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Pediatrics > Peds Exam 1 > Flashcards

Peds Exam 1 Flashcards

1
Q

Nrml newborn HR

A

120 to 160 bpm

85 to 90 bpm may be nrml if sleeping

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2
Q

Nrml newborn RR

A

40-60 breaths/min

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3
Q

What should you be concerned about if newborn presents with central cyanosis that doesn’t correct with 100% O2?

A

respiratory or cardiac disease

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4
Q

37 0/7 weeks to 38 6/7 weeks gestation

A

Early Term

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5
Q

32 0/7 weeks to 36 6/7 weeks gestation

A

Late Pre-term

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6
Q

28 0/7 weeks to 31 6/7 weeks gestation

A

Very Premature

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7
Q

28 weeks or less

A

Extremely Premature

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8
Q

Gestational Age

A

Elapsed time between LMP and delivery

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9
Q

Chronological (post-natal) Age

A

Time since birth

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10
Q

Post-menstrual Age

A

Gestational plus Chronological age

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11
Q

Corrected Age

A

Chronological age minus number of weeks premature

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12
Q

Large for gestational age

A

> 90th percentile for GA

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13
Q

Small for gestational age

A

<10th percentile for GA

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14
Q

Extremely low birth weight

A

< 1000 gm

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15
Q

Very low birth weight

A

< 1500 gm

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16
Q

Low birth weigh

A

<2500 gm

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17
Q

What is meconium and when does it normally occur?

A

Dark color, sticky consistency, odorless stool

At least once in first 48 hrs of life then transitional stools by day 4

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18
Q

What should you consider if meconium passage is delayed?

A

Hirschprung disease
Imperforate anus or other obstruction
Meconium Ileus = Cystic Fibrosis until proven otherwise

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19
Q

Why do all newborns have hyperbilirubinemia at birth?

A

↑ production, ↓ conc bili binging proteins, ↓ conj, ↓clearance

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20
Q

What is breast feeding jaundice?

A

Onset 2 – 4 days of life Related to poor enteral
intake
Self-limiting, improves as milk supply ↑

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21
Q

What is breast milk jaundice?

A

Onset 4-7 days, peaks 1-2 weeks

Due to substances in breastmilk that inhibit glucuronyl transferase

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22
Q

What are the MC d/o found on newborn screening?

A

Hearing Loss
Congenital hypothyroidsim
Hemoglobinopathies (sickle cell disease)
Cystic Fibrosis
Medium chain acyl-CoA dehydrogenase deficiency

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23
Q

What indicated a positive screen for CCHD?

A

O2 sat <90% in either extremity on any screen
O2 sat 90-94% in both extremities on three scans
Difference >3% between extremities on three scans

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24
Q

What can excessive tiredness, fatigue, or sweating during feeding suggest?

A

heart disease or anemia

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25
Q

What cardiopulmonary changes occur in the infant in the immediate post-natal period?

A

Transition perios is first 1-4 hours of life

↓ pulm vascular resistance

↑blood flow to lungs

Lung expansion with clearance of alveolar fluid

Closure of ductus arteriosus

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26
Q

What is normal infant core temp?

A

36.5° to 37.5° C (97.7°-99.5° F)

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27
Q

What is the normal physiological response to cold stress?

A

vasoconstriction
↑ musc flexion
metabolism of brown fat and glucose

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28
Q

Why is newborn with diabetic mother at risk for hypoglycemia?

A

the fetus also has hyperglycemia because feeding through the mother so insulin is high in response and when baby is born the insulin remains high before it can compensate for the loss from the mother

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29
Q

Sx hypoglycemia

A

lethargy, poor feeding, tachypnea, jitteriness, hypothermia

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30
Q

How often should you screen at risk newborn for hypoglycemia?

A

draw glucose within 30 min-1 hr of life (after 1st feed) and measure q6h x 24-48 h

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31
Q

What are the 4 main components of the Apgar score?

A

HR, breathing, grimace, activity (muscle tone), appearance (skin color)

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32
Q

What is administered to all newborns in the delivery room and why?

A

IM vit K to prevent vit K deficient bleeding (all newborns are deficient)

Erythromycin ophthalmic to to prevent gonococcal & chlamydia opthalmia neonatrum

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33
Q

What are the components of newborn screening?

A

Heel stick- 24-48 h after birth (after 1st feed)

Pulse ox- R hand (pre-ductal) and foot (post-ductal) to screen for critical congenitall heart dz (CCHD)

Hearing screen- via ABR or OAE → high risk → eval by 3 mo of age

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34
Q

RF for birth inj

A

Macrosomia (>4000 gm) (large infant has more traumatic birth)

Maternal
Abnormal presentation (breech)
Operative vaginal delivery with forceps for vacuum
Small maternal stature, maternal pelvic anomalies

Precipitous delivery

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35
Q

Edema above periosteum after prolonged fetal head engagement

Soft swelling extending across suture lines

A

Caput Succedaneum

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36
Q

Time course for Caput Succedaneum

A

Largest at birth

Benign and resolves on own within a few days

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37
Q

Collection of blood under periosteum

Firm then fluctuant non-discolored swelling
Does not cross suture

A

Cephalohematom

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38
Q

Time course of Cephalohematom

A

Can grow for 12-24 hrs then resolves over 2-3 weeks

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39
Q

Bleed below aponeurosis and above periosteum

Diffuse fluctuant fluid waves, unconfined

Can extend from orbital ridges to upper neck

A

Subgaleal hemorrhage

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40
Q

Subgaleal hemorrhage time course

A

Can increase after brith and resolves in 203 weeks but must be monitored because associated with high mortality

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41
Q

List the criteria for newborn hospital discharge

A

Stable vital signs at least 12 hours, including temp

Regular urine output, at least one spontaneous stool
At least two successful feedings

No excessive circumcision bleeding for ≥ 2 hours

Appropriate screening for hyperbilirubinemia

Appropriate evaluation and monitoring for sepsis risk
Hepatitis B vaccine, review of maternal vaccinations

Newborn screening (Blood spot, hearing, CCHD)
Discharge Planning (cont.)
Appropriate car seat available
(rear facing until 2 yo)
Follow-up care identified

Maternal and Family Education provided

Risk factors for safe home environment assessed

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42
Q

What can cause ↑ production of bilirubin in newborns?

A

hemolysis, polycythemia, cephalohematoma

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43
Q

What can cause ↓ clearance of bilirubin in newborns?

A

Crigler-Nijjar, Gilbert, hypothyroidism, galactosemia, intestinal obs

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44
Q

Tx for hyperbilirubinemia

A

freq feedings and breast feeding support

phototherapy, hydration, IVIG, exchange transfusion

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45
Q

What is the leading preventable cause of birth defects and developmental disabilities?

A

Prenatal exposure to alcohol

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46
Q

Effects of 1st trimester alcohol exposure

A

Facial anomalies
Major structural anomalies
Brain abnormalities

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47
Q

Effects of 2nd trimester alcohol exposure

A

spontaneous abortion

At every time point

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48
Q

Effects of 3rd trimester alcohol exposure

A

Affects weight, length, brain growth

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49
Q

Define stretor

A

snoring sound, mid pitched, heard loudest near mouth due to normal infant nasopharyngeal obstruction

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50
Q

Effect of maternal DM on newborn

A

Macrosomia, prematurity, hypoglycemia-hyperinsulinemia, resp distress, congenital abnormalities

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51
Q

Effect of maternal drug addiction on newborn

A

hyperirritability, high pitched crying, trmors, GI disturbances, hypertonia, feeding difficulties, autonomic dysfn, seizures, SGA, resp distress

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52
Q

Effect of maternal alcohol use on newborn

A

↓ brain vol and fn, impulse control, memory and learning, motor coord, ability to work toward goals, facial dysmorphia, cardiac, skeletal, renal, ocular and auditory abnormalities

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53
Q

What are the “terrible T’s” of cyanotic lesions?

A 
Tetralogy of Fallot
Transposition of the great vessels
Total Anomalous Pulm Venous Return (TAPVR)
Tricuspid Atresia
Truncus Arteriosus
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54
Q
  1. Describe primary care management factors in children with CHD
A

CHD children at risk for developmental delay → neurodevel screening, immunizations, reg cardio f/u

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55
Q

What are the congenitally acquired infections that may cause significant morbidity and mortality in neonates?

A

Toxoplasmosis

Other (Syphilis, Hepatitis B, Varicella Zoster, HIV, Parvovirus B19)

Rubella

Cytomegalovirus

Herpes Simplex Virus

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56
Q

What is the MC cause of neonatal sepsis?

A

Group B streptococcus (aspirate birth contents)

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57
Q

What is the most common chromosomal abnormality affecting children?

A

Trisomy 21—Down Syndrome

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58
Q

What BMI is considered overweight?

obese?

A

> 85th – 95th percentile

> 95th percentile

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59
Q

Shifts across how many percentile lines may indicate abnormality?

A

≥ 2

shifts across multiple percentiles after age 3 to 4 years uncommon

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60
Q

When do babies shift towards genetic potential for growth?

A

between 6-18 months

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61
Q

What is constitutional delay of growth and adolescence?

A

Slowing of growth, may start to cross percentiles as puberty is delayed

Enter puberty in late teens/early 20’s and reach expected MPH

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62
Q

What growth curve guidelines should you use for formula fed infants?

breast fed?

A

formula-
CDC

breast fed- WHO

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63
Q

When should term infants triple birth weight?

A

by 1 yr

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64
Q

By what age should height double?

A

3-4 yrs

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65
Q

What is normal head circumference for full term infant?

A

35 cm

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66
Q

How much do infants gain every day in the first 3 months?

A

~20-30 g/da

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67
Q

Define microcephaly

A

head circumference

2 standard deviations below the mean for average
or
<3rd percentile

68
Q

Define macrocephaly

A

HC >2 standard deviations above the mean (or >97th percentile)

69
Q

Developmental Surveillance

A

Skillfully observing children’s development, parents concerns, devel hx,

70
Q

Developmental Screening

A

part of surveillance- brief test to “sort out those who probably have problems from those who probably do not”

71
Q

When should you perform developmental screening?

A

if concerns after surveillance and routinely at 9, 18 and 30 mo

72
Q

Rolls front to back

A

4 mo

73
Q

No head lag when pulled to a sit

A

6 mo

74
Q

Sits without support

A

7 mo

75
Q

Begins creeping (crawling on hands and knees):

A

9 mo

76
Q

Takes independent steps

A

12 mo

77
Q

holds own bottle

A

8 mo

78
Q

uses a spoon well

A

22 mo

79
Q

pulls pants off

A

24 mo

80
Q

Seeks object after it falls silent to floor

A

8 mo

81
Q

Reciprocal smiling (responds to adult face/voice)

A

2 mo

82
Q

Recognizes caregiver visually

A

5 mo

83
Q

Stranger anxiety

A

6 mo

84
Q

Separation anxiety

A

9 mo

85
Q

Gives objects to adults for action after demonstration (“requests” help)

A

11 mo

86
Q

Proto-Imperative Pointing (Points to get desired object)

A

12 mo

87
Q

Proto-Declarative Pointing (Points to express interest)

A

14 mo

88
Q

Shows empathy

A

15 mo

89
Q

Coos

A

2 mo

90
Q

Listens, then vocalizes when adult stops

A

6 mo

91
Q

Waves “bye-bye”

A

10 mo

92
Q

Says first word

A

11 mo

93
Q

50+ words with 50% intelligibility (50% of speech understood by a stranger)

A

24 mo

94
Q

4 components of joint attention

A

Orienting and attending to a social partner

Coordinating attention between people and objects

Sharing affect and emotional states with people

Being able to draw others’ attention to objects or events to indicate need or to share experiences

95
Q

When is joint attention achieved

A

12-18 mo

96
Q

What is theory of mind and when does it occur

A

Appreciation that not everyone thinks and feels the way I do

30 mo

97
Q

What is intuitive psych and when does it occur

A

Understands how people work and taking on social cues

4-5 yrs

98
Q

When should anemia screening be done?

A

Hemoglobin/Hematocrit Screening recommended at age 1 year plus screening of iron deficiency risk + anytime at risk

99
Q

When should lead screening be done?

A

Venous blood lead levels (BLL) at age 1 and 2yrs if high risk, Medicaid or gvt assistance

100
Q

When should lipid screening be done?

A

Once between ages 9 and 11 years and once between 17 and 19 years (risk assess at 2, 4, 6, 8 then yearly)

101
Q

When should BP screening be done?

A

Screen annually starting at age 3 years
BP should be checked at every visit after age 3 years in children if they are: Obese, making medications known to ↑ BP, renal disease, have a history of aortic arch obstruction or coarctation, or have diabetes

102
Q

When should vision screening be done?

A

yearly visual acuity screen recommended at age 4 years, risk based starting at 18 mo

Screen for amblyopia (lazy eye) btwn 3-5 yrs

103
Q

When should hearing screening be done?

A

universal newborn screen, ID hearing loss by 3 and treat by 6 mo, assess risk yearly, screen 4, 5, 6, 8 and 10 then once every 3 yrs

104
Q

What is the MC chronic illness in children?

A

dental carries

105
Q

What bacteria causes dental carries

A

Streptococcus mutans (ant other)

106
Q

Safety counseling recommendations for infants

A

Developmental risk of falls, burns, car seats, choking, safe sleep

107
Q

Safety counseling recommendations for early childhood

A

Home hazards, stairs, windows, medicines, poisons, car seats, firearms

108
Q

Safety counseling recommendations for middle childhood

A

Helmets, media exposure, bullying, swimming, sports (trampolines), playground, strangers, firearms

109
Q

Safety counseling recommendations for adolescence

A

HEADDSSS (Home, Education, Activities, Diet, Drugs, Safety, Sexuality, Suicidality)

110
Q

What age can children watch high quality programs, co-watch with parent

A

Children 18-24 mo

111
Q

What age should children : Limit screen use to 1 hour/day?

A

Children 2-5 years

112
Q

What age is it okay to have consistent limits on time and type of media as long as it is not replacing sleep, physical activity, face-to-face social interaction?

A

6 and older

113
Q

What should women do immediately after birth to promote feeding?

A

post partum skin to skin, and breastfeeding within about 1 hour

114
Q

What is exclusive breast feeding?

A

only breast feeding

115
Q

What is full breast feeding?

A

mostly breast feeding but recognizing that life happens and the baby may have other things sometimes

116
Q

How long is recommended to breast feed?

A

6 mo of exclusive/full and with appropriate complementary foods and feeding for 1 year or longer as mutually desired by mother and baby (or up to 2 years and beyond)

117
Q

Women who were encouraged to breastfeed are how many times as likely to initiate breastfeeding as women who did not receive encouragement?

A

4 x

118
Q

What are maternal CI to breast feeding in the US?

A

HIV, Human T-cell lymphotrophic virus I or II

Active TB only (express milk; breastfeed after 14 days of treatment)

Herpes lesions on nipple

Active varicella

Isolate mother, give infant VZIG, express milk when no breast lesions, breastfeed when no longer contagious

Drugs of abuse and alcohol abuse Methadone- can still breast feed

Maternal medications

119
Q

What are infant CI to breast feeding in the US?

A

Galactosemia or Tyrosinemia (metabolic d/o picked up on newborn screening)

PKU (causes AA build up)

120
Q

Benefits of breastfeeding to infants

A

Complete nutrition

Reduced incidence of: URI, Otitis media, GI infections, NEC, IBD, Asthma, Obesity, Type I Diabetes, SIDS

Higher IQ scores

121
Q

Benefits of breastfeeding to mothers

A

Decreased post-partum bleeding

Possible decrease in post-partum depression

Reduction in breast and ovarian cancer

May decrease risk of HTN, CVD

Promotes infant-mother bonding

Saves money

122
Q

What are early hunger cues?

A

Hand to mouth
Arousal
Rooting

123
Q

Why should you avoid early pacifier use?

A

Associated with SIDS avoid in first few weeks while trying to breast feed

124
Q

How often should non-demanding infants should be aroused to feed in early weeks?

A

every 4 hours

125
Q

How much does a newborn eat per feeding?

A

0-24 hours: 2-15 mL

24-48 hours: 5-15mL

Day 2-3: 15-30 mL

Day 3-4: 30-60 mL

Day 4-5: 45-60 mL

126
Q

What urine output is potentially worrisome?

A

Brick dust after day 3

127
Q

When should 1st stool be passed?

A

within 1st 48 hrs

128
Q

When is urine usually colorless?

A

day 3-4

129
Q

When does stool transition to seedy and yellow?

A

by day 5

will have 406 per day

130
Q

When is irregular stooling pattern not a concern?

A

after 1-2 mo of age as long as soft

131
Q

What should you supplement breastmilk with daily?

A

400 IU vitamin D

132
Q

When should you initiate fluoride supplement/

A

after 6 months if household water supply is deficient (< 0.3 ppm)

133
Q

How long should you avoid water, juice, or solids?

A

6 mo

134
Q

How long should you avoid cows milk?

A

12 mo

135
Q

What does the ACA require for breast feeding mothers?

A

reasonable break time for breastfeeding mothers for 1 year after a child’s birth

private place, other than a restroom

coverage of breast pump materials

136
Q

What is the only formula that does not contain lactose?

A

soy-based formula

137
Q

What is the MC used infant formula?

A

Cow’s Milk Protein

138
Q

What is hydrolyzed formula?

A

small peptides and some
free AA

Good for cows milk protein allergy

139
Q

What is AA based formula?

A

100% free amino acids

good for extreme allergy, intestinal failure

140
Q

When is Soy Based Formula indicated?

A

Parents desire a vegan diet for infant

Infant is diagnosed with galactosemia

Infant has hereditary or transient lactose intolerance

141
Q

When should you initiate solids for infants?

A

4-6 months of age

when they have head control and oral motor coordination influence timing

142
Q

How often can you introduce new food?

A

One new food every 3-5 days

143
Q

When is cows milk introduced for formula fed infants?

A

1 yr

Whole milk
Low Fat/Skim >24 months
No bottles

144
Q

What supplement is recommended for vegan breastfed infants?

A

vit B12

145
Q

Fn of iron

A

Hb, myoglobin, enzymes

146
Q

Fn of vit D

A

structure of bone

147
Q

Fn of calcium

A

structure of bone, ion transport across cell mem, NM excitability, blood coag

148
Q

Fn of fluoride

A

bone adn tooth structure, resistan e to dental carries

149
Q

Copper fn

A

cofactor for enzymes, cross linking of collagen

150
Q

Fn od iodine

A

Fn of thyroid gland

151
Q

What does food allergy testing tell you?

A

The higher the result the higher the likelihood of having a reaction to the offending agent does not tell the strength or severity of the reaction

152
Q

Sensitization

A

The detection of specific IgE toward an allergen through skin prick, intradermal, or serum specific IgE testing

153
Q

IgE mediated hypersensitivity

A

Characteristic clinical symptoms upon exposure to
an allergen
AND
detection of specific IgE toward that allergen

154
Q

What are the MC types of food allergies?

A

cow’s milk, egg, soy, wheat, peanuts, tree nuts, fish, and shellfish

155
Q

What are uncommon causes of allergies?

A

Strawberry, fruits/vegetables, natural food additives, artificial preservatives

156
Q

RF for food allergy development

A

Eczema
Asthma
Environmental allergies
Family history of allergies

157
Q

What food allergies typically develop tolerance and what remain for life?

A

Milk, egg, wheat, soy majority develop tolerance
by school age

Peanut, tree nuts, seafood typically remain for life

158
Q

Why is testing for milk protein protocolitis and food protein enterocolitis not indicated?

A

not IgE mediated

159
Q

According to the LEAP study when should peanuts be introduced?

A

Start with other solid food first

If severe eczema, egg allergy or both by 4-6 mo

If mild to mod eczema 6 mo

If no eczema or food allergy then age appropriate/ family preference

160
Q

Benefits fo circumcision

A 
Reduction in UTIs
Reduction in STIs,
including acquisition of
HIV
Easier hygiene
Reduced phimosis and
paraphimosis
Squamous cell penile cancer
161
Q

Risks of circumcision

A 
Procedure related complications (rare)
Procedural Pain
Penile injury
Urethral complications
(fistula)
Glans injury
Excessive skin removal
Adhesions
162
Q

Contraindications to circumcision

A

Hypospadias
Chordee without hypospadias
Dorsal hood deformity
Micropenis (delay until urology consult)
Wandering raphe (relative contraindication) Should be straight
Bilateral undescended testes (until after eval)
Ambiguous genitalia
Known bleeding diathesis (until after heme consult)

163
Q

When can circumcision be done?

A

Infant is at least 12 and preferably 24 hours old

Infant has voided at least once since birth

164
Q

Post-Circumcision Care

A

Some swelling expected

Blood on diaper should be < quarter sized

Clean with mild soap and water if soiled

Petroleum jelly to prevent adhesion to diaper

165
Q

Congenital defect in which opening of urethra is on underside of penis rather than at the tip

2nd MC congenital defect of male genitalia

A

Hypospadias

Pediatrics (7 decks)

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