Pediatrics Notes Flashcards
What is the difference between anaphylaxis and angioedema?
Anaphylaxis has hypotension
Angioedema looks like anaphylaxis but there is no hypotension/other organ system involvement
A patent ductus arteriosus is a connection between what 2 structures?
Aorta and pulmonary artery
What abnormality of the biliary tree is expected in pts with sickle cell?
Pigmented gallstones (d/t constant hemolysis and elevated bilirubin)
Cholecystectomy is expected to occur early.
Developmental dysplasia of the hip is diagnosed during the well-baby exam when you hear a click sound on hip flexion (Barlow and Ortolani). How is the diagnosis confirmed?
Ultrasound at 4-6 weeks
Peripheral eosinophilia, recurrent “cold” abscesses (Staph, H.flu, Strep pneumo), eczema, retained primary teeth, fractures, and post-infectious pneumatoceles
Dx?
Hyper-IgE (Job) Syndrome
In newborns, primary apnea occurs due to any perinatal insult. After ongoing primary apnea, there is a brief period of gasping respirations followed by a period of secondary apnea.
Describe management of primary vs. secondary apnea
Primary apnea responds quickly to stimulation
Secondary apnea requires bagging (via mask or tube) — stimulation will NOT work
Neonate presents with failure to pass meconium and bilious vomiting. X-ray shows air-fluid level with gas-filled plug. Dx and tx?
Meconium ileus
Perform water-soluble contrast enema to help breakdown obstruction
What causes erythema infectiosum
Parvovirus B19
Definitive diagnosis of _______ _______ is made with ultrasound showing “donut sign”
Pyloric stenosis
Diagnostic algorithm for suspected meningitis if there are signs of increased intracranial pressure (bulging fontanelles)
[Note: FAILS positive = signs of increased intracranial pressure]
Blood culture —> Abx —> CT scan —> LP
Management of meconium aspiration syndrome
If meconium is present but infant is vigorous (pulse >100, good resp effort and muscle tone), simple suctioning of nose and mouth is sufficient
If infant has poor tone and resp effort or pulse <100, endotracheal suctioning with passage and withdrawal of ET tube should be performed
Continuous machinery like murmur that usually resolves within 7 days in term infants
PDA
Patient presents with colicky bladder pain following an alcohol binge, and ultrasound reveals hydronephrosis without hydroureter. Dx?
Ureteropelvic junction obstruction — the ureter at the UPJ has been narrowed, which restricts flow of urinary volume (particularly in high volume states/diuresis)
Causes of bilious vomiting in neonate
Duodenal atresia
Annular pancreas
Malrotation/volvulus
Intestinal atresia
Immunodeficiency that can present in adults as well as children, both male and female. Less severe but with similar infection types to x-linked agammaglobulinemia. Diagnosis requires deficiency in at least 2 out of 3 of IgA, IgG, and/or IgM. Treat with scheduled IVIG
Common variable immunodeficiency
Orthopedic emergency that occurs in adolescents who are either obese or in a growth spurt. They complain of hip or knee pain of sudden onset. Confirm dx with frog-leg position x-ray. Surgery is required
Slipped capital femoral epiphysis
First 2 things to do if baby is yellow
Start with transcutaneous sensor
Draw a bilirubin level to determine conjugated vs. unconjugated hyperbilirubinemia
Bilious vomiting indicates obstruction distal to the ampulla of Vater. The workup begins with an x-ray and from there, the gas patterns help differentiate disease.
Double bubble sign with a normal gas pattern and a contrast enema showing abnormal cecum position indicate __________
Malrotation
What does VACTERL stand for?
Vertebral anomalies Anus (imperforate) Cardiac anomalies Tracheoesophageal fistula Esophageal atresia Renal anomalies Limbs
Hep B vaccine guidelines for baby if mom is Hep B negative
Hep B vaccine within 2 months
West syndrome (infantile spasm) = symmetric jerking of the head, trunk, or extremities WITHOUT fever, and interictal EEG shows hypsarrhythmia.
The treatment is _______ which can help with spasms, normalizing EEG.
ACTH
The old term “ALTE” meant Apparent Life-Threatening Event, and has since been replaced by “BRUE” for Brief Resolved Unexplained Event because ALTE led to too extensive a workup that often found nothing. Define BRUE
<1 year old + <1 minute duration + any of the following:
Change in color
Change in muscle tone
Change in respirations
Change in responsiveness
Separated into low-risk and high-risk — if low-risk you do nothing, if high-risk you pursue relevant tests/imaging
T/F: The use of antipyretics to control fever prevents recurrent febrile seizures
False
T/F: Erythromycin eyedrops offer prophylaxis against conjunctivitis caused by chlamydia and gonorrhea
False — protects against conjunctivitis caused by gonorrhea only
Bilious vomiting indicates obstruction distal to the ampulla of Vater. The workup begins with an x-ray and from there, the gas patterns help differentiate disease.
________________ presents as polyhydramnios in utero and bilious vomiting in the neonate. XR reveals double-bubble sign but there’s no distal air. Repair is surgical. It is associated with ___________
Duodenal atresia; Down syndrome
Age at which you would expect the following developmental milestones:
Can hop, draw a cross, speaks in 4-word sentences
4 years
Pharyngitis + rash on palms and soles
What virus?
Coxsackie
Anatomically stenosed connection between nose and mouth. In severe cases, baby will be blue at rest because they are obligate nose-breathers, and will pink up with crying. May see childhood snore. Surgery is required.
Choanal atresia
In term infants, PDA’s are usually no big deal and self-resolve within 7 days. How are they handled in preterm infants?
Closure with indomethacin or surgery (since they can cause hemodynamic instability)
However, prostaglandins are used to maintain PDA if needed for critical heart lesion
A pt with sickle cell usually has a hemoglobin between 7 and 9. Transfusions should be avoided unless absolutely necessary. If patients receive transfusions, they’ll become iron overloaded — what do you do if this occurs?
Use iron chelators like deferoxamine (or deferasirox)
Don’t do phlebotomy (like for hemochromatosis), this would just make them anemic
Rash caused by togavirus that looks similar to measles (macular, starts on face, spreads down to toes) but pts don’t look as sick and the prodrome consists of tender generalized periorbital and postauricular lymphadenopathy. Forcheimer spots on the palate can be seen.
Rubella (german measles)
Key exam findings in allergic rhinitis
Allergic shiners (venous congestion under eyes)
Allergic salute (transverse nasal crease from upward nose-wiping)
Pale/boggy nasal mucosa
Cobblestoning of posterior oropharynx
A less-than-one y/o child has symmetric jerking of the head, trunk, or extremities WITHOUT fever, and interictal EEG shows hypsarrhythmia. Dx?
West syndrome (infantile spasm)
When are tympanostomy tubes indicated for recurrent OM?
3x in 6 months OR 4x in 12 months
Baby presents with jaundice. You draw a bili level and determine it is a conjugated/direct hyperbilirubinemia. What is the next step?
HIDA scan (check for obstruction) Hepatic U/S Sepsis eval (CBC, cultures) Metabolic eval (check for metabolic dz — Crigler-Najjar, Rotor, dubin-johnson)
Apnea of prematurity consists of episodes of true apnea (20+ seconds) associated with drop in O2 sat and heart rate. They can be central, obstructive, or mixed. Essentially, the neonates respiratory centers have not matured appropriately. Treatment with ______ can decrease the episodes of apnea. Noninvasive PPV or supplemental O2 can also be considered.
Caffeine
Age at which you would expect the following developmental milestones:
Skips, can draw a triangle, speaks in 5 word sentences
5 years
Immunodeficiency presenting with recurrent “normal” infections — sinusitis, otitis, pneumonia, etc., and only presents in males
X-linked Agammaglobulinemia (XLA aka Bruton’s)
Age at which you would expect the following developmental milestones:
Can do stairs, speaks 2-word sentences, follows 2-step commands
2 years
If an infant was born at <32 weeks AND continues to require supplemental O2 at day 28, they probably have _____
Bronchopulmonary dysplasia (BPD)
Harsh holosystolic murmur depending on size of defect (smaller defect = louder murmur)
VSD
A child with intellectual disability presents with seizures, and on exam you notice ash leaf spots with Wood’s lamp and angiofibromas on the face. What is the dx?
Tuberous sclerosis
[seizures are caused by cortical tubers]
What drug can be used to increase HgbF in sickle cell patients?
Hydroxyurea
Standard newborn care
Assess umbilical cord for 2 arteries, 1 vein. Clip cord above base and trim excess.
Obtain and plot initial weight, length, and head circumference on growth chart.
Give shots and drops (Vit K, Hep B, conjunctivitis prophylaxis)0
Check glucose if baby is large or small for gestational age (LGA/SGA)
How do you test for TB in a pt less than 5 y/o vs. greater than 5 y/o?
<5 = PPD
> 5 = interferon gamma release assay
You suspect biliary atresia in a baby with persistent jaundice after 2 weeks of age. You have done an ultrasound and obtained LFTs. What is the next test in the hierarchy to obtain?
HIDA scan done 5-7 days after phenobarbital stimulation (will show lack of bile reaching the duodenum)
[Intraoperative cholangiogram can be done if still uncertain]
Age at which you would expect the following developmental milestones:
Walking, pincer grasp, knows 1 word, has separation anxiety
1 year
Autosomal recessive disorder leading to indiscriminate lysosome fusion. Features include albinism, neuropathy, and neutropenia. Look for giant granules in neutrophils.
Chediak-Higashi
Hep B vaccine guidelines for baby if mom is Hep B positive
Hep B Ig and Hep B vaccine immediately
Most common cyanotic defect of the NEWBORN
Transposition of the great arteries
Transient tachpnea of newborn (TTN) = Condition in which there is delayed clearance of fetal lung fluid, typically seen with cesarean deliveries. Presents as near-term infant that has grunting and tachypnea with a hyperexpanded and “wet” appearing CXR.
What is the management?
Supplemental O2 or CPAP/intubation if needed
Examples of heart defects causing left to right shunts
ASD
VSD
PDA
Age at which you would expect the following developmental milestones:
Sits up, fine motor skills include raking, babbles, has stranger anxiety
6 months
Primary bone tumor found in mid-shaft caused by t(11;22) translocation with onion skin pattern
Ewing sarcoma
Examples of right to left shunts (cyanotic heart defects)
Transposition of great arteries
Tetralogy of fallot
[above 2 are most common; there are others — T-diseases like Truncus arteriosus, Tricuspid atresia, and Total anomalous pulmonary venous return (TAPVR)]
Patient presents with a dirty wound and has had <3 lifetime doses of TDaP. Management?
Give TDaP and TIG
Treatment for allergic rhinitis includes allergen avoidance, intranasal corticosteroids, intranasal antihistamines, oral antihistamines, and/or leukotriene antagonists may be used. Which is considered the most effective?
Intranasal corticosteroids
Inflammation of hippocampus and bloody LP
HSV encephalitis
Inheritance of sickle cell disease
Autosomal recessive
What type of hypersensitivity?
Antibody:Antigen complex; serum sickness
Type 3
Potentially lethal complication of measles seen later in life
Subacute sclerosing panencephalitis
treatment for gastroschisis or omphalocele
Cover visceral contents (plastic + saline gauze)
Place NG tube for decompression
Maintain fluid balance (increased insensible losses)
Surgical treatment with silo to allow extruded contents to re-enter abdomen
A baby presenting with blood emesis or stool can be due to swallowing of maternal blood during peripartum process. What test should you do to see if blood is of fetal vs. maternal origin?
Apt test (alkali denaturation test)
[fetal blood is resistant to denaturation, yields a positive test, and requires further investigation]
Sinopulmonary infections, absent IgA, poor DNA repair, lymphoma, leukemia, skin lesions, abnormal gait
Dx?
Ataxia Telangiectasia
_______ bilirubin is water soluble, so it can’t cross the BBB but it can be excreted in urine. It is always pathologic as it indicates problems with biliary excretion.
Conjugated
Purulent bilateral conjunctivitis occurring on day 2-7 of life. Dx and tx?
Gonorrhea
Ceftriaxone IM (although this should have been prevented with erythromycin gtt)
Hep B vaccine guidelines for baby if mom’s hep B status unknown
Baby gets hep B vaccine now AND check mom’s HBsAg
Diagnostic algorithm for suspected meningitis if there are no signs of increased intracranial pressure
LP —> CSF and blood cultures —> antibiotics
Bilious vomiting indicates obstruction distal to the ampulla of Vater. The workup begins with an x-ray and from there, the gas patterns help differentiate disease.
Double-bubble sign and multiple air fluid levels indicates ________
Intestinal atresia
Adenosine deaminase deficiency leading to susceptibility to opportunistic infections. Pts require PCP prophylaxis, scheduled IVIG, and bone marrow transplant (although gene and enzyme replacement have been used)
SCID
Which live virus vaccine is typically given orally and is absolutely contraindicated in pts with hx of intussusception?
Rotavirus
_______ bilirubin is lipid-soluble so it can cross the BBB, potentially leading to ________ (irreversible deposition in the basal ganglia and pons) which is potentially fatal
Unconjugated; kernicterus
6 y/o pt presents with insidious onset knee pain and antalgic gait due to avascular necrosis of the hip. Dx?
Legg-Calve-Perthe disease
Ischemia causes autoinfarction of the spleen in sickle cell kids, making them prone to infection with encapsulated organisms. They should receive normal vaccine schedule in addition to pneumococcal vaccines. Prophylactic ______ is also indicated for kids <5, and sometimes until age 18
Penicillin
Preterm infant has CXR showing low lung volumes and uniform granular pattern — dx?
Respiratory distress syndrome (RDS)
Patient presents requesting a flu shot but states they have an egg allergy. The allergy causes them to break out in a rash. What do you do?
They can get the inactivated vaccine as long as they are monitored for 30 minutes following administration
If child is suspected to be HIV+ and is less than 18 months, mom’s antibodies make for false positives on typical HIV testing with 4th gen antibody/antigen tests, ELISA, and Western blot. What test is used in this age group?
DNA PCR
Young patient with likely foreign body ingestion or aspiration presents with positive coin sign on AP X-ray. What does this tell you?
The object is not in the trachea
What criteria are used to differentiate a septic hip from transient synovitis?
Kocher criteria — non-weight bearing, ESR >40, fever >38C, WBC >12,000
1: Not a septic joint
2. Not sure
3. 93% septic joint
4. 99% septic joint
Most common congenital heart disease
VSD
Dx and tx of X-linked agammaglobulinemia (bruton’s)
Immunoglobulin level — all are deficient
Flow cytometry will show absence of B cells
Confirm with genetic testing for BTK gene
Tx with scheduled IVIG
If pt presents with angioedema and you suspect hereditary angioedema as the cause, C1 inhibitors can be administered, but the safe bet (from availability perspective) is _____
FFP
What would you expect on a CMP in a neonate with pyloric stenosis?
Hypochloremic hypokalemic metabolic alkalosis
Rule of 9s for pediatric burns
Head = 18 Arms = 9 each Torso = 18 front, 18 back Legs = 14 each Genitals = 1
Infant presents with pertussis. Give the child and all contacts _______ to decrease the contagion.
Erythromycin
Simple febrile seizures do not require extensive workup beyond identifying the underlying cause of the fever. What are the criteria to be considered a simple febrile seizure?
Generalized
<15 minutes in duration
Single episode in 24 hours
No underlying neuro problems
[if above criteria are not met, i.e., if seizure is focal, >15 minute duration, or recurrent within the day, investigation for complex febrile seizure needs to happen]
Infants requiring ventilatory support should have their respiratory status and pulse checked at one minute. Pulse ox can be used to assess respiratory status if cyanosis is present. What are goal O2 sats at 1 minute, 5 minutes, and 10 minutes?
1 minute: 60-65%
5 minutes: 80-85%
10 minutes: 85-95%
In a newborn with inappropriate respiratory status or pulse:
A pulse between 60-100 requires ongoing ventilation. If it drops below 60, chest compressions are needed. These are done in a _______ ratio of compressions to breaths. 45-60 seconds should be completed before pulse check is done. If no improvement, administer ________ via ___________ vein catheter
3:1
Epinephrine
Umbilical vein
Tx for absence seizures
Ethosuximide
Patient presents with a clean wound and has had <3 lifetime doses of TDaP. Management?
Give TDaP
Pharyngitis + conjunctivitis
What virus?
Adenovirus
Disease in which macrophages can eat but not kill organisms that are catalase positive. Pts present with chronic skin or organ abscesses. Confirm with negative nitro-blue test that reveals absent respiratory burst
Chronic granulomatous disease
Most common primary immunodeficiency
Selective IgA deficiency
Definitive surgical treatment for biliary atresia in an infant
Kasai procedure (hepatoportoenterostomy)
Unilateral conjunctivitis occurring on day 5-14 of life, goes from watery to purulent to bloody — may spread to other eye. Dx and tx?
Chlamydia
Erythromycin PO (not topical!)
Check for systemic illness — can turn into a pneumonia
Most common cyanotic heart defect in CHILDREN
Tetralogy of fallot
Bronchiolitis is an inflammatory disorder of the small airways caused by a viral infection (usually RSV) in a very young child (<2 years). Why doesn’t the wheezing in this infection respond to beta agonists?
Because the wheezing is caused by partial airway obstruction from sloughed epithelial cells (not bronchospasm)
Previously healthy pt presents at 6 months of age with feeding intolerance, vomiting, failure to thrive, and bloody stools. Dx?
Milk-protein allergy
[there is cross-reactivity with soy. Treat by avoiding cow’s milk protein until 2-3 years of age. Use hydrolyzed formula in interim]
What is amblyopia?
Essentially a cortical blindness and defect of development
Something happens to obscure vision in one eye (like congenital cataracts), and the brain shuts off input from defective eye, causing it to go completely blind
Immunodeficiency that may present with an anaphylactic reaction after a blood transfusion; otherwise relatively benign other than possibly more frequent respiratory or GI infections
Selective IgA deficiency
Antibiotic used to cover listeria
Ampicillin
What is the difference between breast feeding jaundice and breast milk jaundice?
Breast feeding jaundice is a QUANTITY issue. Without sufficient volume, bowels don’t move fast enough and the body reabsorbs bilirubin which builds up. By increasing the number of feeds, the problem fixes itself.
Breast milk jaundice is a QUALITY issue. Breast milk inhibits glucuronyl transferase. Formula can be temporarily substituted for breast feeding.
[both cause an indirect hyperbilirubinemia]
DTaP vaccine guidelines:
Kids get a total of _____ doses:
____ doses in their 1st year and _____ doses between 1-4 years
Td (booster) or Tdap at least once in adolescence and then q10 years.
5
3; 2
While performing a neonatal exam, you notice that the umbilical cord has only a single umbilical artery instead of two…what test should now be considered?
Renal ultrasound — this could indicate agenesis of ipsilateral kidney
What are modified centor criteria?
C — absent Cough +1 E — Exudates (tonsillar) +1 N — Nodes (LAD) +1 T — Temp >38 C +1 OR — less than 14 or greater than 44 y/o -1
Score 0-1 = No further testing
Score 2-3 = Perform rapid testing
Score 4+ = Empiric abx
Primary bone tumor associated with retinoblastoma that presents with sunburst pattern typically at distal femur
Osteogenic sarcoma
Tx for DiGeorge syndrome
Prophylax against PCP (TMP/SMX)
Scheduled IVIG
Cure with thymic transplant
Watch calcium — as absent parathyroid glands can lead to hypocalcemia and seizures
Antibiotic tx for otitis media is amoxicillin, or amoxicillin-clavulanate if recurrent. What do you use if pt is penicillin-allergic?
If allergy is non-anaphylactic, try cephalosporin, such as cefdinir
If allergy is anaphylatic, use azithromycin
Pt presents with micrognathia, wide-spaced eyes, low-set ears, and either fungal or pneumocystis pneumonia. Dx?
22q11.2 Deletion — DiGeorge syndrome
All patients with imperforate anus require evaluation for _________, and should undergo sacral ultrasound and x-ray, VCUG, NG tube passage, and echocardiogram
VACTERL
Why must every premature neonate <30 weeks be screened with cranial US?
R/o intraventricular hemorrhage
[The intraventricular lining (germinal matrix) is highly vascular and susceptible to BP changes. It usually involutes at 34 weeks, so if a neonate is born prior to 34 weeks, they have this risk of bleeding]
Best radiographic test for osteomyelitis
MRI
Age at which you would expect the following developmental milestones:
Lifts head, tracks past midline, coos, has social smile
2 months
Most common cause of osteomyelitis
Staph aureus
Patient presents with a dirty wound and has had 3+ lifetime doses of TDaP, the most recent being >5 years ago but was within 10 years. Management?
Give TDaP
[if it was within 5 years they could be sent home. If wound was clean, shot only needs to be within 10 years]
Baby presents with jaundice. You draw a bili level and determine it is an unconjugated/indirect hyperbilirubinemia. What is the next step?
Coombs test
CBC
Reticulocyte count
[Coombs positive means isoimmunization — Rh disease or ABO incompatibility. High Hgb indicates twin-twin transfusion, maternal-baby transfusion, or delayed cord clamping. High Retic count indicates hemolysis (spherocytosis, G6PD, pyruvate kinase def) or hemorrhage. Low retic count means reabsorption — breast feeding jaundice or breast milk jaundice]
Caused by paramyxovirus, there’s an obvious prodrome of low grade fever and the 4 C’s — cough, coryza, conjunctivitis, and Coplik spots (Koplik). The rash starts on the face then spreads to the body which is when fever starts. The rash spreads and clears from head to toe
Measles
What type of hypersensitivity?
Cytotoxic, antibody-mediated; hemolytic anemia
Type 2
What congenital heart defect is associated with increased risk with pre-gestational diabetes?
Transposition of the great arteries
Indications for immediate exchange transfusion in sickle cell patients
Encephalopathy or focal neuro deficit
Chest pain
Noncardiogenic pulmonary edema
Patients with myelomeningocele can also have __________________ which can lead to upper extremity and respiratory symptoms
Chiari malformation (type 2)
Patient presents for immunizations and has an egg allergy. What vaccine(s) can they NOT have?
Influenza
Yellow fever
[note that recombinant influenza vaccine is not made with eggs and can be used in those 18+]
Why is a baby’s first temp never taken rectally?
First must r/o imperforate anus
What causes hand foot and mouth disease?
Coxsackie A
Causes of non-bilious vomiting in neonate
Pyloric stenosis
Tracheoesophageal fistula
T/F: When it comes to strep testing, children under 3 have low incidence, so generally should not be tested. Children age 5-15 have high incidence, so generally can test right away without considering CENTOR criteria
True
Caused by HHV6, there’s a prodrome of high fever (>40C) that breaks as the rash starts. The rash is macular and begins on trunk and spreads to face. Febrile seizures may be seen
Roseola
What congenital heart defect is associated with Down syndrome and DiGeorge syndrome?
Tetralogy of fallot
What type of hypersensitivity?
Delayed T-cell mediated reaction; poison ivy
Type 4
What test confirms posterior urethral valves as the cause of low/no urine output in a newborn male?
VCUG
What type of hypersensitivity?
IgE-mediated; anaphylaxis
Type 1
5 components of apgar score
Appearance (blue/acrocyanosis/pink)
Pulse (absent/<100/>100)
Grimace (absent/with high stim/with stim)
Activity (none/flexion/resist extension)
Respiration (absent/irregular/strong)
Parkland formula for burns
(%body surface area burned) x (body weight in kg) x (4)
50% of fluids given in first 8 hours
50% given in 16 hours
Acute otitis media with postauricular swelling and/or anteriorly rotated ear; dx?
Mastoiditis — need prompt surg eval
What do you do if pt with croup is experiencing significant respiratory impairment?
Supplement with O2 and give racemic epinephrine and steroids (usually dexamethasone)
Electrolyte derangements that can cause constipation
Hypercalcemia
Hypermagnesemia
Hypoglycemia
Hypokalemia
[other metabolic causes include hypothyroid and adrenal insufficiency]
What causes intestinal atresia in the neonate?
Cocaine and/or tobacco abuse in pregnancy leading to vascular accidents in utero
Meconium ileus raises suspicion for pancreatic insufficiency due to ______
Cystic fibrosis
Baby with HTN, claudication, differing BP in arms and legs, and rib notching on x-ray
Dx?
Coarctation of aorta
What do you give HIV+ mom during delivery to prevent vertical transmission?
AZT
Fixed wide split S2
What heart defect?
ASD
3 stages of pertussis
Catarrhal (days of rhinorrhea and low-grade fever)
Paroxysmal (coughing spells, whoops)
Resolution (regular cold sxs)
Condition in which there is delayed clearance of fetal lung fluid, typically seen with cesarean deliveries. Presents as near-term infant that has grunting and tachypnea with a hyperexpanded and “wet” appearing CXR
Transient tachypnea of the newborn (TTN)
Contraindications to DTaP vaccine
Absolute: hx of encephalopathy <7 days after previous dose
Relative: fever, shock, or persistent crying (>3 hrs) w/i 48 hrs, or seizures w/i 3 days
[if there is a bad reaction to DTaP, try TD (no acellular pertussis). If there’s a bad reaction to that, try TT (tetanus toxoid)]
_________ is an antibiotic that may cause hyperbilirubinemia in infants <30 days old, so in these cases _______ should be used
Ceftriaxone; cefotaxime
Features of tetralogy of fallot
Pulmonary stenosis
Right ventricular hypertrophy
Overriding aorta
Ventricular septal defect
[PROVe mnemonic]
Bilious vomiting indicates obstruction distal to the ampulla of Vater. The workup begins with an x-ray and from there, the gas patterns help differentiate disease.
_____________ presents with double-bubble sign on XR with or without distal air. Like duodenal atresia, it is also associated with Down syndrome
Annular pancreas
Premature infants are at increased risk for bronchiolitis. What is the option for prophylaxis against bronchiolitis given in select cases?
Palivizumab (Synagis)
Describe diagnostic steps in suspected hirschprung’s disease
- X-ray (shows dilated proximal colon and normal looking distal colon)
- Contrast enema (shows transition zone)
- Biopsy
Alternatively, if pt presents later with overflow incontinence or stool eruption after DRE in nursery, next step after x-ray is anorectal manometry which shows increased tone which is then followed by biopsy.
Newborn hypoglycemia (<45) risk factors include LGA, SGA, infant of diabetic mother (IDM), and IUGR. How is it managed in asymptomatic vs. symptomatic newborns?
Asymptomatic = feed and recheck
Symptomatic = 2 mL/kg D10W and recheck
Which vaccine is absolutely contraindicated in pts with hx of encephalopathy <7 days following a previous dose of the vaccine?
DTaP
Age at which you would expect the following developmental milestones:
Can ride a trike, can draw a circle, speaks in 3-word sentences
3 years
During initial neonatal assessment, you note that the anus is not present. What is your next diagnostic step?
Cross table x-ray on the child in prone position
[this will give relationship between gas bubble and anus. Low lesions (closer to anus) require correction by dilation or minor surgical procedure. High lesions (away from anus) require colostomy with future correction]
Age at which you would expect the following developmental milestones:
Rolls over, fine motor skills are clumsy but able to grasp, laughs and squeals, looks around room
4 months
What “shots and drops” are given as part of standard newborn care?
Vitamin K given IM to prevent hemorrhagic disease of newborn (babies don’t have gut flora to make Vit K)
Hep B vaccine
Conjunctivitis prophylaxis
Condition occurring in teenage athletes, presents as painful knee with swelling over tibial tubercle. Athlete can stop exercising (curative) or play through it resulting in palpable painful nodule but no other sequelae
Osgood-Schlatter disease (osteochondrosis)
Primary treatment for retinopathy of prematurity (ROP)
Laser photocoagulation
What are some characteristics of physiologic jaundice in a newborn?
Onset 1-7 days after birth
Slow bilirubin increase of <5/day
Direct bili is <10% of total
Resolves by day 10
Premature infant has bloody bowel movement and xray shows pneumatosis intestinalis. Dx?
Necrotizing enterocolitis
[tx with NPO, IV abx, and TPN]
Immunodeficiency that may present early with delayed separation of umbilical cord
Leukocyte adhesion deficiency
[neutrophils can’t adhere or get out of the blood vessels. So there’s no pus despite a massive leukocytosis and high fever. Requires bone marrow transplant]
What labs are used to determine whether a confirmed sickle cell patient is in crisis or not?
Baseline bilirubin
Baseline reticulocyte count
Baseline hemoglobin
Whether or not there are sickled cells on smear
Pt presents with a dirty wound and has not been immunized for tetanus. The first step is to prevent disease with ____________ to bind up the toxin and then give _________ to induce immunity.
If symptoms have already started, give sedation+intubation, muscle relaxers, and IV ____________.
Tetanus immunoglobulin (TIG); toxoid
Metronidazole
When are Apgar scores recorded?
1 minute and 5 minutes
If child has required ongoing resuscitation, additional apgar scores may be calculated at 10 minutes
Parvovirus B19 causes erythema infectiosum (slapped-cheek) rash. It is benign on its own and resolves spontaneously. If there’s underlying issues like sickle cell, anemia, or heavy metal exposure, it can precipitate aplastic crisis. If a pregnant mom comes into contact with the virus it can cause ___________ in the fetus
Hydrops fetalis
Hyper-IgM syndrome occurs when there is an issue with class-switching, so there are low levels of IgA and IgG, but a normal to high level of IgM. What is the tx?
Scheduled IVIG
How does squatting relieve cyanosis in kids with tetralogy of fallot?
Squatting causes an increase in systemic vascular resistance, pushing more right ventricular blood into the lungs
Management of RDS in newborn
Surfactant administration and mechanical ventilation
X-linked immunodeficiency presenting with “normal bug” infections, thrombocytopenia, and eczema. Immuno-studies will show increased IgE and IgA. Treat with IVIG, and perform splenectomy or bone marrow transplant
Wiskott-Aldrich
GCS Score Components
Eye opening (scored 1-4 from none, pain, voice, spontaneous)
Motor response (scored 1-6 from none, decerebrate, decorticate, flexion withdrawal, localizes pain, obeys commands)
Verbal response (scored 1-5 from none, incomprehensible, inappropriate words, disoriented conversation, oriented/appropriate)
[In a nonverbal child, eye opening is scored the same. Motor response is graded none, extension abnormal, flexion abnormal, flexion withdrawal, localizes pain, normal movements. Verbal response is graded none, grunts, inappropriate crying/screaming, cries, cries normally/smiles/coos]
Delineating factor between ITP and HSP
ITP has thrombocytopenia, while HSP typically does not
Pediatric maintenance fluids
4-2-1 rule
For 0-10 kg: 4 mL/kg/hr
For 11-20 kg: 2 mL/kg/hr
For >20 kg: 1 mL/kg/hr
[example: 5 kg male gets 20 mL/hr]
Syndrome that presents in neonates with a variety of defects including overgrowth, macroglossia, anterior abdominal wall defects, hepatomegaly, and pitting of the external ears. As the child gets older, mental retardation and embryonal tumors are associated, requiring serial abdominal US to screen for tumor development (especially Wilms tumor) and careful maintenance of blood glucose for optimal intellectual development
Beckwith-Wiedemann syndrome
[In short, presents in LGA infant with neonatal hypoglycemia, protruding tongue, and pitting of ears]
What age(s) do you give MMR vaccine?
First dose at 12-15 months
Second dose at 4-6 years
First dose of influenza vaccine cannot be given until ______ of age
6 months
What immunizations are given at 2 months?
Hep B Rotavirus DTaP Hib IPV Pneumococcal (PCV)
Disorder caused by defect in transport of neutral amino acids leading to decreased availability of tryptophan in the body for niacin synthesis. Most children remain asymptomatic but some exhibit severe cutaneous photosensitivity
Hartnup disorder
Rare disease characterized by severe metabolic acidosis in the first few days of life, as well as jaundice and mild to moderate hemolytic anemia
Glutathione synthetase deficiency
Acid-base disturbance associated with respiratory distress syndrome (RDS)
Mixed metabolic acidosis and respiratory acidosis
Metabolic acidosis is due to lactic acid production as a result of anaerobic metabolism and poor tissue perfusion
Respiratory acidosis is due to alveolar atelectasis (leading to poor ventilation) and/or central hypoventilation
The most common type of congenital adrenal hyperplasia is a _____________ deficiency, leading to hyponatremia and hyperkalemia because the individuals are unable to produce aldosterone and cortisol. An elevated blood level of ___________ is diagnostic for this condition.
21-hydroxylase; 17-hydroxyprogesterone
Rare autosomal dominant disorder characterized by HTN in young patients with hypokalemic metabolic alkalosis
Liddle syndrome
[AD inheritance; mutation causes epithelial sodium channel in distal tubule to be constitutively active]
Looks like Liddle syndrome (hypokalemic metabolic alkalosis) but BP is low or normal
Bartter syndrome
Autosomal recessive disorder that presents with hypokalemia, metabolic alkalosis, hypomagnesemia, hypocalciuria, and normal BP
Gitelman syndrome
Patient with confirmed group A strep pharyngitis is put on amoxicillin and initially improves, but 7 days later develops urticarial rash, fever, polyarthralgias or polyarthritis, and malaise. What is the dx?
Serum sickness-like reaction
[Type III hypersensitivity]
Patient with group A strep develops migratory arthritis, carditis, CNS involvement (chorea), erythema marginatum, and subcutaneous nodules. Dx?
Acute rheumatic fever
Patient complains of URI symptoms that began 2 days ago, and now notes diffuse, papular erythematous rash that blanches on palpation and feels like sandpaper. You later determine the URI is due to group A strep infection. Dx?
Scarlet fever
Antimicrobial therapy of choice for its with pertussis and for close contacts
14 day course of oral erythromycin
Other options include azithromycin or clarithromycin. Adults who cannot tolerate macrolides can take TMP-SMX.
Neonatal abstinence syndrome describes s/s in infants who undergo withdrawal after being chronically exposed to a substance (most commonly opiates) during fetal life. _____ is the most common cause of neonatal abstinence syndrome, presenting with poor feeding, diarrhea, restlessness, and a high-pitched cry at 1-5 days of life. Similar symptoms may present at 1-4 weeks of life in the case of maternal ______ use.
Heroin; Methadone
