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a m.d. step 3 - ZIP DECK > 13 ⼀PEDIATRICS COPY > Flashcards

13 ⼀PEDIATRICS COPY Flashcards

1
Q

What is the treatment for Developmental Dysplasia of Hip?

A

Pavlik Harness tat holds hip in flexion and ABduction

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2
Q

What demographic is affected by Hypertrophic Pyloric Stenosis ?

A

[3-6 week old boys]

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3
Q

describe Puberty timeline for females (4)

A

[8-12 yof: breast + pubic hair]

–(within 2.5y)–>

growth spurt ->

MENARCHE
_________________

1º amenorrhea = NO MENSES + ([≥15y with F∆] or [≥13y with no F∆])

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4
Q

What does Constitutional Short Stature refer to

A

“late bloomer” but will attain normal adult height later

pts have normal birth wt and ht but ht velocity slows between 6 mo-3 yo, picks back up after and slows again at adolescence. bone radiographs will show delayed bone age

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5
Q

[Genu Varum] is normal during age ⬜ and presents as (⬜3) . When should this correct by?

A

0-2 yo ; [BL symmetric bow leg, normal stature, no lateral thrust]
_________________
should correct by 2 yo

obtain XR if > 2 yo, short stature or uL

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6
Q

Newborn failure to pass meconium within 48 hours of birth likely indicates ⬜

MOD

A

Hirschsprung Disease

________________

[absence of ganglion cells in rectosigmoid (confirmed by rectal suction biopsy)] ➜ transition zone cutoff between

[narrow aganglionic rectosigmoid] and [markedly dilated innervated descending colon] EARLY AFTER BIRTH

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7
Q

Craniopharyngioma etx

A

Calcified low grade malignancy dervied from epithelial remnants of Rathke pouch within the pituitary stalk and reside in the SUPRAsellar region

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8
Q

Marfan Syndrome and Ehlers Danlos can present similarly

How do you discern the two?-2 ; What is the etx for Ehlers Danlos?

A

“Marfan BAATHES a lot! “

BUT Ehlers Danlos does NOT have

  1. Ectopia Lentis
  2. Arm-to-Height Ratio that’s INC

Ehlers Danlos etx = defective collagen production

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9
Q

diagnostic criteria for suspected septic joint
_________________

empiric abx for septic joint​

A

[WBC >50Kneutrophil predominance] in [aspirated joint synovial fluid]
_________________

Vanc IV​

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10
Q

cp for [Measles rubeOla] -2

A

[fever + conjunctivitis + coryza + Koplik spots + cough] prodrome –(2-4days)–> [maculopapular rash sspreading head to body]

________________

tx = supportive +/- [Vitamin A if hospitalized]

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11
Q

After successfully treating Acute Otitis Media, how should you manage a patient who p/w persistent middle ear fluid build up?
_________________

Explain why

A

WATCHFUL WAIT X 3 MO after treatment
_________________

serous fluid may persist in middle ear up to (but usually self limited to) 3 mo after treatment (= [serous otitis media with effusion] ).

further w/u if: infection / BL effusion / sx > 3 mo

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12
Q

Risk factors for Developmental Dysplasia of Hip - 3

________________

when should you stop screening for this?

A
  1. Breech Delivery - GET HIP IMAGING IF FEMALE AND BREECHED
  2. Female - GET HIP IMAGING IF FEMALE AND BREECHED
  3. Fam hx

12 months old

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13
Q

Dx Criteria for Kawasaki Disease

A

{[4/5 CRASH] + [Burning HIGH Fever ≥ 5 days]}

  • Conjunctivitis
  • Rash
  • Adenopathy uL in cervical region (least likely)
  • Strawberry tongue/oral mucosa changes
  • Hand/Feet redness or swelling
  • THIS IS DX OF EXCLUSION! THERE CAN NOT BE ANOTHER OBVIOUS CAUSE OF PRESENTATION*
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14
Q

Meckel’s Diverticulum etx

tx = surgery

A

failure of vitelline duct to obliterate during first 8 WG ➜ leaves behind RLQ [ectopic gastric tissue in a blind pouch] ➜ mucosal irritation and bleeding from gastric acid➜ [PAINLESS HEMATOCHEZIA IN 2 Y/O]

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15
Q

Malrotation and Volvulus are both diagnosed with ⬜

Describe how both would look on this diagnostic?

A

Upper GI Series barium swallow

________________

Malrotation = Ligament of Treitz on the R side of the abd in a gasless abd

________________

Volvulus = corkscrew image on barium swallow Upper GI series

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16
Q

management of

pediatric functional constipation (3)

A

1st: dietary ∆
2nd: Osmotic Laxatives

ACUTE DISIMPACTION: STIMULANT LAXATIVE
_________________

dietary ∆ = [⇪ fiber/water] ​​| [cow’s milk< 24oz]

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17
Q

How do you manage infants born to Mothers with Active Hepatitis B (4)
_________________

How do you determine if the infant was vertically infected? ​

A

infant receives

  1. [AT BIRTH (within 12h of delivery) [HBVIG and HBVV1]]
  2. [2 mo HBVV2]
  3. {[6 mo HBVV3]
  4. –(3 months later)–> [9 mo obtain HBV Surface antigen]}​
    _________________

if [HBsAg] positive = HBV VERTICALLY INFECTED!

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18
Q

Annual Influenza vaccine is recommended for kids age ⬜ for what purpose?

A

≥6 month old ; prevent [infection and spread] to at-risk populations (asthma/chronic illness/<2 yo)

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19
Q

Hypetrophic Pyloric Stenosis cp (6)

A
  1. age 3-6 weeks old
  2. [POSTPRANDIAL PROJECTILE NONBILIOUS EMESIS]
  3. [“Hungry Vomiter” (hunger immediately after vomiting)]
  4. [Epigastric Palpable Olive mass]
  5. Visible peristalsis
  6. [hypOchloremic hypOkalemic metabolic alkalosis]

​
_________________
[dx = US] | [tx = IVF ➜ Pyloromyotomy]

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20
Q

FPIAP is a ⬜ reaction to ⬜ that presents in normal infants as ⬜ . The treatment in formula-fed infants is ⬜

FPIAP = Food Protein Induced Allergic Proctocolitis

A

[non-IgE allergy] ; [milk protein (cow’s milk or soy protein)] ; blood-streaked stools ; Extensively Hydrolyzed Formula

FPIAP = non-IgE rxn to milk protein (casein/whey) = no skin/pulm rxn

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21
Q

Slipped Capital Femoral Epiphysis is a complication of childhood obesity

When does this present?

________________

How does this present?

________________

dx?

A

puberty (most common hip disorder in fat teens!)

________________

[M: Months of vague hip/knee pain] without acute onsets

________________

pelvis XRay

fat teen ➜ [ANT SUP slippage of femoral neck] ➜ [POST INFERIOR displacement of Femoral head] ➜ [Months of vague hip/knee pain]

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22
Q

Oligohydramnios –> ⬜ sequence.

Name the 3 most common causes of Oligohydramnios

A

Oligohydraminos –> POTTER Sequence

POSTERIOR URETHRAL VALVES are the most common cause of obstruction in newborn boys (which causes renal damage –> oligohydramnios during utero)

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23
Q

Oligohydramnios –> ⬜ sequence.

Name the 3 most common causes of Oligohydramnios

A

Oligohydraminos –> POTTER Sequence

POSTERIOR URETHRAL VALVES are the most common cause of obstruction in newborn boys (which causes renal damage –> oligohydramnios during utero)

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24
Q

What is [Impetigo Diaper Dermatitis]?

________________

Tx? -3

A

secondary bacterial diaper infection (by Staph > GASP) characterized by honey-crusted papules and pustules (and in neonates can be c/b sepsis)

________________

  • skin :* [Topical Mupirocin] or [PO Cephalexin]
  • [skin+ sepsis s/s]*: [Admit for IV Abx and sepsis w/u]

________________

sepsis s/s = [neonatal fever/irritability/lethargy]

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25
Q

Both Croup Laryngotracheitis and Epiglottitis can cause inspiratory stridor

How do you discern the two?

A

Epiglotitis causes Drooling!

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26
Q

Language delay in any child warrants ⬜

A

Audiology

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27
Q

2 main sx of Bronchiolitis

________________

cause?

A
  1. [Wheezing w/respiratory distress]
  2. Fever

_________________

RSV

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28
Q

[Clubfoot Equinovarus] is a deformity of the ⬜ bone which results in what clinical presentation?
_________________

Tx for this?

A

Talus; PIA BL feet [Plantar flexed + Inverted + ADDudcted]
_________________
serial Foot Cast

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29
Q

In a neonate, when should compressions be started?

A

HR <60

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30
Q

There are 5 major complications of Kawasaki Disease

In order of GREATEST to least, list them

A

{[4/5 CRASH] + [Burning HIGH Fever ≥ 5 days]}

[CNS ∆(irritability/aseptic meningitis)] > [CORONARY ARTERY ANEURYSM (within 1-4 wks!)] > Liver dysfxn > Arthritis > GallBladder Hydrops

________________

THIS IS DX OF EXCLUSION! THERE CAN NOT BE ANOTHER OBVIOUS CAUSE OF PRESENTATION

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31
Q

In Infants, what is “Periodic Breathing” ?

A

BENIGN physiologic breathing pattern in young infants in which they demonstrate

(➜ [breath pause x 5-10 seconds] ➜ [rapid shallow breaths x 10-15 seconds] ➜)

x several cycles before returning to normal breathing

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32
Q

Which diseases in kids involve rash involving palms and soles - 4

A
  1. Kawasaki
  2. Enteroviruses
  3. Syphilis
  4. Rocky Mountain Spotted Fever
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33
Q

⬜ is a [pediatric renal tumor that crosses the midline] and presents in the ⬜ year of life

A

Neuroblastoma

________________

first

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34
Q

Explain why [unconjugated Bilirubin] in newborns is physiologically elevated -3

________________

How does phototherapy treat this?

A
  • liver immaturity
  • lack of intestinal bacteria to catabolize bilirubin
  • high hgb turnover (will ⇪ if cephalohematoma present)

________________

phototherapy converts bilirubin ➜ [water soluble bilirubin] ➜ excrete in urine and stool

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35
Q

The 2 major causes of [bloody stool < 6 month old are FPIAP] and ⬜
_________________

What is the long term prognosis of an infant with FPIAP?

FPIAP = Food Protein Induced Allergic Proctocolitis

A

Anal fissure
_________________

[self limited to 2 weeks] & they will be able to tolerate milk protein BY 1 YEAR OLD
_________________

FPIAP = non-IgE rxn to milk protein (casein/whey) = no skin/pulm rxn

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36
Q

A child comes in with neonatal conjunctivitis

DDx?-3

________________

How do you differentiate each?

A
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37
Q

Based on PECARN rule, name the [high risk Pediatric TBI features] for [2 -18 yo] (5)

A

high risk Ped TBI = [noncontrast head CT (or 5h obs if med risk)]

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38
Q

List the Vaccines that are Live Attenuated

A

RM V RM

Rubella

Measles rubeOla

Varicella

Rotavirus

Mumps
_________________

Pregnant Women should NOT get Live attenuated vaccines but their household contacts SHOULD as this is less severe than wild-type

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39
Q

explain why early environmental exposure for newborns is important

A

Normal newborn immunity is polarized toward [Th2 response ( which will ➜ ATOPY = IgE, mast cell, eosinophil production) = Asthma/Eczema/Allergic Rhinitis]

BUT this is balanced by the [Th1 cytokine profile] you can only develop from exposure to nonpathogenic microorganisms

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40
Q

APGAR is used to assess newborn status immediately postpartum

Describe the grading system for Activity & tone?

A

APGAR

0 = no motion

1 = arms & legs flexed but not active

2 = Active Motion of extremities

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41
Q

infant presents with refractory candidiasis

suspected diagnosis?

A

infant HIV

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42
Q

PSGN-PiG is a compliation of ⬜ that typically presents with (⬜3)
_________________

What’s the treatment for PSGN-PiG? (2)​

A

GASP ; [(Hematuriiia with low complement) / Edema/ HTN]

Tx = Supportive + Furosemide​
_________________

MOD: [IgG-C3-antigen] lodges into glomerular capillaries and recruits C5a complement ➜ damage ➜ gross hematuria + inappropriate RAA activation ➜ Na+ retention ➜ fluid retention]

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43
Q

Malrotation and Volvulus are both diagnosed with ⬜

What would Volvulus look like on this diagnostic?

A

[Upper GI series barium swallow]

corkscrew image

Try not to use CT scans in kids

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44
Q

What is the treatment for BreastMilk Jaundice?

A

OBSERVATION

(BMJ is self limited to 3 mo :-))

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45
Q

What microbes are the most common causes of serious bacterial infection in [neonates LOE 28 days]? -3

________________

Name abx for each -3

A
  1. GBS = Ampicillin
  2. Listeria = Ampicillin
  3. E Coli = [Gentamicin {or CefoTaxime/CefTazidime if meningitis suspected}]
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46
Q

Precocious puberty is (premature) development of 2º sex characteristics in girls age ⬜ and boys age ⬜

​
_________________

What’s the treatment of central Precocious puberty?​

A

g< 8 ​| b< 9
_________________

[GnRH R agonist]​

(binds to hypothalamus GnRH Receptors ➜ negative feedback ➜ ⬇︎GnRH secretion ➜ ⬇︎LH/FSH)

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47
Q

clinical features of Down Syndrome (7)

A

SHALA Has Down syndrome

  1. [SEPTAL ENDOCARDIAL CUSION DEFECT]
  2. Hirschsprung’s disease
  3. Atlanta-axial instability
  4. [Leukemia (LATER IN LIFE!)]
  5. [Altered Psyche (Autism/ADHD/Alzheimer-like dementia)]
  6. hypOthyroid
  7. Duodenal atresia
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48
Q

diagnostic criteria for SIDS

________________

Sudden Infant Death Syndrome

A

[Sudden unexplained (Infant<12 mo) Death with inconslusive autopsy]

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49
Q

What are the recommendations regarding Patient Confidentiality and Adolescents?

A

MD should honor [Adolescent Patient Confidentiality] for care regarding [SEX, DRUGS and PSYCH]

BUT MUST BREAK AND ALERT PARENTS IF AT RISK FOR HARM TO SELF OR OTHERS

(pregnancy/contraception, STI, substance abuse/mental health)

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50
Q

Kawasaki dx = [4/5 CRASH] + [Burning HIGH fever ≥5d]

Recite the very important caveat regarding incomplete diagnostic criteria for Kawasaki Disease (4)

A

KD dx normally requires: {[4/5 CRASH] + [Burning HIGH fever ≥5d]}

▶but Because Kawasaki Disease sx do NOT manifest simultaneously → [dx caveat] =

▶if {[<4 CRASH] is present BUT pt does have [Burning HIGH fever ≥5d]}

▶= [“febrile vasculitis of uncertain etiology”]→

⭐[obtain CRP, ESR and f/u daily to reassess for onset (or not) of final criterion]

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51
Q

Congenital Toxoplasmosis is given to baby via ⬜ but acquired by Mom via ⬜-3

________________

Sx-4

A

Transplacental

  • Raw undercooked meat
  • unwashed produce (contaminated soil)
  • cat feces

________________

Tox- HICH

Hydrocephalus

Intracranial Calcifications

Chorioretinitis

(also Hearing impairment)

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52
Q

child presents with 2º enuresis

DDx? -2

_________________

2º enuresis = bed wetting ≥5 yo after established period of nighttime dryess

A

DM (order CBC/CMP)

vs

psychological stressor (I.e. parents’ divorce)

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53
Q

What is the most common cause of hip pain in kids?

________________

Dx?

A

Transient Synovitis

________________

Clinical but obtain Xray to r/o Legg Calve Perthes

may have ⬆︎inflammatory markers but xrays will be normal

54
Q

Because of serious possible sequelae associated with Kawasaki disease (Coronary artery aneurysms), ⬜ must be performed at ⬜ , ⬜ and ⬜.

A

TTE; [baseline, 2w after tx, 6w after tx]

[4/5 CRASH] & [Burning HIGH Fever ≥ 5 days] sl;l

55
Q

What is the mngmt for an ingested coin? - 3

A
  1. Obs for up to 1 day after ingestion UNLESS
  2. Pt is symptomatic = flexible endoscopy
  3. Pt has no recollection of ingestion time = flexible endoscopy
56
Q

Risk factors for Developmental Dysplasia of Hip - 3 ; when should you stop screening for this?

A
  1. Breech Delivery - GET HIP IMAGING IF FEMALE AND BREECHED
  2. Female - GET HIP IMAGING IF FEMALE AND BREECHED
  3. Fam hx

12 months old

57
Q

Why can’t Ceftriaxone be used during the 1st month of life?

A

Ceftriaxone can displace albumin-bound bilirubin ➜ allows free bilirubin to cross blood brain barrier ➜ Kernicterus

58
Q

Cerebral Palsy is a group of clinical syndromes generally characterized as ⬜

How does it present? - 3

A

Nonprogressive motor dysfunction (Prematurity>EtOH = RF) ;

Cerebral Palsy is SAD

  1. BL equinovarus club feet (image)
  2. UMN signs LE >UE
  3. Mental Retardation

Greatest RF = prematurity ( < 32 wks gestation)

59
Q

In Infants, what is [Apnea of Prematurity]?

A

[TRUE apnea episodes ≥20 seconds] in premature infants, that resolves by [corrected gestational age 37 WG]

60
Q

What is Osgood Schlatter Disease

A

Traction apophysitis of the tibial tubercle from Self-limited irritation of the growth plate at the tibial tuberosity (front of tibia) possibly –> hard nodule, relieved with rest/growth spurt

xray: lifting of tubercle from the shaft

61
Q

Dx for Intussuception

A

AIR contrast enema ultrasound guided

Intussuception age = 3-36 mo

Look for the Target Sign on US!

62
Q

DDx for neonatal rectal bleeding - 4

A
  1. [**Milk/Soy ALLERGIC Proctocolitis** = PAINLESS]
  2. Meckel Diverticulum = PAINLESS
  3. Volvulus (bloody stool from intestinal ischemia)
  4. Intussuception (dx= AIR contrast enema)
63
Q

APGAR is used to assess newborn status immediately postpartum

Describe the grading system for Grimace & reflex irritability?

A

APGAR

Test response to stimulation (i.e. pinch)

0 = no rxn

1 = grimace

2 = grimace AND cough/cry/sneeze

64
Q

A: Potters Sequence etx

B: Clinical Presentation - 6

A

A: [Fetal Renal Agenesis bilaterally / Dysfunction] –> Oligohydraminos (No Amniotic Fluid)

B: POTTER

Pulm hypOplasia

Oligohydraminos

Twisted Face

Twisted and shortened Limbs

Ears set low

Renal agenesis = cause

65
Q

What is the mngmt for an ingested coin? - 3

A
  1. Obs for up to 1 day after ingestion UNLESS
  2. Pt is symptomatic = flexible endoscopy
  3. Pt has no recollection of ingestion time = flexible endoscopy
66
Q

by age ⬜ , full term infants should be able to sleep thru the night without overnight feeds

If they can’t, how do you change this?

A

6 months old
_________________

AVOID OVERNIGHT FEEDS

(do NOT offer feeding during nocturnal awakenings. Just check on baby)

67
Q

In terms of etiology, what is a difference between Breastfeeding Failure jaundice and Breast Milk jaundice?

A

BFF jaundice within the First week of life: inadequate feeding –> inadequate stooling –> ⬇︎bilirubin elimination –> ⬆︎Unconjugated bilirbuin recycling with Failure to thrive/dehydration

68
Q

Tx for Croup-2

A
  1. Mild = Humidified air +/- CTS
  2. > Mild = CTS +/- Racemic Epi nebulized

Croup = paraflu that –> subglottic edema and narrowing

69
Q

Common characteristics of Down Syndrome pts - 7

A

the SHEEPPS of genetics

  1. Skin excessive at the nape of the neck = nuchal skin
  2. HypOtonia w/ ⬇︎ Startle Moro reflex
  3. Epicanthal folds
  4. Ears that are small
  5. Protruding tongue w/flat face
  6. Palpebral fissures are upslanted
  7. Single palmar crease

these pts also have ⬆︎risk for hypothyroidism

70
Q

What are the 2 major complications of Mumps

A
  1. Orchitis
  2. Aseptic Meningitis
71
Q

in newborns, bilirubin greater than ⬜ ➜ ⬜. Describe this condition

________________

management?

A

[20-25] ➜ [Kernicterus bilirubin encephalopathy] (mvmnt DO and hearing loss)

________________

Exchange Transfusion

exchanging [blood with SEVERE HYPERBILIRUBINEMIA and/or DAT+ maternal Ab] from baby and transfusing baby with replacement RBC

72
Q

cp for neonatal Lactose Intolerance - 3

A
  1. NONBLOODY diarrhea
  2. flatulence
  3. crampy abd pain

Lactose Intolerance = no Lactase ➜ NONBloody Flatulence & Diarrhea

73
Q

What is the tell tale sign of child abuse

A

SUDDEN CHANGE IN BEHAVIOR

(RISQUE SEXUAL BEHAVIOR/IRRITABILITY/CONCENTRATION ⬇︎)

74
Q

[Strabismus ocular misalignment] after the age of ⬜ is abnormal and requires intervention to prevent ⬜

________________

Which intervention is employed for this? - 3

A

4 mo ; Amblyopia(vision loss from disuse of the deviated eye)

  1. CTL eye patch to strengthen deviated eye OR
  2. CTL cycloplegic eye drops (blurs normal eye to strengthen deviated eye)
  3. Corrective lens

Dx = asymmetric corneal light reflex

75
Q

At what age should you be concerned for an infant not walking yet?
_________________

What age do infants usually learn to walk?​

A

> 16 mo
_________________

​9-16 mo

76
Q

Pts who’ve recovered from RSV Bronchiolitis are at ⇪ risk for recurring ⬜. Ergo, ⬜ should be avoided

A

WHEEZING; cigarette smoke (and other airway reactivity triggers)

77
Q

Osgood Schlatter Disease tx -3

A
  1. NSAIDs
  2. Ice
  3. self-limited (stops with end of growth spurt)

xray: lifting of the tibial tubercle from the shaft

78
Q

Peds with untreated iron deficiency anemia are at INC risk for what 2 comorbidites?
___________________

How is this mitigated? -3

A

psychomotor delay

neurocognitive impairment
_________________
[universal screening starts age 1 yo]

–(if hgb <11)–> [PO ferrous sulfate]
_________________

IDA is the most common nutritional deficiency in kids

79
Q

Slipped Capital Femoral Epiphysis is a complication of childhood obesity

MOD
_________________

management?

A

fat teen ➜ [ANT SUP slippage of femoral neck] ➜ [POST INFERIOR displacement of Femoral head] ➜ [Months of vague hip/knee pain]
_________________

[surgical pinning within 24 HOURS]

80
Q

Reconstruction of cleft lip is generally performed at (⬜age)

A

10 weeks old

________________

(in accordance with rule of 10s = 10 lbs|10 weeks old|10 g hgb)

81
Q

APGAR is used to assess newborn status immediately postpartum

Describe the grading system for Appearance?

A

APGAR

0 = entirely blue

1 = pink with blue extremities

2 = entriely pink

82
Q

What is the most common congenital cyanotic heart defect in the neonatal period?

A

Transposition of Great Vessels

Look for the single Loud second heart sound!

83
Q

Malrotation and Volvulus are both diagnosed with ⬜

What would Volvulus look like on this diagnostic?

A

[Upper GI series barium swallow]

corkscrew image

Try not to use CT scans in kids

84
Q

What is Erythema Toxicum Neonatorum ; tx?

A

benign neonatal rash with blanching erythematous papules and/or pustules ; self limited to 2 weeks after birth

85
Q

cp for Reye syndrome - 2

A
  1. [⇪ ICP → encephalopathy, seizure, vomiting, lethargy –>eventually DEATH]
  2. liver dysfunction
86
Q

Bronchiolitis is an ⬜ respiratory infection that occurs in the ⬜ by the ⬜ virus

What are the s/s ? (4)

A

lower; Winter ; RSV
_________________

[Wet nose (rhinorrea)] ​| [Wheezing (possibly recurring)] ​| WOB⇪

dx = clinical > nasal/pulmonary antigen test​

87
Q

[T or F]

UNILATERAL cervical LAD in kids (typically from ⬜ bacteria ) is not common and needs further workup

A

FALSE!

________________

ped uL cervical LAD (typically from Staph > GASP) is common

88
Q

APGAR is used to assess newborn status immediately postpartum

Describe the grading system for Respiration?

A

APGAR

0 = not breathing

1 = breathing slow/irregular

2 = crying

89
Q

Slipped Capital Femoral Epiphysis is a complication of childhood obesity

When does this present?

________________

How does this present?

________________

dx?

A

puberty (most common hip disorder in fat teens!)

________________

[M: Months of vague hip/knee pain] without acute onsets

________________

pelvis XRay

posterior displaement of capital femoral epiphysis thru cartilage growth plate

90
Q

Identify causes of this rash - 3

A

THE STRAWBERRY TONGUE!

  1. GASP +/- mononucleosis
  2. Kawasaki disease
  3. Toxic Shock Syndrome
91
Q

Oligohydramnios –> ⬜ sequence.

Describe this clinical presentation for this Sequence

A

Oligohydraminos –> POTTER Sequence

Pulmonary hypOplasia

Oligohydraminos from renal agenesis/damage (cause)

[Twisted Face & Extremities]

Twisted Skin

Ears set low

Renal Failure

92
Q

Based on PECARN rule, name the [high risk Pediatric TBI features] for [0 -1y 11m] (5)

A
93
Q

At what point, should you consider Antibiotic prophylaxis (continuous vs postcoital) for young female patients with recurrent UTI? (2)

A

[≥ 2 UTI in 6 mo]

OR

[≥3 UTI in 1 year]

obtain further diagnostics if c/f nephrolithiasis or obstruction

94
Q

Necrotizing Enterocolitis cp - 3

________________

X ray finding?

A
  1. Bloody stools
  2. feeding intolerance
  3. abd distension

X-ray = Pneumotosis Intestinalis

Risk factors= prematurity, congenital heart disease, hypotension

95
Q

Neonatal Respiratory Distress Syndrome is caused by ⬜

What are the major risk factors?-2

A

Surfactant Deficiency

  1. Prematurity
  2. Maternal DM
96
Q

What is Legg Calve Perthes Disease?

________________

Demographic?

________________

mngmt-2?

A

Avascular necrosis of the Capital Femoral Epiphysis ; [Boys 4-10 yo) ;

  1. Self limited but can –>deformity/degeneration
  2. contain femoral head within acetabulum during encounter
97
Q

How do you manage a choking child? (2)

A

IF UNCONSCIOUS = CPR!

98
Q

Name the markers of onset Puberty for

Girls

________________

Boys

A

[girls: Breast by 12 yo]

________________

[boys: testicular enlargement (≥4 mL) by 14 yo]

________________

delayed secondary sexual characteristics + delayed XR bone age = [Constitutional Delay of Puberty]

99
Q

cp for Meckel’s Diverticulum

________________

dx

A

PAINLESS hematochezia

________________

technetium 99 pertechnetate scan

100
Q

What’s used to keep the PDA Patent?

A

Prostaglandin E1

101
Q

Describe the best approach to [Vaccine Refusal/Hesitancy] (4)
_________________

A
  1. [LISTEN OPENLY to (parental) concerns]
  2. [CORRECT misinformation (i.e. Autism/Overload/Natural immunity)]
  3. [DISCUSS risk/benefits of immunization]
  4. [CONTINUE ONGOING DIALOGUE AT SUBSEQUENT VISITS DESPITE INITIAL REFUSAL]
102
Q

cp for Meckel’s Diverticulum

________________

dx

A

PAINLESS hematochezia

________________

technetium 99 pertechnetate scan

103
Q

McCune-Albright Syndrome

clinical features (3)

A
104
Q

cp for Congenital Rubella Syndrome (6)

A

[BL cataracts]

[sensorineural hearing loss]

[patent ductus arteriosus]

[Bluberry muffin rash (purpuric lesions)]

low birth weight

microcephaly

105
Q

At what age does Bedwetting start to become pathological for kids?

A

5 yo

106
Q

A Contrast enema demonstrating microcolon is indicative of what condition? ; etx?

A

Meconium iLeus 2/2 Cystic Fibrosis

viscous meconium accumulation obstructs terminal iLeum –> underused colon –> contracted microcolon

107
Q

Typically, for minors, informed consent must be provided by a legal guardian

List the 3 exceptions to this

A
108
Q

cp for Febrile Seizure -4

________________

⬜ is the primary management. When do you give [Abortive Antiepileptics]?

A
  1. [child [6 month - 5 year old] with [< 15m nonfocal seizure]]
  2. NO previous afebrile seizure within prior 24h
  3. NO signs of CNS infection (meningismus, bulging fontanelles)
  4. NO acute metabolic derangement (hypOglycemia)

________________

tx = AntiPyretics ➜ [AntiEpileptics if seizure ≥5 min]

109
Q

cp for Bronchiolitis in neonates - 3 ; px for this?

A
  1. Wheezing and/or Crackles
  2. URI sx
  3. Respiratory distress eventually –> APNEA

Px = Palivizumab for kids<2 yo

110
Q

Why can Moms breastfeed on methadone treatment, but can NOT breastfeed if actively using recreational substances/opioids?

________________

What is the requirement to be candidate for [breastfeeding on methadone tx] -2

A

[methadone treatment concentration in breastmilk] is low and unrelated to maternal dose

but

recreational substances have unpredictable pharmacology (mixed with other drugs/inconsistent dosing)

________________

compliant with methadone treatment throughout pregnancy and after pregnancy/postpartum/breastfeeding

+

NO active recreational drug use relapse

111
Q

What is [Idiopathic premature pubarche]?

A

[precocious (male <9 / female<8)] and isolated development of pubic hair

with NO other endocrine ∆ ​

112
Q

Diagnosis? ; Name the major risk factor for this

A

HIRSCHSPRUNG DISEASE ; [Mom ≥ 35 yo]

markedly dilated descending colon

113
Q

cp for [Radial head subluxation Nursemaid’s elbow]
_________________

Tx? (2)

A

sudden refusal to move arm after arm is forcibily pulled

affected arm with forearm pronated
_________________

extension ➜ forearm HYPERpronation

114
Q

SIDS

risk factors for the infant? -4

________________

risk factors for Mom during pregnancy? -3

________________

Sudden Infant Death Syndrome = [Sudden unexplained (Infant<12 mo) Death with inconclusive postmortem exam]

A

SLEEPING PRONE > > > [prematurity | low birth wt | smoke exposure]

________________

[teen Mom<20] | pregnant smoking/substance use | spotty prenatal care

115
Q

Diagnostic Criteria for Colic - 4 ; tx

A

Colic = the 3’s

excessive crying during first 3 weeks of life that’s

≥3hrs/day (usually evenings) for

≥3days / week for

≥3weeks in a healthy infant

Tx = Soothing and feeding techniques

116
Q

Describe Metatarsus Adductus

A

Most common congenital foot deformity in which there is BL medial deviation of the forefoot usually in 1st born infants

Tx = this corrects spontaneously

117
Q

cp for Meckel’s Diverticulum

________________

dx

A

PAINLESS hematochezia

________________

technetium 99 pertechnetate scan

118
Q

clinical features of

Neonatal Clavicular fracture (3)

A
  1. self limited with NO LONG TERM SEQUELAE (tx = spportive only)
  2. localized clavicular creptius
  3. irritability with passive IPL UE movement
    * dx confirmed by XR*
119
Q

Tx for Kawasaki disease-2

________________

when should this be given?

A

[4/5 CRASH] & [Burning HIGH Fever ≥ 5 days]

  1. [ASA 80-100 mg/kg/day divided into 4 doses] –> [3-5 mg/kg/day as one dose after defervescence] –> DC after 6 wks if no coronary involvement. Cont indefinitely if so.
  2. [IVIG 2g/kg given over 12 hours] ⼀DEC Coronary Aneurysm risk

________________

give Kawasaki tx within 10 days of Burning HIGH FEver

120
Q

[Atlantoaxial joint] Instability MOD

________________

Which demographic are at most risk for this?

A

excessive laxity in the Posterior transverse ligament ➜ ⬆︎mobility between [C2 aXis: dens] and the [C1 atlas] –> spinal cord compression ➜ UMN signs

________________

Down Syndrome (remember pts with down syndrome are usually hypOtonic but not with Atlantoaxial instability!)

121
Q

What is Primary nocturnal enuresis?
_________________

1st step in evaluation? ​

A

lack of nighttime dryness in kids age ≥5 y/o that usually spontaneously resolves over time ​
_________________

UA (r/o DM, DI, infection)

122
Q

For a patient receiving ⬜ to diagnose and treat intussusception, what is a potential complication ? ​
_________________

how is it managed?

A

[air/water contrast enema] ; intestinal perforation
_________________

[abd xr series] (to assess for free air)​

123
Q

Name the 7 most common manifestations of Marfan Syndrome

etx = mutation of fibrillin 1 gene

A

“Marfan BAATHES a lot! “

  1. Ectopia Lentis
  2. Arm-to-Height Ratio ⬆︎
  3. Heart issues (MVP or [idiopathic Aortic cystic medial degeneration]–> Aortic Dissection and Aneurysm)
  4. Scoliosis vs. Kyphosis
  5. Breastbone structural abnormalities
  6. Arachnodactyly (Steinberg thumb & wrist)
  7. Tall / slender / flat feet

etx = mutation of fibrillin 1 gene

124
Q

Name the 3 major points of misinformation regarding Vaccines ​
_________________

How do you mitigate each one?

A
  1. AUTISM: following retraction of the fraudulent Wakefield study, many large-scale systematic reviews have consistently shown no association between Vaccines and Autism
  2. “VCCs OVERLOAD IMMUNE SYSTEM?”: exposure to multiple antigens at once is NOT harmful and will NOT “overload” immune system
  3. “NATURAL IMMUNITY IS BETTER”: Natural immunity/infxn = ⇪ risk for severe complications (i.e. hospitalization)
125
Q

When should ingested batteries be emergently and endoscopically removed?

A

ONLY when the battery is still IN the esophagus and not distal to it. If distal –> obs

this also includes sharp objects, or multiple magnets

126
Q

neonates > 28 days old

what organisms cause sepsis? -3

________________

Name the empiric abx -2

A
  1. [Ceftriaxone (Strep Pneumo + Neisseria meningitidis)]
  2. [+/- Vancomycin (MRSA or meningitis)]
127
Q

the timing of neonatal jaundice differentiates [G6PD deficiency] from [Hemolytic Disease of Newborn] explain

A

neonatal jaudice presenting within first

HDN: 24 hours of life

(+ direct Coombs | A or B infant born to O mother)

________________

G6PD deficiency: 2-3 DAYS of life

128
Q

What is the treatment for Bronchiolitis?

typically from RSV

A

supportive

contact + droplet precautions ​

_________________

supportive = IVF/nasal bulb suctioning/humidified O2

129
Q

Pediatric dyslipidemia is a risk factor for adulthood progression of ⬜ and ⬜.

Because of this, what is the recommended lipid screening for peds?

A

atherosclerosis / CVD

note: universal [fasting lipid panel] screening should still be obtained ages 9-11 and 17-21 regardless of CV risk factors

130
Q

3 classic Clinical Manifestations of [Tetralogy of Fallot]

A

A:

  1. [Systolic Ejection HARSH Murmur @ L Sternal 2/3 ICS] from [RVOO -R Vt Outflow Obstruction]
  2. Squatting relieves sx (INC afterload–> [DEC amount of R to L shunt]
  3. [Cyanotic lethal Tet Spells] (tx: Knee chest positioning and inhaled O2)

“VOIR is to have See + Sight & Cry”

a m.d. step 3 - ZIP DECK (6 decks)

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