Peds - general Flashcards
Ages of well-child checks
2 weeks 2 months 4 months 6 months 12 months 15 months 18 months 2 years Then every year until age 18
When does baby acne begin to resolve?
By 6 months to 1 year
Congenital spot, usually on the lower back, that looks similar to a bruise
Mongolian spot
By what age do mongolian spots usually resolve?
2-5 years
Tool used to screen eyesight for ages 2-3
Allen “E” chart
Tool used to screen eyesight after age 4
Snellen letter chart
Leading cause of death through 4 months of age
SIDS
Leading cause of death after 4 months of age
Trauma
Second leading cause of death in childhood
Drowning
Leading chronic illness in childhood
Dental caries
By what age should the full set of 20 primary teeth erupt?
25-33 months
What is associated with weak and/or delayed femoral pulses as compared with the right brachial pulse?
Coarctation of the aorta
Where would you expect to best hear a murmur associated with “normal” delay of ductus arteriosus closure?
Continuous murmur over the 2nd left ICS
When does the umbilical cord “dry” and then fall off?
Dries within days and falls off within 3-4 weeks
A cord that’s still attached after what time period could indicate a neutrophil disorder?
8 weeks
Abnormal urethral opening along the ventral surface of the penis - what’s it called?
Hypospadias
Fixed fibrotic ventral bowing of the penis, often associated with hypospadias
Chordae
Term used to refer to undescended testicle
Cryptorchidism
Congenital blockage of the posterior nasal airway by a membranous or bony obstruction
Choanal atresia
Neonate holds his right arm close to his body, extended at the elbow, internally rotated, with the forearm fixed in pronation. His hand movement is normal. What do you suspect?
Erb palsy - Damage to the C5-C6 nerve roots
Neonate has weak hand movement and grasp reflex is absent. What do you suspect?
Klumpke paralysis - Damage to the C7, C8, and T1 nerve roots
What do we call medial curving of the forefoot?
Metatarsus adductus
Three important and major reflexes to check for during the neonate exam
- Rooting
- Palmar grasp
- Moro startle
MCC of polyhydramnios
Impaired fetal swallowing, which may occur due to congenital GI obstruction/malformation, conditions that interfere with normal neural function, and certain other congenital conditions
MCC of oligohydramnios
Renal disease (renal agenesis, widespread multicystic disease, severe obstruction)
Normal respiratory rate of a newborn
30-60
Normal HR of a newborn
100-160
Normal BP of a newborn
60/35
Normal rectal temp of a newborn
99.1
What does respiratory distress syndrome result from?
Deficiency of surfactant
When is fetal lung maturity generally attained?
34 weeks’ gestation
How do infants with respiratory distress syndrome normally present?
With grunting, tachypnea, nasal flaring, chest wall retractions, and cyanosis in the first few hours of life
CXR findings with respiratory distress syndrome
Ground-glass pattern
MC pathogens responsible for neonatal pneumonia
- Group B strep
- E. coli
- Klebsiella sp.
What should you think if a neonate has abdominal distention and constipation?
Celiac disease (gluten allergy) -Usually presents under age 2 with failure to thrive, malabsorption, bloating, and foul, explosive stools and vomiting
Patient presents with projective vomiting. You palpate an olive-shaped mass to the right of the child’s midline. What do you suspect?
Pyloric stenosis
In neonates, jaundice becomes clinically apparent when serum bilirubin levels rise past what point?
> 5mg/dL
Which type of hyperbilirubinemia, conjugated (direct) or unconjugated (indirect), is always pathologic and never physiologic?
Conjugated (direct)
What type of jaundice is due to indirect hyperbilirubinemia which occurs in the absence of any underlying abnormalities in bilirubin metabolism?
Physiologic
With physiologic jaundice, when do indirect bilirubin levels usually peak and at what values do they peak?
Between days 3-5 at or below 12-15mg/dL
Most common cause of nonphysiologic unconjugated hyperbilirubinemia?
ABO incompatibility
Common causes of nonphysiologic conjugated hyperbilirubinemia?
Diseases involving the liver (biliary atresia, neonatal hepatitis) and congenital infections
Test that detects maternal antibody on the surface of neonatal RBCs and is positive in ABO incompatibility
Direct Coombs test
Test used to identify the specific type of maternal antibody present on neonatal RBCs in ABO incompatibility
Indirect Coombs test
On physical exam, how does jaundice progress in a neonate’s body?
Progresses in a cephalopedal direction and disappears in the opposite direction
In neonates with unconjugated hyperbilirubinemia, what treatments are available after hydration status is normal?
- Phototherapy
- Exchange transfusion
What total serum bilirubin levels require exchange transfusion in a neonate?
> 25mg/dL
Is phototherapy effective in treating conjugated or unconjugated hyperbilirubinemia?
Unconjugated only
What respiratory rate is necessary for a diagnosis of tachypnea in a neonate?
> 60 breaths/min
Tx for pertussis
Erythromycin or Azithromycin can shorten duration of illness if given early in the catarrhal phase - not after the coughing begins
1 month-old WF presents with tachypnea (60 breaths/minute), irritability, poor feeding, and low-grade fever. What do you suspect?
Pneumonia (tachypnea out of proportion to fever)
You suspect a patient has meningitis. As part of your PE, you have the patient lie on his back while you extend his leg at the hip. You then extend his lower leg at the knee and he gasps in pain. What is this sign?
Kernig sign
You suspect a patient has meningitis. As part of your PE, you have the patient lie on his back with his arms and legs straight. You then flex his neck and he reflexively flexes his legs at the knee. What is this sign?
Brudzinski sign
What antibiotics are used to treat bacterial meningitis in infants and older children?
Vancomycin plus a 3rd-gen cephalosporin (Cefotaxime, Ceftriaxone)
What antibiotics are used to treat bacterial meningitis in neonates?
Ampicillin (to cover GBS and L. monocytogenes) and Cefotaxime (for gram - coverage)
What infection causes profuse, rice-water stool (clear and flecked with mucus)?
Cholera
What viruses are major causes of gastroenteritis that involves profuse diarrhea, vomiting, and low-grade fever?
Rotavirus and Norovirus
Commonly water-related, this GI disease causes frequent, foul-smelling, watery stool, abdominal pain, nausea, vomiting, anorexia, and flatulence.
Giardiasis (parasite)
Retention cysts along the gum line and/or at the junction of the hard and soft palate present in newborns
Epstein pearls
When does the rooting reflex disappear?
3-4 months
When does the traction response reflex disappear?
2-5 months
When does the palmar grasp reflex disappear?
3-4 months
Describe the placing reflex
Rub the dorsum of one foot on the underside of a surface. The infant will flex the knee and bring the foot up
When does the placing reflex disappear?
3-4 months
When does the Moro startle reflex disappear?
4-6 months
Describe the tonic neck reflex
Forcibly turn the infant’s head to one side. The arms and leg on that side will extend while the arm and leg on the opposite side will flex
When does the tonic neck reflex disappear?
8 months
Describe Hirschsprung disease
Caused by a failure of neuronal migration of the myenteric plexus of the distal bowel so that the distal bowel lacks ganglion cells, causing a lack of peristalsis in that region with a functional obstruction
What should you think if a newborn presents with bilious vomiting and no distention or tenderness?
Malrotation with a midgut volvulus
In what type of patient do you see meconium ileus?
Those with cystic fibrosis
Omphalocele
Membrane-covered herniation of abdominal contents into the base of the umbilical cord. The sac may contain liver and spleen as well as intestine
Gastrooschisis
This is when the intestine extrudes through an abdominal wall defect lateral to the umbilical cord. There is no membrane or sac and no liver or spleen outside the abdomen.
Achondroplasia
Disorder of bone growth that causes the most common type of dwarfism
Most common breast mass in female adolescents
Fibroadenoma
Where are fibroadenomas most commonly found?
Upper outer quadrant
Medical management of hyperprolactinemia
Bromocriptine (Dopamine agonist which suppresses secretion of prolactin)
Painless, rubbery, cervical lymphadenopathy
Hodgkin Lymphoma
