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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
Q

why is whole milk used in the first 12-24 months?

A

better for brain development

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26
Q

when is low/fat free milk started?

A

after 2 years old

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27
Q

why are bottles discouraged?

A

caries and overconsumption

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28
Q

when are children supposed to transition to cups and utensils?

A

toddler/preschool

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29
Q

which nutritional deficiency puts a child at risk for edema and immunodeficiency?

A

protein

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30
Q

what is anaphylaxis?

A

reaction including skin/mucosa, respiratory compromise, hypotension/end organ dysfunction (sometimes GI sx)

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31
Q

skin sx of anaphylaxis

A
  1. pruritus
  2. flushing
  3. hives
  4. angioedema
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32
Q

respiratory sx of anaphylaxis

A
  1. dyspnea
  2. wheeze
  3. stridor
  4. hypoxemia
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33
Q

hypotension sx of anaphylaxis (rare)

A
  1. collapse
  2. syncope
  3. incontinence
34
Q

epinephrine autoinjectors

A

Adrenaclick
EpiPen
Auvi-Q

35
Q

how long observation post anaphylaxis?

A

4-8 hours

36
Q

factors that compel admission post anaphylaxis?

A
  1. > 1 dose Epi needed
  2. IV fluids for hypotension
  3. laryngeal edema
  4. severe asthma
  5. trigger = ingestion
37
Q

what is the difference between sensitization and allergy?

A 
sensitization = detection of IgE on allergy test
allergy = characteristic clinical sx upon exposure to an allergen + detection of specific IgE toward allergen
38
Q

3 principle characteristics of allergic reaction

A
  1. objective
  2. immediate
  3. reproducible
39
Q

typical sx of food allergy

A
  1. urticaria
  2. angioedema
  3. emesis
  4. rhinorrhea
  5. wheezing
  6. hypotension
  7. anaphylaxis
40
Q

RF for developing a food allergy

A
  1. eczema
  2. asthma
  3. environmental allergies
  4. family hx of allergies
41
Q

which food allergies are usually lifelong?

A

peanuts, tree nuts, seafood

42
Q

is milk/food PROTEIN induced proctocolitis IgE mediated?

A

no

43
Q

IgE mediated allergies

A
  1. milk
  2. eggs
  3. wheat
    4 . soy
  4. peanuts
  5. tree nuts
  6. seafood
44
Q

what did the LEAP study show?

A

peanut allergy prevalence was less in consumption group than the avoidance group

45
Q

why is GERD more pronounced in kids?

A

LES is less toned

46
Q

what is GER?

A

passive passage into esophagus w/o regurg or vomit
normal response
occurs daily in infants

47
Q

what age is GER common and when does it resolve?

A

1-6 months

resolves by 1 year

48
Q

GERD sx

A
  1. regurg/vomiting
  2. weight loss
  3. irritability
  4. chest pain
  5. hematemesis
  6. dysphagia
  7. wheezing
  8. stridor
  9. cough
49
Q

what is more commonly used to dx GERD in kids?

A

hx and PE (endoscopy not as helpful in kids)

50
Q

what can be done for the “happy spitter” (GER)?

A

reassurance
if persistence - thicken food
FTT - acid suppression, refer to ped GI

51
Q

what is the MC surgical disorder in neonates

A

pyloric stenosis

52
Q

what can be used for kids w/heartburn?

A

PPI

53
Q

pyloric stenosis sx

A
  1. vomiting (can be projectile)
  2. weight loss despite hunger
  3. hypertrophied pylorus
  4. metabolic alkalosis, electrolyte disturbances
54
Q

tx for pyloric stenosis

A
  1. correct dehydration and alkalosis

2. pyloromyotomy

55
Q

when is malrotation more common?

A

infancy

56
Q

what are the sx of malrotation?

A

can be asx

  1. bilious emesis
  2. abd distention
  3. peritonitis
57
Q

treatment for malrotation

A

Ladd’s procedure

58
Q

what is a volvulus?

A

life threatening condition characterized by malrotation around the mesenteric axis

59
Q

how is volvulus dx?

A

upper GI series shows corkscrew appearance of small bowel (not required to make dx!)

60
Q

what is intussusception and where does it commonly occur?

A

telescoping of intestines

usually at ileocolic distribution

61
Q

at what age does intussusception most commonly happen in kids?

A

2 y/o

62
Q

classic triad for intussusception

A
  1. abd pain
  2. vomiting
  3. currant jelly stools
63
Q

PE findings in intussusception

A

hypotonia, sausage mass in RLQ or RUQ

64
Q

tx for intussusception

A
  1. fluid resuscitation
  2. antibiotics
  3. surgical consult
65
Q

what is Meckel’s diverticulum?

A

congenital anomaly of GI tract
ectopic tissue (gastric or pancreatic)
usu w/i 2 ft from ileocecal valve
usu 2 ft long

66
Q

who is most likely to have symptomatic Meckels?

A

children <2y/o

67
Q

what is Hirschprung disease?

A

absence of ganglion cells in intestine

68
Q

how does Hirschprung disease present in neonates?

A
  1. abd distention
  2. bilious emesis
  3. LBO

*could be asx other than delayed meconium passage

69
Q

how does Hirschprung disease present in older kids?

A

constipation

70
Q

gold standard dx for Hirschprung disease

A

rectal bx

71
Q

how is Hirschprung disease tx?

A

resect aganglionic segment

72
Q

sx tx for constipation in kids

A

Miralax, lactulose, milk of magnesia, stimulant laxative (not non-sitmulant!)

73
Q

sx tx for constipation in babies

A

prune juice

74
Q

how long should constipation be tx for?

A

continue tx for > 2 months and not stopped until sx gone for > 1 month

75
Q

what is encopresis?

A

“overflow” - stool withholding (accumulation of stool in rectum)
liquid stool seeps around the mass of the stool

76
Q

what is typically the cause of acute watery diarrhea lasting hours-days

A

viral or toxin

77
Q

how to fluid resuscitate kid who is vomiting

A

spoonfuls of liquid every so often is all they can handle

78
Q

what is typically the cause of bloody diarrhea or dysentary?

A

food protein allergy or infection (shigella, salmonella, campylobacter)

79
Q

what infection can cause extraGI sx in kids < 3mon old?

A

salmonella can cause meningitis and osteomyelitis

80
Q

what infections can cause prolonged or persistent diarrhea?

A
  1. giardia
  2. cryptosporidium
  3. C.diff

Clin Med/Spec (11 decks)

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