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Peds EOR > Buzzwords, Dx, Tx > Flashcards

Buzzwords, Dx, Tx Flashcards

1
Q

Tx progression for acne

A

1.) Topicals, including benzoyl peroxide, salicylic acid, +/- topical clinda or erythromycin

2.) Topicals + PO:
- Antibiotics: micocycline or doxycycline
and/or
- Antiandrogen (spironolactone)

3.) Severe: PO isotretinoin, 0.5-1mg/kg/day divided BID x15-20 weeks

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2
Q

Monitoring for and AEs of isotretinon use

A
  • 2x negative pregnancy tests before initiating treatment then –> q/mo
  • Can cause liver damage
  • Can elevate triglycerides/cholesterol
  • Severe dry skin, lips
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3
Q

Physiology of androgenic alopecia

A
  • DHT activates androgen receptors

- Shortens anagen (growth) phase of hair cycle –> decreased anagen:telogen ratio

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4
Q

Treatments, MOAs, and AEs for/of androgenic alopecia

A

Topical minoxidil: increases blood supply; AE: itching, flaking

Finasteride: 5-a-reductace inhibitor, inhibits conversion of T –> DHT. AE: decreased libido/sexual dysfunction, elevated risk of prostate cancer

Spironolactone: antiandrogenic, blocks DHT. AE: Hyperkalemia, decreased libido

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5
Q

Buzzword: spongiosis on histology

A

Contact dermatitis

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6
Q

What type of hypersensitivity is atopic dermatitis?

A

Type 1 (IgE-mediated)

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7
Q

What type of hypersensitivity is contact dermatitis?

A

Type 4 (T-lymphocyte-mediated)

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8
Q

The genitocrural folds are spared in this kind of dermatological condition

A

Non-candidial diaper dermatitis

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9
Q

Buzzword: satellite lesions – what is the treatment?

A

Candidial diaper dermatitis.

Tx with antifungal (nystatin) +/- low strength hydrocortisone

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10
Q

What is the Rule of 9s for kids?

A

Major alterations:

  • Head = 18%
  • Each leg = 14%
Entire Rule:
- Head = 18%
- Anterior torso = 18%
- Posterior torso = 18%
- Each arm = 9%
- Each leg = 14%
(No 1% for groin)
  • For infants <10kg:
  • Head = 20%
  • Anterior torso = 16%
  • Posterior torso = 16%
  • Each arm = 8%
  • Each leg = 16%
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11
Q

What is the Parkland formula for fluid resus?

A

For fluid replacement in burns:
- Kids with >10% BSA burns need fluid res:

LR 3mL x kg x BSA%

  • 1st half given over 8 hours
  • 2nd half given over 16 hours
  • via two large bore IVs
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12
Q

Regardless of BSA involved, what type of burns require referral in kids?

A

Anything on hands, feet, face, perineum, crossing major joints, or circumferential

Mod/severe burns –> admission

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13
Q

Urticaria is what type of hypersensitivity; what is the mediator?

A

Type 1 hypersensitivity = IgE mediated

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14
Q

What is the mediator of Type 2 hypersensitivity reactions?

A

Type 2 hypersensitivities (cytoxic/cell lysis hypersensitivities) are antibody mediated

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15
Q

Erythema multiforme is what type of hypersensitivity? What is the mediator?

A

Erythema multiforme (as well as morbilliform and delayed drug reactions) are Type 4 hypersensitivities and are cell-mediated

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16
Q

Describe what may be seen in a patient experiencing a Type 4 hypersensitivity reaction?

A

Likely a delayed drug reaction:

  • Morbilliform/maculopapular eruption that becomes confluent
  • Occurs 5-14 days after initiation of drug (may be faster in already sensitized patients)
  • Occurs primarily on trunk and proximal extremities
  • May also have low fever, generalized pruritus
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17
Q

How is erythema multiforme treated?

A
  • Prompt withdrawal of offending drug
  • PO antihistamines
  • PO steroids if severe
  • IVF if necessary
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18
Q

How is angioedema treated?

A

Depends on subtype:

Mast-cell mediated:

  • Occurs with other allergic symptoms
  • More likely on a peds exam
  • Tx with steroids, antihistamines, and epi if necessary

Bradykinin-mediated:

  • Ass’d with ACEi or hereditary C1-esterase inhibitor deficiency
  • Antihistamines will not help
  • Stop ACEi if applicable

**In both: prompt airway management

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19
Q

What are 6 characteristics of an erythema multiforme eruption?

A
  • Target/iris lesions
  • Peripheral red halos
  • Blanchable
  • Non-pruritic
  • Negative Nikolsky sign
  • Affect distal extremities + mucosa
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20
Q

What differentiates major vs minor erythema multiforme?

A

Major: widespread lesions, 2+ mucosal sites involved, +/- systemic symptoms

Minor: peripheral distribution, limited/no mucosal involvement, no systemic symptoms

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21
Q

What classes of medications are generally ass’d with a drug-associated eruption that occurs during the 2nd week of use?

A

(Simple dermatitis medicamentosa)

  • PCNs
  • Quinolones
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22
Q

What classes of medications are generally ass’d with a drug-associated eruption that occurs during the 3rd week of use, and are often accompanied by systemic symptoms?

A

(Complex dermatitis medicamentosa)

  • Sulfas
  • Allopurinol
  • Anticonvulsants
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23
Q

What is the major difference between SJS and TEN?

A

SJS = <10% of BSA

TEN . >30% of BSA

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24
Q

What is one key distinguishing feature that differentiates SJS from erythema multiforme?

A

Erythema multiforme has (-) Nikolsky sign

SJS/TEN has +

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25
Q

What is the tx for SJS/TEN?

A

Manage airway, withdraw offending agent, manage fluids, electrolytes

IVIG

Admit to burn unit

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26
Q

Pt with dermatologic complaint has a biopsy that shows necrotic epithelium, eosinophilia, and atypical lymphocytes. This is suspicious for what condition?

A

SJS or TEN

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27
Q

What is the tx for perioral dermatitis?

A

Topical metronidazole

**Avoid steroids!!!

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28
Q

What are common triggers for SJS/TEN?

A

Sulfas and anticonvuslants

Less commonly: mycoplasma, HIV, HSV infections or malignancy

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29
Q

Describe the exanthem seen with Rubeola

A

(Measles):

  • Brick red
  • Blanchable
  • Maculopapular
  • Starts on face around hair line
  • Progresses caudally; soles and palms last
  • Darkens and coalesces into plaques
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30
Q

Other than the rash, what symptoms are seen with measles?

A

URI symptoms:

  • Cough
  • Coryza
  • Conjunctivitis
  • Pharyngitis

Koplik spots:

  • Precede rash by ~24-48 hours
  • Red spots in buccal mucosa with blue-white, pale centers

Lymphadenopathy

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31
Q

When is the MMR vax given?

A

12-15 months

4-6 YO

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32
Q

What is the treatment for measles?

A

Supportive; anti-inflammatories
*Isolate for 1 week after onset of rash

  • Vitamin A may reduce morbidity/mortality
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33
Q

Patient with a low-grade fever, lymphadenopathy, and a pink/light-red rash that spreads cephalocaudally and lasts for ~3 days:

  • Dx?
  • Tx?
  • Other possible ass’d symptoms?
A
  • Rubella
  • Supportive treatment, anti-inflammatories
  • May also see photosensitivity, joint pain, soft palate petechiae
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34
Q

What are two major/hallmark sequelae of in-utero exposure to rubella?

A
  • Sensorineural deafness

- Blueberry muffin rash (thrombocytopenia)

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35
Q

Patient with pruritic, lacy, reticular rash on extremities, red rash on face with circumoral pallor, and a prodrome of viral symptoms:

  • Dx?
  • Tx?
  • Incubation period?
  • Pathophys of rash?
A
  • Erythema infectiosum (Parvo, 5th disease)
  • Supportive treatment, anti-inflammatories
  • 4-14 day incubation period
  • Infects/destroys reticulocytes, causing subsequent transient decrease in erythropoiesis
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36
Q

Pt with rash and non-specific viral prodrome, with serology showing enlarged nuclei with peripherally displaced chromatin

A

Parvovirus 19 (erythema infectiosum/5th dz)

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37
Q

Which childhood exanthems are ass’d with teratogenecity?

A
  • Parvovirus 19 (erythema infectiosum/5th dz)

- Rubella exposure in 1st trimester

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38
Q

What immunoglobulin may be seen post-Measles infection?

A

IgM-rubella antibodies, can be present 1+ years after infection

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39
Q

What IG may be seen following hand-foot-mouth disease?

A

Coxsackievirus specific IgA

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40
Q

Pt with painful sores in the mouth with prodrome of sore throat, malaise, and low fever:

  • Dx and etiology?
  • Tx?
  • Complications?
A
  • (Early) Hand-Foot-Mouth, Coxsackievirus type A
  • Supportive treatment, anti-inflammatories
  • Can be ass’d with aseptic meningitis and Guillain-Barre
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41
Q

Describe 4 hallmarks of the rash ass’d with GAS infections and the type of hypersensitivity

A

Scarlet fever - Type 4 (cell-mediated) hypersensitivity rxn

Sandpaper-like rash starts at axillae, groin –> spreads to trunk and extremities, sparing palms and soles

Circumoral pallor
Strawberry tongue

Pastia’s lines: linear petechial lesions at pressure points, axillary, antecubital, abdominal, or infuinal areas

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42
Q

What is the tx for Type 4 hypersensitivity rxn to pyrogenic strains of S pyogenes

A

(Scarlet fever)

PCN G = first line, amoxicillin is 2nd

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43
Q

Buzzword: herald patch and possible etiological associations

A

Pityriasis rosea

  • HSV 6 or 7
  • Consider syphilis in sexually active pts
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44
Q

Buzzword: honey colored crust

  • Dx
  • Tx
A

Impetigo

Tx:

  • Warm water soaks 15-20 min
  • Topical mupirocin x 5 days
  • If widespread, consider cephalexin or erythromycin x 1 week, or doxycycline if concern for MRSA
  • If systemic features are present –> vancomycin
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45
Q

Tx for lice, alternative, and tx for refractory cases?

A

Permetherin shampoo, leave on for 10 minutes. Follow with fine tooth comb to remove nits. x 7-10 days.

Alternative: Malathion 8-12 hr tx
Refractory: PO ivermectin

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46
Q

Tx for scabies?

A

Permetherin from neck down, leave on for 8-14 hours before showering

<2 months: sulfur 5-10%

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47
Q

What are the classic s/sx of lichen planus?

A

6 Ps:

  • Purple
  • Polygonal
  • Planar
  • Pruritic
  • Papules or
  • Plaques

MC on flexor surfaces

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48
Q

What will biopsy of tissue affected by lichen planus reveal?

A

Sawtooth lymphocyte infiltration at dermal-epidermal junction

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49
Q

Tx for tinea, and refractory tinea?

A

1st line: topical -azoles

Refractory: terbinafine
If hair, nails are affected: griseofulvin (monitor LFTs)

** hydrocortisone can make infection worse

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50
Q

Hypopigmented macules that do not tan: Dx, Tx?

A

Tinea versicolor

Selenium sulfide 2.5% for 10 minutes, then wash thoroughly, x 7-10 days

Do not use nystatin!

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51
Q

Tx and MC etiology for skin lesions with pinpoint black dots that bleed when shaved

A

Verrucae, MC caused by HPV

Salicylic acid (can self-administer)
Cryotherapy

Most resolve within 2 years without treatment

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52
Q

MC etiology of viral conjunctivitis?

A

Adenovirus; spread via contact and also swimming pools

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53
Q

Buzzword: punctate staining on slit lamp exam

A

Viral conjunctivitis

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54
Q

Cobblestone mucosa on inner/upper eyelid, accompanied by bilateral conjunctival erythema

A

Allergic conjunctivitis

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55
Q

2 YO arrives at the ED with a swollen and erythematous eyelid, proptosis, pain with movement of the eye, and an inability to adduct or abduct his eye.

Dx? Tx?

A

Orbital cellulitis

Tx: admit and start IV vanc + ceftriaxone with referral for opthal eval

56
Q

Buzzword: asymmetric corneal reflex

A

Strabismus

57
Q

What is one difference between orbital cellulitis vs preorbital cellulitis that can be discovered on ROS (not via imaging)?

A

Orbital cellulitis has pain with eye movement; pre-orbital cellulitis does not

58
Q

4 YO girl brought to the clinic by her mother who states that the child has been complaining of progressively worsening ear pain and itchiness over the past week. Examination reveals left tragal tenderness and an edematous canal. Weber lateralizes to the left.

Dx?
MC etiology?
Tx?

A

Dx: Otitis externa

MC etiology = Pseudomonas and S aureus

Tx: Topical Ciprodex ($$$) or Cipro drops

Do not use neomycin/polymixin if TM cannot be visualized

59
Q

Tx for TM rupture

A

Floxin topical drops

no aminoglycosides

60
Q

Buzzword: forward protrusion of auricle

Dx, Tx?

A

Concern for mastoiditis

  • Culture
  • CT w/ contrast
  • IV vanc + Zosyn
  • Surgical I&D
61
Q

Weber-Rinne test in patient with known cerumen impaction

A

Conductive hearing impairment

Weber lateralizes to abnormal ear
Rinne: abnormal bone conduction > air conduction

62
Q

Buzzword: boggy turbinates

Dx, Tx?

A

Allergic rhinitis

Fluticasone (flonase) +/-
Ceterizine +/-
Mast cell stabilizers, short term decongestants

63
Q

Tx for pharyngitis with cough, conjunctivitis, coryza, and no fever

A

Supportive

Likely viral, adenovirus MC

64
Q

Tx for pharyngitis with fever, anterior cervical lymphadenopathy, and no cough

A 
PCN or amoxicillin
Likely strep (GABHS)
65
Q

Tx for pharyngitis with splenomegaly and malaise

A

Supportive, no contact sports 3-4 weeks from symptom onset
Likely mono, EBV

Do not give amoxicillin, can cause rash

66
Q

Tx for pt with history of asthma presents with pharyngitis and white patches in oropharynx

A

Clotrimazole or nystatin

Likely fungal pharyngitis 2/2 improper ICS use

67
Q

Buzzword: uvula deviation to contralateral side

Dx, Tx?

A

Peritonsillar abscess

Tx is aspiration followed by PO amoxicillin

If admitted, parenteral Unasyn (amp/sulbactam)

68
Q

Buzzword: thumbprint sign

Dx, tx?

A

Likely epiglottitis

Secure airway in OR, intubate if necessary; dexamethasone can be given for airway edema

Ceftriaxone

Also give Rifampin as prophylaxis to close contacts

69
Q

Tx for respiratory dz transmitted via soil and water, showing infiltrates and cavitations of upper lobes on CXR

A

MAC (Mycobacterium avium complex):

Tx with clarithromycin, ethambutol, and rifampin x 12+ mo

70
Q

Patient presenting with fever, cough, weight loss, fatigue, diarrhea, hepatosplenomegaly, and submandibular & maxillary lymphadenitis - Dx and Tx?

A

MAC (Mycobacterium avium complex), disseminated disease

  • Clarithromycin
  • Ethambutol
  • Rifampin
  • IV aminoglycoside (tobramycin or gentamicin)
  • Surgical excision of infected lymph nodes
71
Q

What type of lepromatosis is more common in an immunocompromised patient, and what are some key distinguishing features?

A

Lepromatous:

  • Lesions are poorly defined
  • Lesions have sensation preserved
  • Nerve involvement is gradual and symmetric
72
Q

What type of lepromatosis is more common in an immunocompetent patient, and what are some key distinguishing features?

A

Tuberculoid:

  • Lesions are sharply demarcated
  • Lesions are numb
  • Nerve involvement is sudden and asymmetric
73
Q

What is the treatment of choice for lepromatosis in an immunocompromised patient?

A

MC lepromatous lepromatosis:

Tx = dapsone + rifampin + clofazimine x 2-3 years

74
Q

What is the treatment of choice for lepromatosis in an immunocompetent patient?

A

MC tuberculoid lepromatosis:

Tx = dapsone + rifampin x 6-12 months, then another 2 years of dapsone

75
Q

Tx for pt with perianal itching that is worse at night

A

Likely pinworms (enterobiasis)

Tx: aldenazole, mebendazole or pyrantel
Treat the entire household, trim fingernails, and take early morning baths to reduce eggs

76
Q

Until what gestational age are antenatal steroids given?

A

From 24-36 weeks GA

77
Q

Buzzword: reticular atelectasis, air bronchograms

A

Hyaline membranous disease

78
Q

Tx for a patient with rhinorrhea, pharyngitis, HA, malaise, low fever, reticulonodular patterns on CXR and positive cold agglutinin test?

A

This is likely mycoplasma PNA

Tx: Azithromycin
If < 8 YO: clarithro/ or erythromycin
If >8 YO can use doxy or tetracycline

79
Q

What is the most likely etiology of bacterial CAP PNA in an afebrile 1-6 month old patient, and what is the treatment?

A

Most likely C trachomatis (“afebrial PNA of infancy”)

If:

  • Hypoxemic
  • Febrile
  • Younger than 3 months
  • -> admit

Abx: Erythromycin first line
– AZ as alternative

80
Q

What is the treatment for a patient with fevers, chills, dyspnea, dry cough, malaise, myalgia, recent travel and hotel stay, and Gram (-) bacteria seen on Gram stain?

A

Likely Legionella, treat with AZ or levofloxacin

81
Q

What is the tx for a patient with salmon-colored sputum, dyspnea, CXR showing cavitary lesions, and Gram (+) cocci in clusters on Gram stain?

A

Likely S aureus PNA – likely hospital-acquired – treat with:

  • Gentamicin +
  • Pip-tazo OR clinda OR cefepime OR ceftazidime OR meropenem
82
Q

What is the most common etiological agent of typical CAP in children, and what is the treatment?

A

S pneumo, treat with amoxicillin

83
Q

Pt with sudden onset of chills, fever, productive cough, blood-tinged sputum, and Gram + diplococci on Gram stain – dx and tx?

A

Likely S pneumo CAP - tx with amoxicillin

84
Q

What are the hallmark findings in Tetralogy of Fallot?

A

PROVe:

  • Pulmonary stenosis
  • Right ventricular hypertrophy
  • Overriding aorta
  • Ventricular septal defect
  • Will see boot-shaped heart on CXR
  • EKG will have evidence of RVH and RA enlargement
85
Q

Describe the murmur associated with Tetralolgy of Fallot

A

Harsh, crescendo-decrescendo, holosystolic murmur at LSB (pulmonic area), radiating to back

86
Q

What is the tx for Tetralogy of Fallot?

A
  • Surgical repair, ideally in first 4-12 months of life
  • Administer prostaglandins prior to surgery (maintain a PDA)
  • Prophylax against endocarditis
87
Q

Describe some parent-reported symptoms that might be present in a patient with Tetralogy of Fallot

A
  • Difficult feeding
  • FTT
  • Tet spells:
      • cyanosis
      • LOC with crying
      • paroxysms of cyanosis, relieved with squatting or pulling knees to chest
88
Q

What is the congenital heart defect that is most likely to be associated with a harsh, systolic murmur at the pulmonic area that radiates to the back?

A

Tetralogy of Fallot

This could be mistaken for an ASD, but ASD does not radiate to the back and is often associated with a wide, fixed, split S2

89
Q

What is the congenital heart defect most likely to be associated with a harsh systolic murmur best heart at the tricuspid area that does not radiate?

A

VSD

  • Smaller defects associated with louder murmurs than large
90
Q

Pt presents with easy fatigability with a harsh, systolic murmur in the tricuspid area.

  • Best method of Dx?
  • Tx?
A

Likely a VSD:

  • Dx via echo (better than cath)
  • Tx: most small - med close spontaneously by age 6
      • If large or symptomatic, surgical patch repair by age 2, preferably
91
Q

What is the congenital heart defect most likely to be associated with a wide, fixed, split S2 plus a systolic ejection murmur at the pulmonic position with mid-systolic rumble, with possible right ventricular heave?

A

ASD

This could be mistaken for Tetralogy of Fallot; the wide, fixed, split S2 is more specific for ASD and there is no radiation to the back with ASD.

92
Q

What is the MC type of ASD, and what is a condition with which it is associated?

A

Ostium secundum is most common – ASD 2/2 enlarged foramen ovale, inadequate septal growth, or excessive septal absorption.

It is commonly associated with mitral valve prolapse.

93
Q

Pt presents with wide, fixed, split S2 plus a systolic ejection murmur at the pulmonic space. What is the best test to diagnose?

A

Likely ASD

Echo is best initial test

Catheterization is definitive for dx an ASD, but rarely needed

94
Q

Buzzword: Figure of 3, posterior rib notching on CXR

A

Coartication of the aorta

95
Q

What is the congenital heart defect most likely to be associated with a late systolic ejection murmur at the aortic position that radiates into the L axilla?

A

Coartication of the aorta

96
Q

Pt presents with wide, fixed, split S2 plus a systolic ejection murmur at the pulmonic space. What is the treatment?

A

Likely ASD

If symptomatic, treat with diuretics, ACEi, and/or digoxin

If symptomatic and >1cm, consider definitive treatment:

  • Percutaneous transcatheter closure vs
  • Surgery
97
Q

Patient presents with weakness in the legs and elevated BP in bilateral upper extremities. Figure of 3 is seen on CXR. What is the treatment?

A
  • Prostaglandins to maintain a PDA

- Urgent surgical repair of coartication of the aorta

98
Q

Congenital heart defect most likely to be associated with murmur in the pulmonic area that radiates to clavicle and is associated with a wide pulse pressure

A

PDA (likely to be described as machine-like)

99
Q

What is the treatment for a congenital heart defect associated with murmur in the pulmonic area that radiates to clavicle and is associated with a wide pulse pressure?

A

(PDA)

Indomethacin with surgical correction performed before 3 YO (if necessary)

100
Q

Describe the MOA of the drug used to treat PDA

A

Indomethacin is used to treat PDAs

  • NSAID
  • Decreases prostaglandins
  • Encourages closure of ductus arteriosus
101
Q

Describe the mechanism that maintains communication between the pulmonary artery and the aorta in fetal circulation

A

Circulating prostaglandins (from placental delivery) and low arterial [O2] maintain a patent ductus arteriosus

During delivery, placental delivery of prostaglandins ceases, and arterial [O2] increases 2/2 spontaneous respiration. This encourages closure of the ductus arteriosus.

If NSAIDs are used to drop levels of prostaglandins, this can also contribute to PDA closure.

102
Q

What is the congenital defect likely to be associated with a medium-pitched, mid-systolic, crescendo-decrescendo murmur at the pulmonic position?

A

HOCM

103
Q

Describe changes in HOCM-associated murmur intensity with positional changes

A

Murmur will get louder with standing or valsalva (these decrease preload)

Murmur will get softer with squatting or leg raise (these increase preload)

Murmur will get louder with amyl nitrate (decreases afterload)

Murmur will get softer with handgrip (increases afterload)

104
Q

What is the Jones Criteria for dx acute rheumatic fever?

A

2 major OR
1 major + 2 minor PLUS
Evidence of strep (ASO titer)

Major:

  • polyarthritis
  • carditis
  • chorea
  • erythema marginatum
  • subQ nodules

Minor:

  • arthralgia
  • fever 101.3+
  • elevated ESR/CRP
  • prolonged PR interval
  • leukocytosis
105
Q

What are the typical symptoms of Kawasaki dz?

A

CRASH & burn

Conjunctival injection
Rash
Adenopathy
Strawberry tongue
Hand and foot rash/swelling

Burn: fever x 5+ days

Evidence of vasculitis of coronary arteries is diagnostic

106
Q

Failure to pass meconium within first 48 hours of life is suspicious for what, and how is it diagnosed?

A

Hirschsprung disease, diagnosed by rectal biopsy

107
Q

Ddx for bilious emesis in infant

A
  • Duodenal atresia (hours of birth)
  • Malrotation with volvulous (any age)

Less common:
- Hirschsprung disease

108
Q

Non-bilious emesis around 3-5 weeks old is suspicious for what?

A

Pyloric stenosis

109
Q

Two causes of hematochezia in baby

A
  • Intussusception (painful, 6 mo - 6 YO)

- Mecklel’s diverticulum (non-painful)

110
Q

Kernicterus is ass’d with bilirubin at what level?

A

20+

111
Q

Jaundice can be seen when bilirubin reaches what level?

A

5+

112
Q

Between conjugated and unconjugated, which type of hyperbilirubinemia is more concerning in a newborn?

A

Conjugated bili is more likely to be pathological

113
Q

Phototherapy should be initiated when bilirubin reaches what levels in a newborn?

A

24 hrs: 12+
48 hours: 15+
72 hours: 18+

Use lower thresholds in patients with risk factors

114
Q

Transient episodes of jaundice (esp during stress, fasting, or illness) is associated with what syndrome?

A

Gilbert syndrome

115
Q

Describe three hereditary syndromes that affect bilirubin levels and differentiate between them

A

Dubin-Johnson: ^ conjugated/direct

Crigler-Najjar: ^unconjugated/indirect
Gilbert: ^ unconjugated/indirect

Both Crigler-Najjar and Gilbert have deficit of UGT enzyme needed to conjugate; Gilbert also has decreased bilirubin uptake and is more common

116
Q

Describe symptoms of B3 deficiency and hallmarks of diet that might be described in a case

A

(Niacin deficiency = Pellagra)

3 Ds:

  • Dermatitis (esp sun-exposed areas)
  • Diarrhea
  • Dementia

Diets high in untreated corn, lack of tryptophan

117
Q

Describe symptoms of vitamin A deficiency and the diet that might be described in the case

A

Think eye changes:

  • night blindness
  • dry eyes
  • retinopathy
  • squamous metaplasia: Bitot’s spots, white spots on conjunctiva

Also rashes

Vitamin A is found in organ meats, egg yolk/butter, leafy greens, sweet potatoes and carrots

Fat-soluble vitamin:
- Pt may have Crohn’s or fat malabsorption

118
Q

Describe symptoms of vitamin C deficiency and the diet that might be described in the case

A

Scurvy symptoms develop after 3 months of depletion

3 H’s:

  • Hyperkeratosis (coiled hairs)
  • Hemorrhage (bleeding gums, poor healing)
  • Hematologic (anemia, glossitis, malaise)

Will be patient with diet low in fruits and veggies

119
Q

Describe symptoms of vitamin D deficiency and the diet that might be described in the case

A

Rickets

  • Delayed fontanel closure
  • Growth delays
  • Delayed tooth eruption
  • Genu varum (bowed legs)
  • Bone changes (osteomalacia, costochondral thickening)

Pt will likely be breastfed without vit D supplementation or 2/2 CF, celiac, Fanconi syndrome, or Ca2+ deficiency

120
Q

Where are most brain tumors of childhood found, and what are the most common type?

A
  • Posterior fossa

- Glial cell tumors

121
Q

HA that is worse in AM, wakes patient at night, positional with altered mental status and vision changes is suspicious for what?

A

Astrocytoma

122
Q

HA with n/v, vision changes, and ataxia is suspicious for what?

A

Medulloblastoma

123
Q

Vision changes in patient with short stature, with calcification seen on CT is suspicious for what?

A

Craniopharyngioma

124
Q

Brain tumor that develops in the lining of ventricles and spinal column?

A

Ependyoma

125
Q

Treatment for bacterial meningitis and MC etiologies?

A

Give antibiotics after LP:

  • 1+ mo: vanc + ceftriaxone
  • <1 mo: amp + gent + cefotaxime

<1 mo: GBS MC
3 mo - 10 YO: Strep pneumo MC
10 - 19 YO: Neisseria MC

  • In Neisseria, prophylax close contacts with either 1 dose cipro or 2 days of rifampin
126
Q

Describe the altered ROM that may be seen on PE in avascular necrosis of proximal femur

A

Loss of abduction

Loss of internal rotation

127
Q

Ddx for prolonged PTT:

A 
Heparin use
vWD
Hemophilia A or B
Antiphospholipid antibody syndrome
DIC
128
Q

Ddx for prolonged PT:

A

Warfarin use
Vitamin K deficiency
DIC

129
Q

Desmopressin can be used for what bleeding disorders?

A

VWD and hemophilia A

130
Q

Buzzword: Heinz bodies

A

a-Thalassemia

131
Q

Buzzword: Target or teardrop cells

A

B-Thalassemia

132
Q

Buzzword: Basophilic stippling

A

B-Thalassemia or lead poisoning

133
Q

MC etiologies of microcytic anemia and how to distinguish between them

A

Iron deficiency and thalassemias

  • Low ferritin in iron deficiency (<15 is pathognomonic)
  • a-Thal = Heinz bodies, ^iron
  • B-Thal = target/teardrop cells, basophilic stippling
134
Q

MC etiologies of macrocytic anemias and how to distinguish between them

A

B12 or folate deficiency

  • B12 deficiency will have high MMA
  • MMA will be normal in folate deficiency
135
Q

1st line treatment for cystitis in kids?

A

Cephalosporin (Cefdinir)

If allergy exists (incld PCN), TMP-SMX

Nitrofurantonin can also be used

Peds EOR (2 decks)

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