Peds Cumulative- Exam 1

Infant aged 0-28 days

Neonate

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

Pre-term

First day of 37th week

Term

37 weeks to 38+6

Early term

39 weeks to 40+6

Full term

41 weeks

Late term

Born on or after first day of week 42

Post-term

Small for gestational age = < ____th percentile

10

Large for gestational age = > _____th percentile

90

Low birth weight = ≤ ______ grams

2500

Very low birth weight = ≤ _____ grams

1500

Extremely low birth weight = ≤ _____ grams

1000

Umbilical vein closes = ______

Ligamentum teres

Umbilical cord components

2 arteries, 1 vein

If there is only 1 artery in the umbilical cord, think ____

Renal abnormality

MC Pathologic cause of later pregnancy

Abruptio placenta

MC cause of minimally painful bleeding after 20 weeks GA

Placenta previa

Common cause of twin-to-twin transfusion

Fetal hydrops

When one placenta is shared between twins resulting in an unbalanced blood shared between placenta and fetuses

Twin-to-twin transfusion

Prevention of fetal hydrops

RhoGAM

When is the triple screen & anatomy scan done?

16-20 weeks

When is the OGTT and RhoGAM given?

28 weeks

When is the group B strep culture of vagina/rectum done?

35-37 weeks

When is APGAR score taken?

1 and 5 minutes

APGAR score ≤ _____ at 1 minute = severe depression requiring immediate resuscitation

4

APGAR score ≤ ______ at 5 minutes = high risk for CNS dysfunction or CV abnormality

7

Newborn routine prophylaxis

Eye: erythromycin, Vitamin K, Hep B vaccine

Surfactant deficiency

Hyaline membrane disease/Neonatal RDS

Newborn pt presents with tachypnea, grunting, inc work of breathing, and cyanosis. CXR shows air bronchograms and ground glass appearance. Dx?

Hyaline membrane disease/Neonatal RDS

Prevention of Hyaline membrane disease/neonatal RDS

Antenatal steroids (betamethsone, dexamethasone)

MCC of respiratory distress in term infants

Transient tachypnea of the newborn

What causes Transient tachypnea of the newborn?

Fetal lung fluid is retained

Tx for Transient tachypnea of the newborn

O2

Periodic breathing is common in ______ infants

Pre-term

KUB shows pneumatosis intestinalis (possible portal air/free air)

Necrotizing enterocolitis

Inflammatory bowel condition characterized by ischemic necrosis of intestinal mucosa, invasion of enteric gas-forming bacteria, and dissection of gas in the bowel wall and portal venous system

Necrotizing enterocolitis

Bowel evisceration, near umbilicus, NOT covered by membrane

Gastroschisis

Bowel loop +/- organs, through umbilicus, COVERED with membrane

Omphalocele

Bowel sounds auscultated in thorax

Congenital diaphragmatic hernia

If PCN prophylaxis was given > ____ before birth for Group B strep, there is no concern

4 hours

Newborn jaundice/hyperbilirubinemia on the 1st day is _____

ALWAYS pathologic

Newborn jaundice/hyperbilirubinemia on the 2nd-3rd day is _____

Physiologic and/or sepsis

Newborn jaundice/hyperbilirubinemia on the 1st week is _____

Breast fed jaundice

Newborn jaundice/hyperbilirubinemia on the 3rd week is _____

Biliary atresia

Used to assess the risk of developing severe hyperbilirubinemia based on age and total serum bilirubin

Bhutani nomogram

Complication of jaundice/hyperbilirubinemia that causes lethargy, vomiting, irritability, poor feeding, high pitched crying

Kernicterus

Infant preventative measure for SIDS

Supine sleep position

Normal HR of newborn

120-160 bpm

Normal temp of newborn

36.5-37.5C

Superficial edema/ecchymosis that crosses the suture line

Caput succedaneum

Blood collection occurs under the periosteum and does NOT cross the suture line

Cephalohematoma

Bleeding that occurs between the scalp & skull, blood migrates to the dependent side

Subgaleal hemorrhage

When sutures DO NOT CLOSE due to supine position

Positional plagiocephaly

Fusion of the metopic suture (forehead) causing a prominent ridge running down the forehead

Trigonocephaly

Early fusion of the sagittal suture causing a "hull-shaped" skull

Scaphocephaly

Lacunar skull is associated with

Chiari malformation & myelomeningocele

White/grey reflex

Cataracts

Absent red reflex

Retinoblastoma

CHARGE syndrome

Coloboma, Heart defects, Atresia of choanae, Retardation of growth, GU defects, Ear defects

Ear anomalies sometimes associated with ____ abnormalities

Renal

A developmental vascular proliferative disorder that occurs in the retina of premature infants with incomplete retinal vascularization, initial injury caused by hypoxia, hypotension, or hyperoxia disrupts normal angiogenesis

Retinopathy or prematurity

A sacral tuft/sinus tract could indicate

Spina bifida, Spina bifida oculta, Meningocele, Myelomeningocele

RFs for developmental hip dysplasia

Breech position in utero

Developmental hip dysplasia PE test that promotes dislocation

Barlow maneuver

Developmental hip dysplasia PE test that reduces the joint

Ortolani maneuver

Cleft in the vertebral column without exposure of neural tissue

Spina bifida occulta

Cleft in the vertebral column with corresponding defect in the skin so that the meninges and spinal cord are exposed

Myelomeningocele

MCC of Erb Duchenne palsy

Shoulder dystocia

Waiter's tip

Erb duchenne palsy

Claw hand

Klumpke's palsy

Upper brachial plexus injury

Erb duchenne palsy

Upper brachial plexus injury

Erb duchenne palsy

When should a hemangioma in a newborn be referred to ENT?

If in beard distribution

Blockage of the duct within the epidermis and sometimes dermis, erythematous 2-4 mm papules on skin folds/neck/groin

Miliaria rubra

Gingival inclusion cyst located on palate

Epstein pearls

Gingival inclusion cyst located on vestibular or lingual surface of the alveolar ridge

Bohn nodule

MC location of dermal melanocytosis (Mongolian spot)

Sacral gluteal region

Symmetric reticular mottling of the skin most commonly seen on extremities and trunk

Cutis marmoraata

Blueberry muffin baby

CMV, Rubella

Screening test for autism

M-CHAT

When should the M-CHAT be done?

18 & 24 months

Weight should double by ______

4-6 months

Weight should triple by _____

1 year

- Hold the child's head and neck above a flat surface with his/her arms folded at the chest

- Suddenly let go of the head/neck and hands

- Child will abduct and extend arms

Moro reflex

Child's head is turned to the side --> he/she assumes the "fencer" position

ATNR

- Child placed in ventral suspension position and one side of the trunk is stimulated

- Child's trunk and hips swing toward the side of the stimulus

Galant reflex

As a child is in free fall in ventral suspension --> extremities extend symmetrically to distribute weight over a broader and more stable base on landing

Parachute reflex

Moro/stepping/grasp reflex

a. Newborn

b. 2-3 mos

c. 4 mos

d. 6 mos

e. 9 mos

f. 12 mos

Newborn

Lifts head to 45 degrees when prone --> arms extended

a. Newborn

b. 2-3 mos

c. 4 mos

d. 6 mos

e. 9 mos

f. 12 mos

2-3 mos

Tracks moving object past midline --> 180 degrees

a. Newborn

b. 2-3 mos

c. 4 mos

d. 6 mos

e. 9 mos

f. 12 mos

2-3 mos

No head lag when pulled to sits

a. Newborn

b. 2-3 mos

c. 4 mos

d. 6 mos

e. 9 mos

f. 12 mos

4 mos

Rolls prone to supine (belly to back)

a. Newborn

b. 2-3 mos

c. 4 mos

d. 6 mos

e. 9 mos

f. 12 mos

4 mos

Rolls supine to prone (back to belly)

a. Newborn

b. 2-3 mos

c. 4 mos

d. 6 mos

e. 9 mos

f. 12 mos

6 mos

Sits with support

a. Newborn

b. 2-3 mos

c. 4 mos

d. 6 mos

e. 9 mos

f. 12 mos

6 mos

Sits with NO support

a. Newborn

b. 2-3 mos

c. 4 mos

d. 6 mos

e. 9 mos

f. 12 mos

9 mos

Pulls to stand, may cruise furniture

a. Newborn

b. 2-3 mos

c. 4 mos

d. 6 mos

e. 9 mos

f. 12 mos

9 mos

May stand without help or walk independently

a. Newborn

b. 2-3 mos

c. 4 mos

d. 6 mos

e. 9 mos

f. 12 mos

12 mos

Tandem walks

a. 15 mos

b. 18 mos

c. 24 mos

d. 3 yrs

e. 4 yrs

f. 5 yrs

4 yrs

Skip alternating feet

a. 15 mos

b. 18 mos

c. 24 mos

d. 3 yrs

e. 4 yrs

f. 5 yrs

5 yrs

Crawls up stairs

a. 15 mos

b. 18 mos

c. 24 mos

d. 3 yrs

e. 4 yrs

f. 5 yrs

15 mos