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Aq Flashcards

1
Q

Roseola

A

A viral exanthem that classically follows 3-5 days of a febrile illness.

As the fever resolves, patients develop a pink, maculopapular rash that starts on the trunk and may spread to the face and extremities.

Caused by human herpes virus-6 (HHV-6).

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2
Q

Papular urticaria

A

Caused by insect bites.
Papular 3 mm to 10 mm in diameter.
Can be recurrent or chronic.
Pruritic.

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3
Q

Sandpaper rash

A

Strep infection, scarlet fever.

Accentuated at skin creases.

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4
Q

Erythema multiforme

A

An acute hypersensitivity syndrome - HSV or medications.

Symmetrical rash starts as a dusky red macules and evolves into sharply demarcated wheals and then into target-like lesions.

Individual lesions stay fixed for 1-3 weeks.

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5
Q

Erythema infectiosum (Fifth disease)

A

Parvovirus B19

“slapped”-cheek appearance followed by a reticular (lacy) erythematous rash on the trunk and extremities.

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6
Q

Erythema migrans

A

Early localized Lyme disease.
Starts as a red papule at the site of a tick bite.
Expands to form a large erythematous, annular patch.

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7
Q

Seborrheic dermatitis (cradle cap)

A

From malassezia.
Erythematous plaques with fine to thick, greasy yellow scale.
Typically seen on the scalp, but may spread elsewhere

Treat with baby oil, antifungal shampoo or creams (older kids)

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8
Q

Eczema vs psoriasis

A

Eczema: pruritic, erythematous, scaling plaques on extensor surfaces
Psoriasis: More erythematous, with a thicker, non-waxy scale and more defined borders

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9
Q

Pseudofolliculitis

A

Papules, but not pustules

Around hair follicles

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10
Q

Acne vulgaris

A

Keratinous material and excess sebum (due to androgenic influence) plug the pilosebaceous gland.
Or
Increased sebum provides growth medium for superinfection with Propioniobacterium acnes.

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11
Q

Hidradenitis suppurativa

A

Pustular lesions caused by occlusion of the apocrine follicular units (instead of the pilosebaceous units).

Often superinfected with Staph aureus or Strep pyogenes.

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12
Q

Rosacea

A

No comedones.

Worsens with alcohol, spicy food, temperature extremes, and stress.

Can be treated with topical metronidazole and various other medications.

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13
Q

Perioral dermatitis

A

variant of rosacea, treated the same way.

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14
Q

Acne severities

A

Mild - Comedonal acne with perhaps a few papules or pustules mixed in.
Tx OTC benzoyl peroxide or retinoids

Moderate - Significant inflammatory lesions with concern for scarring.
Tx topical antibiotic like clindamycin or erythromycin. Oral therapy includes abx like doxycycline or tetracycline, or contraceptive pills.

Severe - Nodulo-cystic type, with an even higher risk for significant scarring
Tx should be referred to a dermatologist. They will use oral isotretinoin.

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15
Q

Nickel contact dermatitis hypersensitivity type

A

delayed type IV hypersensitivity reaction

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16
Q

Impetigo

A

Usually Staphylococcus aureus and Streptococcus pyogenes

Tx with topical mupirocin.

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17
Q

Steroid potencies

A

Mild - hydrocortisone acetate, 1% (OTC)

Intermediate - triamcinolone acetonide, 0.1%

Potent - betamethasonedipropionate, 0.05%

Super potent - clobetasol propionate, 0.05%

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18
Q

Pediculosis Capitis (Head Lice)

A

No need to treat for lice prophylactically

1st-line treatment - 1% permethrin lotion

2nd line Benzyl alcohol 5% (>6 mo age)
or malathion 0.5% (>2y age)

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19
Q

Scabies

A

Caused by a mite, Sarcoptes scabiei.
Significant itching especially at night.
Classic lesion for scabies is about a 5-10 mm curvilinear thread-like lesion–the burrow.

Tx - 2 applications of permethrin 5% cream, one week apart, for all affected household members.
2nd line - oral ivermectin

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20
Q

Ringworm (Tinea corporis)

A

Annular, well-circumscribed, scaly plaque with a raised border and a center that is brown or hypopigmented.

Lesions can be mildly pruritic and gradually enlarge and may coalesce with surrounding lesions.

Clinical Dx but can do KOH wet-mount.

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21
Q

Tinea Versicolor

A

Actually from malassezia species.
Pink, brown, or white lesions can increase risk with heat or humidity.
Tx selenium sulfide lotion.

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22
Q

Tinea Capitis

A

ringworm of the scalp
Systemic therapy is required for this type of tinea
Tx griseofulvin 6-8wks.

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23
Q

Pityriasis alba

A

hypopigmentations

Associated with sun exposure.

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24
Q

Pityriasis rosea

A

scaly papules and plaques in the hallmark “christmas tree” distribution on the back and trunk, following the lines of skin cleavage.
initial lesion, called the “herald patch,” is usually the largest scaly plaque with a raised border and can easily be confused with tinea corporis.

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25
Q

Warts treatment

A

Salicylic acid has best data.

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26
Q

Types of diaper rashes

A

Irritant Dermatitis - most common, from poop/pee. Tx with cleanliness and zinc oxide creams/ointments.

Diaper Candidiasis - inflamed plaques have more erythematous papules “satellite” lesions. Tx w/ nystatin.

Bacterial Infection - Much less common. Standard treatment with oral antibiotics is effective.

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27
Q

Rare systemic illnesses that present w/ diaper rash

A

Acrodermatitis enteropathica, a rare inherited form of zinc deficiency
Langerhans Cell Histiocytosis
Refer to dermatology if diaper rash worsens w/ tx

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28
Q

vision/hearing screening

A

Hearing - At birth, then ask parents as baby ages

Vision - screen with vision chart at age 3y.

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29
Q

Breastfeeding supplementation

A

Baby should get 400 IU vit. D daily

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30
Q

Timeline for newborn to regain birthweight

A

Age 2wks.

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31
Q

When baby should transition to cow’s milk

A

1yr

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32
Q

Caloric requirements for 1-2 month olds

A

Term - 100-120kcal/kg daily
Preterm - 115-130 kcal/kg daily
Very preterm (<32wks) - 150 kcal/kg daily

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33
Q

Age for flu vaccine

A

6 months

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34
Q

Anticipatory guidance examples

A

4 months - spoon feeding, sleeping through the night
6 months - rolling over, sits unsupported, walker are NOT recommended! Can introduce solid food. Read!
1yr - Can stop sleeping on back/firm surface. Standing, ~walking, 4 words, playful.
2yr - Rear-facing car seat until age 2.
13yr - sit in back seat.

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35
Q

Age to double and triple birth weight

A

Double at 4-5 months

Triple at 1yr

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36
Q

When to refer for abnormal red reflex

A

Always, especially if leukocoria or signs of abusive trauma.

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37
Q

Neuroblastoma prognosis

A

Metastatic (stage 4s) can regress completely in <1yr olds.

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38
Q

Neuroblastoma inheritance

A

autosomal dominant, low penetrance

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39
Q

Initial testing for an abdominal mass in an infant

A

CBC, catecholamines (VMA, HVA), CXR, skeletal survey, abdominal US and x-ray.
CT if non-cystic mass found on US.

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40
Q

Ddx of RUQ mass + palor in infant

A

Hydronephrosis - Will see lots of UTIs. Can be from multicystic kidney.
Neuroblastoma - Check for neck, chest, abdomen mass. Sx are fever, pallor, weight loss.
Wilms Tumor - Mass doesn’t cross midline. HTN, abdominal pain, vomiting.
Hepatic Neoplasm - Jaundice notable.
Teratoma - Rare. Causes pressure effects on ab organs.

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41
Q

3 year old development

A

Socio-emotional - Brushing teeth, feeds self.
Communication - 2-3 word sentences. 75% understandable.
Cognitive - Knows name/use of cup, ball, spoon, crayon.
Physicial - Can build tower of 6-8 cubes.

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42
Q

4 year old development

A

Socio-emotional - Knows age/gender, plays with others, fantasy play.
Communication - Knows first/last name. Can sing.
Cognitive - Knows colors, gender, can draw person with 3 parts.
Physicial - Hops on one foot.

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43
Q

5 year old development

A

Socio-emotional - Listens, knows difference between real and fake. Sympathy.
Communication - Full sentences. Counts to 10.
Cognitive - draws person >6 body parts.
Physicial - Balances on one foot. Can dress self.

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44
Q

What to do if child isn’t reaching developmental milestones.

A

If <3yrs old, refer to early childhood intervention, peds psych, developmental-behavioral peds, or learning specialist.
If >3yrs old, school will have some kind of program to catch them up.

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45
Q

Treatment of eczema

A

Lubricate
Short burst anti inflammatories
Treat any underlying infection

Steroids - OTC stuff doesn’t work
Topical NSAIDS - Calcineurine inhibitors (cyclosporine, tacrolimus) are 2nd line
Antihistamines - help with itch

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46
Q

When to check serum lead levels in children

A

If aged 1-2yrs and they have spent >25% of their time in a home built before 1960.

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47
Q

Anemia screening for children

A

At age 1yr and again at start of preschool/kindergarten.

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48
Q

Constitutional short stature

A

“late bloomer” will attain normal height later than peers

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49
Q

Female puberty milestones

A

Onset 8-13yrs

Breast buds + pubic hair (10yrs) -> growth spurt -> periods (12-13yr) -> adult height (15yrs)

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50
Q

Male puberty milestones

A

Onset 10-15yrs
Testes enlargement + pubic hair (12yr) -> penile growth + ejaculations (13yr) -> growth spurt (14yr) -> adult height (17yr)

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51
Q

mononucleosis sx

A

Lymphadenopathy, pharyngitis, fatigue

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52
Q

How is menses in adolescents different than adults

A

Increased cramps/discomfort with little bleeding/clots

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53
Q

Which adolescents should be screened for suicidality

A

Everyone

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54
Q

Anorexia signs

A

bradycardia, postural hypotension.

Low glucose, albumin, Na, Mg, Ca

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55
Q

Ddx for adolescent worsening school performance

A

Medical (thyroid)
Personal (home problems)
Mind (psych conditions)
Drugs

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56
Q

Weight age and height age

A

Weight age: age where current weight is at 50th%

Height age: age where current height is at 50th%

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57
Q

ADHD symptoms

A

↓ attention
↑ activity
↑ impulse

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58
Q

Ddx for ADHD

A 
Sensory deficits
Sleep abnormalities
Mood disorder
Learning disability
Conduct disorder
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59
Q

Red flags for future learning disabilities

A

Maternal substance abuse
Meningitis
Head trauma
Family hx learning disabilities

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60
Q

Stimulants SEs

A 
↓ appetite
insomnia
↓ growth
No addiction risk
Cardiovascular risk only to those with heart disease
Can uncover tic disorder
61
Q

Obesity risk factors

A

↑ birth weight
maternal diabetes
obese parents
↓ socioeconomic status

62
Q

Main obesity complications

A 
HTN
HLD
OSA
DMII
Fatty liver
Slipped capital femoral epiphysis
63
Q

DMII Dx criteria

A

A1c >6.5
Random glucose >200
Fasting >126
GTT >200

64
Q

Screening criteria for DMII in children

A

BMI >85% + one of: Family Hx, race, maternal DM

Screen @ age 10/puberty - Q3yrs

65
Q

Signs of insulin resistance

A

PCOS, acanthosis nigricans, HTN, HLD

66
Q

HTN categories in children

A

Pre-HTN 90-95%
HTN stage I - 95-99%
HTN stage II - >99%

67
Q

How can you tell endocrine problems vs just being obese from diet

A

Endocrine problems –> short stature

68
Q

Causes of 2ndary HTN

A

UTI, renal causes, ↑ catecholamines, coarcted aorta

69
Q

How to manage HTN in children

A

Re-check in 6 months.

Don’t do medications unless stage II HTN

70
Q

vWD facts

A

Most common hereditary bleeding disorder
Autosomal dominant w/ variable penetrance (Type I and II)
Sx: ecchymoses, epistaxis, menorrhagia, gingival bleeding.

71
Q

vWD diagnosis

A

theoretically PTT should be prolonged but can be normal.
Check von Willebrand factor antigen and/or
platelet function analysis and factor VIII levels

72
Q

HEADSSS

A 
Home
Education/employment
Eating disorders
Activities
Drugs
Sexuality
Suicide risk
Safety
73
Q

How to discuss confidentiality

A

Promising absolute confidentiality yields more information.

Relative confidentiality is less misleading but yields less information.

74
Q

vWD treatment

A

IV or intranasal desmopressin. Or vW factor concentrate.

75
Q

Diagnosis & management of neonatal hypoglycemia

A

Reagent strip showing whole blood glucose <40

  • Symptomatic -> IV Dextrose
  • Asymptomatic -> Promote feeding
76
Q

Feeding recommendations for tachypnic neonates

A

Still try to feed.

If unable to feed -> pump in the meantime.

77
Q

Gestational age categories

A

SGA - <10% –> risk of polycythemia, temp instability, hypoglycemia

AGA - 10-90%
LGA - >90% –> ↑ birth injuries, hypoglycemia

78
Q

Vasovagal reflex

A

Normally has prodromal sx:

dizziness, light headed, sweating, nausea, vision changes

79
Q

Precordial catch syndrome vs costochondritis

A

Precordial catch: unknown, msk pain lasting seconds

Chostocondritis: msk pain lasting hours-days.

80
Q

signs/sx of cardiac chest pain

A 
exertional
crushing/pressure
10-15 minutes
syncope
murmur
81
Q

At what stage does “just say no” instruction no longer work

A

Works for pre-adolescents but doesn’t work for adolescents.

82
Q

Male Tanner staging

A 
1 - Pre-puberty
2 - fine hair
3 - coarse hair
4 - scrotal darkening
5 - medial thigh hair
83
Q

Immunizations for adolescents

A

11-12yrs –> TDaP, MCV4 (meningitis), HPV

16 –> MenB, MCV4 booster

84
Q

Sports exam for males

A

Check for undescended testes and inguinal hernias

Screen strength, tone, ROM symmetry

85
Q

Syncope evaluation

A

ECG –> ECHO if exertional to check for hypertrophic cardiomyopathy

86
Q

Differential for tachypnea of newborn

A

Respiratory distress syndrome - ↓ surfactant.

  • Up to 37wks.
  • ↑ risk in diabetic mothers -> ↓ surfactant production
  • Ground glass appearance of lungs

Transient tachypnea of newborn - delayed fluid clearance from birth.
-↑ in diabetic mothers and C-sections

Pneumothorax - ↑ with mechanical ventilation.
-Uncommon

Meconium aspiration.

Hypoglycemia - It just happens.

Hypothermia.

Cardiac abnormalities - Transient hypertrophic cardiomyopathy (diabetic -> ↑ organ size)
-VSD, PDA, coarctation of aorta.

Neonatal sepsis - ↑ risk w/ GBS, long ROM

Diaphragmatic hernia - Mostly on left side. ↓ lung development, pushing of heart/mediastinum.

87
Q

Jaundice etiologies

A
  • Breastfeeding jaundice - first few days - ↓ oral intake.
  • Breast milk jaundice - 1-2wks of life, from the milk deconjugating bili -> ↑ reabsorption.
  • Hemolysis
  • RBC breakdown - bruising, swallowed blood
  • Sepsis
  • TORCH infections
88
Q

Biliary atresia

A

-Jaundice
-Dark urine
-Pale stools
Tx: Surgery to prevent early liver damage

89
Q

Normal baby voiding/stooling patterns

A

Void: 3-4x daily –> 6-8x daily by day 6.
Stool: 3-4x daily, meconium ends after day 3.

90
Q

Hemolysis PE findings

A

Jaundice

Hepatosplenomegaly

91
Q

When to start fluoride

A

Age 6 months

92
Q

CAH findings

A

↑ 17-OH –> ↑ androgens –> virilization

↓ cortisol + aldosterone –> salt wasting: ↓Na, ↓K, ↓H2O

93
Q

Hypothyroid presentation of babies

A

Normal at birth -> feeding issues, ↓activity, constipation

Over long time -> large tongue, hoarse cry, puffy face

94
Q

What prophylaxis do you give for those with sickle cell

A

Penicillin to prevent strep pneumonia

95
Q

Poor feeding/decreased activity differential

A 
Congenital hypothyroid
Shaken baby
Down syndrome
CAH
Metabolic disorders
Botulism
Polycythemia
96
Q

6-mo Fever ddx

A 
UTI
Pneumonia
sepsis
meningitis
roseola
hsv
otitis media
viral URI
97
Q

Infant meningitis signs

A 
Fever or low temp
bulging fontanelles
lethargy
crying when picked up
vomiting/diarrhea
98
Q

CSF findings bacterial vs viral

A

Bacterial ↓glucose

Viral normal glucose

99
Q

Causes of UTI

A

E. coli > klebsiella, proteus, enterococcus

100
Q

UTI abx

A

IV:

  • Amp + Genta
  • Ceftriaxone (no pseudomonas/enterococcus coverage)
  • Meropenem
  • Ciprofloxacin

PO:

  • Bactrim
  • Cephalexin
  • Nitrofurantoin (not for pyelonephritis)
  • Amoxicillin-Clavulanate - High SEs, 2nd line
101
Q

Testing for fever without a source

A
  • UA + Urine catheterized culture
  • CBC if ill-appearing -> left shift = serious bacterial illness
  • Blood culture if ill-appearing
102
Q

At what age is rapid strep not indicated

A

Don’t do rapid strep checks until age 2

103
Q

Voiding Cystourethrogram purpose

A

Shows reflux, use if there are recurrent UTIs (>1)

104
Q

Sx of viral meningitis

A

GI sx since it’s usually from enterovirus.

105
Q

Roseola

A

High fever turning into rash. No therapy needed.

106
Q

Cervical lymphadenopathy ddx

A 
Acute infxn
Kawasaki
Cervical adenitis (infected lymph node)
Cat scratch disease
TB
107
Q

Causes of strawberry tongue

A

Strep, kawasaki disease

108
Q

Kawasaki disease diagnostic criteria

A

5d fever + 4 of:

  • lymphadenopathy
  • red/swelling extremities
  • strawberry tongue
  • conjunctivitis
  • rash
109
Q

Kawasaki stages

A

Acute phase: fever

subacute: 1-3wks -> sx resolve, aneurysms happen, hand/feet peeling
convalescent: 1-2months, still serologic evidence of condition

110
Q

Kawasaki disease complications

A

Aseptic meningitis
Aneurysms
Arthritis
Gall bladder hydrops

111
Q

Kawasaki disease management

A

Aspirin high dose, IVIG (to prevent aneurysms)
-Cardiology f/u in 2wks + low-dose aspirin 2months
Flu/vzv vaccine to prevent reye syndrome

112
Q

Kawasaki lab changes

A 
↑ PLATELETS!
↑ ESR, CRP
↑ AST/ALT
↓ Albumin
↑WBCs
Normocytic anemia
113
Q

Fever + Rash DDx

A 
Adenovirus
Kawasaki
meningitis
measles
rocky mountain spotted fever
scarlet fever (stre)
sjs
enterovirus
varicella
erythema infectiosum (parvovirus B19, slapped cheek, fifth disease)
Roseola
114
Q

Wheezing DDx

A 
Viral bronchitis
asthma
aspiration gerd
tracheomalacia
obstruction
CF
115
Q

Pertussis sx

A

Catarrhal stage: URI sx -1-2wks
Paroxysmal stage: whooping cough -1month
Convalescent stage: episodic cough -months

116
Q

Causes of epiglottitis

A

Hib»>Staph, strep

117
Q

Diphtheria findings

A

Gray membrane on throat.

Pharyngitis, fever.

118
Q

Asthma X-ray findings

A

hyperinflation, atelectasis

119
Q

10 month old child pneumonia causes

A

Usually vira (adenovirus, rsv, parainfluenza, flu)

120
Q

neonatal pneumonia causes

A

GBS, e. coli, klebsiella.

121
Q

Viral vs bacterial pneumonia findings

A

Viral: ↑ WBCs. variable, diffuse/patchy infiltrates, effusion
Bacterial: ↑ WBCs w/ ↑neutrophils. Lobar/segmental consolidation

122
Q

Croup cause and treatment

A

Parainfluenza, treatment is supportive w/ racemic epi

123
Q

When to do daily controller for asthma

A

If interfering with activity.

124
Q

Purpose of Peak Expiratory Flow (PEF) with asthma

A

NOT for diagnosis

FOR determining baseline function

125
Q

When to add anti-leukotrienes, antihistamines, flonase etc to asthma treatment

A

If known environmental causes

126
Q

At what age can you start doing PFTs for kids

A

Age 5

127
Q

Asthma testing findings

A

Obstructive findings
↓ FEV1
Scalloped loop

128
Q

Otitis media w/ effusion vs acute otitis media

A

Otitis media w/ effusion - Just fluid behind eardrum. No other symptoms.
Acute otitis media - Bulging +/- redness. Can’t just be redness alone.

129
Q

Acute otitis media facts

A

Usually strep. pneumonia
Effusions last for weeks after recovery
Management: Amoxicillin, especially if bilateral

130
Q

Persistent otitis media

A

> 3 months of effusion after infection

If hearing loss, will need tubes.

131
Q

Sinusitis course

A

> 10days

URI -> get better -> get worse

132
Q

Pyloric stenosis electrolyte abnormalities

A

↓ Cl-, ↓Na+, Alkalosis

133
Q

Rehydration therapy for kids

A

Always start with oral rehydration therapy first.
Don’t do sporty drinks
Do 10-20ml/kg boluses

134
Q

Complications of DKA

A

Cerebral edema

Potassium loss but maybe be low, normal, or high.

135
Q

DKA sx

A

Vomiting
diuresis (starts at glucose >180)
SOB
Ab pain

136
Q

DKA management

A

Admit to hospital
Fluids + insulin (.1units/kg/hr)
Consult endocrinology
DO NOT give HCO3-

137
Q

Limping DDx

A 
Legg-calve-perthes (avascular necrosis of epiphysis, subtle chronic pain)
Leukemia
Osteomyelitis
REactive arthitis
septic arthtitis
Transient synotvitis
JIA (>6wks)
Slipped epiphysis (Vague hip or knee sx)
138
Q

Septic arthritis findings:

A 
Fever
↑ ESR
↑WBCs
↑Non weight bearing
Dx w/ aspiration: turbid w/ WBCs.
139
Q

Transient synovitis of the hip

A

Post-viral URI syndrome, swelling of tissues around joint

Tx supportive

140
Q

Ibuprofen dosing

A

10mg/kg Q6-8hrs

141
Q

Age to reach birth weight

A

2wks

142
Q

Hepatomegaly in newborns suggests

A

CHF

143
Q

Murmur in ASD

A

Wide split fixed S2 with systolic murmur

144
Q

Coarctation of aorta abnormalities

A

HTN in UEs

Decreased femoral pulses

145
Q

Bicuspid aortic valve auscultation findings

A

Early systolic click

146
Q

Aortic stenosis murmur

A

Systolic + early diastolic murmur

147
Q

VSD

A

Won’t show up until days-weeks
Increased pulmonary blood flow
High voltage QRS in V1 and V2

148
Q

CHF treatment in kids

A

Furosemide
Digoxin
Enalapril

149
Q

Seizure DDx

A 
Toxic ingestion
Seizure
Syncope
Head injury
Infxn
Tumor
intussusception

ped (3 decks)

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