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Own peds boards > General pediatrics > Flashcards

General pediatrics Flashcards

1
Q

What is the most common neck masses?

A

Thyroglossal duct cysts

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2
Q

What is the second most common neck masses?

A

Brachial cleft

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3
Q

Rx for thyroglossal duct cyst

A

surgical excision

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4
Q

Post-op carefor thyroglossal cyst

A

Thyroid scan

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5
Q

What happens to cyst during URI?

A

Get larger

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6
Q

Which neck mass transilluminates?

A

cystic hygroma - lymphangioma

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7
Q

Rx lymphangioma

A

Resection vs sclerotherapy

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8
Q

With how many hemangiomas will you need to search for internal hemangiomas?

A

5

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9
Q

Pattern: a mass over sternocleidomastoid

A

torticollis

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10
Q

Pattern: larger with crying/valsalva

A

hemangiomas and cervical lung herniation

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11
Q

Most common bacteria cuase of lymphadenitis?

A

strep and staph

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12
Q

Rx for reactive lymphadenopathy

A

can observe for 3 to 4 weeks if asymptomatic and no concerning features or empiric antibiotics

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13
Q

Concerning features for acquired neck mass

A
  1. Persists >8-12 weeks
  2. Firm, rubbery, non-mobile, non-tender, matted
  3. Growing or >2cm in children or 1.5cm in adolescents
  4. Supraclavicular mass because they drain mediastinum, lungs and abdomen
  5. Systemic signs/symptoms
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14
Q

Workup for acquired neck mass

A

CBC, ESR, LDH, uric acid, PPD, EBV, CMV, HIV, Bartonella, US, CXR

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15
Q

What age is monospot best for

A

> 4yo

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16
Q

First line abx for lymphadenitis

A

clindamycin, augmentin, cephalosporin

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17
Q

Abs for Bartonella

A

azithromycin, doxycycline or quinolone

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18
Q

Hearing loss dB and qualitative scale:

Miss up to 50% speech, may seem disinterested, or dx’ed wth ADHD

A

20-40dB; mild hearing loss

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19
Q

Hearing loss dB and qualitative scale:

Miss >50% speech, poor expressive language

A

40-70dB; moderate hearing loss

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20
Q

Hearing loss dB and qualitative scale:

Miss 100% normal volume speech, poor or absent expressive verbal language

A

70-90dB; severe hearing loss

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21
Q

Hearing loss dB and qualitative scale:

Sound vibrations are felt

A

> 90dB sound vibrations are felt

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22
Q

Syndromes associated with hearing loss

A

Goldenhar, Treacher Collins’ (AD), Down

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23
Q

Pattern: long QT + SNHL

A

Jervelle Lange-Nielsen

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24
Q

Pattern: Retinitis pigmentosa + SNHL

A

Usher syndrome

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25
Q

Pattern: glomerulonephriis + high frequency SNHL

A

Alport’s

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26
Q

Pattern: pigment defects (white forelock), SNHL

A

Waardenburg

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27
Q

Pattern: Goiter + SNHL +/- balance problems

A

Pendrid syndrome

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28
Q

Pattern: bone fragility and SNHL

A

osteogenesis imperfecta type 1

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29
Q

Maternal medication + SNHL

A

alcohol, isotretinoin, cisplatin

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30
Q

Medications children take that causes SNHL

A

aminoglycosides, furosemide, vancomycin

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31
Q

Pattern: SNHL + vertigo

A

perilymphatic fistula from trauma

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32
Q

Pattern: conductive hearing loss on SNHL

A

abnormal bone and air conduction, but bone >10dB better than air conduction

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33
Q

Pattern: Abnormal bone and air conduction but each within 10dB of each other

A

SNHL

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34
Q

Will infants with profound deafness startle, laugh and babble

A

yes

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35
Q

Hearing loss after what yr is less poor prognosis

A

5yr

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36
Q

Most common non-sydromic genetic HL

A

connexcin 26 gene defect, AR bilateral, mod/sever

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37
Q

Most common congenital infection SNHL

A

CMV

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38
Q

Most common acq infection that leads to SNHL

A

Meningitis

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39
Q

Pattern: abnormal bone and air conduction

A

SNHL (within 10dB of bone) CMV and meningitis

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40
Q

Pattern: abnormal bone and air conduction (>10 dB worse than bone)

A

Mixed HL - multiple factors

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41
Q

When is the universal screening age for newborns?

A

screening by 1 mo, confirm by 3 mo, receive early intervention by 6 months

42
Q

What kind of hearing loss is identified by newborn screens

A

moderate/severe hearing loss, not ild (<40dB)

43
Q

OAE or BAER

Cannot tell degress of hearing loss, just pass/fail

A

OAE

44
Q

OAE or BAER

Can estimate ear specfic thresholds

A

BAER

45
Q

OAE or BAER

Neurologic function. ability to hear is inferred

A

BAER

46
Q

Describe behavioral observation audiometry exam

A

Placed on parent’s lap, stimuli with external speakers, look for change in child’s behavior, no threshold or ear specific info is obtain

47
Q

What can behavioral observation audiometry tell you?

A

Exclude profound hearing loss

48
Q

Describe visual reinforcement audiometry (VRA)

A

Same as BOA, but observe child to look for sound 6mo to 3 years old

49
Q

Describe conditioned play audiometry

A

Headphones provide ear specific information, ask child to do play task in response to sound
3 to 5 years old

50
Q

Pure-tone audiometry

A

tests air and bone conduction, distinguish CHL, SNHL and mixed hearing loss

51
Q

Static admittance (compliance) peaks at what pressure

A

P = 0

52
Q

Normal volume is for tympanometry is what?

A

0.5 to 1.5ml

53
Q

Less comcompliant ear drum cause

A

early effusion

54
Q

Too compliant ear drum

A

Thin ear drum or healing

55
Q

Pattern: poorly compliant TM normal volume

A

likely middle ear effusion

56
Q

Pattern: poor compliant, low volume

A

cerumen impaction or probe against canal wall

57
Q

Pattern: poor compliant, high volume

A

TM perforation or tympanostomy tubes

58
Q

Pattern: peak compliance at negative pressure

A

Retracted TM (URI, eustachian tube dysfunction)

59
Q

Age that will ensure best outcome with cochlear implants

A

<2yo

60
Q

What are children with cochlear implants are most at risk for?

A

PPSV-23

61
Q

What organism has the highest resistance to PCN that causes otitis media?

A

M. catarrahlis

62
Q

What are the three most common bacterial because of AOM?

A

S pneumonia, H influenzae, M catarrhalis

63
Q

Most common 4 viruses of AOM?

A

RSV, rhinovirus, influenza, parainfluenza, adenovirus

64
Q

What are some risk factors for AOM?

A

<2yo, day care, allergy/atopy, bottle eeding, not breastfeeding, first AOM <6 months of age, immune deficiency, craniofacial anomalies (cleft palate)

65
Q

To treat or not to treat?

Bilateral non-severe <2yrs

A

Treat

66
Q

To treat or not to treat?

Unilateral non-severe <2yrs

A

observe

67
Q

To treat or not to treat?

bilateral >2yrs

A

observe

68
Q

To treat or not to treat?

Unilateral non-severe >2yrs

A

observe

69
Q

Rx AOM?

A

Amoxicillin 80-100mg/kg for 10 days

70
Q

If patient doesn’t respond within 48hrs of amoxicillin treatment, then what?

A

Augmentin

71
Q

If if AOM doesn’t respond to 2nd line, then what?

A

ceftriaxone IM/IV x 3 days

72
Q

Rx for PCN allergic pt

A

3rd gen cephalosporin or +clindamycin

73
Q

Why can’t you use clindamycin for AOM?

A

lacks H influenza activity

74
Q

Why can’t you use macrolides for AOM

A

limited S pneumonia, H influenza activity

75
Q

What can’t you use bactrim for AOM

A

very limited S pneumonia

76
Q

Augmentin is reasonable 1st line under what circumstances?

A

Amox within last 30 days for any purpose; conjunctivitis (H influenzae), h/o of recurrent AOM unresponsive to amoxicillin

77
Q

Follow-up plan for AOM treatment

A

2-3 months for child <2 years old; >2 years old if language/learning concerns

78
Q

When would you consider tympanostomy tube?

A

> 4 AOM/year

79
Q

Describe otitis media with effusion

A

Fluid in middle ear without signs/symptoms of acute ear infection, pneumatic otoscopy, decreased TM mobility, cloudy TM, air fluid levels

80
Q

Management of OME?

A

If has risk factors, then check hearing and refer to ENT if abnormal

1) previous permanent hearing loss
2) speech/language delay
3) developmental delay
4) Syndromes or craniofacial disorders
5) cleft palate
6) blindness

81
Q

In patient with OME, at not at high risk, how do you manage

A

recheck in 3 months

82
Q

Define chronic suppurative otitis media

A

purulent otorrhea assoicated with chronic TM perf for >6 weeks

83
Q

What is most common organism for chronic suppurative otitis media?

A

P aeruginosa, S aureus, enteric GNRs

84
Q

Rx suppurative otitis media

A

topical ciprofloxacin

85
Q

What is the most common agent for otitis externa

A

P aeruoginosa, S aureus, often polymicrobial

86
Q

Rx for otitis externa

A

topical quinolones polymixin or aminoglycoside

87
Q

Rx of perforated TM or tympanostomy tube

A

non-toxic topical antibiotics

88
Q

What is the biggest risk factor for bacterial sinusitis?

A

viral uri

followed by allergic rhinitis

89
Q

When do the following sinuses develop?

A

Ethmoid/maxillary - present at birth, sphenoid 5 years, frontal 7 years

90
Q

Define acute bacterial sinusitis

A

<30 days

91
Q

Define subacute bacterial sinusitis

A

30-90 days

92
Q

Define chronic bacterial sinusitis

A

> 90 days

93
Q

Define recurrent acute

A

multiple episodes of acute with at least 10 days asymptomatic in between

94
Q

Define bacterial sinusitis persistent illiness presentation

A

nasal discharge, daytime cough or both for >10 days without improvement

95
Q

Define bacterial sinusitis severe onset presentation

A

concurrent T >39 and purulent nasal discharge >3 days

96
Q

Define bacterial sinusitis worsening course

A

worsening or new onset nasal discharge, daytime cough, fever after initial improvement

97
Q

Causes of chronic sinusitis

A

same as acute, s aurueus or fungi

98
Q

Dx of of acute bacterial sinusitis

A

aspiration

99
Q

Rx for persistent acute sinusitis

A

observation ok for 72 hours, then antibiotics

100
Q

Rx for severe onset or worsening

A

start antibiotics - amox or augmentin

101
Q

Start with Augmentin

A

day care attendance, amoxicillin within last 30 days, <2yo

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