Peds1 Flashcards
1
Q
What are the parts of calculating an APGAR score?
A
Appearance, Pulse, Grimace, Activity, Respiration
2
Q
When are APGAR scores calculated?
A
1 and 5 minutes
3
Q
If an infant has a low pulse and respiratory difficult after 30 seconds, what should be done?
A
Positive pressure ventilation
4
Q
What is the oxygen saturation goal at 1, 5, and 10 minutes after birth?
A
1 min: 60-65%
5 min: 80-85%
10 min: 85-95%
5
Q
When would a newborn need chest compressions?
A
if their pulse is below 60
6
Q
What is the most common complication of meconium presentation in the umbilical fluid?
A
meconium aspiration causing severe pulmonary complications
7
Q
What “shots and drops” should be given to a newborn?
A
- Vitamin K to prevent hemorrhage
- Hepatitis B vaccination
- Chlmydial conjunctivitis
8
Q
A single umbilical artery would make you consider what abnormality?
A
renal a genesis of IL kidney
9
Q
How would you differentiate between a cephalohematoma and a caput succedaneum?
A
A caput succedaneum would cross suture lines
10
Q
What is the cause of transient tachypnea of the newborn?
A
failure to resorb pulmonary fluid during transition to life
11
Q
What would the CXR of an infant with TTN look like?
A
“wet” lungs that are hyperextended with perihilar streaking in the interlobular fissures
12
Q
What infants are at an increased risk of TTN?
A
Large infants and C-section babies
13
Q
What is the cause of IRDS?
A
lack of surfactant production preventing alveoli distension
14
Q
What infants are at an increased risk for IRDS?
A
premature infants
15
Q
What would the CXR of an infant with IRDS look like/
A
Uniform granular, ground glass appearance .Air bronchograms.
16
Q
What is considered “low glucose” in a newborn?
A
<40-45
17
Q
What are the risk factors for hypoglycemia?
A
LGA, SGA, Infant of a diabetic mother, IUGR
18
Q
What are some symptoms an infant suffering from hypoglycemia might exhibit?
A
jitteriness, tremors, lethargy, poor feeding
19
Q
How would you handle an infant with a blood glucose reading of 30?
A
If asymptomatic: feed and recheck
If symptomatic: given 2 ml?kg of D10W and recheck
20
Q
How does bronchopulmonary dysplasia develop?
A
its a chronic consequence of IRDS causing scarring of the lungs
21
Q
What is the diagnostic criteria for BPD?
A
an infant born with IRDS that continues to require supplemental oxygen at 28 days of life.
22
Q
What causes retinopathy of prematurity?
A
premature birth stops the vascularization of the retina, but the capillaries still continue to grow resulting in neovascularization.
23
Q
What worsens retinopathy of prematurity?
A
excessive oxygen
24
Q
What are the exam findings of retinopathy of prematurity? How is it treated?
A
- scarring, distortion, and retinal detachment
- laster photocoagulation
25
When does the germinal matrix involute? What happens if an infant is born prior to that involution?
- 34 weeks
| - infant is susceptible to IVH from minor BP changes
26
What is the screening test for IVH?
cranial ultrasound
27
What are the worse prognoses associated with IVH?
MR, CP, and seizures
28
In an premature infant with a bloody bowel movement, what would be the first thing to check for?
X-ray shows pneumatosis intestinalis (air in the bowel wall)
29
What is the treatment for necrotizing enterocolitis?
NPO, IV antibiotics, and TPN
30
A child is presenting for a WCC. On exam you note that the child smiles when she sees your face. She is cooing and babbling. When you move across the room you notice she lifts her head to track you. How old is this child?
2 months
31
A 4 month old male presents for a WCC. He is laughing and squealing. He is smacking around for a toy and is able to lift it to his mouth. He follows his Mom around the room with his eyes. What gross motor skill should you test for?
Ability to roll over
32
When does stranger anxiety occur? Separation anxiety?
6 months; 1 year
33
A pincer grasp is a characteristic fine motor skill of this age group?
1 year old
34
A 2-year old follows the rule of 2's developmentally. What does this include?
2-words
2-step commands
Steps
35
If a child can hop, what age would this occur at?
4 years
36
When is strabismus normal?
until 3 months of age
37
What things could leukocoria indicate?
- retinoblastoma
- congenital cataracts
- ROP
38
What are the signs and symptoms in an infant with lead poisoning?
Irritability, headache, hyperactivity, anorexia, intermittent abdominal pain, peripheral neuropathy, acute encephalopathy.
39
A peripheral smear of a patient with lead poisoning would show?
microcytic, hypochromic anemia with basophilic stippling
40
What vaccinations are given at 2, 4, and 6 months?
DR. HHIP
41
You are seeing a 4-year old in the ED who recently immigrated from Africa. The child was brought in with a 103 degree fever and difficulty breathing. On exam it is noted that the child has a grey pseudomembrane fixed to the pharynx. What is the diagnosis? what is the treatment?
Dx: Diphtheria
Tx: secure the airway, antibiotics, antitoxin
42
If an 8-year-old presents with a nail in the bottom of their foot from walking in a creek bed, what tetanus coverage should be provided?
Tdap and TIG
43
What are the three stages of a pertussis infection?
Catarrhal stage is inconspicuous and at the highest risk of transmission
Paroxysmal phase has whooping cough and post-tussive emesis
Resolution phase has regular cold symptoms
44
What vaccine is contraindicated in patients with egg allergy?
Yellow fever
45
What is the treatment for pertussis?
Erythromycin
46
What is the only absolute CI to the DTaP vaccination?
recent encephalopathy
47
What is the most common adverse reaction to HPV vaccine?
syncope
48
What risk might be increased with RSV vaccine?
intussusception
49
Where are the lesions of scabies typically located?
webs of hands and genitalia
50
If the HIV status of a mom is unclear, what should you do?
Give the mom AZT prior to delivery
51
How do you test an infant for HIV?
DNA PCR (mom's antibodies make babies ELISA false positive)
52
What three infectious agents are specific to newborns?
E. coli, Listeria, GBS
53
At what age can you start using Ceftriaxone? What would happen if it was used prior to that?
>1 month of age
| Hyperbilirubinemia
54
What is the major side effect of erythromycin in young children?
pyloric stenosis
55
What antibiotic coverage is used to treat Listeria?
Ampicillin
56
Meningitis with a rash covering the palms and soles is from this bacteria?
Nisseria meningitis
57
An encephalitis that presents with BL paralysis?
West Nile
58
What is the empiric treatments for meningitis in children?
neonates: ampicillin plus cefotaxime or gent
| Older children: ceftriaxone and vanc.
59
What are signs of meningitis in neonates?
lethargy, poor tone, vomiting, bulging anterior fontanelle
60
A arthrocentesis of an infected joint in a teenage male that shows a WBC of 65, 000 is likely due to?
Gonorrhea
61
If a mom has active TB during delivery, what should be done for the newborn?
Isoniazid and Vitamin B6
62
What are the symptoms of Parvovirus B19 in each of the following groups: congenital, children, sickle cell, adults?
Congenital-hydrops fetalis
Children-"slapped cheek" rash that is itchy and worsens in the sun.
Sickle cell-aplastic crisis
Adults-arthritis
63
What is the cause of the measles? what are the five classic symptoms?
Parayxovirus
Rash that starts on the face and spreads to the toes that presents with a fever. Plus, a prodrome of Cough, coryza, conjunctivitis, and Koplik spots
64
What is the lethal complication of the measles?
subacute sclerosing panencephalitis
65
What is the prodrome present in Rubella?
tender generalized lymphadenopathy
66
How does Rubella present in adolescents?
polyarthritis
67
What is the big differentiating factor between the Measles and Roseola?
Measles: fever starts with rash. Rash spreads from head down.
Roseola: fever breaks when rash starts. Rash starts on trunk and spreads to face.
68
What is the major complication of Roseola?
Febrile seizure during the prodrome phase
69
When is the chicken pox no longer contagious?
When the final lesion crusts over.
70
What are the symptoms of mumps?
BL parotid swelling and BL orchitis
71
What causes "hand, foot, and Mouth"?
Coxsackie virus A
72
What types of lesions does coxsackie virus A cause?
vesicular
73
Neural tube defects are most commonly caused by?
maternal folate deficiency
74
Chiari II malformation will present with?
Myelomeningocele, Upper extremity weakness, respiratory symptoms
75
When do you correct a cleft lip? A cleft palate?
Lip at 10-12 weeks and palate at 10-12 months
76
What is normal adult hemoglobin composed of?
two alpha and tow beta subunits.
77
What is the physiologic defect that causes sickle cell?
Glutamine to valine substitution at the 6th position on the beta chain causes the hemoglobin to sickle.
78
How is sickle cell diagnosed?
On prenatal screen or on hemoglobin electrophoresis (also determines severity)
79
How is it determined whether or not a sickle cell patient is in a crisis?
Get a baseline bilirubin, baseline reticulocyte county, baseline hemoglobin, and sickle cells on smear
80
What are lab values that will always be altered in sickle cell patients?
elevated bilirubin, elevated LDH, low haptoglobin, elevated reticulocyte count
81
Why should you avoid transfusions in sickle cell patients?
transfusions will lead to iron overload and then they will need deferoxamine to decrease the iron in their system.
82
What two body parts can be destroyed in patients with sickle cell?
- autoinfarction of the spleen
| - avascular necrosis due to chronic vaso-occlusion
83
If sickle cell patients develop osteomyelitis in chronically infarcted bones, what organisms would you suspect?
- s. aureus
| - salmonella
84
What is the treatment for a sickle cell patient in an acute crisis?
IVF, oxygen, IV pain control
85
What are the indications for acute transfusions in sickle cell patients?
- encephalopathy
- chest pain
- noncardiogenic pulmonary edema
- priapism
86
Serum sickness is what type of hypersensitivity reaction? What is the physiologic cause?
- Type III
| - Antibody-antigen complex
87
Give an example of a cytotoxic, antibody mediated reaction (Type II)?
Hemolytic Anemia
88
What is the treatment for anaphylaxis?
epinephrine 1:1000 IM
89
What is the clinical diagnosis of anaphylaxis?
symptoms involving more 2 or more organ systems including CV, GI, Skin, and Pulmonary.
90
Skin reactions from contrast, opiates, and red man syndrome are due to?
mast cell degranulation
91
What is the difference between urticaria and angioedema?
Angioedema involves deeper tissues
92
What are the clinical exam findings of allergic rhinitis?
- allergic shiners
- allergic salute (transverse nasal crease)
- pale and boggy nasal mucosa
- cobble-stoning of the posterior pharynx
93
what is the most effective treatment of allergic rhinitis?
intranasal GC's
94
What surfaces of a child would you find atopic dermatitis?
Infants: extensor surfaces
Children: flexor surfaces
95
A 6 month old child presents to clinic due to vomiting and bloody stool. He has lost weight on his growth curve. Mom states he is not tolerating his feeds well. What is your differential diagnosis?
Milk-protein allergy
96
Amblyopia is a defect where in the eye?
cortical blindness
97
How do you fix strabismus?
patch the good eye to correct the offending eye
98
Reflection of light from separate locations on each eye is known as?
strabismus
99
A pure white retinal reflex coming from the posterior portion of the eye is likely?
retinoblastoma
100
What future tumor are children with retinoblastoma at risk for?
osteoblastoma of the distal femur
101
What is the major cause of cataracts in infants?
Think TORCH infection if born with it or galactosemia if it develops in early life.
102
Why should high flow oxygen be used sparingly in premature neonates?
risk for retinopathy of prematurity
103
What is the treatment for retinopathy of prematurity?
laser ablation
104
erythromycin gel for the eyes of newborns is used to prevent?
gonococcal conjunctivitis
105
In a neonate with chlamydial conjunctivitis should be evaluated for?
pneumonia
106
What infectious conjunctivitis develops early in a neonate?
gonorrhea develops before chlamydia
107
What is the first line treatment for AOM? What if the child has a PCN allergy?
Amoxicillin
Cefdinir or Azithromycin
108
In a child with AOM with an anteriorly rotated ear, what should be done?
Surgery consult for acute mastoiditis
109
What are the most common organisms in acute otitis externa?
S. aureus and pseudemonas
110
When are antibiotics required for acute otitis externs?
if there is evidence of malignant otitis externa
111
In a child with pharyngitis and conjunctivitis, the most common culprit is?
adenovirus
112
In a child with pharyngitis and a rash on the palms and soles?
Coxsackie virus
113
What are the Centor criteria for strep diagnosis?
```
C-absent cough
E-exudates on tonsils
N-nodes (anterior chain)
T-Temp greater 38
OR-Less than 14 or greater than 44 years old
```
Must have 4 for treatment or 2-3 to do a rapid strep
114
What age range in children should never be tested for strep throat?
Less than 3 years of age
115
An infant who turns blue at rest, but pinks up with crying should be evaluated for?
choanal atresia
116
The difference between simple and complex seizures is?
complex involves loss of consciousness
117
A simple febrile seizure has these four characteristics?
generalized in origin, lasts less than 15 minutes, only one 2seizure in a 24 hour period, no underlying neurological problems
118
An EEG in an infant without fever, which shows symmetrical spasm that shows high amplitude and irregular spikes and waves should be treated with?
ACTH for infantile spasm
119
In a child with ash leaf spots, MR, angiofibromas of the face, and seizures should be evaluated with?
MRI to look for cortical tubers of tuberous sclerosis
