Before the get sick
What is the only vaccine curenttly reccommended at birth?
Hepatitis B
Hep B should be administered to all newborns within 24 hrs of birth. Hep B and hep B immunoglobulin are recommended within 12 hrs of birth in infants whose maothers are HbsAg+. Administer 2nd dose at 1-2 months of age (minimum interval of 4 wks). Administer the 3rd dose at 6-18 months (minimum interval of 8 wks after 2nd dose)
What test should be performed in well appearing, < 2 year old siblings of physically abused children?
Skeletal survey
A significant number of siblings of abused children have fractures that are not suspected clinically. Twins are at especially increased risk
Whne should universal screening for vaginal rectal group B Streptococcus (GBS) be conducted in pregnant women?
Between 36 0/7 and 37 6/7 weeks of gestation
The prevention of perinatal GBS disease in pregnancy, 36 0/7 to 37 6/7 weeks of gestation is the optimal timing for prenatal GBS screening
What is the most common childhood malignancy?
Acute lymphoblastic leukemia (ALL)
Leukemia is the most common cancer in childhood (25% of pediatric cancern), and aALL in particular is the single most common childood malignancy (75% of all pediatric leukemia cases). Luckily, ALL is one of the most curable cancers today. Its peak incidence is between 2 and 5 years of age
A newborn presents with delay of the femoral pulse compared to the radial pulse.
What cardia condition does this indicate?
Coarctation of the aorta (CoA)
Abnormalities of arterial pulses can indicate significant cardiac anomalies. Significant delay, or even absence, of the femoral pulse compared to the radial pulse indicates CoA
All infants should have a hearing screen by no later than what age?
1 month of age
Universal hearing screening should ideally be completed before newborns are discharged from the hospital, nut no later than 1 month of age in all infants. Screening is usually performed with auditory brainstem response testing, which measures how CN 8 responds to sound.
Screening by 1 month of age, diagnosis of hearing loss by 3 months, and entry into early intervention services by 6 months
- Decreased sweating, urinary retention, flushing, mydriasis, agitation, seizures, hyperthermia
Ingestion of what type of agent causes these symptoms?
Anticholinergic
Anticholinergic agents include antihistamines (ex. diphenhydramine), tricyclic antidepressants (ex. amitriptyline), atropine, some mushrooms, jimson weed, and deadly nightshade
An infant was born at 28 wks of gestation. He was given surfactant at birth and intabated for acute respiratory distress. He was transitioned to nasal CPAP but had to be reintubated twice due to pneumonia and sepsis. He is now term but persistently requires oxygen. He is fluid restricted and is on a concentrated formula diet
What is the most likely reason for his persistent oxygen requirement?
Bronchopulmonary dysplasia (BPD)
BPD occurs most commonly in preterm infants born at < 30 weeks of gestation. It is characterized by perisstnet respiratory insufficiency, despite the abscense and elimination of all other correctable causes. Infection and fluids overload are known risk factors for developing BPD.
What major side effect of do you worry about with the use of doxorubicin?
Cardiomyopathy
The antracycline chemo drugs (doxorubicin or daunorubicin) can cause cardiotoxicity, presenting as cardiomyopathy
A 7 year old boy presents for a camp physical. The following is found:
- systolic ejection murmur with a vibratory or musical character
- the murmur is heard best at the left lower sternal border and not in the back
- murmur dec markedly with positional changes that dec venous return
What is the most likely murmur
very common in childhood. It usually has a musical quality
A child has not had any immunization.
Assuming that the child is immunocompetent, what is the cut-off age for receiving a Haemophilus influenzae type b vaccine?
> 5 years of age
Do not immunize children > 5 years because they are at much lower risk for serious sequelae. One dose of Hib is recommended for those > 5 if they are considered high risk (ex. functional/anatomic asplenia, HIV, leukemia, immunocompromised)
A child presents to the emergency department pulseless and is found ot have ventricular tachycardia on the cardiac monitor. CPR is initiated.
What is the next step in management?
Defibrillation with 2 J/kg
Once cardiac arrest is recognized, begin CPR while preparing to assess the rhythm. Pulseless ventricular tachycardia and ventricular fibrillation require defibrillation. Begin with 2 J/kg, then resume CPR for 2 min before rechecking puls/rhythm. Give epi every 3-5 min. The 2,d shock is 4 K/kg; 3rd and subsequent shocks are 4 J/kg. The sequence is CPR --> shock --> CPR --> drug --> shock (repeat).
What does cigarette smoking most commonly cause in babies born to mother who smoke?
Low birth weight
maternal smoking can also lead to a higher incidence of miscarriage, prematurity, and stillbirht. It is also a risk factor for SIDS
A child presents with an orbital chloroma and hepatosplenomegaly
What is the most likely diagnosis?
Acute myeloid leukemia (AML)
An orbital or epidural chloroma, which is a localized mass of leukemic cells, may be the 1st clue of AML. Hepatosplenomegaly can sometimes occur, but anemia and thrombocytopenia are almost always present
A 13 year old boy presents with:
- Mid to laste systolic murmur at the apex
- The murmur is preceded by 1 or more "clicks"
- If the patient goes from a supine to a standing position, the murmur gets louder; when he squats, the murmur becomes softer
What is the most likely diagnosis?
Mitral valve prolapse (MVP)
MVP occurs when 1 or both leaflets of the mitral valve prolapse back into the left atrium in systole. So, for a mid to late systolic murmur that gets louder with standing, think MVP; on the other hand, for an early sistolic murmur that gets louder on staning, think hypertrophic cardiomyopathy
An adolescent receives the MMR vaccines and experiences joint pain 10 days after the vaccination
What component of the vaccines is likely responsible for this?
Rubella
Adverse events of MMR include:
- tenderness/warmth at injection site
- Fever to 39.4 C (103 F) -- some get febrile sz
- Transient rash occusting 6-12 days after MMR
- Transient thrombocytopenia
- In adolescents, joint pain secondary to rubella component occurs 7-21 days after MMR
It is wintertime and an entire family, including children, presents with:
Headache, nausea, confusion, lethargy, malaise, flu like symptpms, pulse ox is normal
What is the likely diagnosis?
Carbon monoxide poisoning
CO is colorless and odorless; poisoning form it presents with nonspecific symptoms. Be very suspicious if you see a family in wintertime or during periods of prolonged power outages (ex. hurricanes) when using gas generators with similar complaints, especially if afebrile.
- Mean pulmonary artery pressure _____ dramatically at birth
- Pulmonary blood flow ____ dramatically at birth
- Pulmonary vascualr resistance ____ dramatically at birth
Fill in the blanks using either "decreases" or "increases"
Decreases; increases; decreases
These are changes in pressures and flow of pulmonary vascular system as the baby transitionas from in utero to breathing air
A child presents with: Nausea/vomiting, abdominal mass and pain in the ileocecal junction area, and fever.
CT scan of the abdomen confirms that the mass is at the ileocecal junction, with no evidence of intussusception.
What is the likely diagnosis?
Burkitt Lymphoma (BL)
BL is the most common form of non-Hodgkin lymphoma, with 90% originating from relatively mature B cells in Peyer patches within the GI tract- most commonly at the ileocecal junction. Jaw involvement is very common in the African form but occurs in only 15% of US cases. BL is the fastest growing malignant tumor and can result in life threatening tumor lysis syndrome
Alagille and Noonan syndrome are both associated with what cardiac abnormality?
Pulmonic stenosis (PS)
Alagille syndrome, caused by absence of or mutation in the JAP1 gene, primarily affects the liver but also has cardiac manifestation. In addition to PS (8%), individuals with Alagille syndrome have peripheral and branch PS (67% of pts) and ToF (7-16% of pts). Noonan syndrome is a genetic congenial disorder due mostly to mutation of the PTPN11 or SOS1 gene and affects many parts of the body ~50-60% of children with Noonan syndrome have PS
A preterm girl born at 26 wks is now 2 months of chronologic age and remains in the NICU. The child is clinically stable and has steady growth. She will likely stay in the NICU for several weeks to gain additional weight.
List the vaccinations she may receive prior to discharge from the NICU.
Hep B; DTaP; PCV15/PCV20; Hib; IPV
All immunizations recommended at 2 months may be given simultaneously to this preterm infant expect for the live oral rotavirus vaccines. Defer this vaccines until discharge from the NICU to prevent the potential for nosocomial spread of the vaccines virus.
- Appears intoxicated with slurred speech and drowsiness
- Renal failure with calcium oxalate crystals in the urine
- High anion gap metabolic acidosis
Ingesting what substance produced these signs and symptoms?
Ethylene glycol
Ethylene glycol is in antifreeze. Ingesting it results in an osmol gap and a high anion gap metabolic acidosis with the development of calcium oxalate crystals in the urine and eventual renal failure if not treated. Remember to differentiate ethylene glycol ingestion (renal failure) from methanol ingestion (visual disturbances)
A newborn presents with the following:
Jitteriness, irritability, tremulousness, muscle rigidlity, and intracranial hemorrhages
What ilicit drug used by the mother during pregnancy is most likely responsible for these findings.
Cocaine
Chronic cocaine use by the mother during pregnancy results in jitteriness, irritability, tremulousness, and muscle rigidity in the infant. If these effects occus without the intracranial hemorrhages, they commonly resolve several days after birth without known long term effects. Increased risk of placental abruption and intracranial hemorrhage are associated with cocaine use near delivery.
- Impaired upward gaze
- Dilated pupils with better reactivity to accommodation that to light
- Retraction or conversion nystagmus with lid retraction
What is the syndrome associated with this triad?
Perinaud syndrome
Perinaud syndrome is caused by compresion or infiltration of the midbrain tectum, particularly with pineal tumors
What cardiac condition is associated with Williams syndrome?
Supravalvular aortic stenosis (AS)
Williams syndrome is associated with supravalcular AS, which is narrowing just above the level of the coronary arteries. Other arteries may also be narrowed in Williams syndrome, including the pulmonary arteries and the real arteries