Frequently Missed Flashcards
1
Q
Other than chlamydia trachomatis, what other organisms cause reactive arthritis?
A
- Shigella
- Salmonella
- Campylobactor
- Yersinia
- Strep species
- C diff
- Lyme
- Giardia
(I.e. many of the inflammatory diarrheal organisms)
2
Q
What are the three main features of prune belly (Eagle-Barrett) syndrome?
A
- abdominal muscle deficiency
- cryptorchidism
- urinary tract abnormalities
3
Q
Is CF a restrictive or obstructive lung disease?
A
Obstructive (low FEV1 and FEV1/FVC ratio)
4
Q
Ketamine side effects?
A
Hypertension and tachycardia (ie opposite of precedex)
5
Q
Dexmedetomidine side effects
A
Bradycardia
6
Q
- Multilocular cystic mass in the nuchal region describes what pathology
AND
- What associated condition(s)
A
- Cystic hygroma
- Most common: Turner Syndrome but also seen in other aneuploidies (e.g. 13, 18, 21)
7
Q
Where do most Burkitt Lymphomas arise?
A
90% arise in the Peyer patches within the GI tract, most commonly at the ileocecal junction
8
Q
CXR: Snowman sign
A
Total anomalous pulmonary venous return (TAPVR)
9
Q
CXR: Egg on a string
A
Transposition of the great arteries (TGA)
10
Q
- What nutritional deficiency can be seen in a patient with untreated or improperly managed celiac disease?
- What is the pathophysiology?
A
- Iron deficiency anemia
- Since celiac disease inflammation, starts in the proximal small intestine (duodenum) and then progresses distally, iron is not properly absorbed. Furthermore, patients who are not compliant with the gluten-free diet (remember alcohol contains wheat/barley) this can often lead to proximal small bowel inflammation and subsequent IDA
11
Q
TORCH infection: IUGR, microcephaly, cicatricial (zig-zag) skin scarring, cortical atrophy, ocular abnormalities, limb hypoplasia
A
Congenital varicella syndrome
12
Q
TORCH infection: IUGR, microcephaly, hepatosplenomegaly, jaundice, petechial/purpuric rash, chorioretinitis, seizures, peri ventricular calcifications
A
CMV (remember periVentricular)
13
Q
TORCH infection: IUGR, microcephaly, petechial/purpuric rash, HSM, cataracts, PDA
A
Congenital rubella
14
Q
What is a bronchogenic cyst and what are possible complications?
A
- Abnormal budding of the tracheal diverticulum of the foregut before 16 weeks of gestation.
- Complications include: recurrent infection, cyst rupture, leading to spontaneous pneumothorax or hemoptysis. Best treated with excision
15
Q
KUB: “Soap bubble” appearance with dilated air-filled loops
A
Meconium ileus
16
Q
What does CHARGE Syndrome stand for?
A
C = Coloboma
H = Heart defects (e.g. VSD, aortic arch)
A = Atresia choanae
R = Restricted growth
G = Genitourinary anomalies
E = Ear anomalies
17
Q
What are ketamine’s contraindications?
A
Age < 3 months (and relatively contraindicated in < 1 year of age)
18
Q
Features of familial Mediterranean fever
A
- Fever
- Abdominal pain
- Testicular pain
- Swelling of the knees and ankles
19
Q
What are the 3 criteria for diagnosis of T2DM?
A
- Fasting glucose >/= 125
- 2-hr plasma glucose during 75-g OGTT >/= 200
- HgA1c >/= 6.5
20
Q
How to manage femoral anteversion?
A
It is a relatively benign condition! Unless it causes significant pain or functional impairment, imaging or treatment (physical therapy) is not really indicated
21
Q
Genetic syndrome:
Onset in early childhood, course facial features, hearing loss, corneal clouding, hepatosplenomegaly
A
Hurler Syndrome (MPS 1)
Build up of glycosaminoglycans (dermatan and heparin sulfate) due to deficient a-L-iduronidase
22
Q
Metabolic syndrome:
Pain crises, angiokeratomas, corneal and lenticular opacities, stroke, LVH, sweating, progression to ESRD
A
Fabry Disease (X linked lysosomal storage disorder)
23
Q
Marked hypotonia, poor growth, hypertrophic cardiomyopathy within the first year of life
A
Pompe disease (LSD caused by deficient alpha-glucosidase)
24
Q
First-order kinetics
A
The rate of clearance of a drug is dependent on the drug concentration.
25
Zero-order kinetics
A constant amount of medication is metabolized and eliminated per unit time. The rate of metabolism is therefore independent of the plasma concentration of the drug.
26
Which two antibodies are highly specific for systemic lupus erythematosus?
anti-dsDNA and anti-Smith
27
Warfarin and diclofenac drug interaction?
**D**iclofenac can **d**isplace, protein-bound warfarin, which increases the free biologically active warfarin
28
Early localized (stage 1) Lyme
- appears within one to two weeks after the tick bite
- Characterized by annular rash (erythema migrans)
- Within a few weeks, it left untreated, secondary smaller lesions with the similar appearance will occur
- Treatment: oral doxycycline x 10 days OR amox or cefuroxime x 14 days
29
Early disseminated (Stage 2) Lyme
- Characterized by multiple skin lesions consistent with erythema migrans
- May include isolated nerve palsy (doxycycline x 14 days)
- May also manifest as Lyme carditis (start with IV then may switch to oral for total 14-21 d treatment)
30
Late (Stage 3) Lyme
- usually begins months to years after an untreated tick bite
- Characterized by arthritis that involves the large joints
- Treatment: oral doxycycline x 28 days OR amoxicillin
31
Which vaccines are given as subcutaneous injections?
MMR, varicella, MMRV, IPV
32
How many half lives until a drug meets therapeutic study state?
5
33
What is the formula for calculating the fluid deficit based on %?
Deficit (mL) = Weight (kg) * % dehydration * 10
Eg a 5% fluid deficit in a 30 kg patient is
= 30 * 5* 10 = 1500 mL
34
Benefit of adding subcutaneous or IM allergen immunotherapy (eg. Monoclonal antibody) to allergic asthma therapy?
Reduces the need for ICS
35
Which lab abnormality differentiates FAOD from other inborn errors of metabolism?
Absent urine ketones
36
Which lab abnormality differentiates glycogen storage disorder from other inborn errors of metabolism?
Normal ammonia w/ mild or normal lactic acid level.
Low glucose, mild metabolic acidosis or normal.
37
Which lab abnormality differentiates organic acidemia from other inborn errors of metabolism?
High ammonia and high lactic acid
Low glucose and metabolic acidosis.
38
Which lab abnormality differentiates urea cycle disorder from other inborn errors of metabolism?
VERY HIGH ammonia and respiratory alkalosis.
39
During what window of maternal infection with VZV surrounding delivery should VZIG be given to neonates to prevent perinatal transmission?
Maternal infection diagnosed between 5 days before delivery and 2 days after
40
History of walking barefoot outside, presenting with eosinophilia, hypochromic microcytic anemia and +/- itchy skin.
Hookworm (*Necator americanus*)
41
What other abnormalities can be seen in patients with Sturge-Weber syndrome or a facial port wine stain?
- leptomeningeal angiomatosis
- Eye abnormalities: Abnormal intraocular vascular development which can lead to glaucoma
- subclinical seizures
42
What other skin findings can be seen in ichthyosis?
Accentuated (e.g. hyperlinear) palmar and planter skin markings
43
Myocarditis EKG changes
Elevated ST segments and T wave inversions
44
Meds that can precipitate hemolysis in individuals with G6PD deficiency?
VACAN
- Vitamin K analogs
- Aspirin
- Chloramphenicol
- Anti-malarials
- Nitrofurantoin
45
Metabolic disorder: academic difficulty, adrenal insufficiency w/ possible hyperpigmentation, ataxia, slurred speech
X-linked adrenoleukodystrophy
(Characterized by elevated levels of VLCFA’s)
46
Which organism is implicated in osteomyelitis of the calcaneus?
*Pseudomonas aeruginosa*
47
How does Swyer syndrome differ from complete androgen insensitivity syndrome?
Swyer syndrome is characterized by streak gonads and low/absent testosterone, whereas AIS is characterized by cellular resistance to androgens and hence elevated testosterone.
48
How long after treatment with high dose systemic corticosteroids must you wait before administering live vaccines?
4 weeks
49
Features of minimal sedation
Anxiolysis while maintaining normal response, protective airway reflexes, and cardiovascular functioning
50
Features of minimal sedation
Anxiolysis while maintaining normal response, protective airway reflexes, and cardiovascular functioning
51
Features of moderate sedation
Loss of orientation to the environment, preservation of protective airway reflexes, and requires continuous monitoring.
52
Features of deep sedation
Involves partial or complete loss of protective reflexes and requires continuous monitoring
53
Features of general anesthesia
Commonly used in operating rooms, GA involves lack of response to painful stimulation and requires respiratory assistance.
54
In addition to an EKG, what else must be performed for infants, mothers with SLE or positive antibodies?
- Echocardiogram (to look for structural defects that can be associated with neonatal lupus syndrome)
- CBC (to examine neutropenia, thrombocytopenia or anemia)
- LFTs (to examine transaminase levels)
55
Which vaccine(s) must be kept frozen?
Any vaccine containing **V**aricella because it must be kept **v**ery cold (eg. MMRV, Varicella)
56
By what age should the testes be descended?
6 months
If not descended by then, refer to Urology for orchiopexy
57
Which pathogens are most common causes of chronic rhinosinusitis?
Staph aureus, fungi, aerobic gram negative bacilli, and anaerobes
58
Methods to prevent kidney stones:
- increased fluid intake
- decreased salt intake
- HCTZ if hypercalciuria is significant
- K citrate if hypocitriuria is significant
59
How much energy (kcal/g) per day are in fat, carbs, and protein?
Fat = 9
Carbs = 4
Protein = 4
60
How long should an infant and mother be separated if the mother has active TB?
After at least 2 weeks of treatment
61
How long should an infant and mother be separated if the mother has latent TB?
No separation required
62
Treatment for prolonged QT syndrome in infants?
Beta blockers (e.g. propranolol)
63
Treatment for prolonged QT syndrome in infants?
Beta blockers (e.g. propranolol)
64
Treatment of SJS/TEN?
Discontinuation of offending drug and supportive care
65
Enterococcus treatment
Ampicillin
66
Marcus-Gunn (jaw-winking) phenomenon is caused by abnormal innervation of which two nerves?
Trigeminal (CN 5) and Oculomotor (CN 3)
67
Which vaccine is contraindicated in children living with someone who is severely immunocompromised?
Live attenuated influenza vaccine (LAIV)
68
Which cause of bacterial diarrhea can also be associated with purulent vulvovaginitis?
*Shigella flexneri*
| (*She*gella)
69
What is the maximum HgbA1c for which treatment of pediatric T2DM is appropriate with metformin alone?
For HgbA1c **>/= 8.5**, insulin must be added
70
Which medication is used to treat serotonin syndrome?
Cyproheptadine
71
Teratogenic effect: arched eyebrows, hypertelorism, short upturned nose, shortened/stubby digits with hypoplastic nails
Fetal hydantoin syndrome (FHS; a.k.a. Phenytoin embryopathy)
72
What are the criteria of NF1?
NF1 is diagnosed if 2 or more of the following are present:
- Axillary or inguinal freckling
- >= 6 café au lait spots (>= 5mm diameter if prepubertal or >=15mm if postpubertal)
- Lisch nodules (hamartomas of the iris)
- >= 2 neurofibromas or >= 1 plexiform neurofibroma
- osseous lesions of the sphenoid or long bones
- optic gliomas
- 1st degree relative with NF1
73
Which 2 cardiac conditions are commonly seen in Marfan syndrome?
- Aortic root dilation
- Mitral valve prolapse
74
Which factor increases the risk of the development of follicular ovarian cysts?
Smoking
75
Which factor increases the risk of breast cancer?
Alcohol use
76
How does autoimmune hepatitis (AIH) Type 1 differ from AIH Type 2?
AIH Type 1 is more likely to present in females between 10-20 years of age, ANA or anti-Smooth muscle Ab positive
AIH Type 2 is usually more severe and presents in younger children. Usually requires lifelong immunosuppression.
77
Ulcerative colitis is associated with what biliary pathology?
Primary sclerosing cholangitis (PSC)
78
When can children with the group a strep pharyngitis return to school?
When they are afebrile and on antibiotics for 12 hours
79
Immunologic disorder: recurrent/chronic pulmonary infections, unexplained bronchiectasis, recurrent Giardia, splenomegaly
Common variable immunodeficiency (CVID)
80
How is CVID treated?
Monthly IVIG
81
Glucoma is a side effect of which antiseizure medication?
Topiramate
82
Which medications can be associated with telogen effluvium?
- Beta blockers
- Amphetamines
- ACEI’s
- Oral contraceptives
- Retinoids
83
What is the treatment for PLEVA?
Erythromycin
84
What is the scoliosis curvature angle for which observation/follow up is appropriate?
< 25 degrees
85
What is the scoliosis curvature angle for which bracing is appropriate?
25 to 45 degrees
86
What is the scoliosis curvature angle for which surgical management is appropriate?
> 45 degrees
87
Most common cause of obstructive uropathy/weak urinary stream in boys?
Posterior urethral valves (PUV)
88
Which organism causes Parinaud oculoglandular syndrome?
*Bartonella henselae*
89
What is the mechanism of hyponatremia in RMSF?
Rickettsia-induced CNS vasculitis and inflammation leads to SIADH which results in hyponatremia
90
What is the most common cause of spinal cord masses in pediatric patients?
Tumor
91
Corn mash is deficient in what essential vitamin?
Vitamin B3/Niacin
92
Newborns are at the most risk of severe or fatal varicella infection if their mothers developed varicella in which time frame related to delivery?
5 days before to 2 days after delivery
93
What is traumatic myositis ossificans and how is it treated?
1. Calcification of a hematoma within damaged muscle following a blunt injury
2. Physical therapy and immobilization are first line (followed by excision if it does not resolve or interferes with function after 6-12 months)
94
By what age should testes be descended (ie. when would I referral for surgical evaluation be needed?)
6 months
95
How much gain in each of the following anthropometric areas is expected in the first year of life?
- Height
- Head circumference
- Weight
- Height: 25 cm
- HC: 13 cm
- Weight: 6-7kg
96
Patients with cyclic neutropenia are at risk for which types of infections?
Sepsis due to *Clostridium septicum*
97
What is the most common type of craniosynostosis?
Sagittal
98
Hypocalcemia results in which abnormalities on EKG?
Prolonged QTc and prolonged ST
99
What is the primary function of diuretics?
Decreasing preload
100
What is the primary function of angiotensin-converting enzyme inhibitors?
**A**CEI’s decrease **A**fterload
101
Which organism that can cause neonatal meningitis can also cause brain abscesses?
*Citrobacter koseri*
102
When is the T wave in a pediatric EKG normally inverted?
After DOL 7 through age ~9-10
103
What is the best/preferred screening test for Cushing syndrome?
24-hour urinary free cortisol
104
Why is sickle cell anemia testing recommended by the NCAA for all collegiate athletes?
Due to risk for exertional rhabdomyolysis
| ("exertional sickling”)
105
What is the 1st line treatment for alopecia areata?
Intralesional corticosteroids
106
This Group A Strep mimic is resistant to amoxicillin, but responsive to erythromycin?
*Arcanobacterium haemolyticum*
107
Which organism is the most common cause of discitis in children?
*Staphylococcus aureus*
108
How long must a tick be attached to the skin in order for doxycycline prophylaxis to be considered for Lyme disease?
>/= 36 hours
109
What happens to the platelet count in the setting of acute splenic sequestration crisis?
Thrombocytopenia (due to sequestration of the platelets in the spleen)
110
"Alice in Wonderland" syndrome can be a complication of which condition?
Infectious mononucleosis
111
Which organism is responsible for summertime encephalitis?
West Nile Virus (an arborvirus)
112
Bath salts are similar to which class of meds?
Amphetamines
113
What is the most common cyanotic heart defect diagnosed in the newborn period?
TGA
114
What is the treatment for stable VT with a pulse?
IV amiodarone
115
What is the treatment for unstable VT with a pulse?
Synchronized cardioversion
116
What is the treatment for unstable VT without a pulse?
Unsynchronized defibrillation
117
True or False: PEA is a shockable rhythm?
FALSE
118
What is the treatment for pulseless electrical activity?
Start CPR and administer .01mg/kg epinephrine every 3-5 minutes
