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STEP 2CK Review > 14 Peds > Flashcards

14 Peds Flashcards

1
Q

You suspect child has immunodeficiency

-what tests first

A

Start with these 2:

CBC
Ig panel (quantitative levels of Igs)
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2
Q

Newborn management: TTN vs RDS

  • what is diff
  • how to tx
A

TTN: delayed clearing of lung fluid, mainly in C/S

  • hyperexpanded/wet lung on CXR
  • give O2, possible CPAP/intubation

RDS: preemie, lack of surfactant

  • hypoextended lungs, atelectasis on CXR
  • give surfactant, possible CPAP/intubation
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3
Q

Leukocyte adhesion def,

Chediak higashi

A

LAD: massive leukocytosis but no pus. Baby has delayed cord separation. Tx with BMT

Chediak (think train tracks). impaired microtubule polymerization. Albino, neuropathy, neutropenia

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4
Q

Ataxia-telangiectasia

-what assocs to rememeber

A

telangiectasias, ataxia, DNA repair, lymphoma, leukemia

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5
Q

Bilious vomiting in neonate

-DDx, how to dx and tx

A

4 to know. KUB to dx, all have double-bubble and:

  1. normal gas beyond: Malrotation

2/3. double bubble only: Annular pancreas (no Down’s) and Duodenal atresia (Down’s)

  1. Air fluid levels: Intestinal atresia from cocaine

Malrotation: Barium enema if colonic (dx, might also tx), Upper GI series if not colonic. Surgery if dying bowel

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6
Q

Sickle cell dz:

-what see on blood smear, other than sickled cells

A

Howell Jolly bodies, if older and you assume spleen autoinfarcted.

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7
Q

Premature, BPD

-tx

A

surfactant, steroids in mom antenatal.

-lung protective strategy (try to keep FiO2 and pressures low)

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8
Q

DiGeorge

-how present?

A

CATCH 22

cardiac
abnl facies
thymic absence (no T cells)
cleft palate
hypoCa (no parathyroid)
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9
Q

Neonatal jaundice, you see elevated conjugated Bili

-DDx (3), how to workup

A

think:

  1. obstruction (biliary atresia)–HIDA scan, U/S
  2. sepsis–WBC, Cx
  3. metabolic inborn
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10
Q

CGD

  • what infxns
  • dx
  • tx
A

macrophages not working (catalase bugs): Staph, Aspergillus

Dx: normal CBC and Ig’s (WBCs just don’t work), negative nitro blue.

Tx: Daily Bactrim, bone marrow trans

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11
Q

Bronchiolitis

-who gets admitted (4)

A

spO2 <92
premature <34wks
age<3 mo
cardiopulm abnormality

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12
Q

APGAR

  • what are they
  • when to do
A 
1 and 5 min
Appearance: blue, acrocyanosis, pink
Pulse: 0, <100, 100+
Grimace: none, high stim, regular stim
Activity: none, flexion, resists extension
Resps: none, irregular, strong
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13
Q

VACTERL

-how to check

A

Vertebral–XR
Anal–visual
Cardiac–Echo

Tracheal–NG tube down throat
Esophageal–

Renal–VCUG
Limbs

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14
Q

rash that is blanching vs non-blanching

-think what

A

Blanching means blood is still inside vessels, so hypervascularization or vasodilation

non-blanching means extravasation of blood through vessel wall. This is worse. Non-blanching is purpura/petichiae. eg think meningococcus, HSP, etc.

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15
Q

Premature, NEC

  • dx
  • tx
A

Premature in ICU has bloody BM

  • do XR, see pneumatosis intestinalis
  • NPO, IV Abx, TPN
  • Surgery
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16
Q

why never take 1st temp rectaly?

A

imperforate anus. found on visual inspection

  • upside down XR (babygram) to find end of pouch
  • can fix now or colostomy to later

Check VACTERL

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17
Q

Neonate, bilious vomiting, KUB shows “ground glass” apperance

A

Meconium ileus, CF

Dissolve plug with gastrograpin enema

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18
Q

Measles vs rubella

-how to tell diff

A

Different prodome:

Measles: 4 C's
Coriza
Conjunctivitis
Cough
Koplik spots

Rubella: not as sick, prodrome of tender LAD, esp postauricular

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19
Q

Coin sign

A

foreign body aspiration, object pushes posterior

see only on lateral film

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20
Q

SCID

-what do they need

A

Think ‘Mega-AIDS:’

PCP and MAC ppx (bactrim and azithro)

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21
Q

gastroschisis, omphaloecele, what else not to confuse?

A

also Bladder extrophy–red, shining, wet with urine

omphalo”sealed”

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22
Q

MCC immunodef?

A

IgA def, 1/500

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23
Q

Newborn management/resuscitation

-describe

A

Minute 1: Stimulate infant to breathe and suction (primary apnea).

30 sec: assess pulse and breathing. If <100 or resp difficulty, do PPV or intubate

Min 1-5: APGAR and pulse ox. make sure HR>100 and resps good.
If HR 60-100 or resps not good, continue PPV
If HR <60, do chest compressions
If no improvement, Epi into umbilical vein

Min 5+: APGAR, continue resus if necessary.

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24
Q

Premature infant, 4 problems

A

BPD
ROP
IVH
NEC

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25
Newborn management: Meconium -what to do
If meconium present but infant vigorous (HR>100, good resps, etc), then simple mouth/nose suctioning. If infant poor tone, HR<100, bad resps: ET suctioning. If pulse <60, shift to ventilatory support
26
Neonatal jaundice, you see elevated unconjugated Bili | -DDx and Workup tests (3)
3 tests: Coombs, Hgb, Retic ct 1. Isoimmunization? (Rh dz, ABO dz)--Coombs test 2. Hgb high? Blood transfusion from Twin-twin or maternal-baby delayed cord clamping 3. Hemolysis? Retic high, then think genetic: spherocytosis, Pyruvate k def, G6PD 4. All-, then think Breast milk jaundice
27
Newborn head exam | -what to know
``` Caput succedaneum (Crosses Sutures) Cephalohematoma ```
28
Croup | -meds
Steroids | -if stridor at rest, do racemic epi
29
Premature, ROP - tx - what is complication long term
Caused by high O2 Laser ablation future: early glaucoma
30
Breast feeding vs Breast milk jaundice - diff by timing - tx
``` Breast feeding (lack of): Not enough feeding, so low gut motility leads to more uptake of Bili <7days ``` Breast milk: enzyme inhibition >10days Both can tx with formula feeding. breast feeding--increase feeding
31
Devo milestones to know - motor - fine motor - speech - social
2,4,6mo. 1,2,3,4,5y motor: lift head, lift body (roll), lift and stay (sit). then: walk. fine motor: 3,4,5,--circle, cross, triangle speech: 1,2,3,4,5: 1,2,3,4,5-word sentences social: social smile (2mo), stranger anx (6mo), separation anx (1y)
32
Premature, IVH - how it is dx - tx - long term complications
- asx screening with Cranial Doppler (also do if bulging fontanelle) - tx with surgery--VP shunt, drains -future mental retard, sz d/o
33
Febrile sz: simple vs complicated 5 things
5mo-5y Fever not Focal <15 min not repeat in 24h
34
Crohn's and UC: -which has more diarrhea, which has more blood in stool -if suspect IBD, what things to check on physical exam:
More likely: UC: blood in stool Crohn's: diarrhea - check oral ulcers (Crohn's) - eyes - skin - joints
35
BCG vaccine protects from what?
against disseminated TB, but NOT pulmonary TB
36
Bruton's X-linked agammaglobulinemia - presentation - dx - tx
Boy, repeated bacterial infxn (esp pseudomonas) Dx: all Ig's deficient. Confirm with low B cells. Tx: ppx abx, monthly Ig's
37
Baby: blue at rest, pink when crying - think what, and what else - dx, tx
Choanal atresia, also think Tet Fallot | -catheter doesn't pass through nose. Get ENT to look surgery
38
RPA | -presentation
opposite of meningitis: pain with extension of neck hot potato voice, drooling, etc
39
EEG shows "hypsarrythmia" | dx, tx
``` Infantile spasm (West) give ACTH (cosyntropin) ```
40
1yo boy presenting with ear infection. Also has rash and easy bruising. Think what
WAX TIE Wiskott (upside down, low IgM) Aldrich (high IgA) X linked Thrombocytopenia Infxn, recurrent Eczema (high IgE) Tx: bone marrow trans
41
IgA def | -how presents (2)
1. repeated GI/resp infxn (remember, IgA is mucosal) | 2. Asx, but anaphylactic rxn to blood transfusion
42
Non-bilious vomiting, baby - always think what - what age - dx, tx
Pyloric stenosis, 6 week baby (not day1) Projectile vomit, olive mass IVF to rehydrate, U/S donut, myomectomy
43
Child with recurrent PNA | -no immunodeficiency, think what?
CF with recurrent resp/lung infections
44
Croup that is not responding to steroids and racemic epi | -do what
possible Bacterial tracheitis (rare) get tracheal cx to dx, abx
45
Lyme dz in peds | -what to know
Amox in kids<8 (if >8, Doxy.) Disseminated Lyme (bell's palsy, heart block, meningitis): Ceftriaxone, still.
46
What peds rash to keep away from pregnant mom?
B19 parvovirus. | danger Hydrops Fetalis!
47
Neonate with persistent jaundice at 6 weeks | -think what, do what
Biliary atresia. (also think inborn metab or CF) Do HIDA scan after phenobarb x1 week. (phenobarb stim biliary tree) So, if HIDA reaches duodenum, then not biliary atresia
48
Why don't give Azithromycin for sinusitis
resistance to Strep pneumo
49
What infxns: CGD complement def thymic hypoplasia Abnormal B-cell maturation
- catalase+ (staph, aspergillus) - Gonorrhea, meningococcal (C5-C9 in Neisserias) - Viral, fungal - Giardia (IgA), encaps bact
50
Peds seizures | -3 weird ones to know, and what to remember about them
1. Infantile spasm (West)--baby, afebrile, 'clonus of UE'. EEG shows "hypsarrythmia" 2. Lennox-Gastaut Boy 2-6, recurrent sz, EEG shows 'spike and wave.' mental retard 3. Tuberous sclerosis - toddler with afebrile sz or complicated febrile sz, gets CT, see tubers
51
peds immundeficiencies tend to appear what age, why?
6 month, mom's Ab start wearing off. Keep drinking mom's milk
52
``` ALTE/BRUE: possible causes (5 to know), what hx/physical clues? ```
1. Sz: eye deviation/limb-jerking 2. Infxn: fever, fussy baby 3. cardiac: difficulty feeding, murmur, FTT 4. Abuse: multiple injuries 5. Reflux: after eating, food in mouth.
53
chronic sinusitis - when to suspect - how to workup (do what 3 things)
Sxs >8weeks duration, possible intermittent flareups. Get: Sinus CT endoscopy allergy eval consider rheum or immuno cause
54
Suspect Reye's syndrome - what lab to get - what else to suspect
- get ammonia (this is hepatic encephalopahty) | - also suspect inborn errors of metabolism, can present similarly (vomiting, AMS)
55
BRUE definition
brief resolved unexplained event <1y and <1 min, and any change in: - color - muscle tone - resps - responsiveness
56
Neonate, Failure to pass meconium: | DDx, when to suspect and how to dx/tx
3 to know: 1. imperforate anus 2. hirschsprungs 3. CF--meconium ileus 1. look at anus, no rectal 1st temp. KUB, fix now or later 2. FTPM>48h. First KUB, then barium enema, confirm with full thickness bx, surgery 3. FTPM>48h. KUB shows dilated loops, Gastrografin enema dx and dissolves
57
hydrolyzed formula | -what for
babies with milk-soy protein allegies (which can present with FTT and bloody diarrhea). Milk and soy protein can have cross reactivity. So, give proteins that are broken down (hydrolyzed)
58
Child with melena | -think what, ask or do what 4 things
Remember, babies can swallow maternal blood, children can swallow own Look for: - hx epistaxis - Fe supplement - Beets diet Apt test to diff maternal from neonatal blood
59
CVID - how present - what tx
Usu present in teenage, mild recurrent infxn (B and T cells combined) -get regular IVIGs
60
Hirshsprungs - presentation (2 ways) - how is dx different
1. FTPM neonate--Barium enema | 2. child with chronic constipation, explosive BM after DRE--use anorectal manometry
61
Child with hematochezia - think what if painful - if painless
painful: intususseption painless: think Meckel's. Also food allergies, eg milk-soy
62
SIDS | -what to tell parents to prevent
1. BACK to sleep 2. remove blankets/stuff animals in crib 2. no sharing beds 3. smoking cess
63
Newborn presents with choking with feeds and excessive salivation -do what
esophageal atresia - attempt NG passage, will coil - before surgery, look for VACTERL (esp cardiac and renal)
64
Adult pt with tracheostomy gets resp sxs, looks like PNA. But CXR shows no consolidation think what, do what
Think: Bacterial tracheitis (in trach pts) they get Zosyn
65
Infectious peds rashes: think what 1. starts head, then spreads down body 2. trunk, spreads to extremities 3. palms, soles
1. measles, rubella 2. roseola, scarlet fever 3. hand foot mouth, others
66
DiGeorge - you dx'ed - do what
- Most risk from fungi and PCP - PPx abx from PCP (bactrim or dapsone) - thymic transplant - careful hypocalcemia

STEP 2CK Review (20 decks)

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