Pediatrics Flashcards
Normal RR and HR in Newborn
RR 40-60
HR 120-160
APGAR
A -appearance - blue all over, blue extremities, normal
P - pulse - <60, 60-100 or > 100
G - grimace - no response, grimace/feeble cry, strong sneeze/cough
Activity - no tone, some flexion, active movement
R - respiration - absent, weak/irregular or strong
**Assesses need for resuscitation at 1 min and response to resuscitation at 5 min
Newborn conjunctivitis
Give TOPICAL erythromycin, TOPICAL tetracycline and silver nitrate at birth
Depends on timing
- Day 1 irritation
- Day 1 to 7 - gonorrhea, treat with ceftriaxone (prevented by topicals)
- After Day 7 - chlamydia, treat with ORAL erythromycin (not prevented by topicals)
> 21 days -herpes, treat with acyclovir
8 National Newborn Screening Tests
PKU
CAH
Biotinidase
Beta thalassemia
Congenital hypothyroidism
CF
Galactosemia
Homocystinuria
Contraindications to Breastfeeding
HIV / HTLV-1
active Tb
Herpes of the nipple
Maternal use of drugs of abuse
Cytotoxic medication use by mom (methotrexate, cyclosporine)
Neonatal galactosemia
NOT HEP C
What is commonly associated with transient tachypnea of newborn? When should you be worried?
C - section because no birth canal to compress rib cage and remove fluid from lungs
Worry if lasts > 4 hrs - work up for sepsis (blood and urine culture +/- LP)
What is the most common cause of failure to thrive? What do you do?
Psychosocial deprivation
CPS
What vaccine is contraindicated if egg allergy?
Yellow fever
NOT flu or MMR
Vaccine Schedule
Hep B - birth, 1-2 months, 6-18 months
Rotavirus - 2, 4, 6 mo
DTAP, IPV - 2, 4, 6, 15-18 mo, 4-6 yrs
Hib, PCV13 (bacterial) - 2,4, 6, 12-15 mo,
MMR, Varicella - 12 mo, 4-6 yrs
Hep A - 12 mo then second dose shortly after
Meningitis, HPV, Tdap at 11 yrs old
Caput v. Cephalohematoma
Caput - superficial, crosses lines
Cephalohematoma - subperiosteal, does NOT cross lines
NO TX, both improve wks to months, can in bilirubin
CXR Findings in Meconium Aspiration Syndrome + Mgt + Risks
CXR - patchy infiltrate, coarse streaking of both lung fields, flat diaphragms
Mgt - ventilate, inhaled NO, surfactant if worsens (breaks down meconium), ECMO severe
Risks - post term baby
Elevated AFP
1 reason - wrong dates (check with US)
Associated with neural tube defects AND ab wall defect (omphalocele)
Which genetic disorder is omphalocele associated with?
Edwards (trisomy 18)
WAGR
Wilms tumor
Aniridia
GU malformations
Retardation
What is the most common heart defect in Down’s?
Endocardium cushion defect atrioventricular canal
Name 6 Cyanotic Heart Defects. Which are PDA-dependent? Which have accompanying VSD?
1 - tetralogy 2 - tricuspid atresia 3- transposition of great arteries 4 - truncus 5 - hypoplastic L heart 6 - total anomalous pulmonary venous return
Need PDA - transposition, tricuspid atresia and hypoplastic L heart (give prostaglandin E1)
VSD - tetralogy and truncus (holosystolic murmur at L lower border)
Turner Syndrome
Associated with coarctation
Short, webbed neck, shield chest, horseshoe kidney
What is Long QT associated with? How do you treat it?
Hearing loss
Family hx
Syncope
Tx = beta blocker, if multiple episodes consider ICD
How do vascular rings present? Dx and tx?
Respiratory sx that improve with neck extension
DiGeorge or Down Syndrome
“Noisy breather”
Dx - CT or MRI
Tx - surgical if symptomatic
5 Reasons Hyperbilirubinemia is Pathological
First day of life
Persists after 2nd week of life
Inc by more than 5 mg/dL/day
Total >19.5 in term baby
Direct > 2 at any time
Kernicterus (acute versus chronic)
Acute - sleepy –> hyper-reflexive –> fever, sz, coma
Chronic - CP, hearing loss, upward gaze palsy, dental enamel dysplasia
Most Common Esophageal Atresia + Most Common Complication
Blind pouch w/ distal TEF
Recurrent aspiration pneumonia - so give anaerobic antibiotics
CHARGE
C - coloboma of eye
H - heart defects
A - atresia (choanal)
R - retardation
G - GU defects (hypogonadism)
E - ear anomalies, deafness
VACTERL
V - vertebral anomalies
A - anal atresia
C - cardio anomalies
T - TEF
E - esophageal atresia
R - renal anomalies
L - limb anomalies
Antibiotics in Necrotizing Enterocolitis
Vancomycin + gentamicin + metro
Lead Poisoning Tx by Severity
Lead > 70 - IV dimercarpal, BAL
Lead 45-70 - inpatient oral succimer
Lead < 45 - outpatient follow up with lifestyle change
Findings in Infants of Diabetic Mothers
Hypoglycemia at birth because high insulin with no more mom’s glucose - shaking seizures
Macrosomia of all organs, polycythemia and hyperviscosity
Small left colon syndrome
Asymmetric septal hypertrophy
Renal vein thrombosis
Hypocalcemia, hypomagnesia
Hyperbilirubinemia - icterus
3 Types of CAH
21 hydroxylase - no aldosterone, no steroids, high testosterone so virilization in girls, hypotension and hyperkalemia
17 hydroxylase - HIGH aldosterone, low cortisol and sex hormones, so HYPERTENSION with HYPOKALEMIA, girls sexually normal at birth
11beta hydroxylase - same as 21 except have high 11-DOC which acts on aldosterone receptor so HTN and hyperkalemia + virilization
How do you treat Legg-Calve-Perthes?
Rest and NSAIDs
Then surgery on both hips because if one becomes necrotic then other is likely to later
Kawasaki Criteria and Tx
CRASH and Burn (fever 5 days)
C - conjunctivitis R - rash A - adenopathy (cervical) S - strawberry tongue (mucous membranes) H - hand/foot edema and erythema
Tx = IVIG and ASA (not steroids); prevent coronary aneurysm
Organisms and Abx of Neonatal Sepsis
Early - group B strep, E. coli, Listeria
Later - Staph, E. coli, Listeria
Tx = amp, gentamicin and cefotaxime
Retropharyngeal Abscess
Croup
Epiglossitis
Retro - beta hemolytic strep, deviated uvula, do CT neck, I&D + amp-sulbactam
Croup - positive steeple sign and inspiratory stridor, steroids or epinephrine
Epiglossitis - EMERGENCY, Hib infection so give ceftriaxone, INTUBATE because hypoxia is inevitable, thumbprint sign
Whooping Cough Tx
Erythromycin or azithromycin if in early catarrhal stage (congestion and rhinorrhea)
Juvenile Myoclonic Epilepsy
Seizures in the morning in adolescence
Irregular spike and wave on EEG
Tx - valproic acid
Infantile Spasms
Mixed flexor and extensor spasms during first year of life
75% associated with underlying CNS disorder (DS)
Tx - ACTH, prednisone, Vit B6, vigabatrin
Vit B5 Deficiency
Burning Feet Syndrome
UTI Mgt in Kids
First febrile UTI - renal US (look for hydronephrosis), if abnormal do voiding cystourethrogram for VUR
If pt has 2+ febrile UTIs - also indication for voiding cystourethrogram
If UTI persists despite treatment with antibiotics for 48 hrs - broaden antibiotics and do renal/bladder US
Tx - 3rd generation cephalosporins
Rett Syndrome
Regression of speech and loss of purposeful hand movements
Repetitive hand movements - writhing, flapping
Gait abnormalities
Alternating hyper/hypoventilation episodes
Associations w/ neuroblastoma
Abdominal mass
Opsoclonus-myoclonus
Periorbital ecchymoses from mets
