Pediatrics: Exam 1: Various Topics
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| What is meconium? | first stool infant passes
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| Define apnea. Normal neonate RR? | breathing pauses longer than 15 seconds. 30-60.
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| T/F: Since they have more water weight, adults dehydrate faster than children. | False, PEDS dehydrate much faster than adults
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| What is a normal cap refill for Peds? What does an abnormal refill indicate? | Normal: <2 seconds. Prolonged indicates hypovolemia.
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| Sunken fontanel, absence of tears, dry mucus membranes, wt loss, absent wet diapers, skin turgor that tents indicate | DEHYDRATION
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| 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.
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| What is the clinical term for what visual abnormalities lead to? | Lead to uncorrectable vision loss or amblyopia
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| uncovered eye moves inward to pick up fixation | Exotropia
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| uncovered eye moves outward to pick up fixation | Esotropia
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| Define strabismus: | lazy eye or deviation of the eye
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| Define pseudostrabismus: | When corneal light reflexes are symmetrical, but strabismus is mild or not noticeable
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| 2 examples of hypotonic newborns | Down Syndrome and Prader-Willi
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| What scoring correlates with gestational age? | New Ballard Score
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| More mature or less mature? Leathered/wrinkled skin | More mature
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| More mature or less mature? Lanugo | Average maturity has abundant hair. Less mature and more mature have no hair
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| More mature or less mature? Straight posture | Less mature
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| More mature or less mature? Less flexibility | More mature
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| Apgar status: 7-10 | normal cardiorespiratory status
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| Apgar status: 0-3 | cardiorespiratory arrest, bradycardia, CNS depression.
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| Apgar status: 4-6 | Monitor and intervene as needed
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| When do you assess Apgar score? | 1 and 5 minutes after birth
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| 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
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| What is acrocyanosis? | hands/feet purpleish-blue at birth
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| What is the clinical term for mottling? What is mottling? | Cutis marmorata, the vasculature pattern
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| Low birth wt infants where half of their bodies are erythematous | Harlequin. Normal variant due to a minor lack of development
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| T/F: Jaundice is common w/in 24 hours of life | FALSE, always abnormal
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| Skin white, moist, cheese-like, usually full term | Vernix caseosa
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| Downy hair on shoulder/back | Lanugo
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| What syndrome has a more prominent edema of the hands and feet? | Turner's
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| 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])
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| Salmon patch/angle kisses/stork bites on back of neck, eyelids, forehead | nevus simplex
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| When would you refer a capillary hemangioma? | When obstructing vision
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| small, 1-2mm yellow-white papules on the face 1st 2-3 months. epidermal cysts, keratin material. will resolve spontaneously. | Milia
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| white to yellow papules due to maternal androgens | Sebaceous hyperplasia
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| red, slightly bumpy rash. “prickly heat” “heat rash”. Obstructed sweat glands. Overbundled baby. | Miliaria
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| Black/blue spots usually on buttocks/low often mistaken for a bruise. More frequent on darker skinned children. | Mongolian spots
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| erythematous pustulo-vesicular rash that develops after birth and involves eosinophils in the vesicular fluid. Tx? | Erythema toxicum; Tx: Normal routine care
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| 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
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| When should posterior fontanel close? | 2 months of age
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| When should anterior fontanel close? | 12-24 months of age
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| 4 reasons for abnormal fontanels | 1) Hypothyroidism 2) Down syndrome 3) ICP 4) Rickets
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| Premature fusion of sutures/closure of fontanelles | Craniosynostosis
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| diffuse edematous, swelling of the soft tissue of the scalp that extends across the midline and suture lines (scalp edema) | Caput succedaneum
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| subperiosteal hemorrhage that does not cross suture lines (CONFINED) | Cephalohematoma
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| older infant may show evidence of a blocked lacrimal duct with excessive tearing; Tx? Clinical name | Usually need nasolacrimal massage; Dacryostenosis
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| What does nasal flaring signify? | Respiratory distress
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| Small white papules on palate and gums (normal variant) | Epstein's pearls/Bohn's nodules
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| How do you distinguish thrush? Tx? | resistance to being wiped off; nystatin suspension
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| Head tilt of neck | Torticollis
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| Most common fracture due to birth injury? PE? | Clavicles (swelling and crepitus)
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| Subcostal/intercostal retractions a sign of | Respiratory distress
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| Condition where chest caves in with expiration | Pectus excavation
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| May cause a scaphoid (flattened) abdomen – emergency! Diaphragm has a hole in it with intestines in thoracic cavity! | Congenital diaphragmatic hernia
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| Vasculature of umbilical cord? | 2 arteries, 1 vein
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| What do you do for an umbilical hernia? | Nothing, common and they resolve
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| Omphalitis? | serious umbilical cord infection
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| Treatment for scaphoid abdomen? What is this indicating? | Surgical emergency, indicates diaphragmatic hernia
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| Decreased or absent fem pulses suggests | coarctation of the aorta
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| 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
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| Asymmetry in knee height when knees are bent and feet planted on the exam table | (+) Galeazzi sign
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| Barlow | adduction attempt to dislocate
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| Ortolani | abduction attempt to reduce a dislocation
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| flexible midfoot deformity | Metatarsus Adductus
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| rigid, bony deformity of the hindfoot | Club foot; - needs orthopedic referral
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| 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
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| abnormal placement of the urethral opening | Hypospadias
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| urethral meatus on dorsal surface | Epispadius
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| 2 conditions where meconium passage is delayed: | 1) Cystic Fibrosis 2) Hirschsprung's Disease
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| Moro reflex | Startle reflex
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| Rooting reflex | head turns to the side of a facial stimulus
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| 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
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| Define tachypnea in a newborn? | RR > 60
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| 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
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| 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.
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| 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.
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| T/F: 65% of infants will have visible jaundice in the first week of life | TRUE, called physiological jaundice
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| What kind of bilirubin is neurotoxic? | Unconjugated/indirect
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| What kind of bilirubin isn't toxic, but indicates something is wrong? | Conjugated/direct
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| Exhaled ____ can be measured as an indication of ongoing hemolysis | CO (carbon monoxide). Bilirubin derived from breakdown of heme in RBCs
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| T/F: Neonates have a higher rate of bilirubin production and a limited ability to excrete it | True
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| Bilirubin level for jaundice to be apparent in neonates? | 5-10 mg/dL
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| What is Coombs test? | Test for RBC antibodies (can be an immune reason for hemolysis)
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| 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.
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| T/F: Jaundice always abnormal if present on first day of life | TRUE
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| T/F: Indirect/unconjugated hyperbilirubinemia is always pathollogic | FALSE, while unconjugated IS neurotoxic, whenever CONJUGATED/DIRECT is present: always pathologic
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| 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)
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| What is kernicterus? | Bilirubin encephalopathy. Neurologic syndrome due to unconjugated bilirubin deposition in the brain
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| Treatment of hyperbilirubinemia/jaundice (4) | 1) Careful I/O and wt monitoring. 2) Phototherapy 3) Exchange transfusion 4) IVIG
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| 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
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| Most common Sx of early onset sepsis | Respiratory distress w/ pneumonia
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| Full sepsis workup for a Peds (5 labs) | CSF, CBC, U/A, blood/urine Cx
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| Empiric Tx for neonatal sepsis suspicion? With late onset? | Ampicilin, gentimiacin, cefotraxime. Add vanc w/ late onset
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| 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)
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| Hydrocephalus, intracranial calcifications, chorioretinitis (--> blindness) | Toxoplasmosis
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| Characteristics: ophthalmic (cataracts, retinopathy, glaucoma), cardiac, auditory, neurologic, intrauterine growth restriction. Highest risk of defects during FIRST trimester (can even cause SAB) | Rubella
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| Most common congenital infx, high risk of Sx disease: hearing loss, mental retardation. are the most common. Tx? | Cytomegalovirus (CMV); Tx: IV Ganciclovir
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| 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
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| 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
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| Snuffles-profuse rhinitis, often bloody. Mucocutaneous lesions. Hepatosplenomegaly, lymphadenopathy, hemolytic anemia, and thrombocytopenia, bone abnormalities. Tx? | Syphilis, IV Penicillin G
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| Slap cheek disease | Human Parvovirus B19
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| What is CONTRA with a mother w/ HIV? | Breastfeeding
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| Can cause cirrhosis, hepatocellular carcinoma, acute neonatal hepatitis, chronic carrier state. Infants should get immunization w/in 12 hours of birth | Hep B
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| Ophthalmia neonatorum. Prevention? Tx? | Neisseria Gonorrhoeae; Pre: Erythromycin eye drops; Tx: Ceftriaxone IM or IV
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| 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)
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| Increase size of body | Growth
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| Increase function of processes related to body and mind | Development
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| Double birth weight by: | 4-5 months
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| Triple birth weight by: | 1 year
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| 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.
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| What is the usual order of drop off in nutritional deficiency? | Wt -> Ht -> head circumference
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| Increasing wt along w/ decreasing height suggest: | hypothyroidism
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| 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
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| Child and parents are small. Growth runs parallel to and just below the normal curves | Familial short stature growth deviation
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| 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.
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| 4 domains in Denver Developmental Screening | 1) Personal-social 2) Fine motor-adaptive 3) Language 4) Gross motor
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| Appropriate age of development? 2-3 word phrases | 2
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| Appropriate age of development? Routine use of sentence sequences | 4
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| When does stranger anxiety develop? | 9-18 months
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| Appropriate age of development? Will alert to sound like a bell, moves head side to side | 2 weeks
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| Appropriate age of development? Rolls on back, lifts up on hands, no head lag, reaches, laughs and squeals | 4 months
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| Appropriate age of development? lifts head/shoulders when prone, smiles and coos | 2 months (possibly 1)
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| Appropriate age of development? Pulls to stand, bang blocks together, waves | 9 months
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| Appropriate age of development? Sits alone, babbles, transfers object from one hand to another, eats finger food | 6 months
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| Appropriate age of development? Scribbles, follows commands, 3-6 words, uses spoon or fork | 15 months
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| Appropriate age of development? Walks, stoops/stands, drinks from cup | 12 months
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| Appropriate age of development? Runs, can remove garment, kicks ball | 18 months
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| Appropriate age of development? Walks steps alternating feet, puts on T shirt, names pictures | 3 yo
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| Appropriate age of development? Balances/hops on 1 foot, brushes teeth w/o help, dresses w/o help | 4 yo
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| Appropriate age of development? Walks up/down stairs, throws overhand, copies a line, points to pictures | 2 yo
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| Appropriate age of development? Copies triangle, draws person w/ 6 body parts, defines words, Left from Right | 6 yo
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| Appropriate age of development? Skips, copies squares, counts, understands opposites | 5 yo
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| 3 or more hours of loud, intense, constant crying, not responsive to soothing (>3 days/week for > 3 weeks) | Colic
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| Inattention, hyperactivity, impulsivity in at least 2 environments | ADHD Attention Deficit/Hyperactivity Disorder
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| First line Tx for ADHD. Others? | Stimulants; anti-depressants, anti-hypertensives
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| 1) Activating 2) Focusing 3) Effort 4) Emotions 5) Memory 6) Action | 6 impaired executive functions of ADHD
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| Autism prevalence in 2008? | 1/88
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| When do temper tantrums happen? | Normal toddler behavior, typical 1-4 yo
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| 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
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| Autism Tx: | Early behavioral intervention w/ focus on communication, social interaction, play skills
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| Non-progressive motor impairment due to brain abnormality usually early in development. Affects muscle tone, strength, coordination, movements. Etiologies? | Cerebral Palsy; infx, asphyxia, kernicterus
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| Most common type of CP? | Spastic, increased tone and hyper-reflexia
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| T/F: Minimal co-existing conditions w/ CP | False, MANY; especially visual abnormalities
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| Screening test for a newborn? | Heel stick
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| What is the point of newborn screening exams? | ID infants at risk for catastrophic outcomes from treatable/preventable illnesses
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| 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)
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| 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
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| 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
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| Newborn hearing screen? 4 year old hearing test? | NB: Hearing test via auditory brainstem response; 4: audiometry
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| What age should infants be tracking light? | 1 month. Abnormal if not tracking by 2 month visit
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| Age appropriate for BP evaluation? | 3 yo
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| Age appropriate for hemoglobin checks? | 12 monhs
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| 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
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| 4 RF of lead poisoning | 1) older homes w/ peeling pain 2) home remedies from Mexico/other countries 3) Lead pottery 4) Poverty
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| What age is a U/A recommended? | No longer recommended at all.
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| 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
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| RFs for TB? (4) | 1) immunocompromised 2) from another country 3) contact w/ active TB 4) Poverty
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| When do you screen for dyslipidemia? | 9-11 yo and 17+ yo
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| What are baby bottle caries and how do you get them? | babies going to bed with something other than water
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| First dentist appointment? | 3 yo
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| When should you begin a fluoride varnish or brushing w/ fluorinated toothpaste? | At tooth eruption AFTER 6 months
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| What is the number 1 cause of death in all Peds groups? | Injury
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| 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
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| 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
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| 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
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| 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
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| Live attenuated viruses? (5) | MMR, nasal influenza, varicella
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| 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
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| 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
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| 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
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| 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
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| gram-negative coccobacillus, lasting for many weeks and typically causes severe coughing episodes, whooping, and post-tussive vomiting. | Pertussis
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| 5 CONTRAs to Immunizations | 1) Anaphylaxis 2) Immunocompromised 3) Pregnancy for LIVE viruses 4) Moderate+ acute illnesses 5) Anaphylactic reaction to eggs
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| DTaP CONTRAs (2) | 1) Encephalopathy w/in 7 days 2) Progressive neurological disorder
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| 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
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| Most common cause of diarrhea in children? When do you generally give immunizations? | Rotavirus, 2 and 4 months
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| sore arm, low grade fever, that resolve within days | Common adverse to immunizations (only added this in because it was in the study guide)
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| 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
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| When do you give DTaP? | after intial series of 5, every 10 years
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| 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
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| T/F: Infants not yet ambulatory unlikely to sustain bruises | True, suspect physical child abuse
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| subdural hematoma, retinal hemorrhage, and skeletal injuries | Classic shaken baby findings
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| loop marks, forced immersion burn pattern | Pathnognomonic injuries of child abuse
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| will show clear lines of demarcation, uniform burn depth and characteristic pattern vs a splash injury | Immersion burns
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| T/F: If testing for Gonorrhea or Chlamydia, Cx for medicolegal purposes | TRUE
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| 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)
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| 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
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| 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
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| 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!)
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| 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)
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| 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
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Review the information in the table. When you are ready to quiz yourself you can hide individual columns or the entire table. Then you can click on the empty cells to reveal the answer. Try to recall what will be displayed before clicking the empty cell.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
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Created by:
crward88
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