Principles 3 Flashcards
Do not Rotavirus vaccine to a child with history of __________
intussusception
Precautions should be taken when giving MMR Varicella vaccine to a child with personal or family history of _________
seizure
____________ is the most common form of glomerulonephritis in the pediatric age group.
ACUTE POSTSTREPTOCOCCAL GLOMERULONEPHRITIS (APSGN)
Which is more common
APSGN Following Throat Infection
APSGN Following Skin Infection
APSGN Following Skin Infection
Clinical features of VSDs
Breathlessness, feeding difficulties, FTT, profuse sweating, chest infections etc. Congestive cardiac failure early in infancy
________ murmur: best heard at ________________
-________ (in the presence of pulmonary hypertension)
-______________ murmur (due to increased blood flow across mitral valve)
Pan-systolic
lower left sternal border (LLSB)
Loud P2
Apical mid-diastolic
Paradoxical embolism: this is the blockage of a _________ by a thrombus formed in a ___________, which has passed through a defect in the heart. This defect is usually a patent foramen ovale (PFO) but may also be a VSD or ASD
systemic artery
systemic vein
Clinical features of PDA
Asymptomatic (small PDA)
-Breathlessness, feeding difficulties, FT, profuse sweating, chest infections etc.
-_______________ murmur best heard over the left 1” and 2ndCI spaces Others: wide pulse pressure, apical mid-diastolic murmur, splitting of Sz, loud 2P
Continuous machinery
CVS findings in TOF:
_________ murmur at ______ or _______ murmur at _________, a single S2, and ________________ heave with or without systolic thrill
pansystolic ; LLSB
ejection systolic; LUSB
left parasternal
Hypercyanotic spells (hypoxic, Tet or blue spells)
These are paroxysms of _________,___________ , agitation, vigorous cry, increasing _________, and ———— intensity of murmur; which folows events causing sudden decrease in oxygen saturation and or systemic vascular resistance e.g. crying,
defecating, playing etc.
Unconsciousness, convulsions, hemiparesis and death may folow severe spells
hyperpnea ; restlessness
cyanosis; reduced
• Treatment of Tet spells: _________ position, supplemental oxygen, _________ (for volume expansion), ________ (intranasal midazolam or fentanyl are alternatives), _______ (IV propranolol or esmolol), _________________ (if metabolic acidosis is present)
knee-chest
IV fluids
IV morphine
B-blockers
Sodium bicarbonate
egg-on-a-string on X-ray is for?
Transposition of great vessels
Constant Features of Down syndrome
List 3
Hypotonia
Developmental delay
Mental retardation
Other Features of Down syndrome
Head: ______cephaly, ______cephaly,______ ears, _______ tongue, ______ nasal bridge
Eyes: __________ palpebral fissures, ___________ , epicanthal folds, brushfield spot, ____________
brachy; micro; small
protruding; flat
upslanting; cataract
strabismus
Other features of Down syndrome
Cardiovascular: ________________ defects, VSD, ASD, PDA
Musculoskeletal: ________ neck with ________ skin, ________ 5th digit with clinodactyly, wide gap between ________ and ___________ , _____________________ palmar creases
endocardial Cushing defects,
short ; redundant skin
short ; 1st and 2nd toes
single transverse
Other features of Down syndrome
Gastrointestinal: _______________ , annular pancreas, __________ , _______________
Others: _________ disorders, __________ dx, ______thyroidism, _________ , ________ , AL, AML etc.
duodenal atresia
T-E fistula
imperforate anus
behavioral ; Alzheimer
hypothyroidism ; obesity
DM
Neuroblastoma
Genetics: most cases are _______, only about 1-2% are ________
sporadic; familial
Neuroblastoma
Familial cases occur at a younger age, and are associated with mutations in ________ and ________ genes
PHOX2B and ALK
Clinical Presentation of neuroblastoma : depends on tumor site and extent of the disease
• Tumor site
Neck: _____________
Paraspinal: _________ and _________ __________
Horner syndrome (ptosis, myosis; anhidrosis)
Spinal cord and nerve root compression
Associated anomalies with neuroblastoma : _________ disease, _______________ syndrome, and ____________ type I
Hirschsprung disease
central hypoventilation syndrome
neurofibromatosis type I
According to ________________ hypothesis, ______ mutations in the RB1 gene are required for retinoblastoma to develop
Knudson’s “two-hit”
2
Microscopically, retinoblastoma classicaly appears as a small round blue cell tumor, with rosette formation (____________________ rosettes)
Flexner-Wintersteiner
List the hypotonic crystalloid fluids
0.45% NaCI (1/2 NS)
0.2% NaCI (1/4 NS)
0.33% NaCI (1/3 NS)
2.5% dextrose in water
List the isotonic crystalloid fluids
Normal saline (0.9% NaCl)
Ringer’s lactate solution
5% dextrose in water
List the hypertonic crystalloid fluids
5% NaCl
3% NaCl
5% dextrose in 0.9% saline
5% dextrose in 0.45% saline
10% dextrose in water
50% dextrose in water
Limitation/Contraindications of normal saline : ______________ failure, severe __________ impairment, _____________ etc
congestive cardiac failure
severe renal impairment
liver cirrhosis
____________ is the most physiological IV fluid; it has electrolyte content similar to that of plasma
Ringer’s lactate
The ____________ in Ringer’s lactate is metabolized to _________ in the liver, which helps to correct metabolic acidosis
sodium lactate
bicarbonate
Limitation/Contraindications of Ringer’s lactate
Severe ________ disease
Metabolic ____________ e.g. in severe vomiting, gastric outlet obstruction
Patient on ________________ (It may promote clot formation, as Ca binds citrate) Others: congestive cardiac failure, severe renal impairment, hypoxia etc.
liver
alkalosis
blood transfusion
The fluid of choice for maintenance and replacement of ongoing loss in pediatrics is???
5% Dextrose in 0.45% NaCl (D5 1⁄2NS)
It is recommended that maintenance KCL (_____mEq) be added to each ______ of D5 1⁄2NS in patients with no underlying electrolyte derangement, and NOT in the ___________ age group
20
liter
neonatal
_______ fluid is used for the Hydration of neonates in the first 48 hr of life
10% dextrose in water
_______ is superior to mannitol in treating raised ICP
3% NaCl
Normal Head circumference at birth is ???
35cm
Rate of increase of Normal Head circumference from birth is ???
2
1
0.5
2
1.5
1
About 5-10% of birth weight (BW) is lost within the first _______ of life birth weight (BW) returns around ___________ of life
5-7 days
10-14 days
A term baby doubles its BW around ___________ and triples it around _____________
4-5 months
12 months
Daily weight gain is ______g in the first 3-4 mo, and ______ gfor the rest of 1st vr
20-30
15-20
Birth weight
Measuring device: _________________ (at <2 yr) or ___________ (at ≥2 vr)
Bassinet weighing scale
Stadiometer
Formulae for weight
4months - 12 months
1year to 6
7 years to 12
n+9/2
2n+8
7n-5/2
Length is measured in children <____yr using the ___________
2
Infantometer
Worthy of note is that length is about 1-2cm greater than height
T/F
With reason
as joint spaces are reduced by gravity while standing
Mid-Upper Arm Circumference (MUAC)
It remains fairly constant ni children, between ages ________ , thus, it is particularly relevant in this age group
1-5 yr
MUAC
It is measured midway the distance between the _________ and ________
acromium and olecranon
Head circumference Measurement: an inelastic tape measure is passed (inches up) around the head through the supraorbital ridges and _________ in front and the _________ behind
glabella
occiput
Moderate VA severe dehydration
Using the first 11 parameters
Restless, irritable ; drowsy, lethargic , unconscious
Depressed; sunken
Slightly sunken; deeply sunken
Reducer; absent
Dry; very dry and parched
Eager to drink; unable to drink
Rapid; deep and rapid
Recoils in <2s ; Recoils in >2s
Rapid and thready; feeble or absent
Prolonged; much prolonged
Oliguria; Anuria
