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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
First step in evaluating a child with poor performance with attention problems
check hearing and vision
26
WAGR syndrome
Wilms tumor Aniridia - absent iris Genitourinary abnormalities: cryptorchidism, ambiguous genitalia, renal impairment Retardation - intelectual disability
27
7 day old newborn with purulent discharge from eyes - management
Culture drainage - MC Chlamydia trachomatis at this age ppx: erythromycin ointment - not used for active infections PO erythromycin x14 days for active infection
28
Pertussis
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
Fetal alcohol syndrome
``` 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
Strawberry hemangioma management
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
Teratogenic agent associated with ebstein cardiac anomaly
Lithium
32
Teratogenic agent associated with clear cell adenocarcinoma of vagina
DES
33
Teratogenic agent associated with microcephaly, intellectual disability, smooth philtrum
alcohol
34
Teratogenic agent associated with gray baby syndrome
chloramphenicol
35
Teratogenic agent associated with phocomelia (malformation of the limbs)
thalidomide
36
Teratogenic agent associated with craniofacial anomalies, fingernail hypoplasia, developmental delay
phenytoin
37
Roseola infant (HHV-6)
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
Brachial cleft cyst vs thyroglossal duct cyst
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
Measles
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
Management of undescended testis
Most descend by 3-4 months, rarely come down after 6 mo Surgery at 6 mo
41
Management of febrile UTI in pens
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
pediatric immunodeficiency associated with recurrent bacterial infections after the age of 6 months
X-linked (Bruton) agammagloblinemia
43
pediatric immunodeficiency associated with recurrent sinopulmonary infections + anaphylactic reaction to blood transfusion
IgA deficiency
44
pediatric immunodeficiency associated with thyme aplasia + t cell deficiency + hypocalcemia
Digeorge Sn
45
pediatric immunodeficiency associated with severe recurrent infections by a variety of organisms (bacteria, virus, fungus, protozoa)
SCID
46
pediatric immunodeficiency associated with thrombocytopenia + eczema + recurrent infections
Wiskott-Aldrich sn
47
Infant botulinum
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
Absence seizure mangement
ethosuximide | If fails -> valproic acid
49
Adverse effects of stimulates used in management of ADHD
Insomnia - take early Appetitie suppression - eat big breakfast Decreased growth velocity - generally catch up later Tics Psychosis or mania
50
Biliary atresia
birth - 8 wks develop jaundice stools become acholic, urine dark, scleral icterus Labs: elevated conjugated bilirubin, elevated LFTs Imaging: cholangiogram to diagnosis
51
Primary goal of treatment in gonadotropin-dependent precocious puberty
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
Treatment of 21-hydroxylase defiency
95% congenital adrenal hyperplasia Ambiguous genitalia Tx starts immediately! - glucocorticoid - hydrocortisone - mineralocorticoid - fludrocortisone
53
Post-strep glomerulonephritis
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
Duchenne muscular dystrophy
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
Infectious mononucleosis
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
Thrush
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
Risk of unrepaired clinically significant atrial septal defect
Risk RVF/CHF arrhythmias Eisenmenger sn: Right to left shunt paradoxical embolus/stroke
58
Respiratory syncytial virus (RSV) bronchiolitis
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
Hirschsprung disease
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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