Peds CMS III FINAL

Is BW dependent on Gestational Age?

NO

Low = < 2500 g

Very Low = < 1500 g

Extremely Low = < 1000 g

Ductus Arteriosus connects the _______ to the ________

Pulmonary artery to the descending aorta

If a fetus has only 1 umbilical cord artery rather than 2, what is it most likely due to?

renal congenital anomaly

Common complication to fetus' of diabetic mother

Macrosomnia

Apgar score

Appearance

Pulse

Grimace

Activity

Respiration

> 5 @ 1 min & 8-10 @ 5 min = normal

What APGAR score at 1 minute requires immediate resuscitation?

< 4

What APGAR score @ 5 mins indicates increased risk of CNS/Cardiac dysfunction?

< 7

What is indicated in the newborn routine protocol treatments?

- Eye prophylaxis (silver nitrate)

- Vitamin K (support clotting factors)

- Hep B Vaccine

What is the cause of hyaline membrane deficiency?

Surfactant deficiency

TX - surfactant replacement

Prevention - antenatal steroids @ 24-34 wks

2 Hour old newborn presents with tachypnea, nasal flaring and hypoxemia. You perform CXR ad see air bronchograms & ground glass appearance. What is the likely diagnosis?

Hyaline Membrane Disease (Neonatal RDS)

What is the MCC of respiratory distress in term infants and how do you treat?

Transient Tachypnea of newborn (TX: O2 )

CXR - Increased lung volumes + flat diaphragm

What is the imaging of choice in necrotizing enterocolitis (NEC)?

KUB - pneumatosis intestinalis

Newborn PE reveals bowel sounds auscultated in the thorax, a barrel shaped chest, and scaphoid abdomen. What is the likely diagnosis?

Congenital Diaphragmatic Hernia

*Bochdalek - posterolateral defect (L-sided MC)*

Pregnant women tests positive for GBS screening at 36 wks. How should she be treated?

< 4 hours before birth, then held for observation for 48 hrs

What level bilirubin is required for diagnosis of Kernicterus (bilirubin encephalopathy)

Total bili > 18 (lethargy, vomiting, poor feeding in newborn)

What diagnostic test assesses risk using age and serum bilirubin levels for neonatal jaundice?

Bhutani Nomogram

When is newborn jaundice ALWAYS pathologic?

1st day

1st week = breastmilk

3rd week = biliary atresia

How can you educate parents to avoid Sudden Infant death syndrome (SIDS)?

Promote supine sleeping and avoid co-sleeping

What head abnormality is characterized by superior edema/ecchymosis that crosses the suture lines

Caput succedaneum

Cephalohematoma does NOT cross the suture line

Which type of osteogenesis imperfecta is characterized by easily fractured bones

type 1

If a child has no red reflex, what diagnosis should you be suspicious of

Retinoblastoma

What is the MC sex chromosome disorder in females, resulting in wideset nipples, excessive nuchal skin, & lymphadema?

Turners syndrome

Are males or females more likely to develop developmental hip dysplasia?

females

Which reflex is elicited by sudden dropping of infants head, resulting in abductions and extension of arms/hands

MORO

Birth - 3-6 mo

What does it mean if an infant has absent Moro reflex ? What if it is incomplete?

Absent - UMNL

Incomplete - Brachial Plexus injury

Which reflex is elicited by stroking the infants cheek, resulting in their head turning in the direction (preparing to suck)

ROOTING

Birth - 3 mo

When is palmar vs plantar grasp reflex normally seen in babies

palmar grasp = birth - 3 mo

plantar grasp = birth to 9-12 mo

Which reflex: place the infant in prone and stroke the paravertebral region to elicit movement of their trunk and hips toward the side of the stimulus

GALANT

birth - 3-6 mo

Which reflex: turn infants head and neck to one side to elicit extension of upper & lower extremities on the side to which the head is turned, with flexion of the C/L upper extremity (fencing posture)

ATN (Asymmetric tonic neck)

How long is it normal for babinski to be positive (plantar extension) in babies?

birth - 9-10 mo

What is the MCC of Erb Duchenne Palsy?

Shoulder dystocia

Erbs = Waiters tip

Newborn presents for his 6 week checkup with white papules distributed across the cheeks and chin. What is the likely diagnosis ?

Note: etio is from keratin/pilosebaceous follicles

Milia

Miliaria rubra vs Milaria Crystallina

Rubra = erythematous papules on skin folds

Crystallina = clear vesicles on head/neck & upper trunk

Small keratin filled cyst found on the vestibular or lingual surface of the aleolar ridge

Bohn nodule

Epstein pearl is on palate

When does the AAP recommend screening kids via the modified checklist for autism and toddlers (M-CHAT) ?

18 + 24 mo visits

What is an involuntary muscle reaction to stimulus strength, indicating neurological development and function?

Reflex

Do Gross Motor Developmental Milestones develop cephalocaudally or proximal to distal?

Cephalocaudal (head to toes)

Do Fine Motor Development Milestones develop cephalocaudaully or proximal to distal?

Proximal to distal (shoulder --> finger)

In the picture...

A = cephalocaudal (Gross motor)

B = proximal to distal (Fine motor)

At what age should a baby be able to sit with support?

6 months

At what age should a baby be able to roll from prone to supine?

4 months

At what age should a baby be able to sit with NO support?

9 months

At what age should a baby be able to tandem walk & climb up and down stairs alternating feet?

4 y/o

What age should a baby be able to sit themself in a chair, throw a ball overhead, and handle spoons well for solids?

18 mo

What age should the early vs mature pincer grasp be present?

Early - 9 mo

Mature - 12 mo

What age should a child eat neatly with a spoon and fork?

3 y/o

At what age should a child be able to focus on faces and track vertically and horizontally ?

Birth (if term)

What age should a child track across midline and follow movement?

2 mo

What age should a child be able to use their eyes and head to track 180 degrees?

3 mo

At what age should a baby be able to reach for an object

4-5 mo

At what age should a baby respond to their name, and say "mama & dada" non-specifically?

9 mo

By what age should a child have 1 or more words with meaning?

12 mo

24 mo = 2-word sentences

A mother comes to you with her 4 y/o son, concerned that he has been stuttering in short, brief repetitions for the last 3 months. She states it does not seem to distress her son at all. How do you plan to manage this patient?

Reassure her that a stutter can be normal from 2.5-5

Needs further eval if onset > 5 y/o or persists for > 6 mo

What medications can be used to improve anxiety and ritualistic behaviors in a 7 y/o boy with 5 year history of restricted, repetitive patterns of behaviors, interests, and activities?

Autism Spectrum Disorder

- M-CHAT or CARS to screen

- Sertraline

ASD or Aspergers: NO language impairment

Aspergers

Which trisomy is associated with risk of VSD/ASD and subluxation of c-spine?

Trisomy 21 (Down Syndrome)

Which trisomy is associated with holoprosencephaly?

trisomy 13 (Patau's)

Which trisomy is associated with rocker bottom feet & clenched hands with overlapping fingers?

trisomy 18 (edwards)

high infant mortality :(

young female presents with underdeveloped breasts & uterus, primary hypogonadism, ovarian dysgenesis and short stature (4.5 feet). What is the probable diagnosis ?

Turner Syndrome (45,X)

paternal absence of X

20 y/o tall, thin male presents with gynecomastia and micropenis. What is the likely diagnosis?

Klinefelters (47,XXY)

increased risk for ADHD/Autism

What is the MC inherited intellectual disability in males?

Fragile X Syndrome

- long protruding ears

- velvety skin

- testicular enlargement

10 y/o boy presents with cryptorchidism, syndromic obesity, and fish-like mouth. What is the likely condition ?

Prader-Willi

maternal vs paternal deletion of 15q11

maternal - angelman

paternal - prader willi

Which syndrome is known for lower lid coloboma, malar hypoplasia, resporatory compromise, and a beak like nose?

Treacher collins - auto dom mutation on chrom 5

Mother presents with her 3 y/o son because he has recently been briefly crying, holding his breath and then losing consciousness during a temper tantrum. What is the most likely diagnosis?

Cyanotic breath holding (MC type)

Pallid = rare type where LOC leads to breath holding

What is the MC neurobehavioral disorder in children?

ADHD

A concerned mother comes to you with her 6 y/o son, complaining that he has been displaying negative, hostile behavior for the last 9 months. It is usually directed at his parents, teachers, and peers at school. What is the likely diagnosis?

ODD

Where is the fibrotic narrowing located in coarctation of the aorta, and what symptoms will we see as a result?

DISTAL to L subclavian (after bifurcation)

- leads to dorceful UE pulses and delayed LE pulses

- bounding radial & diminished femoral pulse

- rib notching & figure 3 sign

What is the MC cyanotic CHD?

Tetralogy of Fallot - boot shaped heart

PS

RVH

Overide aorta

VSD

What congenital heart defect is associated with maternal lithium ingestion?

Ebstein anomaly

Which heart murmur changes intensity with head rotation, and disapears with compression og the jugular vein?

venous hum

What is the MCC of syncope in kids?

Vasocardiogenic (vasovagal)

What is the leading cause of acquired heart disease in children?

Kawasakis

What is the MCC of acquired conductive hearing loss in children?

middle ear effusion

Child with recent URI presents for ear pain. On exam you visualize opacification of TM / air-fluid levels. How do you treat?

Serous otitis Media - NOOOO ABX

What is mastoiditis a complication of?

AOM

Child presents with hot potato voice, drooling, & dysphagia with U/L sore throat. What is the MC etiology?

PTA - GAS

Child presents with stiff neck, sore throat, and erythematous edematous posterior pharynx with uvula and tonsillar displaced anteriorly. What is the MC etiology?

RPA - S pyogenes or S aureus

Child presents with sudden onset, rapidly progressive stridor, drooling, dysphagia, and fever. They are sitting on their parents lap leaned over with their hands on their knees. What do you expect to see on XR ?

Epiglotittis - thumb print

"Steeple" sign on CXR

Croup (parainfluenza virus)

Tx - racemic epi + dexamethasone

MCC of URI?

Rhinovirus

Infant presents with meconium ileus, jaundice, and FTT. How do you evaluate for the suspected cause?

Cystic Fibrosis - sweat Chloride test > 60

Meconium ileus = water contrast enema for definitive dx

Which type of esotropia is only present with OUT glasses on?

Accomodative

TX - corrective glasses

What is it called when the white of the sclera is between the cornea, obscuring the inner canthus & giving the appearance of esotropia?

pseudostrabismus

How do you treat the MCC of pediatric monocular vision loss?

Amblyopia - patch the UNAFFECTED eye

Blue mass below the medial canthel tendon

Congenital Dacryocystocele

Follicular vs Papillary Conjunctivitis

Follicular = Viral

Papillary = Bacterial

What is the rule of 3's with Colic?

Colic = benign prolonged crying or irritability

> 3 hr/day

> 3 days/wk

> 3 wks

4 mo old patient presents with inconsolable crying and stool containing mucus and blood x 2 days. On PE you palpate a sausage shaped mass in the upper abdomen. What do you expect to see on US?

US: "Target" / "Donut" sign

Tx: Air contrast enema

Give the confirmative diagnosis and treatment for the most emergent cause of sudden bilious emesis & severe abdominal pain

volvulus

Dx: upper GI w SBFT

TX: Surgical Emergency (ladds procedure)

Child presents with dad for evaluation of postprandial projectile, non bilious emesis. You palpate a firm, marble sized round mass in the abdomen. How do you confirm the likely diagnosis?

Pyloric stenosis -- (olive shaped mass)

confirm via US

Down syndrome male infant 72 hours after birth has still not passed meconium. What is the Gold standard to diagnosis the suspected disease?

Hirschsprungs - Rectal Bx

Does hind breastmilk or fore-milk have higher calories?

HIND

What is in colostrum?

- igA

- protein

- growth factors

- lactoferrin

What patient education must be given to breastfeeding moms?

Supplement with vitamin D

How much should a babies weight increase by 12 mo of age?

triple

double in 4-5 mo

How many Kcal/kg/day is required for children?

100

When can you introduce solid foods to a baby's diet?

4-6 mo

When is it okay to introduce cows milk into a baby's diet?

12 mo

Which immunodeficiency has a decreased response to immunization (vaccines aren't working?)

Common Variable Immunodeficiency (CVID)

Which type of immunideficeincy is a result of defects in T & B cells, and weak NK cells?

Severe Combined Immunodeficiency (SCID)

- recurrent skin, GI or pulmonary infections