Pediatrics 1&2

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HuskerDevil
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86824
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Pediatrics 1&2
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2011-05-19 20:54:21
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DPAP2012 Pediatrics
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Pediatrics questions from previous students
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  1. What is the most common method of preventing infectious diseases available to practitioners
    Immunizations
  2. Name the 15 diseases against which US infants and children are vaccinated
    • Diphtheria
    • Tetanus
    • Pertussis
    • Polio
    • Measles
    • Mumps
    • Varicella
    • Rubella
    • Influenza
    • Hepatitis A
    • Hepatitis B
    • Rotavirus
    • Meningococcal meningitis
    • HPV
    • Pneumococcal disease
  3. What is DTap
    Diptheria Tetanus and acellular pertussis, this is a vaccine for young children
  4. What is Tdap
    Tetanus diphtheria and pertussis, older child and adult vaccine
  5. If you give someone a live vaccine how long do you need to wait before doing a TB skin test
    • It is ok if you do them at the same time.
    • If you give the live vaccine first you have to wait 6 weeks for the TB skin test.
  6. Vaccination or Immunization – the actual process of administering agent (toxoid, antitoxin or Ig)
    Vaccination
  7. Vaccination or Immunization – the process of inducing immunity which is active or passive
    Immunization
  8. Vaccination results in active or passive immunity
    Active
  9. What are the 5 types of vaccine
    Live attenuated, inactivated, subunit, recombinant, conjugated
  10. What is the purpose of an adjuvant (aluminium salts) in a vaccine
    Enhance host response
  11. How many doses of live attenuated vaccine does it usually take to confer immunity
    Usually one
  12. What are some examples of inactivated vaccines
    • Influenza (TIV)
    • Polio
    • Hep A/B
    • Diphtheria
    • Tetanus
    • Pneumococcal
    • Meningococcal
    • HIB
    • HPV
  13. What are some examples of live attenuated vaccines
    • Measles
    • Mumps
    • Rubella
    • MMR
    • Varicella
    • Yellow fever
    • Rotavirus
    • Influenza (LAIV)
  14. What type of vaccine (recombinant, conjugate, subunit) – genes that code for a specific viral protein are expressed in another microbe (Hep B, HPV)
    Recombinant
  15. What type of vaccine (recombinant, conjugate, subunit) – vaccines for bacteria with polysaccharide capsules, linked to protein carriers (pneumococcal, HIB, meningococcal)
    Conjugate
  16. What type of vaccine (recombinant, conjugate, subunit) – produced from specific purified antigens (DTaP, Tdap)
    Subunit
  17. Most vaccines are administered by which route
    IM
  18. Currently most children receive __
    • vaccines between 0-18 years
    • 40
  19. What is the reason children are vaccinated against hep A
    Children often have asymptomatic and or unrecognized infections and therefore play a major role in transmission of disease to adults
  20. Hep A vaccine is recommended for all children at __ of age
    12 months
  21. What is the reason children are vaccinated for hep B
    • Chronic infection is more likely if infection is acquired early in life
    • 25% of HBV infected infants will die of related disease
    • transmission from child to child has been documented
  22. HBV vaccine is recommended for all infants and unvaccinated children by age __
    11-12 years
  23. Reason to vaccinate against pertussis
    Pertussis infections occur in infants and young children and is highly contagious
  24. The Tdap vaccine is for __
    Adolescents/adults
  25. The DTap vaccine is for __
    Children up to age 7
  26. Adverse effects generally attributed to whole cell pertussis – have decrease dramatically with D Tap
    • High fever
    • unusual cry
    • seizures/rarely
    • acute encephalitis
  27. Reason for the HIB vaccine
    • Before vaccine availability HiB was the #1 cause of bacterial meningitis in children <5 with a high rate of neurologic problems.
    • It was also a big cause of pneumonia, cellulitis, epiglottitis, and septic arthritis
  28. Reason for the polio vaccine
    Highly infectious, viral meningitis and paralytic polio
  29. When were the Americas declared polio free
    1994
  30. Reason for the Measles, Mumps and Rubella (MMR) vaccine
    • Few clinicians recognize measles
    • measles cause >1million deaths/yr worldwide
    • fetal rubella can result in devastating sequelae,
    • The combined vaccine is more effective than individual components
  31. Reason for varicella vaccine
    • Highly infectious, before vaccine complications accounted for more than 80% of the 10,000 annual hospital admissions,
    • neonatal infections are particularly severe,
    • infections in young adults can be life threatening
  32. Reason for pneumococcal conjugate vaccine (PCV-7)
    S. pneumo responsible for many cases of serious, invasive disease in children <5 yrs
  33. Reason for rotavirus vaccine
    • Major cause of severe gastroenteritis in children 0-5 yrs (1/80 US infants hospitalized annually),
    • highly contagious
  34. LAIV is now approved for healthy kids as young as __
    2 years
  35. Do not immunize children <__ of age against influenza
    • 6 months
    • __ allergy may be a contraindication for influenza vaccine
    • Egg
  36. Do not give LAIV to children <5 years of age with a history of __
    Wheezing
  37. Why vaccinate against influenza
    • Highly contagious,
    • 0-2 year olds at increased risk,
    • children have highest attack rate
  38. HPV vaccine (Gardasil) is recommended for __
    Females age 11-12 years
  39. HPV vaccine (Gardasil) catch-up is recommended for __
    Females 13-26 years of age
  40. Why vaccinate against HPV
    • HPV is now the most common STD in the US,
    • prevalence is highest among sexually active females <25 years of age,
    • infections occur early after onset of sexual activity,
    • infection can lead to cervical cancer
  41. What are the contraindications for vaccination
    • Severe allergic reaction,
    • pregnancy (not all),
    • known severe immunodeficiency,
    • encephalopathy or other serious neurological sequelae after DTP or DTaP,
    • influenza vaccine in patients with severe allergic reaction to eggs
  42. What is the timing for pediatric office visits
    • 2-4 day,
    • 1 month,
    • 2 month,
    • 4 month,
    • 6 month,
    • 9 month,
    • 12 month,
    • 15-18 month,
    • 2 yr,
    • Q yr
  43. Measure head circumference every visit until __
    2 years
  44. When do formal vision tests begin (tumbling E’s, picture tests)
    3-4 years
  45. __ month old should fixate on a face with eyes
    1
  46. What is the minimally acceptable visual acuity for a 3-5 y/o
    20/40
  47. What is the minimally acceptable visual acuity for a 6 y/o
    20/30
  48. Ocular malalignment
    Strabismus
  49. Loss of vision due to disuse
    Amblyopia
  50. When is the hearing screen performed
    Before discharge from the hospital
  51. When are children screened for anemia
    Minimum: 12-24 months, 4-6 yo, & once after onset of menses
  52. When are children screened for lead
    At least once between 12 and 24 months
  53. Name the 7 disorders/conditions newborns are screened for in NC
    • Amino acid disorders (including PKU),
    • fatty acid disorders,
    • organic acid disorders,
    • biotinidase deficiency,
    • hypothyroidism,
    • congenital adrenal hyperplasia,
    • sickle cell disease
  54. Most common cause of anemia
    Iron deficiency
  55. What are risk factors for anemia in children
    Low birth wt, cow’s milk, anemic mother
  56. Lead levels >__micrograms/dL is a medical emergency
    70
  57. Lead levels >__micrograms/dL causes colic, nausea, myalgia, seizures, headache, anemia
    50
  58. What is an acceptable level of lead
    <10 micrograms/dL
  59. Consider chelation at lead levels >__micrograms/dL
    25
  60. At what age should children be screened for lead
    Between 12 and 24
  61. TB skin testing can be done as early as __
    3 months
  62. Cholesterol screening can be done as early as __ for those at risk
    2 years
  63. What are risk factors for childhood hypercholesterolemia
    Parent/grandparent with CAD or MI<55yo, parent cholesterol >240, overweight, evidence of insulin resistance
  64. When should you put a child on cholesterol lowering medication (cholestyramine, colestipol)
    >10 yo with LDL >190 after diet treatment
  65. Children <__lbs should be in rear facing car seats
    20
  66. Children __lbs should be in front facing car seats
    20-40
  67. Children __lbs should be in booster seats
    40-60
  68. Children >__lbs or __ft can be in a regular lap/shoulder belt
    60, 4
  69. Vax administered SubQ
    • MMR,
    • IPV,
    • Varicella
  70. Vax administered orally
    Rotavirus
  71. Sub-periosteal swelling contained in suture lines
    Cephalohematoma
  72. Extra-periosteal swelling crosses suture lines, poorly defined
    Caput succedaneum
  73. Cephalohematoma reabsorbs within ____
    2-12 weeks
  74. Premature fusion of suture
    Craniosynostosis
  75. Treatment for torticollis
    Active and passive stretching, botulinum injections in refractory cases.
  76. When do you refer torticollis for surgical consult
    If not improved in 6 months
  77. Annular ligament entrapment due to traction. Presents as flexed and internally rotated forearm
    Radial head subluxation (nursemaid’s elbow)
  78. Treatment for nursemaid’s elbow
    Therapeutic x-ray, hyperpronation, flexion/supination/extension
  79. Treatment for polydactyly/syndactyly
    Excision at 6-9 months
  80. Stenosing tenosynovitis aka __
    Trigger finger (painful thickened flexor tendon or nodule at the A-1 pulley
  81. What is the classification of physeal fractures
    Salter-Harris
  82. What does the mnemonic SALTR stand for when referring to Salter-Harris fractures
    • S=straight (I),
    • A=above (II),
    • L=lower (III),
    • T=through (IV),
    • R=ram (V)
  83. Treatment for greenstick fx
    Reduction if needed and short arm cast for 3-4 months
  84. Buckle fracture with intact periosteum
    Torus fx
  85. Treatment for torus fx
    3-4 weeks immobilization in a short arm cast (young children need long arm cast)
  86. __ fat pad sign is usually normal
    Anterior
  87. __ fat pad sign is always pathologic and indicates supracondylar fx
    Posterior
  88. What is the most common elbow fx in children
    Supracondylar fx
  89. Which epicondyle is most commonly fractured
    Medial
  90. CRITOL
    • mnemonic for the ossification of the elbow
    • C=capitellum,
    • R=radius,
    • I= internal epicondyle,
    • T=trochlea,
    • O=olecranon,
    • L=lateral epicondyle
  91. For scoliosis monitor curves less than __
    20 degrees
  92. For scoliosis curves <__ are unlikely to progress
    20; monitor (6-12 month xrays)
  93. Scoliosis; for curves __ x-ray and bracing
    25-45 degrees
  94. Scoliosis; for curves >__ rod and grafting
    45-50 degrees
  95. When should you order an MRI for scoliosis
    Onset before 8 yo
  96. Most common place for spondylolysis
    L5
  97. Growing pains are more common in __
    • 2-5 year old boys,
    • calves most common location
  98. Osgood-schlatter is more common in __
    10-14 year old boys
  99. What should be in your differential for a limp
    • Transient synovitis,
    • septic joint,
    • Legg-Calve-Perthes,
    • SCFE,
    • fractures,
    • contusion,
    • malignancy
  100. Septic joint and osteomyelitis frequently follows __
    URI
  101. SS of septic joint/osteomyelitis
    • Fever,
    • joint or bone pain,
    • leukocytosis
  102. Common etiologic organisms for septic joint and osteomyelitis
    • Bone: GAS, S. aureus
    • Joint: H. flu, GAS, E. coli, N. gonorrhea
  103. Avascular necrosis of the femoral head, 2-11 yo, insidious groin and anterior thigh pain, limp. Loss of int and ext rotation. Mottled femoral head on x-ray
    Legg-Calve-Perthes disease
  104. Femoral head displace from femoral neck through the physis. Obese, hypogonadic, adolescent boys, presents with limp and hip/thigh, or knee pain, loss of IR, flexion/abduction; 60% bilateral
    Slipped Capital Femoral Epiphysis (SCFE)
  105. #1 bone tumor in children, pain free mass, rarely malignant
    Osteochondroma
  106. Most common foot deformity of the newborn, caused by uterine packing, can be passively corrected, self correcting by 12-18 months
    Metatarsus adductus
  107. Tibial torsion self corrects by __
    2-4 years
  108. Bow legs
    Genu varum
  109. Differential for genu varum
    Rickets, Blount’s disease
  110. Knock knees
    Genu valgum
  111. Gait appears clumsy, patellae and feet point inward, child may trip often and tends to sit in “W” position, spontaneous resolution by late childhood
    Femoral anteversion
  112. Congenital deformity, fixed ankle plantar flexion, heel inversion, varus forefoot
    Talipes equinovarus “club foot”
  113. Well localized posterior calcaneus pain along Achilles insertion, very common in 7-15 y/o
    calcaneal apophysitis (Sever’s disease)
  114. Absent longitudinal arch of foot
    Pes planus
  115. Spondylo imaging
    • Spondylolysis oblique (Scottie dog);
    • spondylolisthesis lateral (step-off sometimes seen)
  116. Intoeing DDx
    • Metatarsus adductus;
    • Tibial torsion;
    • increased femoral anteversion;
    • Genu varum
  117. Club foot epidemiology
    1:1000, M>F slightly
  118. Tx (Poseti) for club foot
    • Serial casting;
    • Surgical tendon release;
    • Night brace 2 years
  119. How many primary (deciduous) teeth
    20
  120. How many permanent teeth
    32
  121. Process by which teeth emerge into oral cavity
    Eruption
  122. First teeth to erupt
    Mandibular central incisors
  123. Teeth that are next to erupt after mandibular central incisors
    Maxillary central incisors
  124. First degree dentition are fully erupted by age __
    30 months
  125. __ is not associated with teething
    Fever
  126. Signs of teething
    Crying and drooling
  127. Process of loss of primary teeth with eruption of permanent teeth
    Exfoliation
  128. When does exfoliation usually begin
    Age 6
  129. What are some possible causes of delayed eruption/exfoliation (>6 months)
    • Genetics,
    • hypothyroidism,
    • hypopituitarism,
    • rickets
  130. What is the most common chronic disease of childhood
    Dental caries
  131. __% of US children 2-11 years have caries in primary teeth
    50
  132. Microbe most commonly associated with dental caries
    S. mutans
  133. White spot lesion of tooth
    Initial carious lesion
  134. What factors are protective against early childhood caries
    • Good salivary flow,
    • good oral hygiene,
    • balanced diet,
    • adequate fluoride
  135. Children with caries in primary teeth are __ times more likely to develop caries in their permanent teeth
    3
  136. What is the primary strategy for prevention of caries
    Improving maternal dental health
  137. Parents should supervise teeth cleaning up to age __
    6
  138. To avoid dental caries limit fruit juices to __oz/day
    4
  139. Fluoride supplements should not be used in children <__ of age
    6 months
  140. Parents should supervise use of fluoridated toothpaste in children <__ of age
    6 years
  141. No fluoride rinses in children <__ of age
    6 years
  142. ADA advises mixing infant formula with __ water
    Non-fluoridated
  143. What is recommended if your child’s fluoride exposure is unknown
    Buy fluoridated water and omit supplements
  144. When should the initial visit to the dentist take place to establish the dental home
    12-18 months
  145. When should children stop sucking their thumbs
    Age 6
  146. According to the AAP children should stop using pacifiers at age __, and according to the AAPD by age __
    1, 3
  147. Gingivitis usually occurs secondary to __
    Plaque formation
  148. Loss of dental attachment/destruction of bone
    Periodontitis
  149. What is the treatment for periodontitis
    • Surgical and non-surgical debridement,
    • antibiotic therapy
  150. Antibiotics used for odontogenic infections
    • Pen VK 25-50mg/kg/d
    • erythromycin for pen allergy
    • clindamycin
  151. Classic signs of infection/inflammation once infection has spread to pulp of tooth
    • Pain,
    • facial swelling,
    • parulis (gumboil)
  152. What do you give for pediatric dental infection SBE prophylaxis
    Amoxicillin 50mg/kg
  153. Intrusion injuries of __ teeth is most severe
    Primary maxillary front teeth
  154. Intrusions < __ have good prognosis
    3mm
  155. Severe luxations usually require __
    Extraction
  156. Mild dental injuries usually result in color change, monitor for __
    6 weeks
  157. A primary tooth that has been avulsed is usually
    Not re-implanted
  158. Immediate treatment for avulsed permanent teeth
    Handle tooth by crown only, attempt to re-implant and hold with gentle pressure.
  159. What do you do if unable to reimplant an avulsed permanent tooth
    • Do not allow to dry,
    • place in protective solution (Hank’s salt solution, milk, saline),
    • take child to dentist or ED
  160. Luxations are intrusive and require __
    Surgical or orthodontic repositioning
  161. For dental traumas update __, and give antibiotic prophylaxis
    Tetanus
  162. Children with moderate to severe bleeding disorders may need __ for oral surgeries
    Hospitalization
  163. What may you need to give children with bleeding disorders needing dental surgery
    Antifibrinolytics
  164. What defines the newborn period
    First 28 days of life
  165. Term infants are those that are born between __ weeks
    38-42
  166. What is the post natal period
    28th day to end of 1st year
  167. To what nursery level do healthy infants go
    Level 1
  168. What is a level 3 nursery
    Regional center for critical infants
  169. When is the APGAR score normally done
    1 & 5 minutes, 10 minutes in depressed infants
  170. Infant conjunctivitis is common or uncommon
    Common
  171. Most babies will lose __% of their birth wt in first 24 hours
    8-10
  172. Most babies will regain their birth wt by __
    2 weeks
  173. Normal vital signs for newborns
    • HR: 120-160
    • RR: 30-60
    • BP: 50-70 systolic
    • Record & plot Ht, Wt, HC
  174. Hematoma contained in skull suture lines
    Cephalohematoma
  175. Hematoma that crosses skull suture lines
    Caput succedaneum
  176. When does the anterior fontanelle usually close
    4-24 months, average 1 year
  177. When does the posterior fontanelle usually close
    2-4 months
  178. What is the term for premature fusion of the sutures
    Craniosynostosis
  179. Intermittent strabismus is normal up to __
    3-6 months
  180. Cloudy cornea from cataracts or glaucoma
    Leukocoria
  181. Newborns are obligate __ breathers
    Nose
  182. Hearing is fully developed by __
    1 month
  183. Macroglossia is associated with __
    Trisomy 21, Beckwith-Wiedemann
  184. Where is a branchial cleft cyst locate
    Anterior to SCM
  185. Where is a thyroglossal duct cyst located
    Neck midline
  186. Where is a cystic hygroma located
    Posterior to SCM
  187. Name some common neck masses
    Branchial cleft cyst, thyroglossal duct cyst, cystic hygroma
  188. What does APGAR stand for
    Appearance, Pulse, Grimace, Activity, Respiration
  189. What are the five components of the APGAR (not the mnemonic)
    Skin color, pulse rate, reflex irritability, muscle tone, breathing
  190. APGAR – blue all over gets a score of
    0
  191. APGAR – blue at extremities body pink gets a score of
    1
  192. APGAR – no cyanosis gets a score of
    2
  193. APGAR – absent pulse gets a score of
    0
  194. APGAR – pulse <100 gets a score of
    1
  195. APGAR - pulse > 100 gets a score of
    2
  196. APGAR – no response to stimulation gets a score of
    0
  197. APGAR – grimace/feeble cry when stimulated gets a score of
    1
  198. APGAR – sneeze/cough/pulls away when stimulated gets a score of
    2
  199. APGAR – no muscle tone gets a score of
    0
  200. APGAR – active movement gets a score of
    2
  201. APGAR – some flexion gets a score of
    1
  202. APGAR – no breathing gets a score of
    0
  203. APGAR – weak or irregular breathing gets a score of
    1
  204. APGAR – strong breathing gets a score of
    2
  205. APGAR score of __ are considered critically low
    3 and below
  206. APGAR scores of __ are considered fairly low
    4-6
  207. APGAR scores of __ are considered normal
    7-10
  208. APGAR scores are taken at __ and again at __ in depressed infants
    1 and 5 minutes, 10 minutes
  209. Umbilical cord should have __ artery to vein ratio
    2:1
  210. Eye prophylaxis to prevent GC
    Erythromycin ointment within 1 hour of birth
  211. What is given 1mg IM within 4 hours of birth to prevent hemorrhagic newborn disease
    Vitamin K
  212. What tests are done on the cord blood
    Type, Coombs test, Newborn screening, Hct, glucose
  213. Normal newborn HR
    120-160
  214. Normal newborn RR
    30-60
  215. Normal newborn BP
    50-70 systolic
  216. Birth weight decreases by __% in the first 24 hours but is regain by 2 weeks
    8-10
  217. What are the parts of the evaluation of the newborn in the nursery
    • Skin,
    • auscultation of heart and lungs,
    • palpate abdomen,
    • HEENT,
    • genitalia,
    • hips,
    • Neurologic (tone, reflexes, symmetry of movements)
  218. What are the parts of the initial care of the newborn
    • Bulb suction oropharynx,
    • support body temp,
    • eye prophylaxis to prevent GC,
    • hep B vaccine,
    • glucose testing,
    • state mandated newborn screen,
    • hearing screen,
    • cord blood eval,
    • vitamin K,
    • position (supine, or R side dependent arm extended)
  219. Cloudy cornea from cataracts or glaucoma
    Leukocoria
  220. Tachypnea in an infant is a rate >__
    60
  221. What are signs of respiratory distress in an infant
    Tachypnea, retractions, grunting
  222. Transient tachypnea of the newborn is from retained secretions, and usually resolves in __
    24-36 hours
  223. Murmurs heard at birth should be considered __ in etiology until proven otherwise
    Valvular
  224. Congenital heart disease is present in __% of infants
    0.8
  225. __ due to PACs is not uncommon in the first few days of life
    Irregular heart rate
  226. Newborn has excessive drooling and choking with attempted feeding, diagnosis made with CXR after placement of nasogastric tube, surgical treatment is required
    Tracheo-esophageal fistula
  227. Abdominal wall defect to right of umbilicus. Intestines/stomach/bladder/liver are outside the peritoneal cavity
    Gastroschisis
  228. Liver and stomach covered by peritoneum at the umbilical orifice
    Omphalocele
  229. Umbilical hernias are found in up to __% of black infants
    40
  230. Umbilical hernias <__cm usually close by age 5
    1.5
  231. What are signs that an umbilical hernia needs surgical repair
    >1.5 cm at 2 years of age, or signs of incarceration
  232. Congenital absence of intramural colonic ganglion cells in rectosigmoid. Inability of bowel complex to relax causes functional bowel obstruction. Presents in 1st 24-48 hours with failure to pass meconium, abdominal distention, and bilious vomiting
    • Hirschsprung disease;
    • dx requires rectal bx
  233. What nursery level will an infant >30 weeks and 1200 gm not requiring ventilation or circulatory support go to
    Level 2
  234. How is hypoglycemia defined in the infant
    <35-40 mg/dL
  235. By age 3 hours, glucose should be __mg/dL
    50-80
  236. What are the symptoms of infant hypoglycemia
    • Lethargy,
    • poor feeding,
    • irritability,
    • jitteriness,
    • seizures
  237. What is the treatment for infant hypoglycemia
    IV glucose D10W @ 2ml/kg
  238. Four criteria required before discharge of a newborn in 24-36 hours
    • Feeds and voids well,
    • yellow stools,
    • <10% wt loss,
    • bili levels stable;
    • ensure f/u in 48-72 hrs
  239. Neonatal mortality:
    from birth to 28th day
  240. Perinatal mortality:
    20th week of gestation to 7th day after birth
  241. LBW
    <2500 g; 7% live births & 70% neonatal mortality
  242. VLBW
    <1500 g
  243. Fetal scalp ABG of ____ indicates fetal hypoxic compromise
    <7.20
  244. Fetal scalp ABG of ____ is borderline & needs repeat test
    7.20 - 7.25
  245. Soft creamy layer on skin in preterm infants =
    • vernix caseosa;
    • also often see lanugo in preterm
  246. transient blue/black macules on lower back/buttocks in 90% AA, Indian, Asian infants
    Mongolian spots
  247. Salmon patch =
    Nevus simplex: pink macular hemangiomas; neck, eyelids, forehead
  248. Portwine stain, aka _______, consider:
    aka nevus flammeus; Sturge Weber
  249. skin feature in post term infant
    peeling skin
  250. Neonatal vision
    20/200
  251. white eye, cat eye:
    Retinoblastoma
  252. Most common congenital anomaly of nose
    • choanal atresia (stenosis);
    • poss resp distress/apnea at birth
  253. micrognathia, cleft palate, airway obstruction
    Pierre Robin syndrome
  254. Persistence or aggravation of pulmonary vasoconstriction results in:
    persistent pulmonary hypertension of the newborn (PPHN)
  255. TTN
    • Failure to replace pulmonary alveolar fluid completely with air can lead to resp distress;
    • retained secretions;
    • usually resolves in 24-36 hrs
  256. Periodic breathing
    normal crescendo breathing followed by a brief apneic period
  257. Capillary vs cavernous hemangiomas
    • capillary: raised, red lesions;
    • cav: deep blue masses;
    • Both enlarge after birth & resolve at 1-4 yo;
    • may produce high-output heart failure or plt trapping/ hemorrhage
  258. Erythema toxicum:
    • erythematous, papular-vesicular rash;
    • common in neonates;
    • involves eosinophils in the vesicular fluid
  259. Pustular melanosis:
    • more common in AA;
    • small, dry vesicle on a pigmented brown macular base
  260. Bacterial infxn in newborn
    • sepsis,
    • pneumonia,
    • meningitis,
    • UTIs,
    • omphalitis
  261. Perinatal viral infxn:
    • HSV,
    • hepatitis B, C
  262. congenital infxn in newborn
    • CMV,
    • rubella,
    • varicella,
    • toxoplasmosis,
    • syphilis,
    • TB
  263. Observe infants born to GPS-positive moms for:
    48 hrs
  264. Severe cardiac defects & infection present in:
    6 hours
  265. What 6 aspects are included in a pediatric nutrition assessment
    • Medical hx,
    • anthropometric,
    • biochemical,
    • clinical,
    • dietary,
    • social
  266. Provides information about child’s physical growth. Measurements may be compared to growth charts
    Anthropometric indicators
  267. Laboratory values can provide information about a child’s macronutrients and micronutrients stores
    Biochemical indicators
  268. How much juice should a young child have per day
    No more than 4 ounces
  269. Head circumference is usually measured until what age
    3 years
  270. What children have specialty growth charts
    Those with Turner’s, Williams, Cornelia Delong or Down syndrome
  271. Until what age should you use recumbent measurements for linear growth
    36 months
  272. What measurement may be used for linear growth if a child cannot stand
    Arm span
  273. At what age is linear growth measured while standing
    3 years
  274. Infants usually double birth wt between __ months
    4-6
  275. By the first year of life birth wt is __
    Tripled
  276. Between 1-2 years average growth in stature is __
    4 ¾ inches
  277. Between 1-2 years, average growth in wt is __
    5.5-6.6 lbs
  278. After 9th to 10th year, wt increases at a rate of __
    4 kg/year
  279. Ht increases an average of __ per year until puberty
    6-8
  280. When can you introduce solids
    When the child sits with balance, ready for high chair, transfers food from front of tongue to back, 4-6 months
  281. How many calories do toddlers need
    90 calories/kg
  282. __% of children with eating disorders are male
    5
  283. The baby should be put to breast within __ post birth
    1-2 hours
  284. Precursor to milk
    Colostrum
  285. Milk transitions in between __ postpartum
    2-4 days
  286. In the case of a premature infant and infants with special needs initiate pumping within __ after delivery
    6-8 hours
  287. In the case of a premature infant and infants with special needs pump every __ hours around the clock
    3
  288. Ratio of weight ot the square of height in meters
    BMI
  289. CDC growth charts are not useful for assessing weight for height in __
    Teens
  290. What are the key nutrients to be concerned with for children on a vegetarian diet
    Calories, calcium, iron, zinc, vitamin B12
  291. Eating disorders can start as early as age
    9
  292. Childhood obesity is defined as
    Greater than 90th percentile for wt for ht, or greater than or equal to the 95th percentile BMI for age and sex
  293. What is the recommended calcium intake for 1-3 year olds
    500 mg/d
  294. What is the recommended calcium intake for 4-8 year olds
    800 mg/d
  295. What is the recommended calcium intake for 9-18 year olds
    1300 mg/d
  296. Length increases by ____ and HC by ___ in the first year
    Length 50-55% and HC 40%
  297. Teen gains about ___% of adult height and ___% of adult weight during adolescence
    • 20% of height,
    • 50% of weight
  298. Peak height velocity
    9.5-10.3 cm/year (boys); 8.4-9.0 cm/year (girls)
  299. Wt gain re: breastfed vs formula
    formula-fed infants gain wt more rapidly than breastfed, esp after 3-4 months old; higher risk for later obesity
  300. Cow's milk forumula
    Iron fortified, veg oil (fat source); CHO = lactose; casein:whey varies; 20 kcal/oz
  301. ____ formula not recommended for premature infants
    Soy
  302. Soy formula
    • CHO: sucrose/corn syrup (glucose oligomers);
    • methionine;
    • Ca & PO4 increased by 20% (to compensate for soy's interference with their absorption)
  303. Protein hydrolysate formulas: disadvantages
    • Not recommended for colic, sleeplessness or irritability;
    • expensive
  304. Formula indicated for babies with food allergies
    Amino acid-based; very expensive
  305. Amino acid-based formula composition
    CHO: corn syrup; fat: LCFA & MCT
  306. Stomach capacity FT infant
    20-90 mL; inc to 90-150 ml by 1 month of age
  307. Who is overweight/obese in NC?
    61% of adults; 27% of HS students
  308. Number of kids getting adequate calcium
    <1 in 10 girls & 1 in 4 boys (9-13 yo)
  309. Therapeutic formulas: to treat:
    digestive and absorptive insufficiency or protein hypersensitivity
  310. After 2 y.o., fat should be ___% of diet
    20-30%
  311. Marasmus sx
    • <70% of IBW;
    • emaciation;
    • loss of mx mass/subQ fat;
    • dry skin/hair;
    • atrophy of the filiform papillae of the tongue;
    • monilial stomatitis;
    • bradycardia, hypothermia
  312. Kwashiorkor =
    • hypoalbuminemic,
    • edematous malnutrition;
    • inadequate protein intake
  313. Kwashiorkor sx
    • <60-80% IBW;
    • maintenance of subQ fat & mx mass atrophy;
    • Flag sx (hair color changes: band);
    • hyperpigmented hyperkeratosis;
    • red macular rash (pellagroid) trunk/ext;
    • flaky paint rash
  314. B vitamin deficiencies & sequelae
    • B1 beriberi (BF kids <4 mos w/EtOH mom);
    • B3 pellagra;
    • B6 seizures;
    • B12 pernicious anemia
  315. Strict vegetarians need:
    B12 supplement
  316. Vit K prophylaxis at birth is to prevent:
    HDN
  317. vitamin ADEK deficiencies
    • A xerophthalmia (night blind, xerosis conjunctiva/cornea);
    • D rickets/ craniotabes;
    • E neuropathy;
    • K
  318. 7 essential minerals:
    • Ca,
    • PO4,
    • Mg,
    • Na,
    • P,
    • Cl,
    • S
  319. Don't give fluoride before:
    6 months
  320. Most abundant major mineral
    Calcium
  321. Rectal temp is mandatory under age __, and ideal up to age __
    • 1, 3;
    • do not routinely perform on older child (check oral, axillary, tympanic)
  322. Blood pressures start at age __
    3
  323. What is the normal range for body temperature
    97 to 100.3
  324. What is the normal RR in early childhood
    20-40
  325. What is the normal RR in late childhood
    15-25
  326. RR approaches adult level by __ of age
    15 years
  327. What is the average HR for ages 1-2
    110 (70-150)
  328. What is the average HR for ages 2-6
    103 (68-138)
  329. What is the average HR for ages 6-10
    95 (65-125)
  330. Where do you measure head circumference
    Measure over occiput and just above eyebrows
  331. For how long do you measure head circumference
    Up to age 2 at each well child visit
  332. A child with a BMI between 85th and 95th percentile are considered __
    Overweight
  333. A child with a BMI under __ percentile is considered underweight
    5th
  334. Screen visual acuity at every well exam starting at age __
    3
  335. How do you position the ear to straighten the canal for otoscopic examination
    Pull up and posterior
  336. Characteristic of murmurs that are not innocent
    Loud, harsh, or heard in diastole, change with provocative maneuvers
  337. __% of neonates have an undescended testis
    3
  338. __ of undescended testis resolve by 1 year
    2-3
  339. Flat feet are normal until age __
    3
  340. What is the least threatening and best restraining position for a child to be in during the otoscopic exam
    Parent’s lap (can be done supine)
  341. How do you straighten the ear canal in a child
    Pull ear up and posterior
  342. __ is more reliable sign of meningitis in children than classic meningeal signs
    Nuchal rigidity
  343. __ of adolescent boys develop gynecomastia, usually resolves when wt is addressed
    2/3
  344. Up to __% of all children have heart murmurs
    50; systolic, short; Grade 3 or less; loudest at LSB
  345. Toddlers and young children have __ abdomens
    Protuberant
  346. Many umbilical hernias resolve by age __
    • 2;
    • common in kids (esp AA);
    • Auscultation: metallic tinkling every 10-30 seconds
  347. When should you do a speculum exam on a female child
    Only when there is a specific problem
  348. __% of male neonates have an undescended testis
    3
  349. 2/3 of undescended testes resolve in by __
    1 year
  350. Urethral orifice appears at some point along ventral surface of glans or shaft of penis
    Hypospadias
  351. Serous fluid swelling in scrotum, will transilluminate unlike a hernia
    Hydrocele
  352. Enlargement of veins in the scrotum
    Varicocele; usually after puberty
  353. Varicoceles, although usually benign, warrant __, as sterility could be a problem, especially if found before puberty
    A urology referral
  354. When should a pediatric rectal exam be performed
    If intraabdominal, pelvic or rectal disease is suspected (severe constipation, stool impaction, rashes, rectal bleeding)
  355. Genu varum (bow legs) usually self corrects by __ of age
    2 years
  356. Genu valgum (knock knees) usually self corrects by __ of age
    4 years
  357. True foot deformities do not __ with manipulation
    Return to neutral position
  358. BP normal if:
    • SBP & DBP <90th percentile for sex, age, ht;
    • if high, measure on at least 3 separate occasions
  359. high normal BP:
    average SBP and/or DBP for age, sex and height in 90-95th percentile
  360. high BP:
    average SBP and/or DBP for age, sex and height ≥ 95th percentile
  361. Measuring ht & wt
    • wt: infant scale up to 1 yo (weigh naked, same scale each time);
    • ht supine to 2 yo
  362. BMI used for age:
    2-21 yo
  363. Abnormal BMI: 1st step of investigation =
    Remeasure
  364. Rashes: common causes:
    • bacterial infxn;
    • atopic or contact dermatitis;
    • dermatophytic infection
  365. Normal visual acuity
    • 1 yr: 20/200;
    • <4 yrs: 20/40;
    • >4 yrs: 20/30
  366. Neck exam: kids > 1 year:
    exam same as adult
  367. In kids, sinus arrhythmia is:
    Normal
  368. abdomen exam
    • may palpate for TTP/rigidity while pt sitting on mom’s lap;
    • on table, supine w/knees & hips flexed;
    • liver & spleen tip often palpable;
    • palpate areas of concern/complaint last
  369. Tanner 1: breast devt
    Elevation of papilla only
  370. Tanner 2: breast devt
    Breast buds: areola projects
  371. Tanner 3: breast devt
    Enlargement of breast only
  372. Tanner 4: breast devt
    Enlargement & projection of areola & papilla as secondary mound
  373. Tanner 5: breast devt
    Adult breast; areola no longer projects separately from breast
  374. Tanner 1: pubic hair devt
    No pubic hair
  375. Tanner 2: pubic hair devt
    Straight hair along labia
  376. Tanner 3: pubic hair devt
    Increased quantity, darker, present in triangle shape
  377. Tanner 4: pubic hair devt
    More dense, curled and adult distribution
  378. Tanner 5: pubic hair devt
    Abundant, dense to inner thigh
  379. Boys: Tanner 1
    No hair, genitalia of child
  380. Boys: Tanner 2
    Light, downy hair laterally, later dark penis and testes slightly larger
  381. Boys: Tanner 3
    Hair across pubis, testes and scrotum are further enlarged, penis larger
  382. Boys: Tanner 4
    More abundant hair with curling; glans larger/ broader, scrotum darker
  383. Boys: Tanner 5
    Testes and scrotum adult size
  384. For __% of athletes preparticipation evaluation is their only health care contact
    78
  385. Preparticipation evaluations should take place at least __ prior to practice to allow time for referrals and rehab
    6 weeks
  386. Routine labs recommended for preparticipation evaluation
    None unless indicated by medical condition
  387. Marfan’s Syndrome causes __% of sudden cardiac death
    5
  388. Congenital coronary artery abnormality causes __% of sudden death
    19
  389. Hypertrophic cardiomyopathy causes __% of sudden death
    36
  390. Hypertrophic cardiomyopathy is found in __% of the population
    0.02 – 0.2
  391. What is the first indication of hypertrophic cardiomyopathy
    Sudden death
  392. Common inhaled asthma meds that are accepted by NCAA and IOC
    Albuterol, terbutaline, Serevent, cromolyn, inhaled steroids
  393. What cardiac murmurs need follow up
    • All murmurs >3/6,
    • diastolic murmurs,
    • murmurs that increase with Valsalva
  394. Murmur of hypertrophic cardiomyopathy increases or decreases with Valsalva
    Increases
  395. What is the cause of the murmur associated with hypertrophic cardiomyopathy
    Hypertrophy and stiffness of the left ventricle
  396. Murmur associated with hypertrophic cardiomyopathy __ with squatting and __ when the patient stands
    Decreases, increases
  397. What is the characteristic of hypertrophic cardiomyopathy murmur
    Systolic crescendo-decrescendo , heard best between apex and LSB, radiates to axilla but not to neck
  398. Why is Marfan’s syndrome associated with sudden death
    Rupture of thoracic aortic aneurysm
  399. What is the stigmata of Marfan’s
    • tall/thin, long extremities,
    • hands and feet (arm span greater than height).
    • Sparse muscle mass,
    • pectus deformities,
    • hyperextensible joints,
    • pes planus
  400. What constitutes the two minute orthopedic exam
    • Inspect symmetry,
    • neck ROM,
    • resist shoulder shrug/abduction,
    • internal/external shoulder rotation,
    • elbow flexion/extension, pronation/supination,
    • clench/spread fingers,
    • back extension,
    • back flexion,
    • contract quads,
    • duck walk,
    • heel and toe standing
  401. “stingers”
    stretch or compression injury of brachial plexus (C5-T1)
  402. When is it OK to play with a stretch or compression injury of the brachial plexus
    First episode, no neurologic symptoms
  403. What is post concussion syndrome
    • Headache,
    • dizziness,
    • N/V,
    • memory/attention deficit,
    • may not play until resolve (up to 6 months)
  404. Grade __ concussion= no LOC, confusion <15 min
    1
  405. Grade __ concussion= no LOC, confusion >15 min
    2
  406. Grade __ concussion= any LOC
    3
  407. How soon after a grade 1 concussion can a player get back in the game
    If symptoms clear in 15 min
  408. How many grade one concussions does it take to remove a player from the game
    Remove after the second one
  409. When can a player with a grade 2 concussion reenter the game
    • May not return that day, r
    • eturn with negative neuro exam and asymptomatic after 1 week
  410. Treat a grade 3 concussion as a __ injury
    C spine
  411. What is asthma
    • Airway inflammation,
    • airway hyperreactivity,
    • reversible airway obstruction
  412. What are the symptoms of asthma
    • Wheezing,
    • coughing,
    • chest tightness or pain,
    • shortness of breath
  413. What parts of the physical exam do you include for a child with asthma
    • Pulmonary,
    • HEENT,
    • skin,
    • extremities
  414. What should be in your differential for chronic asthma
    • Anatomic abnormality,
    • infection,
    • foreign body,
    • cystic fibrosis,
    • gastroesophageal reflux,
    • bronchopulmonary dysplasia,
    • pulmonary edema,
    • laryngeal dysfunction
  415. What are the indications to get a chest x-ray when evaluating for asthma
    • Atypical presentation,
    • asymmetric breath sounds,
    • suspicion of foreign body,
    • lack of clinical improvement,
    • worsening of clinical course,
    • persistent oxygen requirement
  416. What is the ideal asthma management
    Daily anti-inflammatory agent plus PRN bronchodilator agent
  417. What are the types of bronchodilators
    • Methylxanthine derivatives,
    • beta-2 agonists,
    • anti-cholinergics
  418. What are the types of anti-inflammatories used for asthma
    • Mast cell stabilizers,
    • steroids,
    • leukotriene inhibitors,
    • anti-IgE antibodies
  419. What are the beta-2 agonists
    • Albuterol,
    • levalbuterol (Xopenex),
    • salmeterol (Serevent)
  420. What are the anti-cholinergics
    Atropine, ipratropium (Atrovent)
  421. What are the mast cell stabilizers
    • Cromolyn (Intal),
    • nedocromil (tilade)
  422. What are the inhaled steroids
    • Beclomethasone (Qvar),
    • triamcinolone (Azmacort),
    • flunisolide (Aerobid),
    • fluticasone (Flovent),
    • budesonide (Pulmicort)
  423. Name two combo therapies for asthma
    • Advair (fluticasone and salmeterol),
    • Symbicort (budesonide and formoterol)
  424. What are systemic steroids useful for when treating asthma
    Acute attacks
  425. How long should a patient be on systemic steroids for a mild to moderate flare
    3-5 days with no taper
  426. How long should a patient be on systemic steroids for a moderate to sever flare
    5 days with taper as per clinical course
  427. What are the short term side effects of systemic steroids
    Increased appetite, wt gain, fluid retention, irritability
  428. What are the long term side effects of systemic steroids
    • Growth suppression,
    • adrenal suppression,
    • immunosuppression,
    • decreased bone density,
    • hypertension,
    • diabetes,
    • glaucoma,
    • cataracts
  429. What is the best way to asses inhaler canister fullness
    Count the number of uses
  430. What are inaccurate methods for determining canister fullness
    Weight, sound, bone dry
  431. Peak flow meters are very useful for __
    Following lung function at home
  432. Peak flow reading of __ is in the green zone
    >80%
  433. Peak flow reading of __ is in the yellow zone
    50-80%
  434. Peak flow reading of __ is in the red zone
    <50%
  435. What may be the possible reason for a patient on what appears to be a good asthma treatment plan that is still doing poorly
    • Not enough medication,
    • confounding feature (allergies, GERD, CF),
    • wrong diagnosis,
    • suboptimal medication delivery (poor technique, poor adherence)
  436. When should you refer your allergy patient
    • Acute life threatening attack,
    • moderate to severe asthma,
    • steroid dependent,
    • atypical/complicated asthma,
    • poor response to optimal therapy,
    • confounding variables,
    • more complicated diagnostic studies required
  437. __% of the pediatric population experiences sleep apnea
    7-10
  438. What is the male female ration for sleep apnea in children before the onset of puberty
    Male=female
  439. What is the treatment plan for primary snoring
    No intervention
  440. Partial to complete upper airway obstruction during sleep, associated with O2 desaturations and or CO2 elevations
    Obstructive sleep apnea syndrome
  441. __% of the pediatric population experiences obstructive sleep apnea syndrome
    1-3
  442. Pediatric obstructive sleep apnea syndrome peaks at ages __
    2-7 years
  443. What are the possible etiologies of pediatric obstructive sleep apnea
    • Enlarged tonsils and or adenoids,
    • obesity,
    • craniofacial abnormalities,
    • nasal polyps,
    • chronic allergic rhinitis,
    • pharyngeal infections
  444. What are some complications of pediatric obstructive sleep apnea
    • Pulmonary hypertension,
    • developmental delay,
    • growth retardation,
    • death,
    • cor pulmonale,
    • behavioral problems,
    • failure to thrive
  445. Symptoms of obstructive sleep apnea while asleep
    • Snoring,
    • observed apnea,
    • resuscitative gasps,
    • disturbed or restless sleep,
    • paradoxical chest wall movements,
    • observed difficulty breathing, enuresis
  446. Symptoms of obstructive sleep apnea while asleep
    • Mouth breathing,
    • nasal obstruction,
    • excessive daytime tiredness,
    • behavioral problems,
    • hyperactivity trouble concentrating
  447. What are the respiratory parameters for obstructive apnea in children
    Obstructive apnea for 2 or more breaths
  448. What are the respiratory parameters for obstructive apnea in adults
    Obstructive apnea for >10 seconds
  449. What is the respiratory parameter for central apnea
    • Central apnea for > or = 20 seconds,
    • any central apnea associated with an O2 desat >4% and or bradycardia
  450. What is the parameter for hypopnea
    Decreased in measured airflow of > or = 50%
  451. The apnea index for children is >__ apneas/hour
    1
  452. The apnea index for adults is > __ apneas/hour
    5-10
  453. Treatment options for pediatric obstructive sleep apnea
    • Observation,
    • surgery,
    • wt loss,
    • CPAP,
    • dental appliance,
    • medication
  454. What are indications for surgery for obstructive sleep apnea
    • Failed CPAP therapy,
    • patient not a candidate for CPAP therapy,
    • surgically amenable problem
  455. What is the key to successful surgery with obstructive sleep apnea
    Correctly identifying the area of obstruction
  456. What are the causes of obstruction in the nasopharynx
    • Turbinate enlargement,
    • deviated septum,
    • nasal polyps
  457. What are the causes of obstruction in the oropharynx
    • Tonsillar hypertrophy,
    • adenohypertrophy,
    • macroglossia,
    • adipose tissue
  458. What are the causes of obstruction in the hypopharynx
    Adipose tissue, macroglossia, mandibular size or structure abnormalities (micro/retrognathia)
  459. What is the most common obstructive sleep apnea surgery in children
    Adenotonsillectomy
  460. What are the advantages of adenotonsillectomy
    • High safety record,
    • very common,
    • outpatient procedure,
    • curative in many cases
  461. What are the disadvantages of adenotonsillectomy
    • Pain,
    • dehydration,
    • bleeding,
    • post-op swelling can transiently worsen obstructive sleep apnea,
    • adenoids can grow back
  462. Number of apneas decreases by up to __% for each 10% decrease in wt
    50
  463. CPAP complications
    • Nasal/oral dryness,
    • epistaxis,
    • nasal congestion,
    • sneezing,
    • rhinorrhea,
    • sinusitis,
    • claustrophobia,
    • mask irritation,
    • nasal abrasions,
    • aerophagy,
    • facial deformities,
    • decreased cardiac output
  464. Medications used for treatment of obstructive sleep apnea
    • Oxygen,
    • thyroxine,
    • theophylline,
    • acetazolamide,
    • medroxyprogesterone,
    • antidepressants (SSRI, tricyclic)
  465. What is the main difference between the treatment of adult vs pediatric obstructive sleep apnea
    Surgery is comes before CPAP, and wt loss in for children
  466. What is the difference in causes of pediatric vs adult obstructive sleep apnea
    Children usually have enlarged tonsils and adenoids whereas adults are usually obese
  467. What are the criteria for not sending a snoring child to get a polysomnogram for evaluation of obstructive sleep apnea
    • Patient > 2 yo,
    • “classic” history,
    • excellent underlying health,
    • normal physical exam,
    • no underlying risk factors,
    • low risk for post-operative complications
  468. What are the indications for sending a child for polysomnography
    • Snoring,
    • witnessed apneas,
    • restless sleep,
    • excessive daytime tiredness,
    • sleep disturbances,
    • neuromuscular dz with FEV1 <40-50%,
    • poorly controlled SS dz, unexplained pulm hypertension/cor
    • pulmonale/polycythemia
  469. __% of infants develop jaundice in the 1st week
    65
  470. Jaundice that appears on days 2-3 and disappears by day 5 is __
    Physiologic jaundice
  471. __ fed babies are at higher risk for physiologic jaundice
    Breast
  472. Jaundice with bilirubin >5mg/dL
    Clinical jaundice
  473. What is the bodily progression of jaundice
    Starts at the head and moves down
  474. Elevated conjugated bilirubin, think:
    biliary atresia
  475. Unconjugated hyperbilirubinemia that results from increase in RBC destruction – antibody mediated hemolysis is Coombs __
    +
  476. Non-immune hemolysis is Coombs __
    Negative
  477. How does phototherapy work for unconjugated hyperbilirubinemia
    Unconjugated bilirubin in skin is converted to water soluble isomers that are excreted without conjugation
  478. Risks for physiologic jaundice
    preterm; affected sibling; Asian>white>AA; BF-assoc jaundice is common; tx = phototherapy
  479. Pathologic unconj bilirubinemia: causes: Increased production:
    • Increased RBC destruction d/t Ab-mediated hemolysis;
    • nonimmune = spherocytosis, G6PD, cephalohematoma, polycythemia, ileus
  480. Pathologic unconj bilirubinemia: causes: decreased conj rate
    UDPGT deficiency; Gilbert syndrome
  481. gives a direct reaction in the van den Bergh test
    Conjugated bilirubin
  482. can cross placenta & is conjugated by mom’s enzymes
    indirect/unconjugated bili
  483. Water-soluble; placenta is impermeable to:
    Direct/conjugated bili
  484. serious, rare, permanent deficiency of glucuronosyltransferase that results in severe indirect hyperbilirubinemia
    Crigler-Najjar syndrome
  485. unconj bili w/o hemolysis; usu ≤20 mg/dL
    Breast milk jaundice
  486. Jaundice >2 wks after birth =
    pathologic; prob direct bilirubinemia (DBil >2 or >20% of TBil)
  487. Begin phototherapy when indirect bili =
    16-18 mg/dL
  488. Breast milk composition
    • highly bioavailable protein;
    • essential FA;
    • LC unsat FA;
    • relatively low Na;
    • low but highly bioavailable Ca, Fe, Zn
  489. Adequate milk intake is assessed by:
    infant's voiding/ stooling patterns; well-hydrated infant voids 6-8 / day
  490. By 5 to 7 days, loose yellow stools should be passed how often:
    at least 4 times/day
  491. Bilirubin: BF vs formula
    • higher bili in BF infants;
    • bili level inversely related to feeding frequency
  492. infants w/ insufficient milk intake & poor wt gain may have increase in unconjugated bili secondary to exaggerated enteropathic circulation of bili; this is:
    Breastfeeding jaundice
  493. In older breastfed infant, prolonged elevated serum bili may be due to presence of unknown factor in milk that enhances intestinal absorption of bilirubin; this is:
    Breast milk jaundice; dx of exclusion
  494. Exclusively BF kids: supplement with:
    Vit D (200 IU/day start at 2 mos)
  495. fever, chills, and malaise, think:
    mastitis (usu d/t S. aureus)
  496. Mastitis tx
    • Dicloxicillan;
    • Oxacillin;
    • 1G ceph;
    • erythromycin;
    • Fungal: Diflucan
  497. Chronic illness: effect on BF
    • HIV: CI for BF;
    • TB,
    • syph,
    • VZV: poss restart after tx
  498. Breastfeeding is contraindicated for:
    • HIV;
    • pt on: radioactive compounds, antimetabolites, lithium, certain antithyroid drugs;
    • recreational drugs
  499. Drugs that are allowed when breastfeeding
    • methadone;
    • antidepressants: Zoloft preferred, Prozac okay
  500. Decision to breastfeed is usually made when:
    • before delivery; of
    • ten when mom feels quickening
  501. Function of Estrogen:
    • stimulates ductal system to grow;
    • levels drop at delivery
  502. Function of Progesterone:
    • Increase in pregnancy;
    • growth and size of alveoli/lobes;
    • drop at delivery/triggers milk
  503. Function of Human Placental Lactogen:
    instrumental in breast/ nipple/ areolar growth; before birth
  504. Function of Prolactin:
    Increase contributes to accelerated growth of alveoli
  505. Function of Oxytocin:
    contracts smooth mx layer of cells surrounding the alveoli to squeeze milk into ductal system
  506. breast milk volume
    • Colostrum (precursor; pro & Ab rich): 5-10 mL/ feeding;
    • milk: 750ml–1000 ml/24 hrs by 10-14 days pp
  507. Lactation: timing
    • Baby to breast within 1-2 hrs pp;
    • encourage feeding 8-12 times/24 hrs;
    • average feeding 20-40 min active sucking/ swallowing (15-20 min each breast)
  508. Frequent feedings stimulate the body to transition:
    colostrum to milk by day 3-4
  509. Foremilk & hindmilk
    • Foremilk: high vol, low fat;
    • fat content rises as feeding progresses;
    • Hindmilk: low vol, high fat
  510. easiest positions in the early post-partum period
    Football or crosslap holds
  511. 4 breastfeeding positions:
    • cradle,
    • crosslap,
    • football (clutch)(good for C/S),
    • reclining
  512. Breast milk for premature infant
    • Initiate pumping within 6-8 hrs pp;
    • pump q3 hr around the clock while establishing supply;
    • at 2 wks, goal = 20-25 oz/ 24 hr
  513. Engorgement sx
    • Gradual onset, immediately pp;
    • bilateral;
    • general heat, swelling, pain;
    • mom temp <38.4;
  514. Engorgement tx
    • Heat prior to feeding;
    • ice after;
    • cabbage leaves
  515. Mastitis sx
    • gradual or sudden onset (after 10 days);
    • local edema, heat, erythema, pain;
    • unilateral;
    • temp >38.4;
    • flulike sx
  516. Pinkish-red appearance with shiny nipples/areola; white plaques on nipples; persistently sore; think:
    Yeast
  517. Gradual onset, unilateral; no heat, swelling may shift; mild local pain; temp <38.4; think:
    Plugged duct; tx: heat/ massage/ nurse; infant's chin pointed toward plugged duct; lecithin?
  518. If breast augmentation, lactation success depends on:
    surgical technique used; potential for nerve disruption/ pressure from implant; f/u & observe for engorgement
  519. 3 C’s of measles (rubeola)
    cough, coryza, conjunctivitis
  520. Koplik’s spots
    oral lesions (enanthem) appear before rash
  521. Second dz tx
    scarlet fever; Pen VK
  522. Third dz
    rubella; postauricular & occipital adenopathy
  523. Measles vs rubella: resolution
    measles self limiting in 7-10 days; rubella in 4 days; Rx = sx for both
  524. Rubella dx:
    paired sera
  525. Rubella complication
    Arthralgia
  526. Fifth dz s/s
    • mild flu-like;
    • rash at 10-17 days (first: slapped cheeks; reappears for 2-4 wks; second: lacy on arms/legs)
  527. Fifth dz complications
    • arthralgia (symmetric poly in older);
    • fetal / 1st trimester death
  528. Caused by parvo B19, spring/summer; adol/YA; LA, fever, arthralgia, self-limiting in 1-2 wks
    Papular purpuric glove & sock syndrome
  529. Roseola (6th dz)
    Exanthem subitum; HHV6 & HHV&; 6 mos-3 yo; abrupt fever to 104 (3-7 days); Defervescence precedes rash
  530. VZV: incubation in ___ & crusts in ___; contagious for ____
    10-20 days; 3-5 days; 1 week
  531. HFMD S/S
    vesicles; poss genl scarlet rash; low fever, anorexia
  532. HFMD comps
    myocarditis, substernal chest pain, dyspnea
  533. papular acrodermatitis of childhood AKA:
    Gianotti-Crosti Syndrome
  534. Gianotti-Crosti Syndrome age onset/etiology
    • 6-14 mos (mean 2 yo);
    • EBV (poss HHV4 or hep B)
  535. Gianotti-Crosti S/S
    • symmetric red-purpuric papules and papulovesicles on face, buttocks, extremities;
    • low fever, LA; self-limiting 3-4 wks
  536. Mumps parotitis is bilateral in ___% of cases
    70%
  537. Mumps presentations
    • 2-3 wks incubation;
    • stenson duct red w/yellow d/c;
    • dx w/paired sera, clinical dx
  538. Mumps comps
    orchitis, pancreatitis, oophoritis, aseptic meningitis
  539. Viral gastroenteritis etiologies
    • rotavirus;
    • caliciviruses (includes noroviruses);
    • astroviruses ;
    • adenoviruses
  540. Bacterial gastroenteritis etiologies
    • nontyphoidal Salmonella;
    • Shigella;
    • Campylobacter;
    • E. coli (EPEC, 0157-H7)
  541. Viral gastro: explosive, watery diarrhea, N/V, fever, 2-8 days
    Rotavirus
  542. Gastroenteritis: Abx
    • recommended for Shigella or EPEC if <3 mos old;
    • NOT for Salmonella or 0157:H7
  543. Giardia may cause:
    vulvovaginitis in prepubescent girls
  544. Pearly dome shaped papules with central umbilication:
    molluscum contagiosum (poxvirus)
  545. Most at risk for bacterial meningitis:
    kids <1 y.o.
  546. bacterial meningitis: common causes in newborns
    • GBS,
    • E. Coli;
    • Klebsiella;
    • Enterobacter;
    • L. monocytogenes
  547. Viral meningitis usually due to:
    coxsackie / enterovirus (mumps is uncommon)
  548. Pinworm can cause:
    vaginitis and/or UTIs in prepubescent girls
  549. Atopy is ____ mediated
    IgE
  550. Most common of the atopic disorders
    allergic rhinitis
  551. allergic rhinitis is rare in:
    infants <6 months
  552. allergic rhinitis: Dx by:
    Clinical; allergy prick skin tests-; serum RAST tests; nasal smear eosinophilia
  553. allergic rhinitis: Tx includes:
    allergen avoidance, pharm; immunotherapy
  554. atopic dermatitis: labs
    Allergy skin tests; ImmunoCAP to specific antigens; Skin cx; Double blind food challenge
  555. Gold standard to dx food allergies
    double-blind food challenge
  556. atopic dermatitis has a strong association with ____ allergies
    food allergies
  557. Atopic dermatitis: Clinical features (Major)
    • Pruritis; rash distribution varies;
    • Relapsing nature;
    • h/o other allergic sx
  558. Atopic dermatitis: acute lesions
    • poorly defined papules, patches and plaques;
    • +/- scale;
    • edema, erythema and excoriation
  559. Atopic dermatitis: chronic lesions
    skin thickening (lichenification) , hyperpigmentation
  560. Atopic dermatitis: Clinical features (minor)
    • xerosis;
    • hyperlinear palms;
    • infraorbital shiners (Dennie lines);
    • food intolerances;
    • secondary cutaneous infxn (SA, MRSA, HSV);
    • wool intolerance;
    • increased itch with sweating
  561. allergic rhinitis DDx
    • sinusitis;
    • rhinitis medicamentosa;
    • local (polyp, deviated septum, adenoid, foreign body);
    • vasomotor rhinitis
  562. atopic dermatitis DDx
    • seborrhea;
    • contact dermatitis (nickel);
    • scabies
  563. allergic rhinitis DDx
    • sinusitis (HA, purulent d/c, PND);
    • rhinitis medicamentosa;
    • local (polyps, deviated, FB);
    • vasomotor
  564. Seasonal allergies usu present at age:
    >3 yrs
  565. Six foods cause 90% of food allergy in children:
    Milk, egg, peanut, wheat, soy, tree nuts
  566. ImmunoCap test: No proven value of food specific:
    IgG levels
  567. Food allergy: tx
    • eliminate offending food; pt education;
    • Medic Alert bracelet;
    • emergency plan;
    • Epi Pen
  568. Which allergies usually resolve by 10-12 yo & which persist?
    • Milk, egg, wheat, soy resolve;
    • tree nuts, peanut, & seafood persist into adulthood
  569. Food anaphylaxis
    • 150 deaths/year;
    • peanut, tree nut, shellfish;
    • biphasic rxn;
    • lack of cutaneous sx
  570. Food allergies: effectiveness not established for:
    • breastfeeding >6 mos;
    • maternal diet restrictions;
    • delayed intro of allergic foods;
    • hypoallergenic formulas
  571. Oral allergy syndrome: usually with:
    • fresh fruits/veg;
    • cross-reactive proteins in pollen & food
  572. Potentially life threatening =
    <3 mos; 101F (38.3C)
  573. Viral rhinitis (3-8/yr): etiology
    • rhino, corona;
    • more bronchial = adenovirus, RSV
  574. Viral rhinitis (50% of URIs) transmission
    hand, inhaled droplet; incubation 2-5 days; sx resolve 5-7 days
  575. Viral rhinitis tx
    • tylenol; ibuprofen if >6 mos;
    • no ASA; sudafed/ phenylephrine;
    • poss Afrin >2 yo;
    • DM for cough;
    • No Role for antihistamines
  576. FDA: viral rhinitis tx
    no cough/cold meds for kids <2 yo
  577. Purulent rhinitis s/s
    • persistent mucopurulent nasal d/c and irreg fever;
    • often GAS / SP
  578. Strep tx
    Amox; clinda for tx failure
  579. Sinus devt
    • maxil / ethmoid dz most common;
    • fully formed at birth (clinical dz at 6 mos);
    • sphenoid 7-8 yrs;
    • frontal early teens
  580. Rhinosinusitis: 2 presentations in kids
    • 1: ≥10 days nasal congestion, purulent nasal drainage and/or persistent cough;
    • 2: abrupt onset w/ fever >101F, facial pain & purulent nasal drainage
  581. Rhinosinusitis agents:
    Big 3, esp SP (declining)
  582. Chronic Rhinosinusitis agents:
    • alpha-hemolytic strep;
    • SA;
    • anaerobes
  583. Mild-mod Rhinosinusitis tx
    • Amox (10-14 d);
    • if allergy, 3G ceph or macrolide
  584. Severe Rhinosinusitis tx
    Augmentin; macro or ceph
  585. Frontal osteomyelitis secondary to frontal sinusitis =
    • Pott puffy tumor;
    • surgical drainage & IV Abx
  586. Rhinosinusitis: indications for referral
    • need surgical drainage;
    • need polypectomy;
    • recurrent sinusitis (esp w/ exacerbation of asthma);
    • rare/ resistant microbe;
    • intracranial or orbital complications;
    • suspected immunodeficiency
  587. AOM most common in:
    • boys; formula-fed;
    • winter;
    • 6 mos-3 yo (esp 6-12 mos);
    • 2nd peak at 5 yo
  588. AOM agents
    • Big 3
    • GAS;
    • RSV,
    • rhino,
    • CMV
  589. AOM in assoc w/conjunctivitis, think:
    H flu
  590. AOM: ABx for:
    febrile children and those < 2 years
  591. AOM: PRSP RFs
    • Recurrent tx w/beta-lactams;
    • Recurrent AOM;
    • Day care;
    • Winter; age <2 years
  592. AOM: indication for tubes
    bilateral effusion for 3 mos AND a bilateral hearing deficiency
  593. Flu incubation
    1-4 days post-exposure
  594. Flu presentation in kids
    • croup,
    • bronchiolitis,
    • GI upset,
    • conjunctivitis,
    • OM;
    • sore throat,
    • nasal congestion,
    • conjunctivitis,
    • nonproductive cough
  595. Flu: comps
    • Pneumonia;
    • Myositis;
    • Myocarditis, pericarditis;
    • Aseptic meningitis;
    • Encephalitis;
    • Reye syndrome;
    • Guillain-Barré syndrome
  596. Flu: dx
    • Epidemiologic;
    • Virus isolation or antigen detection; Serologic
  597. Most common clinical manifestation of acute upper airway obstruction:
    Croup
  598. Croup presentation
    • stridor, barking seal;
    • worse at night;
    • winter;
    • 6 mos-3 yo; males;
    • Parainfluenza;
    • high RR, rales, rhonchi, retractions;
    • steeple sx
  599. Prolonged expiratory phase, hyper-resonance to percussion, & wheezing =
    Bronchiolitis
  600. Bronchiolitis presentation
    • <2 yo (peak 6 mos);
    • M>F;
    • winter;
    • if cardiopulmonary dz / immunodeficiency: more severe dz;
    • concurrent URI;
    • low fever
  601. Bronchiolitis agent
    RSV or HMPV (also poss PIV, flu or adeno)
  602. Premies w/bronchiolitis often have:
    apneic spells as presenting sx
  603. Bronchiolitis: X-ray may show:
    hyperinflation, atelectasis and infiltrates
  604. Croup/bronchiolitis tx
    • supportive;
    • cool mist humidification;
    • pulse ox, O2 if hypoxemia;
    • poss bronchodilators
  605. Pneumonia RFs
    • CHD/ lung dz; CF;
    • asthma; SCD;
    • immunodeficiency syndromes
  606. Pneumonia: viral causes
    • more common in kids <5 yo;
    • RSV, PIVs, Influenza, Adenovirus
  607. Pneumonia: viral causes in neonates:
    consider CMV, Herpes, rubella
  608. Pneumonia: bac causes if <1 month old
    GBS, SA, gram neg enteric bacilli; T. pallidum; Listeria
  609. Pneumonia: bac causes for 1 month-5 yo
    • SP (most common);
    • H flu;
    • GAS;
    • SA (&MRSA);
    • M. pneumo;
    • C. pneumoniae
  610. Pneumonia: bac causes for >5 yo
    • M pneumo most common;
    • SP, C pneumo;
    • TB
  611. Less common bac causes of pneumonia
    • C trachomatis (afebrile pneumo in 2 wks-3 mos);
    • pertussis, PCP
  612. Pneumonia: dx
    • CXR = segmental infiltrates, atelectasis, pleural effusions;
    • poss empyema;
    • blood cx pos in 10-30% of bac
  613. Viral pneumonia s/s
    • tachypnea, retractions, nasal flaring & use of accessory mx;
    • diffuse rales, wheezing;
    • CXR diffuse interstitial infiltrates & hyperinflation
  614. M pneumo findings
    • CXR interstitial or bronchopneumonic infiltrates, frequently in the middle or lower lobes;
    • Fever, cough, HA, malaise;
    • sore throat / OM
  615. Sporadic UTI =
    ≤ 1 UTI/6 mos and ≤ 2 UTIs/year
  616. Recurrent UTI
    • ≥ 2 UTIs/6 mos or ≥ 3 UTIs /year;
    • Relapse / Reinfection
  617. UTI epidemiology
    • M>F until 6 mos;
    • after 6 mos, F>M;
    • by 2 yo, M:F 1:10
  618. UTI prevalence in older
    • 2-18 yo: 0.1-0.5% M, 1-5% F;
    • adult F 1-3%
  619. UTI s/s in newborns
    • Fever,
    • Sepsis,
    • Jaundice,
    • Vomiting,
    • Failure to thrive
  620. UTI s/s in infants/preschool
    • Fever,
    • Vomiting,
    • FTT,
    • Diarrhea,
    • Abd/ flank pain,
    • New onset incontinence;
    • Dysuria;
    • Urgency
  621. UTI s/s in school age
    • Fever;
    • Vomiting;
    • Abd/ flank pain;
    • New onset incontinence;
    • Dysuria;
    • Urgency;
    • Frequency
  622. UTI dx
    • UA & UCC;
    • Blood tests;
    • Radiologic studies
  623. UA for UTI: LE & nitrite
    • LE: about 80% sens/spec;
    • nitrite 50% sens, 98% spec
  624. RBC casts
    Glomerulonephritis
  625. Positive UCC =
    • >100K if clean catch;
    • >10K if cath;
    • any growth if suprapubic
  626. UTI blood labs
    • CBC/diff;
    • chem;
    • blood cx;
    • CRP
  627. Distinguish upper vs lower UTI by:
    clinical judgement
  628. UTI orgs
    • E coli no. 1;
    • Klebsiella 2nd most common;
    • proteus M>F
  629. UTI orgs uncommon in kids
    Enterococci (uncommon >1 month); coag neg staph, SA; GBS
  630. Cystitis tx
    • TMP/SMX;
    • Cephalosporins (cephalexin, cefixime);
    • Amox (?with clavulanate);
    • 7 – 10 days
  631. Fn of US & VCUG
    • US: anatomy;
    • VCUG: check for vesicoureteral reflux (Normal to Grade V)
  632. Reflux
    • 30% familial;
    • Abx, surg (Reimplantation; Endoscopic placement of bulking agent)
  633. Pts 2 mos-2 yo who don’t have expected clinical response within 2 days:
    • US ASAP;
    • VCUG or RNC at earliest convenience
  634. Pts 2 mos-2 yo with expected clinical response within 2 days:
    • US at earliest convenient time;
    • VCUG or RNC strongly encouraged
  635. most common reason for transfusion in NICU
    Removal of blood for lab testing
  636. Neonatal tests
    • Newborn screen,
    • blood type & screen / DAT,
    • Bili,
    • Glucose,
    • TORCH,
    • Hemoglobin
  637. TORCH =
    • Toxoplasmosis;
    • Other (syphilis, varicella zoster, parvovirus, HIV, Hep B, Borrelia burgdorferi);
    • Rubella;
    • Cytomegalovirus (CMV);
    • Herpes Simplex (HSV)
  638. Newborn screen: all states:
    PKU, congenital hypothyroidism
  639. Newborn screen: most states also test for:
    galactosemia, MSUD
  640. Info on newborn screen State Lab slip:
    • Date, time, feeding source;
    • dry paper 3 hrs flat surface, mail to lab within 24 hrs
  641. False negative PKU if:
    • if tested prior to 24 hours of age;
    • if so (or untested at d/c from hosp), retest within 7 days
  642. NC newborn screen:
    • Amino acid disorders (7);
    • Organic acid disorders (10);
    • Fatty acid oxidation disorders (8);
    • Other (10)
  643. blood type & DAT if:
    mom is type O or Rh neg
  644. Pos Ab screen vs pos DAT
    • AB screen = passive mom Ab;
    • DAT = mom Ab attached to infant RBCs (HDN)
  645. confirm & tx infant if glucose is:
    <45
  646. TORCH: consider cx for:
    • rubella,
    • CMV,
    • HSV,
    • GC,
    • TB
  647. TORCH: consider Ag testing for:
    Hep B, Chlamydia
  648. TORCH: consider Ab testing:
    IgM or increasing IgG for Toxoplasmosis, syphilis, parvovirus, HIV, Borrelia)
  649. Hgb: screen at-risk neonates within:
    3-6 hrs
  650. Tests: children
    • Hgb;
    • Hgb electro;
    • Pb;
    • TST;
    • Chol/ lipids;
    • (UA if FH kidney dz)
  651. Hgb: test at-risk kids when:
    9-12 mos; 15-18 mos; q yr thru 5 yo
  652. Lead testing guidelines
    • screen at least once ideal: at 12-24 mos, repeat in 12 mos for high-risk
  653. Pb venous dx test
    • 10-19: do within 3 mos;
    • 20-44 within 1 wk;
    • retest q2-3 mos until 3 consec <10
  654. Begin TST when:
    >3 mos for high risk (repeat annually)
  655. Chol/lipid test when
    >2 yo; parent total Chol >240, FH CVD <55 yo
  656. Tests: adolescents
    • Hgb,
    • UA,
    • STI,
    • cervical ca screening
  657. UA if
    • annually if sexually active;
    • FH kidney dz
  658. STI testing:
    • If early onset,multi partner, sx, h/o CSA;
    • GC/CT, syphilis, HIV
  659. annual Pap when:
    within 3 yrs of sexual debut or h/o CSA
  660. Endotracheal tube should be located:
    below the thoracic inlet and above the carina
  661. thickening along the lateral and apical portions of the lung seen =
    pleural effusions (usu 2/2 chylothorax)
  662. UAC tip should be at:
    L3-L4 or T6-T10 (if L1-L2, risk of thrombosis)
  663. Pyloric stenosis: test of choice
    U/S: donut shaped mx (olive mass to R of umbilicus)
  664. Double bubble on xray
    duodenal atresia
  665. Most common GI emergency in premature infants
    necrotizing enterocolitis
  666. Meckel’s: if h/o bleeding:
    get nuclear medicine study
  667. Most masses in abd arise from:
    kidneys, most commonly hydronephrosis
  668. Best studies for renal fn / detail:
    IV urogram; f/u studies with US or nuclear med
  669. Most common pulmonary mass is
    round pneumonia (bac pneumo)
  670. The most common middle mediastinal mass
    Lymphadenopathy
  671. necrotizing enterocolitis: earliest radiographic finding =
    air within the bowel wall (pneumatosis)
  672. Deciduous Central Incisor
    6 - 10 months
  673. Deciduous Lateral Incisor
    10 - 16 months
  674. Deciduous Cuspid
    17 - 23 months
  675. Deciduous First Molar
    14 - 18 months
  676. Deciduous Second Molar
    23 - 31 months
  677. Permanent Central Incisor
    7 - 8 years
  678. Permanent Lateral Incisor
    8 - 10 years
  679. Permanent canine
    11 - 12 years
  680. Permanent first premolar
    10 - 11 years
  681. Permanent second premolar
    10 - 12 years
  682. Permanent first molar
    6 - 7 years
  683. Permanent second molar
    12 - 13 years
  684. Permanent third molar (wisdom)
    17 - 21 years
  685. Lower P lateral incisor
    7 - 8 years
  686. Lower P canine
    9 - 10 years
  687. Lower P second premolar
    11 - 12 years
  688. lower P first premolar
    10 - 12 years
  689. Lower P second molar
    11 - 13 years

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