Peds Flashcards
What are the two major features of autism?
Persistent deficits in social communication and interaction
Restricted, repetitive patterns of behavior, interests, and/or activities
What are the core features of ADHD? (3)
Hyperactivity
Inattention
Impulsivity
What percentage of weight loss is appropriate after birth?
10% - however should regain bw by age 10-14 d age
Definition of FTT
Weight < 3rd
Fall across 2 major percentile lines
<80% of expected weight for height and age
Differential to short stature
ABCDEFG: Alone (neglect) Bone dysplasias (rickets, scoliosis) Chromosomal (Turner, Down) Delayed growth (constitutional) Endocrine (low GH, Cushing, hypothyroid) Familial GI malabsorption (celiac, Crohn’s)
Presentation of Epiglottis
Drooling, tri-pod position, inspiratory stidor
Complication GABHS pharyngitis
Scarlet fever (rash initially appears on the neck and chest, then spreads over the body. May develop Pastia's lines, bright red coloration of the creases under the arm and in the groin.
What should an infant’s weight be at two weeks of age
birth weight
Colic
Rule of three:
Unexplained paroxysmal bouts of fussing and crying that lasts at least three hours a day, at least three times a week, for longer than three weeks.
Common reason for infant FTT
Improper feeding - make sure to ask about formula preparation, food insecurity
Acceptable APGAR Score at birth?
7 or higher (most babies do not get 10), assess at 1 min and 5 min, and if less than 7 at 5 min, every 5 min until >7
Clinical signs of dehydration in child/infant
Sunken fontanelles, dry oral mucosa, sunken eyes, decreased skin turgor, may see decreased urine output, weight loss and drop in BP as well as tachycardia
Hourly maintenance fluids for child?
4:2:1 1-10kg = 4cc/hour \+ 11-20 kg = 2cc/hour \+ >20kg = 1cc/hour
Infants may need a dextrose solution added to NS. This maintenance fluid should be considered along with ongoing losses and fluid replacement
Fever work up in infant less than 28 days old?
Complete work up with admission - LP, blood C&S, CBC and differential, urine, CXR if resp , stool if GI sx and start empiric abx
Fever in infant between 28 days and 3 months of age?
Non-toxic appearing - consider is follow-up reliable? Consider Rochester criteria.
Toxic appearing - Admit, full work up and empiric abx
Fever in infant 3 months to 3 years
Non-toxic and no focus of infection - urine (add CBC if temp >39), observation and Tylenol, if high WBC (>15) empiric abx. Otherwise observe and follow up regularly
Prophylaxis for febrile seizures?
No, in most cases simply provide counselling for family, fluid and antipyretics
Features of high risk seizures - warranting further work up: longer than 15 mins, focal, recurrent (>1 in 24 hours), hx of neurological impairment, neurological deficit after seizure
Consider LP if child is <12mo
Neonatal vomiting - what feature of the vomitus should be considered?
Is it bilious or not?
- if green - indicates obstruction below bile duct (Hirshprung’s, duodenal atresia, volvulus). If not then obstruction above (GERD, pyloric stenosis, TEE)
Tx for intussusception?
Barium enema
Tx for functional constipation?
Education, dietary modifications, encourage activity and behavioural modification - such as regular reminders to toilet and allowing enough time for toiletting
Dis-impaction can be achieved via oral or rectal PEG
PEG can also be used as a long-term treatment
Follow-up and consult gastroenterologist if refractory
ED Tx for children with vomiting likely due to gastroenteritis?
Oral ondansetron is preferred over gravol (less drowsiness S/E) give ).15mg/kg up to 8mg in oral liquid form and commence rehydration therapy 15-30 mins after oral ondansetron - only need to give one dose.
Nutrition for healthy term infants - up to 6 months
- Breast feed exclusively if possible, confers great benefits
- Daily Vit D supplements (400IU)
- First foods should be iron-rich (meat, meat alternatives and iron fortified cereal)
- Routinely monitor growth
What is the most common congenital heart defect?
Ventricular Septal Defect
Ductus Arteriosus closure
Functional closure within first 15 hours of life
Anatomic closure within first days of life
Diminished femoral pulses could indicate
Coarctation of the aorta
Acute Asthma exacerbation Tx?
Escalate method of corticosteroid delivery based on severity
Mild - salbutamol + ICS
Moderate - salbutamol + Oral CS consider ipratropium
Severe - salbutamol and ipratropium and oral steroids if possible consider IV CS, magnesium, and nebulizers
Severe to impending respiratory failure - salbutamol and ipratropium nebulized continuous, IV CS may need intubation - call PICU
Initial tx for anaphylaxis?
Give epinephrine IM 1:1000 ratio (0.01mg/kg) into lateral thigh repeat every 5-15 minutes
Screen time for children?
None under 2 years of age, <1 hour for 2-4 years of age and <2 for children any older
Physical activity guidelines?
Pre-school - 180 minutes per day of PA at varying activities
School - 60 minutes per day of moderate to vigorous levels - aiming to have vigorous activity at least 3 times a week and bone strengthening activities at least 3 times a week
Caloric requirement of term babies
100-120 kcal/kg/day
Absence of red reflex
Retinoblastoma
Cataracts
Glaucoma
Chorioretinitis
Otitis Media managment?
Amoxicillin - PO 10 days of therapy for children less than 2, 5 days for older children
Uncomplicated pneumonia sx and DX?
Commonly overlap with sx of reactive airway disease or other viral respiratory disease, DX of bacterial pneumonia should be supported with a CXR
Tx for uncomplicated bacterial pneumonia
Amoxicillin or ampicillin 7-10 days as empirical therapy
True or false breastfed infants are more at risk of developing Hyperbilirubinemia than formula fed
True. Important to ensure breast feeding support is set up prior to discharge from hospital and that there is frequent follow up in first days of life.
Also important to do RBC testing and Coombs to ensure that there is not blood reactivity.
Breastfeeding can continue while infant is in phototherapy
Inheritance pattern of achondroplasia
Autosomal dominant (so if the parents both do not have it then the risk is the same as general population)
