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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
Q

Newborn management:
Meconium
-what to do

A

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

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26
Q

Neonatal jaundice, you see elevated unconjugated Bili

-DDx and Workup tests (3)

A

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
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27
Q

Newborn head exam

-what to know

A 
Caput succedaneum (Crosses Sutures)
Cephalohematoma
28
Q

Croup

-meds

A

Steroids

-if stridor at rest, do racemic epi

29
Q

Premature, ROP

  • tx
  • what is complication long term
A

Caused by high O2
Laser ablation

future: early glaucoma

30
Q

Breast feeding vs Breast milk jaundice

  • diff by timing
  • tx
A 
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
Q

Devo milestones to know

  • motor
  • fine motor
  • speech
  • social
A

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
Q

Premature, IVH

  • how it is dx
  • tx
  • long term complications
A
  • asx screening with Cranial Doppler (also do if bulging fontanelle)
  • tx with surgery–VP shunt, drains

-future mental retard, sz d/o

33
Q

Febrile sz:
simple vs complicated
5 things

A

5mo-5y

Fever
not Focal

<15 min
not repeat in 24h

34
Q

Crohn’s and UC:
-which has more diarrhea, which has more blood in stool

-if suspect IBD, what things to check on physical exam:

A

More likely:
UC: blood in stool
Crohn’s: diarrhea

  • check oral ulcers (Crohn’s)
  • eyes
  • skin
  • joints
35
Q

BCG vaccine protects from what?

A

against disseminated TB, but NOT pulmonary TB

36
Q

Bruton’s X-linked agammaglobulinemia

  • presentation
  • dx
  • tx
A

Boy, repeated bacterial infxn (esp pseudomonas)
Dx: all Ig’s deficient. Confirm with low B cells.

Tx: ppx abx, monthly Ig’s

37
Q

Baby: blue at rest, pink when crying

  • think what, and what else
  • dx, tx
A

Choanal atresia, also think Tet Fallot

-catheter doesn’t pass through nose. Get ENT to look surgery

38
Q

RPA

-presentation

A

opposite of meningitis: pain with extension of neck

hot potato voice, drooling, etc

39
Q

EEG shows “hypsarrythmia”

dx, tx

A 
Infantile spasm (West)
give ACTH (cosyntropin)
40
Q

1yo boy presenting with ear infection. Also has rash and easy bruising. Think what

A

WAX TIE

Wiskott (upside down, low IgM)
Aldrich (high IgA)
X linked

Thrombocytopenia
Infxn, recurrent
Eczema (high IgE)

Tx: bone marrow trans

41
Q

IgA def

-how presents (2)

A
  1. repeated GI/resp infxn (remember, IgA is mucosal)

2. Asx, but anaphylactic rxn to blood transfusion

42
Q

Non-bilious vomiting, baby

  • always think what
  • what age
  • dx, tx
A

Pyloric stenosis, 6 week baby (not day1)

Projectile vomit, olive mass
IVF to rehydrate, U/S donut, myomectomy

43
Q

Child with recurrent PNA

-no immunodeficiency, think what?

A

CF with recurrent resp/lung infections

44
Q

Croup that is not responding to steroids and racemic epi

-do what

A

possible Bacterial tracheitis (rare)

get tracheal cx to dx, abx

45
Q

Lyme dz in peds

-what to know

A

Amox in kids<8 (if >8, Doxy.)

Disseminated Lyme (bell’s palsy, heart block, meningitis): Ceftriaxone, still.

46
Q

What peds rash to keep away from pregnant mom?

A

B19 parvovirus.

danger Hydrops Fetalis!

47
Q

Neonate with persistent jaundice at 6 weeks

-think what, do what

A

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
Q

Why don’t give Azithromycin for sinusitis

A

resistance to Strep pneumo

49
Q

What infxns:

CGD
complement def
thymic hypoplasia
Abnormal B-cell maturation

A
  • catalase+ (staph, aspergillus)
  • Gonorrhea, meningococcal (C5-C9 in Neisserias)
  • Viral, fungal
  • Giardia (IgA), encaps bact
50
Q

Peds seizures

-3 weird ones to know, and what to remember about them

A
  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
Q

peds immundeficiencies tend to appear what age, why?

A

6 month, mom’s Ab start wearing off. Keep drinking mom’s milk

52
Q 
ALTE/BRUE:
possible causes (5 to know), what hx/physical clues?
A
  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
Q

chronic sinusitis

  • when to suspect
  • how to workup (do what 3 things)
A

Sxs >8weeks duration, possible intermittent flareups. Get:

Sinus CT
endoscopy
allergy eval

consider rheum or immuno cause

54
Q

Suspect Reye’s syndrome

  • what lab to get
  • what else to suspect
A
  • get ammonia (this is hepatic encephalopahty)

- also suspect inborn errors of metabolism, can present similarly (vomiting, AMS)

55
Q

BRUE definition

A

brief resolved unexplained event

<1y and <1 min, and any change in:

  • color
  • muscle tone
  • resps
  • responsiveness
56
Q

Neonate, Failure to pass meconium:

DDx, when to suspect and how to dx/tx

A

3 to know:

  1. imperforate anus
  2. hirschsprungs
  3. CF–meconium ileus
  4. look at anus, no rectal 1st temp. KUB, fix now or later
  5. FTPM>48h. First KUB, then barium enema, confirm with full thickness bx, surgery
  6. FTPM>48h. KUB shows dilated loops, Gastrografin enema dx and dissolves
57
Q

hydrolyzed formula

-what for

A

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
Q

Child with melena

-think what, ask or do what 4 things

A

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
Q

CVID

  • how present
  • what tx
A

Usu present in teenage, mild recurrent infxn (B and T cells combined)

-get regular IVIGs

60
Q

Hirshsprungs

  • presentation (2 ways)
  • how is dx different
A
  1. FTPM neonate–Barium enema

2. child with chronic constipation, explosive BM after DRE–use anorectal manometry

61
Q

Child with hematochezia

  • think what if painful
  • if painless
A

painful: intususseption
painless: think Meckel’s. Also food allergies, eg milk-soy

62
Q

SIDS

-what to tell parents to prevent

A
  1. BACK to sleep
  2. remove blankets/stuff animals in crib
  3. no sharing beds
  4. smoking cess
63
Q

Newborn presents with choking with feeds and excessive salivation

-do what

A

esophageal atresia

  • attempt NG passage, will coil
  • before surgery, look for VACTERL (esp cardiac and renal)
64
Q

Adult pt with tracheostomy gets resp sxs, looks like PNA. But CXR shows no consolidation

think what, do what

A

Think: Bacterial tracheitis (in trach pts)

they get Zosyn

65
Q

Infectious peds rashes: think what

  1. starts head, then spreads down body
  2. trunk, spreads to extremities
  3. palms, soles
A
  1. measles, rubella
  2. roseola, scarlet fever
  3. hand foot mouth, others
66
Q

DiGeorge

  • you dx’ed
  • do what
A
  • 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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