General pediatrics Flashcards
1
Q
Which growth curve is best for breastfed babies?
A
WHO
2
Q
Which growth curve is best for formulafed babies?
A
CDC
3
Q
What is major difference in growth of breast and formula fed babies that is reflected in WHO and CDC?
A
Breastfed babies gain weight faster in first 3 months and then velocity slows down a bit. WHO reflects that.
4
Q
Describe typical growth percentile pattern from 6 to 12 months.
A
They can cross 1 or 2 major percentile lines because weight at birth is intrauterine and weight during this period is more genetic potential.
5
Q
Define malnutrition in children <3 yrs old.
A
Weight to height <5th percentile
6
Q
Growth at 2 yrs of age signifies what?
A
Mean parenteral height
7
Q
Pattern: mucopurulent cervical discharge, intermenstrual bleeding, cervical friability, and lower abdominal pain
A
Gonorrhea
8
Q
What is the treatment for gonorrhea?
A
Ceftriaxone 250mg IM x1; Azithro 1g x1 or doxy 100mg twice a day for 7 days.
9
Q
Best testing for gonorrhea
A
NAAT
10
Q
Can gonorrhea be tested by NAAT in child abuse?
A
No, because hasn’t been verified for recto and oropharyngeal secretions
11
Q
Pattern: numerous erythematous papules located on the trunk and extremities, including the hands and feet, penis in boys and areola in girls. Found mostly in flexure surfaces and can see burrowing
A
Scabies
12
Q
What does rash represent in scabies?
A
hypersensitivity 3 weeks after infestation. So can use hydroxyzine and hydrocortisone, might take 2 to 3 weeks to subside.
13
Q
What is the treatment for scabies?
A
Permethrin from neck to toes for 8 to 14 hours and then repeat in 7 to 14 days because it is not completely ovicidal.
14
Q
How do you clean clothing and bedding with scabies?
A
Wash and dry in high heat 60C for 10min or store items in bags for >3 days.
15
Q
How should asymptomatic households of scabies infection be treated?
A
single application of permethrin at the time the index case is first treated.
16
Q
What is the difference between action of 3% saline and mannitol?
A
Saline expands intravascular volume while mannitol decreases blood viscosity and causing reflex vasoconstriction and because it is filtered by kidney, can lead to osmotic diuresis. So saline is preferred in trauma to keep intravascular space full.
17
Q
What is the continuum to coma in bad brain?
A
confusion, delirium, lethargy, and stupor
18
Q
What is the schedule for meningococcal vaccine?
A
1) All preteens at 11 and 12. Booster at 16. Meningoconjugate
2) 2 months for asplenia or complement deficiency
19
Q
What serotype is most common? Is there a vaccine for it?
A
Serotype B, yes, there is a vaccine for it; typically used for outbreaks.
20
Q
Modality best for urinary tract stone evaluation.
A
CT (can better localize, catch small ones, and uric acid stones)
21
Q
Limitations of US for urinary stones.
A
Can’t visualize small ones and those in the renal calyces, ureters, papilla and other renal structures.
22
Q
Limitations of Xray for urinary stones.
A
Can’t visualize small ones and uric acid stones
23
Q
What should be measured on first couple of days of starting TPN?
A
1) Glucose
2) Ca, P, Mg
3) Lipids
4) LFT more chronic problem
24
Q
What minerals are typically too hi or lo in premature infants?
A
Ca is too lo
P is too hi
25
Difference in pattern of presentation between urea cycle disorder and organic acidemia?
Organic academia -metabolic acidosis; elevated LFT, low blood sugar, neutropenia
Urea cycle - respiratory alkalosis; normal LFT (ammonia from inability to process protein)
26
Pattern: feeding problems in first 2 days of life, neuro, hyperammonemia, normal glucose, respiratory alkalosis
Urea cycle
27
pattern: feeding problems in first 2 days of life, neuro, hyperammonemia, ketosis, neutropenia, deranged liver function, ketosis, low glucose, metabolic acidosis
organic acidemia
28
Indication for removal of battery immediately.
1) If in esophagus
2) if it doesn't move within 24 hrs
3) symptomatic
4) >20mm
29
Indication for removal of magnets immediately
If 1+ magnets
30
Treatment for coin ingestions
If it has gone past GE sphincter, then watch. Observe for it in stool.
Repeat imaging
31
Indication for immediate removal of sharp or pointed objects
1) If object is >4cm and wider than 2cm
| 2) Or showing no movement on day 3 after ingestion
32
Warning signs for s/l delay in 6 month
Does not respond to sound
33
Warning signs for s/l delay in a 9 month
Lack of babbling
34
Warning signs for s/l delay in a 18 month
No mama and dada
35
Warning signs for s/l delay in a 24 month
No words
36
Warning signs for s/l delay in a 30 month
No 2-word phrases
37
Warning signs for s/l delay in a 36 month
No 3-word phrases
38
Age at which they follow 3-step commands
4yo
39
Age at which they can point to 4 or 5 colors
4yo
40
Age at which they can talk about time
4yo
41
What is the first screening for 6 or 9 months old who don't meet milestones for speech and language?
hearing test
42
Beyond 9 months what is first screening for those who don't meet speech and language milestones
detailed speech eval that will include hearing test
43
Most common functional innate immune system deficiency? What cell type is affected?
CGD
| Neutrophil
44
What is the test for chronic granulomatous disease?
neutrophil oxidative burst
45
Pattern: toddler or child with frequent skin, lung, sinus problems with mainly staph aureus and/or aspergillus
CGD
46
How to treatment pt suspected of having CGD
start bactrim
47
What is the cbc like for pts with CGD?
Normal - it s a function disorder
48
What other immune deficiency looks like CGD but is more rare?
Leukocyte adhesion deficiency - inability to leukocytes to leave blood stream and traffic to area of infection
49
What is most common cause of CHF in newborn? Describe mechanism.
HLHS - critical dependent cyanotic congenital heart disease
PVR lowers --> cardiac output shifts from L to R --> lungs congested, systemic output decrease in proportion to increase in pulmonary flow
50
What is most common cause of CHF in later newborn? Describe mechanism.
Large PDA
Blood flow from aorta to pulmonary artery --> increases blood return to pulmonary veins, left atrium, left ventricle and cause overload
51
What is most common cause of CHF at 4 weeks of age? Describe mechanism.
Large VSD
PVR lowers --> increase flow across VSD --> pulmonary vascular congestion and tachypnea --> volume load to the right and subsequently to the left ventricle
52
What is most common cause of CHF in first few months? Describe mechanism.
AV canal or endocardial cushion
53
What is most common cause of CHF later in childhood? Describe mechanism.
Rheumatic heart disease - mitral valve regurgitation, valve will thicken and not close properly so when LV contracts, some of it goes back up to atrium and then comes back down --> over load volume in left atrium and ventricle --> dilate LV --> both systolic and diastolic dysfunction
54
What is most common cause of CHF in older children?
Cardiomyopathy
55
What is most common cause of CHF in any age?
Myocarditis
56
Which viruses are associated with myocarditis
Coxsackie, parvovirus, adenovirus
57
How is lupus different from rheumatic fever?
Many more organs are typically involved.
58
What are the criteria for rheumatic fever?
Joints, cardic, nodules, erythematous patches on skin
59
Group A strept (GAS) is also called what?
Strept pyogenes
60
Soft tissue infection after trauma is typically caused by what bacteria?
MSSA, MRSA, GAS
61
Of MSSA, MRSA, GAS, which antibiotic would cover which?
1) Clindamycin
2) Cephalexin
3) Cefixime
4) Doxycycline
5) Penicillin
1) Clindamycin - MSSA, MRSA, GAS
2) Cephalexin
3) Cefixime
4) Doxycycline
5) Penicillin - MSSA
62
Describe headache from Chiari I
Increased with valsalva, coughing, sneezing, laughing, defecating
63
Molluscum is caused by what virus
Poxvirus
64
What is typically co-morbid with molluscum?
Atopic dermatitis
65
What are enlarging molluscum lesions that become erythematous, two possibilities?
1) immune reaction
| 2) infection with bacteria
66
When does molluscum resolve?
usually self-resolves
67
How long can molluscum persist?
many months to year if recurrent
68
Treatments for molluscum?
Beetle toxin, iretinonin
69
What are s/sx of imperforate hymen?
bluish bulge, Valsalva causes bulge to increae
70
What age is most susceptible to growth failure in children with CKD?
<1 yr
71
What are some causes of growth failure in CKD pt?
Metabolic, lower insensitivity to GH, acidosis
72
Pattern: firm, nontender, smooth abdominal mass that does not cross midline with abdominal pain, hematuria, hypertension
Wilm's tumor
73
What are clinical findings of multicystic dysplastic kidney?
Typically asymptomatic
74
What are clinical findings of ADPK in childhood?
Typically asymptomatic but can have hypertension
75
Pattern: noncommunicating abdominal cysts with intervening dysplastic renal tissue
Multicystic dysplastic kidney
76
Pattern: renal macrocysts +/- hematuria, flank or abdominal pain, infection, asymptomatic hypertension
ADPK
77
Most common dx for antenatal hydronephrosis
UPJ obstruction
78
How does UPJ obstruction present in newborn?
Typically US
79
How does UPJ obstruction present in older children?
Recurrent abdominal pain
80
How do you dx UPJ obstruction?
US or can do voiding scan
81
How does VUR typically present?
UTI
82
What is primary cause of VUR?
Ureter is too small
83
What is secondary VUR cause?
Abnormally high pressures in the bladder leading to incompetence of the ureterovesical junction and associated reflux
84
Difference in Dx test for enterovirus and arbovirus?
Arbovirus - IgM antibody
| Enterovirus - PCR
85
If CSF is negative for enterovirus, but still highly suspected, what should you test?
Throat and rectal swab
86
Prognosis for VUR
1) Grade 1 and 2
2) Grade 3 and 4
3) Grade 4
1) 60-80% self resolution
2) 10-20%
3) need surgery
87
How do allergic and nonallergic rhinitis differ?
5.26
88
How many calories does a 12kg child require?
1100kcal per day
89
Which cardiac disorder should PDA patency be maintained?
Hypoplastic left hear
Pulmonary atresia
Tricuspid atresia
90
What are red flags that staph coagulase negative might not be a contaminant of normal flora?
1) Repeatedly positive blood cultures
2) symptomatic infection (fever, hypotension, lethargy)
3) IV cath for more than 3 days
4) susceptibility show multiple antibiotic resistance
91
Mild scoliosis degree and Rx
10 to 25 degrees - observation
92
Moderate scoliosis degree and Rx
25 to 45 - bracing
93
Severe scoliosis degree and Rx
45 to 50 - spinal fusion
94
What should you ask in patient you suspect of scoliosis (ie what are the expected complications)
H/o of worsening shoulder or back asymmetry, neurologic symptoms including bowel or blader dysfunction, weakness or pain radiating into the extremities and famil history of scoliosis
95
What test should you order if you suspect scoliosis and when should you order it?
X-ray with any degree of suspicion
96
When does scoliosis did worse?
During years of rapid growth
97
What are causes of scoliosis?
Neuromuscular, NF1 and Marfan
98
What are signs of toxicity from diphenhydramine?
Agitation, confusion, hyperactivity, hallucinations, dry mouth and eyes, dry flushed skin, urinary retention, dilated pupils, tachycardia, tremor and seizures
99
Lithium toxicity
AMS, GI prob, dehydration, tremor, weakness, hyperreflexia, slurred speech, visual disturbances, and seizures
100
Verapamil toxicity
bradycardia and hypotension, CVS toxicity and shock
101
In T21 pt with AV canal defects, what other problems can occur?
Valvular problems such as MVR
102
Which murmur is both diastolic and systolic
Mitral valve regurgitation
103
What are indications for immunotherapy for allergies?
Cardiac disease. Other conditions you should be careful of: autoimmune, malignancy, immunodeficiency
104
What are contraindications for immunotherapy for allergies?
Asthma
105
What drugs are contraindicated during immunotherapy for allergies?
ACE-inhibitors can accentuate angioedema; B-blockers can decrase response to epinephrine
106
What precautions should be taken during immunotherapy?
Should observe for 30 minutes after each injection.
| Should have epi pen at home in case
107
Pattern: Child between 4 to 8 years old, h/o limp and mild activity-related pain, decreased internal rotation and abduction fo the affected hip.
Legg-Calve-Perthese
108
What is the etiology of Legg-Calve-Perthes?
Inadequate blood supply to the femoral head epiphysis leads to synovitis and early necrosis, resulting in collapse of femoral head, which reossifies in the healing phase and may not fit well in the acetabulum
109
What is the xray finding for Legg-Calve-Perthes?
Collapse of femoral head
110
Pattern: Rapidly progressive, severe pain, fever, and refusal to bear weight
Septic arthritis
111
Pattern: bilateral hip pain with morning stiffness and improves with activity
JIA
112
Pattern: unilateral hip pain in obese child between 11 and 15 years
Slipped capital femoral epiphysis
113
Duration of a transient synovitis?
Typically less than 1 week
114
What is erysipelas?
Skin infection mainly caused by GAS, Group A strep, strep pyogenes
115
What is major cause of erysipelas?
GAS (strep pyogenes)
116
What is the most convenient treatment of erysipelas?
IV ceftriaxone (once daily so can do outpatient)
117
Pattern: large, raised, tender area of nonfluctuant induration and erythema with clear borders over the left cheek
Erysipelas
118
Strep throat caused by which streptococcus?
GAS (strep pyogenes)
119
In chidren 1 to 3 years of age, the most common manifestation of GAS infection is what?
Febrile, protracted illness accompanied by rhinitis called streptococcosis
120
If negative rapid antigen testing for GAS, then what?
should send for bacterial culture
121
How do you make diagnosis of streptococcal toxic shock syndrome?
```
Isolation of GAS +2/many
1) hypotension
2) erythematous macular rash
3) Severe soft tissue infection
4) Respiratory distress;
5) Coagulopathy
6) Elevated liver enzymes
7) Increased bilirubin
7) isolated creatinine levels
.
```
122
What antibiotics for GAS infection?
penicillin
123
How do you treat GAS in pt allergic to penicillin?
clindamycin, erythromycin, azithro, clarithro
124
Should clindamycin be used for life-threatening infections? Alternative?
No, need vancomycin
125
Pattern: CNS excitation, HTN, tachy, hyperthermia, diaphoresis, and dilated pupils?
cocaine
126
What is the agent of choice for patient with mild to moderate cocaine toxicity?
IV diazepam
127
How would you describe 46, XY DSD?
Male with amibiguous genitalia
128
How would you describe 46, XX DSD?
Female with ambiguous genitalia
129
What is the most common cuase of 46, XY DSD?
partial androgen insensitiviy
130
What is the inheritance pattern of androgen insensitivity?
X-linked
131
Would a boy or girl with 21-hydroxylase deficiency have ambiguous genitalia
Girl
132
Pattern: child looks female, but has blind vaginal pouch and no Mullerian strutures?
Full androgen insensitivity
133
Pattern: 46, XY DSD, undescended testes, severe kidney disease
Denys-Drash
134
What are the three critieria for distinguishing acute bacterial from viral rhiosinusitis?
1) no improvement in 10 days
2) Onset with severe symptoms/sign of high fever, purulent
3) Worsening symptoms or signs characterized by new onset fever, headache or increase in nasal discharge following typical upper respiratory infection
135
What one process is most critical in development of metabolic syndrome?
insulin resistance
136
What is nonalcoholic steatohepatitis (NASH)?
inflammation from fatty liver
137
Pattern: 1 to 5mm flesh-colored, verrucous papules in the genital that may coalesce into large plaques
papillomavirus or condylomata acuminata
138
What is condylomata acuminate caused by?
HPV
139
How do you treat condylomata acuminate?
topical products - imiquimod or podophyllotoxin
140
How do you treat mild acne?
benzoyl peroxide, BPO/antibiotic once daily for inflammatory or mixed; topical retinoid for comedonal
141
How do you treat moderate acne?
Only face: topical RA at bedtime and antimicrobial in the AM; face and chest or back - topical retinois and oral antibiotic
142
How do you treat severe acne?
Topical retinoid for face (increase potency); high-dose oral antibiotic; Add BPO to the face; contraceptive for woman
143
What changes make up the diving reflex?
bradycardia, apnea and laryngospasm
144
In a drowning or near-drowning case, what should be maintained during therapy?
oxygenation, ventilation, maintenance of blood pressure
145
Malnutrition can affect what apart of immune system? What specifically?
atrophy of lymphoid tissue, decreased cell-mediated immunity, decreased immunoglobulin and complement levels, and diminished phagocytosis
146
What is most important arm of immune system for fighting TB?
lymphocytes via helper T cells
147
PPD is based on activity of what part of immune system?
adaptive
148
Rx for edema and HTN in patietns with GN?
furosemide
149
ACE acts on blunting RAA system via decreased production of ATII, what does it do?
1) arteriolar vasoconstriction
2) sympathetic nervous system activation
3) aldosterone secretion leading to sodium and water reabsorption
4) stimulation of vascular and myocardial fibrosis
150
When is IV hydralazine used?
in emergency situations to lower blood pressure
151
What drug is most commonly used for persistently elevated BP despite edema resolution such as in cases with BP associated with prednisone or other immunosuppressive therapy or chronic kidney disease?
ACE inhibitor or calcium channel blockers
152
Fat malaborption in chronic liver disease is caused via multiple mechanisms. What are they?
1) inadequate bile production
2) vascular congestion
3) small bowel bacterial overgrowth resulting in bile deconjugation
153
Pattern: liver problem, peripheral neuropathy, and hemolysis
Vit E deficiency
154
Pattern: liver problem, osteomalacia and rickets
Vit D deficiency
155
Pattern: liver problem and coagulopathy
Vit K deficiency
156
Pattern: liver problem and night blindness
Vit A deficiency
157
How you manage fat malabsorption from chronic liver disease?
give medium chain fatty acid and supplement with ADEK
158
Describe all defects in VACTERL?
```
Vertebra abnormalities
Anal atreasia
Cardiac defects
TE fistula
Renal anomalies
Limb abnormalties
```
159
Describe all defects in CHARGE?
Choanal atresia
Heart deficits
Anal
Renal
160
What is limitation on breastfeeding mother with varicella 4 days before delivery (any perinatal period)?
Cannot breastfeed, but can pump
161
What is limitation on breastfeeding with mother recently diagnosed with untreated brucellosis?
Cannot breastfeed or provide milk
162
What is limitation on breastfeeding with mother in US with HIV, HTLV1, 2?
Cannot breastfeed or provide milk
163
What is limitation on breastfeeding with mother who received live attenuated rubella virus vaccine immediately after delivery?
Ok to breastfeed
164
Palatal purpura or petechiae are seen in context of what disorder?
Clotting problem
165
What is special about the glabella area with regards to trauma?
Blood doesn't dissolve there readily so will accumulate
166
What three infection would be contraindicated for breastfeeding, but expressed milk can be offered?
Varicella, untreated active infectious tuberculosis, or herpes simplex lesions on the breast
167
What vitamin/mineral deficiencies have also been linked to impaired immune responses?
VitD and zinc
168
What would a small for gestational newborn look like in general and then specifically?
General - thin and lanky
Specifically - decreased muscle mass, dry peeling skin, increased plantar creasing, diminsed breast tissue, underdeveloped ear cartilage and clitoral prominence
169
What are small for gestational age newborns at risk for?
hypothermia, hypoglycemia, polycythemia
170
Pattern: linear growth failure, weight gain, pubertal changes from excess androgen production, easy bruising, facial plethora, myopathy, striae
Cushing
171
What are all the different ways you can evaluate for Cushing?
1) 24 hour urine free cortisol
2) overnight dex suppression
3) late night salivary cortisol
4) diurnal variation in cortisol
172
Which minerals accumulated during the third trimester so that premature newborns are at risk for deficiencies of them?
```
Calcium
Phosphorus
Iron
Copper
Zinc
```
173
What is the recommendation for vitD in preterm babies?
<1500g - 200 to 300IU
| >1500g 400IU
174
Recommendtion for calcium and phosphorus in premature newborns?
150 to 200mg/kg of calcium
| 60 to 75mg/kg of phosphorus each day
175
How much iron is recommended for preterm infants?
2 to 3mg/kg per day beginning at 1 to 2 months of age
176
What abnormal lab findings can be seen during normal puberty?
1) increase alkaline phosphatase
2) Increased insulin secretion
3) increased LH, FSH (will plateau when sexual maturity rating 3 is achieved)
4) estradiol and testosterone
177
Tanner 2 and 3 male
2 - enlargement of testes and scrotum
| 3- enlargement of testes and scrotum with penile growth
178
Tanner 4 and 5 male
4 - Continued growth with enlargement of the glans
| 5 - mature male genitalia with mature pubic hair
179
Tanner 2 and 3 for girls
Breast
2 - breast bud
3 - breast elevation
Pubic hair
2 - presexual hair
3 - sexual hair
180
Tanner 4 and 5 for girls
Breast
4 - Areolar mound
5 - Adult contour
Pubic hair
4 - mid-escutcheon
5 - female escutcheon
181
Pattern: round to oval patches of complete hair loss
alopecia areata
182
Pattern: round to oval patch of hair thinning located at the occiput in young infants who spend much of their time in the supine position
Friction alopecia
183
Pattern: 1 or more patches of alopecia are present as well as scale and black-dot hairs
Tinea capitis
184
Pattern: thinning of hair in areas where the hair is being tretched as the result of braiding or creating ponytails
Traction alopecia
185
Who is at risk for HIV and should be tested at least once?
Pt that live in area where prevalence of HIV is more than 0.1%
Teens who are sexually active
186
Who is at high risk of HIV and should be tested annually?
Teens with multiple sexual partners
Men with men
IV drug user
187
What are causes of transient antenatal hydronephrosis?
UT obstruction or VUR
188
What kidney feature on US suggest patient is at greatest risk for congenital anomalies of the kidneys and urinary tract?
1) severe hydronephrosis (renal-pelvic diameter >15mm)
| 2) Bilateral hydronephrosis
189
Protein requirement for 24-30 weeker
3.5 to 4g/kg/day
190
Protein requirement for 30-40 weeker
3g/kg/day
191
Protein requirement for term infant to 12 months
2-3g/kg/day
192
Protein requirement for children 1-12 years
1.5 to 2.5g/kg/day
193
Protein requirement for children >12
1-1.5g/kg/day
194
Pattern: microcephaly, epicanthal folds, micrognathia, broad nasal bridge, hypertelorism, downward-slanting palpebral fissure, ID, congenital heart disease, renal anomalies, hypospadias, cryptocorchdism, ear tags
Cri-du-chat deletion of short arm of chromosome 5
195
Pattern: Bleeding in child with normal PT/PTT/platelet number
Platelet function problem
1) Bernard-Soulier syndrome (adhesion)
2) Glanzmann thrombastenia (aggregation)
So transfuse functional platelets
196
Pattern: mild to moderate mucosal bleeding and patients present later in life after toddler hood
VWD
197
What other abnormality is associated with bicuspid aortic valve?
Coarctation
198
What is normal differential between arm and leg blood pressure?
Let>arm because of amplification of systolic pressure as blood travels down the aorta
199
BP in leg< arm, suspect what?
Coarctation
200
What percentage of those with bicuspid aortic valve will develop complications? What are the complications?
30% during lifetime; aortic regurgitation, aortic stenosis, dilation of the proximal aorta in adulthood
2% in adolescent
201
What labs are typically elevated in juvenile dermatomyositis?
CPK, AST, ALT, aldolase, LDH
202
Palpation of medial joint is useful for assessment of what?
Medial meniscal tear
203
Tenderness on patellar facet palpation indicates what?
Patellofemoral pain syndrome
204
Apley grind test evaluates what?
Meniscal tear
205
What are some comorbid endocrine conditions with SCFE?
HypoTH
| Panhypopit
206
What is the treatment for SCFE?
Stop bearing weight, orthopedics for urgent surgery
207
The higher degree of slippage in SCFE is associated with a higher risk of what?
osteoarthritis
208
What is the treatment for toxoplasmosis?
Pyrimethamine + sulfadiazine, clindamycin, atovaquone or Bactrim
209
What are indications for treating toxoplasmosis?
1) Pregnancy
2) Immunocompromised status
3) Chorioretinitis or organ damage
210
Differentiate eye problems associated with CMV, HSV, Acanthamoeba, and toxoplasmosis
1) CMV - anterior chamber of the eye
2) HSV - keratitis presenting as ocular pain, visual blurring and discharge (conjunctivitis, chemosis, dendritic lesions of the cornea, and decreased corneal sensation) or retinal necrosis
3) Acanthamoeba - Keratitis, similar to HSV; present with severe pain, photophobia, tearing and sensation of a foreign body in the eye (dx with scrapings)
4) Toxo - chorioretinitis
211
How does congenital toxoplasmosis present?
Most are asymptomatic but can have impairment later in life with learning disability, mental retardation, hearing loss or vision impairment later in life
Symptomatic patients: lymphadenopathy, rash, hepatosplenomegaly, petechie, thrombocytopenia, pneumonitis, meningoencephalitis, chorioretinitis.
212
How does toxo I immunocompromised person present?
PNA, myocarditis, pericarditis, hepatitis, and cutaneous involvement, encephalitis
213
What is the insensible water loss in extremely premature infants and what is it in full-term infant?
200ml/kg and 20ml/kg
214
Activation of the erythropoietin system occurs at what age?
34 to 36 weeks
215
Transfusion of infants with anemia of prematurity can change what vital sign parameters?
Decrease resting heart rate and respiratory rates, increase arterial oxygen content; may not change apnea frequency or oxygen saturation
216
HHV-6 outbreak occurs through which mechanism?
Everyone is exposed by 2yo. They remain latent and re-activate with immunosuppression.
217
When is HHV-6 likely to appear in transplant patient?
2-4 weeks after transplant
218
What kind of immunosuppression is caused by tacrolimus?
Lymphopenia, thrombocytopenia, and anemia
219
What kind of immunosuppression is caused by Bactrim?
Lymphopenia, thrombocytopenia and anemia
220
What are manifestations of HHV-6 infection post-transplant?
Rash, encephalitis, hepatitis, bone-marrow suppression, PNA, fever, graft rejection
221
What are the benefits of circumcision?
Lower UTI, HIV and other STD transmission, penile cancer risk
222
Anesthesia for circumcision
Penile nerve block and subcutaneous ring block, topical can irritate the skin
223
Contraindication for circumcision
Blood dyscrasia or family history of bleeding disorder, congenital penile abnormalities (hypospadias or chordee)
224
What is the Rx for recurrent lower urinary tract infection?
Postcoital antibiotic PPx - TMP, TMP-SMX, nitrofurantoin
225
How do you diagnosis urethral stricture?
retrograde urethrography or direct visualization (cystourethroscopy)
226
What is elevated and reduced in tumor lysis syndrome?
Elevated - potassium, uric acid, LDH and phosphorus (PULP)
| Reduced - calcium
227
What is the risk of having elevated uric acid?
Obstructive uropathy
228
What is the difference in mechanism between allopurinol and rasburicase in decreasing risk for obstructive uropathy?
Allopurinol inhibits xanthine and hypoxanthine from becoming uric acid and rasburicase transforms uric acid to soluble allantoin
229
Describe the four characteristics of X-linked recessive disorder
* 1) Affects mainly males
* 2) No male to male transmission
* 3) Affect males usually born to unaffected parents; mother is the carrier, is asymptomatic, and has an affected male relative
* 4) females may be affected if skewed X inactivation or father affected and mother is carrier
230
Describe the 4 characteristics of X-linked dominant disorders
* 1) Affects either sex, but female more than males
* 2) Females often milder phenotype and with more variable expressivity
* 3) Offspring of affected female have 50% chance of being affected
* 4) affected male has all affected daughters but no affected sons
231
First sign of puberty in female
Breast development - thelarche
232
When does thelarche typically occur? Average
10.7+/- 1 year
233
What is the span of time between the onset of breast development and the age of menarache?
2.3+/-1year but range is 0.5 to 5.75 years
234
When does males begin development of secondary sexual characteristics?
9-14 years of age
235
How long does it take to progress through puberty for males from stages 2 to 5
2 to 5 years
236
What factor has been isolated for earlier development in girls of breast?
Obesity
237
What should you think of it you see a girl with early puberty or rapid pubertal progression?
Pathology such as granulosa cell tumor; something that causes increase in estrogen production
238
What lab values are increased during puberty?
Alk Phos during linear growth
LH/FSH
All sex hormones
Insulin
239
What is average peak growth velocity of girls?
8 to 9 cm/year by sexual maturity
240
What is average peak growth velocity of boys?
10cm/year by sexual maturity
241
After menarche, how much more growth is there?
7.5cm linear growth potential remaining
242
What is hgb level at birth?
17g/dL
243
when does hgb nadir?
2 months to 9-11g/dL
244
What is preterm hgb nadir level?
can be 9.5 to 9
245
What is normal reticulocyte count at 4 mo?
<2%
246
Name all causes of microcytic anemia
lead poisoning, iron def, beta ( more common) thal, chronic inflammation, hemoglobinopathy, sideroblastic anemia
247
What is the RDW for iron deficiency
>14.5
248
what is the mentzer index and interprestation
MCV/RBC count
| <13 then beta thal
249
Most common transfusion reaction and cause
fever, from cytokines, so wash with leukodepletion of granulocytes
250
When should babies start taking iron supplementation?
At 4 mo if exclusively breastfed
251
What are nondietary causes of iron deficiency
blood loss, PNH, pulm hemosiderosis
252
How much iron for deficiency
2-4mg of elemental iron which is 20% of iron sulfate, best with acidic fluid
253
Description route of vitB12 absorption
bins to haptocorrin and travels to duodenum than released, then binds to intrinsic factor and goes to ileum and enters blood stream and binds to transcobalamin
254
Pernicious anemia causes
absence of terminal ileum or deficiency of intrinsic factor
255
Labs for 21-hydroxylase deficiency
17-hydroxyprogesterone, glucose and electrolyte
256
How do you treat 21-hydroxylase deficiency
hydrocortisone -mineral and glucocorticoid
257
Clinical sign of 46 XY DSD with partial androgen insensitivity
bifid scrotum, gonads, small phallus, hypospadias
258
Clinical sign of total androgen insensitivity
look female
259
Inheritance of androgen insensitivity
X-linked
260
Mutation in WT1 gene, testes undescended, severe kidney disease
Denys-Drash
261
Endocrine causes of short stature
GH deficiency, hypoTH, Cushing
262
Test for Cushing
24-hour urine-free cortisol
263
Tests for GH deficiency
IGF-1, IGF-BP3
264
Rx for idiopathic short stature
2.25 SD below or 1.2 percentile can get GH
265
Signs of peripheral precoious puberty
body odor, pubic hair, signs of virilization, but no breast development
266
Labs for peripheral precocious puberty
17-hydroxyprogesterone; total T
267
Labs for central
LH, FSH, estradiol, hCG
268
How can hCG contribute to central puberty
can bind to LH receptor and lead to testicular activation in the absence of GnRH release
269
Signs and significance of premature thelarche
Breasts only; no workup needed; growth not delayed
270
Causes of congenital hypoTH
Aplasia of TH
| Mother has Graves and antibodies cross to inhibit TSH receptors
271
When should treatment begin for congenital hypoTH
before 2 weeks of life with 10ug/kg
272
Symptoms of Addison
Ill-defined; fatigue, generalized muscular weakness, loss of appetite, poor weight gain
273
Typical lab results for Addison
hyponatremia, hyperkalemia, hypoglycemia, adrenal antibodies
274
What is secondary AI
Due to discontinuation of exogenous corticosteroid
275
How is secondary different from primary AI
Secondary AI, isolated hyponatremia without potassium
276
What additional testing for another disease should you routinely evaluate in pt with new-onset type 1 DM
Q1 to 2 years check thyroid function
277
Signs of hypocalcemia
* Trousseau - blood pressure in place for a long time depletes tissue of calcium and causes spasm of hand/forearm
* Chvostek - Tap facial nerve at angle of jaw, facial muscles on same side of the face will contract momentarily
278
Signs of hypercalcemia
polyuria, polydipsia, headache, nausea, abdominal pain, mental status changes can also occur
279
Why is there urinary concentrating defect in hypercalcemia?
Vasopressin action is inhibited
280
What are common conditions associated with congenital scoliosis?
CP, SMA, NF, Marfan, thethered spinal cord, Chiari I malformation with syrinx
281
What is genu varum
bowing of legs
282
What are causes of genu varus?
Rickets, infantile tibia vara (walking an early age and obesity), skeletal dysplasic, achondroplasia
283
What is genu valgum?
knocked knees; kids with genu varum will subsequently develop valgum that peaks around 3 and gradually improved by age 8
284
Pain worsen with hyperextension
Spondylolysis
285
Dx for spondylolysis
oblique films
286
How do you manage back pain?
1) If nothing specific on exam, NSAID and PT first.
2) Revaluate in 1 mo and get AP and lat films maybe with oblique view;
3) lab tests to rule out infection, inflammation cancer;
4) if nothing than MRI
287
How do you manage Down patient who wants to participate in sports?
1) Asymptomatic children do not need routing radiographic screening.
2) If there is cervical spine compression, then get AP and lat x-ray and urgently refer to peds ortho or neurosurgery
288
Clinical findings of heat stroke
AMS, hypotension, tachypnea, sustained tachycardia, vomiting and decreased sweating with dry skin
289
Evaluation and management of heat stroke
Check temp
| Rapid cooling with ice water bath or subsequent fluid bolus after intiating cooling
290
What is exercise-associated collapse
venous pooling in legs --> hypothension; so place supine, elevate legs and offer oral fluids
291
Confusion and loss of consciousness after sports event
hyponatremia
292
Return to play after concussion
step-wise gradual return once asymptomatic for 24 hours
293
What does a hyphema look like?
collection blood in the anterior chamber of the eye from disruption of the blood vessels of the iris
294
How do you treat hyphema?
urgent evaluation by ophthalmologist because of risk of additional bleeding and large collection that can stain cornea or cause glaucoma
295
What does globe rupture look like
sever pain, lack of normal extraocular motion, disruption of the sclera or cornea, decreased visual acuity
Emergency ophthalmologic evaluation
296
Management of overuse injury
Rest for 4 weeks and PT afterwards; for avulsions >0.5 to 1cm, surgery may be required
297
What is little league elbow?
widening of the distal humerus medial epicondyle epiphysis
298
How does little league elbow present?
tendernss over the medial epicondyle of the elbow with decr ROM; Xray show widening of the epiphysis +/- avulsion of piece of the medial epicondyle epiphysis
299
What is Osgood-Schlatter syndrome
Irritation of the tibial tubercle apoplysis
300
Heel pain that worsens when you squeeze it
Sever
301
How do you treat sever?
padded help cups and allow return to play because this is a chronic condition that can last for 1-2 years
302
What is sever disease
calcaneal apophysisitis from traction on the apoplysis by the Achilles tendon and repetitive impact to the heel
303
What kind of protective eyewear for sports?
Shatter-resistant polycarbonate lenses
304
What is the treatment for auricular hematoma
prompt drainage with application of a compressive dressing
305
What is a burner or stinger?
mild brachial plexus injury; pain radiating down the arm, weakness and paresthesias in the arm and shoulder for <24 hours
306
What is the natural history of shoulder dislocation?
High rates of rediclocation after initial traumatic dislocation
307
How do you manage a dislocated shoulder?
1) Xray first to look for specific lesion
2) Reduce to restore normal position of humeral head
3) Shoulder immobilizing for 2 to 3 weeks
4) PT
5) Elective surgical repair of torn ligaments and labrum
308
What is the optimal age-appropriate replacement for fluid losses?
Hydration every 20 minutes during physical activity in pre and adolescents
For exercise lasting 1 hour or less, water is sufficient
309
Name the performance enhancing drug
| Adrogen effects
Androstenedione, nadrolone
310
Name the performance enhancing drug:
| improve energy level and exercise tolerance but side effect is abdominal discomfort
Coenzyme Q
311
Name the performance enhancing drug:
| Enhance oxygen-carrying capacity but can cause hyperviscosity of the blood and thrombosis
EPO
312
Name the performance enhancing drug
| Simulants - weight loss and trouble sleeping
Phentermine, methylphen
313
Name the performance enhancing drug
| Short burst of high-intensity exercise; muscle cramping and diarrhea
creatine
314
Name the performance enhancing drug
| Stimulat that can casue arrhythmias, seizures and stroke and HTN
ephedrine
315
What are the symptoms of congenital CMV?
blueberry muffin rash, thrombocytopenia; IUGR, microcephaly, cerebral atrophy, periventricular intracerebral calcifications, hepatosplenomegaly, jaundice, chorioretinitis
316
What cause oral hairy leukoplakia in HIV patient
CMV
317
What disease is EBV associated with
X-linked lymphoproliferative syndromes, Burkitt lymphoma, nasopharyngeal carcinoma
318
EBV IgM-viral capsid antigen
Acute primary or very recent-past infection
319
EB nuclear antigen
convalescing or post-EBV
320
EBV IgG
not much help
321
At what age can monospot test be sensitive
>50% after 2-4 years
322
What are symptoms of EBV?
Fever, pharyngitis, tonsillitiss, lymphadenopathy, abnormal liver function
323
What are complications of EBV infection
Airway obstruction, neurologic complications, severe hepatitis, myocarditis or hemolytic anemia (can use corticosteroids)
324
What are the three forms of neonatal HSV
45% SEM (skin, eyes, mouth); 30% CNS only; 25% disseminate (liver, lung and CNS involvement)
325
How do you test for HSV?
1) culture of mouth, nasopharynx, conjunctivae, and anus
2) HSV culture and PCR of skin lesions and CSF; blood PCR
3) liver enzymes
326
what is the treatment for HSV?
14 days of acyclovir for SEM and 21 days for CNS and disseminated; continue oral for 6 months;
IV always in immunocompromised host
327
Describe clinical findings associated with OI
bowing, thin cortices, thin beaded ribs, severe osteoporosis, Wormian bones in the skull, codfish vertebrae, multiple fractures, blue or grey sclerae, SGA, and relative macrocephaly
328
Describe OT type 1 findings and complications
mild, normal lifespan, near-normal stuature, ligamentous laxity; no bony deformity
329
Describe OT type 2
bad, perinatal lethal due to respiratory insufficiency because of narrow horax, multiple rib fracture or falail chest
330
Describe OT type 3
Dentinogeneis imperfect, denal care but can have respiratory insufficiency too
331
Describe OT type 4
Common variable OI with normal sclerae
332
What are some common long-term complications?
short stature <3 ft, hearing loss both conductive and sensorineural because of fractures in the middle ear bones; basilar impression (upward protrusion of the top of the spine into the base of the skull - HA, double vision, poor coordination or limb weakness)
333
What are clinical findings of achondroplasia
short stature, short arms and legs, macrocephaly, frontal bossing and midfacial retrusion; normal intelligence and life span
334
What are some complications of achondroplasia?
Craniocervial junction compression, hydrocephalus, delayed motor milestones, sleep apnea, kypohosis, bowing of the legs, obesity and lumbar spinal stenosis
335
What evaluation should infants with achondroplasia have?
Repeat hearing at 1 yr, CT or MRI of craniocervical junction, o/n polysomnography and thorough neurologic examination for cervical myelopathy - signs include lower limb, hyperreflexia or clonus, central hypopnea on sleep study or reduced formane magnum on CT
336
Are the three causes of in-toeing
Infants - metatarsus adductus
Toddlers - tibial torsion
>3yrs - femoral anteversion
337
What is femoral anteversion?
Increase in angle of the femoral neck >20 degrees relative to shaft of the femur
338
When does femoral anteversion happen mostly and what is its nature history
In girls who sit with W position, increases in severity until 5 years of age, then spontaneously resolve by 12 years of age
339
How do kids with tibial torsion often present?
Parents report clumsiness and frequent tripping, can occur unilater or bilateral
340
What evaluation do you do for tibial torsion?
Thigh-foot angle to confirm presence of tibial torsion
341
When is orthopedic evaluation necessary for tibial torsion
When it causes out-toeing which can be associated with neuromuscular conditions
342
What are etiology of osteomyelitis in patients of various ages
Neonate - GBS, G- enteric
<3 years old - kingella kingae
Older - staph aureus
children with hemoglobinopathies - sickle cell disease
343
Where does hematogenous osteomyelitis typically occur?
Metaphysis of long bones and may follow minor trauma to the infected area
344
Management for osteomyelitis
pending cx - start clindamycin
345
What are etiology of pyogenic arthritis in different age groups
Neonates - GAS, coag- staph, enterobactericiae, candida
Young children - Kingella kingae, strep PNA, H. influenza
Adolescents - neiserria gonorrhoeae
346
What is the clinical findings of pyogenic arthritis
ill-appearing with fever, pain and swelling, pseudoparalysis; CRP/ESR elevated, widening of joint space with join effusion on radiographic imaging, synovial fluid WBC >50K with a neutrophil predominance
347
Evaluation of pyogenic arthritis in patients
CRP/ESR, snovial fluid, x-ray
348
Antimicrobial management of pyogenic arthritis
```
GAS - PNC
Gram+ resistant, MRSA - vancomycin
Staph, S pneuomoniae - clindamycin
Gram- pathogen and susceptible strains of pneumococcus - 3rd gen cefotxaime
Pasteurella - Augmentin
```
349
4 differential for bone cyst
1) unicameral (epiphysis humerus and femur)
2) aneurysmal (diaphysis or metaphysis - needs orthopedist to remove immediately
3) Malignant tumors - destroy adjacent bone and lead to irregularity
4) fibrous cortical defects - femur well-delineated lucent lesions surrounded by sclerosis; if 50% of bone diameter than need attention
350
Decreased internal rotation and abduction of the affected hip is caused by what
Legg-Calve-Perthes disease
351
What is Legg-Calve-Perthes disease
avascular necrosis
352
What is the differential diagnosis of avascular necrosis in a patient with a limp?
JIA, septic arthritis, SCFE, transient synovitis
353
Hip is held in externally rotate position and have limited internal rotation
SCFE
354
What is rx for SCFE
no weight bearing and refer to orthopedic specialist for urgen surgery. internal fixation of the femoral head with screws is the most common treatment
355
Differential of back pain in children
spondylolysis, discitis
356
Back pain worsen with hyperextension and how do you evaluate
spondylolyis, oblique films; rest and avoidance of aggravating activities
357
Limping or refusal to walk, back pain in child <5 years
Discitis - MRI. Treat staph aureus
358
MRI for back pain is best to evaluate what
infection, herniated disc, or tumor in children
359
CT for back pain is best to evaluate what
suspected spondylolylsis if normal plain xray
360
How do you eval and treat back pain?
If nothing specific, than NSAID and PT first. Re-evaluate in 1 month and get AP and lat films with oblique view. Lab tests to rule out infection, inflammation, cancer; if nothing than do MRI to look for infection, herniated disc or tumor
361
What is the most common motor neuron condition associated with arthrogryposis
SMA, mito cytopathy, primary myopathy
362
Pattern: fixed in-turning of the hindfoot, plantar flexion at the ankle, and cavus appearance of the distal foot
clubfoot
363
Rx for clubfoot
serial manipulation and casting ASAP
364
Poison: Esophageal perforation, mucosal and skin surface by liquefaction necrosis; odynophagia, dysphagia, drooling, intraoral burns, ulcerations vomiting with hematemesis
corrosives (toilet bowl cleaners, laundry detergents, stain and mildew removers, floor cleaners, laundry detergents, stain and mildew removers, floor cleaners, oven cleaners, rush removers
365
Poison: depressed mental status, nausea, vomiting; seizure and coma within a few hours; hypocalcemia
ethylene glycol,
366
Poison. chemical conjunctivitis, cough with inhalation, vomiting after ingetions
glycophosphate-containing weed killers
367
Poison. salivation, lacrimation, urination, defecation or diarrhea, GI upset and emesis, tachypnea and bradycardia
organophosphate
368
Poison. Respiratory distress due to pulmonary aspiration, acute coughing gagging and choking, fever, tachypnea, cyanosis, and abnormal lung sounds, crackles and wheezing
hydrocarbon-based (furniture polish, pulmonary aspiration)
369
Pattern: dilatation of the proximal muscular urethra against a closed or narrow distal urethral sphincter
spinning top urethral
370
Rx for spinning top
Will resolve on own
371
Indications for VZV IgG
1) neonates born to mothers who develop chickenpos withing 5 days before and 48 hours after delivery
2) Neonates >28wks if mother lacks immunity
3) Neonates <28wks or <1000g regardless of maternal immunity
4) Pregnant women without evidence of immunity
5) Immunocompromised persons without evidence of immunity
372
Indication for VZV vaccine
1) postexposure PPx for healthy people without evidence of immunity 12 mo or older
2) if administered within 72hrs after exposure to varicella
373
Pattern: gradual development of GI symptoms over 3 weeks progressing to development of dysenteric, bloody stools, and can lead to liver abscess
Amebiasis; E histolytica
374
Pattern: travelers' diarrhea, self-limited 1 to 5 day with fever, watery stolls and abdominal cramps
ETEC
375
Pattern: shiga toxin-producing strain associated with diarrhea, hemorrhagic colitis and hemolytic-uremic syndrome
O157:H7
376
Pattern: abdominal bloating, watery diarrhea, and malabsorption
giardia
377
Problems typically seen in infants of diabetic mothers
1) Fetal macrosomia
2) Cardiomyopathy
3) Decreased surfactant production --> RDS
4) polycythemia
5) hypocalcemia
6) congential anomalies - TGV, VSD, caudal regression syndrome, neural tube defects; small left colon syndrome
378
Pattern: FAS hemoglobin
Sickle cell trait
379
Pattern: FS hemoglobin
Sickle cell anemia
380
Pattern: FSC
milder phenotype of SC disease
381
Pattern: FSA
S beta+ thalassemia (mild or no anemia)
382
HbF
alpha and gamma
383
HbA2
alpha and delta
384
HbA
alpha and beta
385
HbA2 is elevated in what
beta+ thalassemia
386
Describe causes of atypical PNA
mycoplasma or chlamydia PNA
387
Describe symptoms of atypical PNA
school-aged or older, not highly febrile, have a dry cough that develops later in the illness as symptoms of HA, myalgias, and malaise improves
388
Rx for atypical PNA
azithromycin
389
Most common cause of PNA in children 3 months to 4 years of age
virus, RSV, Influenza, parainflu, adno, human metapneumo, rhino
390
Rx for bleeding from varices
octreotide infusion
391
TSH at different time points after birth
1) 24hours of life
2) 2 weeks
1) 20-25 mIU/L
| 2) 10 mIU/L
392
What dose of levothyroxine
10-15ug/kg per day
393
What about borderline TSH bwteen 5 and 10?
Can treat, but trial off therapy at 3 years of age
394
BCG will give positive TST during what period of time?
within 10 years of age
395
Pattern: lilac right or violaceous inflammatory border, skin is indurated, skin thickening, ivory-colored center of sclerosis, dermal and subcutaneous atrophy can develop later in the disease course, resulting in visible veins, flat or concave depression of the subcutaneous tissues, lack of hair growth
Localized scleroderma
396
Pattern: Scaly and typically hypopigmented lesions with a cigarette paper-like wrinkled appearance and varying degrees of sclerosis
lichen sclerosus
397
What further testing should you do if you have linear scleroderma on the head or scalp
should do MRI to look for calcifications, white matter changes, vascular malformations, and signs of CNS vasculitis
398
What are complications of untreated localized scleroderma?
growth abnormalities, disfiguring lesions and joint contractures
399
What 2 types of fractures are typically seen in child abuse cases?
spiral and metaphyseal chip fractures
400
Pattern: immune-mediated skin problem characterized by erythematous and edematous papules or targetlike lesion
Erythema multiforme
401
What is the most common cause of EM in young adults
HSV, mycoplasma, GAS
402
What are extrapulmonary manifestations of mycoplastma infection
arthritis, polymorphous skin eruptions, hemolytic anemia, carditis and nervous system disease
403
If small bowel involvement is seen in suspected IBD what test first?
Small bowel series
404
What is the most common consequence of submucosal cleft palate?
conductive hearing loss
405
Onset and duration of SABA and LABA
SABA within 15 min for 4-6 hrs
| LABA within 30 min for 12 hrs
406
What can happen with regular use of LABA and SABA?
dimunition of bronchoprotective effect
407
Positive DAT is consistent with what?
AIHA
408
What two agents/condition is associated with AIHA
Infection and antibiotic
409
What are 3 forms of AIHA
1) Warm-reactive IgG autoantibodies
2) Paroxysmal cold hemoglobinuria
3) IgM-mediated cold agglutinin
410
Which AIHA:
| Extravascular
Warm and cold
411
Which AIHA:
| Intravascular
Paroxysmal cold
412
Which AIHA:
| Intra and extravascular hemolysis
IgM cold
413
Which AIHA:
| associated with mycoplasma
IgM cold
414
Which AIHA:
| leads to intravascular hemolysis at cold temperatures but binds complement at 37C
Paroxysmal cold
415
Rx for severely low hemoglobin in AIHA
steroids and transfusion
416
Tri21 pts have increased risk of what after surgery
1) 3x infection
2) 2x respiratory complications
3) 3x PHTN
4) 3x AV block
417
Cardiac condition with 22q11
conotruncal and great artery defect
418
Cardiac condition with Turner syndrome
coarctation, aortic stenosis or bicuspid aortic valve
419
Cardiac condition with FAS
septal defects
420
Comorbidity with ADPKD
cerebral aneurysms
421
ADPKD pt with fmhx of intracranial aneurysms are at increased risk of developing intracranial aneurysm rupture with what other symptoms?
>7mm, poorly controlled hypertension and <50 year old
422
When is routine imaging needed for aneurysm in pt with ADPKD
1) h/o rupture
2) + fmhx of intracerebral bleeding or IC aneurysm
3) occupation that place them at risk
4) hemodynamic instability and HTN associated with surgeries
423
Screening recs for high risk ADPKD patients
1) Q5 years after initial neg radiographic studies
| 2) Q2-3 if there was bleed and Q2-5 thereafter if aneurysm is stable
424
Difference in description of retinitis versus chorioretinitis
Retinitis - loss or blurring of vision, blind spots, floaters, and flashing lights, floaters and photopsia, retinal detachment, hemorrhage in association with white (or yellow) fluffy retinal lesion close to the retinal vessels
Choriretinitis - white, infiltrative, moundlike lesions on the retina
425
What causes retinitis, what cause chorioretinitis
1) retinitis - CMV, Bartonella henselae, hsv
| 2) Chorio - candida, toxo
426
Sudden bilious vomiting should be concerning for what?
partial or complete intestinal obstruction beyond the ampulla of Vater
427
Study of choice for suspected malrotation
Upper GI series
428
When should you seek care for child with femoral anteversion?
If it persists beyond 11
429
What are most common complications in foreign body aspiration?
PNA and atelectasis
430
Schedule for meningococcal
11 to 12 yrs with booster at 16
431
Meningococcal vaccine schedule for travelers to endemic regions by age
<9 mo - 3 doses (2, 4, and 6)
9 -23 (2 doses)
24mo (single)
432
Who is at increased risk for meningococcal B
1) persistent complement component
2) anatomic or functional asplenia
3) outbreak
433
When do you use 23-valent pneumococcal vaccine
in high-risk children >2yrs in addition to PCV13
| >8 weeks after last PCV13 dose, revaccinate high-risk children once after 5 years
434
When do you need to give a pneumococcal vaccine in kids 6-18 years
1) anatomic or functional asplenia, SC
2) HIV or other immune compromise, malignancy, transplant recipients
3) cochlear implant or CSF leak
4) chronic renal failure, nephrotic syndrome
435
Schedule for Hep A vaccine
>1 yr of age; 2 doses at least 6 months apart
436
Indication for hepA vaccine other than scheduled
Travelers to endemic areas, close contact with international adoptees, HepA outbreak post-exposure ppx, chronic liver disease
437
Age for DTaP or DT
<7yrs
438
Age for Tdap or Td
>7yrs
439
Contraindications for pertussis vaccine
anaphylactic reaction, encephalopathy within 7 days
440
Waning immunity rate to pertussis
10-15% per year
441
When is Tdap used
Routine at age 11-12yrs
Catch-up for adolescent 13-18yrs
Single dose in undervaccinated children
During pregnancy
442
VZV schedule
12-15 months and 4-6 years of age
443
Maximum age for rotavirus
8 months
444
Contraindications for rotavirus
SCID, h/o intussusception
445
Routine schedule for HPV
9-14 years, 2 doses, 6 month interval
446
Schedule for HPV immunocompromised
3 dose series
447
Reye syndrome with aspirin and which virus
influenza
448
Major cause of croup
parainfluenza
449
Parainfluenze type 3 can cause what neuro problem
aspetic meningitis, encephalitis
450
Who should get palivizumab for RSV
```
1) CLD <32 weeks gestation
<12 months of age and require 21% oxygen for 28 days
CHD
Anatomic pulmonary abnormalities
Neuromuscular disease
Immunocompromised children
```
451
For ankle sprains, what are the treatment
If no pain, stirrup brace. If pain, then crutches to avoid weight bearing
452
How do you diagnose hyperinsulinism?
Normal insulin >13uIU/ml in setting of very low glucose
453
What to do immediately for snake bite
splint and keep arm at level of heart
454
What is the official recommendation for hearing screening?
ABR, OAE in newborns, audiologic assessment by 3 months of age who fail their newborn screening; individualized intervention by 6 months of agefor those with significant hearing impairment
455
PNA at birth is usually cuased by
chlamydia
| given erthyromycin
456
Which renal disorder has low C3
Lupus, postinfectios/poststreptococcal, membranoprliferative GN, shunt nephritis, subacute bacterial endocarditis
457
Factors that predict high school completion of pregnant mother
reading material in home, black race, employment of the adolescent's mother, being raised in a smaller family, and having parents with higher educational levels
458
Treatment for corneal abrasion
Do not give topical anesthetics. Just antibiotics
459
Pancreatic elastase in stool is a test for what?
Pancreatic insufficiency
460
Pattern: anemia, neutropenia, low platelets, elevated liver enzymes, hepatomegaly, recurrent infection
Shwachman-Diamond syndrome
461
What imaging test can help diagnosis Shwachman-Diamond
Fatty pancreas
462
Rx for otits externa
Topical fluoroquinones
463
Overdose: hypotension, sinus bradycardia, heart block, AMS, coma, delirium and seizures, increased airway resistance, respiratory depression, hypoglycemia and hyperkalemia
beta blocker overdose
464
Lachman, describe and what is it for
ACL, hold femur and pull tibia forward
465
Valgus stress test; describe and what is it for
MCL sprain; heel of the hand over the alteral aspect of the knee and applies a medially directed force with the joint flexed to 30 degrees; pain indicates stretch or partial tear of the MCL, laxity is complete tear
466
Drawer test, describe and what is it for
PCL; knee flexed enough to allow the foot to rest flat on the examination table, examiner stabilizes the foot and pushes the tibia posteriorly
467
McMurray, describe and what is it for
meniscal tear; pain or there is a palpable click with valgus stress to the knee, external rotation of the tibia and passive motion of the knee from extreme flexion to extension
468
Recurrent hypoglycemia associated with intercurrent illness in the absence of metabolic acidosis or other electrolyte imbalances
Carnitine deficiency
469
Apgar scores
* Activity (1) some flexion (2) active
* Breathing (1) weak cry (2) good cry
* Color (1) acrocyanotic (2) pink
* Grimace reflex irritability (1) grimace (2) cry, withdrawal
* Heart (1) <100 (2) >100
470
PT
Extrinsic
| Factor X, VII, V, prothrombin, fibrinogen NL 9-13s
471
PTT
Intrinsic, HMWK, XII, XI, X, IX, VIII, V, prothrombin, fibrinogen
NL 23.4 - 32.4s
472
normal coag factor levels in newborn
At birth, VitK reduced to about 50% (II, VII, IX, X);
XI and XII are also 50%
Factor V, VIII, XIII similar to adults
ATIII, ProtC/S reduced (30-60%)
473
Pattern: prolonged PT and PTT with Nl fibrinogen
Vit K deficiency
474
Drugs that antagonize Vit K deficiency
warfarin, INH, phenobarb
475
Other causes of VitK deficiency
Diet, antibiotics, malabsorption
476
Long term complications of hemophilia
Chronic hemarthroses leading to joint destruction
477
Name the 7 thrombophilia
```
ProtS, C, ATIII
Factor V Leiden
Antiphospholipid
Hyperprothrombinemia
Hyperhomocysteinemia
```
478
Basic thrombophilia work-up
PT, PTT, INR
Protein C and S
Factor V Leiden/Activated Protein C, MTHFR mutation/homocsteine level, Prothrombin mutation, DRVVT, ATIII
479
What is neonatal purpura fulminans
Sudden, massive microthroombosis, skin necrosis, systemic DIC, Homozygous Protein C or S deficiency
480
Presentation of Protein C and S deficiency heterozygous
VTE
481
If heparin fails to anticoag, what should you think of
ATIII deficiency
482
Describe Factor V Leiden mutation and how that causes disease
Mutation renders FV resistant to cleavage by Protein C
483
Prothrombin gene mutation
Promotes enhanced thrombin generation
484
Rx for hyperhomocysteinemia
Folate
485
Which prothrombotic disorder gives you prolonged PTT
anti-phospholipid
486
What are some acquired thrombotic states
nephrotic syndrome, IBD, paroxysmal nocturnal hemoglobinuria, malignancy, medications (L-asparaginase, warfarin, estrogen, heparin); HIT
487
Congenital cataracts
Tri,WAGR, CHARGE, NF-2, Sturge-Weber, Alport, Galactosemia, copper metabolism
488
Indication for MT tube insertion
1) AOM not response to 3rd line treatment
2) Recurrent AOM: 3 episodes/6 months or 4 episodes/12mos
3) Immunocompromised, eriously ill
4) anatomical abnormalities
