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PGI > 18.6.2013(pediatrics)41 > Flashcards

18.6.2013(pediatrics)41 Flashcards

0
Q

Incision site in pediatric tracheostomy

A

Midway Btw lower border of thyroid cartilage and supra sternal notch(skin incision)
Vertical incision over trachea
Over 3rd and 4th tracheal rings

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1
Q

Indications for tracheostomy

A

Intubation not possible

Assisted ventilation needed for more than 4-6 weeks

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2
Q

Complications of tracheostomy

A

Hemorrhage
Subcutaneous Emphysema
Pneumothorax
Pneumomediastinum

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3
Q

Most common early complication of pediatric tracheostomy

A

Subcutaneous emphysema

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4
Q

Extent of trachea

A

C6 to T4

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5
Q

Diff btw pediatric and adult tracheostomy

A

Tube is not cuffed in pediatric tracheostomy

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6
Q

$ Common sites of mongolian spot

A 
Presacral area
Buttocks(common site)
Thigh
Legs
Back
Shoulder
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7
Q

Cause of mongolian spot

A

Arrest of melanocytes in mid dermis during migration

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8
Q

Age of onset of scurvy in infants and children

A

6-24months

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9
Q

Diff btw scorbutic and rachitic rosary

A

Sharp and angular in scurvy

Dome shaped and semicircular in rickets

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10
Q

Cause of scorbutic rosary

A

Separation of epiphysis of ribs

Backward displacement of ribs

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11
Q

Features of vit C deficiency

A 
Subperiosteal hemorrhages
Pseudo paralysis
Scorbutic rosary
Gum changes(more over incisor)
Sicca syndrome
Poor wound healing
Swollen joints
Peri follicular hemorrhages
Hyperkeratosis of hair follicles
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12
Q

Manifestation of severe vit C deficiency

A

Skeletal muscle degeneration
Cardiac hypertrophy
Bone marrow depletion
Adrenal atrophy

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13
Q

Bone changes of rickets are common in

A

Knee

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14
Q

Wimburger sign is seen in

A

Congenital syphilis

Vit C deficiency

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15
Q

Skeletal features of vit C deficiency

A 
Osteoporosis
Signet ring epiphysis 
Pencil thin cortex
Sub periosteal hemorrhage
Corner sign
Trummerfield zone
Pelken sign
White line of frenkel(at metaphysis)
Wimberger sign
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16
Q

Wimberger sign

A

Epiphyseal centres of ossification have ground glass opacity,surrounded by white ring

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17
Q

Corner sign

A

Well calcified cartilage projecting beyond the limits of shaft

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18
Q

Pelken sign

A

Epiphyseal spur

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19
Q

Trummerfield zone

A

Fragmentation above calcified cartilage in metaphysis

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20
Q

Better indicator of vit C stores

A

Leukocyte vitamin C

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21
Q

Craniotabes is seen in

A

Rickets
Osteogenesis imperfecta
Hydrocephalus
Syphilis

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22
Q

Erythema toxicum disappears in

A

1-3 days

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23
Q

Erythema toxicum spares

A

Palms and soles

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24
Q

Port wine stain is a _________ newborn finding

A

Normal

But doesn’t disappear spontaneously

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25
Q

Causes of splinter hemorrhage

A 
1.minor trauma
SABE
vasculitis
Severe RA
peptic ulcer disease
Hypertension
Chronic glomerulonephritis 
Cirrhosis
Scurvy
Malignant neoplasm
Trichinosis 
Psoriasis
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26
Q

COCPR

A

Compression only or hands only CPR

Should be performed by lay providers

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27
Q

Sequence of events in CPR

A

CAB except in newborns

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28
Q

Nonperfusing arrythmias

A 
Also known as Malignant arrythmias
VF
pulseless VT
PEA
pulseless bradycardia
Asystole
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29
Q

Two rescuer CPR in infants and children

A

15:2

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30
Q

defibrillator used in

A

Even in infants

31
Q

Depth of chest compressions

A

Atleast 2 inches(adult)

Atleast 1/3rd depth of chest(children)

32
Q

Syndromes associated with Wilms tumor

A 
WAGR
Denys drash 
Beckwidth wideman
Hemihypertrophy
Sporadic aniridia
Genitourinary abnormalities
NF1
Sotos syndrome
Pearlman syndrome
Von wilibrand disease
33
Q

Mutations in WAGR

A

Deletion Chr 11p13

WT1 and aniridia gene PAX6 are located

34
Q

Denys drash

A

Male pseudohermaphroditism
Early renal failure(mesangial sclerosis)

Missense mutation in WT1 gene

35
Q

Beckwidth wideman

A

Hemihypertrophy
Visceromegaly
Macroglossia
Adrenal cytomegaly

36
Q

Mutation in Beckwidth wideman

A

WT2 in chr11

37
Q

Diff btw neuroblastoma and Wilms tumor

A

Stippled calcification and hemorrhage
Pushes the kidney inferolaterally,without distortion of collecting system
Crosses the midline
Lung metastasis is rare
Paraneoplastic syndrome (opsomyoclonus)
Can extend into spinal canal and cause compression

38
Q

Neuroblastoma pushing the kidney inferolaterally without distortion of collecting duct

A

Drooping lily sign

39
Q

Tumor markers in neuroblastoma

40
Q

Most common site of metastasis of neuroblastoma

A 
1.Long bones and skull
Bone marrow
Liver
Skin
Lymphnode
41
Q

Mean age of diagnosis of Wilms tumor

A

3 yrs

80% cases are less than 5 yrs

42
Q

Rule of 10 in Wilms tumor

A 
10%
B/L
Unfavourable histology
Vascular invasion 
Pulmonary mets at presentation
Calcification
43
Q

Histological variants in neuroblastoma

A

Neuroblastoma
Ganglioneuroma
Ganglioneuroblastoma

44
Q

Diploidy and prognosis of neuroblastoma

A

Hyperdiploidy,near triploidy indicates better prognosis if age of onset is less than 1 yr

Near diploid indicates worse prognosis

45
Q

Stage 4S neuroblastoma

A 
Less than 1 yr
Subcutaneous nodules
Small primary tumor 
No bone involvement
Massive liver
46
Q

Neurological manifestations of neuroblastoma

A

Horner syndrome
Cord compression
Opsomyoclonus (dancing eyes)
Ataxia(dancing feet)

47
Q

Hormones secreted by neuroblastoma

A

catacholeamines

VIP

48
Q

Chemotherapy for neuroblastoma

A

Cisplatin or carboplatin
Cyclophosphamide
Etoposide
Doxorubicin

49
Q

Familial predisposition to neuroblastoma

A

ALK gene (anaplastic lymphoma kinase) mutation

50
Q

IHC staining of neuroblastoma

A

Neuron specific enolase

51
Q

Histological picture of neuroblastoma

A

Homer wright pseudo rosettes

Dense core granules(contain catacholeamines)

52
Q

Mature neuroblastoma

A

Contains Schwann cells

53
Q

Chr abnormalities in neuroblastoma indicating poor prognosis

A

1p and 11q loss

17q gain

54
Q

Poor prognostic factor in neuroblastoma,cellular expression

A

NMYC amplification
TRK B
telomerase expression

TRKA indicates good prognosis

55
Q

Age,prognosis in neuroblastoma

A

Less than 18 months indicates good prognosis

56
Q

Stages of neuroblastoma with good prognosis

A

Stage 1,2,4S

57
Q

Mitosis-karyorhexis index in neuroblastoma

A

<200/5000 indicates good prognosis

58
Q

Stools of formula fed infants

A

Bacteroids
Clostridium

Breast fed infants have bifidobacterium

59
Q

pH of breast fed infant stool

A

Acidic because of acetate produced by bifidobacterium

60
Q

SGA

A

Weight less than 10 percentile for their gestational age

Or below 2 standard deviations

61
Q

Causes of bossing of skull

A 
Rickets
Thalassemia
Congenital syphilis
Achondroplasia 
Hurler
Lowe
Cleidocranial dysostosis
Ectodermal dysplasia
Ehlers danlos
62
Q

Causes of craniotabes

A 
Physiological
Rickets
Congenital hydrocephalus
Osteogenesis imperfecta
Lacunar skull
Treacher collins
63
Q

Breast feeding in HIV positive mother

A

Exclusively top feeding

Breast feeding for 6month and rapid weaning

64
Q

Intusucception is associated with which infection

A

Adenovirus type C

65
Q

NMYC amplification presents as

A

Extra chromosomal double minutes
Or
Homogenously staining region of other chromosomes

66
Q

Location of N-myc

67
Q

Drug used for differentiation of neuroblastoma

68
Q

Tumors in Denys drash syndrome

A

Wilms

Gonadoblastoma

69
Q

Overgrowth in Beckwidth wideman is due to

70
Q

Mutations causing Wilms tumor

A

WT1 and WT2

Beta catenin

71
Q

Increased risk of developing wilms tumor in opposite kidney is indicated by

A

Nephrogenic rest

72
Q

Wilms tumor unresponsive to chemotherapy

A

P53 mutation

73
Q

Intestine commonly involved in NEC

A

Distal illeum and proximal colon

74
Q

Pathognomonic x ray findings in NEC

A

Pneumatosis intestinalis

Portal venous gas(severe disease)

PGI (16 decks)

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