Test #1 Flashcards
APGAR Scoring System
Activity: Absent (0), Arms&legs flexed (1), Active motion (2)
Pulse: Absent (0), <100 bpm (1), >100 bpm (2)
Grimace (facial reflex): flaccid, grimace, Cry
Appearance: blue/pale, body pink/extremities blue, all pink
Respiration: absent, slow/irregular, vigorous cry
APGAR Value Indications
0-3 = Severely depressed
4-6 = Moderately depressed
7-10 = Excellent condition
Embryonic Period
First 8 weeks
All major organs formed during this period (organogenesis)
Particularly vulnerable during weeks 3 and 4
Fetal Period
Remaining 30 weeks
Organs get larger and more complex
Ductus Venosus
Connects umbilical vein to inferior IVC
Oxygenated blood from mom bypasses liver, goes directly to heart
Sensitive to [O2] of blood - increase in oxygenation after birth causes vasoconstriction/closure
Ductus Arteriosus
Channel between main pulmonary artery and aorta
Bypasses pulmonary vasculature to get blood directly to systemic
Disappears w/in 2 weeks after birth, becomes ligamentum venosum
Kernicterus
Chronic/permanent BIND
Indirect bilirubin > 20-25 mg/dL in newborn
Acute Bilirubin Encephalopathy
Early symptoms
Hypotonia, seizures
Reversable BIND
Estimating bilirubin levels in newborns
Jaundice progresses from head to toe
Head = TSB 5
Upper Chest = 10
Abdomen = 12
Palms/Soles = >15
Pathological Jaundice
Appears w/in 1st 24 hours of birth
Jaundice in newborn older than 2 weeks
Direct bilirubin >1mg/dL with TSB < 5 OR >20% TSB is direct
Increase in bilirubin >0.5 mg/dL/hr
Mottled skin
Cutis Marmorata
Will disappear at birth
White/Waxy covering of skin
Vernix Caseosa
Downy hair
Lanugo
More common with prematurity
Benign erythematous rash with papules/pustules
Erythema Toxicum
Appears in 1-14 days, resolves in weeks
Eosinophils in the pustules
Benign flat red markings
On upper eyelids or back of neck
Nevus Flammeus/Vascular Nevi/Salmon patches
Upper eyelids = crows nest
Back of neck = stork bites
Permanent discoloration
Arteriovenous malformation
Port-wine stain
Small yellow papules
Sebaceous gland hyperplasia
Disappear spontaneously
Smaller, white papules
Milia
Disappears in weeks
Acne from maternal hormones
Acne Neonatorum
Bluish-black lesion over lumbosacral area
Mongolian Spots
Common in Native American, Blacks, and Asians
Elevated collection of capillaries
Strawberry/Capillary hemangiomas
Worrisome skin findings
Grow for 3-7 months, stabilize, then usually involute by 5 years old
Cavernous hemangioma
Less predictable collection of large blood vessels
May be associated with thrombocytopenia
May resolve on own or need steroids/radiation
Neonate
First 30 days of life
Infant
1 month to 1 year old
Child
1-12 years old
Adolescent
12-18 years old
Most common pediatric overdose drugs
Iron supplements (vitamins)
Acetaminophen
Drugs to avoid in peds
Propylene glycol - hyperosmolality (IV drugs)
Benzyl alcohol - metabolic acidosis and neuro damage (IV fluids)
Fluoroquinolones
Tetracyclines
Acetaminophen dosing in pediatrics
Tylenol
10-15 mg/kg q4-6h
Ibuprofen dosing in pediatrics
Motrin for >6 months old
5-10 mg/kg q6h
1 tsp = __mL
5 cc = 5 mL = 1 tsp
TORCH
Toxoplasmosis
Other (HEP-VHS) - HIV, Enterovirus, Parvovirus B-19, Varicella, Hepatitis, Syphilis
Rubella
Cytomegalovirus
Herpes simplex
Other from TORCH
HIV
Enterovirus
Parvovirus B-19
Varicella
Hepatitis
Syphilis
Toxoplasmosis triad and treatment
Triad: Chorioretinitis, Hydrocephalus, Intracranial calcifications
Tx: pyrimethamine & sulfadiazine or Spiramycin
Dx: IgM = acute infection, IgG = previous infection
Safe to treat during pregnancy
Leading cause of sensorineural hearing loss?
Cytomegalovirus
5 T’s of congenital cyanotic heart disease
Tetralogy of Fallot (TOF)
Transposition of great arteries
Tricuspid atresia
Truncus arteriosus
Total anomalous pulmonary return
Corresponding murmurs for the following:
VSD
ASD
PDA
Aorta coarctation
TOF
VSD: loud, pansystolic murmur
ASD: soft, systolic ejection murmur w/ fixed split S2
PDA: continuous machine-like murmur
Aorta coarctation: systolic murmur upper left chest
TOF: loud, harsh systolic ejection murmur with Tet spells
Marfan’s Syndrome mutation, treatment, and typical death
FBN1 gene mutation (fibrillin protein)
Beta blockers (1st line), Losartan (ARB)
Typically die from aneurysm rupture
ADHD Treatment
Stimulants are 1st line
-BBW: sudden death w/ CV problem, dependency
2nd line: Atomoxetine
3rd line: Wellbutrin, Tofranil, Norpramin, Catapres, Tenex
ADHD Stimulants
Methylphenidate (Ritalin, Methylin)
Dextroamphetamine (Adderall)
Start on short-acting, titrate up doses
Depression Treatment
SSRI (selective serotonin reuptake inhibitors)
Fluoxetine (Prozac) - 8-17 yo
Escitalopram (Lexapro) - 12-17 yo
BBW: Increased suicidal risk <24 yo
Pediatric Leukemia
Bone pain, anemia, fatigue, fever, infection, petechiae
ALL and AML (auer rods)
Down’s Syndrome increases risk of AML
Hodgkin’s Lymphoma
painless lymphadenopathy, mediastinal mass, constitutional symptoms
B symptoms diagnostic: weight loss, night sweats, FUO > days
Non-Hodgkin’s Lymphoma
B symptoms are not prognostic
Treatment depends on exact type
Looks like HL with emergent presentation common
Overall survival is high
Wilm’s Tumor
Big belly, not sick
Tumor spill (biopsy) will upstage it to 3 -> requires radiation
Most common malignant brain cancer
Medulloblastoma
Bilious vomiting DDx in newborns
Partial/Complete bowel obstruction
Nonbilious vomiting DDx in newborns
GERD -> most common
Milk protein intolerance
Pyloric stenosis
Gastritis
Abdominal pain DDx
Newborn
Infants
Newborn: GERD, Necrotizing colitis, Volvulus
Infant-2yo: Intussusception, Meckel’s diverticulum, Bacterial enteritis
Colic rule of 3’s
Greater than 3 hours crying per day
More than 3 days a week
Lasts for more than 3 weeks
Infants less than 3 months
Chronic Diarrhea DDx
Bloody: Irritable bowel disease, milk protein intolerance
Non-bloody: Inflammatory bowel syndrome, cystic fibrosis/malabsorption, Immunodeficiency, lactose intolerance
Acute Diarrhea DDx
Tender abdomen/mass: Appendicitis, intussusception, toxic megacolon
Non-tender: bacterial enteritis, parasites
Enuresis temporary treatment
Desmopressin acetate
Suppresses ADH
Only works when taken, no longer term effects
Tanner Sexual Maturity Scale
Stage 1: Pubic hair, breast, penis, testes all preadolescent
Stage 2: sparse downy hair; breast bud; penis/testes enlarge
Stage 3: increased pigment, curly hair; enlarged breast/areola w/o contour; increased length and size testes
Stage 4: adult hair but less; areola forms secondary mound; glans enlarge, testes darken
Stage 5: adult hair distribution; nipple elevation; adult size penis and testes
Delayed Puberty DDx
Primary and Secondary
Primary: Hypogonadism or membrane receptor defect on gonadal cells
Secondary: gonads intact; hormonal secretion issue (LH, FSH, GnRH)
- hypopituitarism, hypothyroidism, hyperprolactinemia
Russell’s sign
Erosions on inside of front teeth from vomiting
Sleep Disturbance Screening
BEARS
Bedtime issues
Excessive daytime sleepiness
Night awakenings
Regularity and duration of sleep
Snoring
Infant vision development
Visual fixation shortly after birth -> 20/400
Follow an object by 3 months old
Stereopsis and binocular vision by 6 months old
20/20 vision by 3-5 years old
