Pediatrics Flashcards
Normal HR and RR for neonates
RR 40-60
HR 120-160
(babies always faster)
Purpose of APGAR
need resuscitation?
1: L&D condition
2: response to resuscitation
not a predictor or morbidity and mortality
How to grade appearance and pulse for apgar
0: blue baby 1: blue limbs 2: pink
0: none 1: 60-100 2: 100+
How to grade grimace and activity for apgar
0: none 1: feeble cry 2: cough and gag
0: no activity 1: flexion 2: active
Neonatal conjunctivitis at 3+ weeks is
herpes
Two prophylactic eye ointments for babes
silver nitrate; e-mycin/tetra
How to TREAT gonococcal/chlamydial conjunctivitis
ceftriaxone/ emycin
Why are babies prone to GI bleed
no gut flora –> no ecoli –> no vitamin K
need single dose vitamin K
Vaccine series started at birth
Hep B
What congenital disorders are on all newborn screens nationally?
(CHB)2 PG Creepy Hitmen Befriend Private Gypsies C-CAH, CF H- homocystinura, HypoTH B-Bthatl/biotinidase P- PKU G- Galactosemia
Most newborn heritable disease (esp enzyme related) are AR but which enzyme deficiency is XR?
G6PD def
Galactosemia diet
eliminate lactose, no breast feeding
Tachypnea in newborn lasting more than 4 hours is
no longer transient rule out sepsis
Treatment of subconjunctival hemorrhage
none will resolve
3 types of neonatal skull fractures
linear common resolves
depressed must repair
basilar fatal
Constrast caput and cephalohematoma
hematoma confined to suture lines
Cephalohematoma is aka
subperiosteal hemorrhage
Best treatment for brachial plexus injury
immobilization
Two common brachial plexus injuries:
upper: 5-6; adducted/internally rotated arm (waiters tip)
lower 7-8/1: claw hand + horners (MAP)
What causes facial nerve paralysis in delivery
forceps
Common causes of polyhydramnios
unable to swallow
werdnig Hoffman-neuro; intestinal atresia
Causes of oligohydramnios
prune belly (no muscles); renal agenesis/potts
Appearance of baby with oligohydramnios
flat face because compression/ no buffer with amniotic fluid
Two types of CDH
Bochdalek- posterolateral, L
Morgagni- retro/parasternal
Causes of high AFP
#1 wrong dates abdominal wall defects NTDs
Cause of omphalocele
failure to retract at 10-12 wks GA
At what age must umbilical hernia be repaired
4 but most regress before this time
Location of gastroschisis
lateral
WAGR syndrome features and chromosome
wilms, aniridia, gu malformation, retardation…. chromosome 11
First test for wilms tumor
US
Neuroblastoma clues
dancing eyes and feet, hypsarrythmia on EEG; high VMA/ metanephrines
Hydrocele clinical appearance + cause
painless, transluminates
origin: tunica vaginalis remnant
Varicocele appearance + cause
bag of worms; check both sides usually bilateral; dilated pampiniform plexus
Cryptorchidism is assc with what risk
malignancy
When must cryptorchidism be repaired
before age 1 to avoid sterility
Hypo vs epi spadias
hypo- under- ventral
epi- on top- dorsal (like a fin)
What is hypospadias assc with
cryptorchidism, ingiuinal hernias
What is epispadias assc with
bladder exstrophy
Chromosome assc with TOF
22
TOF murmur-
VSD murmur (holosystolic, LSB)
VSDs are common in what disorders?
all trisomies
What are the 3 holosystolic murmurs
VSD
TR
MR
TGA murmur + xray findings
single S2 heard; egg on a string
Percentage of patients that survive TGA surgery
1/4
Pulsus paradoxus assc
TPTX; Tamponade
Hypoplastic left heart murmur + pulse + CXR findings
single S2; NO PULSE
globular shaped heart
very few survive surgery
TA murmur + pulse
systolic ejection murmur, single S2; bounding pulses
TA sequelae if not repaired
repair within 4 months or get PHTN
TAPVR w or w/o obstruction….what does the obstruction refer to?
angle that the vein enters sinus
All heart defects with L –> R shunt have what EKG finding
RVH
Cyanotic heart defects have what shunt type? Get what treatment?
R –> L; all get surgery
What are the cyanotic heart defects ?
5 T's transposition Truncus TOF TAPVR TINY left heart
Which of the 5 cyanotic defects have VSDs
TOF; Truncus
Which of the cyanotic defects are PDA dependent
Transposition
Tiny left heart
Conservative medical treatment of VSD
diuretics and dig
Heart defect assc with paradoxical emboli
ASD
During what window is PDA normal?
24 hours after birth
Where do sounds from each valve radiate?
aortic-neck
mitral-axilla
tricuspid and pulm- back
Match the CXR finding to the cardiac defect: pear- boot- egg on a string- globular- jug handle- rib notching-
pear- pericardial effusion boot- TOF egg on a string- TGA globular- Tiny LH jug handle- PPAHTN rib notching- Aortic Coarctation
Syncope, hearing loss, normal vitals & exam=
Long QT syndrome
Treatment of coarctation
surg
When is jaundice concerning
day 1; week 2
more than 5+/day
more than 19.5 t bili
more than 2 direct
When to do exchange for jaundice
20-25 total
Most common type of esophageal atresia
proximal atresia and distal TEF
Pre-op care for TEF
px abx for anaerobic coverage
fluids bc cant swallow
To what GI conditions do each of the radiographic “signs” apply?
- string sign
- doughnut sign
- birds beak
- steeple
- string: PS
- doughnut: intussusception
- birds beak: achalasia
- steeple: croup
PE signs of pyloric stenosis
succusion splash
olive
Choanal atresia description
membrane between nostrils and pharyngeal space
Clinical presentation choanal atresia
blue with feeds; pink when crying
How to dx choanal atresia
ct
CHARGE assc
coloboma/CNS heart defects atresia, choanal retardation of growth GU abnl ear abnl
Duodenal atresia clinical signs +assc syndrome
bilious vomiting, no respiratory distress
assc with downs
Test for duodenal atresia
AXR –> double bubble
Clinical signs of hirschspruings
tight rectal sphincter unable to pass stool or flatus, no meconium first 48 hours
Mainstay dx of hirschsprungs + assc syndrome
downs, full thickness rectal bx (no ganglionic cells in submucosa)
Cause of duodenal atresia
lack of apoptosis
Most common location volvulus in childhood
midgut (ileum)
–> see birds beak like in achalasia
Two assc with intussusception
rotavirus vaccine, HSP
Onset of duodenal atresia vs volvulus
duodenal atresia at birth volvulus within first year
Only true congenital diverticulum + tissue makeup
meckles, all three layers, ectopic gastric tissue + pancreatic
Rules of 2’s for meckels
within 2 ft ileocecal valve 2 in long 2 tissue types 2% pop; 2% symptomatic males 2x more common
Diagnostic tests for diarrhea in kiddos
1) stool for blood and leukocytes
2) O&P
3) +/- c diff
What is always bad for diarrheal illness in kiddos?
loperamide
Three common viral illnesses causing diarrhea
rota, noro, adeno
Which diarrheal illness is most common in the winter?
rota
Which diarrheal illness is 1-2 days instead of a week?
noro- short
What is literally never ever ever the answer on step 2?
calling a consult
Management of NEC
abx (vanc, gent or metro)
fluids
bowel rest
NGT for decompression
Metabolic derangement in IDM
-low glucose NOT HIGH!
They overproduce insulin
-Low Ca,mag
-High bili
Phyiscal abnormalities in IDM
- macrosomia (all organs but brain)
- small left colon
- cardiac abnl
- RVT
MCC CAH
21 hydroxylase def
How to dx CAH
17OHprog/electrolyte levels
Cortisol, test, aldo = three products of steroid synthesis.
In 11/17/21 def, which of these products are high?
21- sex hormones (test) high
11- sex hormones + DOC high
17- aldo high
Which of the CAH forms have hypertension?
all hypertensive except 21 = salt wasting shock
3 forms of rickets
in which is phosphate normal?
2= normal phosphate
1) lack of vitamin D
2) inability to convert D –> OHD
3) X linked hypophos (inability to retain phosphate)
Treatment for rickets
ergocalciferol or 1,2/calcitriol and monitoring
Supplements for breast fed babes
D starting at 2 months
Early causes of neonatal sepsis
GBS, e coli, listeria
Late causes of neonatal sepsis
staph, e coli, GBS
Abx for neonatal sepsis
Amp and Gent +/- cefotaxime
TORCH infection treatment
T-toxo- pyrimethamine O/syphilis- penicillin R-rubella-support C- CMV- ganciclovir H- HSV- acyclovir
Toxo presentation (neonate_
chorioretinitis, hydrocephalus, intracranial calcifications
Syphilis presentation in babe
rash on hands and feet snuffles, saddle nose, 8th nerve palsy
Rubella presentation in babe
blueberry rash, PDA, deagness, cataracts etc
CMV presentation in babe
cross between toxo and rubella BUT: periventricular calcifications
HSV presentation in babe
shock/DIC wk 1 –> skin lesions wk 2 –> encephalitis wk 3
Rubeola (measles) presentation in kiddos
3 C’s –> koplik spot in mouth
Roseola virus + presentation
HHV 6-7
high fever –> rash
Scarlet fever is different than Kawasaki because?
assc with PHARYNGITIS concurrently.
Treatment of scarlet fever
penicillins, azithro, cephalosporin
Treatment of croup +assc viruses
racemic epi
Parainfluenza, RSV
Croup clinical signs
inspiratory stridor, barking cough
Epiglottitis treatment
intubate + treat with ceftriaxone for at least a week; rifampin for close contacts
Dx & Treatment of pertussis
PCR of nasal secretions
Treat with emycin/azithromycin in catarrhal stage (early before bad cough)
*Macrolides for contacts
Treatment of diphtheria
antitoxin (abx don’t work)
**don’t scrape the membranes
Age group for Legg Calves Perthes + pathogenesis
2-8 avascular necrosis if happens to one side will happen to the other
B2/riboflavin def symptoms
angular chelosis
stomatitis
glossitis
B5/B6 def
B5: burning feet
B6: peripheral neuropathy + anemia
What are B1-3
1: thiamine; 2: riboflavin; 3: niacin
Vitamin A and PTH function
low- hypoparathyroid
high- hyperparathyroid
