a newborn who has had elevated conjugated bilirubin for >2weeks?

A
  • U/S

- liver biopsy

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66
Q

What are some symptoms of kernicterus?

A
  • hypotonia
  • seizures
  • opisthotonos
  • delayed motor skills
  • choreoathetosis
  • sensorineural hearing loss
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67
Q

What causes kernicterus?

A
  • build up of unconjugated/indirect bilirubin crossing the blood brain barrier and depositing into the brain
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68
Q

Tx for kernicterus

A
  • immediate exchange transfusion

- phototherapy >10-12 mg/dl

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69
Q

How does phototherapy help a jaundice baby?

A
  • it causes the bilirubin to become water-soluble
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70
Q

Mongolian spots aka?

A
  • congenital dermal melanocytes
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71
Q

Further management of congenital dermal melanocytosis

A
  • rule out child abuse
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72
Q

Firm, yellow white papules/pustules with erythematous base, which peak on the second day of life is known as

A

erythema toxicum

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73
Q

tx for erythema toxicum

A
  • self limited
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74
Q

permanent, unilateral vascular malformations on the head and neck are known as

A
  • port wine stain
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75
Q

What are port wine stains associated with?

A
  • Sturge Weber syndrome
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76
Q

Define sturge weber syndrome

A
  • AV malformation that results in seizures, mental retardation, and glaucoma
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77
Q

Tx for sturge weber syndrome

A
  • anticonvulsants

- pulsed laser therapy

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78
Q

Red, sharply demarcated, raised lesions appearing in the first 2 months, rapidly expanding, and then involuting by 5-9 y/o are known as

A
  • hemangiomas
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79
Q

Tx for hemangiomas

A
  • propanolol and or pulsed laser if large or interferes with organ function
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80
Q

Preauricular tags/pits are associated with?

A
  • hearing loss

- GU abnormalities

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81
Q

When an infant has preauricular tags or pits, what are the next steps in management?

A
  • hearing test

- U/S of kidneys

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82
Q

Coloboma is associated with which syndrome?

A
  • CHARGE syndrome
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83
Q

What does CHARGE syndrome include?

A
  • coloboma
  • heart defects
  • atresia of the nasal choanae
  • growth Retardation
  • GU abnormalities
  • Ear abnormalities
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84
Q

absence of the iris is called?

A
  • aniridia
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85
Q

Aniridia is associated with ?

A
  • Wilms tumor
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86
Q

How often should a child with aniridia be screened for Wilms tumor?

A
  • via U/S every 3 months until age 8
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87
Q

A mass midline of the throat is a thyroglossal duct cyst whereas a mass lateral to the midline is a ?

A
  • branchial cleft cyst
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88
Q

Define umbilical hernia

A
  • congenital weakness where vessels of the fetal and infant umbilical cord exited through the rectus abdominis muscle
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89
Q

An umbilical hernia is associated with?

A
  • congenital hypothyroidism
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90
Q

Define hydrocele

A
  • scrotal swelling with transillumination of the mass
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91
Q

A hydrocele is associated with ?

A
  • inguinal hernias
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92
Q

Unilateral absence of testes in the scrotal sac is?

A
  • undescended testes
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93
Q

What is the definitive tx for undescended testes

A
  • orchiopexy
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94
Q

When should orchiopexy be completed?

A
  • > 1 year of age
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95
Q

How does toxoplasmosis present in a child?

A
  • hydrocephalus with generalized intracranial calcifications and chorioretinitis
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96
Q

What makes toxoplasmosis + in a newborn?

A

+ toxoplasma IgM after 5 days of lifer or + IgA after 10 days of life

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97
Q

How does rubella present in a newborn?

A
  • cataracts
  • deafness
  • heart defects
  • blueberry muffin spots
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98
Q

What is the diagnostic test for rubella in a child?

A
  • rubella virus RNA by PCR
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99
Q

How does CMV present in a newborn?

A
  • microcephaly with periventricular calcifications
  • petechiae with thrombocytopenia
  • sensorineural hearing loss
  • blueberry type rash
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100
Q

What is the diagnostic test for CMV in an infant?

A
  • urine or saliva CMV culture; if negative, consider CMV PCR
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101
Q

If herpes is present in the first week of life, how will it present?

A
  • pneumonia/shock
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102
Q

If herpes is present by the second week of life, how will it present

A
  • skin vesicles

- keratoconjunctivitis

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103
Q

How will herpes present if the infant is 3-4 weeks old?

A
  • acute meningoencephalitis
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104
Q

What is the most accurate test for herpes?

A
  • HSV PCR
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105
Q

How does syphilis present in an infant?

A
  • osteochondritis
  • periostitis
  • desquamating skin rash of palms and soles
  • snuffles
  • hepatomegaly
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106
Q

What is the best initial test for syphilis in an infant?

A
  • VDRL screening
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107
Q

What is the most accurate test for syphilis?

A
  • IgM-FTA-ABS
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108
Q

If an infant develops VZV as a neonate, how will it present?

A
  • PNA
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109
Q

If an infant was infected in utero with vZV, how will it present?

A
  • limb hypoplasia
  • cutaneous scars
  • seizures
  • mental retardation
110
Q

What is the best initial test for varicella?

A
  • IgM serology
111
Q

What is the most accurate test for varicella?

A
  • PCR of amniotic fluid
112
Q

Heroin, cocaine, amphetamine, and alcohol withdrawal will present when in a newborn’s life? if mother was on these substances

A
  • within the first 48 hours
113
Q

If a mother was on methadone while pregnant, when will methadone withdrawal present?

A
  • within the first 96 hours
114
Q
  • Methadone withdrawal in infants is associated with a higher risk of ?
A
  • seizures
115
Q

Infants of mothers with substance use disorders are at a higher risk for?

A
  • low birth weight
  • intrauterine growth restriction
  • congenital anomalies associated with alcohol and cocaine use
  • sudden infant death syndrome
116
Q

Why wouldn’t you give an infant naloxone if the mother was using opioids?

A
  • could cause sudden withdrawal, which could lead to seizures
117
Q

Anesthetics can cause what to neonates?

A
  • respiratory and CNS depression
118
Q

Barbiturates can cause what to neonates?

A
  • respiratory and CNS depression
119
Q

Magnesium sulfate can cause what to neonates?

A
  • respiratory depression
120
Q

Phenobarbital given to neonates can cause?

A
  • vitamin K deficiency
121
Q

Isotretinoin in neonates can cause?

A
  • facial and ear anomalies

- congenital heart disease

122
Q

Phenytoin in neonates can cause?

A
  • hypoplastic nails
  • typical facies,
  • IUGR
123
Q

Diethystilbestrol can cause what in neonates?

A
  • vaginal adenocarcinoma
124
Q

Tetracycline in neonates can cause?

A
  • enamel hypoplasia

- discolored teeth

125
Q

Sulfonamides in neonates can cause?

A
  • displaces bilirubin from albumin (can lead to increased bilirubin levels)
126
Q

NSAIDS in neonates can lead to ?

A
  • premature closure of ductus arteriosus
127
Q

ACEi in neonates can cause?

A
  • craniofacial abnormalities
128
Q

Lithium can cause what in neonates?

A
  • ebstein anomaly
129
Q

Warfarin in neonates can cause?

A
  • facial dysmorphism

- chondrodysplasia (bone stippling)

130
Q

Valproic acid and carbamazepine can cause what in a neonate?

A
  • mental retardation

- neural tube defects

131
Q

What are some classic features of down syndrome (trisomy 21)?

A
  • upward slanting palpebral fissures
  • specking of iris aka brushfield spots
  • inner epicanthal folds
  • small stature
  • late fontanel closure
  • mental retardation
  • hypoplasia of the middle phalanx of the fifth finger
  • high arched palate microcephaly
132
Q

What is the workup for a child suspected of trisomy 21?

A
  • hearing exam
  • echocardiogram
  • TSH
133
Q

What are some characteristics of Edwards syndrome (trisomy 18)?

A
  • low-set malformed ears
  • microcephaly
  • micrognathia
  • clenched hand with index over third, fifth over fourth finger
  • rocker bottom feet and hammer toe
  • omphalocele
  • heart defect most commonly being VSD
134
Q

What is the workup for a child suspected with Edwards Syndrome?

A
  • echocardiogram

- renal ultrasound

135
Q

What are some characteristics of trisomy 13 aka Patau syndrome?

A
  • defect of midface, eye, and forebrain development
  • holoprosencephaly, microcephaly, microphthalmia
  • cleft lip/palate
136
Q

Workup for suspected Patau syndrome?

A
  • echocardiogram

- renal ultrasound

137
Q

What is the presentation of WAGR syndrome?

A
  • wilms tumor
  • aniridia
  • GU anomalies
  • mental Retardation
138
Q

Presentation of klinefelter syndrome?

A
  • low IQ
  • behavioral problems
  • slim with long limbs
  • gynecomastia
139
Q

Workup for suspected klinefelter syndrome?

A
  • testosterone levels

- genetic test to confirm XXY

140
Q

How does turner syndrome present?

A
  • small stature female
  • gonadal dysgenesis
  • low IQ
  • congenital lymphaedema
  • webbed posterior neck
  • wide spaced nipples
141
Q

Horseshoe kidney is common in which congenital syndrome?

A

Turner syndrome

142
Q

Tx for turner syndrome

A
  • estrogen
  • growth hormone
  • anabolic steroid replacement
143
Q

How does fragile x syndrome present?

A
  • macrocephaly in early childhood
  • large ears
  • large testes
  • mental retardation
144
Q

Children with beckwith-wiedemann syndrome are at risk for ?

A
  • WIlms tumor

- hepatoblastoma

145
Q

Presentation of beckwith-wiedemann syndrome

A
  • multiorgan enlargement, such as macrosomnia, macroglossia, pancreatic beta cell hyperplasia, large kidneys, neonatal polycythemia
146
Q

What should be done to look for wilms tumor and hepatoblastoma in a child with Beckwith-Wiedemann syndrome?

A
  • obtain U/S and serum AFP every 6 months through age 6
147
Q

Presentation of prader-willi syndrome

A
  • obesity
  • mental retardation
  • binge eating
  • small genitalia
148
Q

Presentation of angelman syndrome

A
  • mental retardation
  • inappropriate laughter
  • absent speech or <6 words
  • ataxia
  • jerky arm movements
  • seizures
149
Q

Presentation of robin sequence aka pierre robin

A
  • mandibular hypoplasia

- cleft palate

150
Q

What should be monitored in a child with robin sequence?

A
  • airway–> obstruction is possible over the first 4 weeks of life
151
Q

Trisomy is most commonly caused via?

A
  • nondisjunction during meiosis
152
Q

What is the gene responsible for Marfan syndrome

A
  • FBN1 gene on chromosome 15
153
Q

Presentation of Marfan syndrome

A
  • thin patient with long extremities
  • arachnodactyly
  • pectus excavatum deformity
  • hypermobile joints
154
Q

Most accurate test for Marfan syndrome

A
  • genetic testing
155
Q

A common complication later in life in those with Marfan syndrome is?

A
  • aortic root dissection
156
Q

At the first diagnosis of Marfan syndrome, what test should be done?

A
  • TTE to look at the aortic root to make sure it is stable
157
Q

What are some features of ehlers-danlos syndromes?

A
  • extremely elastic, smooth skin that is fragile and bruises easily
  • wide, atrophic scars
  • joint hypermobility
  • molluscoid pseudotumors (calcified hematomas over pressure points such as the elbow)
  • spheroids
    (fat containing cysts on forearms and shins)
  • hypotonia and delayed motor development
158
Q

How to diagnose Ehlers-Danlos Syndromes?

A
  • genetic testing or skin biopsy
159
Q

What are some features of osteogenesis imperfecta?

A
  • recurrent fractures
  • osteopenia
  • joint laxity
  • blue sclerae
  • hearing loss
  • progressive skeletal deformity
160
Q

What is the most common form of osteogenesis imperfecta?

A
  • AD encoding of the alpha1 and 2 chains of type I collage (COL1A1 and COL1A2)
161
Q

Child has moro grasp, rooting, tonic neck, and placing reflexes. When do they disappear?

A

4-6 months of age

162
Q

What is the parachute reflex?

A
  • extension of arms when fall simulated
163
Q

When does the parachute reflex become present?

A

6-8 months

164
Q

The social smile is common at what age?

A

2 months

165
Q

At 4 months, what would you expect the infant to be able to do?

A
  • lift head
  • tracks past midline
  • coos
  • social smile
  • rolls front to back and back to front
  • grasps a rattle
  • orients to voice and can laugh
166
Q

When is stranger anxiety present?

A

by 6 months

167
Q

What are new skills developed by a 6 month infant?

A
  • can sit unassisted
  • transfer objects between hands
  • can babble
168
Q

When would a child be expected to know his or her name?

A

at 9 months

169
Q

What new skills does a 9 month learn?

A
  • pincer grasp

- creeps and crawls

170
Q

By what age should a child know a 1 to handful of words?

A
  • 12 months
171
Q

When can a child start to walk?

A

12 months

172
Q

What new skills can a 15 month old do?

A
  • build a tower of 3 cubes
  • walk alone
  • make lines and scribbles
173
Q

When can a child start to feed themselves?

A

18 months

174
Q

When can a child be expected to start speaking in sentences?

A
  • 24 months
175
Q

When does a child recognize what age and gender they are?

A
  • 36 months
176
Q

When does a child start to participate in group child play?

A
  • 48 months
177
Q

When can a child hop on 1 foot?

A
  • 48 months
178
Q

When does birth weight about double?

A
  • 4 months
179
Q

When does birth weight triple?

A
  • 1 year
180
Q

What is the best indicator for acute malnutrition?

A
  • weight and or height <5th percentile
181
Q

What is the best indicator for under and overweight children?

A
  • BMI
182
Q

Skeletal maturity of a child is related to ____ and not chronologic age.

A
  • sexual maturity
183
Q

Child has decreased weight gain greater than decreased height. What is the differential?

A
  • undernutrition
  • inadequate digestion
  • malabsorption
184
Q

How to work up a child with decreased weight gain greater than decreased height?

A
  • assess caloric intake
  • perform stool studies for fat
  • perform sweat chloride test
185
Q

A child with normal weight gain but decreased height for their age, what is the differential?

A
  • GH or TH deficiency
  • excessive cortisol secretion
  • skeletal dysplasias
186
Q

Work up for a child with normal weight gain but decreased height.

A
  • TSH
  • Insulin-like growth factor 1 and IGF-binding protein 3
  • xray of hand and wrist to get bone age
187
Q

A child has decreased weight gain equal to decreased height for their age. What is the differential?

A
  • systemic illness
  • genetic short stature
  • constitutional delay in growth and development
188
Q

Workup for a child with decreased weight gain equal to decreased height

A
  • CRP
  • ESR
  • CBC with diff
  • CMP
  • xray of hands and wrist to get bone age
189
Q

Define genetic short stature

A
  • bone age is close to chronological age

- puberty occurs at a normal time

190
Q

Define constitutional delay of growth

A
  • bone age is delayed and puberty occurs later than usual
191
Q

What is the first antibody secreted in a child?

A
  • IgM
192
Q

What is the only antibody to cross the placenta and therefore giving sustained immunity to pathogens?

A
  • IgG
193
Q

WHich antibody binds to allergens and secretes histamine?

A
  • IgE
194
Q

Where is IgA found?

A
  • mucosal areas, such as intestines, saliva, tears, breast milk
195
Q

Bedwetting is normal up to what age?

A
  • 5
196
Q

define enuresis

A
  • involuntary voiding of urine at least 2x/weel for the last three months in children >5
197
Q

Tx for noturnal enuresis

A
  • behavior therapy
198
Q

Diurnal enuresis is associated with a higher rate of ____

A
  • UTIs
199
Q

A child coming to the clinic for enuresis should have what as the initial test completed?

A
  • U/A
200
Q

A child with recurrent UTIs should have what completed?

A
  • renal/bladder U/S
201
Q

If behavioral therapy fails to treat the enuresis, what is the next step?

A
  • desmopressin to decrease the amount of urine produced
202
Q

What is the age that most children control their bowel movements?

A
  • 4
203
Q

What is the best initial test for a child with encopresis?

A
  • abdominal xray
204
Q

Retentive encopresis is associated with ?

A
  • constipation and overflow incontinence
205
Q

Nonretentive encopresis is associated with?

A
  • abuse
206
Q

Tx for retentive encopresis

A
  • disimpaction
  • stool softeners
  • behavioral intervention
207
Q

Tx for nonretentive ecopresis

A
  • behavior modification alone
208
Q

Criteria to diagnose a child <17 with ADHD

A
  • they must have at least 6 symptoms of hyperactivity and impulsivity
  • or at least 6 symptoms of inattention
209
Q

Criteria to diagnose patients >17 with ADHD

A
  • they must have at least 5 symptoms of hyperactivity and impulsivity
  • or at least 5 symptoms of inattention
210
Q

All ages for ADHD diagnosis criteria are?

A
  • occur in more than one setting and often
  • start before age 12 and last at least 6 months
  • impair the child’s function
  • be excessive for the child’s developmental status
211
Q

What are some symptoms of inattention

A
  • distraction
  • inability to follow directions
  • inability to complete a task
  • daydreaming
  • inability to stay organized
  • carelessness
212
Q

What are some symptoms of hyperactivity?

A
  • fidgeting
  • excessive talking
  • constant physical motion
  • inability to sit still
213
Q

What are some symptoms of impulsivity?

A
  • blurting out answers

- inability to wait their turn

214
Q

What are some behavioral modifications to help children with ADHD?

A
  • maintaining the same daily schedule
  • using checklists and star charts for tasks
  • keeping distractions to a min
  • rewarding positive actions
215
Q

First line tx for ADHD

A
  • methyphenidate
216
Q

What are some contraindications to immunize?

A
  • reaction to previous DPT with redness, soreness, and swelling
  • mild acute illness in an otherwise healthy child after vaccine
  • family hx of seizures or SIDS
  • egg allergy for MMR, yellow fever vaccine
217
Q

What is the recommendation for a patient with an egg allergy to have the flu vaccine?

A
  • patients older than 6 months with a known egg allergy should receive trivalent inactivated influenza vaccine followed by 30 minutes of observation in a facility prepared to recognize and treat anaphylaxis
218
Q

Post exposure protocol for measles

A
  • patient 0-6 months gets Ig
  • 6-12 months gets Ig + vaccine
  • > 12 months gets vaccine only within 72 hours of exposure
  • pregnant or immunocompromised patient gets Ig ONLY
219
Q

Post exposure protocol for varicella

A
  • children and household contacts get Ig and vaccine
  • susceptible pregnant women and newborns whose mothers had chickenpox within 5 days before and 2 days after delivery get ig ONLY
220
Q

Post exposure protocol for hepatitis B

A
  • Ig + vaccine at birth, 1 month, and 6 months
221
Q

Post exposure protocol for hepatitis A

A
  • age >2 gets Ig + vaccine
222
Q

Routine protocol for hepatitis B vaccine

A
  • if mother is negative for the antigen, the first dose is at birth and then a total of 3 doses by 18 months
  • if the mother positive for the antigen, the first dose plus hep B Ig at two different sites within 12 hours of birth with a total of 3 doses by 6 months
223
Q

Routine protocol for DTaP

A
  • 5 doses before school entry

- Td is given at 11-12 y/o then every 10 years after that

224
Q

The HiB conjugated vaccine does not cover?

A
  • nontypeable Haemophilus
225
Q

What is the age range recommendation for HPV vaccine

A

13-45

226
Q

Workup for suspected child abuse

A
  • PT
  • PTT
  • platelets
  • CBC
  • skeletal survey
227
Q

If a child has severe injuries, what should be conducted?

A
  • head ct scan
228
Q

If a child has abdominal trauma due to abuse, what is the work up

A
  • urine and stool for blood
  • LFTs
  • lipase and amylase
  • abdominal CT
229
Q

In infant abuse, what is important to check?

A
  • dilated eye exam by an ophthalmologist
230
Q

If parents of suspected child abuse refuse hospitalization for their child, what is the next step?

A
  • get an emergency court order
231
Q

X-ray appearance of ewing sarcoma

A
  • onion-skin pattern due to lesions causing laminar periosteal elevation
232
Q

What translocation is common with ewing sarcoma?

A

t11;22

233
Q

What does the x-ray appearance look like for osteogenic sarcoma?

A
  • sclerotic destruction causing a sunburst appearance
234
Q

What does an osteoid osteoma look like on x-ray?

A
  • round central lucency with a sclerotic margin
235
Q

Most accurate test for osteogenic sarcoma?

A
  • ct scan
236
Q

Most accurate test for osteoid osteoma?

A
  • ct or MRI
237
Q

Tx for osteoid osteoma?

A
  • NSAIDs; condition will resolve spontaneously
238
Q

Which test will seal the diagnosis for mononucleosis!

A

Mono spot test or heterophil antibody test

239
Q

In a febrile child, you should always check _____ for proper ventilation.

A

Pulse ox

240
Q

Which two labs will be slightly elevated in mono? * on CMP

A

ASTs and ALTs

241
Q

When advising patients on CCS, you must order it! Patient is a child who is febrile. Which medication should be avoided?

Why?

A

Aspirin

It can cause Reye’s syndrome

242
Q

What is Reye’s syndrome?

A

Hepatic encephalopathy in a child from taking aspirin

243
Q

How does gonorrhea attach to tissues?

A
  • has pili that acts as a hook
244
Q

Pharmacokinetics of erythromycin

A
  • demethylation in the liver

- works through the CYP450 system

245
Q

MOA of vit K

A
  • adds a carboxyl group to glutamate
246
Q

Which has more vit K: formula or breast milk?

A
  • formula
247
Q

What are the absolute contraindications to breast feeding?

A
  • Mom has HIV
  • Mom has herpes active infection on the nipple
  • Mom has TB
248
Q

Define cephalohematoma

A
  • hemorrhage collection on the outside of the skull

- most common with vacuum-assisted deliveries

249
Q

A baby with a cephalohematoma is at an increased risk of ?

A
  • jaundice–> there is more blood that needs to be broken down
250
Q

Patient with acute chest syndrome should be given ____

A

Hydroxyurea

251
Q

MOA of hydroxyurea

A

Increases the fetal hemoglobin so that the RBCs don’t sickle as much

252
Q

Patients in a sickle cell crisis due to an infection should be given what type of antibiotic for coverage?

A

Cephalosporin… ceftriaxone is a third gen so has both positive and negative gram coverage

253
Q

Define dactylitis

A

Aka hand foot syndrome…. Swelling of the dorsum of the hands or feet associated with pallor and fever

254
Q

Any child with sickle cell with a fever should receive?

A

IV fluids for hydration and empirical antibiotic therapy

*always get the blood culture BEFORE you give antibiotics

255
Q

Prophylactic ____ should be give to children over 8 with sickle cell disease

A

Penicillin

256
Q

One way to help keep the Hemoglobin S less than 30% in sickle cell patients is by

A

Providing indefinite blood transfusion every 2-4 weeks depending on morbidity

257
Q

Breastfeeding jaundice is secondary to?

A
  • decreased milk production during the first week of life
258
Q

What are some risk factors for hyperbilirubinemia?

A
  • jaundice in the first 24 hours of life
  • ABO incompatibility
  • cephalohematoma
  • previous sibling needing phototherapy
  • exclusive breastfeeding
259
Q

What is the difference between the direct and indirect coombs tests?

A
  • direct coomb’s test looks for antibodies on the RBCs

- indirect coomb’s test looks for antibodies in the serum (antibodies will attack other RBCs with those antigens)

260
Q

What is the mechanism of G6PD deficiency?

A
  • loss of production of glutathione reductase
  • causes insufficient reducing capacity of RBCs
  • produces Heinz bodies
261
Q

What vaccines are given at 2, 4, and 6 months of age?

A
  • DTap
  • HiB
  • polio
  • pneumococcal
  • rotavirus
262
Q

When is hepB vaccines given to children?

A
  • birth
  • 1-2 months
  • 6 months to 1 year
263
Q

First line for a 2month old infant who developed a fever after vaccine?

A
  • tylenol
264
Q

What age can children start receiving NSAIDs?

A
  • 6 months and older
265
Q

Define bronchiolitis

A
  • inflammation of the small airways

- most common cause of respiratory issues in children 3-6 months of age

266
Q

The most common cause of bronchiolitis in children is?

A
  • RSV
267
Q

Which children should receive the monoclonal antibody for RSV (Palizivumab)?

A
  • premature infants
  • infants with congenital heart disease
  • infants with bronchopulmonary disease
268
Q

Initial antibiotic choice for children 5< with pneumonia

A
  • macrolides like azithromycin
269
Q

What is the main issue in cystic fibrosis?

A
  • there is loss of flow of chloride and water across the membranes, which then causes clogged lungs, pancreas, and GI tract * mucus stays put
270
Q

Children 6 > can have which drug for cystic fibrosis?

A
  • ivacaftor
271
Q

What are the indications for tympanostomy tubes?

A
  • children with more than 3 episodes of otitis media in 6 months or children with 4 or more episodes in 1 year

Master Review (4 decks)

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