Falcon Review Pediatrics 4 Flashcards
1
Q
What is enuresis
A
The involuntary passage of urine in a child who should be toilet trained
Usually by five years of age
2
Q
What are the causes of enuresis
A
Primary which is 90% of time: patient has never been dry
Secondary 10 %: previously continent child becomes acontinent usually associated with emotional difficulty
3
Q
What is the treatment for enuresis
A
Limiting water and take at night
Buzzer
Imipramine
DDAVP
4
Q
What should be considered for a febrile UTI child less than three
A
Pyelonephritis
5
Q
What causes a UTI
A
Usually they sending infection from: Proteus E. coli Enterococcus Klebsiella Staph saprophyticus
6
Q
What are the signs and symptoms of a UTI
A
Lower tract signs: dysuria, polyfrequency
Upper tract signs: fever, flank pain, chills
Nonspecific signs infants (fussiness, lethargic, vomiting)
7
Q
What is the gold standard for diagnosing UTI
A
Urine culture
8
Q
What will a urinalysis demonstrate for UTI
A
Greater than five white blood cells per high-powered field
Positive for nitrites
Leukocyte esterase
9
Q
What imaging can be done for UTI
A
Consider renal ultrasound for first UTI
VCUG abnormal renal ultrasound or recurrent febrile UTI
10
Q
What is a vesicoureteral reflux
A
abnormal backflow of urine from the bladder to the kidney cased by congenital
incompitence of the vesicoureteral junctions
11
Q
What are the classifications of a vesicoureteral reflux
A
Grade I-ureter only
Grade II-without dilation of kidney
Grade III-mild to moderately dilated ureter
Grade IV-moderately dilated ureter pelvis and calyces
Grade V- this massive reflux
12
Q
What is the diagnostic test of choice for vesicoureteral reflux
A
VCUG
13
Q
What is the treatment for vesicoureteral reflux
A
Surgical repair for grade 4 or 5 reflux
14
Q
What are the complications of this vesicoureteral reflux
A
Pyelonephritis
Real scarring
Reflux nephropathy
Hypertension
15
Q
What is required to diagnose acute poststreptococcal glomerulonephritis
A
Evidence of an antecedent strep infection
Low C3 and low CH 50 returns to normal in about eight weeks (in MPGN and lupus nephritis (SLE), the C3 level remains low)
C4 typically normal
16
Q
What is the Pathophysiology of acute poststreptococcal glomerulonephritis
A
Immune-complex depositional glomerular basement membrane
17
Q
What is the treatment for acute streptococcal glomerulonephritis
A
Consider anabiotic’s of untreated step (does not modify renal disease)
Treat hypertension, support real failure
95% will have complete recovery
18
Q
What is the most common cause of chronic hematuria worldwide
A
IgA nephropathy
Bergers nephropathy
19
Q
What are the signs symptoms of IgA nephropathy
A
Acute onset gross hematuria following a respiratory illness
Persistent microscopic hematuria
20
Q
What is the treatment for IgA nephropathy
A
Steroids
ACE inhibitor
21
Q
Discuss hemolytic uremic syndrome
A
Exposure to E. coli 0157:H7 is produces a shiga-like toxin causes microangiopathic hemolytic anemia, acute renal failure and thrombocytopenia
22
Q
What are the risk factors for E. coli 0157:H7
A
Undercooked meat
Inadequately wash fruits
Vegetables exposed to manure
23
Q
What are the signs and symptoms of hemolytic uremic syndrome
A
Approximately one week after acute onset of abdominal pain, nausea vomiting and bloody diarrhea the patient will develop oliguria, pallor, weakness, lethargic, petechiae
24
Q
What is diagnostic for hemolytic uremic syndrome
A
Anemia with hemolysis on smear (schistocytes)
Decreased platelets
Hematuria/protein urea, renal insufficiency (uremia)
25
What is nephrotic syndrome
Glomerular disorder characterized by proteinuria, hypoalbuminemia, edema and hyperlipidemia
90% are idiopathic, of those, 85% are minimal change
26
What are the signs and symptoms of nephrotic syndrome
PeriOrbital edema, abdominal pain and fatigue
Usually follows a viral upper respiratory infection
Hypertension is uncommon
27
What will be seen on electron microscopy for minimal change disease
Effacement of foot processes of renal epithelial cells
28
What are the signs and symptoms of Alport syndrome
Asymptomatic hematuria
Sensorineural hearing loss
Eye abnormalities
29
What will a renal biopsy demonstrate for patient with Alport syndrome
Glomerulosclerosis
Thickening basement membrane
Foam cells
30
What is the pathophysiology of Alport syndrome
Is the most common hereditary nephritis; X-linked
| It's a disorder of type IV collagen affecting basement membranes of kidney, eye and Ear
31
What is the most common cause of hydronephrosis in childhood
Uteropelvic junction obstruction
32
What are the causes of a uteropelvic junction obstruction
Intrinsic: ureteral hypoplasia, kinked ureter
| Extrinsic causes: external compression by renal vessels
33
What is the most common cause of abdominal mass neonates
Hydronephrosis
34
How is a uteropelvic junction obstruction diagnosed
Intravenous pyelography, ultrasound
35
What is the treatment for utero pelvic Junction instruction
Surgery
36
What are the signs and symptoms of posterior urethral valve
Weak or dribbling urine streams
UTI
Leaflets in the prosthetic urethra causing partial bladder outlet obstruction only found in males
37
What is the treatment for posterior urethral valves
Transurethral ablation
38
What is hypospadias
Most common congenital anomaly of the penis in which to urethral meatus is malposition along the ventral surface of the penis
39
What is contraindicated with hypospadias
Circumcision.
| The foreskin will be needed for surgical repair
40
What is cryptorchidism
Undescended testes that cannot be manipulated into the scrotum, retractable testes retracted back into the scrotum.
41
What arrests factors for cryptorchidism
Prematurity
42
What is the treatment for cryptorchidism
Surgical repair if testes have not descended by age 1
43
Or complications are associated with cryptorchidism
Torsion
| Testicular cancer
44
What is a testicular torsion
Twisting of the sporadic cord with Strelach of the blood supply to the effect testicle; surgical emergency
45
What are the signs and symptoms of a testicular torsion
Acute onset of unilateral scrotal pain, nausea, vomiting, swollen exquisitely tender testes, scrotal edema and absence of cremasteric reflex
46
What is the hydrocele
Fluid filled sac of the scrotal cavity (remnant of tunica vaginalis).
Diagnosed by transillumination
Usually self resolving
47
What is a varicocele
Dialated testicular vein and enlarge pampiniform plexus results of absenting venous valve; presents in adolescents
"bag of words" on physical exam while standing and disappears in the supine position
48
What is achondroplasia
autosomal dominant condition (mutation in F GFR 3) resulting in disorder growth
signs and symptoms: short stature, large head, prominent for head, short limbs, lumbar lordosis, normal intelligence
prognosis: normal lifespan
49
What is osteogenesis imperfecta
Abnormal synthesis of type I collagen; most often autosomal dominant
signs and symptoms: brittle bones and blue sclera
multiple fractures
50
What is developmental dysplasia of the hip
Congenital hip dislocation that usually presents in the newborn. That may be detected as late as three years of age
51
Palace developmental dysplasia of the diagnosed
Barlow or Ortolani signs
ultrasounds (newborns)
"frog-leg" lateral x-ray (older infants/children)
52
What is Legg-Calve-Perthes
idiopathic avascular necrosis of the femoral head
| 20% of the cases arebilateral
53
What are the risk factors for Legg-Calve-Perthes
Ages 4 to 12 years
| males 5 to 1
54
What are the signs and symptoms of Legg-Calve-Perthes
Limping
initially painless but may become painful; worsened by activity and relieved by rest
as with all hip problems-referred knee pain
55
What are the steps to diagnose Legg-Calve-Perthes
Plain radiograph reveals wide articular space, necrosis, and eventually a flat femoral head
56
What is a slipped capital femoral epiphysis
SCFE
| Displacement of the femoral head from the epiphysis
57
what are the risk factors for a slipped capital femoral epiphysis
Obese adolescents
58
what are the signs and symptoms of the slipped capital femoral epiphysis
Growing pain or knee pain, often after activity
| limited internal rotation/abduction of the hip
59
What are the steps to diagnose a slipped capital femoral epiphysis
Plain radiography reveals medial displacement of the epiphysis, bare upper femoral neck, wide growth plate
60
What is the treatment for a slipped capital femoral epiphysis
Surgery: pending, external fixation, casting
61
One of the types of Salter-Harris fractures
Type I: fracture through growth plate
type II: fracture through growth plate and metaphysics
type III: fracture through growth plate and epiphysis
type IV: fracture through both the metaphysis and epiphysis
type V: crushed growth plate
62
What a scoliosis
Abnormal curvature of the spine caused by misalignment in the frontal plane
63
What are the causes of scoliosis
Idiopathic
congenital: vertebralanomalies
neuromuscular
64
What are the steps to diagnose scoliosis
Adams tests: forward bending with rib bump
| x-ray
65
What is the treatment for scoliosis
Mel curves needed therapy
bracing recommended to slow down progression
surgery required for severe greater than 45°; fusion, fixations rods
66
What is talipes equinovarus
Clubfoot
causes:
sporadic and/or idiopathic
teratogenic
Oligohydramnios
signs and symptoms:
calcaneus and talus in plantar flexion (adduction); inability to bring foot to plantigrade position-tight Achilles
-forefoot and midfoot in adduction
67
What is the treatment for talipes equinovarus
Stretching/manipulation initially with serial casting
| surgery possible unfavorable response and for severe cases
68
What is metatarsus adductus
Most common foot deformity in infants 2/1000
thought to be due to in utero positioning
Forefoot is adducted but hind foot is normal
"flexible": forefoot can be brought to the neutral position
69
What is the treatment for metatarsus adductus
Observation, passive range of motion for most flexible feet-90% result by age 4
casting/surgery for treatment failures and/or non flexible feet
most common cause of in-toeing less than 18 months
70
What is a tibial torsion
Normal development: lateral rotation of tibia from 5° at birth to 15° of maturity so medial torsion improves with time
most common cause of in-toeing in children 18 months to three years
usually secondary to in utero positioning
almost always self resolving
71
What is a femoral anteversion
Normal development: femoral anteversion of 40° in newborn, decreased to 10 to 15° by adolescence
most common cause of in-toeing in children older than three years, usually presents age 4 to 6
prefer the"W" position and cannot sit cross-legged
72
What is a popliteal cyst
Baker's cyst
arises from capsule or tendon sheath, sometimes as the result of an injury. Common in children between 4 and 7 years
signs and symptoms:
-painless, non-pulsatile swelling on posterior knee; more prominent with the extension
usually resolve spontaneously
73
What is Osgood Schlatter disease
Traction apophysitis of the tibial tubercle caused by overuse
signs and symptoms:
- localized tenderness/swelling of tubercle
- pain worsened with activity; relieved by rest
- seen during periods of rapid linear growth
74
What is the treatment for Osgood Schlatter disease
NSAIDs and rest
| usually self resolves over 12 to 24 months
75
What is nursemaid's elbow
Radial head subluxation
sudden traction of the arm of a child less than 4 years
signs and symptoms:
-sudden pain in refusal to use arm; arm held partially flexed elbow and pronated
76
What is the treatment for nursemaid's elbow
Reduction by gentle supination of hand in flexion at elbow with pressure over the radial head; click may be heard
77
What are the types of juvenile rheumatoid arthritis
Pauciarticular
polyarthritis
systemic
78
What are the general signs and symptoms of juvenile rheumatoid arthritis
Morning stiffness
joint pain
swelling
low-grade fever
79
What are the features of pauciarticular JRA
55%
- four or fewer joints involved
- typically larger joints often asymmetric
- may be ANA positive
- maybe HLA B27 positive
– majority or seronegative
– increase risk of iritis
80
what are the features of polyarticular JRA
35%
– five or more joints involved
– typically small joints, especially hands
– maybe RF positive
– maybe ANA positive
worse prognosis associated with older children
81
What are the features of systemic JRA
10% (stills disease)
– initial extra articulate manifestations such as fever, rash, plueritis, pericarditis
82
What arethe steps to diagnose JRA
– Elevated ESR, CRP, WBC, PLT
– x-ray: soft tissue swelling early, bone changes later
– ANA and haplotyping as indicated by clinical picture
83
What is the treatment for JRA
NSAIDs are first-line treatment
methotrexate
antimalarials
PT, ophthalmology follow-up – iritis
84
What is Systemic Lupus Erythematosus
Autoimmune multisystem disease
primarily affecting females greater than 8 years of age
85
What is the criteria to diagnose Systemic Lupus Erythematous
```
Minimum of 4:
– malar rash
– serositis
– arthritis
– neurologic
– anti-nuclear antibody
– Renal
– discoid rash
– oral ulcer
– photosensitivity
– hematologic
– immunologic
```
86
What are the steps to diagnose SLE
ANA best screening test
double-stranded DNA antibodies
decreased C3/C4/C 50
anti-Smith antibodies
87
What is the treatment for SLE
NSAIDs, steroids, cyclophosphamide
| consider anticoagulants
88
What are the complications of SLE
Nephritis
CNS complications
infection
89
What is neonatal lupus
Newborns of mothers with Lupus
transfers of a IgG autoantibodies
signs and symptoms:
– congenital heart block (highly associated with anti-Ro positivity)
– other transient manifestations such as rash
90
What is dermatomyositis
Inflammatory disease involving small vessels of skin, striated muscle, and occasionally the G.I. tract
usually presents around six years of age
typically will present as a girl having difficulty brushing her hair
91
What are the signs and symptoms of dermatomyositis
Malaise, fatigue, weight loss, intermittent fever
progressive muscle weakness of pelvic and shoulder girdle muscle groups
Violaceuos dermatitis of the eyelids, hands, elbows, knees and ankles
– elevation of serum creatinine kinase
– Groyton papules
– 10% will progress to wheel chair dependence
92
What is Kawasaki disease
Mucocutaneous lymph node syndrome
– most common cause of court heart disease in children
93
What arethe signs and symptoms of Kawasaki disease
Fever lasting greater than 5 days and 4 of the 5 of the following:
1. Conjunctivitis, limbic sparing
2. Oral mucosal changes, strawberry tongue, cracked lips
3. Rash, often perineal
4. Extremity changes (erythema palms and soles, swelling of hands and feet)
5. Cervical lymphadenopathy greater than 1.5 cm usually unilateral
94
What are the complications associated with Kawasaki disease
Coronary artery aneurysms and 25% of untreated individuals
95
What is the treatment for Kawasaki disease
IVIG and high-dose aspirin initially decreases incidence of late onset aneurysms
low-dose aspirin for 6 to 8 weeks until inflammatory markers normalize and eight-week echo shows no aneurysms
96
What is Henloch Schonlein Purpura
IgA mediated vasculitis of small vessel; often follows viral URI
signs and symptoms:
colicky abdominal pain, palpable purpuric rash with normal platelets on buttocks, renal manifestations, edema, arthritis (classically knee)
– increased risk for developing intussusception
97
What is the treatment Henloch Schonlein Purpura
Supportive
not indicated to Arthritis and other criteria present
consider corticosteroids for severe abdominal pain
98
What is precocious puberty
Secondary sex characteristics present in female before age 8 or males before age 9, especially pubarche with virilization
99
What are the causes of precocious puberty
Central (GnRH dependent)
– CNS lesions and idiopathic
– CNS lesions are more common in boys
peripheral (pseudo-precocious puberty: GnRH independent)
– exogenous sex hormones, CAH, adrenal tumors
100
How are sex hormones stimulated
GnRH acting in pulsatile fashion stimulates LH/FSH
| LH stimulates Leydig cells and granulosa cells
101
What are the steps to diagnose precocious puberty
1. Bone age
2. LH – delineates Central from noncentral
3. Hormone levels: testosterone, estrogen, DHEA S, 17 – 0H progesterone
4. CNS imaging if young child or male
102
What is premature thelarche
Isolated breast development
103
what is premature adrenarche
Appearance of sexual hair
steps to diagnose:
– adrenal androgen's are often slightly elevated for chronological age
– bone age is slightly advanced
– usually idiopathic and benign
104
What is the treatment for central precocious puberty
Injections of long-acting GnRH-leuprolide-(interrupts pulsatile stimulation)
105
What is the reason to treat for central precocious puberty
1. Social
| 2. Early puberty equals premature closure of growth plate
106
What definesshort stature
Height below the 3rd percentile
107
How short stature diagnosed
Growth curve
family history and Hts.
wrist film for bone age
108
What are the causes of diabetes mellitus type I
Deficiency of insulin
autoimmune
possible viral trigger
109
What are the steps to diagnose diabetes mellitus
Random glucose > 200
fasting glucose > 126
two hour glucose tolerance test >200
110
What arethe complications associated with diabetes mellitus
Retinopathy
nephropathy
neuropathy
111
What is diabetes insipidus
Loss of ADH secretion and inability to concentrate the urine
– maybe central or nephrogenic
Central: lack of ADH secretion
nephrogenic: kidneys do not respond ADH
112
What are the signs and symptoms of diabetes insipidus
Polyuria
polydipsia
dehydration with dilute urine
113
What is the most common cause of congenital hypothyroidism
Idiopathic thyroid dysgeneisis
114
What are the signs and symptoms of congenital hypothyroidism
```
Jaundice
poor feeding
large tongue
constipation
umbilical hernia
wide fontanelle
hypotonia
developmental delay
```
115
What are the signs and symptoms of acquired hypothyroidism
```
Growth deceleration
constipation
cold intolerance
decreased energy
goiter
```
116
What is the most common cause of hyperthyroidism
Graves' disease (toxic quarter associated with HLA-B8, HLA-DR 3)
117
What causes neonatal hyperthyroidism ininfants
Infants born to mothers with Graves' disease. Maternal antibody's my cross placenta and induce hyperthyroidism
118
What are the signs and symptoms of hyperthyroidism
```
Hyperactivity
increased appetite
emotional disturbance
exophthalmos
sweating
tachycardia
palpitations
```
119
What is the treatment for hyperthyroidism
propylthiouracil, methimazole
propanolol for symptoms
surgery or radio ablation
120
What is congenital adrenal hyperplasia (CAH)
Disorder of steroid biosynthesis resulting in cortisol deficiency in androgen overproduction
21-hydroxylase deficiency is the most common cause
– salt was: hyponatremia, hypokalemia, hyperkalemia, elevated renin, decreased aldosterone
121
Is 11 B hydroxylase deficiency associated with salt wasting
No, they are not so losing
122
How is congenital adrenal hyperplasia diagnosed
ACTH challenge test for diagnosis
check levels of steroids for the precursors (17-OH progesterone levels)
in 21-OH deficiency: decreased cortisol and aldosterone, increased ACTH in 17 OH progesterone levels
123
What is the treatment for congenital adrenal hyperplasia
```
Glucocorticoids (increased doses during stress)
mineralocorticoid's
sodium replacement (salt losers)
```
124
What is Cushing's syndrome
High cortisol level
– exogenous corticosteroids
– endogenous overproduction (pituitary adenoma, bilateral adrenal hyperplasia, adrenal tumor)
```
signs and symptoms:
– Moon feces
– truncal obesity
– abdominal striae
– Buffalo hump
– hypertension
– muscle weakness
```
125
How is Cushing's syndrome diagnosed
Elevated serum cortisol level and increased 24-hour urine free course all tests
if cortisol elevated, dexamethasone suppression test
look for pituitary adenoma, adrenal tumor
126
What is Addisondisease
Adrenal insufficiency resulting in low production of cortisol, two types:
1. Primary adrenal insufficiency
2. Secondary adrenal insufficiency
127
What are the causes of primary adrenal insufficiency Addison's disease
Autoimmune
congenital
ACTH unresponsiveness
infarct hemorrhage
associated with adrenoleukodystrophy
128
What are the causes of secondary adrenal insufficiency Addison's disease
ACTH deficiency
129
What arethe signs and symptoms of Addison's disease
```
Weakness
vomiting
weight loss
salt craving
increased pigmentation (increased ACTH)
```
130
What will the labs demonstrate for Addison's disease
Hyponatremia
hyperkalemia
low serum cortisol level unresponsive to injection of ACTH
131
What is the treatment of Addison's disease
Maintenance oral glucocorticoids and mineralocorticoid's
Adrenal crisis-life-threatening
– D5 normal saline and stress dose steroids
