Pediatrics Flashcards
apgar score assessed when?
1, 5, 10 min
more complex assessment of activity, position, and tone; used to evaluate for neuromuscular and physical maturity; estimates gestation age
New Ballard Score
causes of this include maternal drug use, chromosomal abnormalities, exposure to intrauterine viral infection, multiple gestation, AMA, placental insufficiency, lack of maternal weight gain
causes of being small for gestation age
MC cause of infant being large for gestational age
maternal diabetes
common for 3 to 5 days after birth, small pustules on erythematous bases
erythema toxicum
blockage of eccrine sweat glands, flushed macular appearance involving neck, face, scalp, diaper area
miliaria
light clothing/decreased humidity for ‘prickly heat’ or ‘heat rash’ phenomenon
miliaria
common in dark-skinned infants, small to large blue/black macules
mongolian spots
secondary to areas of surface capillary dilation frequently found on eyelids, nape of neck, and forehead; aka stork bite
nevus simplex
vernix caseosa (greasy covering) and lanugo more abundant in ? infants
preterm infants
dry, cracked, and peeling skin more likely in ? infants
postterm infants
premature fusion of one or more sutures
craniosynostosis
fontanelles
- closes at 10-26 mo ?
- closes around 1-3 mo ?
- -3rd fontanelle along sagittal suture may be associated with ?
- anterior fontanelle
- posterior fontanelle
- trisomy 21
fluid accumulation under scalp secondary to birth trauma
caput succedaneum
hemorrhage beneath scalp; uncommon but may result in enough blood loss to cause hemorrhagic shock
subgaleal hemorrhages
posteriorly rotated or low set ears - suspicion of ?
congenital anomalies
congenital cataracts, glaucoma, or retinoblastoma- finding?
absent red reflex
gray or pale yellow spots at periphery of iris aka ? associated with ?
Brushfield spots, Down syndrome
strabismus does not represent pathology unless persists past ?
4 months
presents w/ unilateral or bilateral obstruction, confirmed with axial CT, present with respiratory distress bc infants are obligate nasal breathers
choanal atresia
small pearly nodules along midline of hard palate, benign retention cysts
Epstein pearls
small mandible and tongue, clefted soft palate, respiratory difficulties (place in prone position)
Pierre-Robin syndrome
large tongues that often seem larger than the mouth
trisomy 21
thyromegaly in infant associated with ?
congenital hypothyroidism
masses
- anterior to sternocleidomastoid:
- posterior to sternocleidomastoid:
- w/in sternocleidomastoid:
brachial cleft
cystic hygroma
torticollis, hematoma
aspiration, congenital pneumonia, and transient tachypnea are MC causes of ?
infant respiratory distress
cyanosis, CHF, and diminished peripheral pulses are MC serious presentations of?
heart dz in infant
infant- prune belly or absence of abdominal musculature may be associated with ?
renal anomalies
infant-severely scaphoid belly plus respiratory distress suggest ?
diaphragmatic hernia
infant- pits, birthmarks, or tufts of hair in gluteal cleft may rep underlying ? or ?
NT defects, spina bifida
delayed stool >24h after birth may indicate ?
Hirschsprung dz
male genitalia
- more common, urethra proximal + ventral
- urethra dorsal
hypospadias
epispadias
testes usually descend in ? month of life
3rd month
undescended testes = risk for ? and ?
testicular cancer, infertility
inguinal hernia more common in ? infants
premature male
helpful in differentiation of hernia and hydrocele
transillumination
collection of fluid in scrotum due to latency of process vaginalis; may be associated with hernia
hydrocele
infants- female genitalia
- vaginal leucorrhea or bloody discharge, edematous labia from?
- vaginal adhesions aka ?»_space; tx with ?
- maternal estrogens
- fused introitus, estrogen or beclomethasone cream for 5-10 days
developmental hip dislocation
- attempts to dislocate hip via posterior pressure; fully adduct hips
- identify hips that are dislocated or subluxed; fully abduct hips and feel for spasm or clunk
- positive of either require?
- Barlow maneuver (femoral head felt to dislocate or leave acetabulum = positive)
- Ortolani maneuver
- bilateral u/s of hips
skin tags at lateral borders of hands and feet?
polydactyly (rudimentary digits)
fixed severe eversion of plantar surface?
club foot (talipes equinovarus)- ortho referral
stroking the face elicits turning of head towards stimulus
rooting reflex
allow infants head to drop 1 to 2 cm, observe for abduction at shoulder and elbows, spreading and extending of fingers; followed by adduction and flexion of same? disappears?
moro reflex; at 3-4 months
palmar/plantar grasp disappears by ?
4 months
pull infant by arms to sitting position, observe head lag initially, finally coming briefly to midline before falling forward
traction response
infant dangled above bed, allowing toe to have minimal contact; response of extremity w/ flexion or stepping response
placing reflex
clonus may be noted; babinski (up going plantar) normal until
2 yrs old
hypogly (less than 40-45 mg/dL) mc in ?
diabetic mothers, IUGR
at 3 hours of age normal glucose?
50-80 mg/dL
tx for infant hypogly
bolus of dextrose & water and IV glucose prn
MCC of unconjugated hyperbilirubinema w/ normal reticulocytes? genetic?
physiologic jaundice; Gilbert or Crigler-Najjar syndrome
results from toxic bilirubin levels of greater than 20 to 25 and is associated with encephalopathy
kernicterus
alpha- antitrypsin def, hypothy, CF, and RBC abn are causes of ?
conjugated hyperbili
? benefits all types of jaundice; ? not recommended for severe but known to lower bill levels
phototherapy, sunlight
resp distress in newborn- greater than?
RR of 60 bpm
cyanosis resolving w/ supplement oxygen supports pulm or NONcv cause- aka?
hyperoxia challenge
MC neurodevelopment d/o? most severe?
ADHD; MR
MC speech/language delay?
conductive hearing loss secondary to chronic middle ear effusion
MR- IQ of less than ?; abnormal muscle tone seen at ?; motor delay apparent by?
70; 6 months; 1 year
spina bifida:
- neural tube defect involves overlying skin?
- hairy tufts, dimples, or dermal sinus noted in lumbosacral region
aperta
occulta
risk factors for spin bifida?
def of FA or use of valproate in mom
commonality in metabolic d/o, ambiguous genitalia, RB, wilm’s tumor
chromosomal abnormalities
initial eval for suspicion of chrom abn?
karyotype, fluorescent in situ hybridization (FISH)
inborn errors of metabolism
- virilized female, male w/ ambiguous genitalia
- n/v jaundice, liver enlargement, MR, cataracts, death
congenital adrenal hyperplasia
galactosemia
single transverse palmar crease aka? seen in ?
simian crease, trisomy 21 (Down syndrome)
? in eyes of down syndrome
brushfield spots
MC congenital heart disease in down syndrome?
atrioventricular septal defects
tall thin and long-limbed, obese in adult years, scoliosis, ataxia, expressive lang d/o?; males? females?
klinefelter syn- XXY
- males: small penis, hypogonadism, minimal pubic/facial hair, gynecomastic
- females: eunuchoid habitus
prominent ears, low posterior hairline, broad chest, congenital lymphedema, webbed neck hearing impairment
turner syndrome (XO)
turner syndrome- associated heart dz? kidney?
coarctation of the aorta, horseshoe kidney
pale blue irides, long narrowed facies, large protruding ears, large testes, protruding jaw, flat feet, hyper extensible fingers, MVP, learning disabilities or MR
fragile X syndrome
large for GA infant, hypoglycemia during infancy, creases & pits in earlobes, asymmetric limbs, organomegaly, large tongue
Beckwith-Wiedemann syndrome (chromosome 11p15)
small for GA infants, hypogonadism, almond shaped eyes, diabetes and pickwickian syndrome common complications
Prader-Willi syndrome (15q11)
severe MR, paroxysmal laughter, tongue thrusting, prognathism, seizures, abnormal gait and posturing
angel syndrome (chromosome 15)
death in Ehler Danlos syn often from ?
ruptured aneurysm
high arched palate, myopia, aortic insufficiency, spontaneous PTX
marfan syndrome
microcephaly, long and smooth philtrum, thin upper lip, small palpebral fissures, small distal phalanges
FAS
auto dom, involves type 1 collagen, bone fragility an pathologic fractures, blue tinted sclera
osteogenesis imperfecta
define failure to thrive
child s weight crosses two major percentiles downward
hereditary, apparent before 2, deceleration in height? bone age?
familial short stature, EQUALS chronological age
aka ‘late bloomer’ may have FH, bone age BEHIND chronological
constitutional growth delay
idiopathic, congenital empty sella syndrome or acquired craniopharyngioma are causes of ?
GH deficiency
dwarfism that results from a mutation in GH receptor
Laron syndrome
truncal obesity may be present in GH def bc GH promotes ?
lipolysis
protein def seen in CF, most severe form?
kwashiorkor
severe form of malnutrition from multiple dietary def including lack of carbs
marasmus
element contained in most public water sources, def may have discolored teeth
fluoride def
ideal source of infant nutrition
breast milk
typical infant diet:
- ? until 6 mo
- ? at 4 mo
- ? at 5 mo
- ? at 6 mo
- ? in the following months
- breast milk or formula
- cereals
- fruit
- vegetables
- complex proteins
cow’s milk with low fat content initiated no earlier than ?
1 year old
premature infants vaccinated same as term infants except for ?
hepatitis B vaccine- recommended for preemies 2 kg or more
avoid hep B vaccine w/ ? allergy
baker’s yeast
avoid varicella vaccine w/ ? allergy
varicella
common preservatives in MMR and IPV?
neomycin, streptomycin
chronic seizure d/o CI to ?
Tdap, Dtap
primary source of lead exposure in US?;
screening at ?; treat levels at ? w/ chelation; ? results in severe damage i.e. severe health probs, seizure, coma
lead-based paint
1-2 y.o.
>45 ug/dL
>70 ug/dL
PNS acting overdose/toxicity
- ? cause warm, dry skin
- ? produce salivation and urination
ANTIcholinergics
organic phosphates
abdominal radiographs not helpful- very few are radio dense i.e. ?
heavy metals, iodine, enteric-coated tablets
in toxicity/poisoning, ? may accelerate elimination
cathartics i.e. sorbitol
? obstruction = abrupt onset of cough, stridor, choking, and cyanosis; complete leads to inability to cough or choke
upper airway obstruction
? obstruction causes acute to subacute cough, unilateral persistent wheezing, recurrent pneumonia; complete may cause a ball-valve effect, which is ?
lower airway obstruction; distal hyperinflation, mediastinal shift
? recommended for caustic (i.e. batteries), sharp, or lodged objects
esophagogastroscopy
MC innocent murmur of childhood
Still’s murmur; 2yo-preadolscence, loudest in apex and left sternal border, musical or vibratory, accentuate with fever
left and right infraclavicular murmur, usually louder on right? usually appears? best heard?
venous hum, after 2 y.o., with child sitting (diminishes w/ turning of head, jugular compression, or supine position)
typically found in older children and adolescents, grade 2 or 3 harsh, systolic ejection murmur
innominate or carotid bruits
common innocent murmur of older children, appears around 3, continues thru adolescence, localized to upper left sternal border, louder with pt supine
pulmonary ejection murmur
acute onset of fever and posterior pharyngeal vesicles (grayish white that form ulcers with erythematous halos)
herpangina; dysphagia, fever, vomiting, and anorexia may occur
hand-foot mouth dz- red papules or vesicles on tongue, oral mucosa, hands, feet, and ?
buttocks
mucocutaneous lymph node syndrome aka?
kawasaki dz
redness and swelling of hands and feet with subsequent desquamation, fever > 5days, strawberry tongue, conjunctivitis, cervical lymphadenopathy?
kawasaki dz
cardiac manifest of kawasaki dz? tx?
coronary arteritis and aneurysm; IV immunoglobulin and aspirin
pruritis, prodrome = fever and resp sx, dew drop on rose petal
varicella
lacy pink macular rash on torso
parvovirus B19/slapped cheek/fifth dz/erythema infectiosum
HHV 6 or 7; fever resolves BEFORE rash
roseola (exanthem subitum)
fever, cough, anorexia, coryza, maculopapular face to EXTREMITIES rash, Koplik spots in mouth
measles (Rubeola)
maculopapular rash from HEAD to TOE, teratogenic
Rubella (German measles)
