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Peds 1

Pediatrics: Exam 1: Various Topics

What is meconium? first stool infant passes
Define apnea. Normal neonate RR? breathing pauses longer than 15 seconds. 30-60.
T/F: Since they have more water weight, adults dehydrate faster than children. False, PEDS dehydrate much faster than adults
What is a normal cap refill for Peds? What does an abnormal refill indicate? Normal: <2 seconds. Prolonged indicates hypovolemia.
Sunken fontanel, absence of tears, dry mucus membranes, wt loss, absent wet diapers, skin turgor that tents indicate DEHYDRATION
What sign indicates head tumor or cataracts? What is the clinical name? What should be seen? White reflex, also called leukocoria. Red reflex should be seen on fundoscopy exam.
What is the clinical term for what visual abnormalities lead to? Lead to uncorrectable vision loss or amblyopia
uncovered eye moves inward to pick up fixation Exotropia
uncovered eye moves outward to pick up fixation Esotropia
Define strabismus: lazy eye or deviation of the eye
Define pseudostrabismus: When corneal light reflexes are symmetrical, but strabismus is mild or not noticeable
2 examples of hypotonic newborns Down Syndrome and Prader-Willi
What scoring correlates with gestational age? New Ballard Score
More mature or less mature? Leathered/wrinkled skin More mature
More mature or less mature? Lanugo Average maturity has abundant hair. Less mature and more mature have no hair
More mature or less mature? Straight posture Less mature
More mature or less mature? Less flexibility More mature
Apgar status: 7-10 normal cardiorespiratory status
Apgar status: 0-3 cardiorespiratory arrest, bradycardia, CNS depression.
Apgar status: 4-6 Monitor and intervene as needed
When do you assess Apgar score? 1 and 5 minutes after birth
What does APGAR stand for? Point system? What do babies often get? Appearance, Pulse, Grimace, Activity, Respiration. 2 points each for a max of 10. Often get 9
What is acrocyanosis? hands/feet purpleish-blue at birth
What is the clinical term for mottling? What is mottling? Cutis marmorata, the vasculature pattern
Low birth wt infants where half of their bodies are erythematous Harlequin. Normal variant due to a minor lack of development
T/F: Jaundice is common w/in 24 hours of life FALSE, always abnormal
Skin white, moist, cheese-like, usually full term Vernix caseosa
Downy hair on shoulder/back Lanugo
What syndrome has a more prominent edema of the hands and feet? Turner's
Port-wine stain. What is it clinically called and what syndrome is it seen in? Nevus flammeus; Sturge-Weber syndrome (seizures [abnormal intracranial blood vessels])
Salmon patch/angle kisses/stork bites on back of neck, eyelids, forehead nevus simplex
When would you refer a capillary hemangioma? When obstructing vision
small, 1-2mm yellow-white papules on the face 1st 2-3 months. epidermal cysts, keratin material. will resolve spontaneously. Milia
white to yellow papules due to maternal androgens Sebaceous hyperplasia
red, slightly bumpy rash. “prickly heat” “heat rash”. Obstructed sweat glands. Overbundled baby. Miliaria
Black/blue spots usually on buttocks/low often mistaken for a bruise. More frequent on darker skinned children. Mongolian spots
erythematous pustulo-vesicular rash that develops after birth and involves eosinophils in the vesicular fluid. Tx? Erythema toxicum; Tx: Normal routine care
more common in African American infants, may be seen at birth- small dry vesicle on a pigmented brown macular base. Tx? Pustular melanosis; Tx: Normal routine care
When should posterior fontanel close? 2 months of age
When should anterior fontanel close? 12-24 months of age
4 reasons for abnormal fontanels 1) Hypothyroidism 2) Down syndrome 3) ICP 4) Rickets
Premature fusion of sutures/closure of fontanelles Craniosynostosis
diffuse edematous, swelling of the soft tissue of the scalp that extends across the midline and suture lines (scalp edema) Caput succedaneum
subperiosteal hemorrhage that does not cross suture lines (CONFINED) Cephalohematoma
older infant may show evidence of a blocked lacrimal duct with excessive tearing; Tx? Clinical name Usually need nasolacrimal massage; Dacryostenosis
What does nasal flaring signify? Respiratory distress
Small white papules on palate and gums (normal variant) Epstein's pearls/Bohn's nodules
How do you distinguish thrush? Tx? resistance to being wiped off; nystatin suspension
Head tilt of neck Torticollis
Most common fracture due to birth injury? PE? Clavicles (swelling and crepitus)
Subcostal/intercostal retractions a sign of Respiratory distress
Condition where chest caves in with expiration Pectus excavation
May cause a scaphoid (flattened) abdomen – emergency! Diaphragm has a hole in it with intestines in thoracic cavity! Congenital diaphragmatic hernia
Vasculature of umbilical cord? 2 arteries, 1 vein
What do you do for an umbilical hernia? Nothing, common and they resolve
Omphalitis? serious umbilical cord infection
Treatment for scaphoid abdomen? What is this indicating? Surgical emergency, indicates diaphragmatic hernia
Decreased or absent fem pulses suggests coarctation of the aorta
What does Ortolani-Barlow maneuver look for and how does it work? Evaluates Developmental Hip Dysplasia and you listen for a clunk on internal/external rotation
Asymmetry in knee height when knees are bent and feet planted on the exam table (+) Galeazzi sign
Barlow adduction attempt to dislocate
Ortolani abduction attempt to reduce a dislocation
flexible midfoot deformity Metatarsus Adductus
rigid, bony deformity of the hindfoot Club foot; - needs orthopedic referral
What is talipes equinovarus? When you can see the whole foot on U/S when normally you would only be able to see a lateral view
abnormal placement of the urethral opening Hypospadias
urethral meatus on dorsal surface Epispadius
2 conditions where meconium passage is delayed: 1) Cystic Fibrosis 2) Hirschsprung's Disease
Moro reflex Startle reflex
Rooting reflex head turns to the side of a facial stimulus
4 routine newborn cares 1) Erythromycin ointment on the eyes 2) anti-septic cord care 3) Vitamin K IM (prevents hemorrhagic disease 4) Heb B immunization
Define tachypnea in a newborn? RR > 60
Sx: Tachypnea, mild retractions, hypoxia, occasional grunting. CXR: perihilar streaking, fluid in fissures. Cause? Tx? Transient Tachypnea of the Newborn (TTN). Cause: delayed clearance of lung fluid. Tx: Self-limited resolution in 12-24 hours
S/sx: tachypnea, hypoxia, hypercapnia and small airway obstruction-air trapping (risk of pneumothorax). What causes this? What can this lead to? Meconium aspiration syndrome. Caused by fetal distress. Can lead to a later chemical pneumonia.
Premature infants suffer from this because their lungs are too premature to create surfactant, so they have a deficiency. CXR: ground glass haze w/ air bronchograms. What does surfactant do? What does this illness cause? Respiratory Distress Syndrome- Hyaline Membrane Disease. Surfactant reduces surface tension in alveoli preventing atelectasis. Causes cyanosis, tachypnea, nasal flaring, intercostal/sternal retractions, grunting.
T/F: 65% of infants will have visible jaundice in the first week of life TRUE, called physiological jaundice
What kind of bilirubin is neurotoxic? Unconjugated/indirect
What kind of bilirubin isn't toxic, but indicates something is wrong? Conjugated/direct
Exhaled ____ can be measured as an indication of ongoing hemolysis CO (carbon monoxide). Bilirubin derived from breakdown of heme in RBCs
T/F: Neonates have a higher rate of bilirubin production and a limited ability to excrete it True
Bilirubin level for jaundice to be apparent in neonates? 5-10 mg/dL
What is Coombs test? Test for RBC antibodies (can be an immune reason for hemolysis)
Why does breast feeding cause jaundice? Pathological or physiological? Initially, neonates are undernourished as it takes a bit for the mother to produce adequate milk supply. Resolves quickly. Physiological.
T/F: Jaundice always abnormal if present on first day of life TRUE
T/F: Indirect/unconjugated hyperbilirubinemia is always pathollogic FALSE, while unconjugated IS neurotoxic, whenever CONJUGATED/DIRECT is present: always pathologic
5 causes of pathologic jaundice. Conjugated or unconjugated? 1) Immune mediated (unconjugated) 2) non-immune mediated (unconjugated) 3) Infx (unconjugated) 4) Hemorrhage (unconjugated) 5) Liver/Biliary (conjugated, but devastating) (1-4 are all neurotoxic)
What is kernicterus? Bilirubin encephalopathy. Neurologic syndrome due to unconjugated bilirubin deposition in the brain
Treatment of hyperbilirubinemia/jaundice (4) 1) Careful I/O and wt monitoring. 2) Phototherapy 3) Exchange transfusion 4) IVIG
Top 4 organisms that can cause sepsis (reflect bacteria of maternal GU tract) 1) Group B Strep, 2) E. coli, 3) H. influenzae, 4) Klebsiella
Most common Sx of early onset sepsis Respiratory distress w/ pneumonia
Full sepsis workup for a Peds (5 labs) CSF, CBC, U/A, blood/urine Cx
Empiric Tx for neonatal sepsis suspicion? With late onset? Ampicilin, gentimiacin, cefotraxime. Add vanc w/ late onset
What are TORCH infections? Toxoplasmosis (LITTER BOX) Other (Syphilis, VZV (varicella zoster), Parvovirus, HIV, Hep B, GC, Chlamydia, TB) Rubella Cytomegalovirus (CMV) Herpes simplex virus (HSV)
Hydrocephalus, intracranial calcifications, chorioretinitis (--> blindness) Toxoplasmosis
Characteristics: ophthalmic (cataracts, retinopathy, glaucoma), cardiac, auditory, neurologic, intrauterine growth restriction. Highest risk of defects during FIRST trimester (can even cause SAB) Rubella
Most common congenital infx, high risk of Sx disease: hearing loss, mental retardation. are the most common. Tx? Cytomegalovirus (CMV); Tx: IV Ganciclovir
Common infection during birth, Sx categories: 1) localized 2) encephalitis 3) disseminated infx; high mortality. Tx? Herpes Simplex Virus (HSV); Tx: IV Acyclovir and a CSection if active infx at labor
Intrauterine: Microphthalmia, cataracts, chorioretinitis, cutaneous and bony aplasia/hypoplasia/atrophy, cutaneous scars, Tx?; Neonatal: Clinical features include severe rash, pneumonia, hepatitis, and death in 20% to 30%, Tx? Varicella Zoster Virus (VZV); Intra: VZIG; Neonate: Acyclovir; Infants born to mothers infected before 5 days prior to delivery have less severe disease
Snuffles-profuse rhinitis, often bloody. Mucocutaneous lesions. Hepatosplenomegaly, lymphadenopathy, hemolytic anemia, and thrombocytopenia, bone abnormalities. Tx? Syphilis, IV Penicillin G
Slap cheek disease Human Parvovirus B19
What is CONTRA with a mother w/ HIV? Breastfeeding
Can cause cirrhosis, hepatocellular carcinoma, acute neonatal hepatitis, chronic carrier state. Infants should get immunization w/in 12 hours of birth Hep B
Ophthalmia neonatorum. Prevention? Tx? Neisseria Gonorrhoeae; Pre: Erythromycin eye drops; Tx: Ceftriaxone IM or IV
Conjunctivitis (mild to intense inflammation), Pneumonia may occur between 2-19 wks of age- characterized by an afebrile illness with repetitive staccato cough, tachypnea, and rales. Hyperinflation with diffuse infiltrates on CXR. Tx? Chlamydia; Oral erythromyacin x 14 days (topical ineffective)
Increase size of body Growth
Increase function of processes related to body and mind Development
Double birth weight by: 4-5 months
Triple birth weight by: 1 year
What is plagiocephaly and how to kids get it? Management? abnormal shaped head due to back to sleep recommendation. Prevents SIDS (decreased incidence by 40%). Helmet orthosis prevents, reposition often, and tummy when awake prevent or treat it.
What is the usual order of drop off in nutritional deficiency? Wt -> Ht -> head circumference
Increasing wt along w/ decreasing height suggest: hypothyroidism
subnormal height relative to other children of the same sex and age, taking into account family heights. Evaluation? Short stature growth deviation; radiologic bone age evaluates
Child and parents are small. Growth runs parallel to and just below the normal curves Familial short stature growth deviation
Variation in normal growth due to delayed puberty. Growth spurt occurs later in adolescence. Adult size normal or taller than average. What will bone age reveal? Constitutional growth delay/short stature. Bone age reveals delay in maturation.
4 domains in Denver Developmental Screening 1) Personal-social 2) Fine motor-adaptive 3) Language 4) Gross motor
Appropriate age of development? 2-3 word phrases 2
Appropriate age of development? Routine use of sentence sequences 4
When does stranger anxiety develop? 9-18 months
Appropriate age of development? Will alert to sound like a bell, moves head side to side 2 weeks
Appropriate age of development? Rolls on back, lifts up on hands, no head lag, reaches, laughs and squeals 4 months
Appropriate age of development? lifts head/shoulders when prone, smiles and coos 2 months (possibly 1)
Appropriate age of development? Pulls to stand, bang blocks together, waves 9 months
Appropriate age of development? Sits alone, babbles, transfers object from one hand to another, eats finger food 6 months
Appropriate age of development? Scribbles, follows commands, 3-6 words, uses spoon or fork 15 months
Appropriate age of development? Walks, stoops/stands, drinks from cup 12 months
Appropriate age of development? Runs, can remove garment, kicks ball 18 months
Appropriate age of development? Walks steps alternating feet, puts on T shirt, names pictures 3 yo
Appropriate age of development? Balances/hops on 1 foot, brushes teeth w/o help, dresses w/o help 4 yo
Appropriate age of development? Walks up/down stairs, throws overhand, copies a line, points to pictures 2 yo
Appropriate age of development? Copies triangle, draws person w/ 6 body parts, defines words, Left from Right 6 yo
Appropriate age of development? Skips, copies squares, counts, understands opposites 5 yo
3 or more hours of loud, intense, constant crying, not responsive to soothing (>3 days/week for > 3 weeks) Colic
Inattention, hyperactivity, impulsivity in at least 2 environments ADHD Attention Deficit/Hyperactivity Disorder
First line Tx for ADHD. Others? Stimulants; anti-depressants, anti-hypertensives
1) Activating 2) Focusing 3) Effort 4) Emotions 5) Memory 6) Action 6 impaired executive functions of ADHD
Autism prevalence in 2008? 1/88
When do temper tantrums happen? Normal toddler behavior, typical 1-4 yo
1) no babbling or pointing or other gesture by 12 months 2) no single words by 16 months 3) no 2-word phrases by 24 mo 4) loss of language or social skills at any age 4 red flags of Autism
Autism Tx: Early behavioral intervention w/ focus on communication, social interaction, play skills
Non-progressive motor impairment due to brain abnormality usually early in development. Affects muscle tone, strength, coordination, movements. Etiologies? Cerebral Palsy; infx, asphyxia, kernicterus
Most common type of CP? Spastic, increased tone and hyper-reflexia
T/F: Minimal co-existing conditions w/ CP False, MANY; especially visual abnormalities
Screening test for a newborn? Heel stick
What is the point of newborn screening exams? ID infants at risk for catastrophic outcomes from treatable/preventable illnesses
Autosomal recessive disorder of amino acid metabolism primarily affecting the brain. Severe mental retardation develops in first year of life unless prevented by diet PKU (phenylketonuira)
Deficiency of enzyme 21-hydroxylase leading to decreased cortisol production --> increase in ACTH --> excess androgen production --> ambiguous genitalia. Tx? What else may they be deficient in? Congenital Adrenal Hyperplasia (CAH); Tx: supplement steroids. May also be deficient in aldosterone
Critical to diagnose early to prevent permanent cognitive impairment Signs/Symptoms: hypothermia, lethargy, poor feeding, jaundice, edema, constipation, large tongue, dry skin, coarse cry . Tx? Congenital Hypothyroidism; thyroid replacement
Newborn hearing screen? 4 year old hearing test? NB: Hearing test via auditory brainstem response; 4: audiometry
What age should infants be tracking light? 1 month. Abnormal if not tracking by 2 month visit
Age appropriate for BP evaluation? 3 yo
Age appropriate for hemoglobin checks? 12 monhs
Preventions of Fe deficiency anemia (3) 1) Formula should be iron fortified 2) Cows milk after 1 yo 3) limit milk so they eat enough
4 RF of lead poisoning 1) older homes w/ peeling pain 2) home remedies from Mexico/other countries 3) Lead pottery 4) Poverty
What age is a U/A recommended? No longer recommended at all.
What levels of lead cause learning problems? Require investigation? Are abnormal? Indicate chelation? 5-10 micrograms/dL= learning problems; >10= environmental investigation; >5=abnormal; 45= chelation recommended
RFs for TB? (4) 1) immunocompromised 2) from another country 3) contact w/ active TB 4) Poverty
When do you screen for dyslipidemia? 9-11 yo and 17+ yo
What are baby bottle caries and how do you get them? babies going to bed with something other than water
First dentist appointment? 3 yo
When should you begin a fluoride varnish or brushing w/ fluorinated toothpaste? At tooth eruption AFTER 6 months
What is the number 1 cause of death in all Peds groups? Injury
Respiratory viral illness with full body rash; the first symptoms are usually high fever, cough, runny nose, and conjunctivitis. 20% will develop a complication including: diarrhea, ear infection, pneumonia, encephalitis, seizure or death Measles
Degenerative CNS disease characterized by behavioral and intellectual deterioration and seizures many years after acute infection Subacute sclerosing panencephalitis or SSPE from chronic measles infection
viral illness causing fever and rash, usually mild lasting about 3 days but will cause birth defects if acquired by a pregnant woman. Posterior occipital and auricular adenopathy. Rubella
Systemic viral infection with respiratory transmission causing fever, headache, muscle aches, tiredness, and loss of appetite, followed by swelling of salivary glands. The parotid salivary glands are most frequently affected. Orchitis Mumps
Live attenuated viruses? (5) MMR, nasal influenza, varicella
Deafness, cataracts, heart defects, growth and mental retardation, liver and spleen damage (25-80% chance of damage to the fetus if a woman is infected early in pregnancy) Congenital Rubella
bacterial, toxin mediated illness, respiratory transmission, causes sore throat with a thick covering in the back of the throat and fever. It can lead to airway obstruction. Neurological complications possible. (cranial neuropathies, extremity weakness) Diptheria
most common type (about 80%) usually presents with a descending pattern, starting with trismus or lockjaw, followed by stiffness of the neck, difficulty in swallowing, and rigidity of abdominal muscles. Opisthotonos body posture Tetanus
itchy skin rash of blister-like lesions, covering the body but usually more concentrated on the face, scalp, and trunk. Fever may occur just before or when the rash appears. Varicella Zoster virus
gram-negative coccobacillus, lasting for many weeks and typically causes severe coughing episodes, whooping, and post-tussive vomiting. Pertussis
5 CONTRAs to Immunizations 1) Anaphylaxis 2) Immunocompromised 3) Pregnancy for LIVE viruses 4) Moderate+ acute illnesses 5) Anaphylactic reaction to eggs
DTaP CONTRAs (2) 1) Encephalopathy w/in 7 days 2) Progressive neurological disorder
What does HiB vaccine prevent? (3) Not to be confused w/ Hep B, this is H. influenzae type B 1) Meningitis 2) Pneumonia 3) Epiglotitis
Most common cause of diarrhea in children? When do you generally give immunizations? Rotavirus, 2 and 4 months
sore arm, low grade fever, that resolve within days Common adverse to immunizations (only added this in because it was in the study guide)
fever (usually high), headache, extreme tiredness, dry cough, sore throat, runny or stuffy nose, muscle aches, GI: nausea, vomiting, and diarrhea (more common in children than adults) Influenza
When do you give DTaP? after intial series of 5, every 10 years
RF for child abuse (6) 1) Parental substance abuse 2) Poor parenting skills 3) Maternal depression 4) Domestic violence 5) Parental history of abuse 6) Poverty
T/F: Infants not yet ambulatory unlikely to sustain bruises True, suspect physical child abuse
subdural hematoma, retinal hemorrhage, and skeletal injuries Classic shaken baby findings
loop marks, forced immersion burn pattern Pathnognomonic injuries of child abuse
will show clear lines of demarcation, uniform burn depth and characteristic pattern vs a splash injury Immersion burns
T/F: If testing for Gonorrhea or Chlamydia, Cx for medicolegal purposes TRUE
Undernutrition due to inadequate intake or caloric absorption or excessive caloric expenditure. Most commonly due to inadequate intake from behavioral or psychosocial issues Failure to Thrive (FTT)
History-dietary (most important)*, social, medical. Labs- CBC, lead, U/A, lytes, PPD, thyroid, LFTs. Other evaluation as Hx/PE suggest: eg HIV, stool ova and parasites, fat. FTT evaluation
1. Cardiac findings: murmur, edema 2. Developmental delay 3. Dysmorphic features 4. Failure to gain weight despite adequate caloric intake 5. Lymphadenopathy or organomegaly 6. Recurrent infections 7. Recurrent vomiting, diarrhea or dehydration RED FLAGS suggesting medical cause of FTT
Factitious disorder where a parent induces symptoms in the child with no external incentive to do so. Often parent has healthcare background. Munchausen Syndrome by Proxy (medical child abuse!)
Vomiting, diarrhea, respiratory arrest, asthma, seizures, poor coordination, loss of consciousness, fever, bleeding, FTT, rash and hypoglycemia. Multiple care providers. Medical Child Abuse (Munchausen by proxy)
T/F: Coining is a form of child abuse FALSE, a DD! heating up coin and rubbing it on skin is acceptable and considered therapeutic in some cultures
Created by: crward88