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DIT Level 3 > Clinical questions - Pediatrics > Flashcards

Clinical questions - Pediatrics Flashcards

1
Q

12 mo old developmental milestones

A

rule of 2s

  • 2 legs - stand, walk
  • 2 words
  • 2 blocks
  • 2 fingers - pincer grasp
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2
Q

Suspected child abuse

A

call CPS
evaluate for other injuries - new or old
PT/PTT, CBC, metabolic panel to r/o thrombocytopenia or coagulapathy contributing to bruising
skeletal survey
CT head if indicated, especially + retinal hemorrhage

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3
Q

APGAR scoring

A

Appearance: blue 0 acrocyanosis 1 pink 2
Pulse: absent 0 less than 100 1 >100 2
Grimace: absent 0 grimace or feeble cry 1 strong cry 2
Activity: no tone 0 some flexion 1 flexed arms and legs 2
Respiration: absent 0 weak/irreg 1 reg, strong cry 2

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4
Q

Respiratory distress syndrome

A

nasal flaring and grunting, rapid RR, CXR with hazy interstitial infiltrates
prematurity

Tx:
resp support:
-CPAP if FiO2 less than 0.4, wean off as able
-Intubate and exogenous surfactant if FiO2 > 0.4

Prevent: prior to delivery, IM betamethasone or corticosteroids to mom

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5
Q

Metabolic abnormalities associated with pyloric stenosis or other frequent emesis

A

hypochloremic, hypokalemic metabolic alkalosis

HCl lost in vomit
Loss of H+ causes alkalosis
H-K pump shuttles K intracellularly to pump H out to compensate for alkalosis

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6
Q

Pneumatosis intestinalis

A

hallmark of necrotizing enterocolitis
premature with bilious vomiting and lethargy
Abd XR with air in the wall of the intestines

Tx:
Stablize pt
stope enteral feeds
start parenteral feeds
Antibiotics - amp + cefotaxime + metronidazole
If perf -> surgery
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7
Q

Croup

A

bark like cough, worse at night

Tx:
supportive care
O2 only if hypoxic
single dose of dexamethasone with prn follow up

If stridor or worse looking

  • > hospitalize
  • > Racemic epi nebulizer
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8
Q

causes and treatment for neonate fever with seizure

A

MC: GBS, e.coli
LC: listeria, enterococcus, staph, GN, HSV

Abx:
Amp + cefotaxime OR amp + gent

If seizure, ill appearing, has vesicles or CSF pleocytosis add on acyclovir to cover HSV encephalitis

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9
Q

Fever of unknown origin

A

If ill appearing and leukocytosis get a CXR even if no respiratory symptoms

If ill -> hospitalize
If outpatient -> ceftriaxone x1 and f/up in 24 hrs

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10
Q

Kawasaki disease

A

Fever 5+ days plus 4 of the following:

  • polymorphous rash
  • oral mucous membrane changes: strawberry tongue, cracking lips
  • Peripheral extremity changes: redness, edema, desquamation
  • B/l bulbar limbic sparing conjunctival injeciton
  • Cervical LAD with 1.5+ cm usually U/L
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11
Q

Classical findings of Henoch-Schonlein purport (IgA vasculitis)

A

MC vasculitis - deposition of IgA immune complexes

Palpable purport without thrombocytopenia and coagulopathies
predominantly lower body, below waist
Artheritis/arthralgia
abdominal pain
renal disease
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12
Q

Cystic fibrosis

A

abnormal chloride transport -> thick viscous secretions
Frequent severe bronchitis with hospitalizations
very foul-smelling stools
hx of meconium ileus

Dx:
sweat chloride test with elevated Cl level
CFTR gene mutation

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13
Q

Acute OM

A

fever + pain
> HD amor 90 mg/kg/d 1st line

if older than 2y with mild sxs - observe and f/up prn

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14
Q

Scarlet fever

A

scarletina rash - diffuse erythematous blanching rash that is rough to touch and non tender on trunk and extremities sparing pals and soles

Very red, contender tongue, hx of sore throat with fever

Tx:
Amox or PCN V for 10-14 days
Should see improvement within 24-48 hrs of abx start

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15
Q

Patent ductus arteriosis

A

continuous machine like heart murmur heard mid left sternal border
MC in premies

Close with indomethacin or ibuprofen

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16
Q

Tetralogy of Fallot

A

MC cyanotic congenital heart defect

RV outflow tract obstruction - PS
RV hypertrophy
VSD with overriding aorta

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17
Q

Physiologic jaundice

A

benign
Starts 2-3 days of life, peaks at day 3-5
bili less than 10 - unconjugated
due to inadequate UDPGT enzyme that conjugates bilirubin

Tx:
phototherapy

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18
Q

Breast milk jaundice

A

benign
elevated bili at day 3-5 or later that persists for 3-12 weeks
bili less than 10
unknown substance in breast milk that increases intestinal absorption of bilirubin

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19
Q

Management of nocturnal enuresis

A

if exam normal -> enuresis alarm - wake up child to finish voiding
short term desmopressin for overnight sleep overs

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20
Q

Mecke diverticulum

A

painless GI bleeding in child
Hgb normal, no distress

Dx:
Meckle’s scan - nut med scan looks for gastric mucosa

if unstable - arteriography for source of brisk bleed

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21
Q

Developmental dysplasia of hip

A

Barlow maneuver - dislocates hip clunk on exam with posterior pressure while adducting flexed hip
Ortolani reduces

Next step: B/L hip US

Tx: abduction splint - Pavlick harness

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22
Q

Slipped capital femoral epiphysis

A

obese child with hip pain causing limp, waddling gait
Improved sxx with hip flexed and externally rotated
Restricted internal rotation of hip

XR hip: ice cream falling off cone

Tx:
Operative stabilization

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23
Q

TORCH infections

A 
Toxoplasmosis
Other (syphilis, Parvo B19, enteroviruses, VZV)
Rubella
CMV
HSV
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24
Q

Hemolytic uremic syndrome

A

abdominal pain with blood diarrhea after eating contaminated meat

EHEC - shiga toxin

Labs:
Hemolytic anemia
Thrombocytopenia
AKI
Stool cx: EHEC
25
Q

First step in evaluating a child with poor performance with attention problems

A

check hearing and vision

26
Q

WAGR syndrome

A

Wilms tumor
Aniridia - absent iris
Genitourinary abnormalities: cryptorchidism, ambiguous genitalia, renal impairment
Retardation - intelectual disability

27
Q

7 day old newborn with purulent discharge from eyes - management

A

Culture drainage - MC Chlamydia trachomatis at this age

ppx: erythromycin ointment - not used for active infections

PO erythromycin x14 days for active infection

28
Q

Pertussis

A

Bordetella pertussis - severe cough with fits, gagging, “whoop” sound
Clears 3-4 weeks

Abx decreases transmission but does not change disease course, also given a sppx for those exposed

-Azithromycin OR clarithromycin

29
Q

Fetal alcohol syndrome

A 
short palpebral fissures
thin vermillion border/upper lip
smooth filtrum
flattened mid face
deficient brain growth:
-structural brain abnormalities
-less than 10th percentile for head circumference
-abnl neuro exam
-variable intellectual disability
Growth retardation:
-less than 10th percentile on height and weight
-FTT despite adequate intake
-disproportionally low wt:ht ratio
30
Q

Strawberry hemangioma management

A

60% resolve spontaneous by 2 yrs, 90% by 9 yrs

Tx:
observation
if on eye or near eye and growing rapidly, consider PO propranolol

31
Q

Teratogenic agent associated with ebstein cardiac anomaly

A

Lithium

32
Q

Teratogenic agent associated with clear cell adenocarcinoma of vagina

A

DES

33
Q

Teratogenic agent associated with microcephaly, intellectual disability, smooth philtrum

A

alcohol

34
Q

Teratogenic agent associated with gray baby syndrome

A

chloramphenicol

35
Q

Teratogenic agent associated with phocomelia (malformation of the limbs)

A

thalidomide

36
Q

Teratogenic agent associated with craniofacial anomalies, fingernail hypoplasia, developmental delay

A

phenytoin

37
Q

Roseola infant (HHV-6)

A

MC under 2yo
high fever but not ill appearing, when fever breaks develops diffuse pink rash that starts on trunk then spreads to entire body

Tx: supportive care

38
Q

Brachial cleft cyst vs thyroglossal duct cyst

A

Brachial cleft cyst - lateral neck

Thyroglossal duct cyst: midline neck, moves with swallowing

  • MC congenital neck cyst
  • associated with ectopic thyroid tissue - MC in tongue
39
Q

Measles

A

Prodrome - nonspecific fever, cough, conjunctivitis
-3 C’s: cough, coryza (rhinitis or irritation of nasal mm), conjunctivitis
Coplik spots - white grey spots with red base on buccal mucosa
Rash 4-5 days - erythematous, maculopapular starts with head then moves to feet - “pouring measles paint”

Tx: supportive +/- PO Vit A

40
Q

Management of undescended testis

A

Most descend by 3-4 months, rarely come down after 6 mo

Surgery at 6 mo

41
Q

Management of febrile UTI in pens

A

Tx: 3rd gen cephalosporin - cefixime, cefdinir, cetibuten

Renal/bladder ultrasound to r/o vesicoureteral reflux in:

  • any less than 2yo with 1st febrile UTI
  • recurrent febrile UTIs
  • any UTI w/ FHx of GU dz, poor growth, or HTN
  • any who don’t respond to abx
42
Q

pediatric immunodeficiency associated with recurrent bacterial infections after the age of 6 months

A

X-linked (Bruton) agammagloblinemia

43
Q

pediatric immunodeficiency associated with recurrent sinopulmonary infections + anaphylactic reaction to blood transfusion

A

IgA deficiency

44
Q

pediatric immunodeficiency associated with thyme aplasia + t cell deficiency + hypocalcemia

A

Digeorge Sn

45
Q

pediatric immunodeficiency associated with severe recurrent infections by a variety of organisms (bacteria, virus, fungus, protozoa)

A

SCID

46
Q

pediatric immunodeficiency associated with thrombocytopenia + eczema + recurrent infections

A

Wiskott-Aldrich sn

47
Q

Infant botulinum

A

occurs 2-8mo
Muscle weakness, poor suck, constipation, ptosis

Associated with contaminated soil, wild honey, home canned foods

Tx:
Close monitoring for respiratory failure
Botulinum IG

48
Q

Absence seizure mangement

A

ethosuximide

If fails -> valproic acid

49
Q

Adverse effects of stimulates used in management of ADHD

A

Insomnia - take early
Appetitie suppression - eat big breakfast
Decreased growth velocity - generally catch up later
Tics
Psychosis or mania

50
Q

Biliary atresia

A

birth - 8 wks develop jaundice
stools become acholic, urine dark, scleral icterus

Labs: elevated conjugated bilirubin, elevated LFTs

Imaging: cholangiogram to diagnosis

51
Q

Primary goal of treatment in gonadotropin-dependent precocious puberty

A

early maturation of the HP-gonadal axis in girls under 8, boys under 9

Assess future predicted adult height
risk early closure of ephyseal plates and short stature

Tx:
GnRH analog therapy - IM q1mo to prevent further development

52
Q

Treatment of 21-hydroxylase defiency

A

95% congenital adrenal hyperplasia
Ambiguous genitalia

Tx starts immediately!

  • glucocorticoid - hydrocortisone
  • mineralocorticoid - fludrocortisone
53
Q

Post-strep glomerulonephritis

A

Hematuria, proteinuria, edema, HTN 3 weeks after throat infection

Confirm with ASO titer

Tx: supportive
Na/H2O restriction
Loop diuretic if HTN

ddx IgA nephropathy - however this starts 1-2 days after URI

54
Q

Duchenne muscular dystrophy

A

2-3 yo with proximal m. weakness, LE involvement
Previously normal milestones
Stands up from flor using hands to push himself up

PE: proximal muscle weakness in LE, calf m. hypertrophied

Tx: PO prednisone 0.75 mg/kg/d

Becker muscular dystrophy is a milder form in teens and early adulthood

55
Q

Infectious mononucleosis

A

Pharyngitis, LAD, significant fatigue

Tx:
supportive
-NSAIDS +/- tylenol
-Rest
-Avoid contact sports - risk of splenic rupture
> return to non contact sports in 3 weeks, contact sports at 4 weeks - gradual return
-Impending airway compromise d/t severe pharyngitis - give steroids

56
Q

Thrush

A

white papular lesions on palate and tongue

Tx:
Nystatin - oral suspension: 1 ml to each side of mouth QID x14 d

If unresponsive - fluconazole 6 mg/kg day 1, then 3 mg/kg for 2 weeks

57
Q

Risk of unrepaired clinically significant atrial septal defect

A

Risk RVF/CHF
arrhythmias
Eisenmenger sn: Right to left shunt
paradoxical embolus/stroke

58
Q

Respiratory syncytial virus (RSV) bronchiolitis

A

URI sxs
Lower airway inflammation: expiratory wheezing -> respiratory distress esp in young infants

Tx:
Supportive O2, IVF prn
NO ICS or racemic epi

PO steroids not recommended

59
Q

Hirschsprung disease

A

Failure of neural crest cells to migrate during intestinal development
Enteric nervous system doesn’t develop properly -> ganglionic segment of colon that can’t relax normally
-> functional colonic obstruction

S/S:
Delay passage of meconium +/- chronic constipation
Bilious vomiting
FTT
Abdominal distention
Explosive stool or gas discharge following rectal exam “squirt” or “blast” sign

DIT Level 3 (32 decks)

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