Peds Exam 1 Flashcards
1
Q
Nrml newborn HR
A
120 to 160 bpm
85 to 90 bpm may be nrml if sleeping
2
Q
Nrml newborn RR
A
40-60 breaths/min
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
4
Q
37 0/7 weeks to 38 6/7 weeks gestation
A
Early Term
5
Q
32 0/7 weeks to 36 6/7 weeks gestation
A
Late Pre-term
6
Q
28 0/7 weeks to 31 6/7 weeks gestation
A
Very Premature
7
Q
28 weeks or less
A
Extremely Premature
8
Q
Gestational Age
A
Elapsed time between LMP and delivery
9
Q
Chronological (post-natal) Age
A
Time since birth
10
Q
Post-menstrual Age
A
Gestational plus Chronological age
11
Q
Corrected Age
A
Chronological age minus number of weeks premature
12
Q
Large for gestational age
A
> 90th percentile for GA
13
Q
Small for gestational age
A
<10th percentile for GA
14
Q
Extremely low birth weight
A
< 1000 gm
15
Q
Very low birth weight
A
< 1500 gm
16
Q
Low birth weigh
A
<2500 gm
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
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
19
Q
Why do all newborns have hyperbilirubinemia at birth?
A
↑ production, ↓ conc bili binging proteins, ↓ conj, ↓clearance
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 ↑
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
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
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
24
Q
What can excessive tiredness, fatigue, or sweating during feeding suggest?
A
heart disease or anemia
25
What cardiopulmonary changes occur in the infant in the immediate post-natal period?
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
26
What is normal infant core temp?
36.5° to 37.5° C (97.7°-99.5° F)
27
What is the normal physiological response to cold stress?
vasoconstriction
↑ musc flexion
metabolism of brown fat and glucose
28
Why is newborn with diabetic mother at risk for hypoglycemia?
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
29
Sx hypoglycemia
lethargy, poor feeding, tachypnea, jitteriness, hypothermia
30
How often should you screen at risk newborn for hypoglycemia?
draw glucose within 30 min-1 hr of life (after 1st feed) and measure q6h x 24-48 h
31
What are the 4 main components of the Apgar score?
HR, breathing, grimace, activity (muscle tone), appearance (skin color)
32
What is administered to all newborns in the delivery room and why?
IM vit K to prevent vit K deficient bleeding (all newborns are deficient)
Erythromycin ophthalmic to to prevent gonococcal & chlamydia opthalmia neonatrum
33
What are the components of newborn screening?
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
34
RF for birth inj
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
35
Edema above periosteum after prolonged fetal head engagement
Soft swelling extending across suture lines
Caput Succedaneum
36
Time course for Caput Succedaneum
Largest at birth
| Benign and resolves on own within a few days
37
Collection of blood under periosteum
Firm then fluctuant non-discolored swelling
Does not cross suture
Cephalohematom
38
Time course of Cephalohematom
Can grow for 12-24 hrs then resolves over 2-3 weeks
39
Bleed below aponeurosis and above periosteum
Diffuse fluctuant fluid waves, unconfined
Can extend from orbital ridges to upper neck
Subgaleal hemorrhage
40
Subgaleal hemorrhage time course
Can increase after brith and resolves in 203 weeks but must be monitored because associated with high mortality
41
List the criteria for newborn hospital discharge
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
42
What can cause ↑ production of bilirubin in newborns?
hemolysis, polycythemia, cephalohematoma
43
What can cause ↓ clearance of bilirubin in newborns?
Crigler-Nijjar, Gilbert, hypothyroidism, galactosemia, intestinal obs
44
Tx for hyperbilirubinemia
freq feedings and breast feeding support
phototherapy, hydration, IVIG, exchange transfusion
45
What is the leading preventable cause of birth defects and developmental disabilities?
Prenatal exposure to alcohol
46
Effects of 1st trimester alcohol exposure
Facial anomalies
Major structural anomalies
Brain abnormalities
47
Effects of 2nd trimester alcohol exposure
spontaneous abortion
| At every time point
48
Effects of 3rd trimester alcohol exposure
Affects weight, length, brain growth
49
Define stretor
snoring sound, mid pitched, heard loudest near mouth due to normal infant nasopharyngeal obstruction
50
Effect of maternal DM on newborn
Macrosomia, prematurity, hypoglycemia-hyperinsulinemia, resp distress, congenital abnormalities
51
Effect of maternal drug addiction on newborn
hyperirritability, high pitched crying, trmors, GI disturbances, hypertonia, feeding difficulties, autonomic dysfn, seizures, SGA, resp distress
52
Effect of maternal alcohol use on newborn
↓ 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
53
What are the “terrible T’s” of cyanotic lesions?
```
Tetralogy of Fallot
Transposition of the great vessels
Total Anomalous Pulm Venous Return (TAPVR)
Tricuspid Atresia
Truncus Arteriosus
```
54
12. Describe primary care management factors in children with CHD
CHD children at risk for developmental delay → neurodevel screening, immunizations, reg cardio f/u
55
What are the congenitally acquired infections that may cause significant morbidity and mortality in neonates?
Toxoplasmosis
Other (Syphilis, Hepatitis B, Varicella Zoster, HIV, Parvovirus B19)
Rubella
Cytomegalovirus
Herpes Simplex Virus
56
What is the MC cause of neonatal sepsis?
Group B streptococcus (aspirate birth contents)
57
What is the most common chromosomal abnormality affecting children?
Trisomy 21—Down Syndrome
58
What BMI is considered overweight?
obese?
>85th – 95th percentile
> 95th percentile
59
Shifts across how many percentile lines may indicate abnormality?
≥ 2
| shifts across multiple percentiles after age 3 to 4 years uncommon
60
When do babies shift towards genetic potential for growth?
between 6-18 months
61
What is constitutional delay of growth and adolescence?
Slowing of growth, may start to cross percentiles as puberty is delayed
Enter puberty in late teens/early 20’s and reach expected MPH
62
What growth curve guidelines should you use for formula fed infants?
breast fed?
formula-
CDC
breast fed- WHO
63
When should term infants triple birth weight?
by 1 yr
64
By what age should height double?
3-4 yrs
65
What is normal head circumference for full term infant?
35 cm
66
How much do infants gain every day in the first 3 months?
~20-30 g/da
67
Define microcephaly
head circumference
2 standard deviations below the mean for average
or
<3rd percentile
68
Define macrocephaly
HC >2 standard deviations above the mean (or >97th percentile)
69
Developmental Surveillance
Skillfully observing children's development, parents concerns, devel hx,
70
Developmental Screening
part of surveillance- brief test to "sort out those who probably have problems from those who probably do not"
71
When should you perform developmental screening?
if concerns after surveillance and routinely at 9, 18 and 30 mo
72
Rolls front to back
4 mo
73
No head lag when pulled to a sit
6 mo
74
Sits without support
7 mo
75
Begins creeping (crawling on hands and knees):
9 mo
76
Takes independent steps
12 mo
77
holds own bottle
8 mo
78
uses a spoon well
22 mo
79
pulls pants off
24 mo
80
Seeks object after it falls silent to floor
8 mo
81
Reciprocal smiling (responds to adult face/voice)
2 mo
82
Recognizes caregiver visually
5 mo
83
Stranger anxiety
6 mo
84
Separation anxiety
9 mo
85
Gives objects to adults for action after demonstration ("requests" help)
11 mo
86
Proto-Imperative Pointing (Points to get desired object)
12 mo
87
Proto-Declarative Pointing (Points to express interest)
14 mo
88
Shows empathy
15 mo
89
Coos
2 mo
90
Listens, then vocalizes when adult stops
6 mo
91
Waves "bye-bye"
10 mo
92
Says first word
11 mo
93
50+ words with 50% intelligibility (50% of speech understood by a stranger)
24 mo
94
4 components of joint attention
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
When is joint attention achieved
12-18 mo
96
What is theory of mind and when does it occur
Appreciation that not everyone thinks and feels the way I do
30 mo
97
What is intuitive psych and when does it occur
Understands how people work and taking on social cues
4-5 yrs
98
When should anemia screening be done?
Hemoglobin/Hematocrit Screening recommended at age 1 year plus screening of iron deficiency risk + anytime at risk
99
When should lead screening be done?
Venous blood lead levels (BLL) at age 1 and 2yrs if high risk, Medicaid or gvt assistance
100
When should lipid screening be done?
Once between ages 9 and 11 years and once between 17 and 19 years (risk assess at 2, 4, 6, 8 then yearly)
101
When should BP screening be done?
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
When should vision screening be done?
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
When should hearing screening be done?
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
What is the MC chronic illness in children?
dental carries
105
What bacteria causes dental carries
Streptococcus mutans (ant other)
106
Safety counseling recommendations for infants
Developmental risk of falls, burns, car seats, choking, safe sleep
107
Safety counseling recommendations for early childhood
Home hazards, stairs, windows, medicines, poisons, car seats, firearms
108
Safety counseling recommendations for middle childhood
Helmets, media exposure, bullying, swimming, sports (trampolines), playground, strangers, firearms
109
Safety counseling recommendations for adolescence
HEADDSSS (Home, Education, Activities, Diet, Drugs, Safety, Sexuality, Suicidality)
110
What age can children watch high quality programs, co-watch with parent
Children 18-24 mo
111
What age should children : Limit screen use to 1 hour/day?
Children 2-5 years
112
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?
6 and older
113
What should women do immediately after birth to promote feeding?
post partum skin to skin, and breastfeeding within about 1 hour
114
What is exclusive breast feeding?
only breast feeding
115
What is full breast feeding?
mostly breast feeding but recognizing that life happens and the baby may have other things sometimes
116
How long is recommended to breast feed?
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
Women who were encouraged to breastfeed are how many times as likely to initiate breastfeeding as women who did not receive encouragement?
4 x
118
What are maternal CI to breast feeding in the US?
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
What are infant CI to breast feeding in the US?
Galactosemia or Tyrosinemia (metabolic d/o picked up on newborn screening)
PKU (causes AA build up)
120
Benefits of breastfeeding to infants
Complete nutrition
Reduced incidence of: URI, Otitis media, GI infections, NEC, IBD, Asthma, Obesity, Type I Diabetes, SIDS
Higher IQ scores
121
Benefits of breastfeeding to mothers
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
What are early hunger cues?
Hand to mouth
Arousal
Rooting
123
Why should you avoid early pacifier use?
Associated with SIDS avoid in first few weeks while trying to breast feed
124
How often should non-demanding infants should be aroused to feed in early weeks?
every 4 hours
125
How much does a newborn eat per feeding?
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
What urine output is potentially worrisome?
Brick dust after day 3
127
When should 1st stool be passed?
within 1st 48 hrs
128
When is urine usually colorless?
day 3-4
129
When does stool transition to seedy and yellow?
by day 5
will have 406 per day
130
When is irregular stooling pattern not a concern?
after 1-2 mo of age as long as soft
131
What should you supplement breastmilk with daily?
400 IU vitamin D
132
When should you initiate fluoride supplement/
after 6 months if household water supply is deficient (< 0.3 ppm)
133
How long should you avoid water, juice, or solids?
6 mo
134
How long should you avoid cows milk?
12 mo
135
What does the ACA require for breast feeding mothers?
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
What is the only formula that does not contain lactose?
soy-based formula
137
What is the MC used infant formula?
Cow’s Milk Protein
138
What is hydrolyzed formula?
small peptides and some
free AA
Good for cows milk protein allergy
139
What is AA based formula?
100% free amino acids
good for extreme allergy, intestinal failure
140
When is Soy Based Formula indicated?
Parents desire a vegan diet for infant
Infant is diagnosed with galactosemia
Infant has hereditary or transient lactose intolerance
141
When should you initiate solids for infants?
4-6 months of age
when they have head control and oral motor coordination influence timing
142
How often can you introduce new food?
One new food every 3-5 days
143
When is cows milk introduced for formula fed infants?
1 yr
Whole milk
Low Fat/Skim >24 months
No bottles
144
What supplement is recommended for vegan breastfed infants?
vit B12
145
Fn of iron
Hb, myoglobin, enzymes
146
Fn of vit D
structure of bone
147
Fn of calcium
structure of bone, ion transport across cell mem, NM excitability, blood coag
148
Fn of fluoride
bone adn tooth structure, resistan e to dental carries
149
Copper fn
cofactor for enzymes, cross linking of collagen
150
Fn od iodine
Fn of thyroid gland
151
What does food allergy testing tell you?
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
Sensitization
The detection of specific IgE toward an allergen through skin prick, intradermal, or serum specific IgE testing
153
IgE mediated hypersensitivity
Characteristic clinical symptoms upon exposure to
an allergen
AND
detection of specific IgE toward that allergen
154
What are the MC types of food allergies?
cow’s milk, egg, soy, wheat, peanuts, tree nuts, fish, and shellfish
155
What are uncommon causes of allergies?
Strawberry, fruits/vegetables, natural food additives, artificial preservatives
156
RF for food allergy development
Eczema
Asthma
Environmental allergies
Family history of allergies
157
What food allergies typically develop tolerance and what remain for life?
Milk, egg, wheat, soy majority develop tolerance
by school age
Peanut, tree nuts, seafood typically remain for life
158
Why is testing for milk protein protocolitis and food protein enterocolitis not indicated?
not IgE mediated
159
According to the LEAP study when should peanuts be introduced?
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
Benefits fo circumcision
```
Reduction in UTIs
Reduction in STIs,
including acquisition of
HIV
Easier hygiene
Reduced phimosis and
paraphimosis
Squamous cell penile cancer
```
161
Risks of circumcision
```
Procedure related complications (rare)
Procedural Pain
Penile injury
Urethral complications
(fistula)
Glans injury
Excessive skin removal
Adhesions
```
162
Contraindications to circumcision
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
When can circumcision be done?
Infant is at least 12 and preferably 24 hours old
Infant has voided at least once since birth
164
Post-Circumcision Care
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
Congenital defect in which opening of urethra is on underside of penis rather than at the tip
2nd MC congenital defect of male genitalia
Hypospadias
