Peds Exam 3

Front 1

Suck/swallow is a reflexive action for infants until around what age?

Back 1

6-12 weeks

Front 2

How many oz is a newborn's stomach capacity?

Back 2

1/2 oz

Front 3

Infant's GI motility is ___________ compared to an adult's

Back 3

increased

Front 4

Infant's GI enzyme function is ___________ compared to an adult's

Back 4

decreased

Front 5

Cleft lip repair is usually done around what age

Back 5

6 months

Front 6

Cleft palate repair is usually done around what age

Back 6

by 18 months

Front 7

Tracheoesophageal fistula (TEF)

Back 7

Abnormal connection between the esophagus and trachea. Multiple different kinds. Frequently a risk for aspiration.

Front 8

Signs of TEF (tracheoesophageal fistula)

Back 8

Cyanosis, coughing, choking, drooling, food returning from nose or mouth

Front 9

When a baby is born with TEF, what is the typical intervention?

Back 9

Prompt surgical intervention to close the fistula. Likely will have a G-tube placed for the time being. May eventually have another surgery to fix the esophagus. May require TPN for some time, or at least feeding by G-tube.

Front 10

Symptoms of pyloric stenosis typically will start around what age

Back 10

2-8 weeks

Front 11

Typical presentation of pyloric stenosis

Back 11

Will start off fine, eating normally, but then start with vomiting that progressively worsens to the point of projectile exorcist vomiting. Child may still be very hungry and losing weight. Abdomen may be hard with visible peristalsis.

Front 12

The 8 week old patient has been having worsening projectile vomiting, which is tinged with bile but not bloody. Does the RN suspect pyloric stenosis?

Back 12

No. With pyloric stenosis there shouldn't be any bile in the emesis.

Front 13

Signs of intussusception

Back 13

Abrupt onset.

Pain.

Vomiting.

Currant jelly stools.

Front 14

"Currant jelly stools", i.e. stools with mucus and blood, are a big indicator of what condition?

Back 14

Intussusception

Front 15

Treatment for intussusception

Back 15

First line treatment will typically not be surgery. Will administer a barium or air enema which can both diagnose and hopefully relieve the condition somewhat. If that does not resolve it, surgery can be indicated.

Front 16

What should you look for in a patient with intussusception that will indicate that the condition has resolved?

Back 16

Normal stools

Front 17

Hirschsprung's disease

Back 17

Also called congenital aganglionic megacolon.

Condition where part of the large intestine lacks innervation, and therefor cannot function.

Front 18

Congenital diaphragmatic hernia

Back 18

Type of hernia where abdominal contents are coming up into the mediastinum. Can cause pulmonary hypoplasia (due to lungs having no space) and a very sick kid.

Front 19

Most common cause of emergent abdominal surgery in kids

Back 19

Appendicitis

Front 20

Signs/symptoms of appendicitis

Back 20

Abdominal pain, generally diffuse or around peri-umbilican region, which may eventually localize around the RLQ. Nausea, maybe fever.

Front 21

McBurney's point

Back 21

Point in the RLQ. Pain here is indicative of appendicitis.

Front 22

A patient has had severe RLQ pain and nausea for a while, and suddenly in the ER seems to suddenly be feeling much better. Is this concerning?

Back 22

Yes. Indicates a likely appendicitis that just ruptured.

Front 23

Appendicitis that results in a rupture can result in what?

Back 23

Peritonitis

Front 24

Short gut syndrome

Back 24

General term referring to a decreased ability to digest/absorb food. Can be due to loss of either intestinal structure or function. Can be acute or chronic.

Front 25

Colic

Back 25

Paroxysmal abdominal pain in infants. Typical onset is 2-6 weeks. Typical peak 6 weeks. Typically resolves by 3 months.

Front 26

Gastroesophageal reflux (GER)

Back 26

Common, affecting as much as half of all infants. Caused by stomach contents coming back up due to inappropriately relaxed sphincter.

Front 27

At what point does GER become GERD

Back 27

When it's prolonged, causes actual emesis, and results in delayed growth

Front 28

Nissen fundoplication

Back 28

procedure where part of the fundus of the stomach is wrapped around the lower end of the esophagus and stitched in place. Assists closing of the esophageal sphincter. Done to reduce GERD. Also done to treat hiatal hernia.

Front 29

Gastroenteritis

Back 29

Very common in young kids. Often viral, but can be bacterial.

Front 30

How common is gastroenteritis in young children

Back 30

Very. It's normal for most kids under 5 to get 1-2 episodes per year, even if they're healthy.

Front 31

What would be important education for the family of a kid with gastroenteritis?

Back 31

Hand washing. It'll spread easily without proper hygiene.

Front 32

Second leading cause of death worldwide in children under 5 years old

Back 32

Gastroenteritis

Front 33

What kinds of fluids should be avoided when treating gastroenteritis?

Back 33

Sugary stuff. It can cause more gas and diarrhea.

Front 34

Encopresis

Back 34

the soiling of the underwear with stool by children who are past the age of toilet training.

Front 35

Giardia

Back 35

Parasite. Protozoan that can be spread by water. Reproduce in the GI tract of animals and can cause Giardiasis.

Front 36

Pinworms

Back 36

Parasites. Once infected, eggs can be found around the anus. Any contact with this, followed by contact with the mouth, can spread the infection.

Symptoms are typically itching around the anus.

Front 37

What types of health care providers are mandated reporters?

Back 37

All licensed ones

Front 38

As an RN, during what times are you a mandated reporter?

Back 38

24/7

Front 39

A school nurse suspects child abuse. She reports it to the principal, who says that it's not enough to file a report, and orders her not to. Does the nurse still have to report it?

Back 39

Yes. Mandated reporting supersedes institutional policies.

Front 40

CPS cases considered "Emergent Response" make up what % of cases

Back 40

15-20

Front 41

CPS cases considered "Emergent Response" warrant a response within ____ hours

Back 41

24

Front 42

CPS cases considered "Emergent Response" warrant a decision on how to proceed within ____ hours

Back 42

72

Front 43

CPS cases considered "Non-emergent Response" warrant response within ____ hours

Back 43

72

Front 44

Most common presentation of physical abuse in kids

Back 44

Bruises or burns

Front 45

Leading cause of head injury in kids

Back 45

Abuse

Front 46

Is baby skin thicker or thinner than an adult's skin?

Back 46

Thinner

Front 47

How do babies absorb topical medications differently than adults?

Back 47

Their skin is thinner, so they will absorb it faster.

Front 48

A baby's __________ glands are functional, but their ________ glands are not, making them less effective at sweating.

Back 48

eccrine; aprocrine

Front 49

Eczema is also known as what

Back 49

atopic dermatitis.

Front 50

Atopic dermatitis

Back 50

Eczema. A type of inflammation of the skin (dermatitis). It results in itchy, red, swollen, and cracked skin. Clear fluid may come from the affected areas, which often thicken over time

Front 51

Contact dermatitis.

Back 51

Skin inflammation, typically on a specific area where it came into contact with an allergen/irritant.

Front 52

Diaper dermatitis

Back 52

Skin inflammation in newborns. Occurs from contact with urine, feces, moisture, or friction. Can progress to thrush.

Front 53

Seborrheic dermatitis

Back 53

Chronic, relapsing and usually mild dermatitis that occurs where there are a lot of sebaceous glands. In infants seborrheic dermatitis is called cradle cap.

Front 54

Acne

Back 54

Chronic inflammatory disorder of the pilosebaceous hair follices. Glands become clogged and inflammed.

Front 55

Impetigo

Back 55

A bacterial infection that involves the superficial skin. The most common presentation is yellowish crust on the face, arms, or legs. Less commonly there may be large blisters which affect the groin or armpits. The lesions may be painful or itchy.

Very contagious.

Front 56

A child has been diagnosed with impetigo. The parent wants to know if she should keep her son out of school for this, and for how long?

Back 56

Child should be kept out of school for 48 hours after treatment.

Front 57

Pediculosis

Back 57

Infection of lice.

Front 58

Scabies

Back 58

A contagious skin infestation by the mite Sarcoptes scabiei. The most common symptoms are severe itchiness and a pimple-like rash. Occasionally tiny burrows may be seen in the skin.

Front 59

Ringworm

Back 59

Tinea corporis. Skin infection that is caused by fungi.

Front 60

With what degree burns can the tissue regenerate, and with what degree can it not?

Back 60

1st and 2nd - tissue can regenerate.

3rd - cannot.

Front 61

What type of burns are not painful?

Back 61

Third degree (partial thickness).

Because the nerve endings have been destroyed.

Front 62

Burns to what body areas are considered major

Back 62

Face, hands, feet, perineum, and circumferential

Front 63

How can you prevent sunburns in kids <6 months of age

Back 63

Avoid prolonged sunlight, or cover them up as much as possible. Avoid a lot of sunscreen when this young, as their skin is thin.

Front 64

Around what age do teeth typically first erupt

Back 64

6 months

Front 65

The esophageal sphincter in an infant is _________ compared to adults

Back 65

more relaxed.

Babies will regurgitate more often.

Front 66

Most common cause of organic failure to thrive

Back 66

Gastroesophageal reflux

Front 67

Young kids have ________ melanin than adults

Back 67

less

Front 68

Atopic dermatitis is _______________ mediated

Back 68

immune; T-cell

Front 69

Seborrheic dermatitis is often characterized by what type of plaques

Back 69

yellow-red patches

Front 70

Can scabies be seen with the naked eye?

Back 70

No

Front 71

Types of ringworm. Tinea corporis, cruris, pedis, capitus. What do they mean.

Back 71

Body part affected.

Corporis - body.

Cruris - groin area.

Pedis - foot.

Capitus - scalp.

Front 72

Gynecomastia is caused by

Back 72

imbalance of estrogen vs testosterone

Front 73

What is the prognosis for gynecomastia

Back 73

It is typically self-limiting over 1-2 years. Will reduce on its own.

Front 74

Primary amenorrhea

Back 74

Menstrual cycles never begin. Defined as having no menstruation at all by age 14, and pt has no sex characteristics as well

Front 75

Secondary amenorrhea

Back 75

Menstrual cycles cease. Most common cause would be pregnancy, but could also be due to hormonal disturbance, anorexia, or premature menopause.

Front 76

Dysmenorrhea

Back 76

painful menstruation. Common.

Front 77

Primary vs secondary dysmenorrhea

Back 77

Primary - normal, idiopathic. Secondary - due to an underlying condition.

Front 78

Primary dysmenorrhea is often caused by what

Back 78

Prostaglandin secretion, which causes often painful uterine contracting. With primary dysmenorrhea, this process may be more active than normal.

Front 79

What is a common treatment for primary dysmenorrhea?

Back 79

An NSAID, taken right before menstruation begins. Will inhibit prostaglandin production, which will reduce painful uterine processes.

Front 80

Signs/symptoms of hypothyroidism in a newborn

Back 80

Excessive sleeping, reduced interest in nursing, poor muscle tone, low or hoarse cry, infrequent bowel movements, exaggerated jaundice, and inability to regulate body temperature

Front 81

Phenylketonuria (PKU)

Back 81

Inherited metabolism defect where the body cannot breakown phenylalanine. Almost always screened for. If untreated, can cause intellectual disability, seizure, and other mental effects.

Front 82

What is the treatment for PKU

Back 82

Keeping pt on a diet without phenylalanine as much as possible.

Front 83

When is PKU testing done?

Back 83

Easy answer is at birth, but not quite. You can't screen for it if the baby hasn't been exposed to phenylalanine yet. Thus, baby needs to feed first before testing.

Front 84

Galactosemia

Back 84

Condition characterized by inability to breakdown galactose. As galactose is one half of lactose, if the patient consumes lactose it can cause a dangerous buildup in their system. Can cause a variety of sequela.

Front 85

Fatty acid oxidation disorder

Back 85

Disorder characterized by inability to oxide fatty acids. Leaves the body unable to produce energy from fatty acid sources.

Basically, patient cannot tolerate hypoglycemia. Typically, though, they can live a normal life with dietary modification.

Front 86

Renal threshold for glucose

Back 86

180 mg/dL

Front 87

Can insulin pumps be used on little kids under 6 years old?

Back 87

Sure they can

Front 88

HA1C goals by age

Back 88

For kids <6 years, up to 8.5 may be goal. As they get to around 12 years, it should be <8. Up to 19 years, it should be <7.5.

Front 89

Why is the HA1C goal for kids higher than for adults?

Back 89

Kids dont tolerate hypoglycemia well, and being a bit more hyperglycemic is often alright. We basically dont want them getting hypoglycemic.

Front 90

The ADA suggests that diabetic kids should be able to independently poke/test themselves at what age

Back 90

8-10 years

Front 91

The ADA suggests that diabetic kids should be able to independently adjust their insulin doses and administer it at what age

Back 91

14-16 years

Front 92

Treatment procedure for hypoglycemia

Back 92

Give 15 mg of carbs and recheck in 15 minutes. If still <70, give another 15 g and wait another 15 minutes. Repeat until above 70.

Follow with a high-protein snack if their next meal is >30 min away.

If unable to remedy with PO carbs, give glucagon injection.

Front 93

A patient is hypoglycemic and is too lethargic to take anything down PO. What's the treatment option at that point?

Back 93

Glucagon injection

Front 94

Acanthosis nigricans

Back 94

Dark, velvety spots on the neck, armpits, and other areas where the skin creases. Often indicates an individual with T2DM.

Front 95

A fasting blood sugar above what indicates T2DM?

Back 95

126

Front 96

How is T2DM often initially treated in kids

Back 96

Lifestyle changes

Front 97

SIADH

Back 97

Syndrome of inappropriate antidiuretic hormone secretion. The increase in blood volume (hypervolemia) often results in dilutional hyponatremia in which the plasma sodium levels are lowered and total body fluid is increased.

Front 98

SIADH results in a/n ____________ in blood volume.

Back 98

increase

Front 99

SIADH causes ___________ urination.

Back 99

decreased

Front 100

What will a urinalysis typically show in a patient with DI?

Back 100

Low specific gravity. Typically low osmolality as well. No sugar.