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
2
Q
Medication that causes non-bloody red stools
A
Cefdinir (Omnicef)
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)
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
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
6
Q
Thing that you don’t think have aspirin that do
A
Pepto Bismol
7
Q
When can antihistamines be started
A
6 months of age
8
Q
Treatment for congestion in pediatrics
A
Pseudephedrine (Sudafed) - may have many side effects (sympathomimetic
1st line - Saline and suction
9
Q
Delsym
A
JUST dextromethorphan
For dry hacky cough
NOT for productive coughs, CF, asthma
Cough suppressent
Robitussin is also but usually combines
10
Q
Mucinex
A
Guaifenecin - helps with productive cough and can give with asthma and CF
Look for JUST guaifenecine
11
Q
Reason for no honey under 1
A
Botulism grows in immature GI tract -helps with cough over 1
12
Q
Times to suction baby snot
A
Before feeding, Before naps, As needed
13
Q
Proper bedding for baby crib
A
Crib sheet and clothing, NOTHING else
14
Q
Saline for Nasal congestion
A
Need two people to hold child in place
Nasal Bulb
Can supplement with a cold humidifier
15
Q
Fever diagnosis in pediatrics
A
Need a rectal temp off 100.4+ or Axillary temp of 99.4+
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
17
Q
Why do we treat fevers
A
Only for comfort!!
18
Q
Motrin and Tylenol fever regimen
A
Alternate every 3 hours but Motrin alone is MOST effective
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
20
Q
Conversion from pounds to kg
A
Divide by 2.2
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?
22
Q
Preterm baby
A
At or before 36 weeks and 7 days
23
Q
Late preterm babies
A
34 weeks to 36 weeks and 7 days
24
Q
Term infant
A
37 weeks to 41 weeks and 7 days
25
Post term infant
42 weeks or later - indication for delivery
26
Time of monitoring for late preterm babies
48 hours in addition to car seat challenge potentially
NO early discharge
27
Early discharge
Discharge within 24 hours
28
Carseat challenge
Baby in car seat with pulse ox for 1 hour to screen for apnea
29
Risks of Post term babies
Meconium aspiration and Pulmonary hypertension
30
SGA
Small for gestational age less than 10th percentile
31
LGA
Large for gestational age over 90th percentile
32
IUGR
Intrauterine growth restriction
33
FGR
Fetal growth restriction
34
Assymetrical FGR
Uteroplacental insufficiency or maternal malnutrition occuring in 2nd or 3rd trimester - less serious
35
Symmetrical FGR/IUGR
More serious - omore often caused by chromosomal abnormalities or other insult in the first trimester
36
Order in which things decrease in failure to thrive
Weight, Height, Head Circumference
37
Umbilical vein
Carries oxygenated blood from the placenta to the fetus
38
Ductus venosus
Bypasses the liver
39
Foramen Ovale
Allows oxygentated blood to bypass non-functional lungs
40
Ductus arteriosus
Allows oxygenated blood to by pass non-functional lungs
41
2 things that prepare the fetus for breathing
Increased production of surfactant
Decreased production of Fetal Lung Fluid and reabsorption
42
2 functions of increased oxygen level in newborn's blood
Pulmonary vasodilation and Ductus arteriosus constriction
43
What closes the foramen ovale
Increased left atrial pressure
44
Stimuli that support respiratory adaptation
Thermal (drop in temp), Light, Sound, Tactile
45
3 things needed for newborn pulm gas exchange
Surfactant, Strong respiratory muscles, Clearance of pulmonary fluids
46
2020 updates to infant resucitation
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
47
Golden hour
Baby should have a full hour of skin to skin contact for the first hour of life
48
Three things to check at birth of baby
Term? Flexion of extremities? Crying?
If yes to all three - routine care, give to mother
49
5 steps of baby resuscitation
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
50
MR, SOPA mneumonic for when positive pressure is failing for the baby
Mask Adjustment
Reposition
Suction (nose then mouth)
Open mouth
Increase pressure
Change Airway
51
Vital signs at which to start PPV
Apnea and gasping with HR under 100 bpm
52
Chest compression ratio for baby
3 compression for one breath with 90 compressions a minute
53
When to administer epinephrine for baby
HR below 100 beats perminute
54
3 Additional conditions to assess for if bay still does not respond
Hypoglycemia, Hypovolemia, Pneumothorax, Sepsis/Shock
55
Pulse ox immediately after birth
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
56
Risk in post resuscitation baby
Seizure is common, monitor temp and blood glucose
57
Risk factors for newborn respiratory distress
In 7% of newborns
Includes: C-section, decreased gestational age, low birth weight, male, maternal asthma or gest. diabetes
58
5 ddx for neonate with respiratory distress
Transient tachypnea of the newborn, Respiratory distress syndrome
Sepsis
Meconium aspiration
Meningitis
59
Transient tachypnea of the newborn
Higher than normal respiratory rate
RR 30-60 bpm
More common in C section
Difficulty clearing lung fluid
Term or Preterm
60
CXR for TTN
Fissures and Perihilar infiltrates
61
Tx for TTN
Presents 2-72 hours of life
Pulse ox and CXR
Self limiting
DO NOT USE LASIX!!!
62
Meconium aspiration syndrome
Not in every meconium stained baby
Higher risk in post term infant
Caused by in utero stress/hypoxia
63
Dx for meconium aspiration syndrome
Meconium present inamniotic fluid or trachea
Bilateral fluffy densities with hyperinflation on CXR - white and hazy
64
Management for meconium aspiration
Dry warm and stimulate newborn
O2 if HR under 100bpm
CPR under 60 bpm
Standard resuscitation do not intubate immediately
65
Respiratory distress syndrome
Preterm babies
Severe symptoms leading to lasting impaired gas exchange
66
Dx ofrespiratory distress syndrome
Cyanosis with grunting tachypnea
Ground glass on CXR - hazy
Echo to rule out heart problems
67
Management for respiratory distress syndrome
Give corticosteroids prenatally
Intubation and sufactant administration
CPAP if less severe
68
Persistent pulmonary hypertension of the newborn
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
69
Risk factors for persistent pulmonary hypertension
Meconium aspiration
Pneumonia
Respiratory distress syndrome
Aphyxia in utero, SSRI use by mother in 2nd half of pregnancy
70
3 mechanisms of persistent pulm hypertension
Vasoconstriction secondary to perinatal hypoxia
Prenatal increase in pumonaly vascular smooth muscle d/t meconium
Lung hypoplasia d/t diaphragmatic hernia
71
Dx for persistent pulmonary hypertension
ABG
Pulse Ox
Echo
Blood cultures
CXR
72
Management for persistent pulmonary hypertension
Goal to decrease pressure
O2 support
Nitric oxide/Slidenafil for vasodilation
Extracorporeal membrane oxygenation - ECMO if all fails
73
Neonatal hypoglycemia
Transient guidelines are 40+ for 0-4 hours and 45+ 4-24 hours, should be 60 after
Treat when symptomatic!!!
74
Risk factors for hypoglycemia
Infants in which to Screen!!
Infant of diabetic mother
LGA
SGA
Late preterm babies
Screening NOT required!!
Lebatolol or terbutiline exposure
Metabolic disorder
75
Symptoms of neonatal hypoglycemia
Broad spectrum
High pitched cry
Exaggerated Moro reflex
Lethargy
Seizures
76
Disease that can look like hypoglycemia
Sepsis - Screen for both
77
Screening for neonatal hypoglycemia
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
78
Confirmation for heel stick glucose
Serum glucose
79
Treatment for neonatal hypoglycemia
Give IV glucose if symptomatic
If asymptomatic can give oral glucose
80
When should physiologic hypoglycemia end
After 24 hours of life
Investigate for metabolic disorder otherwise
81
Physiologic neonatal jaundice
Pathologic if in first 24 hours
Between 1-4 days of life is normal
82
Risk factors for hyperbillirubinemia
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
83
High rate of billirubin rise criteria
rise .3 mg/dL/hr in first 24 hours and .2 mg/dL/hr after
84
Risk factors for neurotoxicity d/t jaundice
Gestational age under 38 weeks
Albumin under 3g/dL
Isoimmune hemolytic disease, G6PD
Sepsis
Instability in previous 24 hours
85
Diagnosis for hyperbillirubinemia
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
86
Type of Billirubinemia in infancy
Unconjugated is normal, Conjugated is NEVER normal
87
Breast milk jaundice
Breast milk inhibits enzymes from processing billirubin, occurs in the first week and persists up to three weeks
88
Breastfeeding jaundice
Infant not receiving enough - need to supplement with formula
Failure to thrive seen in first week
89
Phase one of kernicterus
1-2 days after birth
Poor suck
High pitched cry
Stupor
Hypotonia
Seizures
90
Phase two of kernicterus
3-6 days of life
Hypertonia of extensors
Retrocollis
Fever
Opisthotonus
91
Phase three of kernicterus
7+ days of life
Generalized hypotonia
92
Rebound hyperbillirubinemias
TSB reaches threshold for age within 72-96 hours of phototherapy cessation
Preterm, PT at under 48 hours, and hemolytic disease are risk factors
93
When to d/c phototherapy
When TSB decreases by 2mg/dL below the hour specific threshold
94
G6PD deficiency
X-linked recissive disease
Common in African descent
Causes severe hemolytic crisis
95
ABO incompatability
Incompatability between mom and baby blood type causing jaundice
Can also happen with rh factor
96
Prevention for RH incompatibility complications
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
97
Newborn polycythemia
At risk for poor perfusion
Hematocrit over 65
Higher risk for hyperglycemia and hemolysis
98
Risk factors for newborn polycythemia
Delayed cord clamping
LGA
Larger twin of a pair
99
Findings for newborn polycythemia
Bloody stool
Renal failure
Red looking
100
Tx for polycythemia in newborns
Exchange transfusion for severe, symptomatic cases
101
Reasons to add condition to newborn screen
Cost effective, Simple, Reliable
Intervention can save lives
High frequency
102
Phenylketoneuria
PKU
Proetin metabolism error
Untreated leads to permanent brain injury
Lifelong restriction of phenylalanine -low protein diet
Stop protein intake
103
Galactosemia
Go into shock if given lactose because they cannot metabolize galactose
E. coli sepsis is galactosemia until proven otherwise
104
Neonatal hypothyroidism
Hard to catch early on - part of routine screening
Look at T4 and TSH
105
Baby hearing screen
Should occur in first month and be repeated within 3 months if failure of test
106
Congentital heart defect screening
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
107
Prenatal visit
Free courtesy of most pediatric offices - helps prospective parents "shop" for a pediatrician
108
Gravida
How many times pregnant
109
Para
How many times given birth (twins count as two)
110
When is a newborn given a Hep B shot
Within 12 hours of birth for ALL babies
111
Protocol for newborn with HBV positive mother
HBIG AND Hep B vaccine in opposite legs
112
Protocol for baby of HIV+ mother
antivirals within 6-12 hours
113
APGAR score interpretation
1-3 - Poor
4-6 - Intermediate
7-10 is good
114
Metrics of APGAR score
Activity
Pulse
Grimace
Appearance
Respirations
115
Activity APGAR scores
0 - Absent
1 - Arms/Legs flexed
2 - Active movement
116
Pulse APGAR scores
0 - Absent
1 - under 100bpm
2 - 100+ bpm
117
Grimace APGAR score
0 - Flaccid when aggravated
1 - Some flexion of extremities
2 - Active motion of extremities when aggravated
118
Appearance APGAR score
0 - Pale blue baby
1 - Blue extremities, pink body
2 - All pink
119
Respiration APGAR score
0 - Absent
1 - Slow irregular
2 - Vigourous cry
120
Normal infantile RR
40
121
Dubiwitz Ballard Exam
Helps to evaluate the gestational age of the baby
Lower score is younger
122
Flexibility and gestational age
Wrist bends back more, Knee comes back less, Arm goes over less arm recoil increases
123
Physical characteristics and gestational age
More wringles in foot when older
Lanugo hair appears in earlier term babies
124
When is an APGAR score done?
1 minute, 5 minutes, and every 5 minutes after that
125
Risk factors for SIDS
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
126
MC Age for SIDS
2-4 months old
127
Ways to prevent SIDS
Back to sleep
No pillows or blankets
Never overheat the baby
Separate crib from parents
Pacifier off and breast feed
Vaccinate
128
High pitched baby cry
Sign of abnormality
129
Low hoarse baby cry
Sign of hypothyroidism
130
Weak baby cry
Sign of illness/infection
131
Acrocyanosis
Not a cause for alarm - blue extremities
Blue body IS cause for alarm
132
Cutis marmorata
Lacy marbled
Okay in asymptomatic baby
Baby is usually cold - warm them
Common in downs syndrome
133
Vernix Caseosa
Waxy or cheesy covering after baby is delivered
Better not to wash off right away
134
Lanugo
Baby hair - more in earlier babies
135
Erythema toxicum
Red base papular rash common in newborns - no vescicles
Happens in 2-5 days
Caused by eosinophils
136
Acne neonatorum
Acne on newborn d/t maternal hormone exposure
Looks like acne and resolves on own
2-4 weeks of age
137
Milia
Epidermal cysts full of keratin
Epstein's pear in mouth
Resolve in 2-4 weeks
138
Hemangioma
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
139
Nevus simplex
Stork bite
Red macule found on the nape of the neck
Non pathologic
Few persist into childhood
140
Nevus flammeus
Port wine stain
Starts light gets thick and corrugated
25% with an ophthalmic one will get Sruge Weber
Associated with vision problems, angiomas, glaucoma
141
Congenital dermal melanocytosis
Mongolian spot
Darkish blue birthmark on buttox and back
More common in dark skinned babies
DOES NOT change and can last for years
142
Cafe au lait spots
6+ if neurofibrimatosis
Okay if there are one or two
143
Hydrocephalus
Head gets bigger and bigger due to obstructions of flow or brain malformations
Sunsetting of eyes
VP shunt and serial head measurements to diagnose
144
Anterior fontanelle closure
9-24 months
145
Posterior fontanelle closure
2-3 months
146
Depressed or bulging fontanelle
Depressed = Dehydration
Bulging = Increased intercranial pressure - meningitis, tumor, etc
147
Caput Succedaneum
Cap on baby's head covers multiple bones of the skull
Crosses suture lines
Resolves in 2-3 days
Under the skin - superficial
148
Cephalohematoma
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
149
Craniotabes
Thinning of the parietal bones in babies
Sensation of a ping pong ball
Worry about bone disease if not gone by a few weeks
150
Subgaleal hemorrhage
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
151
Pierre Robin syndrome
Tiny jaw
Causes tounge blocking airway and preventing palate from fusing
Can't breathe, cleft palate
Usually need a tracheostomy
152
Facial nerve palsy at birth
Usually goes away shortly after
153
Conjunctivitis treatment for newborns
Erythromycin to prevent chlamydia infection in eyes
154
Congenital cataracts
May indicate a metabolic disease
155
Newborn glaucoma
Baby in intense pain that does not open its eyes
156
Eye exams for babies
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
157
Leukoria
White response instead of red - red flag to ophthalmology could be a retinoblastoma - emergency
158
Dacryostenosi
Blocked tear duct - not emergent
Redness is normal
Massage 5 times a day
Refer if it won't go away
159
Acute dacryocystitis
Tear duct in infected
Needs to be popped
160
Septal deviation
Can be due to birth trauma
161
Choanal arestia
Can't breath when feeding
Use NG tube or wisp to test
162
Natal teeth
NOT baby teeth
Usually pulled immediately
163
Oral thrush
White, tender, cannot be scraped off, painful for baby to eat, Use nystatin
164
Normal ear level
Line at eyes should bisect ears
165
Preauricular pits of the ears
Small indentations that can be associated with kidney or other disease
Should have a hearing test
166
Coarctation of aorta pickup
Compare upper and lower extremity pulses
167
MC newborn fracture
Clavicle - we usually don't fix it - heals on own in 6 months
168
Abdominal mass MC in kids
Kidneys
169
Diaphragmatic hernia
Abdominal contents move into chest - usually on the left
Surgery is required
Tachypnea, tachycardia, cyanosis
Concave abd with enlarged chest unilaterally
170
Umbilical cord removal
Clamp it and let it fall off - may wait a minute to clamp to give the baby more blood
171
Umbilical hernia
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
172
Umbilical granuloma
Soft pink friable lesion
Treat with silver nitrate
173
Vaginal discharge in newborn females
Normal but scares parents - bloody
Labia may be swollen or bruised
174
Male gonadal exam in newborns
Confirm testicles are in the scrotum, foreskin cannot be retracted at birth
Baby must void before d/c
175
Syndactyly
Fusion of two digits
176
COngenital hip dysplasia
Head of femur does not fit into the hip well
More common in firstborns, multiples, FHx, Girls
Life long limp if missed
177
Hip exams for newborns
Barlow - Push down
Ortolani - Bend in
If you feel a click or clunck get an US
178
Pavlick harness
Used for congenital hip dysplasia - holds hips out
179
Sucking reflex
suck on something put in mouth ALL babies
180
Rooting
Turn head to side of facial stimulation
181
Palmar grasp
Grasp examiners finger by 28 weeks
182
Babinski for babies
Big Toe bends BACKWARDS rather than forwards, toes fan out in kids under 2
183
Moro reflex
Infant flails out arms when startled -drop a little
184
Tonic neck reflex
Turn head to right extend right arm and leg - fencing position
185
Stepping reflex
Baby takes steps when held upright
186
Traction response
Head will lag when baby is pulled up to sitting
187
Brachial plexus injury
Trauma during birth
Waiters tip sign
Most recover with observation
188
Sacral dimple
Dimple over the sacrum
Study if really deep for abnormalities
189
TORCH congenital infections
Toxoplasmosis
Other
Rubella
Cytomegalovirus
Herpes
190
Consequence of earlier pregnancy infection
More growth abnormalities
191
Clinical presentation of toxoplasmosis
Many infants have normal PE
Cerebral calcifications
Chorioretinitis
Small head w/ hydrocephalus
Hearing loss
192
Screening criteria for toxoplasmosis
Mother with fever and swollen lymph nodes
Calcifications in baby brain
Hydrops of fetus
193
Diagnosis of toxoplasmosis
Prenatal - Amniocentesis after 18 weeks
Post natal - Draw blood for ab titer, CT of head for calcifications
194
Treatment for toxoplasmosis
spiramycin - Before 14 weeks
Pyramethamine and Sulfadiazine and Folinic acid - after 14 weeks
195
Post natal treatment for toxoplasmosis
Treat even if we treated mom
Pyramethamine and Sulfadiazine and Folinic acid
For a year
Treat special needs
196
Eye exams for toxoplasmosis
Eye exam every 3 months for first 18 months
Then every 6-12 months
197
Toxoplasmosis prevention
Cook food
Wash fruits and veggies
Avoid cat litter
NOT a routine screen
198
When is rubella the most problematic
First four months - 40% will loose the pregnancy
199
Presentation of rubella
Blueberry muffin - petechiae/purpura
Cataracts
Cardiac lesions
Hearing loss
Small hands and head
200
Rubella prevention
MMR vaccine
201
MC congenital infection
CMV
202
Risks with CMV
Greatest in first trimester but can cause problems in any
203
Presentation of CMV
Leading cause of Hearing loss
Microcephaly
Hepatosplenomegaly and Jaundice
Petechiae
Intercranial calcifications
204
Diagnosis of CMV
High suspicion
Can detect in urine/salive in 1st 3 months
CT scan shows intercranial lesions
Prenatal if caught in first 3 months
205
Treatment for CMV
No approved tx
Gancyclovir and Valgancyclovir can decrease progression of symptoms
206
Diseases that can be passed through breastmilk
HIV
CMV
207
Birth to three
Service that will evaluate and infant and give services if they have 2+ deficits to qualify for it
208
MC time for baby to present with herpes
5-14 days after birth
25-50% likelihood to get if mother has active herpes lesions
209
Modes of herpes transmission
Before or DURING birth
210
Clinical presentation of herpes
Skin vesicles
Ulcerations
Scarring eye damage
Organomegaly
CNS abnormalities - fever, irritability seizures
Before 36 weeks
211
Diagnosis for herpes
Culture anywhere on the baby
212
Treatment for herpes
IV Acyclovir - always add to prophylactic abx, stop if herpes is negative
2-3 days if positive
213
Screening and prevention for herpes
NOT recommended
C section if active lesions within 4 weeks of delivery
Do not kiss the babies!!
214
Percent of women with evidence of past herpes infection
30-60%
215
Percent of herpes babies with no maternal HSV hx
75%
216
VZV congenital infection
Usually only transmitted in the second half - more likely the later you are
Can also be transmitted perinatally
217
Presentation of VZV
Zig zag skin scarring (cicatricial)
Cataracts/retinitis
Microcephaly and seizures
218
Treatment and prevention of VZV
Vaccine available
Swab lesions to diagnose for IgG/IgM
VariZIG - prophylactic antibodies for postnatal exposure
Acyclovir
219
Parvovirus B19
Erythema infectiosum
Fifths disease
Common in children - teachers and daycare workers are at risk
220
Clinical presentation of parvo B19
Fetal anemia
Myocarditis
Hydrops fetalis
Fetal demise 3-6%
Older children get slapped cheeks rash
221
Congenital syphillus infection before 2
MC'ly trans placental
100% passage to baby
40% result in abortion
Rash
222
Clinical presentation of syphillis
Copious white/bloody snot
Big liver
Lymph nodes
Skeletal abnormalities
223
Clinical presentation of syphillis after 2
Hutchinson triad: Interstitial keratitis, 8th cranial nerve palsy, scalloped teeth
Rhagades - cracks around mouth
saddle nose
Mullberry molars
Swollen joints bilaterally
224
Diagnosis and Tx for syphilis
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
% of kids showing syphillis in 1st 3 months
67%
226
Congenital chlamydia
MC STI in US
Affects eyes and lungs
50-70% risk of passing during birth
Screened for with syphillis
227
Presentation of congenital chlamydia
Bilateral conjunctivitis 5-14 days post delivery
Pneumonia
228
Diagnosis of chlamydia
Swab nose and eyes
229
Treatment for chlamydia
Erythromycin PO for 14 days
230
Congenital gogrrhea presentation
Usually acquired during vaginal delivery
Purulent conjunctivitis
Scalp abcess
231
Congenital gonorrhea screening
Multiple partners
Drug use
Commercial partners
232
Treatment of gonorrhea
Single dose ceftriaxone for all mothers
Eye prophylaxis with ointment for all babies
233
Ways HIV can be transmitted to baby
Transplacentally, in utero, breastfeeding
Transmission decreased by antiretroviral therapy to 1-2% from 13-39%
C section
234
Diagnosis of congenital HIV
HIV DNA PCR at under 48 hrs, 2 weeks, 1-2 months, 2-4 months
Exclude after 4 months
235
Tx for congenital HIV
Give antiretroviral if mother HIV+ for six weeks for prophylaxis
236
Congenital Hep C
5% transmission rate
Dx by positive antibody test after 18 months
GI treats - interferon and ribavirin
IV drug use
237
Congenital HPV
May present as hoarseness or stridor later in life
238
Congenital Zika virus
Mosquito borne illness
Fetal growth restriction
Skull collapse w/ craniofacial disproportion
Eye and ear issues
Arthrogryposis - joint malformation
239
Lab evaluation for ZIKA
serum and urine for ZIKA RNA
Head US for screening - cranial calcifications
No tx - prevent with mosquito nets
240
Bacterial sepsis of the newborn
First 28 days of life
Ascending infection
Birth canal infection
Placental infection
241
Presentation of BSNB
Group B strep is MC
Respiratory distress
Temperature drop
Don't feed
Discolored
242
Baby temp that warrants a full sepsis workup
100.4 or higher RECTAL!! and under 10 weeks
243
Tx for newborn sepsis
Ampacillin and Cefotaxime OR Ampicillin and Gentamicin (ototoxic)
May use acyclovir
244
Group B strep screen
Screen for group B step before delivery
245
Prenatal disease screening
Syphillis
VZV
Rubella
HSV
246
Acyanotic heart disease
Right heart gets extra blood leading to right heart failure
Shunt going from high to low pressure
ASD, PDA, VSD
247
Presentation of acyanotic heart disease
Poor feeding, failure to thrive
Pneumonia-like symptoms
Eismenger syndromes - cyanosis, dyspnea, palpitations with exertion
Poor feeding - like a workout for baby
248
Outflow obstruction acyanotic heart disease
Pulm stenosis
Aorta coarctation
249
Presentation of atrial septal defect
Fixed split S2
Resp infections and failure to thrive
Palpitations, exercise intolerance, DOE in adults
Murmur gets louder with time
250
Atrial septum development
Ostium primum - Hole in septum primum that closes
Foramen ovale forms in septum secundum
251
Ostium secundum defect
Foramen ovale does not close - more common
252
Ostium primum defect
Assoc with Down syndrome
More serious
253
Cause of S2 split in ASD
More blood passing through pulmonary valve than normal
254
Dx for ASD
TEE - Gold standard, CXR
Right heart cath with increased oxygenation in RA, RV, PA
255
Tx for ASD
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
VSD development
Two septums meet in the middle to form IVS - Membranous on top, muscular lower
Membranous is better
Muscular is worse
257
Presentation of VSD
Right heart failure and PHTN
3-6 mm are usually asymptomatic - close by 2
Larger may need surgical repair
258
Progression of VSD
Starts as a left to right shunt and becomes a right to left shunt which is worse (deoxegenated blood going systemic)
259
Presentation of VSD
Holosystolic murmur - depends on size
Failure to thrive, tachypnea, and heart failure
May look like respiratory symptoms with negative swab
260
Critical times for heart defect
Newborn and 4 weeks after birth
261
Dx for VSD
RV Hypertrophy and LA enlargement on CXR/EKG - unreliable
Echo - MRI if nondiagnostic
262
Tx for VSD
Most close on own
Diuretics
High calorie feeds
Repair by age 2 - earlier if over 8mm
263
PDA
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
PDA presentation
Asymptomatic if small
Machine-like murmur - COntinuous
Exercise intolerance and HF
Lower extremities become cyanotic but not upper
265
Shunt of PDA
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
Tx for PDA
Monitor if small
10-14 days, prostaglandin inhibitor
DIgoxin and Lasix for heart failure
267
Surgical ligation for PDA
In babies under 5kg/11lbs.
268
Presentation of congenital pulmonary stenosis
Right heart failure
Microangiopathic hemolytic anemia - schistocytes!!
Systolic ejection murmer increasing with inspiration
269
Dx for pulmonary artery stenosis
CXR - normal heart size
Post stenotic dilation of PA
Echo - confirms diagnosis
270
Tx for congenital pulmonary stenosis
Mild/Mod - No intervention
Percutaneous balloon valvuloplasty for severe cases
271
Coarctation of the aorta
Often in females with Turner's syndrome
Often with VSD or ASD as a leading cause of HF
272
Coarctation of the aorta presentation
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
Two types of coarctation
Preductal - Pediatric - Turner's syndrome
Postductal - Adult coarctation (PDA closed) less symptomatic
274
Side to check BP for aortic coarctation
Right side!!
275
Diagnostics for Aortic coarctation
Angiogram
Rib notching 3 sign on CXR
LVH, LAE on EKG
276
Treatment for artic coarctation
Prostaglandin to keep PDA open
Resection and anastomosis
Good prognosis with risk of later HTN and myocardial dysfunction
Testing prior to sports participation
277
Presentation of congenital aortic stenosis
Diamond shaped murmur with a click during systole
LVH with Heart failure
278
Dx for congenital aortic stenosis
Echo - choice
Valvuloplasty to treat
Ross procedure
Usually clear to participate in sports later in life
279
Cyanosis that is concerning
Discoloration of entire skin and mucous membranes - look carfully in dark skinned babies
280
Hyperoxia test
Give baby 100% oxygen. No change in pulse ox means their cyanosis has a cardiac etiology
281
Tetralogy of falot
Pulm stenosis
Large VSD
Overriding aorta
RVH
MC cyanotic heart defect
282
Presentation of tetralogy of fallot
Boot shaped heart on CXR
Shunt to left ventricle
Hypercyanotic episodes with anything that increases oxygen demand - TET spell!!
Squat reverses TET spell
283
Tx for TET spell
Calm
Oxygen
Hydrate
Bicarb to decrease pulmonary resisitance, Phenylephrine, BB, Morphine
Surgical repair
284
D transposition of great arteries
Two separate circuits
PDA or VSD needed for life
More common in males
285
L transposition of great arteries
Ventricles are switched
286
Risk factors for transposition
Diabetes
Rubella
Alcohol
Maternal age
287
Presentation of TGA
Cyanosis with O2
Tachypnea
Acidosis
Pulse ox in lower extremities higher than in the upper extremities!!
288
Dx for transposition of the great arteries
Echo
CSR triad: Egg on string heart, Lung congestion, Cardiomegaly
Presurgery angiogram
289
Egg on string sign
Transposition of great arteries - narrow mediastinum like adults
290
Tx for TGA
Prostaglandin short term for PDA
Septotomy - Short term
Surgical switch
291
Hypoplastic left heart disease
Underdeveloped (small) left ventricle and ascending aorta
Must have ASD, VSD, PDA to live
292
Presentation of hypoplastic left heart disease
Cyanosis
Resp Distress
Poor feeding and failure to thrive
Left heart failure
Cardiogenic shock
Death
293
Dx for left heart hypoplastic disease
Echo
Cardiomegaly
LVH on EKG
294
Tx for hypoplastic left heart disease
Prostaglandin short term to keep PDA
3 step surgery
Norwood, Bidirectional Glenn, Fontan
NO SPORTS
295
Newborn murmur
First few days of life
LLSB without radiation
SEM
Resolves by one month
296
Peripheral pulmonary artery stenosis
Normal branching of PA
ULSB back and axillae
Echo needed to determine whether benign or not
297
Still's murmur
Most common innocent childhood murmur
2-7 years
Apex and LLSB
Vibratory systolic
Loud when supine, gone when sitting
298
Pulmonary ejection murmur
3+ years
Benign
299
Venous hum
After age 2
Right infraclavicular area
Continuous and musical
Grade I-III murmur
300
Supraclavicular carotid bruit
Brief and physiologic
Soft murmur
Aortic stenosis is below the clavicle!!
301
New pregnancy category medication rule
Pregnancy lactation labeling rule
302
Neonatal abstinence syndrome
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
Anticonvulsant use in pregnancy birth defects
Small head circumference
Anteverted nares
Cleft lip/Palate
Distal digital hypoplasia
304
Retinoid (Acutane) birth defects
40% miscarry
CNS malformations, heart defects, small or absent ears, TEF
305
SSRI birth defects
Blinted neonatal abstinence syndrome
Irritable
DIarrhea
306
Tobacco use birth defects
Placental abruption
Low birth weight
Inconsolable
307
Fetal alcohol syndrome
3+ ounces per day
Short, poor head growth
Flat philtrum
Anteverted nostrils
Short palpebral fissure
Disruptive behavior
308
Marijuana birth defects
Increased depression, hyperactivity, delinquency, impulsivity
309
Opiate birth defects
Withdrawal
Low birth weight
IUGR
Prematurity
310
Clinical presentation of neonatal abstinence syndrome
Shaking
Crying - high pitched
Convulsions
Check blood
Sweating/Fever
311
Tx for neonatal abstinence syndrome
Morphine or Methdone - 1st line
Phenobarbital - Second line
Fentanyl - to calm down
312
Finnegan score
Score to determine neonatal withdrawal
Score over 8 is concerning - check every 2 hours and cont. 24 hours after last score of 8
313
Tx for mother with opiate abuse
Put on methadone (better for mom), suboxone, subutex (better for baby)
314
Immunizations CI in pregnancy
MMR
Chickenpox
Flu Mist
Oral Polio
These are LIVE vaccines
315
3 Triploidies
13 - Patau
18 - Edwards
21 - Down
316
Quad screen
Done for congenital disease:
Beta-hCG
AFP
Inhibin A
Estriol
317
Down syndrome facts
Trisomy 21
40% have heart defect
Females are fertile
Risk shoots up at 35
318
Presentation of down syndrome
Hypotonia
Thick, corrugated tongue
SINGLE palmar crease
Upslanting palpebral fissures
319
Down syndrome disease to watch for
Hypothyroidism
Celiac
Polycythemia
Congenital heart disease
320
Down syndrome quad screen of mom results
Low: AFP and Estriol
High: hCG and Inhibin A
321
Mom's for whom quad screen is recommended
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
Quad screen results for turner syndrome
Decreased: AFP and Estriol
Very High: Inhibin and hCG
323
Quad screen results for Edward's syndrome
Normal: AFP and Inhibin A
Low/Very Low: Estriol and hCG
324
Quad screen results for Patau syndrome
Increased: AFP
Normal: Estriol, hCG, Inhibin A
325
Tx for Down
Screen for autoimmune disorders
Speach therapy and other similar support
Immediate Echo for baby
326
Chance of trisomy 21 at 45
1 in 30
327
Trisomy 18 presentation
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
Tx for Edwards syndrome
Support
Termination of pregnancy
10% die in first week
329
Trisomy 13
40% survive a week
Abnormality of every organ system
Small head
Absent skin on scalp
Cutis aplasia
Polydactyly
Cleft lip/Palate
Malformed ears
330
Gender of unique trisomies 18 and 13
More common in females
331
Kelinfelter syndrome
Y chromosome with additional X's
More X's more intellectual impairment
MCC of genetic male hypogonadism
1 in 1,000
332
Presentation of kleinfelter syndrome
Lower IQ
Tall
Gynecomastia
Normal pubic hair but no growth of penis and testes
Infertile
333
Tx for kleinfelter's
Testosterone replacement
Dx via genetic testing
334
Turner syndrome
Single X chromosome
95-99% abort spontaneously
Third diagnosed in infancy, childhood and adulthood respectively
335
Presentation of turner's syndrome
Webbed neck
Short
Shield chest w/ wide nipples
Coarcation of aorta
Horseshoe kidney
336
Development in turner's syndrome
10% MAY have normal pubertal development
Estrogen needed for secondary sex characteristics, GH for height
High risk of Aortic dissection
337
Inheritance pattern of Marfan's syndrome
Autosomal dominant
Mutation in Fibrillin 1 gene on 15
338
Presetation of Marfans syndrome
LONG arms
Tall long face
Pes excavatum
Lax joints
Eye and Heart problems
Flat feet
Scoliosis
339
Heart problem that people with Marfans usually die of
Progressive dilation of the aortic root
340
Ghent criteria
Calculate score for risk of Marfans
341
Tx for Marfan's syndrome
Serial echos with surgery once aorta reaches 5.5cm
Losartan to slow dilation
Eye exams
Exercise restriction
342
Fragile X syndrome
MC inherited cause of mental disability in males
FMR1 gene is responsible
343
Presentation of fragile X
Impulsive
Bid ears
Large testicles
Hyperextendable joints
Mitral valve prolapse
Developmental disorders
344
Tx for fragile X
Counseling for behavioral problems
345
Cystic fibrosis
Autosomal recessive
MC Genetic life-shortening disease in caucasians
39 years median survival
Everything is sticky - can't move chloride around
Salty babies
346
Complications of cystic fibrosis
Respiratory tract infection
Volvulus/Intussusception
Digital clubbing
347
Common colonization organisms in CF patients
Staph aureus
H flu
Pseudomonas aruginosa
348
Dx for CF
Positive sweat chloride test - over 60mmol/L
Uses pilocarpine to stimulate secretions
349
PKU
Autosomal recessive
Must be on a protein restricted diet
Detected in routine newborn screening
Musty/Mousy odor to urine in untreated
350
4 things that can cause cleft lip/Palate
Radiation exposure
Viral infections
Metabolic abnormalities
Teratogens
351
Presentation of cleft lip/palate
Teeth come in weird
Can visualize on 2nd trimester US
High dose folic acid can prevent
352
Tx for cleft lip plate
Special feeder
Surgical closure by 12 months
Speech therapy
Dental healp and tx of ENT infections
353
Duchenne muscular dystrophy
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
Ehlers Danlos
Autosomal Dominant
Like Marfans with fragile skin
Hypermobile joints
Aortic aneurism and spontaneous pneumothorax are complications
Weird scars
355
Beighton Scoring
Assessment for E-D hypermobility of joints
9 Points total for:
Pinky
Thumbs
Elbows
Knees
Spine -one point only
356
Brighton scoring
Major/Minor criteria for ehlers-danlos
Major criteria are - Beighton score of 4+ and Arthralgia 3+ months for 4+ joints
357
Management of Ehlers Danlos syndrome
Avoid contact sports
Treat comorbidities
358
Recommendation for how long baby should be breast fed
6 months at least is ideal
359
Putting the baby on the breast
Done in the first 10 minutes
Helps uterus contract
360
Frequency of breastfeeding
8-12 times per day - first week
361
How long should baby nurse
5 mins per breast on 1st day
10 min per on 2nd day
10-15 min per day after that
362
Baby weight during first week
Drops and then returns to birth weight in the first week
363
Expected weight gain in first weeks
Half ounce to one ounce per day
364
Expected weight gain over the first year
Double in 5 months
Triple in a year
365
Calories an ounce in breast milk
20 cal/ounce
Has calcium, Iron and zinc
Has antibodies
NO VITAMIN D
366
One nutrient not in breast milk
Vitamin D - Must supplement
Not a lot of iron - may need to supplement
367
Contraindications to breastfeeding
Small breast size is not an issue
Breast augmentation/reduction may be an issue
TB, HIV, Chemo, Galactosemia
368
Cautions for breastfeeding
Breast herpes
Hep B
Drug abuse
Over 3 oz alcohol
Lithium or Methotrexate use
369
Breastfeeding jaundice
Baby not getting enough milk - dehydrated with jaundice
May see clogged breasts or engorged ducts in mother
370
Milk protein allergy baby
Eczema and bloody poop
371
Hydrolyzed formula
Protein broken down
Indicated for milk protein allergy and colic
372
Amount of formula a baby should have
2.5 times it weight in ounces
373
Recommended time for introducing solid food
6 months - when the baby can sit up so they do not aspirate
374
3 stages of baby food
Stage 1 - One fruit or vegetable
Stage 2 - Two foods
Stage 3 - Different textures
375
When is a baby ready for solid food - milestones
Baby can sit up and support head
Does not reject spoon put into its mouth
376
Milk to Food regimen
100% liquid at 6 months
25% liquid at 1 year
377
Introduction of some chewing food
7-9 months - instinct to chew
Don't get all of teeth including molars until 18 months
378
Pincer grasping in children
Begins around 8-9 months - table food
379
When do we see a food allergy reaction
The SECOND time the baby is exposed
380
When should allergens be introduced
Before 6-12 months
381
When does the baby stop breast feeding
Generally around 1
Don't breast feed during the night
Over 1-4 weeks give cup
382
Whole milk use in baby
NOT introduced before 1 year to avoid anemia - specifically iron deficiency
Stay on whole milk until 2
Don't need very much
383
Skim milk and babies
Don't give until age 2 - transition to lowest fat milk
384
Appetite change at 1
Drops as growth slows
May not eat anything some days
Don't force to eat
385
2+ years nutrition
High fiber
No TV
Avoid candy, fatty foods, juice, etc.
386
WIC
Women Infant Children Program in WV
Helps mothers get good nutrition for babies
387
Colic
Piercing cry 3 hours a day for 3 days a week for 3 weeks or longer
388
Presentation of colic
Excess crying
Red face
Knees up to chest
Excess gas
Clenched fists
389
Tx for colic
Hydrolyzed protein
Rhythmic movement suggested
Educate pt. about overfeeding
Reflux drug
Avoid abuse
390
Bronchiolitis
Wheezing, lower airway disease in any child under two - over two is asthma, upper resp is croup
391
MCC of bronchilitis
RSC 50-85% of cases
392
Presentation of Bronchiolitis
Upper airway infection that moves to the lungs
First time wheezers
Spring/Winter onset
Increasingly fussy
Resp distress
393
Dx for bronchiolitis
Clinical
O2 and NP swab
No CXR needed
394
Tx for bronchiolitis
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
Hospitalization for bronchiolitis
Persistent hypoxemia below 92%
Toxic appearing
Apnic spells - may be the only sign in infants
Lack of support at home
396
Hospital management for bronchiolitis
High flow O2 or CPAP
Suction!! - with saline
Fluids
Ribavirin sometimes used for immune compromised
397
Discharge criteria for bronchiolitis
RR under 60 for under 6 months
Stable on RA
Caretaker able to provide suction
Adequate oral intake
Afebrile for 24 hours
398
3 Things to avoid in bronchiolitis
Albuterol inhaler
Steroids
Hypertonic saline
399
Bronchiolitis post discharge
Will continue to have some symptoms - not a cause for alarm
400
Prevention for bronchiolitis
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
Cystic fibrosis
Autosomal recessive disorder - CFTR channel gene on chromosome 7
Chloride transport defect
402
Dx for CF
Newborn screen
Meconium Ileus - delayed by 24+ hours
Respiratory systems
Failure to thrive
403
Presentation of CF
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
MC organisms for pneumonia in CF
MRSA, staph - first two years
Pseudomonas - Usually after 1st two years
405
Nutrition for CF
Better nutrition=Better lungs
406
Gold standard for CF diagnosis
Sweat chloride test
2+ weeks and 2+ kg infant
Order in Ileus, Failure to thrive, Fam Hx
407
Borderline sweat chloride level for CF
40-60mmol/L
408
Other test for CF
Abscence of fecal elastase
409
Tx for CF
Send to certified CF center
Get CF culture to rule out chronic infection
Pulmozyme inhaler, hypertonic saline, bronchodilators, chest physiotherapy
410
CFTR modulator
CF drugs - Kalydeco, Orkambi, Trikafta
411
CF infection control
Screen sputum cultures every 3 months
IV and inhaled tobramycin
Erythromycin for inflammation
412
GI tx for CF
High calories, fat, and protein diet
Vitamins
Pancreatic enzyme replacement
Consider G-tube
413
Presentation of CF exacerbation
New/Increased cough
Exercise intolerance
Fever
Increase in sputum
Admit for IV tx and culture
414
Drugs for acute CF exacerbation
Most often Tropomycin and Ceftazidime for Pseudomonas
Vanc for MRSA
415
Long term prognosis for CF
Lung transplant with 50-60% 5 year survival rate
Median life expectancy - 47 years
416
IRDS
Infant respiratory distress syndrome - Hyaline disease
Primarily in premature babies with lack of surfactant
417
Dx for IRDS
Ground glass CXR
Resp. distress in premie
418
IRDS tx
Giver surfactant and intubate
Thermoregulation
Give mothers who are delivering early steroids at least 7 days before delivery
419
Thyroglossal duct cyst
MCC of congenital neck mass
Midline upper neck - inflamed if infected
420
Thyroid glossal duct cyst dx
US first
CT
Fine needle aspirate - gold standard
421
Thyroglossal duct cyst
Surgical removal AFTER treating infection
ABX - Augmentin, Clinda
422
Amblyopia
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
Risk for amblyopia
Premature babies
First degree realative
Small for gestational age
Neuro delay
424
Classifications for amblyopia
Strabismus - misaligned EOM
Refractive Error - Cataracts
Deprivational
425
Presentation of strabismic amblyopia
Double vision leading to shutting down of one eye's signals
426
Three types of strabismus
Esotropia - turned in
Exotropia - turned out
Hypertropia - turned up
427
Refractive amblyopia
Differing visual acuity between eyes
Brain chooses one eye
428
Deprivational amblyopia
Cataract or ptosis leads to lack of visual input to that eye
429
Screening for amblyopia in non-verbal child
Fixation test - will not maintain fixation with affected eye
430
Differential occlusion objection test
If you cover the non-affected eye, the baby will become irritable
431
Snellen in children
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
Red flags for amblyopia
Double vision
Acuity worse than 20/40
433
Tx for amblyopia
Treat underlying problem:
Eliminate cataracts, surgery for strabismus
434
Hypotropia
Strabismus with eye turned down
435
Ocular Instability of Infancy
Normal strabismus in the first 3 months of age
NOT normal after three months
436
Pseudostrabismus
In asian population or those with wide nasal bridge may LOOK like they have strabismus
437
Complications for strabismus
Torticollis from compensatory head rotation
438
Dx forstrabismus
Light on bridge of nose for eye alignment
439
Cover test
To rule out pseudostrabismus
Observe eye with one covered - if non-covered eye refixates after removal strabismus is present in that eye
440
Cover/Uncover test
For latent strabismus
Eye that is covered refixates after being uncovered and is the affected eye
441
Referral indications for strabismus
Persistent strabismus or intermittent at 3+ months
Torticollis
Positive light reflex
442
Tx for strabismus
Corrective lenses and patching
