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Peds CLIPP > Peds CLIPP > Flashcards

Peds CLIPP Flashcards

1
Q

Caused by a deficiency of lung surfactant and delayed lung maturation, can occur as late as 37 wk

A

RDS

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2
Q

What is the most common cause of respiratory distress in premature infants

A

RDS

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3
Q

Who is at increased risk for RDS

A

infants of diabetic mothers

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4
Q

Result of delayed clearance of fluid from lungs following birth

A

transietn tachypnea of the newborn

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5
Q

Caused by a collection of gas in the pleural space with resultant collapse of lung tissue

A

pneumothorax

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6
Q

Who is at increased risk for pneumothorax

A

mechanical ventilation or underlying lung disease like RDS; premature infants with RDS

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7
Q

What babies are at risk for hypoglycemia

A

infats of diabetic mothers due to chronic hyperinsulinemic state

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8
Q

Tachypnea is a nonspecific finding in newborns; possible causes

A

meconium aspiration, hypoglycemia, hypothermia, VSD, PDA, Coartation of aorta, RSD, TTN, pneumothorax, sepsis, congenital diaphragmatic hernia

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9
Q

Risk factors neonatal sepsis

A

maternal GBS, prolonged rupture of membranes (>18 hrs), delivery <37 wks, maternal fever or chorioamnionitis

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10
Q

premature and tachypneic

A

RDS, pneumothorax, sepsis

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11
Q

maternal diabetes and tachypneic

A

TTN and RDS

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12
Q

kernicterus presentation

A

abnormalities in tone and reflexes, choreoathetosis, tremor, oculomotor paralysis, sensorineural hearing loss and cognitive impairment

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13
Q

Risk factors for bilirubin toxicity

A

hemolysis, asphyxia, significant lethargy, temp instability, sepsis, acidosis, albumin

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14
Q

Predisposing factors to hyperbilirubinemia

A

ABO mismatch, breastfeeding, in utero infection, gestational age, Mediterranean ethnicity, microcephaly, Rh incompatibility, small for gestation age, weight loss > 10%

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15
Q

physiologic jaundice

A

total bili <15 mg/dL in full term infants who are asymptomtic

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16
Q

causes of physiologic jaundice

A

increased production (breakdown RBC), hepatocyte protein and UDPGT deficiency, lack of intestinal flora to metabilze bile, high B glucuronidase in meconium, intake

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17
Q

Breast feeding jaundice occurs

A

first week of life when milk supply is low so low intake

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18
Q

breast milk jaundice

A

first 4-7 d but may not peak until 10-14 d; can persist up to 12 wks

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19
Q

Crigler Nijjar

A

AR; causes severe unconjugated hyperbili starting in first few days. Caused by decrease bili clearance caused by deficient or completely absent UDPGT and can lead to kernicterus

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20
Q

Gilbert

A

less severe common cause of unconjugated hyperbilidecrease enzyme function interferes with glucuronidation and conjugation of bili is slowed

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21
Q

presentation biliary atresia

A

healthy infant who develops jaundice, dark urine, and acholic (pale) stools btw 3-6 wks

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22
Q

treatment biliary atresia

A

kasai procedure- anastomosis of the intrahep ducts to a loop of intestine to allow bile to drain directly into the intestine

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23
Q

major risk factors hyperbili (TSB >95th percentile)

A

jaundice iin first 24 hours, blood group incompatibility, gestational age 35-36 wk, previous siblibling, cephalohematoma or significant bruising, exclusive breaskfed, east asia

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24
Q

CXR for TTN

A

wet looking lungs, no consolidation and no air bronchograms

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25
Q

CXR RDS

A

diffuse reticulogranular appearance ground glass appearance and air bronchograms

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26
Q

late preterm infants are at risk for

A

hypothermia, hypoglycemia, respiratory istres, apnea, hyperbilirubinemia, and feeding difficulty

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27
Q

vitamin D dose for breastfed infants

A

400 IU

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28
Q

What should you ask about in a newborn visit

A 
pregnancy history (age, gravida, infection, meds, complications)
Birth hitory (age, weight, size, prenatal health)
Feeding (type, amount, freq)
Parent questions
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29
Q

Breastfed babies lose an avg of ___% of their birth weight in the ____

A

5.8; first few days

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30
Q

How many stools and voids is a 3-5 d; and 5-7 day old expected to make

A

3-5d: V-3-5 S-3-4

5-7d: V- 4-6 S- 3-6

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31
Q

Lethargy

A

failure to recognize parents or interact with persons or objects

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32
Q

Listless

A

no interest in what is happening around herself

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33
Q

Toxic newborn description

A

appearance of pending physiologic collapse such as may be seen in sepsis, poisoning, acute metabolic crisis or shock. Febrile, pale or cyanotic, with depressed mental awareness or extreme irritablility

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34
Q

Distressed child

A

working hard to maintain physiologic stability such as grunting, rapid breathing in order to maintain oxygenation and ventilation

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35
Q

What things are administered in the first hours or days of life

A
  1. hep b vaccine (first 12 hours)
    Vit K (immediately)
  2. Erythromycin eye ointment (gonorrhea prophylaxis)
  3. Critical Congenital Heart Disease Screen
  4. Hearing screen
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36
Q

differential for neonate with poor feeding and decreasesd activity

A

congenital hypothyroidism, shaken baby, downs, congenital adrenal hyperplasia and inborn error of metabolism

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37
Q

polycythemia usually occurs when after birth

A

first few hours to days

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38
Q

findings congenital hypothermia

A

feeding problems, decreased actiivty, constipation, prolonged jaundice, skin mottling, umbilical hernia

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39
Q

findings congenital adrenal hyperplasia

A

decreased feeding and activity, salt losing presents with lethargy, vomiting, and dehydration that can progress to shock

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40
Q

findings inborn error of metabolism

A

typically newborns appear well for at least the first 1-2 days and then become symptomatic d/t protein load in breast milk; initial signs include somnolence and poor feeding followed by voiting and lethargy

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41
Q

findings of botulism

A

poor suck and weak cry and usually presents 3-4 months of age

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42
Q

hypoxic ischemic encephalopathy

A

altered mental status shortly after birth; low apgar and multi system dysfunction early in neonatal course

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43
Q

Polycythemia

A

hematocrit above normal (>65%); may be found incidentally, or present with altered metnatl status and poor feeding; plethora, acrocyanosis or hyperbili; occurs in first few hours to days of lif

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44
Q

Conditions associated with large fontanels

A 
skeletal disorders (rickets, osteogenesis imperfecta)
chromosomal (downs)
Hypothyroid
malnutrition
increased intracranial pressure
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45
Q

conditions associated with small fontanels

A

microcephaly, craniosynostosis, hyperthyroid, normal variant

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46
Q

sunken fontanels

A

dehydration

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47
Q

bulging fontanels

A

meningitis, hydrocephalus, subjural hematoma, and lead poisoning

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48
Q

umbilical hernias will spontaneously close by what age

A

5 yo

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49
Q

serum ammonia would be elevated in what newborn conditions

A

inborn errors of metabolism esp ornithine transcarbamylase deficiency

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50
Q

Sepsis

A

SIRS (temp or leukocyte count plus H, tachypnea or acute need for mechanical vent) plus suspected or proven infection

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51
Q

signs of meningitis in infants

A

fever, hypothermia, bulging fontanelles, lethargy, irriablility restlessness, paroxysmal crying, poor feeding, vomiting and or diarrhea

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52
Q

kernig’s sign

A

resistance to extension of the knee

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53
Q

brudzinski sign

A

flexion of the hip and knee in response to flexion of the neck

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54
Q

CSF for bacterial meningitis

A

Glucose- low
protein- high
WBC- high

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55
Q

CSF for viral meningitis

A

Glucose- normal
protein- normal or slightly elevated
WBC- elevated
gram stain- negative

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56
Q

pyuria

A

> 5 WBCs per high power fieild

57
Q

what does a nitrite test test for

A

gram negative bacteria esp E coli, klebsiella and proteus

58
Q

leukocyte esterase test

A

detects esterases released from broken down leukocytes; a positive test indicates the presence of WBCs thus a positive test is not alone sufficient to diagnose UTI

59
Q

why is ampicillin not a good choice for treating treating a uti

A

resistance rats are rising so should be combined with gentamicin. Amp gives enterococci coverage which is a benefot

60
Q

why is ciprofloxacin not a good choice for uti in kids

A

adverse reactions in kids plus expensive

61
Q

Oral antibiotic tx for UTI

A

cephalexin (keflex), trimethoprim/sulfamethoxazole, nitrofurantoin (but only cystitis), augmentin (gi side effects)

62
Q

what follow up studies are done after first episode of pyelonephritis

A

renal and bladder US

63
Q

renal technetium

A

provides evidence of pyelonephritis; not required in a patient who has responded to tx

64
Q

when would you get a VCUG

A

after second febrile UTI or if renal and bladder US suggest high grade reflux

65
Q

meningococcemia

A

fever, chills, rash and may lead to shock and DIC

66
Q

causes of unilateral cervical LAD

A

reactive cervical adenitis, kawaskai, bacterial cervicaladenitis, cat scratch disease, mycobacterial infection

67
Q

strawberry tongue

A

strep pharyngitis, kawaski, TSS

68
Q

diagnostic criteria for kawasaki disease

A

high fever at least 5 d and 4/5: strawberry tongue, extremity changes, unilateral cervical LAD, rash, conjunctivitis

69
Q

typical age of onset for kawasaki

A

15-18 mo

70
Q

what lab findings support a diagnosis of kawasaki

A

CBC (WBC elevated, hgb anemia, platelets - thrombocytosis)
iver enzyes (elevated and albumin low)
UA (sterile pyuria

71
Q

complications of kawasaki

A
  1. aseptic meningitis 2. coronary artery aneurysm 3. liver dysfunction 4. arthritis, 5 hydrops of the gallbladder
72
Q

initial management of kawasaki

A

ivig 2g/kg, asprin, echo and ec

73
Q

HSV-1

A

causes gingivostomatitis and sometimes fever and malaise

74
Q

Enterovirus

A

fever, tender vesicles on hands and feet and oral ulcers (cocksackie A)

75
Q

sandpaperlike rash

A

group a strep scarlet fever

76
Q

croup is most common in what age group

A

2-5 yo

77
Q

Pertussis course

A

Catarrhal- 1-2 wks and has URI symptoms
Paroxysmal next 4-6 wks; repetitive, whoop cough
Convalescent- months with episodic cough

78
Q

CXR asthma

A

hyperinflation, increased interstitial markings and patchy atelectasis

79
Q

Tx acute exacerbation

A

anti-nflammatory therapy with corticosteroids and bronchodilation with B 2 agonists

80
Q

Tx maintenance therapy asthma

A

freq symptoms- inhaled corticosteroids with B agonish

81
Q

CXR bronchiolitis

A

hyperinflation, increased interstitial markings, peribronchial cuffing and scattered atelectasis

82
Q

most common bacterial pneumonia neonate

A

GBS, E coli and Klebsiella

83
Q

pneumonia at 4-12 wks suspect

A

chlamydia

84
Q

school aged children bacterial pneumo

A

M pneumoniae then S pneumoniae

85
Q

WBC findings in viral vs bacterial pneumo

A

Viral nml or slightly elevated

Bacterial- usually elevated with neutrophilic predominance

86
Q

tx croup

A

supportive (humidified air or mist) if severe aerosolized epi or oral or IM dexamethasone

87
Q

mono vs polyphonic wheeze

A

poly- multiple pitches and typical of asthma

Mono- typical of focal airway obstruction

88
Q

chronic cough over how many weeks

A

4

89
Q

Dry cough ddx

A

environmental irritant, asthma, fungal infection

90
Q

Barking cough ddx

A

croup, subglottic disease, and foreign body

91
Q

paroxysmal cough ddx

A

pertussis, chlamydia mycoplasma, foreign body

92
Q

coughs worse at night

A

asthma and sinusitis

93
Q

possible indication for change in voice in school age child with cough

A

laryngeal irritation due to chronic rhinitis or GERD

94
Q

possible indication for chest pain in school age child with cough

A

GERD rarely myocardiits d/t infection

95
Q

most common radiographic finding in ifants and children wih TB

A

hilar adenopathy although not present in 50%

96
Q

allergic shiners

A

darkening of lower eyelids as a result of venous stasis

97
Q

dennie morgan lines

A

infraorbital creases tha apear due to intermittent edema caused by allergies

98
Q

tracheal deviation

A

pneumothorax or foreign body aspiration

99
Q

retractions

A

asthma, bronchiolitis or foreign body

100
Q

accessory muscle use

A

sign of significant respiratory distress

101
Q

decreased inspiration time to expiration

A

obstructive disorders

102
Q

general cause of wheezing

A

intraluminal obstruction and external compression

103
Q

rhonchi

A

due to mucus secretions in airways

104
Q

at what age are kids able to do spiromatry

A

5

105
Q

rare but potential side effects of log term asthma therapy

A

elevated BP, monitor sugar and grwoth delay and cataracts

106
Q

speech dev for an 18 mo

A

6 words

107
Q

onset of otitis media

A

3-5 days after onset URI

108
Q

bacterial pneumonia presentation

A

abrupt onset of high fever, productive cough, ill appearing and sometimes chest pain

109
Q

viral pneumonia presentation

A

moderate fever, nonproductive cough and gradual onset of upper respiratory symptoms

110
Q

sinusitis presentation

A

symptoms persistent > 10 d worsening or severe (fever >39)

111
Q

bacterial organisms in AOM in order of frequency

A

S pneumo, H fluu, Moraxella catarrhalis, and S pyrogenes

112
Q

visual reinforcement audiometry

A

evaluates 6 mo-2.5 yo hearing

113
Q

which sinuses are large enough to become infected in infants

A

maxillary and ethmoid

114
Q

Diagnosis DKA

A

a random blood glucose >200, a venous pH <7.3 or serum bicarb <15; moderate or large ketonuria or ketomenia

115
Q

Early management of DKA

A

insulin drip after patient has received about 1 hour of fluid resuscitation

116
Q

what should you suspect in a patient presenting with vomiting, wt loss, dehydration, SOB, abdominal pain or change in level of consciousness

A

DKA

117
Q

signs of cerebral edema

A

headache, recurrence of vomiting, bradycardia, htn, decreased O2 sat, reslessness, lethargy, CN palsy, abn pupil responses,

118
Q

admission orders for patient in DKA

A

monitor vitals, hourly neuro, ins and outs insulin drip until acidosis resolves, serum glucose q1 hr, check serum pH q1, urine dipstick for ketones

119
Q

which pediatric patients should be screened for TIIDM

A

Overweight plus any two: maternal hx or gestation, FH in 1st or 2nd degree, race, signs of insulin resistance

120
Q

how often should kids at increased risk for TIIDM be screened

A

fasting glucose plasma at 10 yo or puberty onset and then every 3 yrs

121
Q

presentation of appendicitis in peds

A

often lacks migration of pain to RLQ, negative rovsing’s sign, and involuntary guarding and fever without perforation. Often worse with movt or coughing

122
Q

Cushings triad

A

htn, bradycardia, and irregular respirations indicates increased ICP

123
Q

kussmaul breathing

A

deep breaths that may be rapid, normal or slow associated with metabolic acidosis

124
Q

Differential for limp or refusal to walk

A

leukemia, osteromyelitits, reactive arthritis, septic arthritis, transient synovitis, trauma, JIA, slipped capital femoral epiphysis, Legg calve-perthes disease

125
Q

osteomyelitis is most often caused by

A

S aureus

126
Q

peak age for transient synovitis

A

3-8 years

127
Q

presentation of transient synovitis

A

acute onset without significant constitutional symptoms oftern following a viral URI

128
Q

most common hip disorder in adolescents

A

slipped capital femoral epiphysis

129
Q

presentation of slipped capital femoral epiphysis

A

months of vague hip or knee symptoms and limping

130
Q

how do you diagnose slipped capital femoral epiphysis

A

plain film showing posterior displacement of the femoral head

131
Q

who is most often affected by legg calve perthes disease

A

boys btw 4 and 10

132
Q

presentation of legg calve perthes

A

indolent or chronic pain

133
Q

developmental dysplasia of the hip

A

group of conditions in infants where the femoral head is not properly aligned with the acetabulum

134
Q

Risk factors DDH

A

female, breech and FH

135
Q

characteristics of synovial fluid in septic arthritis

A

turbid, increased WBC predom polymorphs, gram stain positive for bacteria

136
Q

most common organisms for septic arthritis

A

S aureus, Strep, H flu, N gonorrhea, Kngellakingae (children <4)

137
Q

tx septic arthritis

A

empiric IV antibiotic

138
Q

tx transient synovitis

A

rest and Ibuprofen

139
Q

difficulty breathing, respiratory distress and diaphorisis in 2 wk old

A

CHF, respiratory infection, sepsis and metabolic disorder

Peds CLIPP (1 decks)

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