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Peds > Emma Holliday part 2 > Flashcards

Emma Holliday part 2 Flashcards

1
Q

why rectal prolapse with cystic fibrosis?

A

chronic diarrhea

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2
Q

treat CF pt with pneumonia

A

must cover pseudomonas and b cepacia

pipearacillin + tobramycin
or
ceftazidime

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3
Q

what makes mild vs moderate asthma?

intermittent vs persistent?

A

PFTs normal vs abnormal
for mild vs moderate/severe

freq of sx for intermittent (v2&2 2 days/wk 2night/mo) vs
persistent
(2-6 days, daily, throughout the day… weekly nights)

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4
Q

infectious complication of chronic asthma….

A

allergic bronchopulmonary aspergillus

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5
Q

why add K+ to IVMF for T1 diabetic hospitalized kid with hyperglycemia and hypochloremic anion gap metabolic alkalosis from puking

A

because you are going to give insulin and that drives K+ into cells, don’t want serum to get hypokalemic

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6
Q

diagnostic criteria for diabetes

A

fasting gluc ^125 (twice)
any gluc ^200 with sx
2hr OFTT (75g) ^200

(any of the above I think..)

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7
Q

High fever, Then rash maculopapular erythematous on trunk

dx
bug

A

roseola

HHV6 human herpes virus 6

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8
Q

when do we worry about erythema infectiousum, slapped cheek, parvovirus B19

A

sickle cell kids - can cause aplastic crisis

pregnant women - fetus can get hydrops fetalis

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9
Q

2yo low grade fever, lacy reticular rash on cheeks and upper body that spares palms/soles

dx
who to worry about

A

erythema infectiousum, slapped cheek, parvovirus B19

worry about
sickle cell kids - can cause aplastic crisis
pregnant women - fetus can get hydrops fetalis

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10
Q

fine maculopapular desquamating rash begins on chest and spreads to neck, trunk, extremities
strawberry tongue
sore throat 1-2 weeks prior

dx
tx

A

scarlet fever

penicillin to prevent rheumatic fever (won’t prevent PSGN post strep glomerulonephritis)

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11
Q

how and why treat scarlet fever

A

penicillin to prevent rheumatic fever (won’t prevent PSGN post strep glomerulonephritis)

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12
Q

cough runny nose fever.. macular rash begins behind ears and spreads down, gray spots on buccal mucosa

dx
bug
tx

A

measles

paramyxovirus

vitamin A

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13
Q

sore throat, joint pain, fever… pinpoint rash on face spreads down, rose spots on palate

dx
bug

A

rubella

paramyxovirus

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14
Q

complications of lyme

A

arthritis, heart block, meningitis, bell’s palsy

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15
Q

treat lyme

A

doxy ^8yo
amox v8yo

iv ceftriaxone to penetrate csf if complicated by meningitis

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16
Q

tf

treatment of lyme and rocky mountain spotted fever is age dependent

A

lyme is age dependent
doxy ^8yo
amox v8yo
iv ceftriaxone to penetrate csf if complicated by meningitis

RMS is not age dependent
everyone gets doxy

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17
Q

kid went camping, got fever, myalgias, abdominal pain

dx
bug
tx
compx

A

rocky mountain spotted fever

rickettsia rickettsii

doxy for everyone every age

can be complicated by gangrene via vascular infection

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18
Q

treat impetigo

A

topical mupiricin

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19
Q

inflamed conjunctiva and multiple nikolsky positive blisters

dx
path
tx

A

staph scalded skin syndrome
from exfoliative toxin

iv abx

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20
Q

meningitis bug that gets young and immunosuppressed

tx

A

listeria

ampicillin

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21
Q

meningitis bug that gets brain surgery patients

A

staph aureus

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22
Q

tf

TB can cause meningitis

A

T

treat with RIPE and ‘roids

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23
Q

what to give dorm roommate of college kid who got bacterial meningitis and petechial rash

A

rifampin

for nisseria meningitidis ppx

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24
Q

most sensitive finding for otitis media

A

limited mobility on insufflation, or air-fluid level visualized

(may be erythematous and angry just from kid crying)

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25
Q

when to consider ear tube

A

bilateral effusion ^4mos or bilateral hearing loss

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26
Q

treat otitis externa

what bug to cover

A

topical ciprofloxacin

cover pseudomonas

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27
Q

complications of otitis media vs otitis externa

A

media - deafness, so place ear tubes if bilateral effusion ^4mos or bilateral hearing loss

externa - malignant external otitis - can invade temporal bone - facial paralysis, vertigo… so get CT and IV abx if concerned, surgery may be needed

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28
Q

muffled voice, stridor, stiff painful neck

dx
tx
bugs
compx

A

retropharyngeal abscess

IandD for culturs and sensitivities
3rd gen cephalosporin + amp or clinda… to cover GAS and anaerobes

mediastinitis

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29
Q

treat peritonsilar abscess

A

aspiration or IandD + abx

tonsillectomy if recurrent

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30
Q

indications for tonsillectomy

A

recurrent peritonsilar abscess

recurrent step throat
^5 strep/year for 2 years
^3 strep/year for 3 years

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31
Q

what happens if you give mono kid amp or amox,

why

A

maculopapular rash

immune mediated vasculitic

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32
Q

dx mono

A

blood smear with atypical lymphocytosis

heterophile antibody (monospot) test

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33
Q

treat mono

A

rest

no contact sports till splenomegaly resolved

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34
Q

most common epiglottitis bugs in vaccinated child

A

ga strep pyogenes
strep pneumo
staph aureus

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35
Q

epiglottitis
next step
next step

A

intubate IN THE OR (very sensitive airway, manipulation may inflame and cut off acutely)

anti-staph abx + 3rd gen cephalosporin

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36
Q

acute bronchitis

get cxr?

A

no

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37
Q 
suspect pneumonia
next step
most common bugs in v1mo
most common bugs in 1-3mo
specific finding for chlamydia pna?
most common bugs in 4mo-5yo
most common bugs in ^5yo
A

cxr

v1mo GBS Ecoli Lysteria
(same as meningitis)

1-3mo strep pneumo, chlaymidia trachomatis, RSV, paraflu

chlamydia pna staccato cough, eosinophilia

4mo-5yo VIRAL (RSV) then strep pneumo (the only age that viral is most common)

^5yo mycoplasma and strep pneumo like adults

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38
Q

cxr findings in rsv bronchiolitis

A

hyperinflation with patchy atelectasis

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39
Q

who needs rsv vaccine

A

palivizumab for premies, congenital heart disease, lung disease (CF), immune disease

40
Q

lab finding in pertussis

A

high lymphocytes

weird because it is a bacteria

41
Q

treat family members and kids in daycare of pt with pertussis?

A

yes
with erythromycin, just like pt
(very contagious)

42
Q

tf

cystitis can have fever

A

f

febrile uti is PYELONEPHRITIS

43
Q

prophylactic tx for child with vsicoureteral reflux

A

ppx abx for recurrent uti risk

44
Q

when get ultrasound for UTI

A

anytime uti is febrile

for anatomy, abscess, hydronephrosis

45
Q

treat UTI

treat pyelo

A

uti - po tmpsmx or nitrofurantoin

pyelo - 14 days IV ceftriaxone or amp + gent

46
Q

who needs VCUG in setting of UTI

A

any male at first UTI

any female v5yo
any female ^5yo with 2nd uti
any pyelo

47
Q

best test for scarring in setting of pyelonephritis

A

Tc-labeled DMSA scan…

48
Q

most common cause of limp in child

A

just trauma
not transient synovitis, septic joint, ddh, legg-calve perthes, scfe,

just trauma, ouchie, booboo

49
Q

5yo boy with painless limp now has pain in thigh

A

legg calve perthes

AVN of hip

50
Q

preteen female with 2wk hx daily fevers, random rash, joint pain and swelling

dx
good prognostic factor
bad prognostic factor
tx

A

JRA juvenile rheumatoid arthritis

+ANA actually good prognostic factor

+RF bad prognostic factor, also older age, multiple joints

1st line tx NSAID
2nd MTX
3rd steroids

51
Q

best 1st test when kawasaki’s diagnosed

A

echo and ekg

for scary coronary artery aneurysms

52
Q

treat kawasaki

A

high dose aspirin
IVIG

then aspirin and warfarin

53
Q

treat kawasaki with high or low dose aspirin?

A

high dose aspirin
IVIG

then aspirin and warfarin

54
Q

diffuse bone pain in peds pt w petechiae, pallor, and increased infections

top dx

A

leukemia

55
Q

sickle cell pt w point tenderness over femur, fever, and malaise

top dx

A

osteomyelitis

salmonella

56
Q

howell jolly bodies in sickle cell pt tells you…

A

autosplenectomy has occured

57
Q

sickle cell pt, acute drop in HCT, with decreased retics

A

aplastic crisis

suspect parvovirus B19 slapped cheek erythema infectiousum

58
Q

recurrent RUQ pain after meals in sickle cell pt think…

A

cholecystitis from pigment gallstones, do cholecystectomy

59
Q

sickle cell pt in respiratory distress without fever cough chest pain chills think..

A

hyperplastic tonsils
(waldeyer ring)
get tonsillectomy

if fever cough chest pain chills sob think acute chest syndrome (pulmonary infarct) - get exchange transfuion to rid sickle cells

60
Q

most common surgical procedures for sickle cellpatients

A

cholecystecomy for cholecystitis from pigment gallstones

tonsillectomy for waldeyer ring (hyperplastic lymphoid tissue… respiratory distress)

61
Q

proteinuria and increased Cr and recurrent UTIs in sickle cell pt think..

A

kidney infarcts

62
Q

most common cause of sepsis in sickle cell pt

A

strep pneumo
(not salmonella!)
because…encapsulated? post-autosplenectomy?

63
Q

sickle cell pt in respiratory distress with fever cough chest pain chills think.. tx…

A

acute chest syndrome (pulmonary infarct)

get exchange transfuion to rid sickle cells

64
Q

most common cause of death in sickle cell patient

A

acute chest syndrome (pulmonary infarct)

sickle cell pt in respiratory distress with fever cough chest pain chills

65
Q

acute confusion and fnds in sickle cell pt

think. ..
tx. ..

A

stroke

exchange transfusion to rid sickle cells
not tPA!

66
Q

can increase HbF in sickle cell baby with

A

hydroxyurea

67
Q

vaccinations and ppx for sickle cell pt

A

strep pneumo
h flu
nisseria meningitidis
(encapsulated organisms, because autosplenectomy)

penicillin ppx till age 6…

68
Q

sickle cell pt with fativue and megaloblastic anemia think.. why?

A

folate deficiency

because more RBC turnover, higher demand

69
Q

treat baby with sickle cell

A

hydroxyurea to maintain HbF
manage pain
bone marrow transplant is curative but 10% postop mortality…

70
Q

unconcerning anemia in kids

A

physiologic HandH drop v3mos old

immunosuppresion after viral infection - transient erythroblastopenia 3mos-6yo

71
Q

lab tip for thalassemia

A

very low MCV (e.g. 60)

72
Q

8mo irritable, glossitis, failure to thrive, drinks goats-milk formula, picky eater

top dx
tx

A

folate deficiency

supplement folate

73
Q

pale baby, anemic, low retics, triphalangeal thumbs

top dx
tx

A

blackfan-diamond anemia

corticosterods, transfusions, stem cell bone marrow transplant

74
Q

anemia
no thumbs
no radius

top dx
diagnostic tests
tx
complications

A

fanconi anemia

bone marrow shows bone marrow hypoplasia, chromosomal breaks on cytogenetic tests

corticosteroids, androgens, bone marrow transplant

increased cancer risk

75
Q

baby with low WBC, anemia, low plts… cafe-au-lait spots, microcephaly, absent thumbs

top dx
diagnostic tests
tx
complications

A

fanconi anemia

bone marrow shows bone marrow hypoplasia, chromosomal breaks on cytogenetic tests

corticosteroids, androgens, bone marrow transplant

increased cancer risk

76
Q

2yo hyperactivity, impaired growth, abdominal pain, constipation, basophilic stippling of RBCs on peripheral smear

top dx
dx test
tx

A

lead poisoning

led level in venous blood sample

  • treat level ^45 with oral succimer (sucks to be a kid with lead poisoning)
  • treat really high level ^70 with admission for EDTA and dimercaprol IV
77
Q

lead poisoning screening

A

blood lead levels 12-24 mos age 1-2years

especially if low SES, old house from 1960s or earlier

78
Q

15yo F recurrent epistaxis heavy menses petechiae, low platelets

top dx
tx
give platelets?

A

ITP

IVIG for 1-2 days
predisone
splenectomy

NO DON”T GIVE PLTS!…

79
Q

15yo F recurrent epistaxis heavy menses petechiae, normal platelets, inc bleeding time and PTT

top dx
tx

A

von Willebrand disease (normal number but defective platelets)

DDAVP for bleeding or preop
replace factor VIII and vWF

80
Q

7yo M with recurrent bruising, hematuria, hemarthroses, inc PTT

top dx
tx

A

hemophilia

if mild tx w DDAVP
otherwise replace factor VIII or IX depending on type of hemophilia

81
Q

diathesis means

A

tendency to suffer from a particular medical condition

82
Q

1wk newborn born at home now bleeding from umbilical stump and bleeding diathesis (tends to bleed)

top dx and pathophys
tx

A

Vitamin K deficiency
(dec factors II VIII IX X)

give FFP and vit K shot

83
Q

risk factors for vit k deficiency

one healthcare related

one genetic

A

born at home without vitamin K shot

CF malabsorption

84
Q

peds pt with wilson disease developed fulminant liver disease

1st factor depleted
1st coag abnormality
two factors not depleted

A

factor VII depleted first
PTT increased first

vWF and factor VIII are normal

85
Q

toddler with petechiae, abdominal pain, vomiting, lethargy. bloody diarrhea 5 days ago after hamburgers at family picnic. labs thrombocytopenia and inc Cr

top dx
rank most common causes
tx
give platelets?
give abx?
A

HUS hemolytic uremic syndrome

ecoli O157H7
shigella
salmonella
campylobacter

aggressive TPN nutrition
early peritoneal dialysis
*don’t give platelets!! can inc HUS
*don’t give abx to treat bloody diarhea! can inc HUS

86
Q

give abx for bloody diarrhea?

A

NO!
can inc risk of HUS
(toddler with petechiae, abdominal pain, vomiting, lethargy. bloody diarrhea 5 days ago after hamburgers at family picnic. labs thrombocytopenia and inc Cr)

87
Q

IgA and __ deposited in skin in HSP

A

IgA and C3

88
Q

peds new onset seizure, ataxia, headache worse in morning, vomiting, for a month

most common, prognosis
2nd most common, prognosis

A

most common brain tumor of childhood - pilocytic astrocytoma of cerebelllum, resect, 90% survive

2nd most common brain tumor of childhood - medulloblastoma.. very poor prognosis

89
Q

adolescent 5% for height, bitemporal hemianopsia, calcifications in sella turcica

top dx
pathogenesis

A

craniopharyngioma

remnant of Rathke’s poutch

90
Q

2yo hypertensive with asymptomatic abdominal mass noticed while mom bathing him

top dx
associations
best test
treatment

A

Wilm’s tumor

assoc Wilms tumor with aniridia, GU anomalies, hemihypertrophy, Beckwith-Weidemann syndrome

abdominal CT, CXR to check for lung mets

resect, chemo, radiation

91
Q

4yo dancing eyes dancing legs bluish skin nodules and tender abdominal mass

top dx
diagnostic test

A

neuroblastoma

urine HVA and VMA
(homovanillic acid and vanillylmandelic acid… catecholamine metabolites… sympathetic chain ganglion / adrenal medulla tumor)

92
Q

CALLA and TDT are markers of

A

ALL

93
Q

best test for ALL

A

bone marrow biopsy with ^30% lymphoblasts

94
Q

treat ALL

A

chemo
+
intrathecal methotrexate for CNS

95
Q

poor prognostic factors for ALL

A

v1yo or ^10yo

lots of WBCs.. on bone marrow biopsy? ^30% lymphoblasts is diagnostic… a lot more than that means poor prognosis?

96
Q

peds pt with large painless rubbery nodes, drenghing fevers, 10% weight loss, owl eyes on path

top dx
best test
next step
tx

A

Hodgkin lymphoma

best test excisional biopsy

next step staging CT

tx resection chemo radiation

97
Q

peds pt with non-productive cough and large anterior mediastinal mass on cxr

top dx
best test
tx

A

non-hodkin lymphoma

biopsy mass
biopsy bone marrow for staging

resect if abdominal
anti-cd20 if bcell tumor
radation for some

Peds (12 decks)

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