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Clin Med/Spec > Peds Exam Lecture 4 > Flashcards

Peds Exam Lecture 4 Flashcards

1
Q

what is optimal infant and young child feeding?

A
  1. immediate postpartum skin to skin
  2. breastfeeding within 1 hours
  3. 6 months of exclusive breastfeeding
  4. continue breastfeeding with appropriate complementary foods and feeding for 1 year or longer
  5. maternal nutrition and care
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2
Q

CI to breastfeeding

A
  1. HIV
  2. Human T-cell lymphocytic virus I or II
  3. active TB
  4. herpes on nipple
  5. active varicella
  6. drugs/alcohol
  7. maternal meds
  8. infant galactosemia
  9. infant tyrosinemia
  10. PKU (elevated phenylalanine)
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3
Q

how does breastfeeding help the mother?

A
  1. decr post partum bleeding
  2. possible decr in post partum depression
  3. reduction of breast and ovarian CA
  4. may decr HTN, CVD risk
  5. promotes bonding
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4
Q

how can normal urine output be gauged?

A

number per day = day of life

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5
Q

at what point does urine become colorless?

A

day 3-4

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6
Q

what is normal stool pattern?

A

4-6 BM per day by day 5

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7
Q

how many wet diapers per day in infant?

A

6-8

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8
Q

what should be avoided in the first 6 months? 12 months?

A

6 months - water, juice, solids

12 months - cow’s milk

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9
Q

when should normal iron supplementation begin and how?

A

6 months

iron rich foods or supplements

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10
Q

when does vitamin D supplementation begin? why?

A

immediately (PO QD) b/c human milk does not give enough vitamin D to prevent Rickett’s

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11
Q

what is are the types of protein included in most formulas except soy formula (in which soy protein is used)?

A

whey and casein

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12
Q

what carbohydrate is used in most formulas?

A

lactose

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13
Q

for which babies is hydrolyzed formula used?

A

those with fat malabsorption/maldigestion

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14
Q

for which babies is amino acid based formula used?

A

extreme allergy, intestinal failure

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15
Q

what is food protein proctocolitis?

A

painless blood in stool
presents in 1-2 months of life
resolves w/i days - 2 weeks

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16
Q

why is soy formula used?

A

vegan
galactosemia
hereditary or transient lactose intolerance

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17
Q

what is food protein induced enterocolitis syndrome (EPIES)?

A

non-IgE mediated response to food

vomiting, diarrhea with intake of food

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18
Q

what are the most common culprits in EPIES?

A

cow’s milk protein and soy

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19
Q

how is EPIES treated?

A 
fluid resuscitation and anti-emetics
avoid trigger (can reintroduce later in life)
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20
Q

when should solids be started?

A

4-6 months (when child developmentally ready)

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21
Q

how should solids be started?

A

single ingredients so can identify offending agent if rxn

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22
Q

what babies are susceptible to lactose intolerance and why?

A

premature babies

born without sufficient enzyme to breakdown lactose

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23
Q

symptoms of lactose intolerance

A

increased gas, diarrhea (osmotic load)

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24
Q

when does secondary lactose intolerance (more common than primary) typically present?

A

post gastroenteritis

celiac disease

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25
why is whole milk used in the first 12-24 months?
better for brain development
26
when is low/fat free milk started?
after 2 years old
27
why are bottles discouraged?
caries and overconsumption
28
when are children supposed to transition to cups and utensils?
toddler/preschool
29
which nutritional deficiency puts a child at risk for edema and immunodeficiency?
protein
30
what is anaphylaxis?
reaction including skin/mucosa, respiratory compromise, hypotension/end organ dysfunction (sometimes GI sx)
31
skin sx of anaphylaxis
1. pruritus 2. flushing 3. hives 4. angioedema
32
respiratory sx of anaphylaxis
1. dyspnea 2. wheeze 3. stridor 4. hypoxemia
33
hypotension sx of anaphylaxis (rare)
1. collapse 2. syncope 3. incontinence
34
epinephrine autoinjectors
Adrenaclick EpiPen Auvi-Q
35
how long observation post anaphylaxis?
4-8 hours
36
factors that compel admission post anaphylaxis?
1. >1 dose Epi needed 2. IV fluids for hypotension 3. laryngeal edema 4. severe asthma 5. trigger = ingestion
37
what is the difference between sensitization and allergy?
``` sensitization = detection of IgE on allergy test allergy = characteristic clinical sx upon exposure to an allergen + detection of specific IgE toward allergen ```
38
3 principle characteristics of allergic reaction
1. objective 2. immediate 3. reproducible
39
typical sx of food allergy
1. urticaria 2. angioedema 3. emesis 4. rhinorrhea 5. wheezing 6. hypotension 7. anaphylaxis
40
RF for developing a food allergy
1. eczema 2. asthma 3. environmental allergies 4. family hx of allergies
41
which food allergies are usually lifelong?
peanuts, tree nuts, seafood
42
is milk/food PROTEIN induced proctocolitis IgE mediated?
no
43
IgE mediated allergies
1. milk 2. eggs 3. wheat 4 . soy 5. peanuts 6. tree nuts 7. seafood
44
what did the LEAP study show?
peanut allergy prevalence was less in consumption group than the avoidance group
45
why is GERD more pronounced in kids?
LES is less toned
46
what is GER?
passive passage into esophagus w/o regurg or vomit normal response occurs daily in infants
47
what age is GER common and when does it resolve?
1-6 months | resolves by 1 year
48
GERD sx
1. regurg/vomiting 2. weight loss 3. irritability 4. chest pain 5. hematemesis 6. dysphagia 7. wheezing 8. stridor 9. cough
49
what is more commonly used to dx GERD in kids?
hx and PE (endoscopy not as helpful in kids)
50
what can be done for the "happy spitter" (GER)?
reassurance if persistence - thicken food FTT - acid suppression, refer to ped GI
51
what is the MC surgical disorder in neonates
pyloric stenosis
52
what can be used for kids w/heartburn?
PPI
53
pyloric stenosis sx
1. vomiting (can be projectile) 2. weight loss despite hunger 3. hypertrophied pylorus 4. metabolic alkalosis, electrolyte disturbances
54
tx for pyloric stenosis
1. correct dehydration and alkalosis | 2. pyloromyotomy
55
when is malrotation more common?
infancy
56
what are the sx of malrotation?
can be asx 1. bilious emesis 2. abd distention 3. peritonitis
57
treatment for malrotation
Ladd's procedure
58
what is a volvulus?
life threatening condition characterized by malrotation around the mesenteric axis
59
how is volvulus dx?
upper GI series shows corkscrew appearance of small bowel (not required to make dx!)
60
what is intussusception and where does it commonly occur?
telescoping of intestines | usually at ileocolic distribution
61
at what age does intussusception most commonly happen in kids?
2 y/o
62
classic triad for intussusception
1. abd pain 2. vomiting 3. currant jelly stools
63
PE findings in intussusception
hypotonia, sausage mass in RLQ or RUQ
64
tx for intussusception
1. fluid resuscitation 2. antibiotics 3. surgical consult
65
what is Meckel's diverticulum?
congenital anomaly of GI tract ectopic tissue (gastric or pancreatic) usu w/i 2 ft from ileocecal valve usu 2 ft long
66
who is most likely to have symptomatic Meckels?
children <2y/o
67
what is Hirschprung disease?
absence of ganglion cells in intestine
68
how does Hirschprung disease present in neonates?
1. abd distention 2. bilious emesis 3. LBO *could be asx other than delayed meconium passage
69
how does Hirschprung disease present in older kids?
constipation
70
gold standard dx for Hirschprung disease
rectal bx
71
how is Hirschprung disease tx?
resect aganglionic segment
72
sx tx for constipation in kids
Miralax, lactulose, milk of magnesia, stimulant laxative (not non-sitmulant!)
73
sx tx for constipation in babies
prune juice
74
how long should constipation be tx for?
continue tx for > 2 months and not stopped until sx gone for > 1 month
75
what is encopresis?
"overflow" - stool withholding (accumulation of stool in rectum) liquid stool seeps around the mass of the stool
76
what is typically the cause of acute watery diarrhea lasting hours-days
viral or toxin
77
how to fluid resuscitate kid who is vomiting
spoonfuls of liquid every so often is all they can handle
78
what is typically the cause of bloody diarrhea or dysentary?
food protein allergy or infection (shigella, salmonella, campylobacter)
79
what infection can cause extraGI sx in kids < 3mon old?
salmonella can cause meningitis and osteomyelitis
80
what infections can cause prolonged or persistent diarrhea?
1. giardia 2. cryptosporidium 3. C.diff

Clin Med/Spec (11 decks)

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