Pediatrics Flashcards
Increase in function
Development
Increase in size
Growth
Antenatal
Term for occurring before birth (maternal)
Term for 12th week gestation through 28th day of life after birth
Perinatal
Perinatal includes what time periods?
12th week gestation through 28th day after birth
Fetus - Neonate
Embryo
Term for 1st trimester stage of development
Fetus
Term for 12th week gestation through birth
Neonate
Term for birth through one month
Infant
Term for one month through beginning of walking (usually 10-14 months)
Toddler
Term for beginning of walking through 2 years
Child
Term for two years through 12 years
Pubescent / Adolescent
Term for 12 years through 18 years
Gestational age
Age of fetus in weeks
Using either:
Calculated from first day of last menstrual period
OR
Ultrasound measurement
OR
Ballard (Dubowitz) Scoring System based on physical assessment of newborn
Postnatal age
Age after birth
Full-term Neonate
38-42 weeks
Postnatal age < one month
Post-term Neonate
> =42 weeks
Postnatal age < one month
Postconceptional Age
Gestational Age + Postnatal Age
Ex: 25 wk gestation + 6 wk old = 31 wk
postconceptional age
APGAR Scoring System
Heart Rate >100 (<100 = 1)
Respiratory Effort - good and crying (irreg = 1)
Muscle Tone - active movements (some = 1)
Reflex Irritability - crying vigorously (crying = 1)
Color - pink all over (blue extr = 1)
Pre-term Neonate
Equal or less than 37 weeks
Postnatal age < one month
Average birth weight
3.4kg
Age at which birth weight doubles
~4-5 months
Fever in an infant
38.4 C
Severe otitis media
Mod-severe pain plus temp at least 39 C
Recurrent otitis media
3x in 6 mo OR
4x in 1 yr w/1 in last 6 mo
3 holes in fetal heart
Foramen ovale
Ductus arteriosis
Ductus venosus
Kinrix
DTap-IPV
Comvax
HBV-Hib
HBV: (Recombivax 5mcg)
PRP-OMP: (PedvaxHIB) = H.influenzae B
Pediarix
DTaP-HBV-IPV
ProQuad
MMR-V
(4 Live vax)
MMRii
Varivax
Twinrix
HBV-HAV
PENTACEL
Hib-DTaP-IPV
MenHibrix
Hib-MenCY
AOM tx
Amox 80-90 mg/kg/day
Hole separating RA & LA
Foramen ovale
Blood vessel connecting pulmonary artery to proximal descending aorta
Ductus arteriosis
Shunts blood flow from umbilical vein to inferior vena cava
Ductus venosis
Umbilical cord connects ____ to ____.
Fetus
Placenta
Fetal circulation flows through
1 umbilical vein (mom to fetus) MAIN VEIN
2 umbilical arteries (fetus to mom)
Age at which birth weight triples
1 year
A baby weighing 10 kg should be about how old?
1 year
(3 x 3.4kg)
Of weight, height and head circumference, which will decrease first…last?
Weight first
Head circumference last
After a baby dries up from birth, how long until they return to avg birth weight?
~10 days (1-2 weeks)
Hole between pulmonary artery and aorta
Ductus arteriosis
Hole in fetal inferior vena cava
Ductus venosis
Why does fetus have holes in heart?
Lungs are filled with amniotic fluid, so must get oxygenated blood from mother. Holes prevent pushback and heart failure.
When blood enters fetal RA, where does it go?
2/3 to LA (thru Foramen ovale) and 1/3 to RV
Umbilical cord enters placenta through
Ductus venosis
PVR in fetus
Why?
High b/c lungs are full of fluid and blood is shunted away
SVR in fetus
Why?
Low
B/c open line between baby and mom
How does PVR change after birth? Why?
Decreases because first breath fills lungs with oxygen
How does SVR change after birth? Why?
Increases
B/c cord is cut and holes start to close up
Term for bowel movement of newborn
Meconium
Why is it important for a fetus to make it at least 20 weeks?
Surfactant begins to form at 20 weeks
Fetus’s ability to produce surfactant has completely matured by ____ weeks.
34-36 weeks
What happens at first breath?
Decrease PVR Increased SVR causes Foramen Ovale to close Increase blood flow to lungs Increase blood flow to LA Oxygenation and decrease prostaglandins causes PDA to close
What keeps PDA open in utero?
Low oxygenation and prostaglandins that mom is giving baby
What happens if PDA doesn’t close?
Blood going out to body is not as oxygenated and body thinks it needs to work harder. Low oxygenated blood shunts from PA into aorta and to body.
Causes pulmonary edema, enlarged heart, CHF, pulmonary HTN
Tx for PDA that doesn’t close
Close via pharmacological means
Manage symptoms: digoxin and diuretics
Surgical closure
Consequences of PDA remaining open
Pulmonary edema (retrograde flow)
Enlarged heart (L-sided failure)
CHF
Pulmonary Hypertension
Drugs used to close PDA
Prostaglandin Antagonists
-NSAIDS
Ibuprofen, Indomethacin***
-Corticosteroids (inhibit PLP A2 prod)
-COX-2 selective inhibition
***Indomethacin DOC - most studied
(only takes 1-2 doses)
Tx for PPHN
Sildenafil (PDE-5 inhibitor) to allow smooth muscle relaxation and cause vasodilation of the blood vessels in the lungs
Vital signs of infant vs adult
⬆️ RR
⬆️ HR
⬇️ BP
What causes Foramen Ovale to close after birth?
Increased SVR due to removal of umbilical flow from mother
How do you manage symptoms for a PDA closure failure?
Digoxin and Diuretics
At what age can a child start to swallow a capsule?
5 years old
Never give tablet/capsules to children <5
Septic meningitis
Bacterial
Aseptic meningitis
Viral (HSV, HIV, etc.)
Septic meningitis can lead to…
Cerebral edema
Increased ICP
Decreased CBF
SIADH
Cerebral ischemia
Disseminated intravascular coagulation
Death
Classic s/s of meningitis
Severe headache Stiff neck Dislike of bright lights Fever / Vomiting Drowsiness / Impaired consciousness Rash
Two tests for signs of meningitis
Brudzinski's Sign (knees bend with raised neck and legs raise together) Kernig's Sign (Spasm when trying to extend knee)
Initial mgmt of meningitis
- GET BLOOD CULTURES FIRST!
- Lumbar puncture (if pt. is stable)
- Start empiric tx +/- dexamethasone
How to tell if CSF culture is bacterial or viral
Bacterial
- Higher Protein
- Low Glucose (bacteria need nutrition)
- Very Elevated (>90% PMNs…polys+bands)
Viral
- 50% lymphocytes
PMNs
aka Neutrophils
= Polys + Bands
Meningitis pathogens for newborn to 1 month old
LEG
Listeria (unpasteurized dairy)
E. coli (vaginal canal)
Group B strep (GBS+)
Meningitis pathogens if >1 month old
N. meningitidis
Strep. pneumoniae
Empiric tx for meningitis in newborn to 1 month
Ampicillin + Aminoglycoside (gent.)
or
Ampicillin + Cefotaxime
Empiric tx for meningitis if >1 month old
Cefotaxime or Ceftriaxone
AND
Vancomycin
Evidence of nisseria meningitidis
Rash all over (esp limbs)
Tx for neiserria meningitidis
DOC- Pen G (if PCN MIC <0.1)
or 3rd gen ceph (Cefotaxime or Ceftriaxone)
Alt- FQL, meropenem, chloramphenicol
DUR - 1 week
Evidence of strep. pneumo meningitidis
Seizures and coma are common
ADE from Augmentin
Diarrhea (from clav)
- try to maintain clav <10 mg / kg / day
Twinrix min age
18 years
Term describing inflammation of middle ear
Otitis media
Rapid onset of signs and symptoms of inflammation in middle ear
Acute otitis media (AOM)
Acute otitis media without otorrhea
Uncomplicated acute otitis media
Discharge from ear, originating at 1 or more of the following sites: external auditory canal, middle ear, mastoid, inner ear, or intracranial cavity
Otorrhea
AOM with presence of mod-severe otalgia or fever at or above 39 C
Sever AOM
AOM wih the presence of mild otalgia and temp below 39 C
Nonsevere AOM
Angle of eustachian tube in adult vs child
Adult - 45 degrees
Child - 10 degrees
Common pathogens in AOM
Strep. pneumo
Nontypeable H. Influenzae
Moraxella catarrhalis
Who should not be diagnosed with AOM?
Children without otorrhea in middle ear
Concerts technology
OROS
Immediate-release stimulants
Methylin
Ritalin
Immediate-acting CNS stimulants
Metadate ER
Methylin ER
Ritalin SR
Long-acting CNS stimulants
Concerta Metadate CD Ritalin LA Daytrana Quillivant XR
Tx of ADHD + depression
Stimulant and/or
Antidepressant (bupropion, imipramine, or atomoxetine)
Tx ADHD + conduct oppositional/defiant
Stimulant plus
Mood stab (chlorpromazine and haloperidol)
or clonidine
Tx ADHD + Tic Disorder
Stimulant plus Clonidine Risperidone Pimozide Haloperidol
