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Pediatrics Clerkship > Cliff Cases > Flashcards

Cliff Cases Flashcards

1
Q

When can babies start taking solid foods?

A

Between 4 to 6 months of age, they can be spoon fed then

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2
Q

At what age does babies sleep through the night?

A

At about 4 to 6 months of age

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3
Q

Best position for the car seat?

A

Back seat, facing the rear

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4
Q

List the vaccination schedules at birth, 2, 6 and 12 months of age

A
  1. At birth we only give hep B vaccine
  2. At 2 months of age we give (4) HiB, pneumococcal vaccine, rotavirus, dTAP and polio vaccine and 2nd dose of Hep B
  3. At 6 months of age we start flu shots
  4. At 12 months of age we give (3) MMR, varicella, hep A
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5
Q

By what age does an infant double and triple their birth weight?

A

Double by 5 months, triple by 12 months

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6
Q

What are the 12 months developmental milestones for infants

A

Gross motor: Stands alone (many can walk well).
Fine motor: Has a well developed, “neat” pincer grasp.
Language: Says “mama” and “dada” (specific) and one or two other words.
Social/adaptive: Hands parent a book to read, points when wants something, imitates activities and plays ball with examiner.

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7
Q

What is the first best test to order if neuroblastoma is suspected?

A

US

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8
Q

What is usually the most common outcome of neuroblastoma

A

These tumors arise from somatic mutation from the gametes so most of the cases are sporadic, these tumors although having a high metastatic potential normally regress with time (also so does the metastatic lesions). In our patient, the primary tumor was large enough that resection was warranted instead of only observation for resolution.

The tumor was Stage 4S but still have favorable prognosis

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9
Q

What is the HEADS mnemonic

A

H - Home

E - Education and employment

E - Eating disorder screening

A - Activities

D - Drugs

S - Sexuality

S - Suicide risk and depression

S - Safety (fights, car, weapons)

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10
Q

Which depression symptom is more common in adults than in adolescents

A

Early morning waking and then difficulty falling asleep at night

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11
Q

What is the progression of symptoms in anorexia/bulimia?

A

Bradycardia, electrolyte imbalances, arrhythmias, circulatory collapse, death

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12
Q

What is the order of sexual maturity in girls?

Need to know the order of this!

A
  1. Breast buds appear (age 10-11 years), then,
  2. Pubic hair appears (age 10-11 years) then,
  3. Growth spurt (age 12 years) then,
  4. Periods begin/menarche (age 12-13 years) then,
  5. Attainment of adult height (age 15 years)
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13
Q

What is the order of sexual maturity in boys?

A
  1. Growth of testicles ( age 12 years) then,
  2. Pubic hair appears (age 12 years) then,
  3. Growth of penis, scrotum (age 13-14 years) then,
  4. First ejaculations (age 13-14 years) then,
  5. Growth spurt (age 14 years) then,
  6. Attainment of adult height (age 17 years)
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14
Q

What test can be normal and the patient may still have vWF disease?

A

PTT may be normal, so that doesnt exclude vWF disease

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15
Q

What is seen on histology for neuroblastoma

A

Small round blue cells with dense nuclei forming small rosettes

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16
Q

How do you manage oral feeds if the infant is tachypnic

A

Tachypnea can make it difficult for an infant to be put on oral feeds, especially if the infant is in TTN or RDS, if RR is between 60 to 80 they may need an NG or OG tube, however if it is above than 80 or 90 then oral feeds puts the patient in significant stress and they have to be provided with TPN

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17
Q

What infants are considered late preterm?

A

34 weeks gestation and 36 weeks, 6 days

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18
Q

What is the cut off for glucose for hypoglycemia in neonates

A

< 45 mg/dL

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19
Q

What is the most common cause of chest pain in adolescents

A

MSK origin, precordial catch syndrome

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20
Q

Explain precordial catch syndrome

A

Chest pain of MSK origin, not associated with exercise so can come up on rest, deep breaths makes it worse so patients try to breath shallow, benign in nature, goes away on its own

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21
Q

What tanner stage marks the onset of puberty

A

Tanner stage 2

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22
Q

“A 17-year-old boy presents for a sports pre-participation physical. He reports that he occasionally gets short of breath and feels light-headed with exercise, and sometimes he experiences chest pain as well. He lost consciousness once last season during a playoff basketball game, but attributed it to feeling sick at the time. His grandfather died suddenly at age 35 of unknown etiology. Which of the following is the most likely diagnosis?”

How can you tell the difference between HOCM and prolonged QT syndrome

A

Prolonged QT syndrome is also associated with sensorineural hearing loss, they may not tell you that as one of the symptoms in the vignette

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23
Q

What test is indicated in all cases of syncope

A

ECG and refer to cardiology

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24
Q

Why does serum bilirubin alone does not predict bilirubin toxicity

A

Because all these factors also determine how much bilirubin goes to the brain in the basal ganglia: albumin more than 3, active hemolysis, sepsis, temp instability, acidosis, asphyxia

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25
Q

What crosses suture lines? Caput or cephalo?

A

Caput seccundum

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26
Q

What are the 3 symptoms of galactosemia in the newborn?

A

Hepatomegaly, ascites and edema

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27
Q

When does the following present with jaundice in newborn?

Physiologic jaundice
ABO incompatibility
Crigler-Najjar
Biliary atresia

A

Physiologic jaundice would be expected to start earlier than day 4.
ABO incompatibility typically causes jaundice within the first 24 hours of life.
Crigler-Najjar is extremely rare and causes severe jaundice within the first few days.
Biliary atresia would present later, typically at 3-6 weeks of life

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28
Q

How long can breast milk jaundice persist

A

Up to 12 weeks, up to 1/3rd of the infants may have persistent jaundice at 2 weeks of age

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29
Q

When does physiologic jaundice go away

A

By 5th day of life

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30
Q

At what age does infants regain their birth weight

A

Around 2 weeks of age

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31
Q

What amount of formula milk would provide adequate vitamin D supplementation

A

1 liter/day, they have to be exclusively on formula milk to get adequate vitamin D

32
Q

Why should you suspect Down’s syndrome in a 5 day old baby that hasnt been feeding well?

A

Down syndrome babies have difficulty feeding, especially breast feeding due to hypotonia

33
Q

What does sunken anterior fontanelle signify?

A

Dehyrdation

34
Q

What does bulging anterior fontanelle signify?

A

Increase ICP, due to Meningitis, Hydrocephalus, Subdural hematoma, Lead poisoning

35
Q

What are the causes of a small AF?

A

Microcephaly
Craniosynostosis
Hyperthyroidism
A normal variant

36
Q

What are the potential causes of a large AF?

A
  1. Skeletal disorders (e.g., rickets, osteogenesis imperfecta)
  2. Chromosomal abnormalities (e.g., Down syndrome)
  3. Hypothyroidism
  4. Malnutrition
  5. Increased intracranial pressure can also result in large fontanelles and splitting of the sutures.
37
Q

What is the most common cause of congenital hypothyroidism

A

Agenesis, hypoplasia or ectopic thyroid gland, T4 is low, TSH is high

38
Q

What is the most common form of hypothyroidism worldwide?

A

Iodine deficiency

39
Q

How much fluid should be given and over what time in mild to moderate dehydration

A

The recommended fluid replacement volume for mild-moderate dehydration is 50-100 mL/kg, to be replaced over 2-4 hours.

Example:

Patient’s weight = approx. 18 kg
50 mL/kg = 900 mL
100 mL/kg = 1800 mL
Total replacement volume should be 900-1800 mL (30-60 oz.), to be given over 2-4 hours.

40
Q

What is the maintenance fluid 4:2:1 rule

A

Maintenance fluids are generally provided in a volume as follows:
For the first 10 kg, 4mL/kg/hour
For the second 10 kg, 2mL/kg/hour
For any additional kg, 1mL/kg/hour

41
Q

What does the term ‘bilious’ emesis signify

A

The obstruction is BELOW the ligament of Treitz, in other words if the obstruction is above the ligament of Treitz then the emesis will not be bilious

42
Q

What should be the bolus volume for infants that are moderately dehydrated?

A

Moderately dehydrated patients should be bolused with 20 ccs/kg of IV fluid to insure hemodynamic stability and adequate perfusion of vital organs. The preferred fluids would be normal saline or lactated ringers

43
Q

When should lactate ringer be avoided?

A

In pyloric stenosis when the patients develop hypochloremic hypokalemic metabolic alkalosis since it can worsen the hypochloremia/hypokalemia

44
Q

What are the symptoms of cereberal edema

A
  1. Hypertension
  2. Bradycardia
  3. Irregular respirations
  4. Increased ICP
45
Q

What is a potential complication of DKA management

A

Cerebral edema

46
Q

How does K change in DKA

A

Can be high, low or normal

47
Q

Anion Gap equation

A

Anion Gap = Serum Na – (HCO3+Cl)

48
Q

What conditions cause anion gap metabolic acidosis

A

Methanol, uremia, DKA, paraldehyde, INH/Iron, lactic acidosis, ethanol/ethylene glycol, salicylates

49
Q

How do you find corrected Na in hyperglycemia or DKA

A

Calculating an Adjusted Serum Sodium

It is important to calculate a corrected serum sodium is important to calculate because it will guide the choice of fluid composition and tell us if the hyperglycemia fully accounts for the hyponatremia.
It is also important to monitor the corrected sodium with therapy because the combination of an attenuated rise in the measured sodium and a decrease in the corrected sodium could indicate that the patient is receiving too much free water-a risk factor for the development of cerebral edema.
Calculation

Sodium decreases by 1.6 meq/L for each 100 mg/dL rise in glucose. Therefore, to calculate an adjusted serum sodium in the presence of hyperglycemia:

Corrected sodium = [{(measured glucose - 100) / 100} x 1.6] + measured sodium

Example

Serum sodium = 135 meq/L
Serum glucose = 608 mg/dL
Corrected sodium = [{(608 - 100) / 100} x 1.6] + 135 = 143.1

The corrected serum sodium in this example is 143.1 meq/L.

50
Q

Isabella weighs 22 kg and is approximately 10% dehydrated. How much fluid will she need over the next 24-48 hours in order to replace her current fluid deficit?”

A

2440

One way to estimate a patient’s fluid deficit is to use the clinical assessment of dehydration (percent dehydrated) to roughly gauge how much fluid that has been lost.

Dr. Sato explains:

Isabella weighs 22 kg right now - and we think she is 10% dehydrated.
That means that 22 kg is about 90% of her true, pre-illness weight - which would be 24.4 kg.
Think of Isabella’s body as a big bag of water.
1 Liter of water weighs 1 kg.
Since Isabella’s weight has gone from 24.4 kg to 22 kg, she has lost 2.4 kg or 2.4 L (2400 mL)

51
Q

What is the typical presentation of ovarian torsion?

A

Ovarian torsion is more common in the post-menopausal population, though it can present in any age group. It is described as intermittent stabbing pain in the lower abdomen or pelvis. Torsion is often secondary to an ovarian mass, such as a neoplasm or corpus luteal cyst, which may occasionally be appreciated on exam. Nausea and vomiting are very common findings as well. Ultrasound is essential to initial workup. Given Luanne’s pain localized around her belly button, her tenderness at McBurney’s point, and lack of palpable masses on pelvic exam, ovarian torsion is a less likely diagnosis

52
Q

What is the most common form of seizure in children

A

Generalized tonic clonic seizure

53
Q

Describe generalized tonic clonic seizure

A
  1. The event typically begins abruptly with tonic (rigid) stiffening of all extremities and upward deviation of the eyes.
  2. Clonic jerks of all extremities follow the tonic phase.
  3. Finally, the child becomes flaccid, and urinary incontinence may occur.
54
Q

What are simple partial seizures

A

Focal signs, that happen in one part of the body

55
Q

Describe complex partial seizure

A
  1. Loss of conciousness is hallmark of this
  2. Post ictal state of confusion, temporary paraplegia et
  3. Automatisms: lip smacking, frowning etc
56
Q

What are atonic seizure

A
  1. AKA akinetic seizures

2. Involves loss of motor tone

57
Q

Which are more focal and which are more generalized? Simple or complex febrile seizure?

A

Complex are more FOCAL

58
Q

What is special about the intussusception seen in Henoch Schonlein Purpura

A

It is ileo-ileal, not ileocolic, so it does not respond to air enema or water soluble enema, it has to be reduced surgically

59
Q

What is important to monitor for in a patient after a diagnosis of HSP is made?

A

BP and urinalysis results, we need to see if the hemaglobinuria goes away

60
Q

What drugs can cause mydriasis?

A

Drugs that have anticholinergic or sympathomimetic effects can cause mydriasis

G. Antidepressant
H. Sedative-hypnotic
I. Antihistamine
J. Decongestant

61
Q

What does opioids cause?

A

Meiosis

62
Q

What does cocaine cause

A

Mydriasis

63
Q

Explain the features of tricyclic antidepressants toxicity and how is it treated?

A

Presents as

  1. Widened QRS complexes
  2. Hypotension that may be refractory to IV fluids
  3. Hypotensiona arises from alpha 1 blockade and cardiac Na channel blockade
  4. Metabolic acidosis ensures
  5. Seizures can also happen

Treatment is giving hypertonic Na bicarb and continuous monitoring of ABG, the serum pH is raised to 7.5 to 7.55

64
Q

What are the symptoms of TCA toxicity

A
  1. Hypotension
  2. Tachycardia
  3. EKG shows abnormalities like widened QRS complex etc
  4. Skin is warm to touch
  5. Mydriasis
  6. Altered mental status
65
Q

In most pediatric situations how many generations should be involved in gathering a patients family history?

A

3 generations: child, siblings, parents, aunts, uncles, cousins of child, grandparents

66
Q

The 2 most common surgeries in a sickle cell patient are?

A

Tonsillectomy and cholecystectomy

67
Q

Adenovirus conjuctivitis characteristic

A

Often becomes bilateral, accompanied with pharyngitis and preauricular lymphadenopathy

68
Q

Nephrotic syndrome causes a protein:creatinine ratio to be?

A

Urine Protein:Creatinine Ratio

urine protein (mg/dL) / urine creatinine (mg/dL) = urine protein:creatinine ratio:

< 0.2 is normal in children older than 2 years (< 0.5 is normal in 6- to 24-month-olds)
> 1.0 is in a suspicious range for a significant kidney pathology
> 2.0 is diagnostic for nephrotic syndrome

69
Q

Treatment of nephrotic syndrome?

A

Steroids and Na restriction to 2000 mg/day

70
Q

Treatment of nephrotic syndrome if there is symptomatic edema

A

25% albumin and IV furosemide

71
Q

What is one of the most common complications of nephrotic syndrome

A

Spontaneous bacterial peritonitis, Strep pneumo is the most common organism

72
Q

Erythema multiforme

A
  1. An acute hypersensitivity syndrome
  2. Associated with a symmetrical rash that starts as a dusky red macules and evolves into sharply demarcated wheals and then into target-like lesions.
  3. Individual lesions stay fixed for one to three weeks.
  4. Condition does not come and go.
  5. Most commonly caused by herpes simplex infections, but may be associated with medications.
73
Q

What rash is caused by Lyme’s disease

A

Erythema migrans

74
Q

What is permethrin used for?

A

Head lice and scabies

75
Q

What if permethrin does not work for scabies?

A

Oral overmectin can be used then

Pediatrics Clerkship (4 decks)

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