Clinical Pediatrics

100 flashcards by MentisLibrary

Newborn care, growth and developmental milestones, the immunization schedule, childhood infections, respiratory and gastrointestinal disease, congenital heart lesions, genetic syndromes and adolescent health.

What five signs make up the Apgar score, and when is it assigned?
Appearance, Pulse, Grimace, Activity and Respiration, each scored 0 to 2, assigned at 1 and 5 minutes after birth.
Why is jaundice in the first 24 hours of life always abnormal?
Physiologic jaundice does not appear before 24 hours, so early jaundice implies hemolysis or another pathologic cause.
What is kernicterus, and which bilirubin fraction causes it?
Permanent bilirubin encephalopathy caused by unconjugated bilirubin, which deposits in the basal ganglia and brainstem nuclei.
Which newborns are at highest risk for hypoglycemia?
Infants of diabetic mothers, small for gestational age and growth restricted infants, large for gestational age infants, and preterm or ill infants.
What causes neonatal respiratory distress syndrome?
Surfactant deficiency in a preterm lung, which raises alveolar surface tension and causes diffuse atelectasis.
How does transient tachypnea of the newborn differ from respiratory distress syndrome?
It is retained fetal lung fluid in a term or late preterm infant, and it resolves within 24 to 72 hours rather than worsening.
What is meconium aspiration syndrome?
Airway obstruction, chemical pneumonitis and surfactant inactivation caused by aspirated meconium stained amniotic fluid.
Which organisms cause early onset neonatal sepsis?
Group B Streptococcus, Escherichia coli and Listeria monocytogenes.
What does newborn screening test for?
A panel of metabolic, endocrine, hemoglobin and other genetic conditions from a heel stick blood spot, plus hearing screening and pulse oximetry for critical congenital heart disease.
Why is vitamin K given at birth?
To prevent vitamin K deficiency bleeding, formerly called hemorrhagic disease of the newborn.
Why is antibiotic eye ointment applied to newborns?
To prevent gonococcal ophthalmia neonatorum, which can perforate the cornea and cause blindness.
Caput succedaneum vs cephalohematoma: how are they told apart?
Caput succedaneum is scalp edema that crosses suture lines; a cephalohematoma is subperiosteal bleeding that does not cross suture lines.
How is developmental dysplasia of the hip screened for in a newborn?
With the Barlow maneuver, which dislocates a dislocatable hip, and the Ortolani maneuver, which relocates a dislocated one.
How much weight does a healthy newborn normally lose in the first week?
Up to about 7 to 10 percent of birth weight, regained by roughly two weeks of age.
When do infants typically sit without support, pull to stand, and walk alone?
Sitting without support around 6 months, pulling to stand around 9 months, and walking alone around 12 months.
Outline the normal sequence of early language milestones.
Cooing around 2 months, babbling around 6 months, single words around 12 months, and two word phrases around 24 months.
Which social and emotional milestones anchor the first two years?
A social smile around 2 months, stranger anxiety around 9 months, and parallel play around 2 years.
When does an infant develop a pincer grasp?
Around 9 to 12 months, following the raking grasp of about 6 months.
How does infant weight change over the first year?
Birth weight roughly doubles by 4 to 6 months and triples by 12 months.
How much does length increase in the first year?
By about 50 percent over birth length.
When do the fontanelles close?
The posterior fontanelle by about 2 months and the anterior fontanelle between about 12 and 18 months.
What is the first physical sign of puberty in girls and in boys?
Breast budding, or thelarche, in girls, and testicular enlargement in boys.
When do primary teeth first erupt?
Around 6 months, beginning with the lower central incisors.
Which developmental finding is always a red flag?
Loss of a previously acquired skill, called developmental regression.
How is constitutional growth delay distinguished from familial short stature?
In constitutional delay, bone age is delayed and final adult height is normal; in familial short stature, bone age matches chronological age and the child is short like the parents.
How does the adolescent growth spurt differ between girls and boys?
Girls enter it earlier, around 11 to 12 years, and boys later, around 13 to 14 years, with boys gaining more total height.
Which routine childhood vaccines are live attenuated?
Measles, mumps and rubella, varicella, rotavirus, and the intranasal influenza vaccine.
When are the two doses of MMR given?
At 12 to 15 months and again at 4 to 6 years.
Why is the first hepatitis B vaccine dose given at birth?
To prevent perinatal transmission, which carries a very high risk of chronic infection in infants.
Which vaccine has an age limit for starting the series, and why?
Rotavirus. The first dose must be given by 14 weeks and 6 days, and the series completed by 8 months.