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Well Child and neonatology Flashcards

1
Q

What is some routine health screening tests used for pediatric cases

A

Day one of life: Screen metabolic/genetic diseases

Well child visit: 2-4 weeks, 2 months, 4 months, 6 months, 9 months, 12 months, 15, 18, 24 months, then annually

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2
Q

When should lead/anemia screening be done

A

At 9-15 months only in communities where 1/3rd of houses built before 1950s, then repeat at age 2

Age 9-15 months, age 2

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3
Q

When should screening for blood pressure begin

A

Age 3 and every visit after

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4
Q

When should vision and hearing be screened

A

At birth, then annually at age 3

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5
Q

What is the definition of failure to thrive

A
  1. Weight < 3rd-5th weight percentile
  2. Weight for height < 10th percentile
  3. Weight velocity crossing two major percentiles
  4. Height < 3rd percentile or height crossing two major percentiles
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6
Q

What is the differential for failure to thrive

A
  1. Inadequate intake: Secondary to psychosocial issues - MOST COMMON
  2. Inadequate absorption
  3. Increased metabolic demand
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7
Q

What is the treatment for failure to thrive

A
  1. If no organic cause, start calorie count
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8
Q

What are important gross motor development milestones to remember

A 
4 months: Rolls front to back/back to front
6 months: Sits unassisted
9 months: Pulls to stand
12 months: Walks alone
15 months: Walks backwards
2 years: Down steps with help and jumps
3 years: Tricycle
4 years: Hopping
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9
Q

What are important fine motor development milestones to remember

A 
6 months: Transfers objects
9 months: Three finger grasp
12 months: Two finger grasp
2 years: Builds tower of 6 cubes
3 years: copies circle
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10
Q

What are important language skills in milestones

A 
9 months: Says mama/dada non-specifically
12 months: Says mama/dada specifically
15 months: 4-6 words
2 years: 200 words, two word phrases
3 years: three word phrases
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11
Q

What are important social/cognitive skills in development milestones

A

6 months: Stranger anxiety

15 months: Temper tantrum

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12
Q

Safety: How should car seats be placed in the car and what is the timeframe for removing them

A

Place in rear seat, rear facing

Remove when

  1. Child > 20lbs
  2. Child > 1yr of age
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13
Q

What should you do when a child presents with an abnormal fracture of a bone

A

Do a full work up for any other cause of abnormal fractures: Order full assort of labs

Order skeletal survey, head CT, and opthalmological exam

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14
Q

How should infants sleep

A

Sleep on their backs to avoid SIDS

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15
Q

What is the definition of colic in a child

A

Severe paroxysmal crying > 3 hours a day, 3 days a week, for three weeks in healthy well fed child that peaks 6 weeks of life, and regresses 3-4 months

Treatment: Reassurance

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16
Q

What is the definition of neonatology

A

Younger than 28 years old, from birth to ready to be discharged

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17
Q

What are four neonatal respiratory diseases that I should know

A
  1. Respiratory distress syndrome
  2. Transient tachypnea of the newborn
  3. Meconium aspiration syndrome
  4. Congenital diaphragmatic hernia
18
Q

What is respiratory distress syndrome, its diagnosis, and treatment

A

Surfactant deficiency: Poor lung compliance

Occurs in premature infants

Exam: CXR shows decreased air movements, ground glass appearance

Treatment: Prevention by antenatal steroids for mother, and surfactant administration at time of delivery

19
Q

What is transient tachypnea of the newborn

A

Retained fetal lung fluid, resolves completely

Usually happens in short labor or C-section

Exam: CXR shows perihilar streaking and fluid in interlobar fissures

Treatment: Mild to moderate O2 for support

20
Q

What is meconium aspiration syndrome

A

Aspiration pneumonitis caused by aspiration at or near birth

Exam: Hypoxia with CXR showing lobar consolidation

Treatment: Nasopharyngeal suctioning and tracheal suctioning, ventilator support and antibiotics

21
Q

What is congenital diaphragmatic hernia

A

Defect in diaphragm, herniation of abdominal contents into cavity, causing pulmonary hypoplasia

Presents with severe respiratory distress at birth, CXR shows bowel loops in chest

Treatment: Immediate intubation, and surgical correction after stabilization

This is dangerous out of the four

22
Q

When should someone be worked up for neonatal sepsis

A

If the temperature if 38 degrees Celsius in someone < 2mo old, that warrants full sepsis workup including CBC, blood cultures, UA, urine culture, and an LP and given IV antibiotics for minimum of 48 hours

Common pathogens: E. Coli, GBS, gram negative rods

23
Q

What is the treatment for neonatal sepsis

A

IV ampicillin (covers listeria) + gentamicin or third generation cephalosporin (ceftriaxone contraindicated in infants < 28 days old)

24
Q

What are the TORCHES infections

A
  1. Toxoplasmosis
  2. Other
  3. Rubella
  4. Cytomegalovirus
  5. Herpes
  6. Syphilis
25
What is toxoplasmosis infection
Vertical transmission from mother to child, pressentes with hydrocephalus, seizures, chorioretinitis, ring enhancing lesions on CT Treatment: Pyrimethamine, sulfadiazine, spiramycin Prevention: Avoid cats/cat feces during pregnancies, and avoid raw/undercooked meat during pregnancy If mother has active infection during pregnancy, mother must be treated during pregnancy
26
What is rubella infection in child
Will present with blueberry rash, cataracts, hearing loss, and possible PDA heart defect Prevention: Immunize mothers prior to pregnancy No treatment
27
What is cytomegalovirus infection in children
Petechial rash, periventricular calficiations, chorioretinitis Treatment: Ganciclovir Prevention: None
28
What is herpes simplex virus infection
Presents with skin, eye, nad mouth vesicles Treatment: Acyclovir Prevention: Perform C-section if mother has active lesions at delivery (remember that C-section can be done in HIV for some reason)
29
How to prevent syphilis in child
Treat seropositive mothers with penicillin
30
What is cleft lip/palate in a child, and when do you repair
Abnormal ridge/division that presents at birth, associated with poor feeding and recurrent otitis media Treatment: Surgical repair
31
What are abdominal wall defects that are commonly seen in neonates
1. Gastroschises - intestine protrudes through defect 2. Omphalocele - membrane covered herniation of abdominal contents Associated abnormalities with omphalocele Treatment: Cover it with sterile dressing, NG decompressions, antibiotics, stabilization followed by staged closure
32
How would a baby with intestinal atresia present
Abdominal distension with bilious vomiting, failure to pass meconium In down syndrome, look for characteristic double bubble sign of duodenal atresia Treatment: Surgical resection
33
How would a baby with hirschsprung disease present
Absence of ganglion cells in colon leading to narrowing of aganglionic segment with dilation of proximal normal colon Presents with failure to pass meconium, vomiting, abdominal distension Diagnosis: Rectal biopsy at anal verge to look for ganglion cells
34
What is the treatment for hirschsprung disease
Staged procedure with initial diverting colostomy followed by resection with infant > 6 mo age
35
What are neural tube defects
1. Anencephaly - incompatible with life 2. Spina bifida - Myelomeningocele, meningocele Signs/symptoms: Many kinds of defects, related to increased risk of latex allergy Prevention: Decrease risk with folate ingestion during first trimester
36
What are the different kinds of jaundice that can present
1. Physiologic jaundice: INDIRECT hyperbilirubinemia 2. Breast milk jaundice 3. Pathologic jaundice
37
When is jaundice less likely to be phsyiologic
1. Within first 24 hours 2. If direct bilirubin is elevated 3. Indirect bili really high - above 30 can cross into brain and cause kernicterus by depositing in basal ganglia
38
What is the presentation and treatment for physiologic jaundice
Indirect bilirubin starts rising 36-48 hours after birth, peaks 10-15 at 5-7 days 1. Increase feeding 2. Second line - UV phototherapy 3. Third line - Exchange transfusion
39
What is breast milk jaundice
Breast milk that contains enzyme to further delay hepatic bilirubin conjugation Symptoms: Jaundice first 3-5 days, peaks at 2 weeks, reaches 19-20, and lasts two months Treatment: None, continue breast feeding
40
What are the symptoms of kernicterus in pathologic jaundice
High levels of indirect hyperbilirubinemia with jaundice, lethargy, poor feeding, high pitched cry, hypertonicity, and seizures
41
What Is the treatment for pathologic jaundice
Phototherapy and exchange transfusion

Pediatrics (5 decks)

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