Deck 2 COPY Flashcards
what does molluscum contagiosum look like on a child
it is firm round pink or flesh colored papules with a central umbilication, shiny or itchy
treatment of molluscum contagiosum
observation and reassurance
what are the two types of transfusion rxns
anaphylactic and urticarial
management of a transfusion rxn
give antihistamines and stop transfusion
what do you need to do for close contacts of a positive pertussis patient
give close contacts a macrolide
what is a normal anion gap
6-12
causes of non anion gap metabolic acidosis
either renal or GI (diarrhea)
how does a baby present with RTA
chronic poor weight gain, declining weight despite regular weight at birth
presentation of atypical pneumonia
fever cough dyspnea, bilateral pulmonary infiltrates
what bug causes atypical pneumonia most often
mycoplasma pneumoniae
how do you treat mycoplasma pneumoniae
azithromycin
what drug do you use to treat tourettes in children
risperidone
when do pap smears start
age 21
what heart anomaly is seen in trisomy 18
VSD
signs of tricuspid valve atresia
absent tricuspid valve, tall peaked P waves, Left axis deviation, ASD, VSD
if a murmur in a neonate is holosystolic is it benign or pathologic
pathologic
what needs to be administered if a 1-3 day old neonate has sudden onset rapid breathing and cyanosis
prostaglandin E to kEEp the PDA open
are turner patients tall or short
short! very short
signs of choanal atresia
this is when the posterior nasal passage fails to canalize during first trimester causing cyanosis that worsens with feeding and improves with crying
what are the typical causes if a child has a fever without a source
occult bacterial infection (UTI, bacteremia, pneumoniae etc)
signs of chronic granulomatous disease
recurrent infections with catalase positive infections (staph, serratia, aspergillus)
dx of chronic granulomatous disease
DHR flow cytometry
prophylaxis for CGD
TMP-SMX, itraconazole, interferon gamma
pathogenesis of minimal change disease
cytokine induced glomerular injury
signs of LAD
frequent non purulent absesses, delayed umbilical cord separation
lab findings LAD
leukocytosis and neutrophilia
triple bubble sign on xray
jejenal atresia
signs of congenital syphilis
rhinorrhea, skeletal anomalies, desquamating rash on the palms and soles
effects on a neonate of a mother with lupus
they will typically have high creatinine levels
signs of functional constipation
anal fissure, blood on the outside of stools, pellet stools, infrequent defecation
management of functional constipation
adding prune juice or other osmotically active fibers to the diet
when should you switch a baby to a hydrolyzed formula
do this when the baby has blood mixed into the stool and has signs of soy/cows milk allergy
signs of tet spells
cyanosis upon crying or feeding mostly around the lips, children will squat if able
what are tet spells indicative of
tetrology of fallot
signs of gonococcal conjunctivitis in a newborn
copius exudate and eyelid swelling
pathogenesis of neonatal thyrotoxicosis
this is from maternal anti-TSH antibodies like from graves disease
does PSGN present with abdominal pain
No! this is IgA vasculitis
treatment of slipped capital femoral epiphysis
physis stabilization with screw fixation
Wiskott aldrich clinical features
eczema, microthombocytopenia, recurrent infections
etiology of wiskott aldrich
xlinked recessive defect in WAS, impaired cytoskelly
JIA presentation
arthritis, fever with cycles that spike high one time a day then return to baseline
what is another cause of infection in CF patients
pseudomonas, bronchopulmonary aspergillosis
comorbidities in turner syndrome
aortic dilation/dissection, metabolic syndromes, osteoporosis, vision changes, recurrent otitis media, celiac disease, hypothyroidism
signs of congenital diaphragmatic hernia
respiratory distress, absent breath sounds ipsilateral to the defect, concave abdomen, barrel shaped chest
management of congenital diaphragmatic hernia
intubation ,gastric decompression, surgery
why do neonates have physiologic jaundice
due to decreased hepatic bilirubin clearance, low levels of UDP-glucoronidase, especially in eastern asian newborns
lab findings of hereditary spherocytosis
increased MCHC
if a neonate has alveolar densities and pleural effusions what do they have
pneumonia
what are some acute causes of hemiplegia in children
ischemic stroke, intracranial hemorrhage, seizures, hemiplegic migraine
if a chid has acute onset of psychosis with arthralgia and thrombocytopenia, and hematuria what is the cause
lupus
if a child has IgA vasculitis what is a complication they are at risk of
intussusception
in failure to thrive what growth parameter is affected first
weight then length then head circumference
what are the two types of failure to thrive
there is organic (physiologic cause, malabsorption syndromes etc) and inorganic which is typically psychosocial
what is pulsus paradoxus
when the systolic blood pressure varies with inspiration
what is pulsus paradoxus a sign of
asthma exacerbation, pericardial tampanode, pericarditis
asthma physical exam findings
wheezing, hyperexpansion of the thorax, or a prolonged phase of forced exhalation
what drug is given to manage acute asthma exacerbations
SABA, SAMA, steroids
when does the late phase reaction occur in asthma
2-4 hours later after initial wheezing episode
what are eczema lesions described as
erythematous, weeping, crusted lesions
location of infant eczema
central trunk/head and extensor surfaces
location of child eczema
wrists, ankles, face, flexor surfaces
what is first line therapy for acute eczema flair up
topical corticosteroids, can use an oral antihistamine for help with sleep/limiting pruritis at night
what type hypersensitivity is contact dermatitis
type 4
treatment options for ADHD
stimulant meds (methyphenidate, amphetimines. Second line: atomoxetine (norepi reuptake inhibitor), guanfacine/clonidine (alpha 2 agonists)
before treatment with meds for ADHD what else needs to happen
complete psychoeducational assessment
galactosemia eye findings
cataracts
presentation of galactosemia
poor feeding, failure to thrive, jaundice, cataracts
difference between simple febrile seizure and complex febrile
simple is less than 15 minutes and non localizing. complex have multiple seizures within a 30 minute period
what demographic gets complex febrile seizures moreso
children with abnormal development
in a young child (1yo) what test should you do if they have seizure and fever
LP to rule out meningitis bc meningeal tests are not reliable
postnatal effects of intrauterine growth restriction
hypoglycemia, polycythemia, hypothermia, hypocalcemia
signs of androgen insensitivity syndrome
when a patient is phenotypically female but genetically male, no pubic hair, female external genitalia, etc.
treatment of SCID
stem cell transplant
signs of cold abcesses
they are non erythematous and nontender I.e. no sign of inflammation
Hyper IgE signs
eosinophilia, eczema, recurrent cold abscesses
signs of IVH in a newborn
seizures, tachycardia, full fontanelle, acute anemia
what babies develop IVH
premie babies
if a baby has macrocephaly but they have normal development and normal head US do they need further workup
nope!
signs of mercery toxicity
desquamating rash, neuropsychological changes (insomnia, anxiety, personality changes)
in alopecia acreta is there ANY hair growth
none at all
episodic crying, abdominal tenderness, lethargy
intussusception
what causes pneumonia mostly in children with CF
staph aureus
what causes pneumonia in adults with CF
pseudomonas
treatment of minimal change disease
steroids
difference between club foot and metatarsus adductus
club foot the whole foot is turned in and cant be repositioned. metatarsus adductus only the forefoot is inward and the whole foot can be repositioned. only reassurance needed it will correct itself
when is emergency laporatemy indicated
signs of intestinal perf
if a baby has dilated loops of bowel and tight anal sphincter whats going on
hirschsprungs
causes of steatorrhea
CF, gluten sensitivity, malabsorption syndromes
signs of CF in a 1yo
growth decline, wet cough, new onset large bulky stools (steatorrhea)
management of hypoglycemia in an infant
POC glucose check, then send a glucose check via blood to lab, continuous feeds, IV glucose
effect of maternal hyperglycemia on the infant (pulmonary)
respiratory distress due to antagonist effect on surfactant
bronchiectasis appearance on xray
linear opacities in a parallel tram-track configuration
extrapulmonary signs of CF
digital clubbing, recurrent sinusitis, failure to thrive, fat malabsorption, and a history of meconium ileus
signs of HIV infection in a child
lymphadenopathy, hepatomegaly, oral candidiasis, frequent infection
what is always the first step in management of an patient in distress
address ABCs!
signs of diabetes in a child
polydipsia, polyuria, weight loss, tachypnea, abdominal pain, vomiting, fatigue
what is the anion gap like in a child in DKA
elevated
what is the K level like in DKA
hyperkalemia
Fatty acid levels in DKA
increased due to increased lipolysis to use for gluconeogenesis
treatment of DKA
IV fluids, insulin
what is a devastating complication of DKA
cerebral edema, 25% do not survive
what is the honeymoon phase of diabetes
this is when you see a decreased need of insulin ~6mo post diagnosis, it will come back
inheritance of DMD
xlinked recessive
initial screening in suspected DMD
creatine kinase level (muscle breakdown)
what is a common skeletal complication of muscular dystrophy
scoliosis
newborn findings of myotonic muscular dystrophy
high arched palate, inverted V-shaped upper lip, thin cheeks, and wasting of the temporalis muscles
what is the shunt like in PDA initially
it is Left to right bc higher pressure
consequence of maintained PDA
pulmonary hypertension and then eisenmeiger syndrome where the shunt shifts right to left causing cyanosis
does a PDA cause contractile dysfunction
no! just volume overload
how does aortic coarctation effect LV
LV pressure overload with intact contractility initlaly but then it declines if not reversed
causes of LV contractile dysfuction in infants I
cadiomyopathy and MI
signs of meningitis in an adolescent
diffuse erythema of pharynx, non specific fever, myalgias, skin mottling, vomiting, sore throat, headache, petichiae/purpura
when are branchial cleft and thyroglossal duct cysts often detected
post URI they can become secondarily infected
what are cystic hygromas associated with
turners
what bugs are seen in patients with affected oxidative burst (chronic granulomatosis disease)
bacteria: staph, nocardia, burkholderia, serratia // Fungal: aspergillus
what bugs are seen in patients with terminal complement deficiency
neisseria
what bugs are seen in patients wtih T cell deficiency
viral, and fungal infections
ocular presentations of neuroblastoma
periorbital ecchymoses (raccoon eyes), opsoclonus-myoclonus syndrome (rapid jerking movements of both eyes)
what is dactylitis a sign of
sickle cell
what is preseptal cellulitis
this is when the periorbital and eye sockets have cellulitis
difference between preseptal cellulitis and orbital cellulitis
orbital cellulitis has pain with extraocular movements and shows proptosis and ophthalmoplegia with diplopia and involves the orbital space
treatment of preseptal cellulitis vs. orbital cellulitis
preseptal: oral antibiotics // orbital: IV antibiotics +/- surgery
what type of saline do you give initially to rehydrate children
20mL/kg normal saline IV bolus
risk factors for acute otitis media
age (6-18mo), lack of breastfeeding, day care attendance, smoke exposure
signs of tinea capitis in a child
scaly erythematous patch, black dots on the affected area, tender lymphadenopathy
treatment of tinea capitis
oral griseofulvin or terbinafine
signs of drug induced hemolytic anemai
onset severa hours post exposure, jaundice, dark urine, abdominal/back pain
mechanism of drug induced hemolytic anemia
the durg bidns directly to erythrocytes and creates a hapten (place to bind) for IgG which causes the RBCs to be sequestered by splenic macrophages
pathogenesis of UTIs in kids with chronic constipation
urinary stasis, the constipation causes occlusion fo the urethra leading to retention and increased risk of UTI
MEN1
pituitary, parathyroid, and pancreas
MEN2a
parathyroid, pheo, med thyroid
MEN2b
pheo, med thy, Marfanoid habitus, mucosal neuromas
which MEN has marfanoid habitus
MEN2b
screening in an adolescent well child visit
contraceptive/safe sex, depression, substance use
valsalva maneuver/standing effect on preload and afterload
decreases preload and afterload
handgrip effect on preload/afterload
increases afterload
when does HOCM get louder
decreased afterload (valsalva, standing)
Aortic stenosis with increased preload/afterlaod
gets louder with increased preload, quieter with increased afterload
squatting effect on preload and afterload
increases preload and increases afterload
how do you get HOCM to increase in intensity (physiology)
you want decreased blood in the left ventricle so therefore you decreaes preload
definition of amblyopia
this is when you have decreased visual acuity due to visual disturbances early in childhood
causes of amblyopia
cataracts, strabismus, uncorrected refractive error
management of amblyopia
corrective lenses, surgery to remove cataracts, encourage use of the amblyopic eye
signs of 21-alpha hydroxylase deficiency in a genetic female
virulization, high potassium, low BP
signs of virulization in a genetic female
enlarged clitoris, (underdeveloped phallus with hypospadias), fused labioscrotal folds
signs of virulization in a genetic male
phenotypically normal or hypervirilized (enlarged phallus)
lab studies in a 21-a-hydroxylase deficiency
high K, low Na, 17-hydroxyprogesterone elevated
signs of 11B hydroxylase deficiency in XX babies
virulization, high BP, low K
signs of 17-a-hydroxylase deficiency in XX babies
secondary sex characterisitcs underdeveloped, high BP, low K, no cortisol
signs of 17-a-hydroxylase deficiency in XY babies
undescended testes, atypical genetalia (bc no DHT which is necessary for external genitalia)
what does it mean if there are gamma tetramers seen on hemoglobin electrophoresis
this means that there is hemoglobin H which is what happens when there are 3 alpha genes lost and so the Beta globin accumulate as the homotetramers
MCV in alpha thallesimia
low
erythrocyte level in hemoglobin H disease
typically elevated to make up for hemolyzed RBCs
which antibiotics do you use for UTI in children
cephalosporin
what is common variable immunodeficiency
this is when you have abnormal differentiation of b cells into plasma cells and decreased immunoglobulin production
management of common variable immunodeficiency
IV Immune globulin infusion
manifestations of common variable immunodeficincy
recurrent respiratory infections, recurrent GI infections, chronic diseases
normal urine output in a neonate
> or equal to 1 void per day of life so a 48hour old baby should have 2 wet diapers/day
management of oliguria in a neonate
renal and bladder ultrasound
diarrhea in a 1yr following resolved diarrheal illness
secondary lactose intolerance due to damaged epithelium
