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Pediatrics > CLIPP > Flashcards

CLIPP Flashcards

0
Q

Risk factors at birth for obesity

A

Genetic conditions
High birth weight
Maternal diabetes
Family history of obesity

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1
Q

VITAMIN C (differential diagnosis)

A 
Vascular
Infectious
Trauma
Autoimmune
Metabolic
Iatrogenic
Neoplastic
Congenital
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2
Q

What orthopedic diseases are seen in obese children?

A

Blount Disease
-Medial tibial disordered growh
Slipped Capital Femoral Epiphysis (SCFE)
-Occurs at onset of puberty in obese pts
-Limited ROM of the hip (especially internal rotation)

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3
Q

Most common neurobehavioral problem in childhood

A

ADHD (10% incidence)

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4
Q

Criteria for diabetes diagnosis

A

1) Symptoms of DM & random glucose > 200
2) Fasting glucose > 126
3) 2h serum glucose > 200 during oral glucose tolerance test

Any of those 3 can get Dx of diabetes

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5
Q

Weight criteria for testing for DM2

A

1) BMI > 85th percentile
2) Weight:Height > 85th percentile
3) Weight >120% ideal for height & 2 of:
- FH of DM2
- Native American, Black, Hispanic
- Signs of insulin resistance

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6
Q

Wha is the earliest to screen for diabetes?

A

10 years old or the onset of puberty. Whichever is earlier

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7
Q

How often should qualifying children be screened for diabetes?

A

Every 2 years

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8
Q

When to start screening for HTN?

A

Yearly, beginning at 3y

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9
Q

Staging of HTN in children

A

Normal < 90th percentile
Prehypertension 90-95th percentile
Stage 1 HTN 95-99th + 5mmHg
Stage 2 HTN > 99th + 5mmHg

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10
Q

Secondary causes of HTN

A 
Coarctation of the aorta
Renal artery stenosis
Renal parenchymal disease/scarring
Thyroid disorders
Hyperaldosteronism
OSA
Pheochromocytoma
Cushing syndrome
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11
Q

Guidelines for flu vaccine in children

A

Everyone >6mo of age
Children <9y need 2 doses, one month apart
After that, yearly

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12
Q

When to give HepA vaccine

A

Routine at 12 & 18 months

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13
Q

Overweight & obese BMI classifications

A

BMI 85-95th percentile = overweight

BMI >95th percentile = obese

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14
Q

Mimics of ADHD

A 
Hearing/vision impairment
Sleep problems
Mood disorders
Learning disability
Oppositional defiant disorder
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15
Q

What is a learning disability?

A

A disorder of cognition that manifests as a problem involving academic skills. There is a discord between IQ & academic achievement.

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16
Q

Adverse effects of stimulants (ADHD)

A 
Appetite suppression
Tic disorders
	-1%; stops with d/c of med
Insomnia
	-gets better with time
Stunted growth
	-slight; resolves when med stopped
CV risk in adults & kids with pre-existing heart dz
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17
Q

Which heart defect presents with a late murmur?

A

VSD

This is because there is no L–>R shunt when PVR is high. As it drops (few days-few weeks), the murmur is revealed.

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18
Q

Natural history of VSD’s

A

75% of small defects close spontaneously

25-50% of all defects close spontaneously

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19
Q

VSD murmur

A

Holosystolic murmur +/- small diastolic component

Heard best at tricuspid area (LLSB)

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20
Q

Causes of infantile CHF

A

VSD
Severe aortic stenosis
Coarctation of the aorta
Large PDA

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21
Q

Presentation of infantile CHF

A

Respiratory distress with feedings
Diaphoresis with feedings
FTT
Hepatomegaly

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22
Q

How often do infants breastfeed?

A

20-30 minutes every 1-2h

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23
Q

ASD murmur

When does it present?

A

Fixed widely-split S2
Soft systolic murmur (increased flow over pulmonic valve)

Presents at 3-5y

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24
Q

Aortic stenosis murmur

When does it present?

A

Systolic ejection murmur
Early diastolic murmur (usually also some AR)

Presents in infancy

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25
Q

PDA murmur

When does it present?

A

Continuous
-Louder in systole

Presents in infancy

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26
Q

Poor feeding DDx

A 
CHF
Metabolic disorders
Bronchiolitis/pneumonia
Sepsis
GERD
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27
Q

Common causes of an unresponsive child

A 
Seizure
Syncope (breath holding)
Meningitis/Encephalitis
Toxic ingestions
Head trauma
Intussusception
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28
Q

What can precipitate an Absence seizure?

A

Hyperventilation

Photic stimulation

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29
Q

Symptoms of a simple partial seizure

A

Motor signs in 1 extremity or 1 side of body

May generalize

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30
Q

Sandifer’s Syndrome

A

Arching of the back, often unilateral in an infant. Represent’s GERD

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31
Q

What age of children typically get febrile seizures?

What % of children get them?

A

6-60 months of age

2-4% of children get them

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32
Q

Risk of recurrent febrile seizure

A

First febrile seizure before 1y —> 50% risk for 2nd

First febrile seizure after 1y –> 30% risk for 2nd

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33
Q

Risk of developing epilepsy in children with febrile seizures

A

Simple –> Slightly increased above 1% general pop risk

Complex or early & recurrent –> increases risk

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34
Q

Empiric treatment for bacterial meningitis

A

Ceftriaxone + Vancomycin

Treat for 7-14 days

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35
Q

Complications of bacterial meningitis

A 
Stroke
Subdural effusions
SIADH
Developmental delay
Seizures
Hearing loss
Death
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36
Q

When does a post-traumatic seizure typically occur?

A febrile seizure?

A

Post-traumatic –> 1-2h after head injury

Febrile seizure –> First day of illness

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37
Q

What studies/labs to get for fever without a source & general CNS symptoms?

A

CBC w/ diff
Blood culture
Urinalysis/Urine Cx
Lumbar puncture

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38
Q

Threshold for LP with regard to age

A

The younger they are, the lower the threshold

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39
Q

Hep B immunization schedule

A

Birth, 1 month, 6 mo

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40
Q

Pentacel immunization schedule

A

Pentacel = DTaP, HiB, IPV

2mo, 4mo, 6mo

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41
Q

Pneumococcal immunization schedule

A

2mo, 4mo, 6mo

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42
Q

Rotavirus immunization schedule

A

2mo & 4mo

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43
Q

MMR immunization schedule

A

12mo & right before starting school

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44
Q

Varicella immunization schedule

A

12mo & 4y

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45
Q

TDaP immunization schedule

A

11y

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46
Q

HPV immunization schedule

A

3 dose series at 11-12y

before sexual activity

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47
Q

Measles timeline

A

Incubation - 2 weeks
Prodrome - 2 days
Exanthem - 4 days
Recovery - 2 weeks

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48
Q

Symptoms of measles

A 
Fever
Cough
Coryza
Conjunctivitis (b/l)
Koplik's spots
Exanthem - maculopapular & cephalocaudal
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49
Q

Causes of rash on palms & soles

A

Rocky Mountain Spotted Fever
Kawasaki Disease
Enteroviruses (Coxsackie)
Syphilis

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50
Q

Erythema infectiosum rash

A

Appears 7-10d after low grade fever
Slapped cheek rash then lacy rash. Clears centrally first.

Can have polyarthropathy or aplastic anemia

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51
Q

Roseola symptoms

A

Fever, Fever, Fever, RASH
(high fever for 3-4d)

Rash remains central. It’s macular and reticular looking.

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52
Q

Rash of scarlet fever

A

Sandpaper rash begins in groin, axillae, neck

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53
Q

Symptoms: Cholinergic poisoning

A

DUMBBELLS

Diarrhea
Urination
Miosis
Bradycardia
Bronchoconstriction
Emesis
Lacrimation
Lethargy
Salivation
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54
Q

Symptoms: Anticholinergic toxicity

A 
Fever
Dry-mouth & dry skin
Mydriasis
Delirium/seizures
HTN & tachycardia
Urinary retention
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55
Q

Symptoms: TCA overdose

A

Temperature (fever)
Cardiotoxic (hypotension, wide QRS, irregularly irregular)
Agitation

Also dry, hot skin, mydriasis, can cause apnea

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56
Q

Symptoms: SSRI overdose

A

Hyperthermia
Autonomic instability
Rigidity
Myoclonus

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57
Q

Treatment of very hypoglycemic child

A

D25 bolus (20cc/kg)

Octreotide if due to a Tx-refractory sulfonylurea ingestion

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58
Q

What are the indications for activated charcoal?

A

Ingestions NOT due to small molecules or heavy metals

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59
Q

Contraindication to activated charcoal

A

Individual with loss of airway protection. Would have to intubate first.

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60
Q

Treatment for TCA cardiotoxicity

A
  1. Cardiac monitoring for at least 6h
  2. 1mEq/kg NaCO3 bolus Q5 minutes
    • Until QRS narrows & hypotension improves
    • Target serum pH = 7.50-7.55
    • Continue maintenance serum alkalinization for 12-24h
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61
Q

Treatment of TCA-induced seizures

A

Benzodiazepines & alkalinization of serum

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62
Q

Pathophysiology of HSP

A

IgA-mediated small vessel vasculitis involving the skin, GI tract, joints, & kidneys

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63
Q

Symptoms of HSP

A

Non-thrombocytopenic petechiae & purpura
Hematuria
Arthritis (knees & ankles)
Colicky abdominal pain

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64
Q

Typical age of HSP

A

4-6 years

Boys affected twice as often

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65
Q

Treatment for Idiopathic Thrombocytopenic Purpura (ITP)

A

Oral corticosteroids
IVIg
Rhogam

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66
Q

Symptoms of ITP

A

Petechiae & bruising
Possible severe epistaxis or mucosal bleeding (3%)
IC Hemorrhage (0.1%)

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67
Q

Bowel obstruction in a child

A

Intussusception is the most common cause in 6m-6y child

-80% in younger than 2

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68
Q

Location of intussusception

A 
Idiopathic = ileocecal
HSP = ileo-ileal
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69
Q

S/S of intussusception

A 
Triad:
	-Severe abdominal pain (inconsolable)
	-Currant jelly stool (FOBT+)
	-Sausage-shaped mass in right abdomen
Also possible: emesis, lethargy, AMS
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70
Q

Diagnosis of intussusception

A

Non-HSP = air or contrast enema

HSP-related = abdominal US

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71
Q

Treatment for HSP

A

Self-limited lasting 4-6 weeks

Monitor for renal involvement

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72
Q

Simple vs. Complex febrile seizure

A

Simple:

- Generalized
- Less than 15m
- No more than 1 in a 24h period
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73
Q

Glomerular diseases with low complement

A

Membranoproliferative
Post-Strep
SLE

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74
Q

Secondary causes of nephrotic syndrome

A 
SLE
Post-strep GN
HBV
HIV
HSP
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75
Q

Most common age for minimal change disease

A

18m-5y

Boys > Girls

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76
Q

Microscopy seen in minimal change disease

A

Normal histology

Diffuse effacement of epithelial cell foot processes

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77
Q

What serum abnormalities are seen with minimal change disease?

A

Low albumin
Hyperlipidemia
Hyponatremia (fluid overload +/- pseudohyponatremia)

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78
Q

What is seen on exam in minimal change disease?

A 
Anasarca
	-Best seen in scrotum or labial region
	-Pitting edema
	-Periorbital edema
Fluid wave
	-Ascites
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79
Q

What is the limit of normal proteinuria in a child?

A

Up to 2+ proteinuria

30-100mg/dL

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80
Q

Proteinuria in an asymptomatic adolescent

How to test?

A

Orthostatic proteinuria

Urine should be negative for protein when first morning urine.

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81
Q

Treatment of minimal change disease

A
  1. Corticosteroids
    • 95% steroid responsive
    • Can also be relapsing or steroid-resistant
  2. Sodium restriction
    • 1500-2000 mg daily
  3. Albumin infusion then IV Lasix
    • Only if dyspneic or scrotal edema is impairing blood flow
    • Never Alb or Lasix alone
      • Alb alone –> pulmonary edema
      • Lasix alone –> shock
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82
Q

Immunizations to give in minimal change disease

A

Pneumococcal
Varicella
Influenza

Only given once in remission

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83
Q

Complications of minimal change disease

A 
Overwhelming bacterial infections
Spontaneous peritonitis
Pneumonia
Cellulitis
Venous thrombosis
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84
Q

Why are pts with nephrotic syndrome hypercoagulable?

A

Urinary loss of AT-III
Corticosteroid use
Hyperlipidemia destabilizes platelets

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85
Q

Vitals in sepsis

A

Tachycardia
Tachypnea
Hyperthermia

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86
Q

What is the first things to assess in an emergency?

A 
Airway
Breathing
Circulation
Disability (mental status/neurologic)/Dextrose
Exposure (expose entire pt)
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87
Q

Most sensitive signs of impaired circulation

A

Tachycardia

Capillary refill

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88
Q

DDx of altered mental status in a child

A 
Meningitis
Encephalitis
Sepsis
Trauma
DKA
Renal failure
Ingestion
Hypoglycemia
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89
Q

Fluid bolus size for peds

A

20 cc/kg of NS

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90
Q

Indications for intraosseous access

A

If a peripheral IV cannot be placed within 90 seconds

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91
Q

Abx therapy for meningococcemia

A

Penicillin G

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92
Q

Prophylaxis for meningococcal contacts

A

Ciprofloxacin for adults

Rifampin or Ceftriaxone for kids

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93
Q

Immunization against meningococcus

A

Tetravalent Conjugate Vaccine (MCV4)

Given IM to 11-18y adolescents

- Booster at 16y if 1st dose given before then
- College freshmen require booster within 5 years
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94
Q

How can tobacco use affect a fetus?

A

Low birth weight is associated with tobacco use

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95
Q

Effects of marijuana use while pregnant

A

Infants have withdrawal-like syndrome (high pitched cry & tremors)

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96
Q

Effects of cocaine use while pregnant

A

Vasoconstriction –> Placental insufficiency –> Low birth weight

Also can cause placental abruption

Possible deficits in child’s cognitive performance

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97
Q

Things that increase risk of HIV vertical transmission

A 
Unprotected sex during pregnancy
Amniocentesis
High viral load
Breastfeeding
Premature delivery (<37w)
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98
Q

Decreases HIV vertical transmission risk

A

Zidovudine
C-section prior to labor
No breastfeeding

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99
Q

What is included in a neonatal screen?

A

Metabolic screen
Hearing screening
Congenital heart defects screening (some states; O2 sat)

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100
Q

What is mandated in the newborn metabolic screen?

A

PKU

Hypothyroidism

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101
Q

Absolute contraindications to breastfeeding

A

HIV infection
Maternal drug abuse
Infants with galactosemia

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102
Q

Benefits of breastfeeding

A

GI development
Decreases risk of acute illness (diarrhea, AOM, UTI)
Reduced rates of obesity, CA, CAD, allergies, T1DM, IBD
Cognitive advantage

Decreased maternal risk of breast & ovarian CA, & osteoporosis

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103
Q

Recommendations for breastfeeding

A

Exclusive breastfeeding birth-6mo

Add foods & continue breastfeeding until 12mo

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104
Q

Leading causes of death in adolescents

A

Accidents
Homicide
Suicide

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105
Q

HEEADSSS interview

A 
Home
Education/Employment
Eating disorder
Activities/Aspirations
Drugs/alcohol/tobacco
Sexuality
Suicidality/mental health
Safety
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106
Q

APGAR

A 
Appearance (skin color)
Pulse
Grimace
Activity
Respiratory effort
107
Q

What is considered small for gestational age (SGA)?

A

<10th percentile on intrauterine growth curve

108
Q

Problems seen in SGA infants

A

Hypoglycemia
Hypothermia
Hypoxia
Polycythemia

109
Q

What is considered appropriate for gestational age (AGA)?

A

10th-90th percentile

90th = LGA

110
Q

What is considered microcephaly?

A

<10th percentile of head circumference

111
Q

What is the classic triad of a TORCH infection?

A

Microcephaly
Organomegaly
Rash

112
Q

What are the TORCHS organisms?

A 
Toxoplasmosis
Other
Rubella
CMV
Herpes/HIV
Syphilis
113
Q

Symptoms of congenital CMV infection

A

Jaundice
Hearing loss
Chorioretinitis
Intracranial calcifications

114
Q

What studies should be done if congenital CMV is suspected?

A

Urine CMV culture
Newborn hearing test
Head CT
Ophthalmologic exam

115
Q

What medications are given to all newborns?

A

Vitamin K injection
Erythromycin ointment for eyes
-Decreases risk of gonococcal conjunctivitis
-Can also use tetracycline or silver nitrate
HBV vaccine
HBIg if mother is positive for HBSAg

116
Q

How long until a baby should be back at birth weight

A

2 weeks

117
Q

Average daily weight gain for infant

A

20-30g for term infant

118
Q

When should weight be 2x birth weight?

A

4-5mo

119
Q

When should weight be 3x birth weight?

A

1 year

120
Q

When should length be 2x birth length?

A

4 years old

121
Q

What are the 4 domains of development?

A

Gross motor
Fine motor
Language/Communication
Social/Behavior

122
Q

When can children sit in the front seat?

A

Once they are a teenager (13)

123
Q

How to mix formula powder

A

2 scoops of powder in 4oz of water

124
Q

Caloric requirements of premature infants

A 
Preterm = 130 kcal/day
VLBW = 150 kcal/day
125
Q

What supplement do breastfeeding infants need?

A

Vitamin D

126
Q

How often to introduce new solid foods

A

Starting at 4-6mo: one new food Q5-7 days

To identify allergies.

127
Q

Absence of red reflex DDx

A

Cataracts
Retinoblastoma
Glaucoma
Chorioretinitis

128
Q

When does the moro reflex disappear?

A

4mo

129
Q

DDx of asymptomatic abdominal mass in an infant

A 
Neuroblastoma
Wilms' tumor
Teratoma
Hepatic tumor
Hydronephrosis
130
Q

When does neuroblastoma present?

A

Over 50% before age 2

131
Q

Most common sites of neuroblastoma

A

Adrenal glands or anywhere along the sympathetic chain

Abdominal > thoracic > cervical

132
Q

Common presentation of neuroblastoma

A 
Fever
Anemia/pallor
FTT
\+/- abdominal mass
\+/- bone pain (mets; Hutchinson syndrome)
133
Q

Differentiating Wilms’ & Neuroblastoma clinically

A

BOTH abd mass & can show hypertension

Wilms'
	-Aniridia
	-Hemihypertrophy
Neuroblastoma
	-Opsoclonus/Myoclonus
134
Q

Elevated VMA/HVA in a child

A

Neuroblastoma

135
Q

Symptoms of Beckwith-Wiedemann syndrome

A

Hemihypertrophy
Macroglossia
Organomegaly
Wilms’ tumor

136
Q

Study of choice in evaluating for neuroblastoma mets

A

Technetium-99 bone scan

137
Q

Histology: small cell rosettes

A

Neuroblastoma

138
Q

When should firs dentist visit be?

A

Within 6mo of first tooth or by 1y

139
Q

When to face car seat forward?

A

24mo or when they outgrow their car seat

140
Q

When can children stop using booster (forward) car seat?

A

4 feet 9 inches tall

141
Q

What ages is M-CHAT used for?

PEDS?

A

M-CHAT = autism spectrum in 16-30mo

PEDS = development from birth-8y

142
Q

Most common cause of inward-toe gait

A

Tibial torsion

143
Q

When to refer in-toe gait

A

If it doesn’t resolve by 4y

144
Q

Anemia DDx

A 
Iron deficiency (most common)
Chronic GI blood loss
Lead poisoning
Chronic illness
Hemoglobinopathy (thalassemia, SCD, G6PD def)
145
Q

Normal Hgb for a child?

A

6mo-6y: 10.5-14 g/dL

146
Q

Treatment for eczema

A
  1. Lubrication
  2. Topical hydrocortisone
  3. Antihistamines for itching
147
Q

DDx for school failure

A 
Sensory impairment
Sleep disorder
Mood disorder
Learning disability
Conduct disorder
148
Q

What physical & lab findings are seen in eating disorders?

A 
Weight loss
Amenorrhea
Bradycardia
Electrolyte abnormalities
Hypoalbuminemia
Hypoglycemia
Hyponatremia
149
Q

When to start screening for HIV?

A

All sexually active teens (>13)

150
Q

Order of pubertal growth in girls

A

Breast buds –> pubic hair –> growth spurt –> menarche

151
Q

Order of pubertal growth in boys

A

Testes grow –> pubic hair –> penile growth –> growth spurt

152
Q

Define:
Menorrhagia
Metrorrhagia
Dysmenorrhea

A

Menorrhagia - long or heavy periods
Metrorrhagia - irregular periods
Dysmenorrhea - painful periods

153
Q

What is seen on coagulation testing in vWD?

A

Low Factor VIII activity
Low vWF quantity
Low vWF activity

154
Q

Treatment for vWD?

A

Intranasal or IV Desmopressin

155
Q

Most common causes of chest pain in children

A 
Precordial catch syndrome
	-Sudden sharp pain at LUSB
	-Pleuritic & clears with deep inspiration
Costochondritis
	-Lasts hours-days
156
Q

Risk factors for TTN

A

LGA
Diabetic Mother
C-section birth

157
Q

What is considered prolonged PROM?

A

> 18h prior to delivery

158
Q

Most common site of congenital diaphragmatic hernia

A 
Left chest
Posterolateral side (Bochdalek hernia)
159
Q

Problems seen in LGA newborns

A

Birth injuries

Hypoglycemia (diabetic mother)

160
Q

Problems seen in SGA newborns

A

Hypothermia
Hypoglycemia (inadequate glycogen stores)
Polycythemia & hyperviscosity

161
Q

When to intervene on neonatal hypoglycemia

A

Asymptomatic = <45 mg/dL

162
Q

Normal # of wet diapers for a newborn

A

6+ per day

163
Q

Which organs are insulin-sensitive?

A

Heart
Liver
Muscle
Fat

164
Q

Risk factors for NRDS

A 
Prematurity
Maternal DM
Sibling w/ Hx of NRDS
Male
C-section without labor
Perinatal asphyxia
165
Q

Differentiating TTN & NRDS

A

CXR

166
Q

Management of TTN

A

Supportive

If S/s don’t resolve –> Tx for pneumonia

167
Q

When to give IV glucose to newborn with respiratory distress

A

If RR > 80
or
If symptomatic hypoglycemia

168
Q

Criteria for physiologic jaundice

A

tBili up to 15 mg/dL

No other demonstrable cause for high tBili

169
Q

What causes breastfeeding jaundice?

A

Not much milk available early on –> low PO intake –> reabsorption of bilirubin from stool

170
Q

G6PD inheritance pattern

A

X-linked recessive

Seen more in Mediterranean, African, Asian families

171
Q

Symptoms of biliary atresia

A

Jaundice
Dark urine/Acholic stools
Seen between 3-6 weeks of life (late-onset)

172
Q

What supplements should be given to breastfed infants?

A

Birth - Vitamin D

6mo - Iron & Fluoride (if not fluoridated)

173
Q

Bilirubin levels based on PE

A

Jaundice of face = 5mg/dL

Knees = 10-15mg/dL

174
Q

Cephalohematoma vs Caput succedaneum

A

Caput succedaneum can cross suture lines (not subperiosteal)

Also Caput = serum
Cephalohematoma = whole blood

175
Q

What disorders can be missed if metabolic screen is done less than 24h after birth?

A

Any disorder with accumulation of metabolites (PKU, ect)

176
Q

S/S of congenital hypothyroidism

A 
Jaundice
Lethargy
Macroglossia
Umbilical hernia
Constipation
Abd distention
Mental retardation
177
Q

What inborn errors of metabolism can present with jaundice?

A

Galactosemia & Hypothyroidism

178
Q

Definition of FTT in newborn

A

Not back to birth weight by 3 weeks or continuous weight loss after 10 days of life

179
Q

Causes of congenital hypothyroidism

A 
Primary (most common in US; aplasia/hypoplasia)
HP axis defect
Maternal autoimmune thyroiditis
Maternal antithyroid drugs
Iodine def
180
Q

What conditions are associated with large fontanelles?

A 
Congenital hypothyroidism
Down syndrome
Rickets/OI
Malnutrition
^ICP
181
Q

What inborn error classes show hyperammonemia?

A

Urea cycle disorders
Organic acidemias
FA oxidation disorders

182
Q

CXR findings in TB

A

Hilar LAD
Focal hyperinflation
Atalectasis
Sometimes primary Ghon focus

183
Q

Normal RR newborn

A

30-60

185
Q

Normal HR newborn

A

100-160

186
Q

Normal HR 1-12mo

A

90-150

186
Q

Normal HR 3-5y

A

80-110

187
Q

Normal HR 1-3y

A

80-140

188
Q

Normal HR 6-12y

A

70-110

189
Q

Stages of Pertussis infection

A
  1. Catarrhal stage (URI)
  2. Paroxysmal stage (whooping cough)
  3. Convalescent stage (cough subsides)
190
Q

Diphtheria symptoms

A

Pharyngitis with gray pseudomembranes

191
Q

Barky cough

A

Croup

192
Q

Stridor vs wheezing

A

Stridor = pathology above thoracic inlet. Inspiratory.

Wheezing = pathology below thoracic inlet. Expiratory.

193
Q

PPD evaluation in children

A

Positive if:
>5mm in high risk
>10mm in moderate risk
>15mm in low risk

194
Q

DDx for chronic cough in an infant

A 
Vocal cord dysfunction
Laryngotracheomalacia
Vascular ring
Laryngeal web
Tracheostenosis
TEF
Foreign body
195
Q

What age can you give antihistamines?

A

> 2y

196
Q

How long does middle ear effusion stay after abx?

A

1mo in 50%
2 mo in 25%
3mo in 12.5%

197
Q

Oral rehydration guidelines

A

50-100mL/kg over 2-4h
then
10mL/kg per diarrhea afterward
2mL/kg per emesis afterward

198
Q

Solute requirements in maintenance fluids

A 
Sodium = 3.5 mEq/100mL
Potassium = 2.5 mEq/100mL
199
Q

Milk allergy presentation

A

Loose stools

Rash

200
Q

What are the categories of the GCS?

A

Eye response
Verbal response
Motor response

201
Q

Typical age & gender of T2DM Dx in youth

A

12-16y Females

202
Q

Diagnostic criteria of DKA

A

Random blood glucose > 200
Venous pH < 7.3 or bicarb < 15
Moderate or large ketonemia/ketonuria

203
Q

Which type of dehydration has the highest mortality

A

Hypertonic volume contraction

204
Q

Studies to do in newly-diagnosed T1DM

A

Anti-endomysial, anti-TTG, total serum IgA
Anti-insulin, anti-GAD, anti-IA2 (confirm T1DM)
BUN & Cr
Accucheck
Serum ketones (to monitor response)
Electrolytes (will show high K+. low Na+)
Anti-thyroid Ig’s
UA
Venous pH & Bicarb

205
Q

Management of DKA

A
  1. NS Fluid bolus (over 1h)
  2. Insulin gtt
  3. Manage electolytes
206
Q

Normal uop

A

2cc/kg/hr for children <15kg

1cc/kg/hr for larger children or adults

207
Q

Maintenance fluids per hour

A

4-2-1 rule

208
Q

10-10-10 rule

A

10 months
10kg
Hgb > 10

209
Q

Goal for reducing blood glucose in DKA

A

80-100mg/hr

End when glucose is 120-200

210
Q

Leading cause of diabetic death in children

A

Cerebral edema 2/2 DKA

211
Q

Treatment for cerebral edema in DKA

A

IV mannitol

Slow down fluid administration

212
Q

DDx of limp in a child

A 
Trauma
Septic arthritis
Osteomyelitis
Transient synovitis
Reactive arthritis
Leukemia
213
Q

Symptoms of reactive arthritis

A

Follows GI or GU infection

Arthritis, Urethritis, Conjunctivitis

214
Q

Symptoms of Juvenile Idiopathic Arthritis (JIA)

A

6w

Can have fever/rash or psoriasis

215
Q

Predictors of septic arthritis

A

Fever
Non-weight bearing
ESR/CRP
Leukocytosis

216
Q

Types of pediatric brain cancer

A

Medulloblastoma
Astrocytoma
Brainstem glioma
Ependymoma

217
Q

Types of migraine

A

Classic (aura)
Common (unilateral, no aura)
Basilar artery (bilateral vision changes, paresthesias, AMS)
Migraine variants (only in peds)

218
Q

HA patterns if caused by increased ICP

A

Worse after lying down
Awakens pt from sleep
Relieved by vomiting
Worse with valsalva

219
Q

Causes of pediatric ataxia

A 
Post-infectious cerebellitis
Infectious cerebellitis
Medication
^ICP (mass, hydrocephalus)
Opsoclonus-Myoclonus syndrome
Migraine
Metabolic or neurodegenerative disease
220
Q

Physical signs of allergies

A

Allergic salute
Dennie’s lines (infraorbital)
Allergic shiners

221
Q

Vomiting without diarrhea suggests what

A

Extra-intestinal pathology

222
Q

When does testicular torsion typically occur?

A

Early adolescence

223
Q

Reasons to hospitalize for PID

A 
Pregnancy
Noncompliance
High fever
Intractable emesis
Can't exclude a surgical emergency
224
Q

Most specific sign of shaken baby syndrome

A

retinal hemorrhages (pathognomonic)

225
Q

Definition of apnea

A

Cessation of inspiratory flow for 20s

Or for shorter period of time if also accompanied by bradycardia, cyanosis, or pallor

226
Q

ALTE

A

Apparent Life Threatening Event

Apnea with/without other s/s. Recovers only with stimulation or resuscitation

227
Q

DDx for an ALTE

A 
Seizures
Breath holding
^ICP
Arrhythmia
Respiratory infx
GERD
Systemic things (sepsis, metabolic, intoxication, botulism)
228
Q

Skeletal survey findings suspicious for abuse

A

Fractures inconsistent with developmental stage
Multiple fractures at different stages of healing
Leg fracture in non-walking child
Posterior rib fractures (shaken baby syndrome)
Skull fracture

229
Q

Vitamin E deficiency presentation

A

Neuropathy & hemolytic anemia

230
Q

Progression of deficits in growth for a malnourished child

A

Weight –> Length –> Head circumference

231
Q

Definition of FTT in children

A

Weight <3rd percentile

Crosses 2 or more lines on growth chart

232
Q

Causes of organic FTT

A 
Chronic diarrhea
Formula allergy
Heart defect
Cystic fibrosis
Developmental delay (poor suck)
RTA
Severe reflux
233
Q

What is physiologic anemia?

A

Drop in Hgb after birth due to RBC turnover. Marrow isn’t stimulated to respond until Hgb <11 g/dL

234
Q

Diagnosis of CF

A

Newborn screen is just a screen

Sweat chloride test is gold standard

235
Q

What test is used to assess exocrine pancreatic function?

A

Fecal elastase

236
Q

Diagnosing functional abdominal pain

A

No alarm signs
Normal PE
Negative FOBT

237
Q

Causes of hypoalbuminemia

A

Malnutrition
Hepatic disease
Protein losses (enteropathy, nephrotic syndrome)

238
Q

First line medication for Crohns

A

Mesalamine (5-ASA)

239
Q

Extra-intestinal manifestations of Crohns

A

Arthritis
Uveitis
Renal stones
Erythema nodosum

240
Q

Problems seen in preterm infants

A 
BPD
ROP
Hyperbilirubinemia
Periventricular leukomalacia
Cerebral palsy
241
Q

Birth asphyxia & kernicteris cause this type of cerebral palsy

A

Dyskinetic CP

242
Q

MRI findings in CP

A

Periventricular leukomalacia

Thin corpus callosum

243
Q

Physical exam findings in Down syndrome

A 
Epicanthal folds
Flat facial profile
Single palmar crease
Gab between 1st & 2nd toes
Umbilical hernia
244
Q

Complications of Down syndrome

A 
Hypotonia
Mental retardation
Endocardial cushion defects
Duodenal atresia
Leukemia
Hypothyroidism
245
Q

Risk factors for Down syndrome

A

Maternal age >35y

246
Q

Features of Patau syndrome

A 
Trisomy 13:
Microcephaly
Severe mental retardation
Polydactyly
Cleft lip/palate
Cardiac & renal defects
247
Q

Features of Edwards syndrome

A 
Trisomy 18
Prominent occiput
Micrognathia
Overlapping fingers
Rocker bottom feet
248
Q

Most common familial cause of mental retardation

A

Fragile X

249
Q

Cause of Fragile X

A

Abnormal number of trinucleotide repeats for FMR1 gene on the X chromosome

250
Q

Ways to inherit Down syndrome

A

Trisomy 21
Unbalanced translocations
Mosaicism

251
Q

Features of Fragile X

A

Large testes (post-pubertal)
Large ears
Long face
Large mandible

252
Q

Features of Turner syndrome

A 
Short stature
Webbed neck
Edema of hands/feet
Shield chest
Coarctation of the aorta (20%)
Gonadal streaks
253
Q

Features of Klinefelter syndrome

A 
47XXY
Eunuchoid body habitus but tall
Low-normal IQ
Testicular atrophy & sterility
Gynecomastia in adolescence
254
Q

DDx of neonatal hypotonia

A 
Benign neonatal hypotonia
Down syndrome
Zellweger syndrome
Perinatal asphyxia
Sepsis
Metabolic abnormality
Maternal medications
255
Q

What is Zellweger syndrome

A

A peroxisome-dysgenesis disorder causing neonatal hypotonia

256
Q

Recommended screenings for Down syndrome pts

A

Hearing & vision
ECHO
Thyroid studies at birth, 6mo, & annually
Cervical Xrays (antlantoaxial instability)

257
Q

Physical exam findings of sickle cell disease

A

Growth impairment
Scleral icterus
Flow murmur
Splenic enlargment

258
Q

S/s of acute chest syndrome

A 
Fever
Cough
Chest pain
SOB/Hypoxemia
Multi-lobar infiltrates, effusions, atalectasis
259
Q

Prophylaxis for sickle cell disease

A

Penicillin until 6y
HiB & PCV
Meningococcal vaccine early
Flu vaccine yearly

260
Q

Normal Hgb for child with SCD

A

Hgb = 6-9

261
Q

Complications in SCD

A 
Sepsis w/ encapsulated org
Stroke (10% by 15y)
Acute Chest Syndrome
Priapism
Aplastic crisis (parvovirus)
Osteomyelitis (Salmonella or Staph aureus)
262
Q

Management of Acute Chest Syndrome

A 
Pain control
IVF 1.5x normal maintenance
Incentive spirometry
Antibiotics
\+/- PRBC/Exchange transfusion
263
Q

Fever in a child with SCD

A

Blood Cx

IV empiric abx

264
Q

Snoring in a child with SCD

A

Waldeyer’s ring lymphoid tissue hypertrophy

Tx: Tonsillectomy, Adenoidectomy

Pediatrics (3 decks)

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