Pediatrics

Question 1

What is the “happy wheezer”

Answer 1

Bronchiolitis from RSV (respiratory synctial virus) or other flu-like viruses. Airways are partly blocked with mucous so important to keep an eye on breathing so URI doesn’t develop airway obstruction.

Question 1

What is treatment for asthma?

Answer 1

bronchodilator to relax SM and steriod as an anti-inflammatory

Question 2

What could a simian crease on the hand indicate?

Answer 2

trisomy 21

Question 2

What are common labs seen with Cystic Fibrosis?

Answer 2

Low sodium, low Chlorine, increased bicarb, high pH (alkalosis), low CO2 (30), low O2 (60)

Question 3

What are the signs of asthma?

Answer 3

prolongued expiratory phase, scattered wheeze, hyperexpanded chest xray with streaky hilar infiltrates. Decreased FEV1

Question 4

What is the Ballard Score?

Answer 4

It is used to determine age, very useful when no prenatal care. Best performed at 12 hours of life for infants under 26 weeks and 4 days for mature infants. Accuracy within two weeks of age. Has 6 neuromuscular criteria and 6 physical criteria.

Question 4

Why is important to document skin rashes?

Answer 4

so parents don’t CPS called when their child has a port-wine stain or mongolian spot

Question 4

What makes up the chest wall?

Answer 4

ribs, spine, sternum, accessory muscles, diaphragm

Question 4

What does a normal chest x ray look like?

Answer 4

diaphragm should be found at about the level of the 8th - 10th posterior rib Spinous process between clavicles See the vertebral bodies clearly Clavicle overlying the third rib

Question 5

What are obstacles encountered by the breastfeeding mother?

Answer 5

lack of familial/friend support, lack of accommodation at work, hospital nursery - less baby/mom time, working mom

Question 6

Why are some reasons you see jaundice in a newborn?

Answer 6

This could be from not enough breastmilk, and mothers are encouraged to increase breast feeding. Another cause is a product in the breastmilk that inhibits the breakdown of bilirubin. Other reasons: infections, low O2 levels, premature babies. Tx: light

Question 7

What makes up the mediastinum?

Answer 7

3 birds and a mammal: azygus, esophagus, thoracic duct, thymus, aorta, heart

Question 7

What is treatment for pneumonia?

Answer 7

First line - amoxicillin. Alternate: 2nd/3rd generation cephalosporin, clindamycin, levofloxacin. Add macrolide to cover atypical pneumonias.

Question 9

What are some advantages to breast feeding?

Answer 9

Save money, improved maternal and infant outcomes, reduced incidence of disease, diabetes, breast cancer

Question 10

Seal-bark cough, steeple sign?

Answer 10

Croup - normally from parainfluenza

Question 11

What does the APGAR test measure?

Answer 11

it’s a measure at 1, 5, and 10 minutes of life that measures require resuscitation: appearance, pulse, grimace, activity, respirations.

Question 13

What are some contraindications to breastfeeding?

Answer 13

High levels of jaundice - try using supplement HIV positive HTLV -1 (Human-cell Leukemia Virus) Untreated TB (mother may pump, then breastfeed after treatment started) Cancer-treating drugs Alcohol or street drug abuse Radiation therapy Active Chicken Pox (varicella) Active Herpes on breast (only until after healing)

Question 15

What is macroglossia?

Answer 15

Tongue is too big

Question 16

What could a sacral dimple indicate

Answer 16

spina bifida or tethered cord

Question 18

What are some cases where breastfeeding is NOT contraindicated (misconceptions):

Answer 18

You can still breast feed with Hep B,C CMV Occasional drink (wait 2 hours) Nicotine Patch/Gum OK Mastitis and Abcess - still breastfeed, damn!

Question 19

What are the scores for AR of AGPGAR

Answer 19

A - activity, 0-limp, 1-some flexion, 2-active movements R-respirations, 0-limp, 1-slow, irregular, 2-good, crying

Question 21

Do Hemangiomas disappear?

Answer 21

Yes, present and enlarge until 8 - 12 months but disappear by kindergarten

Question 22

How do you treat diaphragmatic hernia?

Answer 22

Treat with ventilatory support initiation and then surgically get the bowel out of the lungs when stable. Baby may not have development of lung if herniated early.

Question 22

What is the most common mutation for Cystic Fibrosis in CFTR?

Answer 22

mutation in delta F508, Deletion of phenylalanine at position 508 on gene.

Question 23

What should you be worried about if no red reflex?

Answer 23

retinoblastoma

Question 23

When should glucose be checked in a baby?

Answer 23

When the mom has gestational diabetes.

Question 24

What can cause thrush in babies?

Answer 24

Candida albicans from mom

Question 25

How do you promote breastfeeding?

Answer 25

Information to pregnant moms, breastfeed within first hour, teach how to pump, give supplements only when medically necessary, no pacifiers for at least a month,

Question 27

What is routine care given to every newborn?

Answer 27

Prophylaxis for gonococcal ophthalmia neonatorum - silver nitrate or erythromycin - within 1 hour of delivery. Vitamin K, turns liver on and clotting factors, to prevent hemorrhagic disease of newborn. Newborn screening: PKU, Galactosemia, Hypothyroidism, Homocystinuria, MSUP, Sickle, CF

Question 28

When should you get a chest xray with pneumonia?

Answer 28

If repeated pneumonia in same place

Question 30

What physiological events happen at birth?

Answer 30

1) lung expansion, cry 2) umbilical cord clamping and sudden increase in BP 3) Decrease in pulmonary vascular resistance 4) Closure of foramen ovale and ductus arteriosis

Question 32

When is preterm, term, and postterm?

Answer 32

under 38 weeks is preterm. Term is 38 - 42, and post-term is 42+

Question 34

How long does it normally take babies to latch for breastfeeding?

Answer 34

55 minutes

Question 35

What is typically the cause of respiratory distress syndrome in a newborn?

Answer 35

Normally occurs when newborn premature. 60% are under 30 weeks, and 25% are 30-34 weeks. Surfactant deficiency. Treat with surfactant via ET tube and ventilatory support.

Question 36

Absent breath sounds on left side, abdomen is soft and scaphoid (sucked in). Possible differential?

Answer 36

diaphragmatic hernia. 1/2500 births, mostly left sided since liver in the way on right side. Could have lung hypoplasia, pulmonary hypertension.

Question 37

What is the treatment for Cystic Fibrosis?

Answer 37

1. airway clearance with same tx for asthma, Pulmozyme (DNAase) 2. Good nutrition, pancreatic enzyme replacement 3. Prevent bacterial overgrowth - Ab (pseudomonas and Staph) 4. Kalydeco - decreases viscosity of secretions 5. Lung transplant, gene therapy

Question 38

How do you test for Cystic Fibrosis?

Answer 38

Newborn screening with Immunoreactive trypsinogen test (60%); Sweat Cl- test; Genetic testing

Question 39

Barky cough, temp of 102, and thumb print?

Answer 39

epiglottitis

Question 40

What constitutes the lower airway?

Answer 40

trachea, bronchi, bronchioles, alveoli, interstitium, pleura

Question 41

What is an infant contraindication to breast feeding

Answer 41

galactosemia

Question 42

When must babies pass stool by?

Answer 42

24 hours. 4x4 rule. Need to pass 4 times in 4 days.

Question 43

What is considered the anatomy of the upper airway:

Answer 43

Sinuses, eustachian tubes, nose, tonsils and adenoids, pharynx and larynx

Question 44

What is a finding on babies feet that signals pre-term vs. mature

Answer 44

preterm babies have slick feet term babies have wrinkled feet

Question 45

What are scores for the APG of APGAR

Answer 45

Appearance: 0 - blue/pale 1 - pink body, blue ext., 2 Completely pink P- Pulse 0 - absent, 1- slow (less than 100), 2 - over 100 G- grimace. 0- none, 1-grimace, 2-cough or sneeze