Peds Flashcards
Normal RR for a newborn
HR
40-60 BPM
120-160
What does the 1 min apgar evaluate?
5 min?
Labor and delivery
Response to resuscitative efforts
What are the 5 apgar criteria?
Appearance Pulse Grimace Activity Respiration
What is the most likely cause of eye redness on day 1?
Day 2-7?
>7 days?
>3 weeks?
Chemical irritation
Gonorrhea
Chlamydia
HSV
What 2 Abx are given babies to prevent eye issues?
Erythromycin or tetracycline ointment
silver nitrate solution
What are 8+1 screenings that occur prior to discharge for newborns?
PKU: treat w special diet CAH: replace steroid deficiencies, repair genitalia Biotinidase Beta thalassemia Galactosemia: eliminate lactose Hypothyroidism Homocysteinuria CF: initial sweat Cl, accurate CFTR genetic test Hearing test
What children get the HepB vaccine?
What kids get the HepB IG?
Every newborn
HbSAg + mothers
What is transient polycythemia of the newborn?
Hypoxia during delivery stimulates EPO to increase RBCs
What is transient tachypnea of the newborn?
C section babies who have fluid in their lungs but should only last less than 4 hours
Why does transient hyperbili occur in newborns?
Infant spleen removes express RBCs carrying HbF
What are the 3 types of skull fracture in newborns?
Linear (common)
Depressed
Basilar (fatal)
What are the 2 scalp injuries and their difference
Caput Succedaneum: crosses suture lines
Cephalohematoma: sub periosteal bleeding that does not cross
What are the 2 types of diaphragmatic hernias?
Morgagni: retrosternal or parasternal
Bochdalek: more common –> posterolateral on left side
What screening is associated with omphalocele?
What genetic disease is highly associated?
elevated AFP (most common cause is incorrect dating) T18
WAGR syndrome=?
Cr11 Wilms Aniridia GU malformations Retardation
What is the initial test for Wilms tumor?
Accurate?
U/S
Contrast CT
What is a hydrocele within?
Does it resolve?
Remnant of tunica vaginalis
What is the most common cyanotic heart defect in kids?
What are the characteristics?
What is the chromosome assn?
What is the murmur?
Tetralogy of fallot
Pulmonary stenosis > VSD > RVH > overriding aorta
Cr22 deletion
Holosystolic at LLSB
What is the most common congenital defect in T21?
Endocardial cushion defect of the AV canal
What are the only 3 causes of holosystolic murmurs?
mitral regurg
Tricuspid regurg
VSD
What is the most common cyanotic lesion in neonates?
What murmur is heard?
What is seen on CXR?
What is the treatment?
TOGV
Single S2
Egg on a string
PGE1 to keep DA open –> surgery (only 25% survive)
What is pulses alternans?
Bigeminus?
Bisferiens?
Tardus et parvus?
LV systolic dysfunction
HOCM
Aortic regurg
AS
What are the Sx of TA and when do they occur?
Why do you want to operate early?
Severe dyspnea + respiratory infections
Prevent pulm HTN
Define Eisenmenger Syndrome and when it occurs
LtoR shunt caused by VSD reverses to RtoL because of hypertrophic RV
What are the 3 types of ASD?
What is the Sx?
What are 2 tests?
Primum (mitral V issues also), Secundum (common), Sinus venosus (rare)
Fixed wide S2
Cath vs ECHO
Where do mitral lesions radiate?
Tricuspid and pulmonary?
Aortic?
Axilla
Back
Neck
What does a pear shaped CXR mean?
Boot shaped?
Jug handle?
3 appearance or rib nothing?
Pericardial effusion
Tetralogy of fallot
Primary pulm HTN
Coarctation
What are 3 signs of long QT
Family hx of sudden death
Hearing loss
Syncope
What are 5 signs of pathological hyperbili?
Appears on 1st day of life Rises over 5mg/dl/day Rises over 19.5 in term child Direct rises above 2 at any time Persists in 2nd week of life
What is kernicterus?
Sx?
Bilirubin in the basal ganglia
Hypotonia/seizures/choreoathetosis/hearing loss
When do you consider a transfusion (what bili level)?
20-25
After delivery what are the next steps?
Mouth/nose suctioned
Clamp/cut cord
Newborn dried/wrapped/warmed
What electrolyte issue would you expect to see with pyloric stenosis?
HypoCl, HypoK, MetAlk (low K made worse by increasing aldosterone to maintain fluid)
What is the initial test for pyloric stenosis?
Accurate?
Tx?
U/S
Upper GI series
Myotomy
What is the CHARGE syndrome of congenital defects?
Coloboma of eye, CNS anomalies Heart defects Atresia of choanae Retardation of growth/development GU defects Ear issues **commonly these come together!
How does a child with choanal atresia present?
How do you diagnose?
Blue with feeding and pink with crying
CT scan
How is Hirschprung Disease diagnosed?
Full thickness biopsy showing lack of submucosal ganglionic cells
What comprises VACTERL?
Vertebral anomalies Anal atresia Cardiovascular issues TEF EA Renal anomalies Limb anomalies
What is DA often due to?
Lack or absence of apoptosis causes improper canalization of the duodenal lumen
Where does a volvulus most commonly occur?
What is the best initial therapy?
Ileum
Endoscopic decompression
What is the initial test for intussusception?
What is the most accurate test for intussusception?
When do you not do that test?
How do you treat?
U/S
Barium enema
Peritonitis/shock/perforation
Barium enema
What is the classic Meckel presentation?
What is the most accurate test?
Painless rectal bleeding
Tech99 scan
What 3 Abx should be used in suspected NEC?
When does NEC occur?
Vanc/Gent/Metronidazole
Premature infants
What is the major disorder in CAH 21?
17?
11?
21=hypoTN
17=ambiguous genitalia boys
11=HTN + ambiguous genitalia girls
What is rickets due to? (3)
Lack of VitD
Inability to convert 25OH to 1,25OH2
XL hypoP: inability to retain P
What children should get a VitD supplament?
When does it start?
Exclusively breastfed
2 months
What are the most common causes of neonatal sepsis? (2)
What are the most common organisms? (4)
What are diagnostic tests? (3)
What are the treatments? (2)
Pneumonia, meningitis
GBS, Ecoli, Saureus, Listeria
Blood culture, urine culture, CXR
Amp + Gent
How does Toxo present?
Initial test?
Accurate?
Tx?
Chorio retinitis + ring enhancing lesions
IgM
PCR
Pyrimethamine + Sulfadiazine
How does rubella present?
Initial test?
Treatment?
PDA, cataracts, deaf, blueberry muffin rash, hyperbili
maternal IgM
Supportive
How does CMV present?
Initial test?
Accurate?
Treatment?
Peri ventricular Ca, microcephaly, chorio, hearing loss
Urine or saliva titers
Urine or saliva PCR
Ganciclovir
HSV presentation in a neonate?
Week 1: shock + DIC
2: vesicular lesions
3: encephalitis
What is the Pentad of scarlet fever?
Fever Pharyngitis Sandpaper rash on trunk and extremities Strawberry tongue Cervical lymphadenopathy
What are the top 2 causes of croup?
How is mild croup treated?
How is moderate to severe croup treated?
Parainfluenza 1 and 2 > RSV
Steroids
Racemic epinephrine
What is the treatment for epiglottis?
Intubate in OR
Administer Ceftriaxone for 7-10 days
Rifampin for all close contacts
What are the 3 stages of whooping cough?
Catarrhal stage: 14 days=severe congestion
Paroxysmal stage: 14-30 days=severe cough/whoop
Convalescent stage:14 days=decreasing cough
How is whooping cough treated?
Erythromycin or azythromicin in Catarrhal stage only
How is strep pharyngitis diagnosed?
Treated?
Rapid DNAse antigen test
Oral penicillin x10 days or macrolide
How is diphtheria diagnosed?
Treated?
Culture of membrane (no scraping!)
Antitoxin (Abx do not work!)
How is congenital hip dysplasia treated?
Pavlik harness
What ages is Legg Calve Perthes?
How is treated?
2-8
Surgery on both hips
How does a SCFE present?
What is the treatment?
Externally rotated leg
Internal fixation and pinning
VitA deficiency
Toxicity
Poor night vision, hypoPTH
Pseudotumor cerebri, HyperPTH
B1 low
High
Beriberi, wernickes
-
B2 low
High
Angular chelosis, stomatitis, glossitis
-
B3 low
High
Pellagra (diarrhea/dementia/dermatitis/death)
-
B5 low
High
Burning feet
-
B6 low
High
Peripheral neuropathy –> prevent by giving with INH
-
B9 low
High
Megaloblastic anemia
B12 low
High
Megaloblastic anemia, peripheral neuropathy from DC
-
VitC low
High
Scurvy
-
VitD low
High
Rickets in kids
HyperCa, polyuria, polydipsia
VitK low
High
Increased PT/INR, bleeding
Rare
