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CNSC Exam > Pediatrics Overview > Flashcards

Pediatrics Overview Flashcards

1
Q

A child with cerebral palsy and a gastrostomy tube is admitted to the hospital for a fundoplication. This procedure is used to manage

A

gastroesophageal reflux

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2
Q

GER is most common in children with ____

A

neuroimpairment

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3
Q

What are the steps used to treat GER in children

A

change feeding regimen
change positioning during feeding
stat medications for reflux and motility

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4
Q

If treatment is refractory to GER, _____ is used a last resort management

A

Fundoplication or PEG-J extension

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5
Q

Premature infants with these types of conditions are at an increased risk for metabolic bone disease

A
  1. cholestasis
  2. immobilization
  3. Chronic steroid use
  4. very low birth weight <1500 grams
  5. chronic diuretic use
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6
Q

MBD is characterized by the development of

A

osteopenia and osteomalacia

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7
Q

When used in the assessment of critically ill children, how do predictive equations compare to indirect calorimetry

A

no consistent comparison can be found

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8
Q

Indirect calorimetry is the gold standard for the assessment of energy needs in the critically ill child and should be used whenever possible. When IC is not available, what should be used

A

Schofield or WHO equation

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9
Q

what is the most common nutrient deficiency in childhood

A

iron deficiency anemia

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10
Q

Term infants have enough iron stores for up to ____ months

A

6 months

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11
Q

Infant formulas are fortified with enough

A

iron

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12
Q

Iron content of breast milk is ______ than formula but more efficiently absorbed

A

less

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13
Q

exclusively breast fed infants require additional iron starting at ________ months old with supplementation or complementary foods

A

4-6 months old

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14
Q

Cows milk has iron but is ___________ because it is high in calcium

A

not efficiently absorbed

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15
Q

Children should not be introduced to cows milk before ___ months because they will be at risk for ______

A

12 months

iron deficient

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16
Q

An obese 12 year old is admitted to the hospital for an evaluation of sleep apnea. A diet history reveals she drinks 3 cans of soda, 24 oz of juice and 8 oz of chocolate milk a day. In what mineral may she be deficient

A

calcium

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17
Q

soda consumption in youth decreases ____ consumption

A

calcium

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18
Q

______ adolescents are at the highest risk of developing _____ deficiency

A

female

calcium

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19
Q

juice consumption should be

A

<8 oz a day school age/adolescence
<4-6 oz pre school children
<4 oz toddlers

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20
Q

Children should consume ____ servings a day of dairy to obtain enough calcium

A

2-3 servings

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21
Q

adolescents should consume ___ servings a day of dairy to obtain enough calcium

A

4

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22
Q

When does the American Academy of Pediatrics recommend universal screening for iron deficiency be performed in young children

A

12 months old

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23
Q

iron deficiency over time can lead to long term _______ deficits

A

neruodevelopmental

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24
Q

Selective screening for iron deficiency is done at any age for infants with the following risk factors

A

prematurity
low socioeconomic status
poor growth
exclusive Breast feeding without supplementation

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25
Q

When reviewing a child’s growth chart data , the child’s weight for length curve is falling below the 3rd percentile. What z-score indicates severely wasted

A

z score below =3

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26
Q

a z-score (also known as the std deviation) is where a child weight falls from the median or percentile in growth charts

A

50th

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27
Q

a positive change in standard deviation/z scores indicates

A

growth

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28
Q

a negative change in standard deviation/z scores indicates

A

slowing growth rate

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29
Q

what is the suggested daily amount of potassium required for maintenance of infants with PN

A

2-4 mEq/Kg

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30
Q

A 13 year old boy whose BMI is at the 97th percentile on the CDC’s growth chart for age and sex would be classified as

A

obese

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31
Q

BMI on growth charts is used for children ages over

A

2 years

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32
Q

a BMI between the 85th and 94th percentile is classified as

A

overweight

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33
Q

A BMI greater than or equal to the 95th percentile is classified as

A

obese

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34
Q

Which conditions are associated with delayed bone age in a child with a short stature (things that delay bone age)

A

hypothyroidism
Cushing syndrome
growth hormone deficiency

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35
Q

____ is a diagnostic test assessing a child with abnormal growth, using radiography of the knees or left wrist

A

bone age

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36
Q

Precocious Puberty is known as

A

advanced bone age

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37
Q

what type of pre-term growth chart allows for comparison for pre-term infants from 22 weeks gestation age up through 10 weeks post term age

A

Fenton

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38
Q

What are the pros of using a Fenton growth chart

A

large sample size
validated tool
assess rate of growth OVER TIME

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39
Q

In newborns, potassium is not added to the PN solution until

A

kidney function is established

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40
Q

what is the daily maintenance fluid requirement for a 5 kg infant

A

500mL

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41
Q

The Holliday Segar Method estimates fluid requirements. For each 100 kcals metabolized ____mL of water will be needed

A

100

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42
Q

The Holliday Segar Method to estimate fluid needs should be used for neonates greater than

A

14 days old

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43
Q

How is the holliday segar method used

A

1st 10 kg provide 100mL/kg/day
2nd 10 kg (over 10kg): provide 50mL/kg/day
each additional kg over 20 kg, provide 20mL/kg/day

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44
Q

On radiographic examination a pediatric patient is found to have osteopenia and multiple fractures in various stages of healing. Serum lab results show calcium is low, phos is low, creatinine is normal, alk phos is high, 25-OH vit D is low, 1,25 dihyroxyvitamin D is low, and PTH is high. What is the likely diagnosis

A

Vitamin D Type Rickets

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45
Q

Signs/Sx of vitamin D type rickets are ______ serum calcium, _____ serum phos, ____ alk phos, _____ PTH, _____ 25-OH vit D 2, and ______1,25OH vitamin D3

A 
normal to low calcium
normal to low phosphorous
high alk phos
increased PTH
low vitamin D 2
low vitamin D3
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46
Q

In vitamin D dependent rickets type 2, whate are the signs and symptoms. ______ 25 OH vitamin D 2 and _______ 1,25 dihydroxy vitamin D 3

A

low vitamin D2

ELEVATED VITAMIN D3

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47
Q

What is the recommended daily enteral elemental iron dose for preterm infants 1 month after birth

A

2-4 mg/kg/day (during stable growth) because the rate of growth and erythropoiesis slows down s/p birth and iron requirements are lower.

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48
Q

elemental iron supplementation in preterm infants starts around ___ month and should last until ______ months

A

2-4mg/kg/day for 4-8 weeks starting until 12-15 months old

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49
Q

Infants not getting human milk should receive ______ formula and preterm infants should get at least ____ mg/kd/day of elemental iron from 1-12 months of age

A

iron fortified formula

2 mg/d/day from 1-12 months old

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50
Q

what trace element should be supplemented in a child with chronic diarrhea

A

zinc

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51
Q

acute diarrhea lasts for < ____ days, persistent diarrhea lasts for more than ____ days, and chronic diarrhea lasts for > ____ days

A

14 days
14 days
30 days

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52
Q

Studies show that ______ decreases the duration of diarrheal episodes, decreased hospitalizations and decreased mortality

A

zinc

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53
Q

____ mg of zinc should be given a day when a child has 10-14 days of acute diarrhea and children under 6 months old should only receive ____ mg o zinc

A

20 mg

10 mg

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54
Q

is pancreatic insufficiency a contraindication to nasogastric feedings in a pediatric patient with cystic fibrosis

A

No, pancreatic enzymes can be given to help with absorption

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55
Q

what are contraindications to NG tube placement in pediatric patients with CF? (will need stomach or small bowel access)

A

upper airway secretion
nasal polyps
recurrent sinusitis
otitis

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56
Q

what is the best indication for the use of a soy based infant formula

A

galactosemia

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57
Q

why are soy based infant formulas not used in children with cow’s milk allergy?

A

a high percentage of children who are allergic to cow’s milk protein are also allergic to soy

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58
Q

patients with soy or cow’s milk allergies require which type of infant formula

A

hydrolyzed or free amino acid formula

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59
Q

An inborn error of metabolism that affects the body’s ability to metabolize galactose

A

galactosemia

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60
Q

A child or infant with galactosemia must _______ from the diet and use ______ based formulas

A

eliminate galactose from the diet

use soy based formulas

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61
Q

What is recommended to prevent vitamin D deficiency in a 1 month old infant who is fed human milk

A

give 400 IU of vitamin D a day soon after birth

62
Q

how much vitamin D is recommended for exclusively breast fed infants

A

400 IU vitamin D

63
Q

A seven month old fed reconstituted infant formula and other age appropriate complementary foods may be at risk of over-supplemetnation of which mineral?

A

Fluoride due to the tap water

64
Q

high amounts of fluoride in a child’s diet can cause

A

disrupted tooth enamel/mineralization (enamel fluorosis)

65
Q

which pediatric patients are at the highest risk for enamel flurosis?

A

infants on re-constituted formulas used with tap water

66
Q

non-nutritive sucking helps prevent ___________ in children

A

oral aversion

67
Q

non-nutritive sucking should be used in the enterally fed neonate less than _______ weeks corrected gestational age to promote__________

A

< 32 weeks

to promote oral feeding when developmentally ready

68
Q

suck/swallow coordination is usually developed between __ and ___ weeks gestation

A

32-34 weeks

69
Q

what are the benefits of non nutritive sucking

A

improves digestion of EN feedings
encourages oral development
stimulates lingual lipase, gastrin, insulin, motilin and vagal innervation during EN feedings

70
Q

which equation is typically used to measure energy needs in pediatrics

A

Schofield equation

71
Q

if a child is under weight, which weight should you use to calculate energy needs in pediatrics

A

ideal body weight as they need rapid weight gain

72
Q

children with cystic fibrosis require _____ energy needs

A

increased

73
Q

why are energy needs elevated in children with cystic fibrosis

A

increased work of breathing, decreased nutrient absorption from pancreatic insufficiency

74
Q

what is the maximum dose in units of lipase/kg/meal for PERT therapy

A

2,500 units

75
Q

too high of a dose of lipase or PERT enzyme therapy can increase the risk of developing

A

fibrosing colonopathy

76
Q

children with cystic fibrosis require _____% of energy needs for optimal growth

A

120%

77
Q

supplement fat soluble vitamins in the _____ form for optimal vitamin absorption in children with CF

A

water miscible (children with CF have fat malabsorption)

78
Q

Infants with cystic fibrosis require additional sodium due to high losses, so salt needs to be supplemented. Infants who are 0-6 months old require ____ teaspoons/day and ____ teaspoons if older than 6 months

A

1/8 teaspoon/day

1/4 teaspoon/day

79
Q

when is enteral nutrition indicated in children with cystic fibrosis

A

if the child cannot meet their energy needs with po intake alone

80
Q

other than fat soluble vitamins, what else important to supplement in children w/ CF

A

calcium as they have a high risk of osteoporosis

81
Q

if a child’s health insurance does not cover enzymes in children with CF, can generic enzymes be supplemented?

A

no, they are not water miscible

82
Q

A 14 year old female with cystic fibrosis weighs 50 kg and is 63” tall with pancreatic insufficiency. She takes PERT at meals at a dose of 25,000 units of lipase per capsule. What is her max per meal?

A

25,000 units x 50 kg = 125,000 units total divided by 25,000 units per capsule, is 5 capsules per meal

83
Q

in the critically ill child, are standard equations used to calculate energy needs?

A

no, they are inaccurate

84
Q

if indirect calorimetry is not available to measure energy needs in critically ill children, which equations should be used, should a stress factor be used?

A

Schofield or WHO equations

NO stress factors should NOT be used

85
Q

overfeeding in critically ill children can cause _____ ,_____and _____ leading to increased time on the vent and increased PICU length of stay

A

cholestasis

hyperglycemia with increased infection

86
Q

what is the gold standard for measuring energy needs in children with burns

A

indirect calorimetry

87
Q

the general goal of % of energy needs for children with burns are about ____ to ___%of their REE

A

120-130%

88
Q

children with burns greater than _____% BSA usually need nutrition support to meet their elevated nutrition needs

A

20% BSA

89
Q

what types of children in the ICU require lower energy needs

A

traumatic brain injury
cerebral palsy
Trisomy 21

90
Q

protein needs ____ during periods of stress, critical illness and short bowel syndrome in children

A

increase

91
Q

as child ages, protein needs typically _____ in healthy children

A

decrease

92
Q

children from 0-12 months usually require ____g/kg/day of protein

A

1.5 g/kg/day

93
Q

children from 13 months to 3 years usually require ____ g/kg/day of protein

A

1.1g/kg/day

94
Q

children 4 to 13 years old typically require ___ g/kg/day of protein

A

0.95

95
Q

children between the ages of 14 and 18 years old typically require ___ g/kg/day of protein

A

0.85

96
Q

protein needs during injury _________ due to nitrogen loss and acute inflammation

A

increase

97
Q

protein needs roughly _____ during injury and illness . Children of 0-2 years require ___ to ___ g/kg/day protein, 2-13 years old require ___ to ___ g/kg/day and ages 2-18 years old need ___g/kg/day protein

A

double
2-3 g/kg/day
1.5-2 g/kg/day
1.5 g/kg/day

98
Q

excessive protein intake of ____ to ___ g/kg/day can contribute to negative consequences such as ___ and ___

A

4-6 g/kg/day
metabolic acidosis
azotemia

99
Q

In infants less than 6 months avoid giving ______ due to inadequate nutrient intake and possible electrolyte imbalances

A

free water

100
Q

how are fluid needs calculated in children

A

Holiday-Segar Method

101
Q

the holiday-segar method of fluid needs provides ____mL/kg for infants 1-10 kg

A

100mL/kg

102
Q

the holliday-segar method of fluid needs provides _______mL + ______mL/kg for every kg over 10 kg up until 20 kg

A

1000 mL + 50mL/kg

103
Q

The holliday-segar method of fluid needs provides _______mL + ____mL/kg for every kg over 20 kg of weight

A

1500 mL + 20mL/kg

104
Q

what are the benefits of breast milk

A

increased resistance to infections, increased GI maturity, decreased risk of overfeeding, decreased risk of NEC in preemies, decreased risk of allergies

105
Q

breast milk contains _____ kcal/oz

A

20 kcal/oz

106
Q

breast milk contains ___ to ___ grams/mL of protein

A

0.9-1.4 grams/mL

107
Q

breast milk contains __ to ___ grams of fat/mL

A

3.5-3.9 g fat/mL

108
Q

pre-mature infants require ____ kcal/oz of formula for weight gain

A

24 kcal/oz

109
Q

infant formula for pre-mature infants are higher in

A

protein, fat, calcium, phosphorous, and zinc

110
Q

infant formula for pre-mature infants post discharge contain ____ kcal/oz until 9 months of age

A

22 kcal/oz

111
Q

Standard infant formula contains ___kcal/oz

A

20 kcaloz

112
Q

infants with ______ CANNOT have standard formula as they cannot consume lactose

A

galactosemia

113
Q

infants with galactosemia require ____ based formula

A

soy

114
Q

should infants with cow’s milk protein allergy use soy based infant formula’s?

A

no they usually also have soy allergy

115
Q

low lactose infant formulas are used for infants with

A

suspected lactose intolerance

116
Q

Anti-Reflux infant formula are for infants with severe ____ who are not gaining weight appropriately. It has a ____ component that makes the formula more viscous which makes it harder to bring back up

A

GER

starch component

117
Q

if an infant is on an acid blocker medication, will anti-reflux medications work?

A

no because the starch relies on the stomach acid to thicken the ofrmula

118
Q

caseine hydrolysate infant formula is used in infants with _____ protein allergy

A

milk

119
Q

elemental infant formula is an amino acid based formula is used for infants with

A

severe food allergies, malabsorption

120
Q

vitamin _____ is supplemented prophylactically to ALL newborns

A

vitamin K

121
Q

_____IU a day of vitamin D is recommended for exclusively breast fed infants

A

400 IU/day

122
Q

for infants breast fed and on formula, what is the recommendation for vitamin D?

A

routinely monitor levels and supplement as needed

123
Q

for infants getting 100% goal volume of infant formula, what are the recommendations for vitamin D supplementation

A

NO supplementation of vitamin D is necessary unless they have a malabsorption disorder

124
Q

which children/infants are at most risk for a vitamin D deficiency

A

breast feeding without supplementation
dark pigmented skin (melanin acts as SPF)
born earlier than 32 weeks gestation
geographic location
recent immigration from developing country
malabsorption disorders such as epilepsy, CP, SBS, biliary atresia, phenobarbital medications

125
Q

phenobarbital medications in infants can lower _____ vitamin

A

vitamin D

126
Q

when are vitamin B12 levels of concern in infants

A

if the baby is exclusively breast fed and mom is vegan s

127
Q

when should iron be fortified in infants

A

by 4-6 months old

128
Q

when does fluoride need to be supplemented ?

A

after 6 months of age based on the water supply (rural areas and well water)

129
Q

0.25mg/day of this is needed to be supplemented in some infants from 6 months to 3 years old

A

fluoride

130
Q

Cow’s milk should not be given before

A

1 year

131
Q

why is Cow’s milk inappropriate for children

A

low in iron
low in vitamin C and E
low in essential fatty acids
has a high renal solute land due to limited ability to concentrate the urin as I stooging high in milliosmoles

132
Q

elemental formulas for children 1-10 years old is used for

A

malabsorption and food protein allergies

133
Q

elemental formulas for children 1-10 years old contains

A

free amino acids, 240-3ckal/oz

134
Q

semi elemental formulas for children 1-10 years old contains

A

protein as peptides and amino acids , 30-45 kcal/oz

135
Q

when would Semi-Elemental formula for children 1-10 years old be used

A

malabsorption

136
Q

a polymeric formula for children 1-10 years contains these properties

A 
fiber
is calorie dense
30kcal/oz
44-53% carbs
35-45% fat
12-15% protein
137
Q

when are orogastric tubes recommended for children

A

premature infants <34 weeks with nose breathing, lack of gag reflux
basilar skull fractures

138
Q

when are NG tube appropriate for children requiring enteral nutrition

A

normal gastric function
no risk of aspiration
short term use

139
Q

when are Nasoenteric tubes recommended for children requiring enteral nutrition

A

short term with significant reglux
gastroparesis
high aspiration risk

140
Q

when are gastrostomy tubes recommended for children requiring enteral nutrition

A

long term for at least 3 months

141
Q

when are gastrojejunostomy tubes recommended for children requiring EN

A

long term
severe GER who aren’t a candidate for a Nissen Fundoplication
already have a gastrostomy but be but not tolerating their feeds

142
Q

when children are given EN via bolus or gravity how should the be initiated and advanced

A

start at 25% of the goal
divide the # of feeds
increase the volume by 25% daily

143
Q

when children are given EN via pump how should they be initiated and advanced

A

start at 1-2mL/kg/hr and advance by 0.5 to 1 mL/hr every 6-24 hours to the goal

144
Q

if possible, don’t use powdered formula for these types of infants

A

immunocompromised

145
Q

what is the recommended hang time of manipulated formula and human breast milk including powdered, re-constituted HBN, and EN formula with additives

A

4 hours

146
Q

what are the indications for EN in children

A

insufficient oral intake to support adequate weight gain and growth, oral motor dysfunction, inborn errors of metabolism, Chron’s disease
a structural or functional GI abnormality such as congenital malformation, head/neck tumor, or injury/critical illness

147
Q

what is the preferred method of feeding in a critically ill child

A

enteral nutrition (the stomach)

148
Q

when should feeding be initiated in the PICU

A

within 24-48 hours of admit if feasible

149
Q

by the end of 7 days (1 week) feeding should provide _____ energy needs

A

2/3 energy needs (60%)

150
Q

when is PN indicated in the PICU

A 
prematurity
severe GI impairment
volvulus intestines
NEC
intestinal atresia
small bowel ischemia
IBD
short bowel syndrome
Gastrochisis
omphalacele
hyper metabolic and unable to meet needs alone with EN, s/p bone marrow if not able to meet needs with EN alone
Hirshcpurngs Disease
151
Q

an opening in the abdominal wall muscles where the intestines, stomach and liver protrude outside of the body

A

Gastrochisis

CNSC Exam (32 decks)

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