Peds 26 Flashcards
Which of the following best describes infant growth between birth and 4 months?
A. Infants gain weight most rapidly if breastfed.
B. Infants lose about 20% of birth weight in the first 3-4 days, and then slowly regain it.
C. The weight gained in the first four months is mostly muscle.
D. Weight doubles in the 4 weeks after birth.
E. Weight gain averages 20-30 grams/day.
E. Weight gain averages 20-30 grams/day.
What is the major underlying mechanism of failure to thrive?
A. Chronic disease B. Endocrine disorders C. Food allergies D. Genetic syndromes E. Inadequate calories to meet metabolic needs
E. Inadequate calories to meet metabolic needs
Bobby is a 9-week-old, former full-term infant with failure to thrive despite a calorically adequate diet. He has chronic fatty stools and new onset of cough with no other symptoms. On exam, you find a hungry infant with minimal subcutaneous fat; tachycardia; pallor; grade 2/6 systolic heart murmur. Mild nasal congestion and cough. He is not dehydrated; No CHF findings; No diastolic murmur; S2 physiologically split; No abdominal mass; neurologically intact. No crackles or wheezes on auscultation.
CBC shows a normocytic anemia. No blood in stool. Serum chemistries are notable for a slightly low sodium and chloride, mildly elevated liver enzymes and slightly low serum albumin
What’s the most likely dx?
Cystic fibrosis
What is the management plan for CF?
Treatment is multi-pronged and includes:
- Nutritional management, with enzymes and vitamins and extra calories
- Airway clearance, and
- Treatment of airway infections.
How do you confirm diagnosis of CF?
Sweat chloride test with sweat chloride > 60
A 4-week-old female infant presents to the clinic for a well child check. This infant had an uneventful delivery by normal spontaneous vaginal delivery at full term. She had a normal neonatal metabolic screen. Her growth chart demonstrates a weight at 3.0 kg (< 3rd percentile) and weight for height at < 3rd percentile. The mother reports no drinking or drugs since before this pregnancy. She started breastfeeding at birth, but changed to formula after a week because she was too tired to nurse the baby frequently. She offers the baby a bottle every 4-6 hours. The baby appears hungry and drinks the full volume offered of 3 ounces very well. The baby feed mostly during the daytime, with minimal feeding at night. There has been no diarrhea, hematochezia, vomiting, difficulty breathing, or fevers. The vital signs and exam (apart from a thin infant) are normal. The mother’s affect is flat, and she seems anxious when you ask her about her infant. What is the most likely diagnosis for this infant’s failure to thrive?
A. Congestive heart failure B. Failure to thrive due to inadequate caloric intake C. Gastroenteritis D. Malabsorption E. Milk protein allergy
B. Failure to thrive due to inadequate caloric intake
An 8-week-old infant is brought to the clinic for a health maintenance visit. She was a twin born at 40 weeks gestation. Pregnancy and delivery were uncomplicated. At birth her weight, height, and head circumference were at the 50th percentile; she is now at the 5th, 10th, and 25th percentiles, respectively. She and her twin sister are exclusively breastfed every four hours scheduled. She does not have any vomiting and has 3 normal stools per day. Physical exam reveals a thin but otherwise healthy infant. What is the most likely cause of this infant’s growth pattern?
A. Congenital heart disease B. Cystic fibrosis C. Inadequate caloric intake D. Inborn error of metabolism E. Milk protein allergy
C. Inadequate caloric intake
A 6-week-old is brought to clinic by his mother for poor weight gain. He was born at 40 weeks’ gestation. Pregnancy and delivery were uncomplicated. Family history reveals a cousin with trouble gaining weight and frequent “lung infections.” The baby drinks four ounces of formula every two to three hours. He does not cough or gag during feeds. He has frequent, loose stools. His weight today is the same as at his 2-week visit. His weight is < 5th percentile, and height and head circumference are at the 25th percentile. Vital signs are normal. Physical exam reveals decreased adipose tissue, but is otherwise normal. Which of the following is the best next step in management of this patient’s growth?
A. Echocardiogram B. Increase formula to a higher calorie mixture C. Stool culture and Wright stain D. Swallow study E. Sweat chloride test
E. Sweat chloride test
A 6-month-old infant is referred to the pulmonology clinic because he was recently diagnosed with cystic fibrosis. His parents have several questions about this diagnosis. Which of the statements about cystic fibrosis is most correct?
A. CF is a disease that exclusively involves the respiratory system
B. CF is an autosomal dominant disorder
C. CF is caused by a mutation in CFTR, resulting in defective salt balance
D. Gene therapy is now the primary source of CF therapy
E. It is important to provide calories at a lower level than recommended dietary allowance for a given age in order to prevent GI upset
C. CF is caused by a mutation in CFTR, resulting in defective salt balance
A two-week-old infant presents to the clinic to follow-up on abnormal newborn screening results. The routine newborn screen showed increased levels of immunoreactive trypsinogen which is concerning for cystic fibrosis. Confirmatory testing is sent. What signs and symptoms should be monitored in this infant?
A. Bloody stools B. Diaphoresis during feeds C. Increased stooling D. Precordial thrill E. Reflux
C. Increased stooling
