Peds

Question 1

Define Infantile Colic

Answer 1

Rule of 3s:
unexplained paroxysms of irritability and crying for >3 h/d, >3 d/wk for >3 wk in an
otherwise healthy, well-fed baby
Usually 10d-3mo

Question 2

Don’t treat primary noctural enuresis with meds until what age due to spontaneous resolution

Answer 2

7 yrs old

Question 3

4 features of ToF

Answer 3

VSD
RV hypertrophy
Overriding aorta
Subvalvular pulmonit stenosis

Question 4

Episodes associated with ToF
Child/infant positioning?

Answer 4

Tet spells (after feeding/crying) due to systemic vasodilation
Squat/knee-chest

Question 5

What are the 5 cyanotic CHDs?

Answer 5

5 Terrible Ts!!
1) Truncus arteriosus (aorta/pulmonary arteria join to make 1)
2) Transposition of great vessels
3) Tricuspid atresia (need ASD + VSD)
4) Tetralogy of Fallot
5) Total anomalous pulmonary vascular return (pulmonary veins back to R atrium, rely on ASD)

Question 6

Acyanotic CHDs divide into what 2 groups? Name 3-4 in each

Answer 6

L->R shunt: ASD, VSD, PDA, AVSD
Obstructive: coarctation of aorta, aortic stenosis, pulmonic stenosis

Question 7

ASD is more common in patients with what 2 syndromes?

Answer 7

Down’s and fetal alcohol

Question 8

Management of ASD

Answer 8

<8mm –> spontaneous closure
Elective surgical closure between 2-5 years of age

Question 9

Management of VSD

Answer 9

Small (most common CHD) –> spontaneous closure
Large –> surgery by 1yo if required

Question 10

Management of PDA

Answer 10

Indomethacin (antagonizes prostaglandin E2) in preemies
If persists beyond 3mo or serious sx –> surgical closure

Question 11

Peds epi dose

Answer 11

0.01 mg/kg

Question 12

Syndrome with MECP2 mutation and regression of development

Answer 12

Rett syndrome

Question 13

Workup for precocious puberty

Answer 13

Bone age
If advanced –> measure LH directly & with GnRH stim
Increased LH (or increased with GnRH stim) –> central –> cranial MRI
Otherwise –> peripheral –> hormone analysis, abdo imaging

Question 14

Elevated LH/FSH in someone with delayed puberty indicates…

Answer 14

Primary hypogonadism

Question 15

Neonatal pneumonia is most commonly caused by

Answer 15

Group B strep, E coli (organisms acquired from maternal genital tract or nursery)

Question 16

Dosing peds fluid bolus

Answer 16

Isotonic solution
20mL/kg over 20 minutes or rapid push
● Repeat as needed up to total of 60mL/kg

Question 17

Peds maintenance fluids rule

Answer 17

4-2-1 (ml/kg/hr)
4 for first 10 kg
2 for 11-20
1 beyond that

Question 18

Peds fluids

Answer 18

● D5NS: Dextrose 5% +0.9%NaCl to prevent hypoglycemia.
● KCl: Add KCl when voiding (usually 20mEq/L)
● 0.9% NaCl: Use in hyperglycemia, DKA
● D5 0.45% NaCl: Hypotonic solution, risk of
hyponatremia. Consider in hypernatremia.

Question 19

Calculate fluid deficit peds

Answer 19

χEach 1% dehydration = 10 ml/kg
fluid deficit
χFluid deficit = % Dehydration x
10 x weight