Pediatrics Pretest F/c's

Front 1

Syndrome of microcephaly, smooth philtrum, small palpebral fissures, short nose, and cleft lip/palate

Back 1

FAS

Front 2

syndrome of protruding tongue, brushfield's spots, redundant neck skin, brachycephaly, small ears, clinodactyly of 5th digit

Back 2

Trisomy 21 (DS)

Front 3

Syndrome of midface hypoplasia, low nasal bridge, ocular hypertelorism, accentuated cupids bow of upper lip

Back 3

Dilantin exposure

Front 4

Syndrome of X-linked hematuria, progressive nephritis

Back 4

Alport's syndrome

Front 5

infants of diabetic mothers have increased risk for what pathologies:

Back 5

cong.heart dis, caudal regression syndrome, small left clon, LGA, hypoglycemia and hypocalcemia

Front 6

Factor associated with ncreased neurological damage due to jaundice in newborn?

Back 6

neonatal sepsis

Front 7

Sulfisoxazole mechanism of decreasing jaundice in newby

Back 7

compete with BR for binding sights on albumin; thus cause dislocation of bilirubin from tissues

Front 8

factors reducing binding of BR in brain in jaundiced newby?

Back 8

Met acidosis, Sulfisoxazole tx, phenobarbitol (INDUCES g transferase) hyperalbuminemia causing increased binding of unconj BR to album and decr free unconj BR.

Front 9

newby has cyanosis +apnea, worse with feeding, better w/crying NS in M?

Back 9

nasal catheter to check for choanal atresia

Front 10

nwby has inspiratory stridor worse with feeding, next step?

Back 10

flexible bscopy to check for laryngeo/tracheomalacia

Front 11

M/C cause of stridor in infant < 2 mo?

Back 11

congenital stridor = M/C = laryngomalacia

Front 12

M/C cause of stridor in 3mo-3y/o

Back 12

Croup = parainfl, infl, or RSV

Front 13

treatment of non-severe stridor?

Back 13

no tx; outside, cool air only (+/- mist)

Front 14

tx of severe stridor in ER?

Back 14

IM steroids, nebulized epinephrine. Do NOT depress tongue or check for gag reflex! may cause bspasm and child may die!

Front 15

causes of cong stridor <2mo?

Back 15

(laryngeomalacia >>>subglottic stenosis, vascular rings, v/c abnormality)

Front 16

all causes of non-cong stridor ie in 3mo-3y/o?

Back 16

infection w/Para, Infl, or RSV, FBA, retropharyngeal abscess, etc

Front 17

2nd child to CMV mother at risk for congenital CMV?

Back 17

No - by then mom has AB's that will cross placenta if she gets infection

Front 18

m/c cause of congenital infection?

Back 18

CMV

Front 19

syndrome of HSM, splenomegaly, jaundice, petechiae, purpura, microcephaly in MOM

Back 19

CMV

Front 20

% of toddlers becoming seropositiv CMV in day/care /

Back 20

up to 80%

Front 21

low apgars, meconium stain, and resp distress suggest what has occurred?

Back 21

asphyxia

Front 22

C/I's to breastfeeding?

Back 22

Lithium, active TB or HIV, ACUTE Hep B, neoplastic drugs, Tetx. NOT mastitis, engorgement, cracked/bleeding nipples, other AB's, or URTI in baby

Front 23

When administer VZIG (immunoglobulin) to baby?

Back 23

only if MOM had VZV inf w/in 5 d before deliv or w/in 2 d after deliv. If baby exposed during this time, also consider Acyclovir

Front 24

Hematemesis or melena in newby: NSiM?

Back 24

Apt test to check if blood is babys or mom's; if mom's no tx.

Front 25

NSiM of clinically suspected NEC in preme?

Back 25

Stop feeds, start IV fluids, order serial abd films, initiate systemic AB's

Front 26

Preme's on breastmilk will develop what?

Back 26

hypocalcemia! must supplement bmilk or form

Front 27

Primiparous mom gives birth to infant w/BR 12 mg/dL at age 36hr, and hematocrit 55%?

Back 27

ABO hemolytic disease (Mom O, baby A or B or AB) (not PCV b/c must have >65% for PCV)

Front 28

SGA more likely to have?

Back 28

congen malformations, future growth retard,neonatal asphyxia +meconium aspiration syndrome --> pthorax, pmediastinum, or pulm hemorrhage, hypoglycemia, increased hct. NOTE: LGA also may have meconium+asp due to stress of birth, as well as old placenta causing hypoxia--> [PCV with incr hematocrit and hypoglycemia due to low glycogen stores]

Front 29

PREME'S more likely to have?

Back 29

hyalin membrane dis (RDS),

Front 30

Apnea def?

Back 30

absence of respirations >20secs

Front 31

apnea in preme while feeding m/c due to?

Back 31

incompleteley developed respiratory center

Front 32

other causes of apnea?

Back 32

OSA, seizures, hypoglycemia, pulm disease (pneum, RSV, etc),

Front 33

recurrent breathing pauses of 3-10sec in low-birth-wt babies?

Back 33

Periodic breathing

Front 34

untreated cong hypothyroidism will cause?

Back 34

cretinism = retardation, poor growth, etc.

Front 35

85% of cong hypothyroidism caused by?

Back 35

sporadic thyroid dysgenesis

Front 36

Who screened for cong hypothyroidism?

Back 36

ALL babies!! tx must be given immediately if found.

Front 37

1 week old infant with R clavicle mass, suspect?

Back 37

clavicular fracture from birth

Front 38

2 types of problems may occur due to injury at birth to brachial plexus?

Back 38

Erb-Duchenne palsy (cant abduct or ext rotate arm = c5,c6), phrenic nerve paralysis = undescending diaphragm on xray and cause of resp problems); C7,8, T1 injuries causing paralysis of hand and possible Horner's... these often spont resolve;

Front 39

3 Newby head fluid findings and differentiation?

Back 39

1. Sbgaleal/subaponeurotic hemorrhage = squishy fluid filled, crossing midline or throughout entire scalp, fluid wave. Life threatening, may lose 1/3 bv and to it and cause hov shock.
2. Caput (edema) Succedaneum= firm, nonfluent, may cross midline.
3. Cephalohematoma = under periosteum of skull bones, so stops at suture lines; feels fluid-filled/fluctuant.

Front 40

Mg sulfate given to preg mother for?

Back 40

for constipation, calf cramps, preterm contraction without cervical effacement

Front 41

Normal blood glucose in FT newby first day?

Back 41

30 mg/dL

Front 42

pregnancy HTN may cause what in fetus?

Back 42

decreases uteroplacental blood flow -> fetal hypoxemia -> dec glycogen storage and increased EPO release in fetus0--> infants born w/ hypoglycemia and PCV

Front 43

PCV def in neonate?

Back 43

persistent venous Hct of >65%

Front 44

Effects of PCV in neonate?

Back 44

Hyperviscosity syndrome: jitters, sludging/thrombi in renal veins, NEC, tachypnea

Front 45

Tx of PCV in infant?

Back 45

partial exchange transfusion of saline / dilutional transfusion

Front 46

Tx of lethargic infant born to mother given local narcotic (meperidine) anasthesia?

Back 46

Naloxone; IM, IV, or intratracheal

Front 47

Birth with pea-soup amnio fluid to 42 w mom, with apneic, pale, limp baby: immediate NSiM?

Back 47

This is a post-term baby and may have chronic placental insufficiency (=LBW for gest age and wasted appearance); has higher risk for asphyxiation from meconium. Thus, must suction trachea (with n/g tube, or laryngoscope if baby is already needing intubation). Do not ventilate immediately as it may push meconium further into smaller airways.

Front 48

Silver nitrate or erthromycin prophylaxis in newby may cause?

Back 48

chemical conjunctivitis w/in 6-12 hrs of birth

Front 49

Most serious bact eye infection of newbies?

Back 49

Gon. conjunctivitis

Front 50

Gonococcal conjunctivitis presentation/ sx?

Back 50

2-5 days post birth, puffy tense eyelids, red conj., copious purulent discarge, chemosis (swelling of conj)---> may lead to blindness

Front 51

Tx of Gon. conjunctivitis?

Back 51

Prompt topical (e-mycin)AND IV AB's (cefotaxime)

Front 52

Chlamydial conjunctivitis (trachoma) presentation/sx?

Back 52

5-14 days post-birth. mucopurulent d/c, conj redness,--> +/- chlamydial pneumonia, corneal scarring (eyelids turn inwards and scratch cornea)

Front 53

Ophthalmia neonatorium 3 m/c causes

Back 53

Gon, Chlamydia trachomatis, chemical

Front 54

Chlamydial conj tx?

Back 54

Oral + topical e-mycin

Front 55

Appropriate meds for delivery for HIV + mother?

Back 55

1. Pre-delivery tx (weeks) w/antiretroviral;
2. Zidovudine for infant directly after birth

Front 56

Does IV Ig to newby prevent HIV transmission from HIV + mom?

Back 56

No

Front 57

How to tell Turner syndrome at birth?

Back 57

Low birth weight, edema over dorsum of hands and feet, and redundant skin folds at nape of neck

Front 58

Other findings in later life of Turner's syndrome?

Back 58

Sexual infantilism, streak gonads, Coarctation of aorta, hypertension, and bicuspid ao valve, horseshoe kidney, high palate

Front 59

Findings in infant of coarse, tremulous movements, harlequin color change (dependent half red, other half white, craniotabes, palpable liver?

Back 59

All these are found frequently in NORMAL infants. NO dx significance.

Front 60

Sharply demarcated, hard red lesion on cheeks, buttocks, limbs?

Back 60

Sub-cut fat necrosis (SCFN) = self-remitting, non-recurring

Front 61

2 signs of diaphragmatic hernia?

Back 61

1) scaphoid abdomen
2) passage of n/g tube goes down then up into thorax!

Front 62

Type of TE fistula dx'd later by multiple recurrent pneumonias ?

Back 62

H-shaped/type

Front 63

M/c TE fistula?

Back 63

Upper Esoph - Trachea fistula with blind end of lower esoph.

Front 64

Failure to give Vit K may cause what in infant?

Back 64

Hemorrhagic Dis of Newby: increased umbilical, GI, venipuncture, and circumcision bleeding ; incr PT time

Front 65

Bleeding time in Hem Dis of Newborn?

Back 65

Normal

Front 66

% of Hep B pts getting cirrhosis? % of Hep B infants developing cirrhosis

Back 66

10% ; 90%!

Front 67

Preg mom takes heparin for dvt...does heparin cross placenta?

Back 67

No

Front 68

preg mom takes Phenytoin. does phenytoin cause birth problems?

Back 68

Yes if taken 1st trimester

Front 69

Preg mom takes penicillin for Rheumatic Disease...does penicillin cross placenta or hurt baby?

Back 69

No

Front 70

Preg mom takes Aluminium hydroxide for acid reflux...does it harm the baby?

Back 70

no

Front 71

Preg mom takes propanolol. Can it harm the baby?

Back 71

YES - may cause IUGR, may cause low HR and inability to increase CO in asphyxiated baby

Front 72

Bilious regurg at 6 hrs old?

Back 72

duod atresia

Front 73

Bilious vomit at 3-4 days old?

Back 73

Midgut volvulus

Front 74

Non-bilious P-rojectile vomiting in 3wk-few month old?

Back 74

Pyloric stenosis

Front 75

Goat's milk for infants has inadequate what?

Back 75

Folate, iron

Front 76

Unpasteurized goats milk for infants maycause?

Back 76

brucellosis!!

Front 77

Jaundice sets in at what BR levels in neonates? kids?

Back 77

>5mg/dL in neonates, >2mg/dL
in kids

Front 78

Conjugated hyperbilirubinemia is always path or non-path?

Back 78

Pathological!

Front 79

Why in preme-s is there greater risk for kernicterus at much lower levels of unconj BR?

Back 79

Their BBB's are even less mature = increased crossing of unconj BR

Front 80

Lethargy, irritability, hypotonia, opisthotonos (arched, hyperextension of full body, seizures, mental retardation, CP, deafness may all be due to what?

Back 80

Kernicterus

Front 81

Physiologic J of Newborn begins when, peaks when, and is caused by what?

Back 81

Begins @ 24hrs, peaks @ 3rd day of life; caused by:
1) Incr. fetal RBC load + decr. fetal RBC survival time + increased enterohepatic circulation = INCREASED BREAKDOWN of RBC's by fetal macrophages in RE system
2) Immature liver = defective hepatic uptake and conj. of BR = DECREASED UPTAKE/CONJ
3) Immature liver = DECREASED BR excretion from liver

Front 82

Definitions of pathological jaundice? (jaundice that must be evaluated) (4)

Back 82

1) J at birth or in first 24hrs +
2) Increase in total BR by > .5mg/dL or >5mg/dL/day +
3) Total BR > 19.5
4) ANY conj hyperbilirubinemia ie direct BR > 2.0 mg/dL
5) prolonged jaundice >1wk FT or 2wks preme

Front 83

What is breastmilk jaundice?

Back 83

Incr. glucuronidases in breastmilk causing incr. b/d of conj. into unconjugated BR = INCREASED ABSORPTION=INCREASED ENTEROHEPATIC CIRC. ; is a pathological condition

Front 84

Unconj pathological jaundice ddx?

Back 84

1-ABO/Rh hemolytic dis of nb
2-hereditary sphero/elliptocyt.
3-drug rxn
4-Hbopathy (Sickle, a, b-thal,
5-DIC/Sepsis
6-PCV
7-cephalohematoma/bruising at birth
8- incr. e-hep circ ie intestinal obstruction, ilius
9- Bmilk jaundice
10-Gilbert';s, C-Najjar
11-Hothyroid, hypopit,
12-Enzyme def ie G6PD, PK def

Front 85

Conjugated jaundice ddx?

Back 85

1-Obstructive: Biliary atresia, chlithiasis, chdochal cyst,common duct stenosis, pcitis
2- persistent intrahepatic cholestasis
3- acquired intrahepatic cholestasis from hepatitis, VZV, EBV, CoxV, cirrhosis, drug induced, neoplasms
4- BR metabolism defects ie Dubin Johnson's (BR secretion defect), Rotor's (similar), galactosemia, disorders of AA, carb, lipid (Niemann-Pick's, Gaucher's), trisomy 18 and 21, metabolic (Wilson's, a-antitrypsin def

Front 86

Bodily assessment of BR levels?

Back 86

when reached umbilicus = 10mg/dL
when reached palms/soles > 15mg/dL

Front 87

Initial eval of jaundice?

Back 87

1) CBC (for Hct) + periph blood smear (for sph/elliptos) and reticulocyte ct,
2) determination of maternal and fetal blood types
3) Coomb's test (direct + indir)
4) BR levels unconj and conj.

Front 88

What is breast-feeding jaundice?

Back 88

Poor breastmilk production (ie after c-section) causes inadequate bowel movements = unable to remove BR from body; gets reabsorbed

Front 89

Main clinical differentiation of path jaundice from physiological jaundice?

Back 89

presence of intrauterine retardation, stigma of intrauterine infections (e.g. cataracts, microcephaly, hepatosplenomegaly etc), cephalhematoma, bruising, signs of intra ventricular hemorrhage etc.; or family history, maternal drugs

Front 90

Cleft lip + palate often has what other ENT complications?

Back 90

recurrent otitis media and hearing loss and speech difficulty

Front 91

Cleft lip repaired when? cleft palate when?

Back 91

3mo ; 5mo-5yrs old

Front 92

large head, large fontanelles, + umbilical hernia and constipation at birth?

Back 92

Congenital hypothyroidism

Front 93

Transient tachypnea of Newborn caused by?

Back 93

retained fetal lung fluid

Front 94

TTPN clinical presentation, cxray findings, and tx?

Back 94

grunting, tachypnea, retractions in FT BABY, cxr: fluid in fissures, prominent pulmonary vascular markings, and flattened diaphragms tx = supportive/ maintain O2sat

Front 95

Normal birth baby that develops into m/p peeling rash on face, palms, and soles, snuffles (serous d/c from nose +/- blood), persistent rhinitis, and hepatosplenomegaly?

Back 95

Congenital syphilis

Front 96

More obvious signs of congenital syphilis?

Back 96

Keratitis (acute inflam of cornea --> scarring --> blindness), hutchinson's teeth, mulberry molars, saddle nose (caused by persistent rhinitis!)

Front 97

Polydactyly that requires further investigation/ chrom studies?

Back 97

thumb (preaxial)- sided. Assoc w/ Trisomy 13 (patau's) and other genetic diseases

Front 98

syndrome of mental & motor challenged, polydactyly (extra digits), microcephaly, low-set ears, holoprosencephaly (failure of the forebrain to divide properly).
heart defects
structural eye defects, including microphthalmia, Peters anomaly, cataract, iris and/or fundus (coloboma), retinal dysplasia or retinal detachment, sensory nystagmus, vision loss,
cleft palate, cleft lip, meningomyelocele, omphalocele, abnormal genitalia, abnormal palm pattern
overlapping of fingers over thumb. cutis aplasia (missing portion of the skin/hair), prominent heel, kidney defects, rocker-bottom feet

Back 98

Patau's syndrome (Trisomy 13)

Front 99

recommended folate / day for preggers?

Back 99

400 ug /day

Front 100

newby with jitters, tremors, vomiting, diarrhea, and irritability?

Back 100

Born to narcotics user: w/drawing from heroin!

Front 101

Idiopathic apnea common and expected in?

Back 101

Preme's; is NOT common and should be reason for concern in full-terms

Front 102

Apnea in FT newby ddx?

Back 102

sepsis, gerd, CongHD, seizures, hypoglycemia, OSA (a/w obstruction)

Front 103

In addition to birthweight decreasing in first few days / week of life, what else also decreases in newby in this time?

Back 103

Hct also decreases as a response to increased O2. During this time the BR also increases.

Front 104

polyhydramnios immediately suspect? (3)

Back 104

1) TE fistula
2) duodenal atresia
3) trisomy 18
4) anencephaly

*T18=micrognathia, low set ears, microceph, coloboma, CHD, clenched hands, crossed legs, pectus carinatum
think: 18=Election age
Ears low set
Edwards
VS:
Patau's (T-13) = Pataus
Puberty age
Polydactyly
Rocker bottom feet

Front 105

oligohydramnios suspect?

Back 105

renal agenesis or GU obstruction

Front 106

petechia and jaundice on 2nd day of life, think?

Back 106

Congenital INFECTION +sepsis! ie syphilis, toxo, CMV, Rubella

Front 107

Workup for petechia +jaundice in 2nd day of life

Back 107

Bculture, Viral cultures, LP, Xrays of long bones (cong rubella has longitudinal striations in metaphyses...syphilis has osteochondritis or periostitis
PLUS ISOLATE INFANT since these syph, cmv, or rubella are all highly contagious

Front 108

bilateral cateracts, microphthalmia, IUGR, hmorrhagic skin lesions and systolic murmur

Back 108

Congenital RUBELLA !

Front 109

week old infant with fever and focal seizure?

Back 109

congenital HSV!

Front 110

newby with **hydrocephalus, chorioretinitis, intracranial calcifications, and anemia

Back 110

congenital TOXO!!

Front 111

Newby with **microcephaly, intracranial calcifications, chorioretinitis, hepatomegaly, and marked hyperbilirubinemia and thrombocytopenia

Back 111

congenital CMV!!

Front 112

Only TORCH infection causing heart defects?

Back 112

cong Rubella!

Front 113

most common congenital infection?

Back 113

cong CMV

Front 114

preme's with persistent O2 requirements, respiratory difficulties, abnormal cxrays, and often requiring diuretics

Back 114

BPD

Front 115

lethargy, vomiting, diarrhea, hypotonia, jaundice, hepatomegaly, FTT and cataracts

Back 115

galactosemia

Front 116

tx of galactosemia

Back 116

removal of lactose from diet (ie give soy milk)

Front 117

PKU tx?

Back 117

Special formulas w/ low phenylalanine producing agents

Front 118

dermatitis, alopecia, ataxia, hypotonia, seizures, dev delay, immunodeficiency and met acidosis?

Back 118

biotinidase deficiency (autosomal recessive trait)

Front 119

aniridia, hemihypertrophy, and flank mass?

Back 119

wilm's tumor