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Pediatrics > Pediatrics Exam 1 > Flashcards

Pediatrics Exam 1 Flashcards

1
Q

Medication delivery for pediatric patients

A

45 degree or greater angle for choking
Pill on back of tongue/Squirt in cheek past the pocket
Add chocolate/marshmallow cream
Play doctor
Tell them they HAVE to take it
Dose as few times a day as possible

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2
Q

Medication that causes non-bloody red stools

A

Cefdinir (Omnicef)

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3
Q

Current FDA and AAP regulations for pediatric OTC cough and cold medicines

A

No evidence of being safe under the age of 2 (3-6 years old were because of overdose)

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4
Q

Danger of using many OTC meds for pediatrics

A

Multiple ingredients per med can lead to accidental overdose

Look for meds with ONE ingredient

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5
Q

Correct doing for peds medicine

A

Use what came with the container to measure
Read directions and follow carefully
Use mL NOT tsp

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6
Q

Thing that you don’t think have aspirin that do

A

Pepto Bismol

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7
Q

When can antihistamines be started

A

6 months of age

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8
Q

Treatment for congestion in pediatrics

A

Pseudephedrine (Sudafed) - may have many side effects (sympathomimetic
1st line - Saline and suction

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9
Q

Delsym

A

JUST dextromethorphan
For dry hacky cough
NOT for productive coughs, CF, asthma
Cough suppressent
Robitussin is also but usually combines

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10
Q

Mucinex

A

Guaifenecin - helps with productive cough and can give with asthma and CF
Look for JUST guaifenecine

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11
Q

Reason for no honey under 1

A

Botulism grows in immature GI tract -helps with cough over 1

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12
Q

Times to suction baby snot

A

Before feeding, Before naps, As needed

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13
Q

Proper bedding for baby crib

A

Crib sheet and clothing, NOTHING else

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14
Q

Saline for Nasal congestion

A

Need two people to hold child in place
Nasal Bulb
Can supplement with a cold humidifier

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15
Q

Fever diagnosis in pediatrics

A

Need a rectal temp off 100.4+ or Axillary temp of 99.4+

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16
Q

Fever treatment in pediatrics

A

Tylenol can be given every 4 hours
Motrin/Ibuprofen every 6-8 hours (not for infants less than 6 months)
Lukewarm bath, don’t swaddle
Keep hydrated

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17
Q

Why do we treat fevers

A

Only for comfort!!

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18
Q

Motrin and Tylenol fever regimen

A

Alternate every 3 hours but Motrin alone is MOST effective

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19
Q

Pharmacokinatic differences in children

A

Immature kidneys and liver
Less GI absorption
Increased IM absorption
Limited protein binding
Increased BBB permeability
Increased Brain:Body ratio

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20
Q

Conversion from pounds to kg

A

Divide by 2.2

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21
Q

First questions to ask as soon as baby is born

A

Is it to term?
Is the baby the right size for gestational age?

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22
Q

Preterm baby

A

At or before 36 weeks and 7 days

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23
Q

Late preterm babies

A

34 weeks to 36 weeks and 7 days

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24
Q

Term infant

A

37 weeks to 41 weeks and 7 days

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25
Q

Post term infant

A

42 weeks or later - indication for delivery

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26
Q

Time of monitoring for late preterm babies

A

48 hours in addition to car seat challenge potentially
NO early discharge

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27
Q

Early discharge

A

Discharge within 24 hours

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28
Q

Carseat challenge

A

Baby in car seat with pulse ox for 1 hour to screen for apnea

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29
Q

Risks of Post term babies

A

Meconium aspiration and Pulmonary hypertension

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30
Q

SGA

A

Small for gestational age less than 10th percentile

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31
Q

LGA

A

Large for gestational age over 90th percentile

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32
Q

IUGR

A

Intrauterine growth restriction

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33
Q

FGR

A

Fetal growth restriction

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34
Q

Assymetrical FGR

A

Uteroplacental insufficiency or maternal malnutrition occuring in 2nd or 3rd trimester - less serious

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35
Q

Symmetrical FGR/IUGR

A

More serious - omore often caused by chromosomal abnormalities or other insult in the first trimester

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36
Q

Order in which things decrease in failure to thrive

A

Weight, Height, Head Circumference

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37
Q

Umbilical vein

A

Carries oxygenated blood from the placenta to the fetus

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38
Q

Ductus venosus

A

Bypasses the liver

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39
Q

Foramen Ovale

A

Allows oxygentated blood to bypass non-functional lungs

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40
Q

Ductus arteriosus

A

Allows oxygenated blood to by pass non-functional lungs

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41
Q

2 things that prepare the fetus for breathing

A

Increased production of surfactant
Decreased production of Fetal Lung Fluid and reabsorption

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42
Q

2 functions of increased oxygen level in newborn’s blood

A

Pulmonary vasodilation and Ductus arteriosus constriction

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43
Q

What closes the foramen ovale

A

Increased left atrial pressure

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44
Q

Stimuli that support respiratory adaptation

A

Thermal (drop in temp), Light, Sound, Tactile

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45
Q

3 things needed for newborn pulm gas exchange

A

Surfactant, Strong respiratory muscles, Clearance of pulmonary fluids

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46
Q

2020 updates to infant resucitation

A

Positive pressure ventilation rather than intubation for non vigourous babies with meconium
Umbilical vein is preferred vascular access
All births attended by one person who can perform newborn recussitation

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47
Q

Golden hour

A

Baby should have a full hour of skin to skin contact for the first hour of life

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48
Q

Three things to check at birth of baby

A

Term? Flexion of extremities? Crying?
If yes to all three - routine care, give to mother

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49
Q

5 steps of baby resuscitation

A

Check for labored breathing
Position and clear airway (suction nose first)
Place SpO2 monitor on RIGHT Pre-ductal blood) hand or wrist
Provide supplemental O2 as needed
Consider CPAP

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50
Q

MR, SOPA mneumonic for when positive pressure is failing for the baby

A

Mask Adjustment
Reposition
Suction (nose then mouth)
Open mouth
Increase pressure
Change Airway

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51
Q

Vital signs at which to start PPV

A

Apnea and gasping with HR under 100 bpm

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52
Q

Chest compression ratio for baby

A

3 compression for one breath with 90 compressions a minute

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53
Q

When to administer epinephrine for baby

A

HR below 100 beats perminute

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54
Q

3 Additional conditions to assess for if bay still does not respond

A

Hypoglycemia, Hypovolemia, Pneumothorax, Sepsis/Shock

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55
Q

Pulse ox immediately after birth

A

May not go right up to 90, depends on minutes of age
80-85% after 5 mins is normal
From 60, 5% per minute of life for first five minutes

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56
Q

Risk in post resuscitation baby

A

Seizure is common, monitor temp and blood glucose

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57
Q

Risk factors for newborn respiratory distress

A

In 7% of newborns
Includes: C-section, decreased gestational age, low birth weight, male, maternal asthma or gest. diabetes

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58
Q

5 ddx for neonate with respiratory distress

A

Transient tachypnea of the newborn, Respiratory distress syndrome
Sepsis
Meconium aspiration
Meningitis

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59
Q

Transient tachypnea of the newborn

A

Higher than normal respiratory rate
RR 30-60 bpm
More common in C section
Difficulty clearing lung fluid
Term or Preterm

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60
Q

CXR for TTN

A

Fissures and Perihilar infiltrates

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61
Q

Tx for TTN

A

Presents 2-72 hours of life
Pulse ox and CXR
Self limiting
DO NOT USE LASIX!!!

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62
Q

Meconium aspiration syndrome

A

Not in every meconium stained baby
Higher risk in post term infant
Caused by in utero stress/hypoxia

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63
Q

Dx for meconium aspiration syndrome

A

Meconium present inamniotic fluid or trachea
Bilateral fluffy densities with hyperinflation on CXR - white and hazy

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64
Q

Management for meconium aspiration

A

Dry warm and stimulate newborn
O2 if HR under 100bpm
CPR under 60 bpm
Standard resuscitation do not intubate immediately

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65
Q

Respiratory distress syndrome

A

Preterm babies
Severe symptoms leading to lasting impaired gas exchange

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66
Q

Dx ofrespiratory distress syndrome

A

Cyanosis with grunting tachypnea
Ground glass on CXR - hazy
Echo to rule out heart problems

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67
Q

Management for respiratory distress syndrome

A

Give corticosteroids prenatally
Intubation and sufactant administration
CPAP if less severe

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68
Q

Persistent pulmonary hypertension of the newborn

A

Occurs when pulmonary vascular resistance remains high after birth
Results in right to left shunting of blood via FO and DA
Hypoxemia results
Term or late preterm infants

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69
Q

Risk factors for persistent pulmonary hypertension

A

Meconium aspiration
Pneumonia
Respiratory distress syndrome
Aphyxia in utero, SSRI use by mother in 2nd half of pregnancy

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70
Q

3 mechanisms of persistent pulm hypertension

A

Vasoconstriction secondary to perinatal hypoxia
Prenatal increase in pumonaly vascular smooth muscle d/t meconium
Lung hypoplasia d/t diaphragmatic hernia

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71
Q

Dx for persistent pulmonary hypertension

A

ABG
Pulse Ox
Echo
Blood cultures
CXR

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72
Q

Management for persistent pulmonary hypertension

A

Goal to decrease pressure
O2 support
Nitric oxide/Slidenafil for vasodilation
Extracorporeal membrane oxygenation - ECMO if all fails

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73
Q

Neonatal hypoglycemia

A

Transient guidelines are 40+ for 0-4 hours and 45+ 4-24 hours, should be 60 after
Treat when symptomatic!!!

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74
Q

Risk factors for hypoglycemia

A

Infants in which to Screen!!
Infant of diabetic mother
LGA
SGA
Late preterm babies

Screening NOT required!!
Lebatolol or terbutiline exposure
Metabolic disorder

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75
Q

Symptoms of neonatal hypoglycemia

A

Broad spectrum
High pitched cry
Exaggerated Moro reflex
Lethargy
Seizures

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76
Q

Disease that can look like hypoglycemia

A

Sepsis - Screen for both

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77
Q

Screening for neonatal hypoglycemia

A

Screen if high risk in first few hours of life with a heel stick within first 4 hours
Preterm and late preterm
LGA
SGA
Diabetic mother

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78
Q

Confirmation for heel stick glucose

A

Serum glucose

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79
Q

Treatment for neonatal hypoglycemia

A

Give IV glucose if symptomatic
If asymptomatic can give oral glucose

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80
Q

When should physiologic hypoglycemia end

A

After 24 hours of life
Investigate for metabolic disorder otherwise

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81
Q

Physiologic neonatal jaundice

A

Pathologic if in first 24 hours
Between 1-4 days of life is normal

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82
Q

Risk factors for hyperbillirubinemia

A

Low gestational age
Jaundice in first 24 hours
Hemolysis
Phototherapy prior to discharge
Sibling with phototherapy
G6PD deficiency
Exclusive breastfeeding
Hematoma
Trisomy 21
Diabetic mother

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83
Q

High rate of billirubin rise criteria

A

rise .3 mg/dL/hr in first 24 hours and .2 mg/dL/hr after

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84
Q

Risk factors for neurotoxicity d/t jaundice

A

Gestational age under 38 weeks
Albumin under 3g/dL
Isoimmune hemolytic disease, G6PD
Sepsis
Instability in previous 24 hours

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85
Q

Diagnosis for hyperbillirubinemia

A

Assess every 12 hours until discharge
RcB or TSB 24-48 hours after birth or before discharge
TSB taken if TcB is within 3mg/dL of phototherapy threshold or if 15+mg/dL

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86
Q

Type of Billirubinemia in infancy

A

Unconjugated is normal, Conjugated is NEVER normal

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87
Q

Breast milk jaundice

A

Breast milk inhibits enzymes from processing billirubin, occurs in the first week and persists up to three weeks

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88
Q

Breastfeeding jaundice

A

Infant not receiving enough - need to supplement with formula
Failure to thrive seen in first week

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89
Q

Phase one of kernicterus

A

1-2 days after birth
Poor suck
High pitched cry
Stupor
Hypotonia
Seizures

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90
Q

Phase two of kernicterus

A

3-6 days of life
Hypertonia of extensors
Retrocollis
Fever
Opisthotonus

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91
Q

Phase three of kernicterus

A

7+ days of life
Generalized hypotonia

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92
Q

Rebound hyperbillirubinemias

A

TSB reaches threshold for age within 72-96 hours of phototherapy cessation
Preterm, PT at under 48 hours, and hemolytic disease are risk factors

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93
Q

When to d/c phototherapy

A

When TSB decreases by 2mg/dL below the hour specific threshold

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94
Q

G6PD deficiency

A

X-linked recissive disease
Common in African descent
Causes severe hemolytic crisis

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95
Q

ABO incompatability

A

Incompatability between mom and baby blood type causing jaundice
Can also happen with rh factor

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96
Q

Prevention for RH incompatibility complications

A

ABO and Rh testing on first prenatal visit
Antibody screening if RH negative and Rho-gam given
Optional injection at 40 weeks
Rho gam within 72 hours of delivery if + child of - mother

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97
Q

Newborn polycythemia

A

At risk for poor perfusion
Hematocrit over 65
Higher risk for hyperglycemia and hemolysis

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98
Q

Risk factors for newborn polycythemia

A

Delayed cord clamping
LGA
Larger twin of a pair

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99
Q

Findings for newborn polycythemia

A

Bloody stool
Renal failure
Red looking

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100
Q

Tx for polycythemia in newborns

A

Exchange transfusion for severe, symptomatic cases

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101
Q

Reasons to add condition to newborn screen

A

Cost effective, Simple, Reliable
Intervention can save lives
High frequency

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102
Q

Phenylketoneuria

A

PKU
Proetin metabolism error
Untreated leads to permanent brain injury
Lifelong restriction of phenylalanine -low protein diet
Stop protein intake

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103
Q

Galactosemia

A

Go into shock if given lactose because they cannot metabolize galactose
E. coli sepsis is galactosemia until proven otherwise

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104
Q

Neonatal hypothyroidism

A

Hard to catch early on - part of routine screening
Look at T4 and TSH

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105
Q

Baby hearing screen

A

Should occur in first month and be repeated within 3 months if failure of test

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106
Q

Congentital heart defect screening

A

Pulse ox of right hand and foot
Pass if 95%+ or <3% difference between hand and foot
If 90-95% recheck twice every hour if continues to fail after two hours - fails screen

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107
Q

Prenatal visit

A

Free courtesy of most pediatric offices - helps prospective parents “shop” for a pediatrician

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108
Q

Gravida

A

How many times pregnant

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109
Q

Para

A

How many times given birth (twins count as two)

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110
Q

When is a newborn given a Hep B shot

A

Within 12 hours of birth for ALL babies

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111
Q

Protocol for newborn with HBV positive mother

A

HBIG AND Hep B vaccine in opposite legs

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112
Q

Protocol for baby of HIV+ mother

A

antivirals within 6-12 hours

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113
Q

APGAR score interpretation

A

1-3 - Poor
4-6 - Intermediate
7-10 is good

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114
Q

Metrics of APGAR score

A

Activity
Pulse
Grimace
Appearance
Respirations

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115
Q

Activity APGAR scores

A

0 - Absent
1 - Arms/Legs flexed
2 - Active movement

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116
Q

Pulse APGAR scores

A

0 - Absent
1 - under 100bpm
2 - 100+ bpm

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117
Q

Grimace APGAR score

A

0 - Flaccid when aggravated
1 - Some flexion of extremities
2 - Active motion of extremities when aggravated

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118
Q

Appearance APGAR score

A

0 - Pale blue baby
1 - Blue extremities, pink body
2 - All pink

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119
Q

Respiration APGAR score

A

0 - Absent
1 - Slow irregular
2 - Vigourous cry

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120
Q

Normal infantile RR

A

40

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121
Q

Dubiwitz Ballard Exam

A

Helps to evaluate the gestational age of the baby
Lower score is younger

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122
Q

Flexibility and gestational age

A

Wrist bends back more, Knee comes back less, Arm goes over less arm recoil increases

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123
Q

Physical characteristics and gestational age

A

More wringles in foot when older
Lanugo hair appears in earlier term babies

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124
Q

When is an APGAR score done?

A

1 minute, 5 minutes, and every 5 minutes after that

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125
Q

Risk factors for SIDS

A

Brain birth defects
Low birth weight
Respiratory infections
Sleeping on stomach and side
sleeping on soft surface
Co-sleeping
Male sex
Second hand smoke
Overheating
Family history of SIDS

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126
Q

MC Age for SIDS

A

2-4 months old

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127
Q

Ways to prevent SIDS

A

Back to sleep
No pillows or blankets
Never overheat the baby
Separate crib from parents
Pacifier off and breast feed
Vaccinate

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128
Q

High pitched baby cry

A

Sign of abnormality

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129
Q

Low hoarse baby cry

A

Sign of hypothyroidism

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130
Q

Weak baby cry

A

Sign of illness/infection

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131
Q

Acrocyanosis

A

Not a cause for alarm - blue extremities
Blue body IS cause for alarm

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132
Q

Cutis marmorata

A

Lacy marbled
Okay in asymptomatic baby
Baby is usually cold - warm them
Common in downs syndrome

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133
Q

Vernix Caseosa

A

Waxy or cheesy covering after baby is delivered
Better not to wash off right away

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134
Q

Lanugo

A

Baby hair - more in earlier babies

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135
Q

Erythema toxicum

A

Red base papular rash common in newborns - no vescicles
Happens in 2-5 days
Caused by eosinophils

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136
Q

Acne neonatorum

A

Acne on newborn d/t maternal hormone exposure
Looks like acne and resolves on own
2-4 weeks of age

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137
Q

Milia

A

Epidermal cysts full of keratin
Epstein’s pear in mouth
Resolve in 2-4 weeks

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138
Q

Hemangioma

A

Vascular birth mark
Most common on face scalp, thorax
Dense blood vessels
90% gone by nine 70% by 7, 50% gone by 5
Remove if they block a major orifice
Massive ones can cause cardiac decomp
Check for one in airway

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139
Q

Nevus simplex

A

Stork bite
Red macule found on the nape of the neck
Non pathologic
Few persist into childhood

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140
Q

Nevus flammeus

A

Port wine stain
Starts light gets thick and corrugated
25% with an ophthalmic one will get Sruge Weber
Associated with vision problems, angiomas, glaucoma

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141
Q

Congenital dermal melanocytosis

A

Mongolian spot
Darkish blue birthmark on buttox and back
More common in dark skinned babies
DOES NOT change and can last for years

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142
Q

Cafe au lait spots

A

6+ if neurofibrimatosis
Okay if there are one or two

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143
Q

Hydrocephalus

A

Head gets bigger and bigger due to obstructions of flow or brain malformations
Sunsetting of eyes
VP shunt and serial head measurements to diagnose

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144
Q

Anterior fontanelle closure

A

9-24 months

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145
Q

Posterior fontanelle closure

A

2-3 months

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146
Q

Depressed or bulging fontanelle

A

Depressed = Dehydration
Bulging = Increased intercranial pressure - meningitis, tumor, etc

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147
Q

Caput Succedaneum

A

Cap on baby’s head covers multiple bones of the skull
Crosses suture lines
Resolves in 2-3 days
Under the skin - superficial

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148
Q

Cephalohematoma

A

Cap does not cover multiple bones
Well defined outline that does not cross suture lines
May be due to suction
Resolves in several weeks
Under periosteum - deep

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149
Q

Craniotabes

A

Thinning of the parietal bones in babies
Sensation of a ping pong ball
Worry about bone disease if not gone by a few weeks

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150
Q

Subgaleal hemorrhage

A

Serious but rare - blood accumulates between scalp and periosteum
Can fill with half the babies blood
Monitor BP, HCT, and for signs of hypovolemia
Same area as a cephalohematoma

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151
Q

Pierre Robin syndrome

A

Tiny jaw
Causes tounge blocking airway and preventing palate from fusing
Can’t breathe, cleft palate
Usually need a tracheostomy

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152
Q

Facial nerve palsy at birth

A

Usually goes away shortly after

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153
Q

Conjunctivitis treatment for newborns

A

Erythromycin to prevent chlamydia infection in eyes

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154
Q

Congenital cataracts

A

May indicate a metabolic disease

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155
Q

Newborn glaucoma

A

Baby in intense pain that does not open its eyes

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156
Q

Eye exams for babies

A

6 inches away from eyes for every visit during the first three years of life
Absent blunted or white reflex can mean glaucoma, cataract, or retinoblastoma

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157
Q

Leukoria

A

White response instead of red - red flag to ophthalmology could be a retinoblastoma - emergency

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158
Q

Dacryostenosi

A

Blocked tear duct - not emergent
Redness is normal
Massage 5 times a day
Refer if it won’t go away

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159
Q

Acute dacryocystitis

A

Tear duct in infected
Needs to be popped

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160
Q

Septal deviation

A

Can be due to birth trauma

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161
Q

Choanal arestia

A

Can’t breath when feeding
Use NG tube or wisp to test

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162
Q

Natal teeth

A

NOT baby teeth
Usually pulled immediately

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163
Q

Oral thrush

A

White, tender, cannot be scraped off, painful for baby to eat, Use nystatin

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164
Q

Normal ear level

A

Line at eyes should bisect ears

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165
Q

Preauricular pits of the ears

A

Small indentations that can be associated with kidney or other disease
Should have a hearing test

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166
Q

Coarctation of aorta pickup

A

Compare upper and lower extremity pulses

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167
Q

MC newborn fracture

A

Clavicle - we usually don’t fix it - heals on own in 6 months

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168
Q

Abdominal mass MC in kids

A

Kidneys

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169
Q

Diaphragmatic hernia

A

Abdominal contents move into chest - usually on the left
Surgery is required
Tachypnea, tachycardia, cyanosis
Concave abd with enlarged chest unilaterally

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170
Q

Umbilical cord removal

A

Clamp it and let it fall off - may wait a minute to clamp to give the baby more blood

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171
Q

Umbilical hernia

A

Often closes itself and does not need intervention
More prominent when baby cries
Black if strangulated (rare)
Intervene if it is 1-2cm or larger

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172
Q

Umbilical granuloma

A

Soft pink friable lesion
Treat with silver nitrate

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173
Q

Vaginal discharge in newborn females

A

Normal but scares parents - bloody
Labia may be swollen or bruised

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174
Q

Male gonadal exam in newborns

A

Confirm testicles are in the scrotum, foreskin cannot be retracted at birth
Baby must void before d/c

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175
Q

Syndactyly

A

Fusion of two digits

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176
Q

COngenital hip dysplasia

A

Head of femur does not fit into the hip well
More common in firstborns, multiples, FHx, Girls
Life long limp if missed

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177
Q

Hip exams for newborns

A

Barlow - Push down
Ortolani - Bend in
If you feel a click or clunck get an US

178
Q

Pavlick harness

A

Used for congenital hip dysplasia - holds hips out

179
Q

Sucking reflex

A

suck on something put in mouth ALL babies

180
Q

Rooting

A

Turn head to side of facial stimulation

181
Q

Palmar grasp

A

Grasp examiners finger by 28 weeks

182
Q

Babinski for babies

A

Big Toe bends BACKWARDS rather than forwards, toes fan out in kids under 2

183
Q

Moro reflex

A

Infant flails out arms when startled -drop a little

184
Q

Tonic neck reflex

A

Turn head to right extend right arm and leg - fencing position

185
Q

Stepping reflex

A

Baby takes steps when held upright

186
Q

Traction response

A

Head will lag when baby is pulled up to sitting

187
Q

Brachial plexus injury

A

Trauma during birth
Waiters tip sign
Most recover with observation

188
Q

Sacral dimple

A

Dimple over the sacrum
Study if really deep for abnormalities

189
Q

TORCH congenital infections

A

Toxoplasmosis
Other
Rubella
Cytomegalovirus
Herpes

190
Q

Consequence of earlier pregnancy infection

A

More growth abnormalities

191
Q

Clinical presentation of toxoplasmosis

A

Many infants have normal PE
Cerebral calcifications
Chorioretinitis
Small head w/ hydrocephalus
Hearing loss

192
Q

Screening criteria for toxoplasmosis

A

Mother with fever and swollen lymph nodes
Calcifications in baby brain
Hydrops of fetus

193
Q

Diagnosis of toxoplasmosis

A

Prenatal - Amniocentesis after 18 weeks
Post natal - Draw blood for ab titer, CT of head for calcifications

194
Q

Treatment for toxoplasmosis

A

spiramycin - Before 14 weeks
Pyramethamine and Sulfadiazine and Folinic acid - after 14 weeks

195
Q

Post natal treatment for toxoplasmosis

A

Treat even if we treated mom

Pyramethamine and Sulfadiazine and Folinic acid
For a year

Treat special needs

196
Q

Eye exams for toxoplasmosis

A

Eye exam every 3 months for first 18 months
Then every 6-12 months

197
Q

Toxoplasmosis prevention

A

Cook food
Wash fruits and veggies
Avoid cat litter
NOT a routine screen

198
Q

When is rubella the most problematic

A

First four months - 40% will loose the pregnancy

199
Q

Presentation of rubella

A

Blueberry muffin - petechiae/purpura
Cataracts
Cardiac lesions
Hearing loss
Small hands and head

200
Q

Rubella prevention

A

MMR vaccine

201
Q

MC congenital infection

A

CMV

202
Q

Risks with CMV

A

Greatest in first trimester but can cause problems in any

203
Q

Presentation of CMV

A

Leading cause of Hearing loss
Microcephaly
Hepatosplenomegaly and Jaundice
Petechiae
Intercranial calcifications

204
Q

Diagnosis of CMV

A

High suspicion
Can detect in urine/salive in 1st 3 months
CT scan shows intercranial lesions
Prenatal if caught in first 3 months

205
Q

Treatment for CMV

A

No approved tx
Gancyclovir and Valgancyclovir can decrease progression of symptoms

206
Q

Diseases that can be passed through breastmilk

A

HIV
CMV

207
Q

Birth to three

A

Service that will evaluate and infant and give services if they have 2+ deficits to qualify for it

208
Q

MC time for baby to present with herpes

A

5-14 days after birth
25-50% likelihood to get if mother has active herpes lesions

209
Q

Modes of herpes transmission

A

Before or DURING birth

210
Q

Clinical presentation of herpes

A

Skin vesicles
Ulcerations
Scarring eye damage
Organomegaly
CNS abnormalities - fever, irritability seizures
Before 36 weeks

211
Q

Diagnosis for herpes

A

Culture anywhere on the baby

212
Q

Treatment for herpes

A

IV Acyclovir - always add to prophylactic abx, stop if herpes is negative
2-3 days if positive

213
Q

Screening and prevention for herpes

A

NOT recommended
C section if active lesions within 4 weeks of delivery
Do not kiss the babies!!

214
Q

Percent of women with evidence of past herpes infection

A

30-60%

215
Q

Percent of herpes babies with no maternal HSV hx

A

75%

216
Q

VZV congenital infection

A

Usually only transmitted in the second half - more likely the later you are
Can also be transmitted perinatally

217
Q

Presentation of VZV

A

Zig zag skin scarring (cicatricial)
Cataracts/retinitis
Microcephaly and seizures

218
Q

Treatment and prevention of VZV

A

Vaccine available
Swab lesions to diagnose for IgG/IgM
VariZIG - prophylactic antibodies for postnatal exposure
Acyclovir

219
Q

Parvovirus B19

A

Erythema infectiosum
Fifths disease
Common in children - teachers and daycare workers are at risk

220
Q

Clinical presentation of parvo B19

A

Fetal anemia
Myocarditis
Hydrops fetalis
Fetal demise 3-6%

Older children get slapped cheeks rash

221
Q

Congenital syphillus infection before 2

A

MC’ly trans placental
100% passage to baby
40% result in abortion
Rash

222
Q

Clinical presentation of syphillis

A

Copious white/bloody snot
Big liver
Lymph nodes
Skeletal abnormalities

223
Q

Clinical presentation of syphillis after 2

A

Hutchinson triad: Interstitial keratitis, 8th cranial nerve palsy, scalloped teeth
Rhagades - cracks around mouth
saddle nose
Mullberry molars
Swollen joints bilaterally

224
Q

Diagnosis and Tx for syphilis

A

Blood titers compared to moms (baby’s should be 4x mom’s)
Evaluate any baby of mom with syphilis
PCN for 10 days and take titers

225
Q

% of kids showing syphillis in 1st 3 months

A

67%

226
Q

Congenital chlamydia

A

MC STI in US
Affects eyes and lungs
50-70% risk of passing during birth
Screened for with syphillis

227
Q

Presentation of congenital chlamydia

A

Bilateral conjunctivitis 5-14 days post delivery
Pneumonia

228
Q

Diagnosis of chlamydia

A

Swab nose and eyes

229
Q

Treatment for chlamydia

A

Erythromycin PO for 14 days

230
Q

Congenital gogrrhea presentation

A

Usually acquired during vaginal delivery
Purulent conjunctivitis
Scalp abcess

231
Q

Congenital gonorrhea screening

A

Multiple partners
Drug use
Commercial partners

232
Q

Treatment of gonorrhea

A

Single dose ceftriaxone for all mothers
Eye prophylaxis with ointment for all babies

233
Q

Ways HIV can be transmitted to baby

A

Transplacentally, in utero, breastfeeding
Transmission decreased by antiretroviral therapy to 1-2% from 13-39%
C section

234
Q

Diagnosis of congenital HIV

A

HIV DNA PCR at under 48 hrs, 2 weeks, 1-2 months, 2-4 months
Exclude after 4 months

235
Q

Tx for congenital HIV

A

Give antiretroviral if mother HIV+ for six weeks for prophylaxis

236
Q

Congenital Hep C

A

5% transmission rate
Dx by positive antibody test after 18 months
GI treats - interferon and ribavirin
IV drug use

237
Q

Congenital HPV

A

May present as hoarseness or stridor later in life

238
Q

Congenital Zika virus

A

Mosquito borne illness
Fetal growth restriction
Skull collapse w/ craniofacial disproportion
Eye and ear issues
Arthrogryposis - joint malformation

239
Q

Lab evaluation for ZIKA

A

serum and urine for ZIKA RNA
Head US for screening - cranial calcifications
No tx - prevent with mosquito nets

240
Q

Bacterial sepsis of the newborn

A

First 28 days of life
Ascending infection
Birth canal infection
Placental infection

241
Q

Presentation of BSNB

A

Group B strep is MC
Respiratory distress
Temperature drop
Don’t feed
Discolored

242
Q

Baby temp that warrants a full sepsis workup

A

100.4 or higher RECTAL!! and under 10 weeks

243
Q

Tx for newborn sepsis

A

Ampacillin and Cefotaxime OR Ampicillin and Gentamicin (ototoxic)
May use acyclovir

244
Q

Group B strep screen

A

Screen for group B step before delivery

245
Q

Prenatal disease screening

A

Syphillis
VZV
Rubella
HSV

246
Q

Acyanotic heart disease

A

Right heart gets extra blood leading to right heart failure
Shunt going from high to low pressure
ASD, PDA, VSD

247
Q

Presentation of acyanotic heart disease

A

Poor feeding, failure to thrive
Pneumonia-like symptoms
Eismenger syndromes - cyanosis, dyspnea, palpitations with exertion
Poor feeding - like a workout for baby

248
Q

Outflow obstruction acyanotic heart disease

A

Pulm stenosis
Aorta coarctation

249
Q

Presentation of atrial septal defect

A

Fixed split S2
Resp infections and failure to thrive
Palpitations, exercise intolerance, DOE in adults
Murmur gets louder with time

250
Q

Atrial septum development

A

Ostium primum - Hole in septum primum that closes
Foramen ovale forms in septum secundum

251
Q

Ostium secundum defect

A

Foramen ovale does not close - more common

252
Q

Ostium primum defect

A

Assoc with Down syndrome
More serious

253
Q

Cause of S2 split in ASD

A

More blood passing through pulmonary valve than normal

254
Q

Dx for ASD

A

TEE - Gold standard, CXR
Right heart cath with increased oxygenation in RA, RV, PA

255
Q

Tx for ASD

A

May close on own if asymptomatic (under 3mm)
May wait if large and okay - safer to wait longer as long as a reverse shunt does not happen
Percutaneous surgical closer

256
Q

VSD development

A

Two septums meet in the middle to form IVS - Membranous on top, muscular lower
Membranous is better
Muscular is worse

257
Q

Presentation of VSD

A

Right heart failure and PHTN
3-6 mm are usually asymptomatic - close by 2
Larger may need surgical repair

258
Q

Progression of VSD

A

Starts as a left to right shunt and becomes a right to left shunt which is worse (deoxegenated blood going systemic)

259
Q

Presentation of VSD

A

Holosystolic murmur - depends on size
Failure to thrive, tachypnea, and heart failure
May look like respiratory symptoms with negative swab

260
Q

Critical times for heart defect

A

Newborn and 4 weeks after birth

261
Q

Dx for VSD

A

RV Hypertrophy and LA enlargement on CXR/EKG - unreliable
Echo - MRI if nondiagnostic

262
Q

Tx for VSD

A

Most close on own
Diuretics
High calorie feeds
Repair by age 2 - earlier if over 8mm

263
Q

PDA

A

More common in females
Normally closes in the first week of life
Can be life saving in some conditions
May be related to rubella

264
Q

PDA presentation

A

Asymptomatic if small
Machine-like murmur - COntinuous
Exercise intolerance and HF
Lower extremities become cyanotic but not upper

265
Q

Shunt of PDA

A

Left to right with progression to right to left
Lower extremities become cyanotic but not upper because shunt occurs AFTER arteries feeding the head and arms

266
Q

Tx for PDA

A

Monitor if small
10-14 days, prostaglandin inhibitor
DIgoxin and Lasix for heart failure

267
Q

Surgical ligation for PDA

A

In babies under 5kg/11lbs.

268
Q

Presentation of congenital pulmonary stenosis

A

Right heart failure
Microangiopathic hemolytic anemia - schistocytes!!
Systolic ejection murmer increasing with inspiration

269
Q

Dx for pulmonary artery stenosis

A

CXR - normal heart size
Post stenotic dilation of PA
Echo - confirms diagnosis

270
Q

Tx for congenital pulmonary stenosis

A

Mild/Mod - No intervention
Percutaneous balloon valvuloplasty for severe cases

271
Q

Coarctation of the aorta

A

Often in females with Turner’s syndrome
Often with VSD or ASD as a leading cause of HF

272
Q

Coarctation of the aorta presentation

A

High blood pressure in upper extremities and low BP in lower extremities
20+mmHg difference indicates coarctation
Diamond shaped murmur
Lower extremity cyanosis
Delayed femoral pulse!!!

273
Q

Two types of coarctation

A

Preductal - Pediatric - Turner’s syndrome
Postductal - Adult coarctation (PDA closed) less symptomatic

274
Q

Side to check BP for aortic coarctation

A

Right side!!

275
Q

Diagnostics for Aortic coarctation

A

Angiogram
Rib notching 3 sign on CXR
LVH, LAE on EKG

276
Q

Treatment for artic coarctation

A

Prostaglandin to keep PDA open
Resection and anastomosis
Good prognosis with risk of later HTN and myocardial dysfunction
Testing prior to sports participation

277
Q

Presentation of congenital aortic stenosis

A

Diamond shaped murmur with a click during systole
LVH with Heart failure

278
Q

Dx for congenital aortic stenosis

A

Echo - choice
Valvuloplasty to treat
Ross procedure
Usually clear to participate in sports later in life

279
Q

Cyanosis that is concerning

A

Discoloration of entire skin and mucous membranes - look carfully in dark skinned babies

280
Q

Hyperoxia test

A

Give baby 100% oxygen. No change in pulse ox means their cyanosis has a cardiac etiology

281
Q

Tetralogy of falot

A

Pulm stenosis
Large VSD
Overriding aorta
RVH

MC cyanotic heart defect

282
Q

Presentation of tetralogy of fallot

A

Boot shaped heart on CXR
Shunt to left ventricle
Hypercyanotic episodes with anything that increases oxygen demand - TET spell!!
Squat reverses TET spell

283
Q

Tx for TET spell

A

Calm
Oxygen
Hydrate
Bicarb to decrease pulmonary resisitance, Phenylephrine, BB, Morphine

Surgical repair

284
Q

D transposition of great arteries

A

Two separate circuits
PDA or VSD needed for life
More common in males

285
Q

L transposition of great arteries

A

Ventricles are switched

286
Q

Risk factors for transposition

A

Diabetes
Rubella
Alcohol
Maternal age

287
Q

Presentation of TGA

A

Cyanosis with O2
Tachypnea
Acidosis
Pulse ox in lower extremities higher than in the upper extremities!!

288
Q

Dx for transposition of the great arteries

A

Echo
CSR triad: Egg on string heart, Lung congestion, Cardiomegaly
Presurgery angiogram

289
Q

Egg on string sign

A

Transposition of great arteries - narrow mediastinum like adults

290
Q

Tx for TGA

A

Prostaglandin short term for PDA
Septotomy - Short term
Surgical switch

291
Q

Hypoplastic left heart disease

A

Underdeveloped (small) left ventricle and ascending aorta
Must have ASD, VSD, PDA to live

292
Q

Presentation of hypoplastic left heart disease

A

Cyanosis
Resp Distress
Poor feeding and failure to thrive
Left heart failure
Cardiogenic shock
Death

293
Q

Dx for left heart hypoplastic disease

A

Echo
Cardiomegaly
LVH on EKG

294
Q

Tx for hypoplastic left heart disease

A

Prostaglandin short term to keep PDA
3 step surgery
Norwood, Bidirectional Glenn, Fontan
NO SPORTS

295
Q

Newborn murmur

A

First few days of life
LLSB without radiation
SEM
Resolves by one month

296
Q

Peripheral pulmonary artery stenosis

A

Normal branching of PA
ULSB back and axillae
Echo needed to determine whether benign or not

297
Q

Still’s murmur

A

Most common innocent childhood murmur
2-7 years
Apex and LLSB
Vibratory systolic
Loud when supine, gone when sitting

298
Q

Pulmonary ejection murmur

A

3+ years
Benign

299
Q

Venous hum

A

After age 2
Right infraclavicular area
Continuous and musical
Grade I-III murmur

300
Q

Supraclavicular carotid bruit

A

Brief and physiologic
Soft murmur
Aortic stenosis is below the clavicle!!

301
Q

New pregnancy category medication rule

A

Pregnancy lactation labeling rule

302
Q

Neonatal abstinence syndrome

A

Pregnant mother abused drugs - fetus is withdrawn
Cord blood sample for drugs to dx
Shaking of babies legs d/t withdrawal
Drug screen at first prenatal visit

303
Q

Anticonvulsant use in pregnancy birth defects

A

Small head circumference
Anteverted nares
Cleft lip/Palate
Distal digital hypoplasia

304
Q

Retinoid (Acutane) birth defects

A

40% miscarry
CNS malformations, heart defects, small or absent ears, TEF

305
Q

SSRI birth defects

A

Blinted neonatal abstinence syndrome
Irritable
DIarrhea

306
Q

Tobacco use birth defects

A

Placental abruption
Low birth weight
Inconsolable

307
Q

Fetal alcohol syndrome

A

3+ ounces per day
Short, poor head growth
Flat philtrum
Anteverted nostrils
Short palpebral fissure
Disruptive behavior

308
Q

Marijuana birth defects

A

Increased depression, hyperactivity, delinquency, impulsivity

309
Q

Opiate birth defects

A

Withdrawal
Low birth weight
IUGR
Prematurity

310
Q

Clinical presentation of neonatal abstinence syndrome

A

Shaking
Crying - high pitched
Convulsions
Check blood
Sweating/Fever

311
Q

Tx for neonatal abstinence syndrome

A

Morphine or Methdone - 1st line
Phenobarbital - Second line
Fentanyl - to calm down

312
Q

Finnegan score

A

Score to determine neonatal withdrawal
Score over 8 is concerning - check every 2 hours and cont. 24 hours after last score of 8

313
Q

Tx for mother with opiate abuse

A

Put on methadone (better for mom), suboxone, subutex (better for baby)

314
Q

Immunizations CI in pregnancy

A

MMR
Chickenpox
Flu Mist
Oral Polio
These are LIVE vaccines

315
Q

3 Triploidies

A

13 - Patau
18 - Edwards
21 - Down

316
Q

Quad screen

A

Done for congenital disease:
Beta-hCG
AFP
Inhibin A
Estriol

317
Q

Down syndrome facts

A

Trisomy 21
40% have heart defect
Females are fertile
Risk shoots up at 35

318
Q

Presentation of down syndrome

A

Hypotonia
Thick, corrugated tongue
SINGLE palmar crease
Upslanting palpebral fissures

319
Q

Down syndrome disease to watch for

A

Hypothyroidism
Celiac
Polycythemia
Congenital heart disease

320
Q

Down syndrome quad screen of mom results

A

Low: AFP and Estriol
High: hCG and Inhibin A

321
Q

Mom’s for whom quad screen is recommended

A

Fam hx of birth defects
35 years+
Used harmful drugs during pregnancy
Have diabetes and use insulin
Viral infection during pregnancy
Exposed to radiation

322
Q

Quad screen results for turner syndrome

A

Decreased: AFP and Estriol
Very High: Inhibin and hCG

323
Q

Quad screen results for Edward’s syndrome

A

Normal: AFP and Inhibin A
Low/Very Low: Estriol and hCG

324
Q

Quad screen results for Patau syndrome

A

Increased: AFP
Normal: Estriol, hCG, Inhibin A

325
Q

Tx for Down

A

Screen for autoimmune disorders
Speach therapy and other similar support
Immediate Echo for baby

326
Q

Chance of trisomy 21 at 45

A

1 in 30

327
Q

Trisomy 18 presentation

A

Edwards syndrome
Only 2% live a year
50% die in one week
Clenched fist
Rocker bottom feet
Small jaw and short neck
VSD - MC defect

328
Q

Tx for Edwards syndrome

A

Support
Termination of pregnancy
10% die in first week

329
Q

Trisomy 13

A

40% survive a week
Abnormality of every organ system
Small head
Absent skin on scalp
Cutis aplasia
Polydactyly
Cleft lip/Palate
Malformed ears

330
Q

Gender of unique trisomies 18 and 13

A

More common in females

331
Q

Kelinfelter syndrome

A

Y chromosome with additional X’s
More X’s more intellectual impairment
MCC of genetic male hypogonadism
1 in 1,000

332
Q

Presentation of kleinfelter syndrome

A

Lower IQ
Tall
Gynecomastia
Normal pubic hair but no growth of penis and testes
Infertile

333
Q

Tx for kleinfelter’s

A

Testosterone replacement
Dx via genetic testing

334
Q

Turner syndrome

A

Single X chromosome
95-99% abort spontaneously
Third diagnosed in infancy, childhood and adulthood respectively

335
Q

Presentation of turner’s syndrome

A

Webbed neck
Short
Shield chest w/ wide nipples
Coarcation of aorta
Horseshoe kidney

336
Q

Development in turner’s syndrome

A

10% MAY have normal pubertal development
Estrogen needed for secondary sex characteristics, GH for height
High risk of Aortic dissection

337
Q

Inheritance pattern of Marfan’s syndrome

A

Autosomal dominant
Mutation in Fibrillin 1 gene on 15

338
Q

Presetation of Marfans syndrome

A

LONG arms
Tall long face
Pes excavatum
Lax joints
Eye and Heart problems
Flat feet
Scoliosis

339
Q

Heart problem that people with Marfans usually die of

A

Progressive dilation of the aortic root

340
Q

Ghent criteria

A

Calculate score for risk of Marfans

341
Q

Tx for Marfan’s syndrome

A

Serial echos with surgery once aorta reaches 5.5cm
Losartan to slow dilation
Eye exams
Exercise restriction

342
Q

Fragile X syndrome

A

MC inherited cause of mental disability in males
FMR1 gene is responsible

343
Q

Presentation of fragile X

A

Impulsive
Bid ears
Large testicles
Hyperextendable joints
Mitral valve prolapse
Developmental disorders

344
Q

Tx for fragile X

A

Counseling for behavioral problems

345
Q

Cystic fibrosis

A

Autosomal recessive
MC Genetic life-shortening disease in caucasians
39 years median survival
Everything is sticky - can’t move chloride around
Salty babies

346
Q

Complications of cystic fibrosis

A

Respiratory tract infection
Volvulus/Intussusception
Digital clubbing

347
Q

Common colonization organisms in CF patients

A

Staph aureus
H flu
Pseudomonas aruginosa

348
Q

Dx for CF

A

Positive sweat chloride test - over 60mmol/L
Uses pilocarpine to stimulate secretions

349
Q

PKU

A

Autosomal recessive
Must be on a protein restricted diet
Detected in routine newborn screening
Musty/Mousy odor to urine in untreated

350
Q

4 things that can cause cleft lip/Palate

A

Radiation exposure
Viral infections
Metabolic abnormalities
Teratogens

351
Q

Presentation of cleft lip/palate

A

Teeth come in weird
Can visualize on 2nd trimester US
High dose folic acid can prevent

352
Q

Tx for cleft lip plate

A

Special feeder
Surgical closure by 12 months
Speech therapy
Dental healp and tx of ENT infections

353
Q

Duchenne muscular dystrophy

A

X linked recessive - more common in males
Elevated CK and calf hypertrophy
Muscle biopsy
Gowers sign - weakness of proximal extremities
Death by early 20s

354
Q

Ehlers Danlos

A

Autosomal Dominant
Like Marfans with fragile skin
Hypermobile joints
Aortic aneurism and spontaneous pneumothorax are complications
Weird scars

355
Q

Beighton Scoring

A

Assessment for E-D hypermobility of joints
9 Points total for:
Pinky
Thumbs
Elbows
Knees
Spine -one point only

356
Q

Brighton scoring

A

Major/Minor criteria for ehlers-danlos
Major criteria are - Beighton score of 4+ and Arthralgia 3+ months for 4+ joints

357
Q

Management of Ehlers Danlos syndrome

A

Avoid contact sports
Treat comorbidities

358
Q

Recommendation for how long baby should be breast fed

A

6 months at least is ideal

359
Q

Putting the baby on the breast

A

Done in the first 10 minutes
Helps uterus contract

360
Q

Frequency of breastfeeding

A

8-12 times per day - first week

361
Q

How long should baby nurse

A

5 mins per breast on 1st day
10 min per on 2nd day
10-15 min per day after that

362
Q

Baby weight during first week

A

Drops and then returns to birth weight in the first week

363
Q

Expected weight gain in first weeks

A

Half ounce to one ounce per day

364
Q

Expected weight gain over the first year

A

Double in 5 months
Triple in a year

365
Q

Calories an ounce in breast milk

A

20 cal/ounce
Has calcium, Iron and zinc
Has antibodies
NO VITAMIN D

366
Q

One nutrient not in breast milk

A

Vitamin D - Must supplement

Not a lot of iron - may need to supplement

367
Q

Contraindications to breastfeeding

A

Small breast size is not an issue
Breast augmentation/reduction may be an issue
TB, HIV, Chemo, Galactosemia

368
Q

Cautions for breastfeeding

A

Breast herpes
Hep B
Drug abuse
Over 3 oz alcohol
Lithium or Methotrexate use

369
Q

Breastfeeding jaundice

A

Baby not getting enough milk - dehydrated with jaundice
May see clogged breasts or engorged ducts in mother

370
Q

Milk protein allergy baby

A

Eczema and bloody poop

371
Q

Hydrolyzed formula

A

Protein broken down
Indicated for milk protein allergy and colic

372
Q

Amount of formula a baby should have

A

2.5 times it weight in ounces

373
Q

Recommended time for introducing solid food

A

6 months - when the baby can sit up so they do not aspirate

374
Q

3 stages of baby food

A

Stage 1 - One fruit or vegetable
Stage 2 - Two foods
Stage 3 - Different textures

375
Q

When is a baby ready for solid food - milestones

A

Baby can sit up and support head
Does not reject spoon put into its mouth

376
Q

Milk to Food regimen

A

100% liquid at 6 months
25% liquid at 1 year

377
Q

Introduction of some chewing food

A

7-9 months - instinct to chew
Don’t get all of teeth including molars until 18 months

378
Q

Pincer grasping in children

A

Begins around 8-9 months - table food

379
Q

When do we see a food allergy reaction

A

The SECOND time the baby is exposed

380
Q

When should allergens be introduced

A

Before 6-12 months

381
Q

When does the baby stop breast feeding

A

Generally around 1
Don’t breast feed during the night
Over 1-4 weeks give cup

382
Q

Whole milk use in baby

A

NOT introduced before 1 year to avoid anemia - specifically iron deficiency
Stay on whole milk until 2
Don’t need very much

383
Q

Skim milk and babies

A

Don’t give until age 2 - transition to lowest fat milk

384
Q

Appetite change at 1

A

Drops as growth slows
May not eat anything some days
Don’t force to eat

385
Q

2+ years nutrition

A

High fiber
No TV
Avoid candy, fatty foods, juice, etc.

386
Q

WIC

A

Women Infant Children Program in WV
Helps mothers get good nutrition for babies

387
Q

Colic

A

Piercing cry 3 hours a day for 3 days a week for 3 weeks or longer

388
Q

Presentation of colic

A

Excess crying
Red face
Knees up to chest
Excess gas
Clenched fists

389
Q

Tx for colic

A

Hydrolyzed protein
Rhythmic movement suggested
Educate pt. about overfeeding
Reflux drug
Avoid abuse

390
Q

Bronchiolitis

A

Wheezing, lower airway disease in any child under two - over two is asthma, upper resp is croup

391
Q

MCC of bronchilitis

A

RSC 50-85% of cases

392
Q

Presentation of Bronchiolitis

A

Upper airway infection that moves to the lungs
First time wheezers
Spring/Winter onset
Increasingly fussy
Resp distress

393
Q

Dx for bronchiolitis

A

Clinical
O2 and NP swab
No CXR needed

394
Q

Tx for bronchiolitis

A

Supportive care
Nasal suction with saline - improves hospital course
NO steroid/abx
Watch for signs of sepsis
Should improve in 5-7 days with some lingering cough/wheezing

395
Q

Hospitalization for bronchiolitis

A

Persistent hypoxemia below 92%
Toxic appearing
Apnic spells - may be the only sign in infants
Lack of support at home

396
Q

Hospital management for bronchiolitis

A

High flow O2 or CPAP
Suction!! - with saline
Fluids
Ribavirin sometimes used for immune compromised

397
Q

Discharge criteria for bronchiolitis

A

RR under 60 for under 6 months
Stable on RA
Caretaker able to provide suction
Adequate oral intake
Afebrile for 24 hours

398
Q

3 Things to avoid in bronchiolitis

A

Albuterol inhaler
Steroids
Hypertonic saline

399
Q

Bronchiolitis post discharge

A

Will continue to have some symptoms - not a cause for alarm

400
Q

Prevention for bronchiolitis

A

Palivizumab - RSV monoclonal antibody for high risk - age guidelines by CDC
Nirsevimab - For all newborns RSV monoclonal antibodies for babies younger than 8 months entering season - more for high risk

401
Q

Cystic fibrosis

A

Autosomal recessive disorder - CFTR channel gene on chromosome 7
Chloride transport defect

402
Q

Dx for CF

A

Newborn screen
Meconium Ileus - delayed by 24+ hours
Respiratory systems
Failure to thrive

403
Q

Presentation of CF

A

Chronic thick mucous in lungs
Fibrosis of pancreas - diabetes and insufficiency chronic diarrhea
Colon obstruction
Rectal prolapse
Persistent cough and respiratory infection
Salty skin

404
Q

MC organisms for pneumonia in CF

A

MRSA, staph - first two years
Pseudomonas - Usually after 1st two years

405
Q

Nutrition for CF

A

Better nutrition=Better lungs

406
Q

Gold standard for CF diagnosis

A

Sweat chloride test
2+ weeks and 2+ kg infant
Order in Ileus, Failure to thrive, Fam Hx

407
Q

Borderline sweat chloride level for CF

A

40-60mmol/L

408
Q

Other test for CF

A

Abscence of fecal elastase

409
Q

Tx for CF

A

Send to certified CF center
Get CF culture to rule out chronic infection
Pulmozyme inhaler, hypertonic saline, bronchodilators, chest physiotherapy

410
Q

CFTR modulator

A

CF drugs - Kalydeco, Orkambi, Trikafta

411
Q

CF infection control

A

Screen sputum cultures every 3 months
IV and inhaled tobramycin
Erythromycin for inflammation

412
Q

GI tx for CF

A

High calories, fat, and protein diet
Vitamins
Pancreatic enzyme replacement
Consider G-tube

413
Q

Presentation of CF exacerbation

A

New/Increased cough
Exercise intolerance
Fever
Increase in sputum

Admit for IV tx and culture

414
Q

Drugs for acute CF exacerbation

A

Most often Tropomycin and Ceftazidime for Pseudomonas
Vanc for MRSA

415
Q

Long term prognosis for CF

A

Lung transplant with 50-60% 5 year survival rate
Median life expectancy - 47 years

416
Q

IRDS

A

Infant respiratory distress syndrome - Hyaline disease
Primarily in premature babies with lack of surfactant

417
Q

Dx for IRDS

A

Ground glass CXR
Resp. distress in premie

418
Q

IRDS tx

A

Giver surfactant and intubate
Thermoregulation

Give mothers who are delivering early steroids at least 7 days before delivery

419
Q

Thyroglossal duct cyst

A

MCC of congenital neck mass
Midline upper neck - inflamed if infected

420
Q

Thyroid glossal duct cyst dx

A

US first
CT
Fine needle aspirate - gold standard

421
Q

Thyroglossal duct cyst

A

Surgical removal AFTER treating infection

ABX - Augmentin, Clinda

422
Q

Amblyopia

A

Functional reduction in visual activity in one or both eyes - lack of use during critical period
Brain may stop using affected eye if not caught

423
Q

Risk for amblyopia

A

Premature babies
First degree realative
Small for gestational age
Neuro delay

424
Q

Classifications for amblyopia

A

Strabismus - misaligned EOM
Refractive Error - Cataracts
Deprivational

425
Q

Presentation of strabismic amblyopia

A

Double vision leading to shutting down of one eye’s signals

426
Q

Three types of strabismus

A

Esotropia - turned in
Exotropia - turned out
Hypertropia - turned up

427
Q

Refractive amblyopia

A

Differing visual acuity between eyes
Brain chooses one eye

428
Q

Deprivational amblyopia

A

Cataract or ptosis leads to lack of visual input to that eye

429
Q

Screening for amblyopia in non-verbal child

A

Fixation test - will not maintain fixation with affected eye

430
Q

Differential occlusion objection test

A

If you cover the non-affected eye, the baby will become irritable

431
Q

Snellen in children

A

Move up a line if misses 2 character in a row
20/40 is normal for 3-5 year old kids
20/30 is normal 6+

432
Q

Red flags for amblyopia

A

Double vision
Acuity worse than 20/40

433
Q

Tx for amblyopia

A

Treat underlying problem:
Eliminate cataracts, surgery for strabismus

434
Q

Hypotropia

A

Strabismus with eye turned down

435
Q

Ocular Instability of Infancy

A

Normal strabismus in the first 3 months of age
NOT normal after three months

436
Q

Pseudostrabismus

A

In asian population or those with wide nasal bridge may LOOK like they have strabismus

437
Q

Complications for strabismus

A

Torticollis from compensatory head rotation

438
Q

Dx forstrabismus

A

Light on bridge of nose for eye alignment

439
Q

Cover test

A

To rule out pseudostrabismus
Observe eye with one covered - if non-covered eye refixates after removal strabismus is present in that eye

440
Q

Cover/Uncover test

A

For latent strabismus
Eye that is covered refixates after being uncovered and is the affected eye

441
Q

Referral indications for strabismus

A

Persistent strabismus or intermittent at 3+ months
Torticollis
Positive light reflex

442
Q

Tx for strabismus

A

Corrective lenses and patching

Pediatrics (3 decks)

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