Pediatrics Flashcards
1
Q
Perinatal Mortality
A
Fetal Death between 20 weeks EGA to the 28th day post-delivery
2
Q
Prematurity (Pre-term Infant)
A
< 38 weeks
3
Q
Low Birth Weight (LBW)
A
< 2500gm ( Prematurity # 1 cause)
4
Q
Very Low birth weight (VLBW)
A
< 1500gm
5
Q
Risks for Low Birth Weight (LBW)
A
Maternal Age < 16 or >35 y/o
Low economic status
TOB/ETOH/Drugs/Rx
Unmarried, African American, Low Education
6
Q
APGAR test predicts long term outcomes and it is performed at what times
A
1 (Birth Toleration) and 5 minutes (Adapting to envir.)
Every 5 min. if score < 8
7
Q
APGAR stands for
A
- Appearance *Pulse
- Grimace *Activity
- Respiration
8
Q
Neonates respond to hypoxia w _____ rather than tachypnea
A
Apnea
9
Q
IV fluid bolus indicated for hypotension in Neonatal Resuscitation
A
10ml/kg NS or LR
10
Q
When is Narcan not given
A
If mother is narcotic or drug abuser or addict–> neonatal seizures
11
Q
When is fetal hemoglobin replaced by adult HGB
A
3-6 months
12
Q
Ductus arteriosus closes typically within ___ days
A
1 Day
13
Q
Ductus Arteriosus shunts blood from
A
Pulmonary Artery trunk to the aorta
14
Q
Foramen Ovale shunts blood from
A
R Atrium to Left Atrium Closes up 1st fetal breath
15
Q
Initial neonatal Nursing care
A
Erythromycin, Vitamin K, Hearing screen, and HEP-B
16
Q
Vitamin K in the neonate prevents
A
Hemorrhagic disease of the newborn MC breast fed pts
17
Q
Iron supplementation for breast fed infants begins at
A
4 Months of age ( 1mg/ kg/day)
18
Q
start vitamin D 400 IU/day to prevent
A
Rickets
19
Q
Changes seen in Vitamin D deficiencies infants
A
Craniotabes- Thinning of outer table of skull (feels like a ping pong ball to touch)
Thickening of wrists and ankles, Rachitic Rosary (Costochondral Junction Enlargement), Enlarged Ant. Fontanelle–> delayed closure
Bowlegs or knock knees
20
Q
<10% weight for age
A
Small Gestational Age (SGA)
21
Q
> 90% weight for age Associated w maternal Diabetes
BG< 45 mg/dL, jitteriness, seizures, lethargy, poor feed
A
Large Gestational Age (LGA)
22
Q
Large Gestational Age (LGA) Tx:
A
Oral feeding or IV D10W
23
Q
Score to ID abnormal growth patterns and predict neonatal complications
A
Ballard Score
24
Q
Enlarged anterior fontanelle/ sutures > 5 cm suggests
A
hypothyroidism
25
Term for closed fontanelles/sutures
Craniocynostosis
26
Leukokoria or white reflex can include which DO
Cataract, ocular tumor, chorioretinitis, retinopathy
27
Cyst or bulge at ant. Sternocleidomastoid muscle
Branchial cleft cyst
28
Cyst or bulge at Post. Sternocleidomastoid muscle
Cystic Hygroma
29
Cyst or Bulge anterior midline of neck
Thyroid d/o
30
Neonatal Exam
* Head fontanelle/suture *Eyes * Neck
* Clavicle Fx *Heart/Lungs * Pulses *Abdomen
* Umbilical cord * Hips * Penis/Vagina * UE/LE
31
Abnormalities of the Fontanelles/ sutures
* Closed sutures *Overriding sutures
* Caput Succedaneum * Cephalohematoma
Subgaleal hemorrhage
32
Less common newborn head deformity that does not cross the suture lines and resolves in weeks-months
Increases in size after birth 12-24 hrs. Can lead to jaundice from Inc. RBC breakdown
Cephalohematoma
33
Common newborn head deformity that crosses suture lines. Boggy edematous swelling of fetal scalp
Resolves in days. Disappears without treatment
Caput succedaneum
34
Rare newborn head deformity that crosses suture lines, beneath epicranial aponeurosis, extends to orbits
Pushes ears anteriorly. May have crepitus or fluid waves. Progressive may be massive
Subgaleal Hemorrhage
35
Subgaleal Hemorrhage Tx
Compression and resuscitate as needed
36
Neonatal Strabismus should resolve by what age
X 4 months
37
improper alignment appearance due to Epicanthal folds
Pseudostrabismus
38
A scaphoid Abdomen (sunken) in a newborn =______ until proven otherwise
Diaphragmatic Hernia
39
Umbilical cord inspection includes ____ artery____ vein
2 arteries (Deoxygenated) 1 vein (oxygenated)
| Falls off 3-4 weeks
40
Examiner adducts while applying post. pressure on knee. Test will dislocate hip.
Barlow
41
Examiner abducts the hip while applying ant. force on the femur, reduces the hip
Ortolani
42
Ligamentous laxity that can --> spontaneous dislocation and reduction of femoral head.
Left hip is affected 3x more than the right.
Joint capsule tightening, muscle contractures dec. motion, and flattening acetabulum. F:M 9:1
Congenital Hip dysplasia
43
Congenital Hip dysplasia Evaluation initial study
Ultrasound obtained after 6 weeks of age w laxity at birth
44
Congenital Hip dysplasia Tx
Refer to Peds/Ortho
* Pavlik Harness (Effective up to 6 mth age)
* Abduction Orthosis or Closed redux with spica cast
45
Newborn exam of the back for
Spine symmetry, Lumbosacral hair tuft (spina Bifida), Gluteal fold for dimples (malformation of spine)
46
Nodules resemble emerging teeth. on gum or palate. Harmless and resolve w/I few weeks of life
Epstein Pearls/ Bohn Pearls
47
occurs 24-48 hrs where infant skin sloths off (Normal)
Infant Desquamation
48
Chalky-white to gray mixture of shed epithelial cells, sebum, Keratin, and sometimes hair. common in preterms
Funx Unknown thought to protect and lubricate in womb
Vernix Caseosa
49
White, smooth papules (up to 2mm) on face and scalp. caused by epidermal pore occlusion w trapped keratin
Self limited within few weeks of life
Milia
50
Common in overheated/ febrile infants head, neck trunk, scalp. "Heat rash" correct overheating
Milia Rubra
51
Transient blue black pigmented macules. Lower back and buttocks. African American/Asians/ Indian
Fades over 1st several years of life
Mongolian Spots
52
Light-Dark brown sharply defined oval macules on any skin surface. > 6 macules > 5mm
Café-Au-Lait Macules
53
Café-Au-Lait Macules should lead you to evaluate further for what d/o?
Neurofibromatosis
54
Stork Bite (Nape of neck) or Angel Kiss (Forehead eyelids) Transient and benign.
Nevus Simples (Salmon Patch)
55
Caused by malformation of capillary bed. Persists throughout the patient's life
AKA "Port Wine Stain"
Nevus Flameus
56
Nevus Flameus present should lead provider to evaluate further for
Sturge Weber Sydnrome ( Trigeminal Distribution)
57
Pustules w erythematous base appearing 24-48 hrs post birth. Resolves in 14 days. On trunk or back.
Microscopic evaluation reveals esoinophils
Erythema Toxycum Neonaturum
58
Due to exposure of maternal estrogen. Appears 1st weeks of life or birth. Cheeks and scalp.
Self-limited
Neonatal Acne
59
Very common physiologic response to cold. Resolves w warmth. decreases w aging
Cutis Marmorata (Mottling)
60
Persistent Cutis Marmorata (Mottling) may indicate____
Hypothyroidism or vascular malformations
61
Seborrheic dermatitis or may be the 1st sign of Atopic Dermatitis
Cradle Cap
62
Medial deviations of the mid and forefoot
Metatarsus Adductus
63
Mid heel bisector line should go between toes ____ and ____
Should not gap at _______ MT with V finger test
Toes 2 and 3 Not Gap at base of 5th MT
Tx- Serial Castings
64
Inversion, adduction and plantar flexion of foot. Bilat 50% of cases.
Extrinsic-able to reduce on exam (Supple)
Intrinsic- Unable to reduce on exam (rigid)
Clubfoot (Talipes Equinovarus)
65
Occurs from incomplete development of the brain spinal cord or meninges
diagnosed during pregnancy 2nd trimester US or Maternal alpha fetal protein
Spina Bifida
66
Minor defect where hair tuft is present no neuro S/S. Check for connecting sinus or Inc. risk for meningitis
Spina Bifida Oculta
67
meninges herniates through neural arch.
Meningocele
68
Meninges and cord herniate through neural arch
Meningomyelocele
69
Open skin and spinal cord exposed
Myeloschisis
70
Spina Bifida is defined as
Meningocele, Meningomyelocele, Myeloschisis.
Any exposure besides hair tuft
71
Spina Bifida S/S and Tx.
Learning/ Mental disability, Paralysis, sphincter laxity, hydrocephalus.
Tx : Neurosurgery (Prevention = Folate)
72
A result of forceps used in delivery
Facial Nerve paralysis (Transient Drooping)
73
Associated w phrenic nerve lesion. Lesion C5-C6
Grasp present, Bicep flex absent. (Waiter tip Palsy)
Shoulder Dystocia typically resolves w PT and Observe
Erb-Duchenne's Palsy (Brachial Plexus Lesion)
74
Assoc. w Ipsilateral Horner's Syndrome (Symp. nerve injured). C8-T1 Lesion Grasp Absent, Bicep flex Pres.
"claw hand" (Rare Lesion)
Klumpke's (Brachial Plexus Lesion)
75
Increased volume in the CSF due to a communicating or Non-comm. w subarachnoid
Macrocephaly, vomiting, anorexia, irritable, papilledema bulging fontanel, Setting sun Gaze
Hydrocephalus
76
Hydrocephalus Tx
Ventriculoperitoneal shunt (Enlarged ventricle to Stomach)
77
Risk factors for neonatal sepsis
Prematurity
> 24hrs Ruptured membranes (Prolonged)
Group B Strep Colonization * Maternal fever
Amnionitis
78
Most common bacterias in Early onset neonatal sepsis
| (0-7 days old) Fast onset progresses quickly
GBS #1 E. Coli #2
Klebsiella Listeria
79
Most common bacterias in Late onset neonatal sepsis
| (8-28 days old) Insidious onset Assoc w Meningitis
H. Influenzae Staphylococcus
HSV CMV
80
Neonatal sepsis treatment
Ampicillin + Gentamycin (Or Cefotaxime)
Sepsis confirmed = 14 days tx Meningitis=21 days
(Negative culture = 48-72 hrs)
Add vancomycin if late onset or meningitis
81
caused by insufficient surfactant production by type II pneumatocytes. common < 34 EGA --> end respiration atelectasis.
Bilateral Ground-glass appearance
Respiratory Distress Syndrome
82
Respiratory Distress Syndrome preventive tx prior to delivery 32-34 wks
Maternal steroids
Post birth Tx intubationand Artificial surfactant via ET
83
caused by acute and chronic effects of O2 toxicity on developing retinal blood vessels
--> retinal detachment, neovascularization, fibrous prolif behind lens
Retinopathy of prematurity
84
Medulla and pons do not stimulate phrenic nerve
Tx:
Apnea of prematurity
Tx O2, Stimulant (Caffeine/theophylline),Tx anemia
85
High pitch or rattling/ noisy breath sounds. worsens w crying, coughing or feeding
If mild, Tx?
Tracheomalacia (Floppiness of cartilage wall)
Tx monitor
86
retained amniotic fluid causing mild hypoxia post-birth that resolves in 24 hrs. CXR shows fluid in fissures
MC LGA infants and C-section (No Pelvic squeeze)
Transient tachypnea of newborne
87
MC cause of hemolytic dz/ Neonatal anemia in newborns.
ABO Incompatibility #1 Rh Incompatibility #2
88
hyperbilirubinemia is defined as Bilirubin..? and MC cause
Bilirubin > 5mg/dL MC cause Hemolytic Dz
89
Jaundice from supply issue due to insufficient milk production or intake during 1st week of life
Breastfeeding Jaundice
90
Unknown beast milk factor inhibits Bilirubin conjugation or breast mil enzyme enhances bili absorption.
After 1st week of life. Infant must be healthy. Dx of exclusion
Breast milk jaundice
91
Physical evidence of jaundice begins at _____mg/dL
5-10 mg/dL
92
Term infant Bili Generally
< or = 12 on day 3
< or = 15 on day 5
< or = 13mg/dL in term infants Rise (.5/hr or >5mg/day)
93
Always pathological jaundice
Jaundice on 1st day of life (Hemolysis ABO/Rh) unconjugated
Conjugated= Hypothyroidism, Gilbert's or Crigler-Najjar, cholestasis, hepatitis, Cystic Fibrosis
94
Neonate physical exam for juandice
Prior siblings, Under tongue 1st to show then sclera
| Progresses from head-toe
95
Lipid-soluble, unconjugated indirect Bilirubin is toxic to developing CNS, deposited in brain cells. disrupts neuronal metabolism and fx
Not common in term infants in Bili of <20-25 mg/dL
Kernicterus (Bilirubin Encephalopathy)
96
Kernicterus (Bilirubin Encephalopathy) S/S and Tx
Lethargy, hypotonia, poor feeding, poor Moro, emesis Bulging fontanel, fever, paralysis, upward gaze, seizures
noticed after day 4 of life.
97
Kernicterus (Bilirubin Encephalopathy) Tx
Mild- Improve/ increase feeding. Exposure to sunlight
Mod- Phototherapy (Unconjugated only)
Severe- Exchange transfusion
98
HOV immunization indications
2-3 shot series given prior to exposure target age 11 as early as 9 (for 90% of Genital Warts)
99
Car seat rules for pediatrics
rear facing until the age of 2
Front facing booster car seat starting at age 2 until 4ft 9in ot 8-12 years of age.
< 13 y/o kids should be restrained in backseats.
100
unexpected death of an infant under 1 year of age that remains unexplained.
MC 2-4 mos Rare before weeks or after 6 mos
Sudden Infant Syndrome (SIDS)
101
Cause due to limited front leaning. First born and prematurity. Improves in 2-3 mos
No improvement by 4-6 months refer to craniofacial specialist.
Plagiocephaly
102
Premature closure of 1 or more cranial sutures.
Type of cranio deformity- Elective Sx @ 6 mos
Craniosynostosis
103
Feeding recommendations
0-6 mos solely breast or formula.
6 mos- start solids; Milk no earlier than 1 year o/a 2%
18-30 oz/day- No Honey or canned goods (Botulism)
104
Patterns of breast milk supply (mom)
Day 1 Colostrum
Day 2-4 Lactogenesis
Day 5 mIlk Present and fullness, leaking felt
Day 6 Brest should feel empty after feeding.
105
Diapers for well hydrated baby in general
6-8 wet diapers at least 4 loose stools a day.
Normal to not stool for 1 week in otherwise notmal appearing baby.
106
Vitamin D and Iron supplementation
Vitamin D if solely breastfeeding until 4 and begin Iron supplement at 4 mos
107
Important mom screen.
Postnatal depression scale 1st 6mths of life
108
toilet training begins at
2-3 Y/O
109
Delayed eruption of teeth
Check TSH and Ca2+/ Hypothyroid, hypopituitarism, rickets. (1st Central Incisor L=6-+2 U=7+- 2
No fluoride tooth paste before 2 y.o begin dentist @ 1 for q 6 mos
110
temporary GH deficiency and poor growth 2T psych abuse. In different psycho social environment --> thrive
Psychosocial Dwarfism
111
GH Rec. mutations, elevated GH serum, and decreased IGF-1, that is Autosomal Recessive
Prominent forehead, hypoplastic nasal bridge, delayed dentition, sparse hair, blue sclera, osteoporosis
Laron Dwarfism
112
Effected by GH Binding Protein (GHBP) -->tissues to produce ______ that attaches to cell membranes Rec.
---> productions of cellular changes and growth effects
Insulin Growth Factor-1
113
Once chronic disease and familial short stature is R/O then offer GH testing for pts who are
short < 5th percentile growth rate for age
Height projection based on bone age is below target
114
Normal routine labs for tests/ studies for failure to thrive
Karyotype (Down, Turner, Kleinfelter, IGF-1, IGF-BP3, Free thyroxine, Prolactine, Bone age, and cranial imaging
115
Failure to thrive definition
Weight is < 3rd percentile or decreases crossing two major percentile lines.
Weight < 80% of median weight for height.
116
Which FTT includes long standing malnutrition, chromosomal abn., congenital infx, teratogenic exp.
Has proportional weight , height/length, and head circumference.
Symmetric Type III
117
Which FTT includes deficiency of linear growth where head circumference is spared
caused by mos of malnutrtition.
Stunting Type II
118
Which FTT includes Deficiency in weight gain caused by malnutrition
Wasting Type I
119
Causes of FTT
2/3 Nonorganic causes (Abuse, neglect, Ignorance)
1/3 Organic (75% GI fistula, atresia Dz process)
120
COmplications of FTT
Malnutrition infection cycle
Refeeding syndrome- Phosphorus, K+, Ca+2, Mg+--> cardiac, pulmonary, and neuro life threatening problems
121
Single copy of genes is sufficient to express condition
(Only one parent required for gene to be expressed) Heterozygous or Homozygous
Autosomal Dominant D/O
122
Two copies of gene required to express a condition HomozygousX2 expression= 100% HeteroX2= 25%
Autosomal Recessive D/O
123
Chromo that carries 500 genes males more commonly affected 50% chance of transmission.
No- father-son transmission. All daughters of affected man will be carriers
X-linked D/O
124
Inc. RF of D/O w maternal age and inheritance. Decreased Moro Reflex, small head,
Up-slanting palpebral fissures, epicanthal folds, flat nasal bridge, small irregular ears, macroglossia, single palmar crease (simian), short mid 5th phalanx, short stubby fingers
Down-syndrome (Trisomy Chrmosome 21)
125
Types of Trisomy 21
Translocation - Part of 21 get stuck on some other chromo before replication
Mosaicism Only some cells in body have 3 copies. Individuals often phenotypically normal
126
Down syndrome Medical complications
Mental retardation- 100%
Hearing loss (SNHL)
cardiac anomalies (50%)- ASD or VSD -->Eisenmengers
Polycythemia (70%) Esophageal Atresia
127
The MC drug induced congenital defect. 3rd MC cause of MR. *ADHD, Smooth philtrum, thin upper lip, Ptosis
Railroad tracks ears (underdeveloped), growth retardation. microcephaly.
Fetal Alcohol Syndrome (X-Linked D/O)
128
Moderate to severe MR w above average memory for events and directions, *Autism, hyperarousal, handflap (sterotypy)
Oblong face, large testes,
Fragile X Syndrome
129
Short Stature, webbed next, shield chest (wide spaced nipple), Aortic Coarctation HTN, Triangular face,
Normal except visual-spatial skills and superior verbal skills. Hypothyroidism, DM I and osteoporosis
Turner Syndrome (45 XO)
130
Results from test deficiency. Hypogonadism, infertile, Gynecomastia 50%, diminished male pattern hair,
Tall feminine build (wide hips), low or normal IQ, Breast cancer 16-30 times, violent tendencies and MR. Prior to puberty, PT normal
Klinefelter Syndrome (XXY)
131
AD mutations in Fibrillin 1 Gene on chromosome 15. Aortic Dissection, Reduced Upper to lower body ratio
Arm span exceeds height, arachnodactyly, Lens dislocation,
Marfan Syndrome (Autosomal Dominant)
132
2nd MC autosomal trisomy. 95% abort in 1st trimester.
| <10% survive to 1 yoa 5% live past 1 YOA
Trisomy 18
133
3rd MC trisomy. usually fatal in 1st YOA 8% survive past 1. Aplasia cutis punched out scalp lesion
Trisomy 13
134
Trisomy 21 Tx and Dx
Chromosomal analysis parents/child
Tx: Hearing screen q 6mos until 3 YOA
Echo always, Ophtho q year by 6 mos OA
Annual Celiac screen and TSH/CBC
135
Fetal Alcohol Syndrome Dx and Tx
Early referral and prevention.
Multidisciplinary effort ADHD, Anxiety, and speech therapy. special ed
136
Turner Syndrome Dx and Tx
Dx- Direct Karyotyping if features seen
Tx- Echo, Cardiac MRI, and ECG
Endocrinology GH estrogen start at 14 YOA
137
Klinefelter Dx and Tx
Direct Karyotyping (Barr Body)
Tx- Testosterone replacement for hypogonadism
138
Marfan Syndrome Dx or Tx
Dx confirmed w FISH studies
Tx- Beta Blockers, restrict vigorous exercise, yearly aortic sonography, aortic root replacement.
139
newborn w hypothermia, acrocyanosis, resp. distress, large fontanelles, abd. distention, lethargy,
poor feeding, prolonged jaundice, constipation, dry skin, hoarse cry.
Congenital Hypothyroidism
Tx Levothryoxine (1st year started= good prognosis intellectual development is excellent
140
Inborne errors of metabolism
Phenylketonuria, Tyrosinemia, homocystinuria, Maple Syrup Urine Dz,
141
Consequence of severe liver Dz or response to ascorbic acid (Vitamin C). Accumulates metabolites
ID'd During neonatal screening
Tyrosinemia
142
Severe liver dz (hypoalbuminemia hypoglycemia bleeding d/o), Renal tubular defect, Liver carcinoma
Type I- Tyrosinemia
Tx- Nitisinone (Phenylalanine and Tyrosine restrict diet)
143
Hyperkeratosis of palms/soles and keratitis
Type II/III Tyrosinemia
Tx- (Phenylalanine and Tyrosine restrict diet)
144
Autosomal recessive involves connective tissue, brain and vascular system. Cystathionine B-Synthase Deficiency--> inc. AA
Lens Dislocation, lon-slender extremeties, malar flushing, arachnodactyly, scoliosis, MR, thromboses
Homocystinuria
145
Homocystinuria has increased____ and _____ AA in Connective tissue, brain and vascular system
Homocysteine and Methionine (Via Homocysteine reconversion)
146
Homocystinuria Tx
1st Pyridoxine and Folic Acid
2nd Methionine Restricted diet, Cystine and Folic Aid
147
Autosomal recessive profound CNS depression- poor feeding, vomiting, tachypnea, opisthonos, seizures
Rare except in Mennonites, manifests @ 1-4 weeks, Maple syrup odor urine
Maple syrup Urine Disease
148
Maple syrup Urine Disease Dx and Tx
Dx: Elevated Leucine, isoleucine, valine, alloisoleucine
Tx: Leucine restricted diet, Dialysis, tx cerebral edema
Liver transplantation.
149
Autosomal recessive uridyltransferase deficiency. when a neonate is fed milk--> Liver failure (hyperbili), coagulation and hypoglycemia.
Renal tubular dysfx (acidosis, glycosuria), cataracts, affected infants may die 1st week from E. Coli sepsis
Galactosemia
150
Galactosemia Dx and Tx
Dx: Quick neonatal screening time
Tx: Eliminate dietary Galactose
151
Galactosemia is caused by a deficiency of the enzyme
Galactose-1-phosphate uridyltransferase
152
Increased fructose 1 phosphate leading to emesis, hypoglycemia, severe kidney and liver disease.
Hereditary Fructose intolerance
153
Hereditary Fructose intolerance enzyme deficiency of?
Tx:
Fructose-1-Phosphate aldolase deficiency
Tx: Eliminate Fructose/sucrose from diet
154
Neonatal red flags post delivery
Maternal Polyhydramnios
Delayed Meconium Passage
Abdominal distention (obstruction)
Perinatal vomiting
155
cannot swallow amniotic fluid--> fluid cannot pass--> placenta cannot dispose--> polyhydramnios
Inc. Salivation, cough, choking, resp. distress, feeding worsens s/s, single umbilical artery.
Tracheoesophageal Fistula
156
Tracheoesophageal Fistula closely associated with other presentations such as
```
Vertebral anomalies (70%)
Limb anomalies (70%)
```
```
Anal Atresia (50%)
Renal Anomalies (50%)
```
157
Tracheoesophageal Fistula Dx-Tx
Failed OG tube pass
CXR OGT tube curled in esophageal pouch
Swallow study (Gastrografin contrast)
Tx=Sx (tube feeding until Sx)
158
Post prandial progressive, progressive non-bilious. Projectile vomiting*, ravenously hungry-> lethargy
Malnourishment and dehydration--> failure to thrive
hypochloremic/hypokalemic metabolic alkalosis, hypertrophy pylorus (Olive), thickened pyloris (sausage)
Barium= String sign (constricted pyloris channel)
Pyloric stenosis
159
Pyloric stenosis management
IV fluid resuscitation (D5W K+ Cl)
OG tube feeding until sx (Polyoromyotomy)
160
Usually unilateral (L side). progressive severe resp. distress post delivery. Scaphoid abdomen Hollow abd.
BS in left chest. Bowel develops before lung. Bochdalek Foramen MC. Posterolateral diaphragm
Congenital Diaphragmatic Hernia
161
Congenital Diaphragmatic Hernia Dx- Tx
Dx- X-ray (Bowels in L diaphragm
Tx- ET and respiratory support, OGT decompression
Sx- Definitive
162
Typically easily reducible, appear at 6 mos and disappear at 1 yoa.
Sx if persists 4-5 yrs or progressively larger after age 1-2 yrs
Umbilical Hernia
163
Intestines twist on themselves--> intestinal obstruction and mesenteric artery occlusion--> necrosis
Bilious vomiting 1st mth of life. 60%.. 40% infancy/child
Mid-gut volvulus
164
Failure of the intestines to rotate normally during development. predisposed to midgut volvulus
Intestinal Malrotation
165
Mid-gut volvulus/Malrotation Dx-TX
DX-Plain x-rays-Corkscrew effect volvulus
barium enema (cecum in RUQ=malrotation)
TX- Fluid resuscitation, OG decompression, Laparotomy
166
Polyhydromnios, failure at attempts to feed. Bilious vomiting, abdominal distention, jaundice
Double-bubble sign, long segments of bowel dilated
Intestinal Atresia
Tx- IV resuscitation, OGNG tube decompress, BSABX,Sx
167
Split/open stomach DT abd. wall defect. lat. median plane. Does not involve umbilicus. DT ischemia of wall
Intestines are exposed and bathed in amniotic fluid. --> exudative covering peel. Atresia common. prolonged parenteral nutrition
Gastrochisis-
Tx: Sx correction
168
DT growth of meso/Ecto-dermal of abd. wall. Intestines fail to return to the abd. during develop. -->
Bowel remains in the umbilical cord and covered by peritoneum and amniotic membranes. umbilical herniation
Omphalocele
169
Omphalocele is associated with what anomalies
Bekwith-Wiedemann syndrome (Cardiac)
170
This disorder is assoc. w Trisomy 21 (30%)
Malrotation (25%)
Anular Pancreas (20%)
Intestinal Atresia
171
Omphalocele and Gastrochisis management
OG/NG decompress, IV fluids, Parenteral nutrition
cover w sterile dressing dec, heat/water loss
<2cm =immediate sx repair >2cm = staged repair
172
May contain small patches of pancreatic/Gastric tissues. Ectopic gastric mucosa secretes acid--> ulcers
remnant omphalomesenteric duct and outpouching of the distal ileum. Mesenteric border of ileum.
Meckel's Diverticulum
173
Meckel's Diverticulum rule of 2s
```
2% of population
2 ectopic mucosae Gastric/Pancreatic
Presents by 2 years
within 2 feet of cecum
2 inches long
```
174
Massive painless GI bleeding, Ectopic gastric tissue--> mucosal ulceration of adjacent ileum. intuss/volvulus
Dx- Tx
Dx- Acid producing gastric mucosa in diverticulum
(technetium Scan)
Tx- Sx excision
175
Congenital aganglionic megacolon. failure of ganglion cells to migrate to distal bowel--> absent motility/Obstr.
75%=Rectosigmoid. proximal dilatation to segment. 95% no passage of stool 1st 24hrs w distention/Bilious vomit
Hirschsprung Disease
176
Hirschsprung Disease Dx and Tx
X-ray= Dialated proximal to affected segment
Barium enema= colonic impaction/Megacolon
DRE-Empty rectum/ Expulsion of retained stool
Tx- Colostomy of segment
177
Ischemia 2DT immature GI system. Assoc. w premies <34weeks. Breast milk reduces incidence.
Abd. distention, feeding intolerance, rectal bleeding, emesis, DIC/schock, bluish abd. discoloration
Necrotizing Enterocolitis (NEC)
178
Necrotizing Enterocolitis (NEC) Dx and Tx
Dx- Bowel loop thickening w Ileus and air-fluid levels.
Pneumatosis Intest.- Bacterial gas in SB lining
Dilated bowel intrahepatic venous gas/pneumoperi
Tx: Total parenteral nutrition. BSABX, Sx, IV fluid resusc
179
Telescoping of proximal bowel into downstream bowel
Peyer's patches- Meckel's Divert assoc., Rotavirus Ass.
Currant Jelly Stool*, RUQ pain sausage shaped mass, paroxysmal crampy pain, refuses feeding, draws legs
Intussusception
180
Intussusception dx and Tx
Dx- Pneumatic or contrast enema under fluoroscopy.
(No Barium if perforation)
Tx- IV Fluid Resusc., NGT, Pneumatic or contrast
enema under fluoroscopy: Resect Bowel
181
MC sx Emergency in children. Peak age 10-12 DT obst.
Less common <5yrs. Ruptures w/I 24 hrs.
RLQ pain (McBurney's), voluntary guarding-->Rebound tenderness w rupture/peritonitis)
Appendicitis
182
Alvarado/mantrels Rule.
Fever Nausea/Vomiting (x2)
Anorexia WBC shift.75% neutro
Rebound pain
Migration pain RLQ (x2)
183
Appendicitis Dx-Tx
Dx: Ct w Contrast, US, CBC, CMP
Tx: Appendectomy and IV Abx
184
Pt laying on his side and hip is extended is what test?
Psoas Sign
185
Pt laying supine and hip is flexed and is rotated is what test?
Obturator sign
186
Neonates may not have febrile response or may present with ___________
hypothermia
187
older infants and children <5 may have fevers up to
105 degrees (exaggerated febrile response)
> 5 YOA and Temp 105 = serious illness
188
fever over 14 days w/o ID etiology despite hx, PE and lab test or after 1wk of hospitalization.
MC cause=__________ Tx=Abx?
Fever of unknown origin
MC Cause= UTI
Tx <1mth=(Ampicillin/Gentamycin)
Tx 1-36 mos = Ceftriaxone or Cefataxime
189
presence of bacteria in bloodstream may be primary or secondary to a focal infx
Bacteremia
190
systemic response to infx w hyperthermia, tachycardia, tachypnea, shock (HYTN)
Sepsis
191
higher risk for serious bacterial infx
Fever in infant < 3 mths
192
All febrile infants < 4wks of age testing
hospitalization admission for empirical abx, pending culture Consider LP 3-36 mos w neuro signs. CXR if resp. , Stool WBC/Culture w NVD
193
Fever 3 mos- 3 years
Most viral infx
194
Antipyretics in children
Acetaminophen 10-15 mg/kg q 4-6 hrs
Ibuprofen 10mg/kg q 6 hrs (not before 6mos old)
NO ASA Reye's Syndrome (Mitochondria destoyed in liver)
195
Risk factors age <36 mos, Temp 102.2 , WBC > 15000, elevated ESR CRP
MC bacteria neonates=______
MC bacteria Infants/childrens= ______
MC Autoimmune =___________
Occult Bacteremia
```
Neonates= GBS
Infants/children= Strep pneumo, H influenza
Autoimmune= JRA (Juvenile RA)
```
196
fever w impaired splenic fx and preperdin-dependent opsonization. Incr. risk for bacteremia in 1st 5 yo life
Osteomyelitis (salmonella) Temp>= 104 WBC> 30 Abx empirically, blood Cx, close outpatient F/U
Sickle cell anemia
197
Systemic Inflammatory Response syndrome= two of the following
Temp < 98.6 or > 100.4
Tachypnea
HR > 90bpm or > 2 SD for age
WBC < 4K or >12K
198
Definition of sepsis
SIRS due to infx
199
Definition of severe sepsis
One or more end organ compromise
200
Definition of septic shock
severe infx w hypotension and hypoperfusion
201
Common to precede a URI s/s fever, headache, diplopia, vomiting. infants=poor feeding, restless,
bulging fontanelle, nuchal rigidity, seizures, sepsis, coma. fecal excretion persist for weeks w virus
Meningitis
202
MC virus for meningitis
| MC Bacteria for meningitis
Enterovirus/ Parechovirus- Herpes, Epstein, CMV
S. Pneumonieae or N. Meningitides (*Think Purpura)
203
Meningitis Tx-
Infants <2 mos= Ceftriaxone or cefotaxime + Ampicillin to cover listeria
1 month-13 yrs= Ceftriaxone or cefotaxime + Vancomyci
N. Meningitidis = 7 days
N influenza= 10 days (Dexamethasone)
S pneumoniae = 14 days
204
kernig and Brudzynski
Kernig's= Flat neck and cannot extend knee
Brudzinski's= Flex neck--> flexion of knees
205
Complications of Meningitis
SIADH (ADH--> Water retention and Hearing loss
206
Sore throat, fever, HA then lethargy behavior changes, neuro deficits, seizures common, macule/papule rash
usually resolves days-2-3 wks. MC virus entero/arbo/herpes (east/West Equine west nile)
Encephalitis (inflammation of Brain)
207
Lumbar puncture
Bacterial - Glucose < 40, Incr. pressure, incr. proteins and PMNs
Virus- Normal Glucose, Normal or slight pressure, Mononuclear cells
Fungal- Glucose <50, Incr. pressure, Mononuclear cells
208
Encephalitis Varicella zoster tx
CMV Tx
Bacterial
Varicella- IV Acyclovir
CMV- Ganciclovir
Doxy, Azithromycin, clarithromycin, erythromycin
209
Highly contagious. Paramyxovirus infx of URI. Infectious 1-2 days before onset. Secretion, Blood, UA
S/S 5 days prior, 4 days after rash. High fever: *Cough, *Coryza,* Conjunctivitis, Koplik spots. Macul,niar Rash head-caudal over 24 hrs. C-LAD, splenomegaly, AOM (MC), liver involvement adults
Measles (Rubeola) (Hard Measles)
210
Measles Dx-Tx
Leukopenia, PCR IgM Ab
| Tx-Supportive hydration and Antipyretics w/I 72 hrs
vaccinate MMR and Immunoglobulins w/I 6 days
Vitamin A for 2 days
211
Invades resp. epithelium. spread through nasopharyngeal secretions. Togavirus in springtime
Most Contagious 2 days prior until 5-7 days post rash.
LAD, pharyngitis, conjunctivitis, anorexia, HA, Erythematous macule papule face to body lasts 3 days
Rose-colored spots on palate, polyarthritis (hands adults) Paresthesias, tendinitis
Rubella (German Measles)
212
Rose-colored spots on palate AKA
Rubella Tx
Forschheimer Spots
Hydration and antipyretics
213
Rubella German Measles complications
In Utero= Blueberry muffin baby (No vaccine in Prego)
Deafness, Cataracts, congenital heart dz (infant sheds dz >12 mos)
214
Parvo Virus B19 high affinity to RBC--> anemias SC, Thalasemias, spherocytosis) resp. secret and transfuse.
3 stages 1. Slapped cheek 2. maculopapular rash 3. Stage 2 rash fades central clearing occurs "lacy rash" desquamation w bathing exercise, rubbing stress
Fifth's Dz (Erythema Infectiosum)
215
Fifth's Dz (Erythema Infectiosum) Dx-Tx
Dx-Hx-N-PE , IgM, PCR
Tx- Transfusions, Hydration/Antipyretics
IV Immunoglobulin w anemia and immunocomp
216
Infects mononuclear cells. Herpes HHV6-7. abrupt fever lasts 3-5 days. GI S/S, URI, red TMs, cough
High fever 3-5 days w/o findings. Defervescence of fever following rash. complications=hemophagocytosis
Roseola (exanthem Subitum)
217
Infects via conjunctivae or resp. replicates in nasopharynx and URT. contagious until lesions cursted
Peak age 10-14 YOA. late winter all lesion in same stage. pruritic rash teardrop vesicles--> crust heal.
Mortality incr. >20 YOA
Varicella
218
Varicella complications
Skin infx- Strep/staph
Pneumonia'
Reye's Syndrome (ASA)
219
Varicella Tx-
Symptomatic-Hydrate antipyretics
Valacyclovir-acyclovir (Not healthy) only severe risk
VZIG- immunoglobulin Neonatal ASAP
220
Acute neuritis w malaise and fever. 75% Occur>45 YOA recurrence of latent Dz
post herpetic neuralgia >1 month. CNV involvement branch or CN VII =facial paralysis Ramsay hunt w ear canal involved.
Zoster
221
Mouth pain, sore throat, refusal to eat/drink, febrile, NVD, abd. pain, 2-3 day fever Rt to school
oral, palm and sole ulcers. Dz lasts 10-14 days. virus shed for wks to months
Hand, foot, mouth Dz
222
Phase in adolescence where abstract thinking, experimentation, fantasy takes place. Identity concern
Strive for independence, high risk behavior.
Middle Adolescence Psych Dev
223
Phase in adolescence where things are concrete and gives little insight to questions.
Concern w normalcy and body changes. focused on present. Ambivalent to independence
Early Adolescence Psych Dev.
224
Phase in adolescence where there is formal concern for future: marriage occupation. commit to sex partners
separation anxiety from formal development stages.
Late adolescence Psych Dev
225
Interview pneumonic for adolescents
Home/ friends Diet
Education Sex
Alcohol Suicide/depression
Drugs
226
first sign of secondary sexual characteristics
Females: Thelarche (Breast development)
Males: Testicular enlargement
227
Onset of menarche is
12.2 -12.9 YOA African American 1st
| Obesity =Early thelarche peripheral Estrogen
228
Growth spurt
females = 1 year after thelarche
Males= 10-16
229
Tanner stage 1
<10 yo pre-pubertal no glandular tissue
| <9 yoa penis < 3 cm
230
Tanner stage 2
10-11.5 yoa female= Breast buds under areola
9- 11.5male/Female= Pubic hair straight and darkens
Testes enlarge
231
Tanner stages 3
11.5-13 yoa Female= Breast enlarge outside of areola
11-13 Male= Penis lengthens, pubic hair dark and curls
232
Tanner stage 4
female 13-15 yoa Areola protrudes, hair completely
Male 12.5-15 yoa Penis widens and hair fills completely
233
Tanner stage 5
female 14+ = Areola rejoins breast
hair fills in completely w thigh
Male= Developed complete w hair to medial thigh
234
secondary sex characteristics < 8yoa FEM <9 MALE
Hypothalamic activation prematurely. Pituitary-Gonadal
GnRH MC, or familial. tumors or Brain or pituitary controlled any condition affecting CNS** if thelarche/menarche or testicular growth** dominant
Precocious Puberty Central
235
secondary sex characteristics < 8yoa FEM <9 MALE
Gonad or adrenal tumors HCG secreting tumors pineal gland or hepatoblastoma. MRI adrenals
Congenital adrenal Hyperplasia males--> early penile growth. * Pubic/axilla hair, body odor, acne dominant
Precocious Puberty peripheral
236
MC cause of GnRH independent precocious puberty MC (girls > boys) ovarian hyperfunction--> gonadarche--> episodic estrogen secretion
hamartoma (B>G) non malignant that produces GnRH. bony DO w Café au-lait spots, Polyostotic fibrous dysplasia
McCune Albright Syndrome
237
Precocious Dx and Tx
Dx- Ct/MRI for central LH/FSH (Incr. in central low in Peripheral)
Tx- GnRH Analogues Suppress pituitary activity
(cease menses and growth velocity dec.) *Testolactone*
Peripheral= No GnRH response
Antiandrogens- blocks estrogen synth.
Antiestrogens - Tamoxifen
238
Untreated precocious puberty leads to
Short stature, closure of epiphyses
Recurrent ovarian cysts and hypopituitarism
239
No pubertal development by age 13= Fem 14=Mal
MC lack response to hypothalamic pituitary-gonad axis
Hypogonadotropic/hypergonadotropic?
Delayed onset puberty
240
Low FSH/LH secretion delayed onset puberty
Malnutrition, stress, or hypothyroidism
idiopathic or tumors
Hypogonadotropic (It is the Hypothalamus-Pituitary)
241
High FSH/LH secretion delayed onset puberty
| Turner syndrome, Klinefelter, Androgen Insensitivity, PCOS
Hypergonadotropic (It is the Gonads)
242
Female Athlete Triad
Eating disorder, irregular periods, low bone density
243
Dx Hypogonadotropic
Low FSH/LH
TSH, Prolactin, & head MRI
244
DX Hypergonadotropic
Karyotype (turner's or Klinefelter's)
245
Breast mass in young
US better for dense breast
Fibroedema or cyst MC
246
Leukorrhea peripubertal girls Tanner stage III clear w no odor or pruritis
Normal variant from ovarian estrogen stimulation of uterus and vagina (culture w/o speculum)
247
Menarche onset (MC complaint in adolescence )
2-3 years after thelarche irregular in 2-5 yrs persist= normal
after 1 tear of regular cycles, irregular bleeding= abnormality
248
Gynecomastia in Males
45-75% of boys. < 3cm= benign
If large, fixed or nipple DC= evaluate
W liver dz= Klinefelter's
Refer >17 yoa (Azoles and marijuana)
249
Primary Amenorrhea
- 16 yoa with thelarche and no period yet= bad
| - 14 yoa with no thelarche or period = bad
250
Secondary Amenorrhea
cessation of menses > 3 consecutive mos post menarche
251
MC causes of Secondary Amenorrhea
pregnancy, anorexia, stress, PCOS, Low FSH/LH estradiol.
| R/O thyroid, prolactinoma
252
Hirsutism, moderate-severe acne, menstrual irregularities, obesity and insulin resistance, polycystic ovaries (US)
2 of the following- Infrequent menses, hyperandrogenism, Polycystic morphology ovary US
Polycystic Ovary Syndrome
253
Amenorrhea Tx
Combo hormonal contraceptive
Hypothalamic low estrogen (Estrogen/progesterone combo)
PCOS- weight loss, exercise, progesterone withdrawal, combo estrogen progesterone.
254
Treatment for hirsutism
spironolactone
| metformin may restore ovulatory cycles w insulin resistant pts
255
pelvic pain in absence of pelvic pathology. 1-3 years post menarche, MC complaint in young women
inc. incidence to age 24. incr degeneration sof endometrium (Progest. declines)--> Inc uterine contract.--> ischmenmia and uterine pressure
Primary Dysmenorrhea
256
Menstrual pain assoc. w pelvic pathology MC caused by endometriosis or PID.
If outflow tract obstructed--> severe endometriosis soon after menarche
Secondary Dysmenorrhea
257
DX Tx of Dysmenorrhea
Outlet obstruction w US, PCOS w US, lLaparoscopy to dx endometriosis and PID Dx if Tx fails (Failed Therapy)
Tx= NSAIDS 2-3 days
NSAID Fail - Combo Estrogen/Progesterone (Depo or Implant) > 4 mos persist re-evaluate
258
Definition of obesity
BMI weight kg/height in meters=BMI - >95th%
Child < 7 yoa = maintain weight not loss
Child >7 yoa = 1 lb/mth until <85%
