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difficult to remember Flashcards

1
Q

findings in infants of diabetic mothers

A
  1. Macrosomia (2nd and 3rd trimester) –> branchial plexopathy, clavicle fracture, perinatal asphyxia
  2. Small left colon syndrome (1st trimester)
  3. Cardiac anomalies (1st trimester)
  4. renal vein thrombosis (1st trimester)
  5. metabolic findings and effects (2nd or 3rd trimester)
  6. spontaneous abortion (1st trimester)
  7. polycythemia (2nd and 3rd trimester)
  8. neural tube defects (1st)
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2
Q

infants of diabetic mothers - Metabolic findings + effects

A

hypglycemia: seizures
hypocalcemia: tetany
hypomagnesia: hypocalcemia + low PTH
hyperbilirubinemia: icterus = kernictuerus

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3
Q

infants of diabetic mothers - renal vein thrombosis

A
  • Flank mass + possible bruit

- hematuria + thrombocytopenia

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4
Q

evaluation of precocious puberty

A

bone age (normal or advanced)
A. normal: isolated breast development (premature thelarche or isolated pubic hair delop (premature adrenache –> reassurance
B. adanced: measure basal LH
- high: central
- low: GnRH stimulation test –> If high is central, if still low is peripheral

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5
Q

glycogen storage diseases - enzymes

A
  1. Von Gierke: glucose-6-phosphatase
  2. Pompe: lysosomal a-1,4-glucosidase (acid maltase)
  3. Cori: a-1,6-glucosidase def
  4. McArble: myophosphorylase
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6
Q

epiglottitis vs croup on x-ray

A

epiglottitis - thumbprint signs

croup - steeple sign

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7
Q

epiglottitis - treatment

A
  1. incubate (in OR in case unsuccesful intubation makes tracheostomy necessary
  2. ceftriaxone for 7-10d
  3. Rifampin for all close contacts
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8
Q

epiglottitis vs croup - most accurate test

A

croup: PCR
epiglottitis: C+S from tracheal aspirate

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9
Q

Whooping cough - treatment

A
  • Erytrhomycin or azithrom aids only in the catarrhal stage, not in the paroxysmal
  • isolate the child
  • macrolides in close contacts
  • DTaP vaccine
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10
Q

primary ciliarry dyskenesia vs CF regarding extrapulm features

A

1ry ciliary: sinus inversus, infertility, NORMAL GROWTH

CF: pancreatic insuf, infertility, FAILURE TO THRIVE

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11
Q

pneumonia and effusion on chest x-ray - management

A

small effusion and No resp distress or hypoxia –> oral antibiotics and close monitoring
moderate/large effusion OR resp distress OR hypoxia –> U/S, IV antibiotics, drainege

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12
Q

indications for palivizumab in infants

A
  1. preterm births less than 29
  2. chronic lung diseaes of prematurity
  3. hemodynamically significant CHF
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13
Q

common causes of neonatal respiratory distress - causes

A
  1. transient tachypnea of newborn (term or posterm)
  2. resp distress syndrome (preterm)
  3. persistent pulm hypertension (term or posterm) –> makes R to L shunts (through foramen ovale, PDA)
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14
Q

Congenital hip dysplasia - age / RF

A

infants

  1. breech positioning
  2. family history
  3. excessively tight swaddling
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15
Q

Osgood Schlatter disease (traction apophysitis) - presentation / radiology

A

anterior knee pain / reproduce pain when extend the knee against resistance / tenderness and edema on tubercle
- anterior soft tissue swelling, lifting of tubercle from the shaft, irregularity or fragmentation of the tubercle

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16
Q

systemic-onset juvenile idioath arthritis - clinical presentation

A

auto-inf disease in children:

  1. long stading daily fever
  2. arthritis of 1 or more joints (more than 6 weeks)
  3. pink macular rash
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17
Q

metatarsus adductus vs congenital clubfoot regarding treatment

A

metatarsus –> reassurance

clubfoot –> serial manipulation + casting (surgery if refractory)

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18
Q

spondylolisthesis is a developmental disorder characterized by

A

forward slip of vertebrae (usually L5 over S1) that usually manifests in preadolescent children
- back pain, neurologic dysfunction (eg. urinary incontinence), papable step-off at the lubosacral area present if the disease is severe

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19
Q

Geleazzi test

A

leg-length discrepancy in developmental dysplasia of the hip

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20
Q

normal delivery - after? (steps) (after apgar)

A
  1. suction of mouth and nose
  2. clamping + cutting of the umbilical cord
  3. newborn is then dried, wrapped in clean towels, and place under a warmer (it was in a warm environment in uterus)
  4. gentle rubbing or stimulating the heels to stimulate crying and breathing
  5. Vit K + opthalmic oitments
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21
Q

neonatal conjuctivitis - types and age of onset

A
  • chemical irritation due to silver nitrate (it is not allergy, esp in developing countries: day 1: eye lubricant
  • gonococcal: day 2-5: single IM dose of 3rd gener ceph
  • chlamydial: 5-14: macrolide PO
  • 3 weeks or more: Hepres infection: systemic acyclovir and topical vidarabine
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22
Q

delivery associated scalp injuries - types

A
  1. capute succedaneum: swelling of soft tissues, CROSS sutures lines
  2. Cephalohematoma: subperiosteal hemorrhage DOES NOT cross suture lines
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23
Q

diaphragmatic hernia - types

A
  1. Morgagni: defect in retrosternal or parasternal

2. Bochdalek: defect in posterolateral (MC, usually left)

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24
Q

Charge syndrome

A 
Cologoma or iris, 
heart defects
Atresia of nasal choanae
Growth retardation
Genitourinary abnormalities
Ear abnormalities
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25
Q

Risk factros for cryptorchidism

A
  1. prematurity
  2. small for gestational age
  3. low birth weight
  4. genetic disorders
  5. hypospadias
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26
Q

jaundice is consider pathologic when

A
  1. appears 1st day
  2. rises more than 5 / day
  3. above 19.5 in term child
  4. Direct bilir rises above 2 at any time
  5. present after the 2nd week
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27
Q

infants - iron

A

full term infants are born with adequate iron stores to prevent anemia for the first 4-6 months. Preterm infants are at significantly increased risk for iron-def anemia –> iron supplementation should be started at birth in exclusively breastfed preterm infants and continued until age 1

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28
Q

risk for iron def anemia in infants

A

prematurity
iron def mother
cow’s milk before 1 year
Delay start of solid food

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29
Q

timeline of infant nutrition

A 
exclusive beastfeeding until 6 months
introduction of pureed foods at 6 months
introduction of cow's milk at 1 year
\+ VIT D
\+ IRON if premature
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30
Q

Fanconi’s anemia

A

pancytopenia + characteristic congenital anomalies such as: hyperpigmentation on the trunk, neck and interginous areas, cafe au lait spots, short stature, upper limb abnormalities, hypogonadism, skeletal anomalis, eye or eyelid changes, renal malformations
DIAGNOSIS AT 8 YEARS OLD

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31
Q

anemia of prematurity - etiology

A
  • impaired EPO production
  • short red blood cell life span
  • Iatrogenic blood sampling
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32
Q

anemia of prematurity - clinical manifestation and labs

A
  • asymptomatic, tachycardia, apnea, poor weight gain

- low reticulocyte count, normocytic, normochromic

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33
Q

anemia of prematurity - treatment

A

minimize blood draws, iron, transfusion

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34
Q

ITP - treatment

A

children: skin manifestation only: observe, if bleeding, IVIG or glucocortic
adults: platelets more than 30000 and cutaneous symptoms, without bleeding: observe, less than 30 or bleeding: IVIG or glucocort

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35
Q

harlequin sign

A

absent facial flushing (Horner syndrome)

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36
Q

Klinefelter syndrome - lab/endocrine profile - mechanism

A
  1. presence of inactivated X chromosome (Barr body)
  2. High FSH (dysgenesis of seminiferous tubuls –> low inhibin B)
  3. high estrogen (abnormal Leydig function –> low testosterone –> high LH –> upregulation of aromatase)
  4. Common cause of hypogonadism seen in infertility work-up
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37
Q

evaluation of primary amenorrhea

A

pelvic examination or U/S –> Uterus present?

  • yes –> serum FSH: if increased do karyotype, if decreased do cranial MRI
  • no –> karyotype and serum test:
    1. 46, XX, normal female test levels –> abnormal Mullerian development
    2. 46 XY, normal male test levels –> androgen insensitivity syndrome
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38
Q

emergency contraception options - methods and efficacy

A
  1. copper IUD –> 99%
  2. Ulipristal pill –> 85 or more
  3. Levonorgestrel –> 85%
  4. OCPs –> 75%
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39
Q

contraindications to breastfeedings

A
  1. galactosemia in baby
  2. HIV
  3. HSV on breasr
  4. Substance abuse
  5. maternal cancer under treatment
  6. Acute maternal diseasae if absent in infant (TB, sepsi)
40
Q

maternal benefits for breastfeeding

A
  1. reduced risk for BREAST + OVARIAN ca
  2. maternal-infant bonding
  3. improved child spacing
  4. faster return to prepartum weight
  5. more rapid uterine involution + decreased postpartum bleeding
41
Q

infant’s benefits from breastfeeding

A
  1. improved immunity
  2. improved gastrointestinal function
  3. prevention of infectious dieases:
    - otitis media
    - gastroenteritis
    - respiratory illness
    - urinary tract infection
  4. decreased risk of childhood cancer, type I diabetes + necrotizing enterocolitis
42
Q

kidney stones - types and urine crystals

A
  1. Calcium oxalate –> shaped like envelope or dumbbell
  2. Caclicum phosphate –> wedge-shaped prism
  3. Ammonium magnesium phosphate –> coffin lid
  4. Uric acid –> Rhomboid or rosettes
  5. Cystine –> hexagonal
43
Q

vesiculateral reflex - grades

A
  1. into nondilated ureter
  2. into pelvis + calyces without dilation
  3. mild to moderate dilatation ureter, pelivis, calyces with minimal blunting
  4. moderate ureteral tortuosity + dilation of the pelvis + calyces
  5. gross dilation of ureter, pelvis, calc=cyes, loss of papillary impressions, ureteral tortuosity
44
Q

indications of renal + bladder U/S

A
  1. infatns and children under 24 months with 1st febrile UTI
  2. reccurent febrile UTI in children of any age
  3. UTI in child of any age with family history of renal or urologic disease, hypertension or poor growth
  4. no respond to appropriate antibiotic treatment
45
Q

Henoch - Schonlein - manifestation / treatment

A

triad: arthralgia, abd pain, palpable purpura on legs and buttocks + IGA NEPHROPATHY
- supportive (NSAID and hydration)
- if severe: hospitalization + glucocorticoids

46
Q

indications for voiding cystourethogram

A
  1. hydronephrosis or scarring in U/S
  2. newborn with UTI
  3. less than 2 years with recurrent UTI
  4. UTI from organism other than E.coli
47
Q

Tourette syndrome - treatment

A
  1. psychoeducation
  2. behavioral therapy
  3. for intractable tics –> a. low dose high potency antipsycotics (flyphenazine, pimozide) b. tetrabenazine
    c. clonidine D. guanfacine
  4. if mild: a2 agonists (clonidine, guanfancine)
48
Q

Reactive attachment disroder

A
  • emotional + social withdraw as well as lack of positive respones to attempts to confront
  • caused by early childhood abuse or neglect
49
Q

Landau-Kleffner syndrome

A

regression of language skills due to severe epileptic attacks –> language skills typically deteriorate at age 3-6

50
Q

selective mutism - treatment

A

CBT, family therapy, SSRI

51
Q

transposition of great vessels - x-ray

A

egg on a string heart

52
Q

which of them are PDA depended

  1. Truncus arteriosus:
  2. D-Transposition of great vessels
  3. Hypoplastic left heart syndrome
  4. Tetralogy of Fallot
  5. Total anomalous pulmonary venous return
A
  • trasnp of great vessels

- Hypoplastic left heart syndrome

53
Q

which of them are VSD depended

  1. Truncus arteriosus:
  2. D-Transposition of great vessels
  3. Hypoplastic left heart syndrome
  4. Tetralogy of Fallot
  5. Total anomalous pulmonary venous return
A

FALLOT

Truncus arteriosus

54
Q

total anomalous pulm venous return with obstruction - x-ray

A

pulm edema, snowman sign

55
Q

patent ductus arteriosus is often due to

A
  1. congenital rubella
  2. prematurity
  3. birth at high altitudes
  4. fetal alcohol syndrome
56
Q

vascular rings?

A

rings that encircle the trachea and/or esophagus + present with resp (biphasic stridor, wheezing, coughing) + esophageal (dysphagia, vomiting) symptoms
stridor typically improves with neck extension

57
Q

transposition of great vessels - examination and x-ray

A

Single S2 +/- VSD murmur

- egg on a strinng heart (narrow mediastinum)

58
Q

viral myocarditis - prognosis

A
  • mortality: gretar in newborns

- outcome of survivors: full recovery in 66%, CHF in 33%

59
Q

Lennox-Gastaut syndrome

A

presents by age 5 with intellectual disability and severe seizures of varying types
ECG: slow spike wave pattern

60
Q

febrile seizures - criteria

A
  1. age 3 months - 6 years
  2. no previous AFEBRILE seizures
  3. no meningitis or encephalitis
  4. no acute metabolic disease
61
Q

absence seizures vs inattentive staring spelss

A

inattentive staring spelss –> 1ry during boring activities, more than 1 min, response to vocal or tactile stimulation, lack of automatics
- absence –> during all activities, less than 20 sec, lack of response to vocal or tactile stimulation, presence of automatism

62
Q

PKU - diagnosis

A
  1. newborn sceening (spectometry)

2. quantitative amino acid analysis (increased phenylalanine levels) (later in life)

63
Q

Trinucleotide repeat expansion diseases

A
  1. Fragile x syndrome - CGG
  2. Friedreich ataxia - GAA
  3. Huntington - CAG
  4. Myotonic Dystrophy - CTG
64
Q

infant vs adult boutilism in presentation

A

adults phas prodrome symptoms of nausea, vomiting, abd pain, diarrhea

65
Q

Lysosomal storage diseases - types and diseases and enzymes

A

A. spingolipidoses:
1. Fabry - a-galactosidase A deficiency
2. Gaucher - Glucocerebrosidase (β-glucosidase)
3. Niemann-Pick - Sphingomyelinase
4. Tay-Sachs - Hexosaminidase A
5. Krabbe - Galactocerebrosidase
6. Metachromatic leukodystrophy - Arylsulfatase A
B. Mucopolysacccharidosrs:
1. Hurler syndrome - a-L-iduronidase
2. Hunter syndrome - Iduronate sulfatase deficiency

66
Q

Krabbe disease findings

A
  1. Peripheral neuropathy
  2. Developmental delay
  3. Optic atrophy
  4. Globoid cells
67
Q

Metachromatic leukodystrophy findings

A

Central and peripheral demyelination with ataxia and dementia

68
Q

Necrotizing enterocoitis - treatment

A
  • stop feeding
  • IV fluids
  • NGT
    antibiotics: vano, gentamicin, metronidazole
    if medical management fail –> surgery
69
Q

how to estimate fluid loss of a baby after diarrhea

A

by the weight AND:

  1. mild dehydr (3-5%): history of decreased intake or loss with minimal or no symptoms
  2. Moderate (6-9%): decreased skin tugor, dry mucus membbranes, tachycardia, irritability, 2-3 sec capillary refill, low urinary output
  3. Severe (10-15%), cool, clammy skin, more than 3 sec capil refill, cracked lips, dry mucus, sinken eyes, hypotension and signs of shock
70
Q

DDX of crying infant

A
  1. Colic: more than 3h / day (usually evening, more than 3 times / wk, for 3 or more weeks
  2. GERD: back pain during or after food (Sandifer syndrome), Frequent spits up or vomiting, poor weight gain
  3. Corenal abrasion: (+) fluorescein examin)
  4. Hair tourniquet: tied hair around extremity
  5. Mild protein allergy: blood-steaked mucousy, loose stools, severe constipation
  6. Normal infant crying: less than 2 h / day, resolves with consoling methds
71
Q

evaluation of bilious emesis in neonates

A

stop feeding, NG, IV fluids –> X-rays

  1. double sign –> duodenal atresia
  2. Free air, hematemesis, unstable vital –> sirgery
  3. Dilated loops –> contrast enema –> microcolon (meconium eleus), transition zone (Hirschsprung)
  4. NG tube in misplaced duodenum –> UPPER GI series –> Ligament of Treitz on the Right side –> malrotation
72
Q

milk- or soy-protein induced colitis - treatment

A

elimiantion of milk + soy from maternal diet of exclusively breastfed infants
initiation of hydrolyzed formula in formula fed infants

73
Q

suspect eosinophilic esophagitis - next step

A

2 months trial of PPI –> if not improvement –> endoscopy (furrows + circular rings) and biopsy (at least 15 eosinoph)
(dietary modification)

74
Q

pediatric GI - down is associated with

A
  1. hirsburg
  2. duodenal atresia
  3. imperforate anus
  4. umbilical hernia
  5. celiac
75
Q

Beckwith-Wiedemann - surveillance

A
  1. serum α-fetoprotein
  2. abd/renal U/S
  3. monitor for hypoglycemia (only at the beginning)
76
Q

angioedema - best initial test

A

test for decreased C2 and C4 in the complement pathway as well as deficiency of C1 esterase inhibitor

77
Q

urticaria - treatment

A
  1. antihistamines: hydroxizine, diphenhydramine, fexofenadine, loratadine, cetirizine, ranitidine
  2. leukotriene receptor antagonist; monelukast or zafirlukast
78
Q

contraindications of rotavirus vaccination

A
  1. anaphylaxis to vaccine ingredients
  2. history of intussusception
  3. SCID
  4. history of uncorrected congenital malformation of GI
79
Q

DTaP - how many doses and when / contains?

A

5 doses
from 6 months to 6 years
accelular pertusis antigen + diphtheria and tetanus toxoids
BOOSTER of Tdap during adolescence and then Td every 10 years

80
Q

Rotavirus - doses, if missed

A

3 doses: 2, 4, 6 months
no catch-up if behind (no after 8 months)
NO IN INTUSSESUCEPTION)

81
Q

MMR doses

A

2 does:
1st 12-15 months
2nd: 4-6 years

82
Q

All pregnant should receive screening for

A
  1. HIV
  2. HBV
  3. Chlamydia
  4. syphilis
83
Q

neonatal dehydration - management of weight loss

A

less than 7%: continue exclusive breastfeeding, follow up at age 10-14 days to check
7 or more: asses for oromotor dysfunction, assess for lactation failure, daily wights, consider formula supplementation
HEALTY INFANTS NORMALLY LOSES 7% OF WEIGHT IN FIRST 5 DAYS

84
Q

First trimester findings in down syndrome

A
  1. Increased nuchal translucency (UL)
  2. Hypoplastic nasal bone (UL)
  3. Decreased serum PAPPA-A
  4. Increased β-hCG
85
Q

Second-trimester QUAD screen shows in Down syndrome

A
  1. Decreased a-fetoprotein
  2. Increased inhibin A
  3. Decreased estriol
  4. Increased β-hCG
86
Q

Edwards syndrome first trimester (Lab)

A

Decreased PAPPA-A and free β-hCG

87
Q

Second trimester QUAD screen show of Edward’s syndrome

A
  1. Decreased α-fetoprotein
  2. Decreased β-hCG
  3. Decreased estriol
  4. Decreased or normal inhibin A
88
Q

First trimester pregnancy screen show for Platau syndrome

A
  1. Decreased free β-hCG
  2. Decreased PAPPA-A
  3. Increased nuchal translucency
89
Q

accidental diagnosis with urehtritis (chlam or neisseria) next step

A

antibiotics immediately and refrain from sex until treatment is complete and symptoms resolved
all sex partners from the preceding 2 months should also be tested and treated for infection

90
Q

Acute rhematic fever vs juvenile regarding migratory arthritis

A

Only acute rheumatic fever

91
Q

acute rhematic fever - minor criteria

A
  1. fever
  2. ESR/CRP
  3. Arthralgia
  4. prolonged PR
92
Q

juvenile arthritis vs transient synovitis regarding time

A

juvenile: more than 6 wks

transien is for less than 4 wks

93
Q

spinal musc atrophy - pupils

A

not affected

94
Q

febrile seizures prognosis

A
  • normal development
  • less than 5% increase in risk of epilepsy
  • 30% or reccurence
95
Q

hirsburg - air in the rectum?

A

NO

96
Q

weight and height in 1 year old

A

weight triples

height increases by 50%

97
Q

respond to name at

A

6 months

pediatrics (16 decks)

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