Peds

Question 1

What is the pre-post ductal pulse oximetry?

Answer 1

Screens for critical congential heart disease.

Echocardiogram is indicated for a positive screen.

Question 2

What is the hyperoxia test (administering 100% O2)?

Answer 2

It can distinguish between cyanosis due to pulmonary disease (improves w/ O2) and congenital heart disease (persistent cyanosis).

Question 3

What is neonatal sepsis?

Answer 3

Decreased activity, poor feeding, fever OR hypothermia less than 96.8, mild jaundice due to transient conjugation deficiency
Dx: cbc, blood cultures, LP, u/a, urine cultures
Empiric abx (amp + gent) after cultures are obtained
In critically ill pts (septic shock, status epilepticus) or who cannot immediately undergo LP, they get abx first.

Question 4

CTs

Answer 4

Neonates do not experience herniation after LP as their open fonatanelles relieve intracranial pressure.
As a result, a head CT is ot required before LP in young infants.

Question 5

What is congenital muscular torticollis?

Answer 5

Postural deformity evident at birth, but noticeable at 1-2mo
Sternocleidomastoid muscle is tight and contracted
Due to intrauterine crowding (breech position, multiple gestation, oligohydramnios)
Assoc. conditions: developmental dysplasia of hip, metatarsus adductus, clubfoot
When infant lies down w/ head facing preferred side: positonal plagiocephaly occurs: flattening of head on taht side as well as anterior displacement of the ear and foreahead ipsilateral to the flattening
PE: limited ROM of the neck, SCM thickening or a well circumscribed mass from fibrosis may be palpable
Tx: positioning (increased tummy time), passive stretching, physical therapy
Missed or delayed diagnosis can lead to craniofacial asymmetry

Question 6

What is cystic hygromas?

Answer 6

Congenital lymphatic malformation located in the posterior triangle of the neck
Often detected prenatally and assoc. w/ aneuploidly
Postnatal exam: Fluctuant mass that transluminates

Question 7

SGA infants.

Answer 7

Wt under 10th percentile for gestational age at birth
Complications: hypoxia, perinatal asphyxia, meconium aspiration, hypothermia, hypoglycemia, hypocalcemia, polycythemia
Polycythemia results from increased erythropoietin secretion in response to fetal hypoxia

Question 8

Treating UTIs in children.

Answer 8

3rd gen cephalosporin such as cefixime, to cover most common pathogens (e. coli).
Cipro not used due to risk of cartilage damage.

Question 9

Prenatal care.

Answer 9

By term (>=37 weeks) majority of fetus will spontaneously rotate into longitudinal lie and cephalic presentation
Manage preterm gestations expectantly w/ u/s at term to evaluate fetal presentation

Question 10

What is Werdnig Hoffman syndrome?

Answer 10

Autosomal recessive disorder
Involves degeneration of the anterior horn cells and cranial nerve motor nuclei.
Causes “floppy baby” syndrome.

Question 11

What is myotonic congenital myopathy?

Answer 11

Autosomal dominant
Muscle weakness and atrophy (most predominant in distal msucles of the upper and lower extremities), myotonia, testicular atrophy, and baldness.

Question 12

GERD

Answer 12

Extremely common, affects more than 50% of infants
Frequent postprandial regurgitation (eg “spitting up”, “spilling”) due to physiologic differences (shorter esophagus, incomplete closure of LES, greater time spent in supine position)
Most are axs (happy spitter)
Recs: frequent small volume feeds, hold infant upright for 20-30m after feeds, place infant prone when awake
Regurge improves around 6mo when baby can sit unsupported and resolves by 1y

Question 13

Goat milk

Answer 13

Deficient in folate and would result in macrocytic anemia.

Question 14

Milk protein induced allergic protocolitis

Answer 14

Can cause painless rectal bleeding
Resolves w/ elimination of dietary cow’s milk
Non-IgE mediated
Exclusive to infants and resolves by age 1

Question 15

Meckels diverticulum

Answer 15

Painless lower GI bleed
Dx with technetium 99m pertechnetate scan (Meckel scan) which shows increased uptake of technetium 99m by gastric mucosa and therefore identifies ectopic gastric tissue
Emits little radiation

Question 16

Neonate diapers

Answer 16

Appearance of “pink stain” or “brick dust” in neonatal diapers represent uric acid crystals.
Uric acid excretion is especially high at birth and decreases until adolescence when adult levels are observed.
Uric acid crystals are commonly seen during the first week as the mother’s milk is coming in or in later months with the morning void after the infant begins to sleep through the night.

Question 17

What is cephalohematoma?

Answer 17

Subperiosteal bleed that DOES NOT cross suture lines.

Question 18

Clavicle fracture

Answer 18

Birth wt >4kg, should dystocia, and vacuum delivery are risk factors for neonatal clavicular fractures.
Mgmt: reassurance and gentle handing as most neonatal clavicular fractures heal rapidly (7-10d) w/o complications.

Question 19

Henoch Schonlein purpura.

Answer 19

An IgA mediated vasculitis that presents most commonly in children w/ palpable purpura, abdominal pain, arthralagia/arthritis, and hematuria.
Children w/ HSP are at increased risk for ileoileal intussusception due to intestinal edema and bleeding.

Question 20

What is necrotizing enterocolitis?

Answer 20

RF: prematurity, LBW, enteral feeds
Vomiting (bilious), bloody stools, and abdominal distension in a preterm neonate are highly suspicious for necrotizing enterocolitis. Pt can be hypothermic; distended abdomen
Labs: leukocytosis (inflammation) metabolic acidosis (intestinal ischemia)
XR: pneumatosis intestinalis (intramural air) and portal venous air.

Question 21

What is a subgalele hemorrhage?

Answer 21

Characterized by blood between the periosteum and aponeurosis due to shearing of the emissary veins during delivery.
Pts have fluctuant scalp swelling that can move, cross suture lines, and expand for days after delivery.
Tachycardia and pallor can occur due to excessive blood loss.

Question 22

What is colic?

Answer 22

Common and begins in the first few weeks of life w/ excessive crying for >=3h/d (usually evenings), >=3d/week, for >=3 weeks in an otherwise healthy infant.
Soothing and feeding techniques should be reviewed and parents should be emotionally supported and reassured.
Techniques: infant swing, swaddling, minimizing environmental stimuli (eg quiet dark room), holding and rocking baby

Question 23

What is malrotation w/ midgut volvulus?

Answer 23

Risk factor for volvulus is malrotation of midgut early in fetal development
Usually presents in neonates w/ bilious vomiting and abdominal distention.
Untreated volvulus can progress to frank bowel ischemia, bloody stools, and perforation.
XR done first to r/o pneumoperitoneum, which would reflect intestinal perforation and immediate need for emergency surgery
An upper GI series (barium swallow contrast study) is the gold standard for diagnosing malrotation - fast, most accurate method.
The finding of ligament of treitz on the right side of the abdomen reflects malrotation while contrast in a “corkscrew” pattern indicates volvulus.

Question 24

Constipation

Answer 24

Constipation is a common problem in toddlers due to transition to solid food and cow’s milk, toilet training, and school entry.
In addition to deitary modification, laxative therapy (polyethylene glycol) should be initiated promptly to soften stools.

Question 25

Bronchiolitis

Answer 25

Most commonly caused by respiratory syncytial virus and manifests as upper respiratory symptoms, wheezing/crackles, and respiratory distress.
Neonates are especially vulnerable to complications such as apnea and respiratory failure.
Also, tend to develop recurrent wheezing throughout childhood.
Palivizumab is monoclonal antibody against RSV that is used for ppx in children age <2 years who are at exceptionally high risk of complications.

Coexisting bacterial pneumonia and sepsis is rare.

Question 26

Klumpke palsy

Answer 26

Rare complication of shoulder dystocia caused by injurty to the 8th cervical and 1st thoracic nerves.
Presentation: hand paralysis (ie claw hand) and ipsilateral Horner syndrome
Tx: gentle massage an PT to prevent contractures
If there is no improvement by 3-9mo, surgical intervention may be considered

Question 27

Erb Duchenne palsy

Answer 27

Most common type of brachial plexus injury
Involves the 5th and 6th cranial nerves, leading to “waiters tip” posture.
The affected arm may have decreased or absent Moro reflexes, but grasph reflex remains intact.