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COMAT Exams > Pediatrics > Flashcards

Pediatrics Flashcards

1
Q

What effect on the fetus can tobacco use cause?

A

Low birth weight

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2
Q

What effect on the fetus/pregnancy can Cocaine and other stimulants cause?

A

Vasoconstriction = placental insufficiency and low birth weight

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3
Q

What effects on the fetus is associated with maternal use of heroin/opiates during pregnancy?

what should these children be monitored for?

A 
increase risk of:
fetal growth restriction
placental abruption
fetal death
preterm labor
intrauterine passage of meconium

infants should be monitored for NEONATAL ABSTINENCE SYNDROME (uncoordinated sucking reflex = poor feeding, irritability, high pitched cry)

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4
Q

What is the definition of Small of Gestational age?

A

less than 1/3 percentile - less than 10th percentile

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5
Q

What is the current guideline for intrapartum antimicrobial prophylaxis against Group B Strep?

A

If the mother is in labor with ruptured membranes and one of the following is present:

  1. Previous infant w invasive GBS dz
  2. GBS bacteriuria during any trimester of the current pregnancy
    • GBS vaginal-rectal screening culture in late gestation
  4. Unknown GBS status at onset of labor or:
    - -delivery < 37 weeks gestation
    - -amniotic membrane rupture >18 hrs
    - -intrapartum temperature > 38C (100.4 F)
    - -intrapartum NAAT + for GBS
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6
Q

What are the components of an APGAR score?

A 
Appearance (skin color)
Pulse (heart rate)
Grimace (reflex irritability)
Activity (muscle tone)
Respiration
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7
Q

what is the Ballard Assessment tool?

A

uses signs of neurologic and physical maturity to estimate gestational age

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8
Q

What does it mean to have a term pregnancy?

A

born at >37 weeks gestation

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9
Q

What are 3 risk factors an infant is susceptible to who is small for gestational age?

A

Hypoglycemia
Hypothermia
Polycythemia

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10
Q

What 3 medications are routinely given to newborns?

A
  1. Intramuscular Vit K
  2. Hepatitis vaccine (HBIG if mother is + for HbsAg)
  3. Erythromycin, tetracycline, silver nitrate - for gonococcal conjunctivitis
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11
Q

What effect on the fetus can occur from a mother on anticonvulsants?

A 
Cardiac defects
Microcephaly, dysmorphic craniofacial features
hypoplastic nails, distal phalanges
IUGR
Mental retardation
rare: methemoglobinuria
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12
Q

Describe infant growth between birth and 4 months

A

Weight gain averages 20-30gram/day

weight typically doubles by 4 months (sometimes 3 months)

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13
Q

What are the 3 circumstances that “Failure To Thrive” describes?

A
  1. Weight falls below the 3rd percentile
  2. Weight for height/length falls below the 3rd percentile
  3. Rate of weight gain slows compared to previous growth (growth chart crosses two or more major percentiles)
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14
Q

What type of congenital heart defect:

neonate is born and initial physical exam is unremarkable. holosytolic murmur is heard on day 5 of life

A

Perimembranous VSD

  • -upper ventricular septum close to aortic/mitral valve
  • -left to right shunt occurs several days after birth when pulmonary vascular resistance decreases
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15
Q

What congenital heart defect causes a redundant tricuspid valve leaflet

A

Ebsteins anomaly

  • -hypoplastic right ventricle
  • -enlarged right atrium
  • -most patients also have an ASD
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16
Q

What is the disease:
5 year old with newly discovered cardiac murmur. elfin facies, mild retardation

what kind of cardiac defect?

A

Williams-Beuren syndrome - also HTN, short status

Bicuspid Aortic Valve

  • -aortic regurg
  • -aortic stenosis develops 40s-50s
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17
Q

How old is the child:
uses more than 50 words, follows two-step commands, engages in parallel play, stacks 5-6 blocks, turn pages in book, throw ball overhand, refer to themselves as “me” or “I”

A

2 years old

-uses two word phrases

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18
Q

how old is the child:
Child says “mama” and “dada” w meaning, follows one-step commands, shows objects to parents to share interest.
plays interactive games (peekaboo, waves bye bye). points to desired object

A

12 months

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19
Q

how old is the child:
10-25 words, names one picture on demand. engages in pretend play (feeding doll).
laugh in response to others, walk up steps, run, stack 2-3 blocks, use spoon, cup

A

18 months

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20
Q

what is dx:
3 year old male w 3 day hx of fever, fussiness, stiff neck, decreased oral intake. Hx shows Upper resp infection one week ago. throat gram stain shows gram positive orgnanisms.
Lateral neck radiography confirms dx

A

Retropharyngeal Abscess

  • -hx of upper respiratory, throat/ear infection
  • -may present w torticollis
  • -S. pyogenes, S. aureus
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21
Q

dx:
4 year old w fever, respiratory distress. toxic appearing, drooling, sitting upright, holding neck in hyperextension. pt rapidly develops stridor and cyanosis

A

Epiglottitis

–lateral neck = thumb sign

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22
Q

What is the caloric requirement for most
1. healthy babies
2. preterm babies
3. VLBW (very low birth weight) infants = <1500g
in the first 1 to 2 months of life?

A
  1. 100 cal/kg/day
  2. 115 to 130 cal/kg/day
  3. 150 cal/kg/day
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23
Q

when does an infant
1. double
2. triple
their birth weight?

A
  1. 5 months

2. 12 months

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24
Q

when does a child double their birth length?

A

4 years of age

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25
Q

For a 6 month old child what are the milestones for:

  1. gross motor
  2. fine motor
  3. language
  4. social/adaptive
A
  1. rolls over, sits unsupported, no head lag when pulled to sit from supine
  2. reaches for objects, looks for dropped items
  3. turns to voice, babbles
  4. feeds self, demonstrates stranger recognition (prelude to stranger anxiety)
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26
Q

For a 12 month old child what are the milestones for:

  1. gross motor
  2. fine motor
  3. language
  4. social/adaptive
A
  1. stands alone (many can walk well)
  2. Well developed pincer grasp
  3. mama, dada + 2 words
  4. hands parent book, points when wants something, imitates, plays ball w examiner
27
Q

For a 18 month old child what are the milestones for:

  1. gross motor
  2. fine motor
  3. language
  4. social/adaptive
A
  1. walks alone, may climb stairs/runs, can help undress
  2. drinks from cup/spoon, make tower of 2 cubes
  3. 6 words in vocabulary
  4. points to show what he wants, shakes head no
28
Q

A 7cm mass is palpated on the right side that does not cross the midline in a 5 month old. The child was born large for gestational age with macrocephaly, macroglossia, hypospadias.

what is the etiology?

A

Wilms Tumor - associated with Beckwith-Wiedemann syndrome = a genetic overgrowth syndrome

a/w omphalocoele, hemihypertrophy, hypoglycemia, large for gestational age, other dysmorphic features.

29
Q

What are 3 side effects of stimulant medication in a child with ADHD?

A
  1. decreased appetite
  2. insomnia
  3. decreased growth velocity
30
Q

What are the four criteria in the diagnosis of diabetes?

A
  1. HbA1c > 6.5
  2. fasting glucose >126mg/dL
  3. 2 hour fasting glucose > 200 mg/dL
  4. random plasma glucose > 200 mg/dL
31
Q

What are the screening guidelines for diabetes?

when do you start screening? frequency?

A

Overweight (BMI>85th, weight:height>85th, weight > 120% ideal for height)
+ 2 Risk factors:
1. fam hx
2. race = NA, AA, Hispanic, Asian
3. signs of insulin resistance
4. maternal hx of diabetes/gestational diabetes

Start screening at 10 yrs****–every 3 years

32
Q

What are the components of the HEEADSSS adolescent screen?

A 
H-home
E-education/employment
E-eating disorder screen
A-activities
D-drugs/alcohol
S-sexuality
S-suicide risk/depression
S-safety (fights, car, weapons)
33
Q

how does depression in adults differ than depression in adolescents?

A

Adult depression often includes early morning waking with difficulty sleeping at night

34
Q

What are the contraindications for a child against receiving a DTaP vaccination?

A
  1. serious allergic reaction/anaphylaxis after a previous dose
  2. encephalopathy within 7 days after dose
35
Q

6 year old with sore throat, painful swallowing

  • no cough
  • febrile
  • bilateral tonsillar hyperemia, edema
  • lymph node enlargement in the anterior cervical chain
  • diffuse, pimply sandpaper-type rash on trunk and extremities
A

Scarlatina = rash that appears w group A streptococcal infection

  1. fever
  2. tonsillar exudates
  3. cervical adenopathy
  4. absence of cough
36
Q

5 year old female with blood in underwear

  • multiple pathological fractures
  • tanner stage 2 breast development
  • multiple hyperpigmented irregularly shaped cutaneous macules
A

McCune-Albright syndrome
–GNAS gene
GnRH independent, peripheral precocious puberty from ovarian hyperfunction and cyst formation, episodic estrogen secretion
–unpredictable vaginal bleeding
–breast development w/o growth of pubic hair
–bone lesions - polyostotic fibrous dysplasia

37
Q

What congenital heart condition results in a persistent left superior vena cava

A

Total anomalous pulmonary venous connection

  • -cyanotic
  • -four pulmonary veins fails to make normal connection in left atrium and drain into systemic venous circulation
38
Q

What congenital heart condition results in a cleft anterior mitral valve leaflet?

A

ostium primum atrial septal defect

  • -clefts in anterior leaflet of the mitral valve
  • -a/w anomalies of the AV valves
  • -possible defects on the ventricular septum
39
Q

What congenital heart defect results in a biscuspid aortic valve and patent ductus arteriosus? neonate has recurrent epistaxis

A 
Coarctation of the aorta
a/w
--bicuspid aortic valve
--persistent ductus arteriosus
--ventricular septal defect
40
Q

What are the two most prevalent causes of acute otitis media?

A

Streptococcus pneumoniae

Haemophilus influenzae, nontypeable

41
Q

when should tympanostomy tube placement be considered?

A

Otitis media w effusion (OEM) for 4 months
+
hearing loss/documented language/developmental delay

42
Q

what are 5 alarming symptoms following vaccination?

A
  1. fever > 104F
  2. persistent crying > 3 hours within 48 hrs
  3. seizure within 3 days
  4. unresponsiveness of infant
  5. signs of severe allergic reaction
43
Q

What is the most likely inborn error of metabolism in a 2 year old that develops severe cutaneous photosensitivity?

A

Hartnup disease - decreased availability (transport) of tryptophan for niacin synthesis

44
Q

What is the most likely inborn error of metabolism in a 2 day old infant with severe metabolic acidosis?

A

Glutathione synthetase deficiency
–severe metabolic acidosis
+ jaundice
+ hemolytic anemia

45
Q

What will a coin appear like in a CXR if in the

  1. esophagus
  2. trachea
A
  1. facing you in AP

2. facing sagittal plane

46
Q

What immunologic abnormalities are found in ataxia-telangiectasia?

A

undetectable IgA levels
elevated IgM
normal IgG

47
Q

A child born to a diabetic mother has an absent Moro reflex on the left. left SCM appears to be in spasm. what is the cause?

A

clavicle fracture = absent moro reflex on affected side + spasm of SCM

48
Q

A 2 year old with 102.6F fever has a seizure. what should you tell the parents?

A

Simple Febrile Seizure = reassure parents

49
Q

What supplement is recommended for exclusively breastfed infants younger than 6 months?

A

Vitamin D

50
Q

what is the cause: 3 day old infant
large bump on head
scleral icterus, abdominal jaundice
swelling over parietal bone - does not cross suture lines

A

Cephalohematoma

51
Q

what is the cause: lethargic newborn
lump on scalp that is slowly growing
firm, fluctuant mass overlying the occiput which crosses over to the left parietal skull

A

subgaleal hemorrhage

52
Q

dx: 2 day old male
numerous small papular, and pustular lesions w surrounding erythema on the anterior chest and abdomen

skin biopsy: multiple eosinophils w/o microbial organisms

A

erythema toxicum neonatorum

53
Q 
How old is the child:
says "mama",  ball", "yes", "no", "hi"
turn pages in a book
greet people, show empathy
listen to story, drink from a cup
A

15 months

54
Q

what is the infective agent:
7 year old w low grade fever, headache, pruritic rash. Rash began on cheeks, spread to trunk and extremities. Physical exam shows maculopapular rash w lacy, reticulated appearance

A

Erythema infectiosum - parvovirus B19

55
Q

What is dz and defect?

Tall 10 year old, arachnodactyly, ligamentous laxity, pectus excavatum

A

Marfan syndrome - fibrillin

56
Q

what is the most appropriate step after suspecting intussusception?

A

air contrast enema

57
Q

What electrolyte abnormalities is most often seen in infants of diabetic mothers?

A

hypoglycemia
hypocalcemia
hypomagnesemia

58
Q

what is the dx?
1 month old with head circumference > 100th percentile. mother had no prenatal care. Macrocephaly w no other dysmorphic features. Transillumination of the head is positive.

A

hydranencephaly

59
Q

what is the etiology:

infant born w part of small bowel protruding from abdomen to the right of the umbilicus.

A

Gastroschisis

—involution of the second umbilical vein

60
Q

Identify the pathogen:
12 day old infant w bilateral eye discharge. conjunctival injection, lid swelling, scant mucopurulent discharge. no rashes

A

chlamydia trachomatis

61
Q

what is the cranial nerve affected:

1 month old presents w poor feeding, suckling difficulty. she had this problem since birth. pt has a cranial dysfunction

A

glossopharyngeal

62
Q

what is the pathogen:
5 year old w axillary lymphadenopathy. small wound on palmar surface of the third digit adjacent to the distal interphalangeal joint. Cultures are obtained resulting in growth on Warthin-Starry stain.

A

Bartonella henselae

63
Q

what is the dx:
6 year old male w painful oral lesions. had similar episode one year ago. multiple round, clearly defined, small buccal ulcerations w a grayish base that are tender to palpation. lips are normal without lesions. oropharynx is clear w/o erythema, exudate or tonsilar enlargement

A

aphthous stomatitis (canker sores)

64
Q

what is the best tx for osgood-schlatter disease?

A

ibuprofen

COMAT Exams (3 decks)

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