Diagnosis and Treatment Pediatrics questions and answers (over 400
questions and answers)
Etiology of neonatal jaundice within first 24 hours of life - ANSWER BAD sign - ABO incompatibility, Rh
incompatibility, TORCH infections, G6PD deficiency // Next step: admit, hydrate, and order Coombs test
Etiology of neonatal jaundice 24 hour - 72 hours - ANSWER Usually physiologic (if gaining weight,
stooling, not anemic, and not direct hyperbili)// Check bilirubin nomogram to determine need for
phototherapy
Etiology of neonatal jaundice > 72 hours - ANSWER DDx: Sepsis, breast milk jaundice, breastfeeding
jaundice, Gilberts syndrome
What is the difference between breastfeeding and breastmilk jaundice? - ANSWER Breastfeeding
jaundice: suboptimal supply of breast milk, requires hydration and supplementation// Breast Milk
jaundice: when the baby's liver is not developed enough to handle breaking down the supply of breast
milk from mom
Diagnosis, Treament: Baby age 1 month with jaundice and direct hyperbili - ANSWER Dx: Biliary atresia
(disease of intra and extrahepatic bile ducts leading to obstructive jaundice, cirrhosis, and death)//
Typically diagnosed before 2 months// Tx: surgery w/ Kasai procedure.
What are the most concerning (and unique) causes of abdominal pain in the following age groups: 0-3
month, 3 month - 2 year, school aged kids - ANSWER 0-3 month: Necrotizing Enterocolitis,
Hirschsprung's/Toxic Megacolon, Volvulus, Pyloric Stenosis// 3 month - 2 year: Intussusception, Meckel's
Diverticulum, Foreign Bodies// School age: similar to adults appendicitis, pregnancy, ect.
Pathophysiology, Signs & Symptoms, Diagnosis, Treatment: Necrotizing Enterocolitis - ANSWER
Pathophys: Inflammation & necrosis of the bowel wall from translocation of gut bacteria; prematurity is
greatest risk factor// SSx: bilious emesis, bloody stools, abdominal wall erythema// Dx: XR with
,pneumatosis intestinalis (pathognomonic), portal vein air (poor prognosis)// Tx: IVF, broad spectrum
antibiotics, NG tube (bowel rest), surgery consult, admit ICU
Pathophysiology, Signs & Symptoms, Diagnosis, Treatment: Hirschsprung Disease - ANSWER Pathophys:
Lack of ganglion cells in the rectosigmoid colon → lack of distal bowel motility// SSx: Delayed passage of
meconium (> 48 hours) → obstruction & bilious emesis (late finding)// Complications: enterocolitis/toxic
megacolon// Dx: rectal suction biopsy (gold standard), contrast enema (shows transition zone)// Tx:
surgery, admit
Pathophysiology, Signs & Symptoms, Diagnosis, Treatment: Midgut Volvulus - ANSWER Pathophys: 1st
month of life; Congenital malrotation → volvulus → midgut ischemia// SSx: bilious vomiting (always
emergent), abd pain/distention, ± rectal bleeding/hematochezia (gut ischemia)// Dx: XR "double bubble"
can also be seen in duodenal atresia, upper GI series "corkscrew" sign (definitive)// Tx: NGT, surgery
consult. // Associated conditions: congenital diaphragmatic hernia, congenital heart disease,
omphalocele
Pathophysiology, Signs & Symptoms, Diagnosis, Treatment: Intussusception - ANSWER Pathophys: 6
month - 3 year; telescoping of bowel (ileocecal most common); typically has a lead point - Tumor,
Meckel's, post-viral, HSP// SSx: colicky abd pain w/ lethargy + abd mass (sausage-shape in RUQ; RLQ
usually empty) + "currant jelly" stools// Dx: XR - obstruction, Dance's sign (pathognomonic); US with
"target sign"// Tx: OR (sick), air/contrast enema (not sick)
Pathophysiology, Signs & Symptoms, Diagnosis, Treatment: Meckel Diverticulum - ANSWER Pathophys:
Most common congenital GI malformation. Incomplete closure of vitelline duct → heterotopic gastric
mucosa// SSx: painless rectal bleeding 2/2 ulceration → obstruction (2/2
intussusception/volvulus/hernia)// Rule of 2s: 2% of population, 2% symptomatic, 2 feet proximal to
terminal ileum, 2x more often in males, 2 year old most common// Dx: Meckel (technetium-99m) scan//
Tx: surgical consult
At what anatomical levels do ingested foreign bodies usually get stuck? - ANSWER Cricopharyngeus C6
(60-80%), GE junction T11 (10-20%), Aortic Arch T4 (5-20%)// **Coin most common object swallowed
,Describe the different appearance on CXR of a coin in the esophagus versus the trachea - ANSWER If in
the esophagus: coin will appear flat on the AP view// If in the trachea: coin will appear flat on the lateral
view
What are indications for emergent endoscopy for ingested foreign body? - ANSWER High-grade
obstruction, object in esophagus > 24 hours, object > 6 cm, sharp objects, multiple objects swallowed,
button battery in esophagus, button battery in stomach > 48 hours or if symptomatic (earlier)
Pathophysiology, Signs & Symptoms, Diagnosis, Treatment: Pyloric Stenosis - ANSWER Pathophys: Age 2-
8 wks. Hypertrophied pylorus. Most common congenital GI disorder. Risk factors: first-born males,
macrolide abx exposure// SSx: nonbilious projectile vomiting, "hungry vomiter"; Exam: palpable "olive-
shaped" mass// Dx: Labs: hypoCl, hypoK, metabolic alkalosis (2/2 vomiting), dehydration; US (target
sign), upper GI series "string sign"// Tx: fluids and correction of electrolytes FIRST, then surgery
What is the most likely location of traumatic C-spine injury in young children? - ANSWER Age < 8 more
susceptible to upper cervical spine injuries (C1-3) given the proportional size of the head relative to the
rest of the body
What are normal variants in pediatric c-spine imaging? - ANSWER Pseudosubluxation (C2 on C3), growth
plates can look like fractures, anterior wedging
What is SCIWORA? - ANSWER "Spinal cord injury without radiographic abnormalities" // May present
with missed old injury leading to significant subsequent injury after relatively minor trauma. XR/CT
without abnormalities, MRI will show problem area. Most commonly seen in children and the elderly.
Common causes and presentations of anemia in young children - ANSWER Physiologic nadir (Hgb 9 at
6wks), B12/folate deficiency (high MCV, hypersegmented polys, seen in vegans), Iron deficiency (1-2yr,
low MCV, associated with pica, breath holding, high milk intake (more than 28-32 ounces per day)),
Sickle Cell dz (hemolysis, high retic count), Lead Poisoning (basophilic stippling, abd pain, AMS)
Approximate weight for newborn, 1yr, 5yr, 10yr - ANSWER Newborn: 3.5 kg// 1yr: 10 kg// 5yr: 20 kg//
10yr: 40 kg
, How do you determine ETT size, depth, and blade size in young children? - ANSWER Term Newborn: 3.5
ETT // Otherwise ETT = Age/4 + 4 (minus 0.5 cm for cuffed)// Depth = 3x tube size// Blade = 1 for
newborn up to 2 yr; 2 for 2-12 yr; 3 > 12 yr
ETT size for premature neonates or small neonates? - ANSWER < 1 kg: 2.5 uncuffed // 1-2 kg: 3.0
uncuffed
Chapter 1: The Newborn Infant
1. Which milestone is developmentally appropriate for a 2-month-old infant when the nurse pulls the
infant to a sitting position?
a. Head lag is present when the infant's trunk is lifted.
b. The infant is able to support the head when the trunk is lifted.
c. The infant is briefly able to hold the head erect.
d. The infant is fully able to support and hold the head in a straight line.
Answer: c. The infant is briefly able to hold the head erect.
Rationale: A 2-month-old infant can hold the head erect only briefly and continues to have some head
lag. It is not until 4 months of age that the infant can keep the head in a straight line when pulled to a
sitting position .
2. Approximately what should a newborn weigh at 1 year of age if the newborn's birth weight was 7
pounds 6 ounces?
a. 14 3/4 pounds
b. 22 1/8 pounds
c. 29 1/2 pounds
d. Unable to estimate weight at 1 year
Answer: b. 22 1/8 pounds
questions and answers)
Etiology of neonatal jaundice within first 24 hours of life - ANSWER BAD sign - ABO incompatibility, Rh
incompatibility, TORCH infections, G6PD deficiency // Next step: admit, hydrate, and order Coombs test
Etiology of neonatal jaundice 24 hour - 72 hours - ANSWER Usually physiologic (if gaining weight,
stooling, not anemic, and not direct hyperbili)// Check bilirubin nomogram to determine need for
phototherapy
Etiology of neonatal jaundice > 72 hours - ANSWER DDx: Sepsis, breast milk jaundice, breastfeeding
jaundice, Gilberts syndrome
What is the difference between breastfeeding and breastmilk jaundice? - ANSWER Breastfeeding
jaundice: suboptimal supply of breast milk, requires hydration and supplementation// Breast Milk
jaundice: when the baby's liver is not developed enough to handle breaking down the supply of breast
milk from mom
Diagnosis, Treament: Baby age 1 month with jaundice and direct hyperbili - ANSWER Dx: Biliary atresia
(disease of intra and extrahepatic bile ducts leading to obstructive jaundice, cirrhosis, and death)//
Typically diagnosed before 2 months// Tx: surgery w/ Kasai procedure.
What are the most concerning (and unique) causes of abdominal pain in the following age groups: 0-3
month, 3 month - 2 year, school aged kids - ANSWER 0-3 month: Necrotizing Enterocolitis,
Hirschsprung's/Toxic Megacolon, Volvulus, Pyloric Stenosis// 3 month - 2 year: Intussusception, Meckel's
Diverticulum, Foreign Bodies// School age: similar to adults appendicitis, pregnancy, ect.
Pathophysiology, Signs & Symptoms, Diagnosis, Treatment: Necrotizing Enterocolitis - ANSWER
Pathophys: Inflammation & necrosis of the bowel wall from translocation of gut bacteria; prematurity is
greatest risk factor// SSx: bilious emesis, bloody stools, abdominal wall erythema// Dx: XR with
,pneumatosis intestinalis (pathognomonic), portal vein air (poor prognosis)// Tx: IVF, broad spectrum
antibiotics, NG tube (bowel rest), surgery consult, admit ICU
Pathophysiology, Signs & Symptoms, Diagnosis, Treatment: Hirschsprung Disease - ANSWER Pathophys:
Lack of ganglion cells in the rectosigmoid colon → lack of distal bowel motility// SSx: Delayed passage of
meconium (> 48 hours) → obstruction & bilious emesis (late finding)// Complications: enterocolitis/toxic
megacolon// Dx: rectal suction biopsy (gold standard), contrast enema (shows transition zone)// Tx:
surgery, admit
Pathophysiology, Signs & Symptoms, Diagnosis, Treatment: Midgut Volvulus - ANSWER Pathophys: 1st
month of life; Congenital malrotation → volvulus → midgut ischemia// SSx: bilious vomiting (always
emergent), abd pain/distention, ± rectal bleeding/hematochezia (gut ischemia)// Dx: XR "double bubble"
can also be seen in duodenal atresia, upper GI series "corkscrew" sign (definitive)// Tx: NGT, surgery
consult. // Associated conditions: congenital diaphragmatic hernia, congenital heart disease,
omphalocele
Pathophysiology, Signs & Symptoms, Diagnosis, Treatment: Intussusception - ANSWER Pathophys: 6
month - 3 year; telescoping of bowel (ileocecal most common); typically has a lead point - Tumor,
Meckel's, post-viral, HSP// SSx: colicky abd pain w/ lethargy + abd mass (sausage-shape in RUQ; RLQ
usually empty) + "currant jelly" stools// Dx: XR - obstruction, Dance's sign (pathognomonic); US with
"target sign"// Tx: OR (sick), air/contrast enema (not sick)
Pathophysiology, Signs & Symptoms, Diagnosis, Treatment: Meckel Diverticulum - ANSWER Pathophys:
Most common congenital GI malformation. Incomplete closure of vitelline duct → heterotopic gastric
mucosa// SSx: painless rectal bleeding 2/2 ulceration → obstruction (2/2
intussusception/volvulus/hernia)// Rule of 2s: 2% of population, 2% symptomatic, 2 feet proximal to
terminal ileum, 2x more often in males, 2 year old most common// Dx: Meckel (technetium-99m) scan//
Tx: surgical consult
At what anatomical levels do ingested foreign bodies usually get stuck? - ANSWER Cricopharyngeus C6
(60-80%), GE junction T11 (10-20%), Aortic Arch T4 (5-20%)// **Coin most common object swallowed
,Describe the different appearance on CXR of a coin in the esophagus versus the trachea - ANSWER If in
the esophagus: coin will appear flat on the AP view// If in the trachea: coin will appear flat on the lateral
view
What are indications for emergent endoscopy for ingested foreign body? - ANSWER High-grade
obstruction, object in esophagus > 24 hours, object > 6 cm, sharp objects, multiple objects swallowed,
button battery in esophagus, button battery in stomach > 48 hours or if symptomatic (earlier)
Pathophysiology, Signs & Symptoms, Diagnosis, Treatment: Pyloric Stenosis - ANSWER Pathophys: Age 2-
8 wks. Hypertrophied pylorus. Most common congenital GI disorder. Risk factors: first-born males,
macrolide abx exposure// SSx: nonbilious projectile vomiting, "hungry vomiter"; Exam: palpable "olive-
shaped" mass// Dx: Labs: hypoCl, hypoK, metabolic alkalosis (2/2 vomiting), dehydration; US (target
sign), upper GI series "string sign"// Tx: fluids and correction of electrolytes FIRST, then surgery
What is the most likely location of traumatic C-spine injury in young children? - ANSWER Age < 8 more
susceptible to upper cervical spine injuries (C1-3) given the proportional size of the head relative to the
rest of the body
What are normal variants in pediatric c-spine imaging? - ANSWER Pseudosubluxation (C2 on C3), growth
plates can look like fractures, anterior wedging
What is SCIWORA? - ANSWER "Spinal cord injury without radiographic abnormalities" // May present
with missed old injury leading to significant subsequent injury after relatively minor trauma. XR/CT
without abnormalities, MRI will show problem area. Most commonly seen in children and the elderly.
Common causes and presentations of anemia in young children - ANSWER Physiologic nadir (Hgb 9 at
6wks), B12/folate deficiency (high MCV, hypersegmented polys, seen in vegans), Iron deficiency (1-2yr,
low MCV, associated with pica, breath holding, high milk intake (more than 28-32 ounces per day)),
Sickle Cell dz (hemolysis, high retic count), Lead Poisoning (basophilic stippling, abd pain, AMS)
Approximate weight for newborn, 1yr, 5yr, 10yr - ANSWER Newborn: 3.5 kg// 1yr: 10 kg// 5yr: 20 kg//
10yr: 40 kg
, How do you determine ETT size, depth, and blade size in young children? - ANSWER Term Newborn: 3.5
ETT // Otherwise ETT = Age/4 + 4 (minus 0.5 cm for cuffed)// Depth = 3x tube size// Blade = 1 for
newborn up to 2 yr; 2 for 2-12 yr; 3 > 12 yr
ETT size for premature neonates or small neonates? - ANSWER < 1 kg: 2.5 uncuffed // 1-2 kg: 3.0
uncuffed
Chapter 1: The Newborn Infant
1. Which milestone is developmentally appropriate for a 2-month-old infant when the nurse pulls the
infant to a sitting position?
a. Head lag is present when the infant's trunk is lifted.
b. The infant is able to support the head when the trunk is lifted.
c. The infant is briefly able to hold the head erect.
d. The infant is fully able to support and hold the head in a straight line.
Answer: c. The infant is briefly able to hold the head erect.
Rationale: A 2-month-old infant can hold the head erect only briefly and continues to have some head
lag. It is not until 4 months of age that the infant can keep the head in a straight line when pulled to a
sitting position .
2. Approximately what should a newborn weigh at 1 year of age if the newborn's birth weight was 7
pounds 6 ounces?
a. 14 3/4 pounds
b. 22 1/8 pounds
c. 29 1/2 pounds
d. Unable to estimate weight at 1 year
Answer: b. 22 1/8 pounds
