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Clin Med/Spec > Peds Exam Lecture 1 > Flashcards

Peds Exam Lecture 1 Flashcards

1
Q

Chelation used for lead poisoning

A

Succimer 10mg/kg PO x 5 days, then Q12hrs for 14 days

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2
Q

RF for dyslipidemia

A 
Obesity
Fhx
DM
HTN
Polycystic ovarian disease
Hypothyroidism
Smoker
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3
Q

MC used formula

A

Cow’s milk protein

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4
Q

What are hydrolyzed formulas good for?

A

Good for babies with fat malabsorption

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5
Q

What is lactose intolerance?

A

Intolerance of lactose (milk sugar)

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6
Q

Which infants MC have problem w/lactose?

A

Premature babies have decr level of enzyme to breakdown lactose

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7
Q

When is 2ndary lactose intolerance common?

A

After gastroenteritis and in celiac disease

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8
Q

When should solids be initiated?

A

A

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9
Q

What does folate deficiency cause?

A

A

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10
Q

What does vitamin C deficiency cause?

A

A

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11
Q

If you don’t have skin sx, is it considered anaphylaxis?

A

Yes

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12
Q

Where is Epi admin?

A

Lateral thigh

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13
Q

How are steroids used in anaphylaxis?

A

THEY’RE NOT

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14
Q

3 principles of determining an allergic reaction

A
  1. Objective
  2. Immediate
  3. Reproducible w/every exposure
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15
Q

Which allergies typically remain for life?

A

Peanuts, tree nuts, seafood

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16
Q

For which food allergies do children usu develop tolerance by school age?

A

Milk, egg, wheat, soy

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17
Q

T/F: Sensitivity incurs allergy

A

False

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18
Q

What must be evaluated for in a child w/biliary emesis?

A

Volvulus

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19
Q

Classic triad of intussusception

A
  1. Abd pain
  2. Vomiting
  3. Currant jelly stools
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20
Q

What causes the problems when infected with diphtheria?

A

Toxin from corynebacterium diphtheriae

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21
Q

What does the DTaP vaccine contain?

A

A

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22
Q

When is the DTaP vaccine given?

A

A

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23
Q

How many doses of DTaP are needed for protection?

A

A

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24
Q

What is the CI to Tdap?

A

Anaphylaxis after receiving Tdap components

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25
Q

Tdap vaccine admin in pregnancy

A

Need a new Tdap for each pregnancy (passive immunity)

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26
Q

what are the main principles of newborn care?

A
  1. smooth transition
  2. screening
  3. parental education/anticipatory guidance
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27
Q

what is considered the transition period for a newborn?

A

1st 4-6 hours of life

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28
Q

what normal physiologic changes happen as soon as the cord is cut?

A
  1. decr pulmonary vascular resistance
  2. incr blood flow to the lungs
  3. lung expansion with clearance of alveolar fluid
  4. closure of DA
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29
Q

what is the ductus arteriosus essentially a substitute for?

A

fetal lungs

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30
Q

mechanisms of heat loss in newborn

A

conduction, convection, evaporation, radiation

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31
Q

why do newborns where hats?

A

head is where they lose the most of their body heat

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32
Q

what is the normal newborn temp range?

A

97.7 - 99.5

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33
Q

how to prevent heat loss in newborn

A

remove wet linens, skin to skin contact, hat, swaddling

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34
Q

why is a preterm baby less able to regulate its body temp

A

doesn’t have as much brown fat and glycogen stores which is put on in the third trimester (esp last month)

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35
Q

what factors impact newborn blood glucose after cord is cut

A
  1. inadequate glycogen stores
  2. hyperinsulinemia
  3. increased glucose use
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36
Q

how does a DM mother impact a newborn’s glucose control?

A

baby sees the excess blood glucose causing it secrete more insulin - results in hyperinsulinemia and hypoglycemia

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37
Q

does a baby born to DM mother automatically get DM?

A

no

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38
Q

how does a hypoglycemic newborn present?

A
  1. lethargy
  2. poor feeding
  3. tachypnea
  4. jitteriness
  5. hypothermia
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39
Q

glucose screening guidelines for asx newborns at risk for hypoglycemia

A
  • glucose w/i first 30-60 minutes of life (post first feed)

- baby should be fed frequently w/prefeeding glucose measured every 3-6 hours for first 24-48 hours

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40
Q

what should happen to HR if you flick a newborn’s heel?

A

its should increase

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41
Q

what is a normal newborn HR?

A

120-160

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42
Q

what is a normal newborn RR?

A

40-60

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43
Q

what can cause apnea in a newborn?

A
  1. maternal meds (mag sulfate which is used to slow delivery)
  2. neurological impairment
  3. sepsis
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44
Q

what is the difference between central cyanosis and acrocyanosis?

A
  • central cyanosis (lips, tongue, trunk) may indicate disease
  • acrocyanosis is normal w/i first 48 hours
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45
Q

how can you differentiate between a pulmonary and cardiac cause of central cyanosis

A

if you give baby 100% O2 - it does not correct

46
Q

when is the APGAR score recorded?

A

1min and 5min

47
Q

what is the APGAR used for?

A

can predict neurological outcomes (NOT predictor of neonatal mortality)

48
Q

what is a newborn given in the delivery room?

A

vitamin K and erythromycin ophthalmic

49
Q

what is vitamin used a ppx for?

A

vitamin K deficient bleeding (hemorrhagic disease of the newborn) in the first few weeks of life (all newborns born with low vitamin K)

50
Q

what does a newborn need synthetic vitamin K?

A
  1. doesn’t transfer from mom to baby
  2. liver can’t produce clotting factors yet
  3. vitamin K is produced by gut flora which isn’t full developed yet
51
Q

what is vitamin K deficient bleeding characterized by?

A
  1. bruising
  2. mucosal bleeding
  3. bleeding at umbilicus or circumcision
  4. intracranial hemorrhage
52
Q

when and how is vitamin K administered?

A

first hours after birth

IM

53
Q

why is erythromycin ophthalmic used?

A

to prevent gonococcal and chlamydia ophthalmia neonatorum

54
Q

what is considered fill term?

A

39-40 weeks

55
Q

early term

A

37 0/7 weeks - 38 6/7 weeks

56
Q

what is chronological age?

A

time since birth

57
Q

what is post-menstrual age?

A

gestational plus chronological age

58
Q

what is gestational age?

A

time between LMP and delivery

59
Q

what is the corrected age?

A

chronological age minus # weeks premature

60
Q

RFs for birth injuries

A
  1. macrosomia (large infant > 4000gm)
  2. maternal obesity
  3. abnormal presentation (breech)
  4. operative vaginal delivery (forceps or vacuum)
  5. small maternal stature
  6. precipitous delivery (delivery w/i 3 hrs of contractions starting)
61
Q

what is caput succedaneum?

A
  1. benign edema above the periosteum after prolonged fetal head engagement or vacuum
  2. soft swelling that extends over suture lines
  3. resolves within days
62
Q

what is cephalohematoma?

A
  1. hemorrhage under the periosteum which is more common w/forceps of vacuum
  2. firm enlargement with distinct margins that do not cross suture lines
63
Q

what is the course of cephalohematoma?

A

can increase for 12-24 hours after birth and then decreases over 2-3 weeks

64
Q

what is a subgaleal hemorrhage?

A
  1. hemorrhage below the aponeurosis above the periosteum which is more common with vacuum
  2. diffuse fluctuant fluid waves that can go from the orbital ridges to the upper neck
65
Q

what is the course of a sugaleal hemorrhage?

A

can increase steadily, usually resolves in 2-3 weeks

66
Q

how is subgaleal hemorrhage treated?

A

blood products and volume (d/t decrease in HCT)

67
Q

which brain injury is associated with erythema and bruising?

A

caput succedaneum

68
Q

what is shoulder dystocia?

A

post delivery of the head
anterior shoulder cannot pass easily below the pubic symphysis
most cases = unilateral

69
Q

complications of shoulder dystocia

A
  1. brachial plexus injury
  2. clavicular injury
  3. humerus fracture
  4. hypoxic-ischemic encephalopathy
  5. death
70
Q

how is shoulder dystocia managed?

A

physical therapy weekly for at least 3 months

71
Q

how can clavicular fracture appear on exam and what is done to manage it?

A 
crepitus over clavicle 
sx treatment (warn parents calcium deposits can develop)
72
Q

criteria for discharge of well term newborn

A
  1. stable vitals > 12hrs
  2. urine output regular
  3. spontaneous stool once
  4. no excessive circumcision bleeding >2 hrs
  5. screening for hyperbilirubinemia
  6. evaluate sepsis risk
  7. Hep B vaccine and review maternal vaccines
  8. blood spot, hearing, CCHD
  9. car seat
  10. F/U identified
  11. family education
  12. RF for safe home assessed
73
Q

what are the characteristics of the meconium stool?

A

dark, sticky, odorless

74
Q

when does the meconium stool typically occur?

A

first 48 hours

75
Q

when should transitional stool start by and what does it look like?

A

occurs by day 4

lighter mustard colored, sesame seed stool

76
Q

what should be considered with a delayed meconium?

A
  1. Hirschprung disease
  2. meconium ileum = likely CF
  3. imperforate anus or other obstruction
77
Q

when does the first urination typically occur?

A

within first 24 hours

78
Q

how should anuria be assessed?

A
  1. pregnancy eval (oligohydramnios?)
  2. assess feeding adequacy
  3. GU, Abd, spine exam
  4. cath, hydration, bladder & renal US
79
Q

what are urate crystals?

A

orange pink substance often mistaken for blood common in first week of life

80
Q

what is vaginal discharge a result of?

A

transmission of maternal hormones

81
Q

when does newborn vaginal discharge typically occur?

A

3rd day of life and lasts a few days

82
Q

weight fluctuation in newborns

A

can lose weight initially

most are back to birth weight by 2 wks

83
Q

when is jaundice considered normal versus pathologic?

A

normal peaks at 3-4 days and resolves by week 1 or 2

pathologic in first 24 hours of life

84
Q

when do premature infants usually have physiologic jaundice?

A

day 5

85
Q

what is the main concern with neonatal hyperbilirubinemia?

A

BIND (bilirubin induced neurological dysfunction

acute bili encephalopathy, kernicterus

86
Q

what are the causes of pathological jaundice?

A

hemolysis: immune mediated (ABO, Rh) membrane defects, enzyme defects, sepsis
polycythemia, cephalohematoma

decreased clearance or excretion: Crigler-Nijjar, Gilbert syndrome, hypothyroidism, galactosemia
intestinal obstruction

87
Q

in which cases should early bilirubin monitoring occur?

A

if antibody positive (mother or infant) or if there is excessive infant jaundice

88
Q

what are the major risk factors for excessive hyperbilirubinemia that may necessitate intervention

A
  1. early jaundice
  2. positive ab screen
  3. GA 35-36 weeks
  4. sibling who needed phototherapy
  5. exclusive breastfeeding
  6. East Asian
89
Q

how does phototherapy help infant jaundice?

A

converts the unconjugated bili into water soluble byproducts which can be excreted in urine and feces

90
Q

treatment options for bilirubin management

A
  1. phototherapy
  2. hydration
  3. IVIg
  4. exchange transfusion
91
Q

what are the 3 components of the newborn screen?

A
  1. hearing screen
  2. heel stick blood sample
  3. pulse ox
92
Q

what is the difference b/w breast feeding jaundice and breastmilk jaundice?

A

breast feeding: related to not getting enough calories, self limiting (improves with incr in milk production)

breastmilk: related to substance in breastmilk that inhibit UGTA and cause decr in bili conjugation)

93
Q

what is the difference in timeline b/w breast feeding jaundice and breastmilk jaundice?

A

breast feeding: 2-4 days of life

breastmilk: 4-7 days of life, peaking in 1-2 weeks

94
Q

when is blood spot screening performed?

A

in first 24-48 hours (after first feeding) - b/c some dz can not present until after feeding

95
Q

what types of cardiac dz represent CCHD (critical congenital heart disease?

A

cyanotic lesions

ductal-dependent lesions

96
Q

when should CCHD be screened for? why?

A

after 24 hours of life b/c requires intervention in first year of life

97
Q

how is CCHD assessed?

A

pulse ox in right hand and foot

repeat 3 times, 1 hour apart

98
Q

why is the right hand and right food specifically used to assess for CCHD?

A

right hand = pre-ductal

right foot = post-ductal

99
Q

what type of hearing loss is most often present in newborns?

A

sensorineural

100
Q

how is newborn hearing screened?

A

ABR (auditory brainstem response) or BAER or OAE (otoacoustic emissions)

101
Q

what is considered a positive CCHD screen?

A
  1. O2 <90% in either place on 1 scans
  2. O2 90-94% in both places on 3 scans
  3. difference >3% between both places on 3 scans
102
Q

how long does it take the umbilical cord to fall off?

A

10-14 days

103
Q

newborn skin care

A
  1. sponge bath until cord detaches
  2. no need for frequent baths (every other day)
  3. avoid powders and direct sunlight
104
Q

what is the typical timeframe for breastfeeding on demand?

A

Q2-3 hours

105
Q

in terms of feeding what should be avoided in baby?

A

water, sugar water (d/t electrolyte disturbances

106
Q

soothing techniques for crying

A
  1. reposition
  2. repeat/rhythm (sight, sound, touch)
  3. white noise
  4. closeness
107
Q

when does crying peak?

A

2 months

108
Q

when is crying more common?

A

late afternoon and evening

109
Q

how long does an infant need to be rear-facing?

A

until 2 y/o or max height/weight

110
Q

when is minimum discharge criteria typically met?

A

48 hours

Clin Med/Spec (11 decks)

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