Peds Aquifer Cases -2023 Latest Questions With Correct Answers Already Passed!!
Management for fever without a source
CBC and empiric treatment with antibiotics are generally NOT necessary.
-vast majority will not have bacteremia or SBI
-even immunized, immunocompetent 3- to 36-month-old chil...
Peds Aquifer Cases -2023 Latest Questions With Correct
Answers Already Passed!!
Management for fever without a source
CBC and empiric treatment with antibiotics are generally NOT necessary.
-vast majority will not have bacteremia or SBI
-even immunized, immunocompetent 3- to 36-month-old children
A 30-minute-old infant is evaluated in the nursery for tachypnea. He was born at
30 5/7 weeks gestation by vaginal delivery. Labor was induced due to severe
maternal pre-eclampsia. Mother received no prenatal care. Apgars were 6 and 7 at
1 and 5 minutes, respectively. One dose of betamethasone was given prior to
delivery. A chest x-ray reveals decreased lung expansion. Likely dx?
Respiratory distress syndrome (RDS)
-Preterm
-Mom got betamethasone = risk for RDS
-Insufficient surfactant.
-CXR and PE shows RDS: reticulogranular or "ground-glass" appearance and
bronchograms
Tobacco affect on newborn?
Low birth weight
Fetal alcohol syndrome
1. Facial abnormalities
2. Growth deficiency
3. Evidence of CNS dysfunction
Maternal heroin use association
1. Risk of fetal growth restriction
2. placental abruption
3. fetal death
4. preterm labor
5. intrauterine passage of meconium
Infant who has uncoordinated sucking reflexes, poor feeding, irritability, and
high-pitched cry likely has?
Neonatal abstinence syndrome
-mothers who use opioids
Cocaine and other stimulant effect on new born?
Causes vasoconstriction:
-placental insufficiency
-low birth weight
Up to 70% of SGA infants are small simply due to ...
constitutional factors determined by maternal ethnicity, parity, weight or height
When is prophylactic antibiotics indicated for GBS?
Gestational age <38 e.g. 35 weeks
TORCHZ infection
Toxoplasmosis
Other-varicella
,Other - syphillis
Rubella
CMV
HSV
Zika*
Components of the Apgar score:
Appearance (skin color)
Pulse (heart rate)
Grimace (reflex irritability)
Activity (muscle tone)
Respiration
-0, 1, or 2 for each component
-Final score range: 0 - 10.
-Reported at 1 minute and 5 minutes after birth
Pulse determination for apgar?
Palpation of umbilical cord shows heart rate
Term pregnancy
Born at >37 weeks gestation
Rooting reflex
Newborn turns his head toward your finger when you touch his cheek
Startle - moro reflex?
Support the newborn's head with one hand and buttocks with the other. With the head in
a midline position, the hand supporting it is quickly dropped to a position approximately
10 cm below its original supporting position, and the head is caught in its new position.
In response, the newborn will flex his thighs and knees, fan and then clench his fingers,
with arms first thrown outward and then brought together as though embracing
something.
Absent red reflex underlying causes?
1. Cataract
2. Opacified cornea (mucopolysaccharidosis)
3. Inflammation (anterior chamber)
4. Developmental anomalies
5. Retinoblastoma, a potentially lethal malignancy (white, irregular mass within the
globe).
Key clinical findings about the present illness
Term
SGA
Normal vital signs
Normal physical exam
Normocephaly
Developmental screening for peds should performed at what times?
9-month
18-month
30-month
autism screening - 18-months and 24-months
developmental surveillance recommended at every health maintenance visit
,Preferred source of nutrition for most babies?
Breast milk
-Until 12 months of age
- Supplement w/Vit D 400 IU daily
Caloric requirement of most healthy term babies in the first 1 to 2 months of life?
100-120 kcal/kg/day - term infants
preterm- require 115-130
very preterm-require 150
Moro reflex disappears when?
4 months
Vitamin D recommendation for children up to 12 months of age
400 units per day
-vitamin D in breast milk is not adequate.
-infants must drink 32 ounces (one quart) of formula or milk a day.
-breastfed should sup w/ liquid vitamin drops
Vaccines at 2 months visit?
Dtap
MMR
HepB
HiB
IPV
PCV13
RotaV
When can flu shot be given to peds pts?
>6 months
By what ages should an infant double and triple his or her birth weight?
2x- 5 months
3x- 12 months
Red reflex
Red to orange color reflected from the fundus through pupil
-viewed through opthalmoscope
-10 inches away from patient
Common etiologies of absent red reflex?
1. Cataracts
2. Glaucoma
3. Retinoblastoma
4. Chorioretinitis
When to refer peds patient to ophthalmologist?
1. Leukocoria
2. Abnormal or asymmetric red reflex
3. Nonaccidental trauma suspected
Developmental milestones of 6 month old infant
pulls to seated
able to sit well w/o support
grabs blocks with nearest hand
transfers object
, raking grasp to pick up toys
babbles, no specific words
Infant waves bye-bye, sits without support. Likely age?
9 months
Mass in RUQ with elevated catecholamines in infant. Dx?
Neuroblastoma
-test for MYC-N gene amplification
- infants <1 years old
- tumors often spontaneously regress
screening test for autism in toddlers
modified checklist for autism -M-CHAT
-20 item questionnaire for parents
-scoring system
Nursemaid's elbow
Radial head subluxation
Toddlers who bottle feed at age 2 are at risk for?
Dental caries
Common nutritional deficiencies in preschoolers?
1. overall poor nutrition
2. inadequate fruit
3. inadequate vegetables
4. inadequate iron
4. inadequate calcium and vitamin D = very common - difficult to attain recommended
daily amount from nutrition of sun exposure.
Exercise guidelines for toddlers
- Enjoyment of outdoor physical activity
- Unstructured exploration under supervision
- e.g. walking in the neighborhood, free play outdoors, and park/zoo
Toilet training age
Toddlers at age 3 may not have achieved full toilet "independence"
Requiring assistance, not a sign of developmental delay at this age
may preclude child care or preschool.
When should children be seen by a pediatric dentist?
within six months of the 1st tooth or by 1 year of age
- all children screened by 6 months old to check risk of developing caries.
- many say first visit should be at age 3 years.
Guidelines regarding car seats?
> 24 months old or outgrown the weight and height limits = forward-facing car
seat in back seat.
Older kids remain in CS until they reach a height of 4' 9" (142 cm).
Interpretation of milestones for children?
some tables present milestones that 50% of kids can perform
others present milestones that 75% or 90% of children can perform.
Child that states first and last name, knows gender and age, plays with toys/
engages in fantasy play is likely what age?
4 years old
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