-
what is given to newborn at birth
- silver nitrate or erythromycin drops
- vit k im
-
What 4 tests are done before discharge
- pku
- hypothyroid
- galactosemia
- sensorineural hearing loss test
-
1 rx for mongolian spots
2erythema toxicum
3 port wine stain
4 hemangioma
5 preauricular tags/pits
6 defect of iris(coloboma)
7 aniridia
8 branchial cleft cyst
9 thyroglossosal duct
10 omphalocele
11 gastroschisis
12 umbilical hernia
13 undescended testis
14 hydrocele
15 hypospadias
16 epispadias
17 inguinal hernia
- 1- rule out abuse
- 2-- resolves on own
- 3-- evaluate for glaucoma/anticonvulsants give laser therapy
- 4- observe bc regresses on own by 5 yo, if large or interferes with organs, give steroids/laser therapy
- 5-preauricular tags- evaluate for deathness/ultrasound of kidney for renal abnormalities
- 6-coloboma evaluate for charge syndrome
- 7-aniridia--screen for wilms tumor q3 untill 8
- 8-infected cyst- abx if large--surgery
- 9-thyroid scan and remove
- 10- screen for trisomies
- 11- surgical repair
- 12- screen- down syndrome dont close till 2
- 13- no rx untill 1 yo. bhcg, test or surgery
- 14-diff from inguinal hernia
- 15- look for other gu-hernia/undescended tes
- 16-evaluate for bladder exstrophy
- 17- surgery
-
infants of diabetic mothers will have what kind of lab abnormalities
- hypoglycemia
- hypocalcemia
- hypomagnesemia
- hyperbili
- polycythemia
-
what structural defects do iodm have
- cardiac- asd, vsd, truncus arteriosus
- small left colon
-
newborn has respiratory distress and hypoxia does not resolve with 100% oxygen, next step
evaluate for cardiac causes
-
what studies are ordered with cases of respiratory distress
- cxr
- abg
- blood culture
- cbc
- cranial ultrasound
- blood glucose
-
best initial rx for rds
- oxygen
- nasal cpap
- empiric abx
-
best predictive tests for rds
L/S of amniotic fluid prior to delivery
-
best initial rx for rds
most effective therapy
- oxygen via nasal cpap
- surfactant
-
how to prevent rds
steroids >24 hrs <34 weeks gestation
-
3 complications of rds
- retinopathy of prematurity
- intracranial hemorrhage
- bronchopulmonary dysplasia
-
Transient tachypnea of newborn vs rds
- ttn--after term delivery--order CXR
- rds---preterm
-
presentation of meconium aspiration
severe rds in a term infant with distress or hypoxia of infant in utero
-
best intitial test for meconium aspiration
cxr
-
how to prevent meconium aspiration
suction and intubate
-
rx for meconium aspiration
- cpap
- intubate
- extracorporeal memebrane
- nitic oxide therapy
-
complications of meconium aspiration
- asporation pneumonitis
- p. artery htn
- air leak--pneumothorax, pneumomediastinum
-
dx of diaphragmatic henria
rx
- cxr with ng tube coiling up in chest
- intubate and surgical correction
-
where do meconium plugs appear in gi tract vs ileus
- plug--lower colon
- ileus-- lower ileum
- causes of plug--iodm
- cystic fibrosis
- hirshsprung
- maternal drug abuse
-
when is high bilirubi pathological
- on first day
- after 2 weeks
- rise of 5mg/day
- more than 12mg/on delivery
- direct bili >2mg
-
what tests are ordered when there is jaundice on first day
- direct and indirect
- cbc, retic, smear
- coombs
- mother and baby type
- urinalysis and urine culture
-
jaundice after 2 weeks and unconjugatd
- uti or infections
- hemolysis
- rbc membrane or enzyme defects
- problem conjugating bili
-
jaundice after 2 weeks and high direct bili
- best initial test--lft
- sono and biopsy
-
when do you do phototherapy
when do you do exchange transfusion
when bili is >12 mg
photo doesnt work or bili encephalopathy is present
-
most common cause of sepsis in first 24hrs
after 24 hrs
and rx for each
- pneumonia--amp and gent
- meningitis--amp and third gen cephalosporin but not ceftriaxone
-
when do you suspect meningitis as cause of sepsis
if there is lethargy and somnolence, otherwise it is not worked up for
-
what is the organism causing the following torch infection
1hydrocephalus, cranial calcifications, chorioretinitis
2- intracranial calcifications, low platelets, hearing loss
3- cataracts, deafness, blueberry muffin
4-osterochondritis, periostitis--hutchinson teeth, bowed bones, sniffles, desquamating rash
5- pneumonia, vesicles, keratoconjunctivitis, meningoencephalitis
6- pneumonia, mental retardation
- toxo
- 2cmv
- 3-rubella
- 4-syphilis
- 5- herpes
- 6- varicella
-
best initial test for torch infections
most accurate
-
which torch infections presents with intrauterine growth retardation, mental retardation, seizures, hepatosplenomegaly, jaundice
all of them
-
screening test for torch infection
total cord blood IgM
-
5 tests for seizures in a newborn
- eeg
- organic acids and amino acid essays--pyridone, pku
- blood cultures
- torch
- ultrasound of head in premature for ICH
- sodium, ca, mg, phosphorus, glucose
-
rx for seizures in infants
- phenobarbital
- phenytoin if not controlled
- correct electrolytes
-
mnx of an infant born to a heroin using mother
give opiods, dont give naloxone
-
the following have what effect on sulfonamidesphenobarbitalnsaidsaceinhibitosisotretinoinphenytoindestetracyclinelithiumwarfarinvalproatecarbamezapine
- sulfonamides-displaces bili from albumin
- phenobarbital- vit k def
- nsaids- closes pda
- aceinhibitos- cranio facial abno
- isotretinoin--facial and ear abnormalit
- phenytoin--hypoplastic nails, abnoral facies
- des- vaginal adenocarcionoma
- tetracycline- discoloration of teeth
- lithium-ebstein abnormality
- warfarin-facial dysmorphysm and chondroplasia
- valproate-nt defect
- carbamezapine-nt defect
-
fever without a focus vs fever of unknown origin <1 week in kids <3 yo
-
when do you give empiric antibiotics for fever without a focus
-
culture first for fever and then give abx
-
what bacteria should be covered for in neonate
infant
- infant--strep. pneumo--well apearing--single im ceftriaxone
- toxic--iv ceftriaxone
-
empiric rx for meningitis
- iv vanco and ceftiraxone
- for hib---ampicillin
- e.coli--- ceftriaxone
- n.meningitis--penicillin
- strep .pneumo--peniciilin or 3rd gen cephalosporin
-
complicatons of meningitis
- throbosis
- seizures
- neurological defects
- hearing loss
-
definition of epilepsy
2 unprovoked siezures 24 hours apart
-
mnx of febrile seizure
- reassure partents
- control fever
- r/o meningitis
-
when are meds stopped for epilepsy
after 2 years free of seizures
-
rx for absence seizures
ethosuxamide
2nd line--valproic acid
-
how does juvenile myoclonic epilepsy present
rx
- seizures in the am
- rx valproic acid
-
most common neurological disorder with west syndrome
down syndrome
-
-
next step when suspecting ITP
order peripheral smear to rule out TTP and HUS
-
rx for hemophilia B
factor 9 concentrates
-
rx for hemophilia a
- minor-ddavp
- major--factor 8 concentrate
-
rx for von willebrand disease
- ddavp for minor
- for major, concentrates of vwd with factor 8
-
best initial and accurate tests for beta thalassemia
hgb electrophoresis
-
rx for beta thalassemia major
- transfusion
- splenectomy
- prophylactic vaccinations
- folate
-
best diagnostic test for sickle cell
hb electrophoresis
-
chorionic villus sampling and amniocenteiss are done at how many weeks
- cvs-10 weeks
- amniocentesis -15 weeks
-
when do you transfuse in sickle cell
in symptomatic anemia
-
when do you exchange transfuse in sickle cell
- priapism
- stroke
- acute chest syndome
- avascular necrosis
- before high risk surgery
-
when do you give hydroxyurea for sickle cells
- >3 episodes/year
- symptomatic anemia
- life threatening complications
-
at discharge instructions for sickle cell pts
- penicillin prophylaxis
- immunizations-pneumovax
- folate
- hydroxyurea
-
blood lead testing is done when in high risk pts
at 12 and 24 months
-
mnx of lead poisoning
- refer to department of health >15
- chelate at >45
-
when do you start cows milk
at 1 yo
-
when do infants get physiological anemia
at 12 weeks, nothing should be done
-
when do you warfarin for kawasakis
if there is thrombosis in the coronaries
-
best initial test for cah 21 hydroxylase deficiency
most accurate
increased 17 oh progesterone
17 oh progesterone after acth stimulation
-
how does cah 21 hydroxylase def present
- ambigous genitalia in girls
- with hyponatremia
- hyperkalemia
- hypoglycemia
- hypotension
-
rx for mild cases of minimal change disease
refractory to initial rx
- steroids
- cyclophosphamide
- azathioprine
- cyclosporine
-
rx for autosomal recessive polycystic kidneys
-
most specific test for acute post streptococcal gn
anti-dnase
-
rx for apsgn
penicillin, salt and fluid restriction
-
most important management in apsgn vs iga nephropathy
apsgn---penicillin
IgA nephropathy---BP controle
-
best initial tests for obstructive uropathy
voiding cystaurethrogram and renal ultrasound
-
rx for vesicourethral reflux
abx untill it resolves
-
best initial test for uti
most accurate
-
rx for cystitis
amoxacillin, tmp smx
pyelonephritis--iv ceftriaxone, amp and gent
-
which antibiotics should you not give to kids and teenagers
- kids <7 tetracycline
- adolescents <16 fq
-
mnx of uti in kids
- treat and obtain urine culture a weak later to confirm sterile urine
- do ultrasound and voiding cystaurethragram if 2 episodes of febrile uti or family history of urological dz or organism other than uti, poor growth
- htn
-
best initial therapy for gerd in kids
h2 blockers not ppi
-
test for carbohydrate malabsorption
clinitest but most accurate is breath hydrogen
-
test for pancreatic enzymes
serum trypsinogen
-
what needs to be ruled out in pancreatic insufficiency?
cystic fibrosis
-
dx of giardiasis
duodenal aspirate/biopsy
-
best initial test for protein malabsorption
spot stool alpha 1 antitrypsin level
-
best initial tests for diarrha
- stool blood, culture, leukocyts
- ova and parasite
- enzyme virus immunoassay
- c diff toxin
-
studies for kids with downs
- tsh
- hearing studies
- echo for cardiac
- ALL
- Alzehiermiesr
- duoednal atresia
-
trisomy 18 associations
- cardiac
- renal
- rocker bottom feet
-
malformations of patau
- everything midline
- micrognathia
- cleft lift/palate
- holoprosencephaly
-
when do you replace test for klinefelters
at 11-12
-
associations with turners
- kidney
- coarctation, bicuspid heart valve
- hypothyroid
-
association with fragile x syndrome
adhd
-
classic Beckwith -wiedman syndrome
- enlarged everythinga
- associated with wilms and hepatoblastoma
-
robin sequence
mandibular hypoplasia, cleft palate
-
skeletal maturity is related wot what
sexual maturity
-
when do you work up kids for small size
when they have crossed 2 major percentiles
-
next step when you have normal weight gain but decreased height
- assess gh
- tsh
- cortisol
- xray of hand and wrist
-
decreased weight gain is equal to decreased height
systemic illness or genetic short stature or constitutional delayed short stature
-
decreased weight gain more then decreased height
- undernutirion
- do stool fat
- sweat test
- assess calories
-
contraindications to breast feeding
- hiv
- cmv
- active herpes
- breast ca
- hbv untill immunized
- tb, sepsis
-
bedwetting before what age is normal
before 5
-
best initil test for enuresis
- urinalysis
- urine culture
- vcug
-
drug therapy for enuresis
-
best initial test for encopresis
abd xray
-
rx for retentive encopresis
stool softeners
-
mnx of someone who was exposed to hep b or a or varicella
ivig and vaccine
-
mnx of somone 6-12mo and >12 mo who was exposed to measles
- 6-12--ivig and vaccine
- >12mo--vaccine
-
mnx of someone who was expose to rubella or mumps
nothing
-
mnx of a baby whose mother has no hep b antigen
has hep b antigen
- regular 3 immunizations
- vaccine and ivig at 2 diff sites at birth and 3 doses by 6mo
-
the only vaccine with a total of 5 doses
DTAP
-
HIB vaccine is given when
<5yo
-
mnx of child abuse
- cbc, pt, ptt platelts, bleeding time
- skeletal surgey
- ct/mri
- stool for blood
- liver enzymes
-
rx for croup
nebulized epi
-
rx for epiglotitis
intubate give abx
-
bacterial tracheitis is susually caused by what organism and it occurs when
rx
- s. auerus
- after a viral infection
abx and may need to intubate
-
best initial and accurate for bronchiolitis
-
rx for bronchiolitis
- not ribavirin
- supportive- oxygen
-
prevention of bronchiolitis
-
what bacteria cause of pneumonia gives staccato cough and peripheral eosinophilia
chlamydia trachomatis
-
what to order on ccs for pneumonia in kids
not sputum cultures
-
best initial and specific tests for cf
sweat chloride conc on two separate days
-
medication for cf
ivacaftor
-
mild respiratory
moderate
severe
- tmp smx, cipro
- zosyn
- inhaled tobramycin
-
when evaluating for chd, should you add abx
yes
-
what gives increased pulmonary markings
- tgv
- truncus arterirosusu
- hypoplastic left heart syndrome
-
rx for severe htn in adolsecents
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