difficult to remember Flashcards
1
Q
findings in infants of diabetic mothers
A
- Macrosomia (2nd and 3rd trimester) –> branchial plexopathy, clavicle fracture, perinatal asphyxia
- Small left colon syndrome (1st trimester)
- Cardiac anomalies (1st trimester)
- renal vein thrombosis (1st trimester)
- metabolic findings and effects (2nd or 3rd trimester)
- spontaneous abortion (1st trimester)
- polycythemia (2nd and 3rd trimester)
- neural tube defects (1st)
2
Q
infants of diabetic mothers - Metabolic findings + effects
A
hypglycemia: seizures
hypocalcemia: tetany
hypomagnesia: hypocalcemia + low PTH
hyperbilirubinemia: icterus = kernictuerus
3
Q
infants of diabetic mothers - renal vein thrombosis
A
- Flank mass + possible bruit
- hematuria + thrombocytopenia
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
5
Q
glycogen storage diseases - enzymes
A
- Von Gierke: glucose-6-phosphatase
- Pompe: lysosomal a-1,4-glucosidase (acid maltase)
- Cori: a-1,6-glucosidase def
- McArble: myophosphorylase
6
Q
epiglottitis vs croup on x-ray
A
epiglottitis - thumbprint signs
croup - steeple sign
7
Q
epiglottitis - treatment
A
- incubate (in OR in case unsuccesful intubation makes tracheostomy necessary
- ceftriaxone for 7-10d
- Rifampin for all close contacts
8
Q
epiglottitis vs croup - most accurate test
A
croup: PCR
epiglottitis: C+S from tracheal aspirate
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
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
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
12
Q
indications for palivizumab in infants
A
- preterm births less than 29
- chronic lung diseaes of prematurity
- hemodynamically significant CHF
13
Q
common causes of neonatal respiratory distress - causes
A
- transient tachypnea of newborn (term or posterm)
- resp distress syndrome (preterm)
- persistent pulm hypertension (term or posterm) –> makes R to L shunts (through foramen ovale, PDA)
14
Q
Congenital hip dysplasia - age / RF
A
infants
- breech positioning
- family history
- excessively tight swaddling
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
16
Q
systemic-onset juvenile idioath arthritis - clinical presentation
A
auto-inf disease in children:
- long stading daily fever
- arthritis of 1 or more joints (more than 6 weeks)
- pink macular rash
17
Q
metatarsus adductus vs congenital clubfoot regarding treatment
A
metatarsus –> reassurance
clubfoot –> serial manipulation + casting (surgery if refractory)
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
19
Q
Geleazzi test
A
leg-length discrepancy in developmental dysplasia of the hip
20
Q
normal delivery - after? (steps) (after apgar)
A
- suction of mouth and nose
- clamping + cutting of the umbilical cord
- newborn is then dried, wrapped in clean towels, and place under a warmer (it was in a warm environment in uterus)
- gentle rubbing or stimulating the heels to stimulate crying and breathing
- Vit K + opthalmic oitments
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
22
Q
delivery associated scalp injuries - types
A
- capute succedaneum: swelling of soft tissues, CROSS sutures lines
- Cephalohematoma: subperiosteal hemorrhage DOES NOT cross suture lines
23
Q
diaphragmatic hernia - types
A
- Morgagni: defect in retrosternal or parasternal
2. Bochdalek: defect in posterolateral (MC, usually left)
24
Q
Charge syndrome
A
Cologoma or iris, heart defects Atresia of nasal choanae Growth retardation Genitourinary abnormalities Ear abnormalities
25
Risk factros for cryptorchidism
1. prematurity
2. small for gestational age
3. low birth weight
4. genetic disorders
5. hypospadias
26
jaundice is consider pathologic when
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
27
infants - iron
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
28
risk for iron def anemia in infants
prematurity
iron def mother
cow's milk before 1 year
Delay start of solid food
29
timeline of infant nutrition
```
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
```
30
Fanconi's anemia
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
31
anemia of prematurity - etiology
- impaired EPO production
- short red blood cell life span
- Iatrogenic blood sampling
32
anemia of prematurity - clinical manifestation and labs
- asymptomatic, tachycardia, apnea, poor weight gain
| - low reticulocyte count, normocytic, normochromic
33
anemia of prematurity - treatment
minimize blood draws, iron, transfusion
34
ITP - treatment
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
35
harlequin sign
absent facial flushing (Horner syndrome)
36
Klinefelter syndrome - lab/endocrine profile - mechanism
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
37
evaluation of primary amenorrhea
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
38
emergency contraception options - methods and efficacy
1. copper IUD --> 99%
2. Ulipristal pill --> 85 or more
3. Levonorgestrel --> 85%
4. OCPs --> 75%
39
contraindications to breastfeedings
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
maternal benefits for breastfeeding
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
infant's benefits from breastfeeding
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
kidney stones - types and urine crystals
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
vesiculateral reflex - grades
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
indications of renal + bladder U/S
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
Henoch - Schonlein - manifestation / treatment
triad: arthralgia, abd pain, palpable purpura on legs and buttocks + IGA NEPHROPATHY
- supportive (NSAID and hydration)
- if severe: hospitalization + glucocorticoids
46
indications for voiding cystourethogram
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
Tourette syndrome - treatment
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
Reactive attachment disroder
- emotional + social withdraw as well as lack of positive respones to attempts to confront
- caused by early childhood abuse or neglect
49
Landau-Kleffner syndrome
regression of language skills due to severe epileptic attacks --> language skills typically deteriorate at age 3-6
50
selective mutism - treatment
CBT, family therapy, SSRI
51
transposition of great vessels - x-ray
egg on a string heart
52
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
- trasnp of great vessels
| - Hypoplastic left heart syndrome
53
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
FALLOT
| Truncus arteriosus
54
total anomalous pulm venous return with obstruction - x-ray
pulm edema, snowman sign
55
patent ductus arteriosus is often due to
1. congenital rubella
2. prematurity
3. birth at high altitudes
4. fetal alcohol syndrome
56
vascular rings?
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
transposition of great vessels - examination and x-ray
Single S2 +/- VSD murmur
| - egg on a strinng heart (narrow mediastinum)
58
viral myocarditis - prognosis
- mortality: gretar in newborns
| - outcome of survivors: full recovery in 66%, CHF in 33%
59
Lennox-Gastaut syndrome
presents by age 5 with intellectual disability and severe seizures of varying types
ECG: slow spike wave pattern
60
febrile seizures - criteria
1. age 3 months - 6 years
2. no previous AFEBRILE seizures
3. no meningitis or encephalitis
4. no acute metabolic disease
61
absence seizures vs inattentive staring spelss
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
PKU - diagnosis
1. newborn sceening (spectometry)
| 2. quantitative amino acid analysis (increased phenylalanine levels) (later in life)
63
Trinucleotide repeat expansion diseases
1. Fragile x syndrome - CGG
2. Friedreich ataxia - GAA
3. Huntington - CAG
4. Myotonic Dystrophy - CTG
64
infant vs adult boutilism in presentation
adults phas prodrome symptoms of nausea, vomiting, abd pain, diarrhea
65
Lysosomal storage diseases - types and diseases and enzymes
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
Krabbe disease findings
1. Peripheral neuropathy
2. Developmental delay
3. Optic atrophy
4. Globoid cells
67
Metachromatic leukodystrophy findings
Central and peripheral demyelination with ataxia and dementia
68
Necrotizing enterocoitis - treatment
- stop feeding
- IV fluids
- NGT
antibiotics: vano, gentamicin, metronidazole
if medical management fail --> surgery
69
how to estimate fluid loss of a baby after diarrhea
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
DDX of crying infant
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
evaluation of bilious emesis in neonates
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
milk- or soy-protein induced colitis - treatment
elimiantion of milk + soy from maternal diet of exclusively breastfed infants
initiation of hydrolyzed formula in formula fed infants
73
suspect eosinophilic esophagitis - next step
2 months trial of PPI --> if not improvement --> endoscopy (furrows + circular rings) and biopsy (at least 15 eosinoph)
(dietary modification)
74
pediatric GI - down is associated with
1. hirsburg
2. duodenal atresia
3. imperforate anus
4. umbilical hernia
5. celiac
75
Beckwith-Wiedemann - surveillance
1. serum α-fetoprotein
2. abd/renal U/S
3. monitor for hypoglycemia (only at the beginning)
76
angioedema - best initial test
test for decreased C2 and C4 in the complement pathway as well as deficiency of C1 esterase inhibitor
77
urticaria - treatment
1. antihistamines: hydroxizine, diphenhydramine, fexofenadine, loratadine, cetirizine, ranitidine
2. leukotriene receptor antagonist; monelukast or zafirlukast
78
contraindications of rotavirus vaccination
1. anaphylaxis to vaccine ingredients
2. history of intussusception
3. SCID
4. history of uncorrected congenital malformation of GI
79
DTaP - how many doses and when / contains?
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
Rotavirus - doses, if missed
3 doses: 2, 4, 6 months
no catch-up if behind (no after 8 months)
NO IN INTUSSESUCEPTION)
81
MMR doses
2 does:
1st 12-15 months
2nd: 4-6 years
82
All pregnant should receive screening for
1. HIV
2. HBV
3. Chlamydia
4. syphilis
83
neonatal dehydration - management of weight loss
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
First trimester findings in down syndrome
1. Increased nuchal translucency (UL)
2. Hypoplastic nasal bone (UL)
3. Decreased serum PAPPA-A
4. Increased β-hCG
85
Second-trimester QUAD screen shows in Down syndrome
1. Decreased a-fetoprotein
2. Increased inhibin A
3. Decreased estriol
4. Increased β-hCG
86
Edwards syndrome first trimester (Lab)
Decreased PAPPA-A and free β-hCG
87
Second trimester QUAD screen show of Edward's syndrome
1. Decreased α-fetoprotein
2. Decreased β-hCG
3. Decreased estriol
4. Decreased or normal inhibin A
88
First trimester pregnancy screen show for Platau syndrome
1. Decreased free β-hCG
2. Decreased PAPPA-A
3. Increased nuchal translucency
89
accidental diagnosis with urehtritis (chlam or neisseria) next step
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
Acute rhematic fever vs juvenile regarding migratory arthritis
Only acute rheumatic fever
91
acute rhematic fever - minor criteria
1. fever
2. ESR/CRP
3. Arthralgia
4. prolonged PR
92
juvenile arthritis vs transient synovitis regarding time
juvenile: more than 6 wks
| transien is for less than 4 wks
93
spinal musc atrophy - pupils
not affected
94
febrile seizures prognosis
- normal development
- less than 5% increase in risk of epilepsy
- 30% or reccurence
95
hirsburg - air in the rectum?
NO
96
weight and height in 1 year old
weight triples
| height increases by 50%
97
respond to name at
6 months
