Pediatrics Flashcards by Sarah Hogan

Normal RR and HR in Newborn

RR 40-60

HR 120-160

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

8 National Newborn Screening Tests

PKU

CAH

Biotinidase

Beta thalassemia

Congenital hypothyroidism

Galactosemia

Homocystinuria

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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)

How well did you know this?

Not at all

Perfectly

What is the most common cause of failure to thrive? What do you do?

Psychosocial deprivation

CPS

How well did you know this?

Not at all

Perfectly

What vaccine is contraindicated if egg allergy?

Yellow fever

NOT flu or MMR

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

Caput v. Cephalohematoma

Caput - superficial, crosses lines

Cephalohematoma - subperiosteal, does NOT cross lines

NO TX, both improve wks to months, can in bilirubin

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

Elevated AFP

1 reason - wrong dates (check with US)

Associated with neural tube defects AND ab wall defect (omphalocele)

How well did you know this?

Not at all

Perfectly

Which genetic disorder is omphalocele associated with?

Edwards (trisomy 18)

How well did you know this?

Not at all

Perfectly

WAGR

Wilms tumor

Aniridia

GU malformations

Retardation

How well did you know this?

Not at all

Perfectly

What is the most common heart defect in Down’s?

Endocardium cushion defect atrioventricular canal

How well did you know this?

Not at all

Perfectly

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