PedsExam2 Flashcards
T/F Males and females are equally likely to have ADD/ADHD.
False. males are more likely and it typically progresses to adulthood about 30% of the time.
What are the symptoms of ADHD?
climbs/runs inappropriately, fidgets, talks too much, difficulty taking turns, interrupts. Hurting other kids
Symptoms for ADD?
poor attention to details short attention during tasks/play poor organizational skills fail to finish task avoids work / school work easily distracted forgetful in daily activities
T/F a diagnosis of ADD/ADHD is made through collaboration between teachers, parents, pediatrician and mental health.
True
T/F ADHD kids will act the same in all environments.
True
Do rewards mean anything to ADHD kids?
Nope
What medications do we prescribe to ADD/ADHD patients?
psycho-stimulants (adderall, ritalin)
What are general symptoms of congenital heart disease (CHD)?
Tachypnea
Tired
Sweaty (especially at night)
poor weight gain
easily infected with community illnesses(especially respiratory flora)
pale, dusky, cyanosis (long term, untreated)
What is the most common type of congenital heart disease? a. VSD B. ASD C. PFO D. Tetralogy of fallot
A. VSD followed by B.ASD and D. tetralogy of fallot
What type of murmur is a harsh holosystolic “washing machine”?
VSD
What is the the most likely VSD to close by itself?
Muscular (“Swiss cheese” if multiple)
When treatment is necessary, how do you treat VSD?
diuretics, digoxin, surgery.
What is the most common type of ASD?
secundum ASD (aka ostium secundum atrial septal defect)
What type of septal defect is common in Downs?
ASD/VSD combination AV canal
A baby has a wide split S2. what is it?
ASD
T/F cyanotic heart defects are “ductal dependent”
True
What are the cyanotic congenital heart diseases?
5 Ts and H
Tetrology of Fallot (TOF)
Transposition of the Great Arteries (TGA)
Truncus Arteriosus
Tricuspid Atresia
Total Anomalous Pulmonary Venous Connection (TAPVC)
PLUS: Hypoplastic Left Heart
cyanotic neonate with “boot sign” on CXR
tetralogy of fallot
What is the tetralogy of fallot?
Overriding aorta, right ventricular hypertrophy, VSD, and pulmonary artery stenosis
cyanotic baby with egg shaped heart with absent thymus on CXR
transposition of the great vessels
What is the most common cyanotic condition that requires hospitalization in the first two weeks of life.
transposition of the great vessels
What medication closes a patent ductus arteriosus?
indomethicin, it inhibits the prostaglandins that keep it open.
What do you see on CXR with tricuspid atresia?
hazy lung fields
What is tricuspid atresia?
Tricuspid valve fails to develop and there is no connection between right atrium and right ventricle.
cyanotic baby with twist “hershey’s kiss” on CXR
truncus arteriosus
What is truncus arteriosus
Only one artery (the truncus) originates from the heart, supplying both the aorta and pulmonary artery.
cyanotic baby with snowman sign on CXR
Total Anomalous Pulmonary Venous Connection
What is Total Anomalous Pulmonary Venous Connection
Pulmonary veins are not attached to the left atrium, but converge in a common confluence just posterior to that atrium
cyanotic baby with decreased pulmonary vasculature on neonate CXR,
pulmonary atresia
What is pulmonary atresia
No communication between the right ventricle and the pulmonary arteries
A cyanotic baby with cardiomegaly on CXR
hypo plastic left heart
Is Bordatella pertussis gram positve or negative?
negative
When stage is most contagious in pertussis?
catarrhal (1-2 weeks)
What stage does the whoop occur?
paroxysmal stage
When do you give DTaP?
2, 4, 6, 15-18 months give it off center
An inconsolable child is a sign of what?
possibly meningitis, the baby won’t calm down no matter what mom does
Is it okay to give DTaP if a patient has a fever?
NOO! DT is given instead of DTaP
T/F a contributing factor to H. flu infection may be antecedent URI (mycoplasma)
True!
What is the youngest age you can give HiB vaccine?
older than 6 weeks
how long can Hep B live on on surfaces?
7 days
When is a Hep B infected person contagious?
1-2 months before and after onset of symptoms
When do we give Hep B vaccines?
birth, 1-2 months, 6 months
When do children receive Hep A vaccine?
12-23 months
What types of HPV does HP4 (gardasil) protect against?
types 16 and 18 (high risk) and types 6 and 11 (low risk)
A pt presents with bacteremia/sepsis, meningitis, fever, petechia, purpuric rash, hypotension, multiorgan failure (from DIC). what are you thinking?
neisseria meningitidis. remember this doesn’t necessarily need meningitis
Menactra (sanofi pasteur) and Menveo (Novartis) are both types of _______________.
quadrivalent meningococcal conjugate vaccines (MCV4)
Vaccinating 80-95% of population will keep disease rate “under control” is known as ____________.
herd immunization
What is VIS?
vaccine information statement, which must be given to the parents before the vaccine is given to explain risks and benefits
What is VAERS?
vaccine adverse event reporting system
What is VICP?
vaccine injury compensation program
what needs to be recorded after vaccine is given?
VIS edition and the date VIS was provided, office address, name and title of person who administered, date administered, vaccine manufacturer and lot, body location, mode of vaccine, immunization record for parent. damn thats a lot of stuff
6 week old infant has a fever of 100.4, should we send him home with some NSAIDs?
definitely not, admit him for full sepsis workup (CBC with diff, blood culture, U/A, urine culture, CXR, NP swab, LP)
A 2 week old febrile neonate presents with a vesicular rash, seizures, ill appearing. After tapping her you find CSF pleocytosis. What did mom have during delivery? How do you tx?
active herpes infection. Tx = IV acyclovir and supportive treatment
Which influenza viral strain is moderate to sever illness?
type A. type B is more of a milder disease and type C rarely is reported in humans
How long is their viral shedding in respiratory secretion during an influenza infection?
5-10 days
A pt presents with abrupt onset of fever, myalgia, pharyngitis, nonproductive cough and headache. what are you thinking?
influenza!
What is the different between the influenza vaccines: TIV and LAIV?
Both are trivalent. TIV (inactivated subunit) is IM or intradermal. LAIV (live attenuated) is intranasal
What are the signs of Measles?
fever over 103, cough, coryza, conjunctivitis, koplik spots, rash
What are the signs/sx of mumps?
myalgia, malaise, headache, low-grade fever
Parotitis in 30%-40%
What are the signs of rubella?
prodrome low-grade fever, maculopapular rash 14-17 days after, lypmhadenopathy after 2 weeks
Blueberry muffin baby
congenital rubella
What are the live vaccines?
MMR & V
MMR is okay during pregnancy right?
definitely not, they’re live viruses plus mumps and rubella are part of the TORCH
What is TORCH?
toxoplasmosis other (such as syphilis, varicella, mumps, parvovirus and HIV) rubella cytomegalovirus herpes simplex
When do you screen mothers for GBS?
35 weeks
how do treat GBS positive mom who is about to go into labor?
amoxicillin, penicillin or cephalexin
how do treat GBS positive mom who is about to go into labor who is pen allergic?
clindamycin
prolonged premature rupture of membranes put babies at risk of what?
early onset GBS infection. they’re gonna crash within 12 hours of life if infected
What are some signs/sx of GBS bacteremia?
Anxious or stressed appearance Increased work of breathing (WOB): grunting, nasal flaring, tachypnea, apnea Heart rate variability (fast or slow) Pallor, lethargy Temperature instability (high or low) Poor feeding
What is the workup for a GBS infected newborn?
Blood cultures x2, CBC with diff, TB/DB (bill), LP, U/A, CXR
how do you treat GBS in neonate?
ABX (ampicillin or gentamicin), IV fluids, O2, warmth, phototherapy, blood transfusion, surfactant, ECMO
What is the cause of infant respiratory distress syndrome?
deficiency of pulmonary surfactant (type II alveolar cells)
How can you Dx infant respiratory distress syndrome?
white out on CXR, hypoxia and hypercarbia on ABG
How can we prevent infant respiratory distress syndrome?
antenatal glucocorticoid
How can we treat infant respiratory distress syndrome?
Synthesized Surfactant Assisted Ventilation Techniques Supportive Care Thermoregulation Fluid Management Nutrition
How long will a neonates glycogen stores last them?
10 hours
What is an accepted glucose level in a neonate?
30-45 mg/dL
What neonate is at risk of hypoglycemia?
LGA Infants of Diabetic Mothers -- Elevated insulin in the womb remains elevated SGA / IUGR Prematurity Sepsis Polycythemia
How do you treat a glucose less than 20?
Quick! IV D10W 2 cc/kg push and IV D10W continuous infusion
How do you treat a glucose more than 20?
Feed, IV D10W continuous infusion
How often should you check a sugar on a baby at risk for hypoglycemia?
q 1-3 hours depending on protocol
What is a normal pediatric EKG?
right axis deviation for about 2 months, RV size greater than LV until 1 month, T wave inverted in V3 and V4 until childhood, upright in V1 until 1 month, mild ST elevations until adolescence
What is wolff-parkinson-white syndrome?
extra conduction pathway / shortcut from the atria to the ventricles
Is V-tach life threatening?
yes
12 lead electrocardiogram shows a narrow complex tachycardia (rate of 240 bpm) with no visible P-waves. Mild ST segment depression in the inferior-lateral leads is present. Dx? Tx?
Dx = supra-ventricular tachycardia and mild congestive heart failure. Tx = Rapid IV bolus dose of adenosine and cold wash cloth on face
How do peds develop?
head to toe, proximal to distal, side by side
How do the senses develop?
touch –> taste –> hearing –> sight –> smell –> equilibrium
When are typical growth spurts and what are sx?
3 weeks, 3 months, 6 weeks, 6 months
restless, poor sleep, increased hunger, fussy, routine feeding
What is the ASQ?
ages and stages. Its a questionnaire given to parents from 2 months to 6 years
primitive reflexes disappear and rolls back to front??
4-6 months
when can a pedi sit unsupported and use a pincer grasp?
7-9 months
when can a pedi play peek-a-boo and is afraid of strangers?
7-9 months
understands object permanence?
7-9 months
pull to stand, eat finger foods and drink from a spouted cup?
10-12 month
dada or mama?
10-12 months
wave bye-bye, favorite toy, blanket andpeople?
10-12 months
walk alone?
15 months
push/pull toys and build towers of blocks?
around one year
one step questions or make believe?
18 months
how old to jump, kick, catch balls “mine!” stage?
2-3 years
when does early sentence structure begin?
2-3 years
When can they walk up stairs, dress themselves, and use the potty chair?
3-4 years
when can they do simple rhymes, name basic colors and interactive play?
3-4 years
catchs, throws, walks down stairs, independent
4 y/o
balances on on one foot with eyes closed, play sports
5 y/o
adult visual acuity
6-10
polio mode of transmission?
fecal oral
Measles mumps and rubell are all spread primarily by what route A. Respiratory B. Contact C. Fecal oral D. Blood
A. respiratory
If you get a reaction after getting Tdap, which component of the vaccination is the likely culprit?
Acellular pertussis
Which of these is not part of congenital rubella syndrome? A. Cataracts B. Microcephaly C. PDA D. Pulmonary Atresia
D. pulmonary atresia
Different chemicals that can alter then anion gap?
M- Methanol and metformin U- Uremia D- DKA P- Paraldehyde I- Iron, INH, Ibuprofen L- Lactic acidosis E- Ethylene Glycol S- Salicylates
What is the most common peds ingestion?
Tylenol
What is the toxic dose of tylenol, what do you do and how do you treat?
more than 200mg/kg. get levels at 4 hours and use nomogram and LFTs. Tx = mucomyst.
A pt arrives with what appears to be croup and the mom thinks its weird since he just had group last week. How do you treat it?
OR, deride and drain. IV cef and vanco for bacterial tracheitis
A child ingested a bunch of kaopectate. How do you treat it?
IV dextrose, correct lyes, target pH over 8. kaopectate has ASA
classic sign of aspirin ingestion?
tinnitus
when do you have mild sx of iron toxicity?
levels below 350. electrolytes and venous gas
when do you have severe sx of iron toxicity?
levels over 500, hopefully they don’t die
