Pediatrics Flashcards
What is the normal respiratory and heart rate for a newborn?
- RR should be 40-60
- HR should be 120-160
How are Apgar scores calculated?
Graded for appearance, pulse, grimace, activity, and respiration (APGAR)
- 2 points are given for: normal color throughout, HR greater than 100, sneeze/cough, active movement, and strong respirations
- 1 point is given for: cyanotic limbs, HR between 60-100, grimace/weak cry, some flexion, and weak or irregular breathing
- 0 points are given for: diffuse cyanosis, HR less than 60, no grimace response, no activity, and no respirations
How should apgar scores be interpreted?
- they are a measure of the need and effectiveness of resuscitation and how no predictive value for morbidity or mortality
- at 1 minute, they evaluate conditions during labor and delivery
- at 5 minutes, they evaluate the response to resuscitative efforts
Describe the etiology, presentation, and diagnosis of retinoblastoma.
- caused by mutations in the tumor suppressor gene Rb on chromosome 13
- presents as a white reflex on ophthalmological exam
- do not biopsy these as there is a risk of seeding; instead, diagnosis is based on a dilated indirect ophthalmoscopic exam
What is the most likely cause of conjunctivitis in the newborn period?
- at 1 day, it is most likely chemical irritatoin
- from 2-7 days, it is most likely N. gonorrhea infection
- from 7-21 days, it is most likely C. trachomatis infection
- after 21 days, it is most likely herpes simplex infection
Describe the prophylaxis and treatment of conjunctivitis given to newborns.
- prophylaxis includes silver nitrate and topical erythromycin or tetracycline
- N. gonorrhea, usually seen at 2-7 days, is treated with ceftriaxone
- C. trachomatis, usually seen at 7-21 days, is treated with oral erythromycin
- Herpes simplex, usually seen after 21 days, is treated with acyclovir
Why do neonates suffer from vitamin K deficiency?
they have a sterile GI tract and breast milk contains very little vitamin K
All newborns should be screened for what eight diseases prior to discharge?
- PKU
- CAH
- CF
- B-thalassemia
- Galactosemia
- Hypothyroidism
- Homocystinuria
- Biotinidase
What is the best initial test for CF? What is the most accurate?
- best initial is a sweat chloride
- most accurate is a genetic analysis
What are three prophylactic steps taken in the immediate newborn period?
- silver nitrate and topical erythromycin or tetracycline for ophthalmia neonatorum
- vitamin K for bleeding prophylaxis
- hepatitis B vaccine
Which newborns receive hepatitis B vaccination and hepatitis B immune globulins at birth?
- all should receive hepatitis B vaccination
- only those with HBsAg-positive mothers should receive immunoglobulin
Which infectious disease are contraindications to breast feeding?
HIV, HTLV-1, active TB, and herpes lesions on the breast
What is transient polycythemia of the newborn?
a physiologic polycythemia presenting with splenomegaly and plethora caused by hypoxia during delivery which stimulates EPO release
What causes transient tachypnea of the newborn and how should it be evaluated?
- normally, compression of the rib cage during delivery helps remove fluid from the lungs, but cesarean may leave excess fluid resulting in tachypneic and hypoxic newborns
- this doesn’t require workup unless tachypnea persists for more than 4 hours
- at that time, blood and urine cultures should be collected for sepsis workup; add a lumbar puncture if there are neurologic signs like lethargy, temp irregularity, and feeding difficulties
In pediatrics, what is the best indicator if a child is over or under weight? What is the best indicator for acute malnutrition?
- over/under-weight: use BMI
- acute malnutrition: look for a weight/height ratio less than the 5th percentile
What is the most common cause of failure to thrive?
psychosocial deprivation
What is the best next step in management of underfeeding?
these cases must be reported to child protective services
How does being a preterm or low-birth-weight baby impact vaccination?
it shouldn’t; there should be no dose-adjustment and patients should be immunized according to their chronological age
How do previous vaccine reactions, acute illness, and family history of seizures impact vaccination?
- a reaction to a previous vaccination limited to fever less than 105F, redness, soreness, and swelling is not a contraindicaiton
- neither are a family history of seizure or current mild, acute illness in an otherwise healthy child
Egg allergy is a contraindication to which vaccine?
only to yellow fever
Infants should all receive courses of which vaccines?
- Hepatitis B
- Rotavirus
- DTap
- Hib
- PCV 13
- Inactivated poliovirus
When are live vaccines started?
MMR and varicella are not given until 1 year of age
When can influenza virus first be given?
at 6 months of age
What causes subconjunctival hemorrhages in the newborn and how should they be managed?
small hemorrhages are physiologic and caused by the rapid rise in intrathoracic pressure while the chest is compressed during delivery and no treatment is indicated
What is the most common skull fracture in the newborn? What is the most fatal?
- delivery is most likely associated with linear skull fractures
- but it can be associated with basilar which have greater mortality
What is the difference between caput succedaneum and a cephalohematoma? How does the management differ?
- caput succedaneum is a soft tissue swelling of the scalp and may cross suture lines
- cephalohematoma is a subperiosteal hemorrhage and thus won’t cross suture lines
- both will improve gradually without intervention
Describe Erb palsy and how it should be managed in the newborn period.
- it is an injury of the C5-C6 nerve roots commonly associated with shoulder dystocia
- it presents with waiter’s tip, an adducted, internally rotated, and pronated arm
- immobilization is the best treatment
Describe Klumpke palsy and how it should be managed in the newborn period.
- it is an injury of C7-T1 nerve roots and presents with claw hand and Horner syndrome
- immobilization is the best treatment
How should clavicular fracture be managed in newborns?
- diagnose with an x-ray
- immobilize and splint the injury and refer to PT
Under what circumstances is delivery likely to contribute to facial nerve palsy and how should it be treated?
- it is usually secondary to forcep use during delivery
- management consists of observation as most cases resolve without surgical intervention
What are two possible fetal causes of polyhydramnios?
- Werdnig-Hoffman syndrome and the inability to swallow
- intestinal atresias
What are two possible fetal causes of oligohydramnios?
- renal agenesis
- prune belly
What is prune belly and how should it be managed?
- it is a lack of abdominal muscles in newborns
- it often manifests as oligohydramnios since they are unable to bear down and urinate
- treatment is with serial Foley catheter placements
Describe the diagnosis and management of meconium aspiration syndrome.
- the diagnosis is suggested by meconium-stained amniotic fluid and respiratory distress
- CXR demonstrates patchy infiltrates, coarse striking of both lung fields, and a flattened diaphragm
- treat with airway management, inhaled NO, surfactant therapy, and ECMO depending on the severity
Describe the presentation, diagnosis, and management of necrotizing enterocolitis.
- the greatest risk factor is premature delivery
- it presents in these individuals with changes in feeding tolerance, abdominal distention, bilious vomiting, rectal bleeding, and diarrhea
- the best initial step for diagnosis is an abdominal x-ray showing pneumatosis intestinalis or hepatobiliary gas
- the best initial step for management is antibiotics: vancomycin, gentamicin, and metronidazole
- then make NPO with an NG tube; surgery may be required for perforation or failure to improve
What is an omphalocele and what other disease is it most associated with?
- it is a defect in which intestines form outside the abdominal cavity with a sac covering
- it is associated with trisomy 18
What is a gastroschisis?
a wall defect lateral to midline with intestines and organs forming beyond the abdominal wall without a sac covering
Which has a sac covering, gastroschisis or omphalocele?
omphalocele
Newborn umbilical hernias are strongly associated with what other disease? How should they be treated?
- strongly associated with congenital hypothyroidism
- they should be surgical corrected if they don’t resolve by age 4
Describe the presentation and diagnosis of a Wilms tumor.
- presents as a large, unilateral flank mass with hematuria and hypertension
- the best initial study is abdominal ultrasound but the most accurate is contrast CT
What are the features of WAGR syndrome?
Wilms tumor, Aniridia, Genital abnormalities, and mental/motor Retardation
Describe Beckwith-Wiedemann syndrome.
Wilms tumor, neonatal hypoglycemia, muscular hemihypertrophy, and organomegaly including the tongue
How are neurobalstomas diagnosed?
with increased VMA and metanephrines on urine collection
Describe the presentation and treatment of congenital hydrocele.
- it is a remnant of the tunica vaginalis
- presents with a swollen fluid-filled sac along the spermatic cords that transilluminates
- resolves within 6 months without intervention
What is the best initial test and what is the most accurate test for diagnosing varicocele?
- initial: physical exam
- accurate: ultrasound
How should cryptorchidism be managed?
all cases should be surgically corrected as soon as possible to maintain fertility and before 2 years of age to reduce the risk of malignancy
What are hypospadias and epispadias associated with?
- hypospadias with cryptorchidism and inguinal hernias
- epispadias with bladder exstrophy and urinary incontinence
Describe the moro reflex.
infants spread their arms symmetrically when scared
Describe the stepping reflex.
infants perform walking-like maneuvers when toes touch the ground
Describe the superman reflex.
infants arms go out when held facing the floor
What are the five etiologies for cyanotic congenital heart disease?
- tetralogy of fallot
- tricuspid atresia
- transposition of the great vessels
- truncus arteriosus
- total anomalous pulmonary venous return
Describe the etiology, syndrome, and presentation of Tetralogy of Fallot.
- it is due to an anterosuperior displacement of the infundibular septum
- this produces an overriding aorta, pulmonary stenosis, right ventricular hypertrophy, and a VSD
- presents as early cyanosis based on the degree of right ventricular outflow tract stenosis and relieved by squatting, a holosystolic murmur, and a boot-shaped heart on CXR
Why does squatting improve cyanotic spells in those with Tetraology of Fallot?
- the degree of cyanosis is dependent on the amount of right outflow tract stenosis
- squatting increases preload and afterload, which reduces the pressure gradient for right-to-left shunting