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177 Cards in this Set
- Front
- Back
polycythemia of the Newborn
|
Hypoxia during labor -> Epo
(first breath will inc. pO2 to stop Epo) |
|
Transient Tachypnea of the Newborn:
|
C/S babies are SOB in first 3-4 hrs due to excess fluid in lungs.
|
|
If a baby is SOB >4 hrs.
what should be considered? |
>4hrs => consider septic, Until proven otherwise
|
|
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. |
|
what stimulates the closing of the fetal circulation?
what are closed? (4) |
O2 stimulates closing of fetal circulation
=> PDA, FO, DV, umbilical aa./vv. |
|
what is physiologic jaundice?
|
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 |
|
what is the normal unconjugated bilirubinemia
|
Normal: <1mg/dL, unconjugated
|
|
if a baby has a yellow sclera. approx the bilirubin?
|
>2mg/dl
|
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what are the DDx of jaundice? (5)
|
G-6PD Deficiency
• Sepsis (bilirubin not delivered to liver) • ABO incompatibility • Hypothyroidism • Breastfeeding (E2 displaces bilirubin off albumin) jaundice but not that bad. |
|
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, |
|
Retinopathy of prematurity:
|
retrolental fibroplasia
(decreased vascularity of retina) |
|
Necrotizing Enterocolitis
define complication |
GI vessels burst during feeding =>ischemic bowel
|
|
Pneumatosis lntestinalis:
presentation management tx |
air in bowel wall
=> stop feedings, NG tube, TPN tx for anaerobes |
|
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 |
|
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) |
|
what is the significance of putting the baby in the warmer right away after being delivered?
|
Place under a warmer
(shivering => burns sugar => hypoglycemia) |
|
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 |
|
why do we need to inject vitamin K?
|
prevents bleeding
(because the baby has no E. coli yet to make Vit K) |
|
why do we need to take the foot prints?
|
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?
|
systemic ceftriaxone
|
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Temperature how should it change when it goes up?
|
⇧1 °: ⇧10bpm
|
|
how should the temperature be taken?
|
Rectal > Oral > Axillary
|
|
VATER Syndrome:
|
• Vertebral abnormality
• Anal (imperforate) • TE fistula • Renal |
|
Neural Tube Defect Risk Factors:
management |
• Previous NTD
• Diabetes • Valproic Acid: give 4mg Folate/ day |
|
Sepsis Workup: (5)
treatment |
• Blood cultures
• UA/ urine cultures • CXR • LP • Tx: Cefotaxime |
|
what is an apgar score?
when does it vary? |
APGAR test: (at 1 and 5 min), normal=7+,
will vary if premature |
|
how is APGAR scored?
|
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 |
|
Eye Infections: Day 1:
|
Eye Infections:
Day 1: Silver nitrate => clear discharge |
|
Eye Infections: Day 1-7:
dx tx |
Gonorrhea=> purulent discharge
(fx: Ceftriaxone) |
|
eye infections > Day 7 and Tx
|
> Day 7: Chlamydia (fx: Erythromycin)
|
|
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 |
|
when should mom stop breast feeding?
|
Should stop by 1 y /o (when teeth come in)
|
|
if mom is vegetarian what would the baby get?
|
rickets
|
|
how often should newborns be fed?
|
Feed newborns q4hrs
|
|
advantages of breast feeding?
|
>>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 |
|
after post-partum day 1-5 and day 6, what is the milk made out of?
|
>>Post-partum Day 1-5: colostrum (protein) + IgA
>>Post-partum Day 6: mature milk |
|
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) |
|
how much formula or calories per day does a baby need?
|
need 100-120cal/ kg/ day= 36oz/ day formula at birth
|
|
what a baby can eat at..
4mo: |
rice cereal
|
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what can a baby eat at 6 months?
|
fruits, yellow veggies
|
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what can a baby eat at 9 months?
|
2% milk, soft table foods
|
|
what can a baby eat at 1 year old?
|
whole milk, table foods
|
|
what can a baby develop if they are fed with protein too early?
|
can get allergies/eczema
|
|
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
|
|
Choanale Atresia:
|
blue when feed
|
|
Tetrology of Fallot:
|
blue with cry
|
|
Hemangioma: define, management and tx.
|
>>flat blood vessels
>>Tx: observe first, if growing rapidly, steroid injection or laser surgery if on face |
|
Milia
|
neonatal acne due to progesterone in utero
|
|
Nevus Flammeus
|
"stork bites" on back of neck, look like flames
|
|
Seborrheic Dermatitis:
define tx |
red rash w/ oily skin and dry flaky hairline
(Tx: baby oil/shampoo) |
|
Mongolian spots
|
melanocytes on lower back (not child abuse), usually on Asian/Hispanics
|
|
Erythema toxicum
|
total body rash, eosinophils (benign), looks like flea bites
|
|
Port Wine stain
what should they be evaluated for? |
evaluate for Sturge-weber
|
|
Acrochordom
|
skin tag
|
|
Vaginal bleeding
|
due to estrogen withdrawal from Mom
|
|
Sacral hair
|
spina bifida occulta
|
|
DDx: cafe aulait
|
NF and Mccune Albright
|
|
what are the top 3 causes of mental Retardation:
|
1) Alcohol·
2) Fragile X 3) down's |
|
what bug can cause Microcephaly in a newborn?
|
due to Toxoplasmosis
|
|
Subgaleal hemorrhage: define and what are its 2 types?
|
prolonged jaundice in newborns (trauma to scalp during birth)
>>Caput succedaneum >> Cephalohematoma |
|
Caput succedaneum
|
under scalp (edema crosses suture lines)
|
|
Cephalohematoma
|
under bone (blood not cross suture lines)
|
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Epstein's pearl
|
white pearls on hard palate (will go away)
|
|
Persistent eye drainage since birth
Dx Tx |
blocked duct
(Tx: gentle-massage) |
|
Wide sutures
|
Poor nutrition, hypothyroid, Down's
|
|
Midline cyst
|
Thyroglossal cyst
(thyroid comes down from tongue) |
|
Lateral cyst
|
Brachial cleft cyst
|
|
Multiple neck cysts
|
Cystic hygroma (Turner's)
|
|
Cleft lip: what did not fuse? and Tx
|
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) |
|
Saddle nose
|
Syphilis
|
|
Neonatal Herpes:
what would be seen? management? |
Purulent crusted scalp blisters
(do Tzanck smear) |
|
No red reflex
|
Cataracts
|
|
White reflex
|
Retinoblastoma
|
|
what is the treatment for a kid with Inguinal hernia?
|
Inguinal: Operate
|
|
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. |
|
Kid Hernia
Tx for Hydrocele: |
Observe
|
|
Clavicle fracture (middle 1/ 3 L clavicle):
|
asymmetric Moro reflex
|
|
Erb's palsy:
describe prognosis dx test: |
C5-6 torn => Waiter's tip,
80% recovery (Dx: MRI) |
|
Klumpke's
|
C8-T1 torn=> claw hand
|
|
Supernumerary nipple
|
extra nipples are always on vertical line
|
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Umbilical stump bleeding
|
Factor 13 deficiency
|
|
Delayed umbilical cord separation (6 wk)
|
Leukocyte adhesion deficiency
|
|
Oomphalocele
|
intestines protrude out of umbilicus w / peritoneal covering
|
|
Gastroschisis
|
abdominal wall defect, intestines protrude off-center
|
|
Wilm's tumor:
define Tx |
• Kidney tumor, aniridia,
• Hemihypertrophy: atrophy of leg on side of tumor (blood supply sucked away from leg) • Tx: Dactinomycin |
|
Neuroblastoma
|
adrenal medulla tumor, hypsarrhythmia, myoclonus, ⇧VMA
|
|
Congenital Adrenal Hyperplasia:
what would you see in female and male babies |
• Females: ambiguous genetalia
• Males: premature penis development |
|
Congenital hip dislocation: management, describe and tx
|
• 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 |
|
what are language abnormalities due to
|
due-to hearing loss
|
|
define mental retardation and how is IQ calculated?
|
Mental retardation is a discrepancy between chronological age and mental age
• Approximate IQ =Mental/ Chronological x 100 |
|
Rooting Reflex
|
touch cheek -=> they turn toward it
|
|
Moro Reflex
|
spread arms symmetrically when startled
|
|
Babinski Reflex
|
toe extension when stroking feet
|
|
Tonic-Labyrinthine Reflex
|
used to support self on a surface, "fencing" reflex
|
|
Stepping reflex
|
"walking" when toes touch surface
|
|
Parachute Reflex
|
when held at stomach, hands will go out
|
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Diving reflex
|
when face is wet, flail arms/legs and close glottis
|
|
Age: Newborn
Language Fine Motor Gross Motor: (head => neck=>shoulder) |
Newborn
Language: Cry Fine Motor: Moro, Grasp reflex Gross Motor: moves head to side |
|
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 |
|
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 |
|
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) |
|
6 month: fine motor
|
Depth perception
|
|
6 month: gross motor
|
Rolls back to belly, Sits, scoots,Sleeps all night
|
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
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 |
|
Age: 6-12 yrs
Language: Fine Motor: Gross Motor: |
Language: Retains accent after this
Fine Motor: Draw letters Gross Motor: Ride bicycle |
|
Puberty
|
pulsatile GnRH secretion
|
|
Females Sexual Development:
|
Breasts "thelarche" => Growth "adrenarche'' => Pubic hair "pubarche" => Menarche
|
|
Males Sexual Development:
|
Testes grow~> Penis grows~> Growth~> Pubic hair
|
|
Female:
Tanner Stage: I -V |
I: nipple
II: bud, growth spurt III: areola, menses IV: secondary mound V: separates from the chest |
|
Male:
tanner stages I-V |
I: proportional
II: red scrotal skin III: growth spurt IV: long penis V: longest penis |
|
Tanner Stage: I-V
Pubic Hair: |
I: none
II: sparse, downy III:corse and curly IV: covers the pubic symphysis V: covers the thighs |
|
Tanner Stage: IV
Female Pubic Hair: Male: |
Female: secondary mound
Pubic Hair: covers pubic symphysis Male: longer penis |
|
Tanner Stage: V
Female: Pubic Hair: Male: |
Female: separates from chest
Pubic Hair: spreads onto thighs Male: longest penis wall |
|
Colic
|
Childhood Illnesses:
cry a lot after eating (not digesting well) will grow out of it |
|
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 |
|
Hand-Foot-Mouth Disease (Coxsackie A): describe and tx
|
mouth ulcers => won't eat or drink, palm/ sole rash
(Tx: observation) |
|
Kawasaki's disease: type of disease and criteria for diaganosis
|
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) |
|
kawasaki management not tx
|
MI in kids (Echo every year), to prevent aneurysm
|
|
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 |
|
what is measels? virus and what would be seen in pathology?
|
Measles = Rubeola (paramyxovirus):
multinucleated giant cells (lymphocytes) |
|
signs and symptoms of measels
|
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" |
|
measels Complications:
|
>>otitis media,
>>demyelinating disease = "subacute Sclerosing Panencephilitis" |
|
Molluscum Contagiosum:
pathogen describe what is it in adults |
(pox virus):
flesh-colored papules w/ central dimple perianal STD in adults |
|
Mumps:
virus presentation: |
(paramyxovirus):
parotiditis red Stenson's duct (behind 3rd molar) lemons hurt |
|
mumps complications:
|
pancreatitis
oophoritis/orchitis meningoencephalomyelitis (what you are afraid of) |
|
mumps treatment
|
Tx: Acetaminophen
|
|
Otitis Media: pathogen, describe and tx.
|
(Strep pneumo)
fluid in middle ear Tx: Amoxicillin or tube placement if chronic |
|
Pertussis
|
whooping cough, retinal hemorrhage, child stroke. #1 child preventable disease
|
|
Pityriasis Rosea:
type of herpes describe tx |
(HHV-7) herald patch => "C-mass tree" appearance on back,
Tx: UV-B-light |
|
DX:>>uncouple ETC (⇧temp => burns kid's livers)
>>Sx: fatty liver, brain edema, coma |
Reye's syndrome
|
|
causes of reye's syndrome
|
Pregnancy, acetaminophen, ASA w/ influenza or varicellla.
|
|
treatment for reye's syndrome
|
Tx= Supportive, Glucose, Albumin if fluid needed, FFP prn
|
|
Rosacea
describe what makes it worse? |
malar rash, worse with alchohol
|
|
Rubella
another name presentation on adults pathogen |
German 3-day measles
(togavirus): trunk rash, lymphadenopathy behind ear |
|
5 Complications of rubella on an infant
|
blueberry muffin rash, cataracts; deafness, PDA (prematurity), extramedullary erythropoiesis.
|
|
CI to rubella vaccination
|
Don't give Rubella vaccine to pregnant women!
|
|
Sixth Disease
name herpes presentation |
(HHV -6)
roseola, exanthema subitum (fever disappears, then rash appears) |
|
Smallpox
presentation |
on face, same stage of development, fever
|
|
Dx on trunk, different stages of development
|
Varicella = Chickenpox (VZV):
|
|
Complications of varicella
|
skin infections
varicella pneumonia =>lethal |
|
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) |
|
Zoster:
name dermatome where does it hide? |
shingles,
likes T4/V1 dermatome distribution, virus hiding in dorsal root |
|
When is it OK to Stay in Daycare /School for RSV?
|
if poop stays in diaper
|
|
When is it OK to Stay in Daycare /School Herpes Zoster?
|
after lesions crust
|
|
When is it OK to Stay in Daycare /School for Fifth Disease?
|
when "slapped.cheeks" appear
|
|
When is it OK to Stay in Daycare /School Chickenpox?
|
when all lesions are scabs
|
|
Most Common Causes of Death: first trimester:
|
miscarriages (chromosomal abnormalities)
TORCH infections |
|
Most Common Causes of Death: 1 month
|
prematurity
|
|
Most Common Causes of Death: 4-6 month
|
SIDS => right ventricular hypertrophy on autopsy
|
|
Most Common Causes of Death: 6 mo-1 year old
|
Child abuse
|
|
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 |
|
4 things that should be ruled out in child abuse
|
osteogenesis imperfecta
bleeding disorders Fifth disease Mongolian spots |
|
Most Common Causes of Death in 1-2 yrs:
|
• Drowning (due to big head )
• Accidental ingestions |
|
Most Common Causes of Death 2-5 yrs:
|
• #1: Car accidents
• #2: Accidental head injury (down stairs) |
|
Most Common Causes of Death 5-10 yrs:
|
• #1: Pedestrian injuries
• #2: Baseball=> epidural hematomas (MMA) |
|
Most Common Causes of Death 10-19 yrs:
|
• Car accidents
• Homicide (Blacks/ Hispanics) • Suicide (white/Asian males/rich) |
|
Most Common Causes of Death: 19-44 yrs:
|
• AIDS (got it as a teenager)
• Car accidents • Homicide |
|
car seat rules:
|
Car seat until 4 yrs old or 40/bs
(face the seat toward the rear until 20 lbs or 1y/o) |
|
Most Common Causes of Death >44 yrs:
|
• Heart disease
• cancer • Stroke· |
|
at what age are the DTap shots are done
|
4 years old
|
|
history of tetanus toxid is <3 doses:
management for clean wounds |
DTap vaccination only
|
|
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 |
|
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. |
|
history of tetanus toxid is <3 doses:
management for dirty wounds |
give both DTap and TIG
|
|
what are the 2 reflexes that stay throughout life?
|
parachute and right reflex
|
|
how do colle's and smith fractures occur?
|
colle's and smiths due to parachute reflex.
|
|
tanner III in females
|
menses
|
|
growth spurt male and female
|
male: tanner III
female: tanner II |
|
what is the most common cause of death in peds?
|
1) chromosome 16
2) TORCH |