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Pediatrics > Case Files 2 > Flashcards

Case Files 2 Flashcards

1
Q

Most commonly used stool softener in young children

A

Oral polyethylene glycol - odorless and flavorless powder

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2
Q

Mickey diverticulum remnant of

A

Omphalomesenteric duct

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3
Q

Lower GI bleeding most often presents with

A

Hematochezia (bright red)

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4
Q

2 diff dx of painless rectal bleeding with hx of normal stopping and no associated symptoms

A

Juvenile polyp or Meckel diverticulum

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5
Q

3 things that would indicated coagulopathy is underlying cause of rectal bleeding

A

Hepatosplenomegaly, petechiae, or purpura

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6
Q

Anal fissures bleed enough to cause anemia?

A

Nah

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7
Q

If constipation resolves but an anal fissure recurs, what could be the cause

A

Look into possible chron disease

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8
Q

MCC of hematochezia in children

A

Anal fissures

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9
Q

First indication that bleeding is causing anemia

A

Tachycardia

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10
Q

3 otitis media bugs

A

S pneumo, H flu, moraxella

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11
Q

Acute OM tx

A

Amoxicillin - 80-90 mg/kg/d for 7-10 days

Add b-lactamase inhibitor if no change after 3 days

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12
Q

AOM with ear lobe pushed superiorly and laterally

A

Mastoiditis

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13
Q

Irritability and lethargy in 1 year old

A

Admit for sepsis workup

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14
Q

MC childhood movement disorder? What is also seen

A

Cerebral palsy

1/3 have seizures and 60% have MR

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15
Q

Most likely cause of CP

A

Antenatal insults, and subsequent difficulties during the pregnancy

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16
Q

What is hemiplegia? diplegia?

A

Hemiplegia: single lateral side of body w/ greater def in upper
Diplegia: four limp involve with greater impairment in LE

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17
Q

What is the motor quotient

A

divide normal milestone by time CP child starts milestone to asses impairment

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18
Q

2 MCC of bronchiectasis

A

Asthma and infections

CF MCC of chronic

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19
Q

Metabolic state in CF? Unique bug to worry about?

A

Hyponatremic, hypochloremic alkalosis

pseudomonas unique

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20
Q

CF dx requires?

A

Two positive sweat tests in conjunction with any of the other features

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21
Q

ALL peak incidence? 2 genetic syndromes that increase risk?

A

2-4 year old boys

  • Down’s and fanconis increase risk*
  • Dont let WBC count
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22
Q

Blast level to confirm ALL in marrow biopsy

A

At least 25%

less than 5% normal

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23
Q

Suspected ALL workup

A

CBC w/ diff and platelets, LP, CXR to look for mediastinal mass

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24
Q

What patients are likely to develop asthma

A

RSV bronchiolitis

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25
Q

Why inc wheezing sometimes after asthma treatment

A

Increased airflow over areas that were previously closed

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26
Q

Long term asthma drugs

A

Mast cell stabilizers (cromyln) and leukotriene modifiers (montileukast)

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27
Q

What is a late phase reaction in asthma

A

Typically occurs 2-4 hours after initial wheezing episode, caused by accumulation of inflammatory cells in airway
Responsible for chronic inflammation seen in asthma

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28
Q

Peak SIDS

A

2-4 month AA or native american boys

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29
Q

3 odd things that seem to reduce SIDS

A

Breast feeding, immunizations, and pacifier use

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30
Q

Investigation for SIDS

A

History, post-mortem exam, and death scene investigation

31
Q

VSD murmur

A

Holosytolic at LL sternal border

32
Q

ASD murmur

A

Fixed, wild split S2

33
Q

Coarctation of aorta murmer

A

Systolic murmur in the left axilla

34
Q

Majority of cyanotic lesions result in change in

A

Volume load (left to right shunt)

35
Q

Most common heart lesions in children? Features of a large one

A

VSD

Dyspnea, feeding diff, growth failure, profuse perspiration

36
Q

3 things a large ASD can cause

A

Growth failure, frequent URIs, exercise intolerance

37
Q

Diff needed to to dx shunt across ductus

A

3-5% diff above and below ductus

38
Q

Single S2 can be heard with

A

Pulmonary valve atresia or truncus arteriosis

39
Q

3 CHD that decreased pulmonary vascularity can be seen with

A

Atretric tricuspid valve, atretic pulmonary valve, or TOF

40
Q

“egg-on-a-strin” or narrow mediastinum seen with

A

Transposition of great artery

41
Q

“Snowman” appearance seen in

A

Total anomalous pulmonary venous return (supra cardiac shadow caused by anomalous pulmonary veins entering the innominate vein and persistent left superior vena cava)

42
Q

Seizures, neurologic changes, and abdominal complaints in child? what else can you see?

A

Lead poisoning

May also see hyperirritiability, altered sleep patterns, and loss of play

43
Q

Next step in kid with lead level of 15-19

A

Lead education and follow up BLL 3 months later

44
Q

What lead level to start chelation therapy

A

> 45

45
Q

Infants exposed to in utero methyl mercury ay display?

A

Low birth weight, microcephaly, and seizures

46
Q

Top 3 neonatal meningitis bugs

A

GBS, E. coli, listeria

47
Q

Top 2 causes of bacterial meningitis in older children

A

S pneumonia and Neisseria

48
Q

Recommendation for bacterial meningitis tx? In neonates?

A

3rd gen cef + vanc

In neonates: amp + 3rd gent ceph

49
Q

Most common long term complication of meningitis

A

Hearing loss

50
Q

Nuchal rigidity is not a reliable finding in meningitis until

A

12-18 months old

51
Q

CSF findings of bacterial meningitis

A

Elevated protein, reduced glucose, lots of wbc’s

52
Q

Salmonella features

A

Gram neg bacilli (non motile facultative anaerobic)

53
Q

When is salmonella more common

A

Warmer months

54
Q

Two infections that can cause SJS in kids? SJS risk factors?

A

Mycoplasma and Herpes viridae

Risk factors include HIV and underlying genetic disorder (Slow N-acetyltransferase)

55
Q

How long for SJS to manifest after drug? What if 2nd exposure?

A

2 weeks for skin lesions, 48 hours if around 2nd exposure

56
Q

Most common mucocutaneous finding in SJS

A

Ocular -> risk of corneal abrasion and eventual blindness (consult optho**)

57
Q

4 antiepileptis known to cause SJS

A

Carbamazepine, phenytoin, lamotrigine, phenobarbital

SJS needs mucosal involvement in 2 or more areas

58
Q

SJS SCORTEN risks

A

Age > 40, ass malignancy, HR > 120, BUN >27, >10% body surface, Bicarb 250

59
Q

Cardinal features of salmonella gastroenteritis

A

N/v, watery diarrhea, fever w/in 8-72 hours

60
Q

Why is shigella easily transmitted

A

Less susceptible to acid than other bacteria

61
Q

CBC in shigella infection

A

Wbc’s usually normal but left shift with lots of bands seen

62
Q

Why ab for shigella

A

Shortens illness and decreases duration that organisms are spread

63
Q

MCC of acute childhood renal failure

A

HUS from 0157:H7

64
Q

Brain injury most common with

A

Subdural

Seizures seen more commonly with them

65
Q

Features of subdurals in kids under 1

A

One third have associated fracture

75% are bilateral, seizures in up to 90%

66
Q

Subdural hematomas by timing

A

Acute: symptoms in 48 hours
Subacute: 3-21 days
Chronic: after 21 days (more common in older children)

67
Q

Schedule for athletes returning from concussion

A

Graduated return to play schedule that begins with light, non impact activity

68
Q

Best test to asses subdural hematoma

A

MRI - can determine the age of the insult

69
Q

Age for febrile seizures

A

6 months - 6 years

70
Q

Simple vs complex febrile seizures

A

Simple: generalized lasting no more than 15 minutes, no post-ictal state, and no recurrence in 24 hours (80% of febrile seizures)

71
Q

Positive Brudzimki sign

A

While supine, passive neck flexion results in involuntary hip and knee flexion)

72
Q

Associated mutation with febrile seizures

A

SCN1A sodium channels

73
Q

Ongoing seizures with no response to benzos can be treated with

A

Fosphenytoin

74
Q

All children with seizures must have what on differential unless proven otherwise

A

Meningitis (esp under 1 year when exam is unreliable)

Pediatrics (14 decks)

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