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177 Cards in this Set
- Front
- Back
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polycythemia of the Newborn
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Hypoxia during labor -> Epo
(first breath will inc. pO2 to stop Epo) |
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Transient Tachypnea of the Newborn:
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C/S babies are SOB in first 3-4 hrs due to excess fluid in lungs.
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If a baby is SOB >4 hrs.
what should be considered? |
>4hrs => consider septic, Until proven otherwise
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why is Transient Tachypnea of the Newborn
is more common to C/S babies than babies that were born vaginally? |
Compression of rib cage squeezes fluid out of lung.
C/S babies do not get their lung squeezed. this why C/S babies are SOB in first 3-4 hrs due to excess fluid in lungs. |
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what stimulates the closing of the fetal circulation?
what are closed? (4) |
O2 stimulates closing of fetal circulation
=> PDA, FO, DV, umbilical aa./vv. |
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what is physiologic jaundice?
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Spleen removes all excess blood cells -> normal jaundice that peaks at day 3-4.
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what does physiologic jaundice lead to?
how does the body compensate with this? |
Leads to physiologic anemia at 2mo: Hb=6mg/ dL
=> Epo turns back on at 6mo: HbF=>HbA |
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what is the normal unconjugated bilirubinemia
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Normal: <1mg/dL, unconjugated
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if a baby has a yellow sclera. approx the bilirubin?
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>2mg/dl
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what are the DDx of jaundice? (5)
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G-6PD Deficiency
• Sepsis (bilirubin not delivered to liver) • ABO incompatibility • Hypothyroidism • Breastfeeding (E2 displaces bilirubin off albumin) jaundice but not that bad. |
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treatment for hyperbilirubinemia?
20 mg/dl? >25 mg/dl? |
• Phototherapy (20mg/dl): 270m down bilirubin to
prevent kernicterous; toxic to retina • Exchange transfusion: if bilirubin >25mg/ dl, |
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Retinopathy of prematurity:
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retrolental fibroplasia
(decreased vascularity of retina) |
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Necrotizing Enterocolitis
define complication |
GI vessels burst during feeding =>ischemic bowel
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Pneumatosis lntestinalis:
presentation management tx |
air in bowel wall
=> stop feedings, NG tube, TPN tx for anaerobes |
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What do I do? The Baby's here!
(six steps) |
>>Suction nose/mouth before deliver 2nd shoulder.
>>Place under a warmer >>Inject vitamin K >>silver nitrate and erythromycin in eyes >>Footprints >> encourage breast feeding right away |
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when the baby is delivered, why do we have
to suction the mouth and nose before the delivery of the 2nd shoulder? |
Suction nose/mouth before deliver 2nd shoulder
(avoid meconium aspiration) |
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what is the significance of putting the baby in the warmer right away after being delivered?
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Place under a warmer
(shivering => burns sugar => hypoglycemia) |
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what are silver nitrate and erythromycin drops for?
when do we use oral erythromycin? |
>>Silver nitrate in eyes to prevent Gonorrhea => opthalmia neonatorum
>>Erythromycin in eyes- prevent Chlamydia=> staccato cough, eosinophilia >>use oral erythromycin when its more than 3 weeks, to protect for disseminated cases |
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why do we need to inject vitamin K?
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prevents bleeding
(because the baby has no E. coli yet to make Vit K) |
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why do we need to take the foot prints?
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for identification (or Down's, Edward's, Patau's)
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if the baby was born with gonnorrhea due to the mother, what is the tx?
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systemic ceftriaxone
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Temperature how should it change when it goes up?
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⇧1 °: ⇧10bpm
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how should the temperature be taken?
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Rectal > Oral > Axillary
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VATER Syndrome:
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• Vertebral abnormality
• Anal (imperforate) • TE fistula • Renal |
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Neural Tube Defect Risk Factors:
management |
• Previous NTD
• Diabetes • Valproic Acid: give 4mg Folate/ day |
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Sepsis Workup: (5)
treatment |
• Blood cultures
• UA/ urine cultures • CXR • LP • Tx: Cefotaxime |
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what is an apgar score?
when does it vary? |
APGAR test: (at 1 and 5 min), normal=7+,
will vary if premature |
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how is APGAR scored?
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A = Appearance, Color
• pink= 2 • acrocyanosis (hands and feet) = 1 • central cyanosis = 0 P = Pulse: normal= l20-160 • >100 = 2 • 80-100 = 1 • <80 = 0 G = Grimace: stick something in it's nose • strong = 2 • weak = 1 • no grimace = 0 A =Activity • all extremities flexed = 2 • partially flexed = 1 • flaccid = 0 R = Respiration • strong = 2 • weak = 1 • none = 0 |
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Eye Infections: Day 1:
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Eye Infections:
Day 1: Silver nitrate => clear discharge |
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Eye Infections: Day 1-7:
dx tx |
Gonorrhea=> purulent discharge
(fx: Ceftriaxone) |
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eye infections > Day 7 and Tx
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> Day 7: Chlamydia (fx: Erythromycin)
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in what situations should mom avoid Breastfeeding?
diseases (4) congenital diseases drugs (7) |
o HIV /HAART, TB, Varicella
o Baby has Galactosemia o Chemo-/Cancer/Street Drugs/Li o Sedative/Stimulant o Metronidazole: stop breastfeeding x 24hr |
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when should mom stop breast feeding?
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Should stop by 1 y /o (when teeth come in)
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if mom is vegetarian what would the baby get?
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rickets
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how often should newborns be fed?
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Feed newborns q4hrs
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advantages of breast feeding?
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>>Bonding
>>Immunity: Lysozyme (detergent), IgA secretion (less mucosal infxn), IL-6, memory T cells >>Breast milk has less Fe, Fluoride, Fat sol vitamins, but Fe is more absorbable (⇧lactoferrin) >>Gentler proteins on GI mucosa => less bleeding |
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after post-partum day 1-5 and day 6, what is the milk made out of?
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>>Post-partum Day 1-5: colostrum (protein) + IgA
>>Post-partum Day 6: mature milk |
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how much should a baby gain weight when:
Birth: 0-2wk: 6mo: lyr: |
Birth: average- 5-7lbs
0-2 wk: weight loss due to evaporation 6mo: double weight (gain 1 lb/mo) 1 yr: triple weight (gain 3/4 mo) |
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how much formula or calories per day does a baby need?
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need 100-120cal/ kg/ day= 36oz/ day formula at birth
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what a baby can eat at..
4mo: |
rice cereal
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what can a baby eat at 6 months?
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fruits, yellow veggies
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what can a baby eat at 9 months?
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2% milk, soft table foods
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what can a baby eat at 1 year old?
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whole milk, table foods
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what can a baby develop if they are fed with protein too early?
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can get allergies/eczema
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if a food is added on the baby's diet.
how much of the formula should be subtracted? |
if add new food, subtract 4oz formula
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Choanale Atresia:
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blue when feed
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Tetrology of Fallot:
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blue with cry
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Hemangioma: define, management and tx.
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>>flat blood vessels
>>Tx: observe first, if growing rapidly, steroid injection or laser surgery if on face |
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Milia
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neonatal acne due to progesterone in utero
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Nevus Flammeus
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"stork bites" on back of neck, look like flames
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Seborrheic Dermatitis:
define tx |
red rash w/ oily skin and dry flaky hairline
(Tx: baby oil/shampoo) |
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Mongolian spots
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melanocytes on lower back (not child abuse), usually on Asian/Hispanics
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Erythema toxicum
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total body rash, eosinophils (benign), looks like flea bites
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Port Wine stain
what should they be evaluated for? |
evaluate for Sturge-weber
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Acrochordom
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skin tag
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Vaginal bleeding
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due to estrogen withdrawal from Mom
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Sacral hair
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spina bifida occulta
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DDx: cafe aulait
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NF and Mccune Albright
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what are the top 3 causes of mental Retardation:
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1) Alcohol·
2) Fragile X 3) down's |
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what bug can cause Microcephaly in a newborn?
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due to Toxoplasmosis
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Subgaleal hemorrhage: define and what are its 2 types?
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prolonged jaundice in newborns (trauma to scalp during birth)
>>Caput succedaneum >> Cephalohematoma |
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Caput succedaneum
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under scalp (edema crosses suture lines)
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Cephalohematoma
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under bone (blood not cross suture lines)
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Epstein's pearl
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white pearls on hard palate (will go away)
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Persistent eye drainage since birth
Dx Tx |
blocked duct
(Tx: gentle-massage) |
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Wide sutures
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Poor nutrition, hypothyroid, Down's
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Midline cyst
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Thyroglossal cyst
(thyroid comes down from tongue) |
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Lateral cyst
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Brachial cleft cyst
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Multiple neck cysts
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Cystic hygroma (Turner's)
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Cleft lip: what did not fuse? and Tx
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Medial nasal prominence did not fuse (reconstruct at 10wk old)
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Cleft palate:
describe what happed what kind of infection do they usually get how should they be fed? |
Maxillary shelves not fuse=>
recurrent otitis media (feed w/ long curved nipple) |
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Saddle nose
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Syphilis
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Neonatal Herpes:
what would be seen? management? |
Purulent crusted scalp blisters
(do Tzanck smear) |
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No red reflex
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Cataracts
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White reflex
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Retinoblastoma
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what is the treatment for a kid with Inguinal hernia?
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Inguinal: Operate
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Kid Hernia <1 y/o asymptomatic
Tx for Umbilical: when should a child be operated? |
Observe
surgery if >3-4 y/o, exceeds 2 cm diameter, causes symptoms, strangulated, enlarges after 1 to 2 years. |
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Kid Hernia
Tx for Hydrocele: |
Observe
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Clavicle fracture (middle 1/ 3 L clavicle):
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asymmetric Moro reflex
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Erb's palsy:
describe prognosis dx test: |
C5-6 torn => Waiter's tip,
80% recovery (Dx: MRI) |
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Klumpke's
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C8-T1 torn=> claw hand
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Supernumerary nipple
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extra nipples are always on vertical line
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Umbilical stump bleeding
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Factor 13 deficiency
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Delayed umbilical cord separation (6 wk)
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Leukocyte adhesion deficiency
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Oomphalocele
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intestines protrude out of umbilicus w / peritoneal covering
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Gastroschisis
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abdominal wall defect, intestines protrude off-center
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Wilm's tumor:
define Tx |
• Kidney tumor, aniridia,
• Hemihypertrophy: atrophy of leg on side of tumor (blood supply sucked away from leg) • Tx: Dactinomycin |
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Neuroblastoma
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adrenal medulla tumor, hypsarrhythmia, myoclonus, ⇧VMA
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Congenital Adrenal Hyperplasia:
what would you see in female and male babies |
• Females: ambiguous genetalia
• Males: premature penis development |
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Congenital hip dislocation: management, describe and tx
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• Barlow maneuver (Bend knee and hip, feel for clunk with middle finger)
-=> do US • Ortolani maneuver (Spread both hips out, feel for clunk) • Tx: Triple diapers to lift hip or Spica cast (cast legs in frog position) for 3mo |
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what are language abnormalities due to
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due-to hearing loss
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define mental retardation and how is IQ calculated?
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Mental retardation is a discrepancy between chronological age and mental age
• Approximate IQ =Mental/ Chronological x 100 |
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Rooting Reflex
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touch cheek -=> they turn toward it
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Moro Reflex
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spread arms symmetrically when startled
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Babinski Reflex
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toe extension when stroking feet
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Tonic-Labyrinthine Reflex
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used to support self on a surface, "fencing" reflex
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Stepping reflex
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"walking" when toes touch surface
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Parachute Reflex
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when held at stomach, hands will go out
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Diving reflex
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when face is wet, flail arms/legs and close glottis
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Age: Newborn
Language Fine Motor Gross Motor: (head => neck=>shoulder) |
Newborn
Language: Cry Fine Motor: Moro, Grasp reflex Gross Motor: moves head to side |
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Language development:
Newborn 2 mo 4 mo 6 mo 9 mo |
Newborn: cries
2 mo: smiles, coo and goo 4 mo: listened and laugh 6 mo: stranger and separation anxiety 9 mo: babble |
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language development:
12 mo: 15 mo 18 mo 2 y/o 3 y/o |
12 mo: say 1 word "dada"
15 mo: say 5 words 18 mo: short phrases 2 y/o: short sentences 3 y/o: full sentenses |
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6 month: language
types of anxieties (2) when do they disappear? |
>>Stranger anxiety
(Should disappear by 2 years) >>Separation anxiety (Should disappear by 5 years) |
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6 month: fine motor
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Depth perception
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6 month: gross motor
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Rolls back to belly, Sits, scoots,Sleeps all night
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language development:
2-5 y/o: 6-12 y/o: |
2-5 y/o: 90% of language ( parents should be involved)
6-12 y/o: retains accents |
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Fine motor development:
Newborn 2 mo 4 mo 6 mo 9 mo |
Newborn: moro, grasp reflex
2 mo: swipes 4 mo: reach and parchute 6 mo: depth preception 9 mo: pincers, waves |
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Fine motor development
12 mo: 15 mo 18 mo 2 y/o 3 y/o |
12 mo: babinski disappears
15 mo: feed themselves 18 mo: scribble 2 y/o: draw circles 3 y/o: draw triangles and sexual ID |
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gross motor development
Newborn 2 mo 4 mo 6 mo 9 mo |
Newborn: moves head from side to side
2 mo: lifts head up 4 mo: leans on arms 6 mo: rolls back to belly, sits, scoots, sleeps all night 9 mo: crawls |
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gross motor development
12 mo: 15 mo 18 mo 2 y/o 3 y/o |
12 mo: stand, first step
15 mo: walk, drop and pick up ball 18 mo: scoots upstairs, throws ball 2 y/o: walk upstairs 3 y/o: walk down stairs, bend over, kick ball, ride tricycle |
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fine motor development:
2-5 y/o: 6-12 y/o: |
2-5 y/o: can draw square and star " 4 and 5 sides"
6-12 y/o: draws letters |
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gross motor development:
2-5 y/o: 6-12 y/o: |
2-5 y/o: rides bicycle with training wheels
6-12 y/o: rides a bicycle |
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Age: 6-12 yrs
Language: Fine Motor: Gross Motor: |
Language: Retains accent after this
Fine Motor: Draw letters Gross Motor: Ride bicycle |
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Puberty
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pulsatile GnRH secretion
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Females Sexual Development:
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Breasts "thelarche" => Growth "adrenarche'' => Pubic hair "pubarche" => Menarche
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Males Sexual Development:
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Testes grow~> Penis grows~> Growth~> Pubic hair
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Female:
Tanner Stage: I -V |
I: nipple
II: bud, growth spurt III: areola, menses IV: secondary mound V: separates from the chest |
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Male:
tanner stages I-V |
I: proportional
II: red scrotal skin III: growth spurt IV: long penis V: longest penis |
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Tanner Stage: I-V
Pubic Hair: |
I: none
II: sparse, downy III:corse and curly IV: covers the pubic symphysis V: covers the thighs |
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Tanner Stage: IV
Female Pubic Hair: Male: |
Female: secondary mound
Pubic Hair: covers pubic symphysis Male: longer penis |
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Tanner Stage: V
Female: Pubic Hair: Male: |
Female: separates from chest
Pubic Hair: spreads onto thighs Male: longest penis wall |
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Colic
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Childhood Illnesses:
cry a lot after eating (not digesting well) will grow out of it |
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Fifth Disease (Parvo B-19)
name presentation avoid school attendance |
erythema infectiosum "slapped cheeks"
red lacy body rash, arthritis in mom, aplastic anemia keep them away from pregnant mothers for a few days can go to school |
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Hand-Foot-Mouth Disease (Coxsackie A): describe and tx
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mouth ulcers => won't eat or drink, palm/ sole rash
(Tx: observation) |
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Kawasaki's disease: type of disease and criteria for diaganosis
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Mucocutaneous Lymph Node Disease: autoimmune vasculitis
"CRASH" • Conjunctivitis • Rash (palm/sole) • Aneurysm (coronary artery) • Strawberry tongue (like scarlet fever) • Hot (fever> 102°F for at least 3 days +cervical lymphadenopathy) |
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kawasaki management not tx
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MI in kids (Echo every year), to prevent aneurysm
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kawasaki
treatment CI |
o ASA (will decrease high platelets)
o IV Ig (coats receptors so they don't see the body's autoimmune attack) o Flu vaccine (to avoid Reye's syndrome) o No live vaccines until 12mo after IV Ig is given |
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what is measels? virus and what would be seen in pathology?
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Measles = Rubeola (paramyxovirus):
multinucleated giant cells (lymphocytes) |
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signs and symptoms of measels
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1) Cough, Coryza (thick rhinorrhea), Conjunctivitis
2) Koplik spot (white spot on buccal mucosa) - 24 hrs before rash 3) Morbilliform blotchy rash - spreads from head down "like a shower" |
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measels Complications:
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>>otitis media,
>>demyelinating disease = "subacute Sclerosing Panencephilitis" |
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Molluscum Contagiosum:
pathogen describe what is it in adults |
(pox virus):
flesh-colored papules w/ central dimple perianal STD in adults |
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Mumps:
virus presentation: |
(paramyxovirus):
parotiditis red Stenson's duct (behind 3rd molar) lemons hurt |
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mumps complications:
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pancreatitis
oophoritis/orchitis meningoencephalomyelitis (what you are afraid of) |
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mumps treatment
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Tx: Acetaminophen
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Otitis Media: pathogen, describe and tx.
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(Strep pneumo)
fluid in middle ear Tx: Amoxicillin or tube placement if chronic |
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Pertussis
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whooping cough, retinal hemorrhage, child stroke. #1 child preventable disease
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Pityriasis Rosea:
type of herpes describe tx |
(HHV-7) herald patch => "C-mass tree" appearance on back,
Tx: UV-B-light |
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DX:>>uncouple ETC (⇧temp => burns kid's livers)
>>Sx: fatty liver, brain edema, coma |
Reye's syndrome
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causes of reye's syndrome
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Pregnancy, acetaminophen, ASA w/ influenza or varicellla.
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treatment for reye's syndrome
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Tx= Supportive, Glucose, Albumin if fluid needed, FFP prn
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Rosacea
describe what makes it worse? |
malar rash, worse with alchohol
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Rubella
another name presentation on adults pathogen |
German 3-day measles
(togavirus): trunk rash, lymphadenopathy behind ear |
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5 Complications of rubella on an infant
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blueberry muffin rash, cataracts; deafness, PDA (prematurity), extramedullary erythropoiesis.
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CI to rubella vaccination
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Don't give Rubella vaccine to pregnant women!
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Sixth Disease
name herpes presentation |
(HHV -6)
roseola, exanthema subitum (fever disappears, then rash appears) |
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Smallpox
presentation |
on face, same stage of development, fever
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Dx on trunk, different stages of development
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Varicella = Chickenpox (VZV):
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Complications of varicella
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skin infections
varicella pneumonia =>lethal |
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varicella appearance
which one is not infectious? |
1) Red macule
2) Clear vesicle on red dot 3) Pustules 4) Scab = > not infectious (most infectious: -2 rash+ 3) |
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Zoster:
name dermatome where does it hide? |
shingles,
likes T4/V1 dermatome distribution, virus hiding in dorsal root |
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When is it OK to Stay in Daycare /School for RSV?
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if poop stays in diaper
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When is it OK to Stay in Daycare /School Herpes Zoster?
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after lesions crust
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When is it OK to Stay in Daycare /School for Fifth Disease?
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when "slapped.cheeks" appear
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When is it OK to Stay in Daycare /School Chickenpox?
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when all lesions are scabs
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Most Common Causes of Death: first trimester:
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miscarriages (chromosomal abnormalities)
TORCH infections |
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Most Common Causes of Death: 1 month
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prematurity
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Most Common Causes of Death: 4-6 month
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SIDS => right ventricular hypertrophy on autopsy
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Most Common Causes of Death: 6 mo-1 year old
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Child abuse
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Dx: >>Multiple ecchymoses or cigarette bums
>> Epidural/Subdural hemorrhages >>Multiple fractures in different healing stages, Spiral fractures (twisted) >>Retinal hemorrhage Dx? |
>>Retinal hemorrhage (shaken baby syndrome),
>>child abuse |
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4 things that should be ruled out in child abuse
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osteogenesis imperfecta
bleeding disorders Fifth disease Mongolian spots |
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Most Common Causes of Death in 1-2 yrs:
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• Drowning (due to big head )
• Accidental ingestions |
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Most Common Causes of Death 2-5 yrs:
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• #1: Car accidents
• #2: Accidental head injury (down stairs) |
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Most Common Causes of Death 5-10 yrs:
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• #1: Pedestrian injuries
• #2: Baseball=> epidural hematomas (MMA) |
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Most Common Causes of Death 10-19 yrs:
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• Car accidents
• Homicide (Blacks/ Hispanics) • Suicide (white/Asian males/rich) |
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Most Common Causes of Death: 19-44 yrs:
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• AIDS (got it as a teenager)
• Car accidents • Homicide |
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car seat rules:
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Car seat until 4 yrs old or 40/bs
(face the seat toward the rear until 20 lbs or 1y/o) |
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Most Common Causes of Death >44 yrs:
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• Heart disease
• cancer • Stroke· |
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at what age are the DTap shots are done
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4 years old
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history of tetanus toxid is <3 doses:
management for clean wounds |
DTap vaccination only
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history of tetanus toxid is >3 doses:
management for clean wounds |
no DTap (vac) and TIG (immu).
except if the vaccination was > 10 years ago then give DTap |
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history of tetanus toxid is >3 doses:
management for dirty wounds |
no DTap and TIG.
Except if the vaccination was given >5 years ago then give DTap. |
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history of tetanus toxid is <3 doses:
management for dirty wounds |
give both DTap and TIG
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what are the 2 reflexes that stay throughout life?
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parachute and right reflex
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how do colle's and smith fractures occur?
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colle's and smiths due to parachute reflex.
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tanner III in females
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menses
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growth spurt male and female
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male: tanner III
female: tanner II |
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what is the most common cause of death in peds?
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1) chromosome 16
2) TORCH |
