Peds Exam 1 - NEED TO KNOWS

Preterm

Born on or before the last day in the 36th week

(Before 37 weeks)

Early term

37 weeks to 38 weeks and 6 days

Full term

39 weeks to 40 weeks and 6 days

Late term

41 weeks to 41 weeks and 6 days

Post term

>42 weeks

small for gestational age (SGA) and causes

<10th percentile

Causes: genetic disorder, placental abnormalities, drug/etoh during pregnancy, infection

Large for gestational age (LGA)

>90th percentile

Causes: maternal gestational diabetes

low, very low, extremely low birth weight

Low: <2500 g

Very low: <1500 g

Extremely low: <1000g

When is BW doubled? Tripled?

Doubled at 6 months

Tripled at 1 year

When do babies gain back the weight they lost post birth?

Lose 10% in first few days

Regain in 10-14 days

Umbilical cord competent

2 arteries: carry deoxygenated blood from fetus to placenta

1 veins carries oxygenated blood from placenta to fetus

Complications associated with infants of diabetic mothers

-hypoglycemia

-hypocalcemia

-hyperbilurubinemia

-macrosomnia (overweight)

-RDS

-HOCM

What does APGAR stand for? What is it used for

Quick assessment of infants immediate adaption to life

Appearance

Pulse

Grimace

Activity

Respiration

How is APGAR graded?

>5 @ 1 min: smooth transition

<4 @ 1 min: severe depression, need resuscitation

<7 @ 5 min: high ris of CNS dysfunction/cardiac problems

Score again @ 10 min if infant cyanotic at 5 min

What does the new Ballard score assess?

Gestational age

Routine newborn protocol

-Eye prophylaxis: silver nitrate & erythro

-Vit K

-Hep B

-Labs

-hearing screenings

Newborn labs

-state newborn screening

-hematocrit

-glucose

-bili

-blood type

Cause of RDS

surfactant deficiency

Risk factors for RDS

-males

-preterm

-maternal DM

-monozygotic twins

-C section

-fam Hx

How to diagnose RDS

CXR: air bronchograms and ground glass appearance

PE: dec breath sounds, nasal flaring, tachypnea

Cause of transient tachypnea of the newborn

Fetal lung fluid not expelled in delivery, & retained in lung

Most common cause of respiratory distress in TERM infants

Transient tachypnea of the newborn

How to diagnose tachypnea of the newborn

CXR: inc lung volume w/ flat diaphragm, no air bronchogram/ground glass

PE: tachypnea (>60) nasal flaring

Presentation of necrotizing enterocolitis

Gastric residuals after feeding

Hematochezia

Abd wall tenderness

Apnea, bradycardia

How to diagnose necrotizing enterocolitis

KUB: pneumatosis intestinalis

Most common hernia on the left side

Bochdalek

When are pregnant women tested for strep?

35-37 weeks

If postive: treat w PCN or amoxicillin

Cause of jaundice @ day 1, 2-3 days, 1 week, and 3 weeks

Day 1: always pathological

Day 2-3: physiologic/sepsis

1st week: breast fed

3rd week: biliary atresia

What is a Bhutani nomogram used for?

Assess risk of developing severe hyperbilirubinemia based on age and total bili

Normal bili levels in term vs preterm

Term: <12

Preterm: <15

Complications of jaundice in the newborn

kernicterus

-lethargy

-vomiting

-irritability

-poor feeding

-crying

Prevention of SIDS

-regular prenatal care

-avoiding tobacco

-supine sleep position

-avoid blankets, bumpers, pillows

-avoid co sleeping

caput succedaneum

Superficial edema that crosses suture line

Reconfigure in 1 week

Absent red reflex is indicative of

Retinoblastoma

cause of retinopathy of prematurity

-hypoxia, hypotension that disrupts normal angiogenesis

-incomplete retinal vascularization

Turner's syndrome presentation

-wide set nipples

-excessive nuchal skin

-lymphedema

Weak pulses could mean

-possible coarctation

-left ventricular flow obstruction

When should you be worried about a sacral tuft/sinus tract

If sinus tract or tuft of hair present

(If not: benign)

Sacral tuft/sinus tract can be indicative of

-spina bifida

-meningocele

-myelomeningocele

Abnormal develop of acetabulum and femur w/ mechanical instability of the hip

Hip dysplasia

Barlow vs Ortolani Maneuver

Barlow: dislocates by adducting and pulling down

Ortalani: reduces the joint but ABducting w/ anterior pressure

Galaezzi sign

What do you evaluate during a neuro exam

Movement and reflexes

Open vs closed spina bifida

Open: myelomeningocele

Closed: spina bifida occulta

Waiters tip sign

Erb's palsy

Erb duchenne palsy

-Adduction and internal rotation of the shoulde

-elbow extension and pronation of forearm

-intact grasp reflex

PHACE syndrome

Posterior fossa malformation

Hemangioma

Arterial abnormalities

Cardiac abnormalities

Eye abnormality's

Sternal cleft

Most common vascular tumor of infancy

Hemangioma

When are screening tests done?

At physicals:

-9 mo

-18 mo

-24 mo

-30 mo

Screenings for autism

M-CHAT

CARS

CHAT

@ 18 mo and 24 mo physicals

Involuntary muscle reaction to a stimulus

Reflex

Absense of Moro reflex suggests?

Absent: UMN lesion

Incomplete: brachial plexus injury

Asymmetric Tonic Neck Reflex (ATNR)

Childs head is turned to the side and assumes the fencer position

parachute reflex

extension of extremities when thrust downward in the prone position

I would personally know all of the reflexes cuz he could switch em up

:)

What age does an infant grasp objects and brings to mouth

4 months

What age does an infant have mature pincer grasp

12 mo

What age does an infant have early pincer grasp

9 mo

What age does an infant transfer objects from hand to hand

6 mo

Language development rule of 4s

2 years: 50% intelligible to strangers

3 years: 75% intelligible

4 years: 100% intelligible

normal dysfluency stuttering occurs when

2.5 - 5 yrs and is not distressing to child

How to manage stuttering

-reassurance

-if >5 yr : speech therapy

-SSRIs

Trisomy 21

Down syndrome

Features of Down syndrome

-intellectual disability

-dementia

-atlantoaxial instability

-inc cardiovascular risk (VSD, CHD)

-hypotonia

Most common sex chromosome abnormality in females

Turner syndrome

Cause of turner syndrome

Absence of an X chromosome

Turner syndrome presentation

-short stature

-sexual infantilism

-primary hypogonadism

-ovarian dysgenesis

-nipple hypertelorism

Cause of Klinefelter syndrome

Extra X chromosome in males

Klinefelter syndrome presentation

-micropenis

-hypospadias

-small testes

-cryptorchidism

-infertility

-gynecomastia

-incomplete virilization

-hypergonadotropic

Treatment of Klinefelter syndrome

-testosterone therapy

-ref to endocrine/genetics

Cause of fragile X syndrome

Religion of a single trinucleotide gene sequence (CGG) on the X chromosome

Developmental features of fragile X syndrome

-delayed milestones

-speech delay

-impaired short term memory

Prader-Willi Syndrome cause

Paternal deletion of chromosome 15q11

Features of Prader-Willi Syndrome

Infant: neonatal hypotonia, poor weight gain

Early childhood: weight gain, speech delay

Adolescence: behavioral issues, CV probs d/t obesity, OSA

(Short, obese, fish mouth, hypogonadism)

Genetic condition that increases connective tissue growth

Marfans

MC cardiopulmonary disorders with marfans

1. Aortic root dissection

2. MVP

Cause of marfans syndrome

Mutation in fibrillin 1 gene

Autosomal recessive disorder of cholesterol biosynthesis

Smith-lemli-opitz syndrome

Fetal alcohol syndrome features

-Thin vermillion border of upper lip

-smooth philitrum

-short palpebral fissure

Catch 22

Deletion of 22q

Cardiac defect

T cell defect

Cleft palate

Hypocalcemia

Treacher Collin's syndrome definition and cause

Def: autosomal dominant disorder of craniofacial development

Cause: mutation on chromosome 5

Features of Treacher Collin's

-malar hypoplasia

-hearing loss

-G tube feedings d/t swallowing prob

-Coloboma lower lid

-beak like nose

-micrognathia

-cleft palate

PKU

Phenylalanine hydroxylase deficiency

Autosomal recessive

PKU features

-seizures

-hyperactivity

-aggressive behavior

-intellectual disability

Most common breath holding spell

Cyanotic: related to tantrums

Crying: breath holding: cyanotic: LOC

ADHD diagnostic criteria

Inattentive: 6+ sx

Hyperactivity: 6+ sx

Associations with ADHD

-learning disabilities

-mood disorders (depression)

Pattern of hostile and defiant behavior that is excessive

Oppositional defiant disorder

Persistent pattern of behavior that violates rules/norms and the basic rights of others

Conduct disorder

Night terrors vs nightmares

Terrors: occur in stage 3 of sleep, no recollection of event, 18 months-6 yrs

Nightmares: occurs during REM, may remember

Night terrors are are precipitated by

Stress, illness, sleep deprivation

Night terror presentation

Child awakened from deep sleep seemingly confused, dilated pupils, and sweating

Most common congenital heart defect

VSD

What CHD is common in Down's syndrome

ASD

Features of CoA

-murmur loudest @ ULSB, left interscapular

-bounding radial pulses

-diminished femoral pulses

tetrad of tetralogy of fallot

PROV

Pulmonary stenosis

RVH

Overriding aorta

VSD

Ebstein Anomaly

Tricuspid vale is displaces towards the apex of the right ventricle

Ebstein anomaly is commonly associated with

Maternal lithium ingestion

Marfan syndrome genetics

75% inherited

25% new mutation

50% chance of passing it only offspring

Venous hum is caused by

Turbulence in SVC