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EOR - Pediatrics (Alice copy + Seth's) > Gastrointestinal/Nutrition (Alice) (10%) > Flashcards

Gastrointestinal/Nutrition (Alice) (10%) Flashcards

1
Q

3 sx of appendicitis

A

crampy/colicky periumbilical pain - first sx
anorexia
nausea

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2
Q

describe pain progression w. appendicitis

A

periumbilical -> RLQ

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3
Q

what is mcburney’s point

A

2/3 the distnce from the navel to the right ASIS

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4
Q

rebound tenderness at mcburney’s point suggests

A

appendicitis inflammation has spread to the peritoneum

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5
Q

4 PE signs associated w. appendicitis

A

mcburney’s point tenderness
rovsing
obturator
psoas

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6
Q

RLQ pain w. palpation of LLQ

A

rovsing sign

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7
Q

RLQ pain w. internal rotation of the hip

A

obturator sign

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8
Q

RLQ pain w. hip extension

A

psoas sign

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9
Q

what on a CBC suggests appendicitis

A

neutrophilia

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10
Q

extremely fussy infant that pulls his legs up as if he is trying to stool - intractable crying x 4 hours for 4 days in a row

A

colic

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11
Q

2 hallmark signs of colic

A

-severe, paroxysmal crying in the late afternoon to evening
-drawing up of knees against the abdomen

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12
Q

colic peaks at _ and ends around _

A

peaks: 2-3 mo
ends: 4 mo

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13
Q

rule of 3’s for colic

A

cry > 3 hr/day
3 days/week
x 3 weeks

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14
Q

besides reassurance, 2 things to consider in a colicky baby

A

formula switch
GERD tx

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15
Q

childhood constipation is almost always

A

functional

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16
Q

diagnostic parameters for constipation

A

< 2 BM’s/week
> 1 episode of encopresis/week

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17
Q

what is encopresis

A

-fecal incontinence/soiling
-repeated passage of stool into clothing

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18
Q

3 mc triggers of constipation

A

transitioning to solids
potty training
starting school

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19
Q

5 red flags w. constipation

A

onset prior to one mo old
delayed passage of meconium after birth
ftt
explosive stools
severe abd distension

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20
Q

constipation red flags make you concerned for what d.o (2)

A

hirschprung dz
metabolic abnormality

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21
Q

supportive care for constipation (5)

A

increase fiber
decrease cow’s milk
mineral oil
miralax
lactulose

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22
Q

3 most accurate signs of dehydration in peds

A

prolonged cap refill
poor skin turgor
abnl breathing

others: sunken eyes, lethargy, lack of tears, dry mm

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23
Q

3 tools used for assessment of pediatric dehydration

A

WHO
gorelick
clinical dehydration scale

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24
Q

2 day old pretern w. abd fullness, bilious aspirate, and absence of distal bowel gas

A

duodenal atresia

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25
Q

what is duodenal atresia

A

congenital absence or complete closure of a portion of the lumen of the duodenum

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26
Q

2 complications of duodenal atresia

A

polyhydraminos
intestinal obstruction

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27
Q

hallmark sign of duodenal atresia

A

early biliary vomiting in newborn

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28
Q

increased assocaition of duodenal atresia occurs with

A

down syndrome

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29
Q

what is this showing

A

double bubble -> duodenal atresia

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30
Q

management of duodenal atresia (6)

A

suction/drain respiratory secretions
elevate head
IV glucose
IVF
abx
surgery

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31
Q

for dx of encopresis, child must be >/= _ yo

A

4

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32
Q

encopresis is almost always associated w.

A

severe constipation

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33
Q

is encopresis mc among males or females

A

males

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34
Q

encopresis is almost always functional, but you should also consider _ causes

A

emotional - ex school/divorce

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35
Q

3 associated sx of encopresis

A

abd pain/fecal mass
dilated rectum packed w. stool
urinary frequency

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36
Q

acute vs chronic tx of encopresis

A

acute: Peg/Miralax, glycerin suppository
chronic: elliminate cow’s milk, maintenance laxatives, increased fiber/fluids, timed toileting

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37
Q

foreign body aspiration is mc in what age group

A

6 mo - 3 yo

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38
Q

4 complications of foreign body aspiration

A

bowel perforation
bowel obstruction
asphyxia
PNA

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39
Q

sx of esophageal foreign body (although often asymptomatic)

A

bloody saliva
couging
drooling
dysphagia
ftt
anorexia
irritability
stridor
tachypnea
vomiting
wheezing

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40
Q

t/f: foreign objects beyond the esophagus have an increased risk of complications

A

t!

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41
Q

5 sx of foreign body obstructions beyond the esophagus

A

abd pain
n/v
fever
hematochezia
melena

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42
Q

5 common foreign body obstruction locations

A

cricopharyngeal
middle 1/3 of esophagus
lower esophageal sphincter
pylorus
ileocecal valve

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43
Q

3 CXR findings of foreign body aspiration

A

regional/asymmetric hyperinflation
collapse/atelectasis
normal

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44
Q

_ is indicated for ALL suspected inhaled foreign bodies regardless of CXR results, unless pt is completely asymptomatic w. normal PE AND CXR

A

bronchoscopy

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45
Q

indication for cultures w. foreign body aspiration

A

post-obstructive PNA

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46
Q

management of foreign body thought to be in the esophagus (3)

A

observe x 24 hr
serial CXR
endoscopic removal after 24 hr

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47
Q

management of foreign body aspiration if timeframe is unknown or if symptomatic

A

bronchoscopy

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48
Q

3 indications for immediate bronchoscopy w. foreign body aspiration

A

sharp object
batteries
symptomatic

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49
Q

management of foreign body aspiration distal to the esophagus

A

small blunt object: obs w. serial CXR; remove if not past pylorus in 3-4 weeks
large object > 3 cm or sharp object: bronchoscopy removal if in the pylorus; serial imaging if beyond pylorus

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50
Q

management of acid/alkali ingestion (3)

A

do NOT induce emesis
monitor ABCs
endoscopy in 2-3 weeks

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51
Q

gastroenteritis/infectious diarrhea usually lasts < _

A

2 weeks

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52
Q

4 HPI clues for gastroenteritis

A

foreign travel
playing in creek
daycare
poultry

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53
Q

gastroenteritis mc has _ etiology

A

viral

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54
Q

mcc of severe gastroenteritis in kids vs adults

A

kids: rotavirus
adults: norovirus

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55
Q

2 parasitic causes of gastroenteritis

A

giardia
cryptosporidium

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56
Q

4 bacterial causes of gastroenteritis

A

campylobacter
e.coli
clostridium
salmonella

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57
Q

reptiles make you think of what cause of gastroenteritis

A

salmonella

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58
Q

7 common food sources of gastroenteritis

A

raw/undercooked meat
seafood
eggs
raw sprouts
unpasteurized milk
soft cheese
f/v juices

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59
Q

3 indications for stool cultures w. gastroenteritis

A

bloody stools
suspect food poisoning
recent travel

+/- : children < 5 yo, elderly, immunocompromised

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60
Q

7 red flags w. gastroenteritis

A

bloody/mucous stools
wt loss
hypotn
sunken fontanelle
dry mm
no crying
decreased urine output

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61
Q

rare complication of campylobacter gastroenteritis

A

reactive arthritis

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62
Q

travelers diarrhea pathogen

A

enterotoxigenic e. coli (ETEC)

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63
Q

diarrhea after a picnic w. egg salad

A

s. aureus

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64
Q

diarrhea from shellfish

A

vibrio cholerae

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65
Q

diarrhea from poultry/pork

A

salmonella

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66
Q

diarrhea w. poorly canned foods

A

c perfingens

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67
Q

diarrhea breakout in daycare

A

rotavirus

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68
Q

diarrhea and horrible muscle cramps after a cruise

A

norovirus

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69
Q

diarrhea 1-3 weeks after camping
waxing/waning foul-smelling bulky stool

A

giardia

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70
Q

3 indications for abx w. gastroenteritis

A

abx
fever
bloody diarrhea

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71
Q

abx used for pediatric gastroenteritis (4)

A

cipro
doxy (?)
azithromycin
bactrim

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72
Q

t/f: mild reflux is common in all infants

A

t!

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73
Q

7 complications of pediatric GERD

A

ftt
aspiration pna
esophagitis
choking
apnea
hematemesis
anemia

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74
Q

mcc cause of pediatric GERD

A

overfeeding

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75
Q

indication that pediatric reflux is NOT GERD

A

emesis independent of meals

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76
Q

work up for mild pediatric reflux

A

pH probe

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77
Q

work up for severe pediatric reflux or projectile emesis (2)

A

abd US
barium swallow
CXR

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78
Q

lab finding associated w. severe pediatric reflux

A

hypochloremic, hypokalemic metabolic alkalosis

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79
Q

supportive management of mild pediatric GERD (3)

A

-small, frequent feedings w. head in upright position x 20 mins after feeding
-thickened feeds
-elliminate cow’s milk

80
Q

indications for PPI/H2 blocker w. pediatric GERD

A

suspect esophagitis

81
Q

surgery for pediatric GERD

A

nissen fundoplication

82
Q

t/f: ppi’s are preferred over H2 blockers for pediatric GERD

A

t!

83
Q

jaundice, clay colored stool, icterus, hepatosplenomegaly

A

neonatal hepatitis

84
Q

mcc of cholestasis in the newborn

A

neonatal hepatits

85
Q

t/f: neonatal hepatitis has a male predispsotion

A

t!

86
Q

50% of neonatal hepatitis present w. what 2 sx

A

jaundice
hepatomegaly

87
Q

t/f: neonatal hepatitis is usually self limited

A

t!

88
Q

supportive tx for neonatal hepatitis (3)

A

MCT containing formula
fat soluble vitamins
+/- TPN

89
Q

pharm for neonatal hepatitis

A

ursodeoxycholic acid (bile acid)

90
Q

what must you do before using ursodeoxycholic acid

A

exclude biliary obstruction

91
Q

2 mcc of pediatric viral hepatitis

A

hep A and B

92
Q

CMP finding of hepatitis

A

uniformly elevated LFTs

93
Q

lab that is pathognomonic for active hep B dz and is used in hep B vaccine eval

A

HBsAg (surface antigen)

94
Q

Hep B lab value that can be positive as a result of vaccination OR natural infxn

A

HBsAb (surface abs)

95
Q

Hep B lab value that results from natural infxn but NOT vaccination, and persists lifelong

A

HBcAb (core abs)

96
Q

hep B lab value useful in assessing acute infxn

A

HBeAg (e antigen)

97
Q

Hep B lab value useful in assessing late infxn

A

HBeAb (e abs)

98
Q

hep B lab value used for both dx and assessing response to therapy

A

HBV polymerase chain rxn (PCR)

99
Q

what lab value confirms hep A infxn

A

anti HAV IgM

100
Q

managment of hep B in infants of infected mothers

A

vaccine
PLUS
HBV immunoglobulin at delivery

101
Q

indication for referral w. pediatric hep B

A

chronic hep B w. persistently abnl ALT

102
Q

2 week old w. no BM x 5 days, 5th %ile for weight, distended abdomen, absence f stool in rectal vault, dilated loops of bowel, and megacolon

A

hirschprung dz

103
Q

congenital aganglionic bowel dz caued by lack of caudal migration of ganglion cells from the neural crest -> contraction of distal segment of colon -> obstruction w. proximal dilation

A

hirschprung dz

104
Q

hirschprung dz is caused by absent _, which regulate bowel fxn

A

ganglion plexuses

105
Q

t/f: hirschprung dz has a 5x male predominance

A

t!

106
Q

t/f: at birth, hisrschprung dz is asymptomatic

A

t!

107
Q

hallmark sx of hirschprung dz

A

inability to pass meconium 48 hr postpartum

108
Q

work up for hirschprung (4)

A

rectal suction
bx
barium assisted radiography
DRE

show absence or paucity of ganglion cells

109
Q

tx for hirschprung dz (2)

A

resection of affected segment
colostomy

110
Q

mc type of pediatric hernia

A

direct: thru external/superficial inguinal ring at hesselbach triangle

111
Q

management of indirect inguinal hernia

A

asymptomatic: elective repair w.in 14 days
symptomatic: emergent referral if concern for bowel incarceration

112
Q

2 sx of bowel incarceration w. hernia

A

erythema of overlying skin
pain/tenderness

113
Q

pathway of indirect inguinal hernia

A

deep inguinal ring -> scrotum

114
Q

which type of hernia passes thru hesselbach’s triangle

A

direct

115
Q

management of direct inguinal hernia

A

monitor
+/- surgical repair

116
Q

12 mo old w. recurrent belly aches x 2 weeks that culminate in sudden colicky pain q 15-20 min w. vomiting - pt presents squatting w. knees to chest

A

intussusception

117
Q

2 hallmark findings of intusussception

A

bloody/mucus stool (currant jelly)
sausage shaped abd mass in RUQ

118
Q

intusussception occurs when a _ portion of the intestines invaginates/telescopes into a _ portion

A

proximal portion invaginates/telescopes into distal portion

119
Q

peak age incidence for intussusception

A

5-9 mo

120
Q

mcc cause of neonatal bowel obstruction in infants < 2 yo

A

intussuception

121
Q

PMH clue for intussuception in peds vs adults

A

peds: viral infxn
adults: cancer

122
Q

management of intussusception that is diagnostic and therapeutic

A

barium enema

123
Q

2 XR findings of intussuception

A

crescent sign
bull’s eye/target/coiled spring lesion sign

124
Q

what is this showing

A

crescent/meniscus sign (intussusception)

125
Q

what is this showing

A

target sign -> intussusception

126
Q

neonatal jaundice appears when bilirubin levels exceed

A

2 mg/dL

127
Q

sx of physiologic jaundice (5)

A

-isolated unconjugated hyperbilirubinemia
-no co-existing illness
-bilirubin rises < 0.2 mg/dL/hr OR 5 mg/dL/day
-bilirubin remains < 18 mg/dL
-hyperbilirubinemia resolves w.in 1 week in fullterm OR 2 weeks in preterm

128
Q

sx of pathologic jaundice

A

-unconjugated hyperbilirubinemia w.in 24 hr after birth
-serious illness
-bilirubin rises >2 mg/dL/hr OR >5 mg/dL/day
-bilirubin rises > 18 mg/dL
-hyperbilirubinemia lasts > 1 week in term OR > 2 weeks in preterm

129
Q

pathologic jaundice is mc due to a _ cause

A

prehepatic

130
Q

work up for neonatal jaundice

A

coombs test:

positive: consider Rh OR ABO incompatability
negative: check Hgb levels

131
Q

in neonatal jaundice, if coombs is negative and Hgb levels are low, consider _
if Hgb levels are high, consider _

A

low Hgb: hematomas
high: diabetic mother, twin-twin or maternal fetal transfusion, delayed cord clamping

132
Q

work up for neonatal jaundice if coombs is negative and Hgb levels are normal, consider _

A

hemolysis

133
Q

lab findings of hemolysis

A

increased: reticulocytes, LDH
decreased: haptoglobin

134
Q

dx for hemolysis

A

-smear: sphreocytosis or elliptocytosis
-presence of G6PD or pyruvate kinase deficiency
-Hgb electrophoresis for thalassemia and SSA

135
Q

you should consider bf’ing jaundice if

A

normal coombs
normal Hgb
normal LDH and haptoglobin

136
Q

2 neonatal syndromes associated w. jaundice

A

gilbert
crigler najjar syndromes

137
Q

what type of hyperbilirubinemia is mc benign

A

unconjugated

138
Q

3 causes of conjugated bilirubin

A

hepatocellular
dubin johnson
rotor syndrome

139
Q

what should you consider if AST and ALT levels are high in setting of conjugated bilirubin (6)

A

hepatitis
TORCH infxns
hemochromatosis
wilson dz
alpha 1 antitrypsin deficiency
galactosemia

140
Q

elevated conjugated bilirubin PLUS elevated ALP

A

post hepatic jaundice -> biliary tree obstruction

141
Q

3 causes of neonatal biliary tree obstruction

A

biliary atresia
choledochal cysts
alagille syndrome

142
Q

what is borborygmi and what does it make you think of in peds

A

rumbling stomach
lactose intolerance

143
Q

sx of lactose intolerance mc occur w.in _ min of eating

A

30

but may take up to 2 hr

144
Q

pt w. lactose intolerance may need _ supplementation

A

calcium

145
Q

lactose intolerance is mc a clinical dx, but what is the definitive dx

A

lactose hydrogen breath test

alternative: fecal pH test

146
Q

lactose hydrogen breath test positive findings

A

post lactose breath hydrogen value rises > 20 ppm over baseline

147
Q

12 yo who easily sunburns and c/o non healing sunburns - PE shows wide stance gait w. instability, extensive erythematous scaling, and hyperkeratotic rash on face, neck, arms, and legs

A

niacin deficiency

148
Q

4 d’s of niacin (b3) deficiency

A

dermatitis - pellagra (raw skin)
diarrhea
dementia
death

149
Q

what is this showing

A

pellagra dermatitis - photosensitive pigmented dermatitis

150
Q

rf for niacin deficiency

A

diets low in tryptophan/niacin -> corn staple diets

151
Q

6 dietary sources of niacin

A

yeast
meats
grains
legumes
tortillas
seeds

152
Q

pediatric RDA for niacin

A

12 mg/day

153
Q

niacin status can be assessed by measuring (2)

A

urinary N- methylnicotinamide
erythrocyte NAD:NADP ratio

154
Q

6 week old w. projectile vomiting after feeding x 24 hr

A

pyloric stenosis

155
Q

hallmark PE finding of pyloric stenosis

A

olive shaped mass in epigastric region

156
Q

what is pyloric stenosis

A

congenital condition:

pyloric hyprplasia/hypertrophy -> obstruction of pyloric valve

157
Q

lab finding of pyloric stenosis

A

hypochloremic, hypokalemic metabolic alkalosis

2/2 to dehydration

158
Q

mc age group for pyloric stenosis

A

< 3 mo old

159
Q

hallmark sx of pyloric stenosis

A

projectile vomiting after every feeding

160
Q

dx for pyloric stenosis

A

US

161
Q

2 US findings of pyloric stenosis

A

double track
string/shoulder sign

162
Q

what is this showing

A

thickened, hypoechoic muscular wall and elongated pyloric canal -> double track sign -> pyloric stenosis

163
Q

what is this showing

A

stirng sign -> pyloric stenosis

164
Q

tx for pyloric stenosis

A

pyloromyotomy (ramstedt’s procedure)

165
Q

persistent opening of the umbilical ring, which spontaneously closes

A

umbilical hernia

166
Q

complete closure of the umbilical ring occurs in almost all children by _ yo

A

5

can take up until 11 yo

167
Q

umbilical hernias are mc asymptomatic, but pt’s can exhibit

A

poor feeding

168
Q

hernias may become symptomatic when children _

A

cry

due to increased intraabdominal pressure

169
Q

peds should be referred for surgery if umbilical hernias persist > _ yo

A

2 yo

170
Q

3 causes of vitamin a deficiency

A

inadequate intake
fat malabsorption
liver d.o

171
Q

3 sx of vitamin a deficiency

A

rashes
dry eyes
night blindness

172
Q

4 sources of preformed vit A (retinols)

A

liver
kidney
egg yolk
butter

173
Q

3 sources of provitamin A (beta carotene)

A

leafy greens
sweet taters
carrots

174
Q

dx for vitamin A deficiency

A

serum retinol levels < 20 mcg/dL

175
Q

tx for vitamin A deficiency based on age

A

6-12 mo: 100,000 IU orally q 4-6 mo
12-59 mo: 200,000 IU q 4-6 mo

176
Q

8 sx of vitamin C deficiency

A

gingival hemorrhage
bruising
petechial rash
hemarthrosis
anemia
poor wound healing
perifollicular and supperiosteal hemorrhages
corkscrew hair

177
Q

t/f: the human body can NOT synthesize vit C

A

t!

178
Q

2 rf for vit C deficiency

A

-food insecurity
-infants eating evaporated/boiled cow’s milk

179
Q

dx for vit C deficiency

A

plasma and leukocyte vit C levels

180
Q

2 MRI findings of vit C deficiency

A

-sclerotic, lucent, metaphyseal bands
-soft tissue edema

181
Q

most specific sx of vit C deficiency

A

perifollicular abnl’s
follicular hyperkeratosis
perifollicular hemorrhage
petechiae
coiled hairs

182
Q

what is this showing

A

perifollicular abnl’s -> vit C deficiency

183
Q

vit C repletion recs: peds vs adults

A

peds: 100 mg ascorbig acid tid x 1 week, then qd until resolved
adults: 300-1,000 mg qd x 1 mo

184
Q

w. vit C deficiency, constitutional sx resolve w.in _

bruising, gingival bleeding resolve w.in _

A

constitutional: 24 hr
bruising/bleeding: several weeks

185
Q

t/f: breastmilk provides adequate vit C for newborns/infants

A

t!

186
Q

4 PE findings of rickets

A

bowed legs
fractures
costochondral thickening
dental caries

187
Q

what is this showing

A

rachitic rosary - costochondral thickening -> rickets

188
Q

2 rf for vitamin D deficiency

A

dark skin pigmentation
exclusive bf’ing beyond 3-6 mo

189
Q

what is sufficienct sun exposure for vit D for people w. light skin

A

10-15 min

190
Q

t/f: reduced vit D stores in MOC correlate w. lowr vit D levels in infant

A

t!

191
Q

what pt pop makes you think about vit D deficiency (3)

A

dark skinned pregnant women
higher latitudes in winter mos
premature infants

192
Q

dx for vit d deficiency

A

serum 250 HD levels:

sufficiency: 20-100 ng/mL
insufficiency: 12-20 ng/mL
deficiency: < 12 ng/mL

193
Q

8 vit D rich foods

A

oily fish
cod liver oil
liver
egg yolk
milk
OJ
bread
cereal

194
Q

vit D supplementation recs for breastfed infants

A

400 IU qd w.in a few days after birth

195
Q

vit D supplementation recs for children 1-18 yo

A

600 IU qd

EOR - Pediatrics (Alice copy + Seth's) (23 decks)

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