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PRCM Clerkship > Swanson _ Children and Adolescents > Flashcards

Swanson _ Children and Adolescents Flashcards

1
Q

Normal respiratory rate in a newborn?

A

RR < 60 breaths/minute

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2
Q

Top 3 diagnoses on the differential for respiratory stress in term infants?

A

(1) Transient tachypnea of the newborn (TTN)
(2) Meconium aspiration syndrome
(3) Neonatal infection/sepsis

Of note, TTN and meconium aspiration syndrome occur immediately after delivery, whereas infectious etiologies manifest hours to days after birth.

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3
Q

TTN pathophysiology?

A

TTN results from residual pulmonary fluid in the neonatal lung and is more common after precipitous ( < 3 hours) and Caesarian deliveries, when there may be delay in the prostaglandin-driven dilation of lymphatic vessels that allows for removal of lung fluid with an increase in pulmonary circulation.

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4
Q

Neonatal infection/sepsis - common pathogens (4)?

A

Group B streptococci
S. aureus
S. pneumoniae
Gram-negative rods

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5
Q

Empiric antibiotic therapy for neonatal infection/sepsis?

A

Ampicillin + gentamicin

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6
Q

Top 3 diagnoses on the differential for hyperbilirubinemia in the newborn?

A

(1) Physiological jaundice
(2) Blood group incompatibility
(3) Infection

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7
Q

Preventive strategies (2) against hyperbilirubinemia in newborns born at 35+ weeks gestation?

A

(1) Nursing 8-12 times per day for the first several days

(2) Avoidance of water or dextrose water in nondehydrated infants.

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8
Q

Newborns should be assessed for jaundice every ___ during the first day of life.

A

Every 8-12 hours

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9
Q

Workup of infants with clinical jaundice in the first 24 hours of life?

A

Total bilirubin level

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10
Q

Workup of infants with clinical jaundice that persists past 3 weeks of age?

A

Total and direct bilirubin levels to evaluate for cholestasis

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11
Q

Total bilirubin level of ___ or higher should be considered a medical emergency. These infants should be admitted to the hospital for ___.

A

Total bilirubin level of 25 mg/dL or higher should be considered a medical emergency. These infants should be admitted to the hospital for PHOTOTHERAPY.

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12
Q

Physiologic jaundice begins on ___ and usually resolves in ___.

A

Physiologic jaundice begins on DAY 2-3 of life and usually resolves in 1-2 WEEKS.

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13
Q

Neonatal fever is defined as a rectal temperature greater than or equal to?

A

38 C (100.4 F)

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14
Q

All infants 0 to 30 days of age with fever should be admitted to the hospital and treated with?

A

IV ampicillin + gentamicin
-OR-
IV ampicillin + 3rd generation cephalosporin

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15
Q

Laboratory studies indicated in the evaluation of infants with fever without an evident source (5)?

A 
CBC with differential 
Blood culture
Urinalysis
Urine culture
Lumbar puncture
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16
Q

Recommendation for breastfed babies that are not exposed to sufficient sunlight?

A

Vitamin D supplementation

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17
Q

Iron supplementation to reduce the possibility of anemia may be begun in breastfed infants at what age?

A

6 months of age

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18
Q

At what age should solid foods be introduced to the baby’s diet?

Frequency of introducing new foods?

A

6 months of age

Add one new food every 1 to 2 weeks

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19
Q

The minimum standard for the growth and development of the newborn is a weight gain of ___ per day

A

20 g/day

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20
Q

All infants should regain their birth weight by what age?

A

10 to 14 days of age

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21
Q

Measures of adequate hydration in the thriving newborn:

# of wet diapers per day?
# of stools per day?
A

5-6 wet diapers per day

2-3 stools per day

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22
Q

During the first few weeks and months of life:

Ideal feeding schedule?
# feedings per day?
A

Ideal feeding schedule is FEEDING ON DEMAND

8 to 12 feedings per day

23
Q

Infants cry for a variety of reasons. Best advice is to assume that crying indicates?

A

Crying may or may not indicate hunger. Assume that the baby needs to be fed until proved otherwise. If the baby refuses the breast, check for other causes of crying.

24
Q

The main determinant of a good milk supply?

A

Frequent, effective milk removal

25
Q

Causal candidates (4) for decreased milk production and let-down?

A

Anxiety, fatigue, stress, and postpartum depression

26
Q

Colostrum

A

Colostrum provides (1) macrophages that synthesize complement, lysozyme, and lactoferrin, and; (2) antibodies against bacteria and viruses that protect against infection through the GI tract

27
Q

Antibody of particular importance in colostrum?

A

IgA

28
Q

Maternal mastitis:

Causal organism?

Treatment?

A

Staphylococcus aureus

First-line is cloxacillin or dicloxacillin

Erythromycin or 1st generation cephalosporin in pen-allergics

29
Q

Maternal mastitis:

Continue/discontinue breastfeeding?

A

Continue breastfeeding and treat the mother with symptomatic treatments, such as hot compresses and antibiotics

30
Q

Frequency of BMs in formula-fed babies?

A

BM every 1 to 3 days is adequate

Formula-fed babies generally have fewer stools than breast-fed babies

31
Q

Use of pacifiers ok in breast-fed babies?

A

No

32
Q

Infantile colic?

A

Unprovoked, unrelieved crying, starting in the afternoon hours and accompanied by the child having clenched fists and pulling its legs toward the abdomen

33
Q

Established cause(s) of infantile colic?

A

None

34
Q

Infantile colic - Wessel criteria (Rule of 3s)

A

Child cries for at least 3 hours per day for 3 days per week for at least 3 weeks, starting before age 3 months

35
Q

In the evaluation of infantile colic, after a complete history and physical, what is the 1st lab test that should be ordered?

A

Urinalysis

36
Q

Colic is more common babies of what demographic of mothers?

A

Smoking mothers

37
Q

Risks (4) for occult bacteremia in a 1-year-old with fever?

A

Fever > 40 C (104 F)
WBC < 5,000
WBC > 15,000
Positive exposure history

38
Q

Most common (4) organisms associated with occult bacteremia in a 1-year-old with fever?

A

S. pneumoniae (most common)
group A strep (S. pyogenes)
Haemophilus influenzae
Neisseria meningitidis

39
Q

Risk of T > 40 C (104 F)?

A

Febrile convulsions/seizures

40
Q

Most common conditions (4) associated with occult bacteremia in a 1-year-old with fever?

A

Otitis media
Bacterial pneumonia
Streptococcal pharyngitis
Meningitis

41
Q

Fever of unknown origin (FUO)?

A

Fever > 38 C (100.4 F) for > 3 weeks with no diagnosis after 3 outpatient visits or 3 days in the hospital

42
Q

Laboratory test indicated in a child 1-year-old (or younger) with FUO to evaluate for occult bacteremia as the cause?

A

WBC count

43
Q

Prodrome of acute meningitis in infants 3-24 months of age?

A

Prodromal respiratory illness or sore throat often precedes the fever, headache, stiff neck, and vomiting that characterize acute meningitis

44
Q

Laboratory test(s) indicated in a child 3-24 months of age with suspected acute meningitis?

A

CBC with diff
Blood culture
Urine culture
Lumbar puncture

45
Q

MCC of acute meningitis in children ages 3-24 months?

A

S. pneumoniae

Other causes include

  • Haemophilus influenzae
  • Neisseria meningitidis
  • Mycoplasma pneumoniae
  • Listeria monocytogenes
46
Q

Antibiotic therapy for acute meningitis?

A

Ceftriaxone (3rd generation cephalosporin)

Highly effective against common meningeal pathogens in patients of ALL ages

47
Q

Analgesic agent of choice in the treatment of childhood fever and mild-to-moderate childhood pain?

A

Acetaminophen

48
Q

Pediatric use of aspirin?

A

Contraindicated secondary to its association with Reye’s syndrome

49
Q

Treatment of a viral URI and/or nasal congestion in an infant or young child?

A

Reassurance; supportive therapy with humidified air (cool steam) and/or nasal saline drops (nasal congestion) and bulb syringe suctioning of nasal passages

Antihistamines do not alleviate the symptoms of a viral URI to a clinically significant degree, especially in the pediatric population

Young children may develop seizures when given antihistamine doses that are meant for older children (on a mg/kg basis)

50
Q

Centrally acting cough suppressants (dextromethorphan) recommended for treatment of cough associated with viral illnesses?

A

No

51
Q

Adverse effects of cough suppressants in infants and young children?

A

Drowsiness, respiratory depression, abnormal limb movements, and coma in infants and children

52
Q

Treatment of viral gastroenteritis in infants and young children?

A

Maintenance of hydration

Antimotility agents and antiemetics should not be used for the treatment of n/v symptoms

53
Q

Teething begins at ___ and continues until ___.

A

Begins at 6-8 months of age

Continues until 2 years of age

PRCM Clerkship (3 decks)

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