2014-03-07 USMLE peds - USMLE peds Flashcards
What should you do if birth screening test is positive
order a confirmatory test
Most states screen for what at birth?
- hypothyroidism
- phenylketonuria
- galactosemia
- sickle cell disease
Cow’s milk should not be given before age
1 year
Hot water should be less than
110-120F
Start introducing solid foods at age
6 months
Head circumference should be measured routinely until what age
2 years
2 major causes of increased head circumference
- hydrocephalus
- brain tumor
TORCH infections =
Toxoplasmosis "other": syphilis and viruses Rubella CMV HSV
What percentage of childhood obesity is due to organic causes like cushings?
5%
Define failure to thrive
growth below 5th percentile for age
Most common case of failure to thrive
psychosocial reasons
Hearing screening should be done
- at birth
- every 2 years from 4 years old to adolescence
Vision should be screened
every few years starting at age 3
Absent red reflex may be sign of
CATARACTS - congenital rubella - other TORCH infections - galactosemia RETINOBLASTOMA
When is lazy eye normal
never, if persistant; may be occational until 3 months of age
2 infections classically associated with hearing loss
- meningitis
- recurrent otitis media
Who should always get iron supplements?
pre-term breastfed babies
First step in lead poisoning
stop the exposure
Classic behaviors/situations for lead poisoning
- eating paint chips
- living by battery recycling
Concerning lead level
if >10 ug/dl need close f/u
Treatment of severe lead poisoning
succimer or DMSA (chelation therapy)
First dentist appointment by age
3 years
Do you need to supplement fluoride?
no, almost always in the water
When should you start Vit D supplements?
6 months
High risk for INFANTS for Vit D defeciency
- inadequate maternal intake
- little sun
- exclusive breast feeding after 6 months
Screening for TB
only in high risk area or immigrant
- at 4-6 years AND
- at 11-16 years
Timing of Hep B vaccine
3 doses:
- 0-1 month
- 1-4 months
- 6-18 months
Timing of DTP vaccine
5 doses: - 2 months - 4 months - 6 months - 15-18 months - 4-6 years AND Td booster every 10 years
Timing of HiB vaccine
4 doses:
- 2 months
- 4 month
- 6 month
- 12-15 months
Timing of polio vaccine
4 doses:
- 2 months
- 4 months
- 6 months
- 4-6 years
Timing of MMR vaccine
2 doses:
- 12-15 months
- 4-6 years
Timing of pneumococcus vaccine
4 doses:
- 2 months
- r months
- 6 months
- 12-15 months
Timing of varicella vaccine
1 dose:
- 12-18 months
Avoid MMR vaccine in
- egg allergy
- neomycin allergy
- immunodeficiency (HIV ok)
If mom has Hep B, at birth give
both Hep B vaccince and immune globulin
Avoid polio vaccine in
- neomycin or streptomycin allergy
Avoid varicella vaccine in
- neomycin allergy
- immunodeficiency
What peds populations should (especially) get influenza vaccine?
- 6+ mo old with immunodefeciency
- severe heart/lung disease
- chronic ASA therapy
What peds populations should get pneumococcus vaccine?
If older than 2 years give if:
- immunodefeciency
- asplenic
- sickle cell disease
Screening test for sexually active female teens
- PAP smear
- GC/Chlamydia
Peds screening for urinary malformations is indicated when? What is test of choice?
- boys: 1st UTI if less than 6 years
- girls: 2nd UTI if less than 6 years
- use voiding cystourethrogram or renal US
When are Apgars done?
1 and 5 min (1 minute meaning immediately)
General categories of for Apgar
each with 2 points:
- HR
- Respiratory effort
- Muscle tone
- Color
- Reflex irritability
Apgar for HR
0- absent
1- less than 100
2- more than 100
Apgar for respiratory effort
0- no cry
1- weak cry
2- strong cry
Apgar for muscle tone
0- limp
1- some flexion
2- active motion
Apgar for color
0- blue all over
1- pink body, blue extrem
2- pink all over
Apgar for reflex irritabilty
0- none
1- grimace
2- grimace and strong cry/cough/sneeze
Important number on Apgar
resustitate/monitoring or to ICU until Apgar above 7
If only one umbilical artery is present, look for
renal malformations
At birth check the umbilical cord for
- 2 arteries
- 1 vien
- absence of urachus
swelling of scap at birth that crosses the midline =
caput succedaneum, benign
True or false: cephalohematomas from birth trauma do not cross the midline
true
What eval needs to occur with cepahlhematomas
- usually benign but may indicate underlying skull fracture, consider x-ray
Time course of cavernous hemangioma
- noticed a few days after birth
- increases in size then rapidly resolves within few years
Treatment of cavernous hemangioma
nothing, just wathc
Anterior fontanelle closes by
18 month
4 causes of delayed anterior fontanelle closure
- hypothyroidism
- hydrocephalus
- rickets
- IUGR
Moro reflex disapears at
6 months
Palmar grasp reflex disappears by
6 months
In premature infants, subtract the time for developmental milestone up until what age?
2 years
Age for social smile
1-2 months
Age for cooing
2-4 months
Age for lifts head to 90 degrees when prone
3-4 months
Age for rolls front to back
4-5 months
Age for voluntary grasp (no release)
5 months
Age for stranger anxiety
6-9 months
Age for sitting no support
7 months
Age for pulls to stand
9 months
Age for pat-a-cake
9-10 months
Age for first words
9-12 months
Age for imitates others’ sounds
9-12 months
Age for voluntary grasp and voluntary release
10 months
Age for waves bye’bye
10 months
Age for separation anxiety
12-15 months
Age for walking
13 months
Age for build tower of 2 cubes
13-15 months
Age for understands 1 step command
15 months
Age for good use of cup and spoon
15-18 months
Age for runs well
2 years
Age for build tower of 6 cubes
2 years
Age for ties shoe laces
5 years
Average age of puberty for girls
10.5
Average age of puberty for boys
11.5
First event for male puberty
testicular enlargement
First event for female puberty
breast development
Tanner stage is based on what?
- pubic hair for both
- boys: testicular and penile growth
- girls: breast growth
Definition of delayed puberty in boys
No testicular enlargement by 14 years old
Definition of delayed puberty in girls
No breast or pubic hair by 13 years old
Most common cause of delayed puberty
constitutional delay (normal variant)
Most common cause of precocious puberty
idiopathic
McCune-Albright syndrome =
girls with:
- cafe’au’lait spots
- fibrous dysplasia
- precocious puberty
girls with:
- cafe’au’lait spots
- fibrous dysplasia
- precocious puberty
McCune-Albright syndrome
Causes of precocious puberty
- McCune-Albright syndrome
- ovarian tumors
- testicular tumors
- CNS disease/trauma
- adrenal neoplasm
- congenital adrenal hyperplasia
Congenital adrenal hyperplasia in boys is usually
21-hydroxylase deficiency
Congenital adrenal hyperplasia in girls usually causes
ambiguous genitalia
Risk of precocious puberty
premature closure of epiphyseal plate
Treatment of otherwise untreatable precocious puberty
GnRH agonists
Boys with recurrent nose bleeds and blood dyscrasia =
nasopharyngeal angiofibromas
Most common cause of nosebleeds
trauma
Fever, anemia and nosebleed =
leukemia
Rate of African Americans heterozygous for sickle cell in US
8%
Diagnosis of sickle cell disease
blood smear with sickles, high retic count; Hb electrophoresis
Aplastic crisis in sickle cell, look for
parvovirus B19
Look for this site problem in sickle cell with bone pain
osteonecrosis of femoral head
Renal complication of acute sickle cell crisis
papillary necrosis
When do symptoms of sickle cell start?
around 6 months (this is when adult Hb production starts)
When are antibiotics given in sickle cell prophylactically
From diagnosis until age 5 years
Classic presentation of sickle cell anemia in children
dactylitis (hand-foot syndrome)
Biggest key points for HUS
- children
- diarrhea
Biggest key points for Henoch-Schonlein purpura
- rash
- abdominal pain
- arthritis
- melena
Biggest key points for TTP in peds
- CNS changes
- young adults
Biggest key points for ITP
- antiplatelet antibodies
Most common age for HUS
children
Most common age for HSP
children
Most common age for TTP
young adults
Most common age for ITP
children or adults
Common previous infection for HUS
E. coli diarrhea
Common previous infection for HSP
URI
Common previous infection for TTP
none
Common previous infection for ITP
viral, esp in children
RBC count in HUS
Low
RBC count in HSP
Normal
RBC count in TTP
Low
RBC count in ITP
Normal
Platelet count in HUS
low
Platelet count in HSP
Normal
Platelet count in TTP
low
Platelet count in ITP
low
Features of peripheral smear in HUS
Hemolysis
Features of peripheral smear in HSP
Normal
Features of peripheral smear in TTP
Hemolysis
Features of peripheral smear in ITP
Normal
Kidney manifestations in HUS
- ARF
- hematuria
Kidney manifestations in HSP
- hematuria
Kidney manifestations in TTP
- ARF
- proteinuria
Kidney manifestations in ITP
none
Treatment of HUS
supportive (may need transfusion or dialysis)
Treatment of HSP
supportive (may need transfusion or dialysis)
Treatment of TTP
- Plasmaphoresis
- NSAIDs
- DO NOT give platelets
Treatment of ITP
- steroids
- splenectomy if meds fails
When do you give steroids in ITP?
- bleeding
- counts below 20-40
What do you NOT do for TTP
- do not give plts, they are likely to form clots
Constant machine like murmur in upper left sternal border
PDA
How do you close a PDA?
indomethacin, surgery
How do you keep a PDA open?
PGE 1
PDA is associated with
- Rubella
- high altitudes
Associated symptoms with PDA
- dyspnea
- possible CHF
Holostyolic murmur next to sternum
VSD
True or false: most VSDs resolve on their own?
true
What is the most common congenital heart defect?
VSD
What heart defect is asymptomatic until adulthood?
ASD
What heart defect often presents with palpitations?
ASD
What heart defect has a fixed split s2
ASD
Treatment of ASDs
No treatment unless very large
The 4 anomalies of tetrology of fallot
- VSD
- Right ventricular hypertrophy
- pulmonary stenosis
- overriding aorta
Most common cyanotic congenital heart defect
tetrology of fallot
Kids who squart after exertion likely have
tetrology of fallow
Upper extremity HTN =
coarctation or aorta
Radiofemoral delay =
coarctation or aorta
Systolic murmur heard over mid-upper back
coarctation or aorta
Heart defect with rib notching on x-ray
coarctation or aorta
Heart defect associated with Turner syndrome
coarctation or aorta
What heart defects need endocarditis prophylaxis?
All except asymptomatic secundum-type ASDs
What % of ASDs are asymptatic secundum-type?
80%
3 syndromes to think about in patient with VSD
- fetal alcohol syndrome
- TORCH infections
- Down syndrome
Teenager with sudden cardiac death =
hypertrophic obstructive cardiomyopathy
Treatment of hypertrophic obstructive cardiomyopathy
- B-blockers
- consider pacemaker placement
Where is fetal circulation O2 highest?
Umbilical vein
Where is fetal circulation O2 lowest?
Umbilical artery
In fetus, which has highest O2 content, blood to arms or legs?
Blood to arms
Resting HR over 100 is normal up to age
10 years
Medications that are contraindicated in obstructive hypertrophic cardiomyopathy
- positive ionotropes
- diuretics
- vasodilators
How does the foramen ovale close?
Increase in left-side heart pressures
Heart pressure changes at time of birth
- 1st breaths cause lung inflation and decreased pulmonary vascular resistance
- -> increased arterial flow –> increase left sided pressures
What triggers closure of the ductus arteriosis?
increased O2 shuts off prostaglandin production
EKG finding of Wolff-Parkinson-White syndrome
delta wave
Delta wave on EKG =
Wolff-Parkinson-White syndrome
What causes symptoms in Wolff-Parkinson-White syndrome?
Transient arrhythmias conducted on accessory pathways
Treatment of pyloric stenosis
surgical
Treatment of duodenal atresia
surgical
Treatment of tracheoesophageal fistula
surgical
Treatment of Hirschsprung disease
surgical
Treatment of anal atresia
surgical
Treatment of choanal atresia
surgical
Presenating age of pyloric stenosis
0-2 months
2 month old with nonbilious projectile emesis likely has
pyloric stenosis
Gender predominance of pyloric stenosis
males MUCH more than females
“double-bubble” sign =
duodenal atresia
duodenal atresia is associated with this syndrom
Down syndrome
palpable olive shaped mass in epigastrium
pyloric stenosis
electrolyte findings in pyloric stenosis
- low chloride
- low potassium
- metabolic alkalosis
Presenting age of duodenal atresia
0-1 week
newborn with down syndrome and bilious emesis may have
duodenal atresia
Presenting age for tracheoesophageal fistula
0-2 weeks
1 week old with food regurgitation = concern for
tracheoesophageal fistula
Describe the most common variant of tracheoesophageal fistula
85% of cases have a fistula from bronchus to distal esophagus
CXR with NG tube coiled in esophagus and large air filled stomach is classic for
esophageal atresia
Age of presentation of Hirschsprung disease
0-2 years
2 year old with feculent emesis =
Hirschsprung disease
