Notes

Peds – Infectious Disease

Neonatal Sepsis Causes Pneumonia Meningitis Organism Early onset GBS from mom E. coli Listeria Late onset Staph E. coli Group B strep Diagnostic workup CBC with diff Blood culture Urine culture U/A CXR LP (if irritable/lethargic → meningitis) Treatment Ampicillin Gentamicin Cefotaxime Pediatric Meningitis Etiology Viral → Enterovirus Bacterial...

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Congenital GI Disease

Atresias Esophageal Atresia Choanal Atresia Duodenal Atresia Blind esophagus Buccopharyngeal membrane Failed duodenal canalization Trisomy 21 Presentation Frothing Coughing Cyanosis Feeding → Resp distress No resp distress at rest Presentation Resp distress Cyanosis with breastfeeding Pink when crying Presentation Bilious vomiting NO Resp distress Initial test CXR Most diagnostic...

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Acyanotic Cardiac Lesions (L→R)

Ventricular Septal Defect (VSD) Most common congenital heart lesion Etiology Trisomy 13, 18, 21 Fetal alcohol syndrome TORCH Cri du chat syndrome Apert syndrome Cranial deformity finger/toe fusion VSD Presentation Dyspnea Respiratory distress High-pitch holosystolic murmur → Smaller VSD = Louder sound Loud pulmonic S2 Mid-diastolic apical rumble (↑...

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Cyanotic Cardiac Lesions (R→L)

R→L shunt PDA dependent VSD Surgery Tetralogy of Fallot ✖︎ If severe ✖︎ ✖︎ Transposition of Great Vessels ✖︎ ✖︎ VSD or ASD ✖︎ Hypoplastic Left Heart Syndrome ✖︎ ✖︎ ✖︎ Truncus arteriosus ✖︎ ✖︎ ✖︎ TAPVR ✖︎ ✖︎ Tricuspid Atresia ✖︎ ✖︎ ✖︎ ✖︎ Tetralogy of Fallot Most...

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Developmental Milestones

Developmental Milestones (Full) Age Gross Motor Fine Motor Language Social/Cognitive 2m Lift head/chest in prone Track past midline Coo Alert to sound Social smile Recognize parents 4m Roll over First front to back Then back to front Grasp rattle Laugh, Squeal Orient to voice Look around 6m Sit up...

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Routine Management of Newborn

After Delivery Suction mouth and nose Clamp and cut umbilical cord Dry Wrap Place under warmer Gently rub or stimulate heels → Stimulate crying/breathing Respiratory distress → ABG + intubation GI decompression → NG tube Sepsis → Antibiotics Normal Vital Signs RR: 40-60 HR: 120-160 Apgar Score Measures need for and effectiveness...

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Postpartum Hemorrhage

Definition Bleeding >500ml after vaginal delivery >1000ml after C-section Early PPH → within 24h Late PPH → 24h-6w Etiology Atony Risk Factors Anesthesia Uterine overdistension Multiple gestations Polyhydramnios Prolonged labor Laceration Retained parts Placenta accreta Coagulopathy Diagnosis Enlarged, soft boggy uterus Laceration Retained parts Placenta Accreta (75%) To superficial uterine wall...

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Labor Complications

Prolonged Latent Stage Prolonged latent phase Primipara: >20h Multipara: >14h Etiology Sedation Unfavorable cervix Uterine dysfunction (irregular/weak contractions) Treatment Rest Hydration Most convert to spontaneous delivery in 6-12h Protracted Cervical Dilation Slow cervical dilation Active stage No change for 4h >5h long Primipara: <1.2 cm/h Multipara: <1.5 cm/h Etiology Power...

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Normal Labor

Electronic Fetal Monitoring (external tacometer) FHR Normal: 110-160 bpm Tachycardia: >160 bpm Hypoxia Maternal fever Fetal anemia Bradycardia: <110 bpm Congenital heart disease Severe hypoxia Uterine hyperstimulation Cord prolapse Rapid fetal decent Variability Absent variability Minimal variability Normal variability Marked variability Sinusoidal variability Acceleration 2 increases in FHR >15...

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Fetal Testing

Nonstress Test (NST) 20 mins Mother in lateral tilt position Result Reactive → 15/15. 2 in 20 Fetal movements ≥ 2 FHR acceleration ≥ 2 >15 bpm Lasts 15-20 secs Nonreassuring Fetus asleep → Vibroacoustic stimulation Biophysical Profile (BPP) 30 mins 5 categories (2 point each) NST Chest expansion ≥ 1 Movement...

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Fetal and Amniotic Size

Fetus IUGR Fetus weight in bottom 10% for GA Symmetric Before 20w Brain in proportion to body Asymmetric After 20w Brain bigger that body Etiology First trimester Chromosomal abnormality Uterine Infection 2/3 trimester Maternal HTN → Asymmetric Maternal smoking → Asymmetric Maternal substance abuse Maternal malnutrition Maternal anemia Placenta...

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Diabetes in Pregnancy

Pregestational Diabetes Diagnosis DM type 1/2 before pregnancy Complications Mother Preterm labor 4x preeclampsia 2x spontaneous abortion ↑ infection ↑ postpartum hemorrhage Fetus ↑ congenital anomalies Heart Neural tube Macrosomia Shoulder dystocia Additional evaluations needed Mother EKG 24h urine Cr clearance Protein HbA1c Ophthalmologic exam Fetus 22-24w → Fetal...

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