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PGY-3 and 4 > Inpatient Peds > Flashcards

Inpatient Peds Flashcards

1
Q

Barlow Test

A

First - adducting hip, applying posterior force, pressure on the knee
femoral head OUT of acetabulum
dislocating

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2
Q

Ortolani Test

A

Abduct the hip, anterior force on femur

reducing

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3
Q

Worrisome Signs of Sacral Dimples

A

cutaneous signs (hypertrichosis, hemiangioma, etc)
greater than 5mm in diameter
greater than 2.5cm above anus

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4
Q

Ductal Steal

A

excessive blood flow through pulm circulation –> hypoperfusion of systemic

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5
Q

Chlamydial conjunctivitis presents at age..

A

5-14d after birth

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6
Q

Chlyamdia PNA presents at what age

A

4-12 weeks of age

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7
Q

Cow Milk and IDA

A

Low Fe content of cow mlik
occult GI blood loss w/ CM in 40% of population
inhibition of non-heme iron absorption by casein and calcium

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8
Q

TEN-4

A

any bruising less than four months

trunks/ears/neck older than 4m

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9
Q

Types of HSV Infection in Neonates

A

Skin Eye Mucous Membranes
CNS/Meningitis
Disseminated

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10
Q

Phototherapy works by

A

converting bilirubin to lumirubin (more water soluble)

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11
Q

Bilirubin peaks on what day of life

A

three (5 if premature)

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12
Q

Phototherapy will decrease bilirubin by what rate…

A

0.5 /hr

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13
Q

Bilirubin in neonates accumulates in what part of brain

A

Basal ganglia

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14
Q

Conjugated hyperbili definition

A

greater than 2 if less than 5

greater than 20%

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15
Q

HSP Diagnosis

A

EULAR Criteria
have to have purpura/petechiae w predom on lower extremities
+ 1/4: abd pain, arthritis, arthralgia, histo, or renal

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16
Q

Most common cause of hemoptysis in peds

A

cystic fibrosis

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17
Q

Febrile seizures simple classification

A

less than 15 minutes
one in 24hr period
generalized, not focal

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18
Q

Monospot/Heterophile Antibody

A

Good test in older kids (younger kids don’t make Ab, less than 4)
Good when symptoms present at least 5 days, more likely to be positive as time goes on

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19
Q

CBC abnormality w/ EBV

A

atypical lymphoctes

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20
Q

Mono- keep out of sports for

A

3 weeks

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21
Q

EBV-NA (nuclear antigen)

A

positive 1-2 months after infection

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22
Q

Rovsing sign

A

pain in the right lower quadrant with palpation of the left side

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23
Q

Obturator sign

A

pain on flexion and internal rotation of the right hip,

which is seen when the inflamed appendix lies in the pelvis and causes irritation of the obturator internus muscle

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24
Q

Iliopsoas Sign

A

pain on extension of the right hip, which is found in retrocecal appendicitis

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25
Q

Age range for typical intussception

A

6-36m

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26
Q

Intussception - most common location

A

ileocecal

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27
Q

Intussception - lead point

A

peyer patches > meckels, lyphoma

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28
Q

Intussception - imaging

A

US: target sign
XR: Crescent sign

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29
Q

intussception treatment

A

air enema

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30
Q

Ladd Bands

A

connect cecum to abdominal wall, cross duodenum

present in malrotation pts

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31
Q

Malrotation imaging of choice

A

UGI with contrast

shows corkscrew sign

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32
Q

Cholinergic Poisoning

A

SLUDGE

Parasympathetic: Salivation, Lacrimation, Urination, Defecation, Gastric Upset, Emesis

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33
Q

Status epilepticus duration

A

Historically 30 minutes

However, >5 minutes likely to be prolonged and lead to status, so treatment algorithms start here

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34
Q

Otitis Externa - Organisms to cover

A

Pseudomonas and Staphylcoccus

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35
Q

PID- Short term complications

A

tubo-ovarian abscess
perihepatitis (Fitz-Hugh-Curtis)
periappendicitis

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36
Q

PID Organisms

A
  • STI- Gonorrhea, Chlamydia
  • Ureaplasma, Mycoplasma
  • Anaerobes/GI- E coli, Bacteroides, Gardenella, actinomyces, etc…
  • Can be due to UTIs
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37
Q

PID Diagnosis

A

1) Cervical, Adenxal or Uterine Tenderness
and
2) Supportive findings including fever, discharge, +STD, elevated ESR/CRP

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38
Q

PID Oral Treatment

A

Ceftriaxone + Doxy +/- Flagyl

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39
Q

Lyme Treatment

A

doxy
amox
cefuroxime

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40
Q

Port Wine Stain

A
  • capillary vascular malformation
  • can be associated with Sturge Weber (seizures, glaucoma)
  • typically in V1 distribution w/ SWS
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41
Q

Tick paralysis-

A

mimics GBS

remove tick!

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42
Q

What common peds meds for chronic kids CAN”T be in solution

A
  • levothyroxine

- baclofen

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43
Q

Colic definition

A

3 hours of crying for 3 days a week for at least 3 weeks

should resolve by 4-6 months

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44
Q

Gianotti Crosti syndrome

A

papular rash on legs, buttocks, arms

hypersensitivity reaction to prior viral infection

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45
Q

Papular Urticaria

A

rxn to to insect bites

red papules or vesicles on extremities, can be umbilicated

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46
Q

Edwards Syndrome

A

Trisomy 18

  • rocker bottom feet (vertical talus)
  • petite face (small mouth, micrognathia)
  • clenched hands, 5th over 4th, 2nd over 3rd
  • GI can be malrotation, meckels, omphalocele
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47
Q

Patau Syndrome

A

Trisomy 13

- micro/anophthalmia, cleft lip and/or palate, and postaxial polydactyly

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48
Q

Apnea Definition

A

cessation of breathing for 20 seconds

or shorter with bradycardia (HR <100, cyanosis or pallor)

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49
Q

Stridor

A

high pitch, upper airway obstruction

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50
Q

Wheezing

A

narrowing of airway

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51
Q

Rhonchi

A

rattling
larger airway
mucus obstruction

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52
Q

Williams Syndrome

A
  • elfin face, friendly demeanor
  • aortic stenosis, arterial stenosis
  • hypercalcemia
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53
Q

Hepatomegaly in Newborns

A

greater than 3.5cm in newborns below costal margin

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54
Q

Hepatomegaly in Children

A

greater than 2cm in children below right costal margin

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55
Q

Noonan Syndrome

A

hypertelorism
short stature
webbed neck
pulmonary valve stenosis

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56
Q

Impetigo- organisms

A 
Staph Aurues (MSSA, MRSA)
GAS
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57
Q

Adenovirus

A

commonly pharyngitis and conjunctivitis

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58
Q

TB treatment in children

A

Under 5 - receive prophylactic treatment

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59
Q

Pneumonia Organisms - Less than age 5

A

Viral: RSV most common, adeno, humanmeta

Strep Pneumo, H flu > Mycoplasma

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60
Q

Pneumonia Organisms - Age 5 through 18

A

Mycoplasma > Strep Pneumo, H flu

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61
Q

Blood Cultures in Peds Pneumonia

A

low clinical utility

  • fail to show clinical improvement
  • moderate to severe
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62
Q

Effusions size in pediatrics

A

small - less than 1/4 of thorax
medium - less than 1/2
large - more than 1/2

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63
Q

Peds Pneumonia with Empyema - antibiotics

A 
consider ceftriaxone (resistant s pneumo) + 
 clindamycin or vancomycin (MRSA coverage)
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64
Q

Nitrites vs LE in UAs

A

nitrite –> specific

LE –> sensitive

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65
Q

Recommendations for Renal Ultrasound in Peds

A

2-24 months following first febrile UTI

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66
Q

Can use see VUR on renal ultrasounds?

A

only Grade III-IV

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67
Q

Recommendation for VCUG in Peds

A 
2 or more febrile UTIs
1st febrile UTI w/ 
- abnormal u/s
- 39+ temp + organism other than E coli
- Poor growth or HTN
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68
Q

How does H flu get resistance to Amox

A

Beta lactamase

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69
Q

How does Strep give resistance to Amox

A

PCN binding proteins

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70
Q

HUS triad

A

anemia, thrombocytopenia, acute renal failure

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71
Q

McCune Albright Triad

A

precocious puberty
café-au-late spots
fibrous dysplasia

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72
Q

Cover Test

A

First eye covered for 1-2 seconds, observe uncovered eye

Cover opposite ever for 1-2 seconds

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73
Q

congenital melanocytic nevi

A

transformation to melanoma in large CMN, >20cm

grow as children grow

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74
Q

Phytophotodermatitis

A

rash following citrus exposure and then UV light

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75
Q

Measles- symptoms

A

cough, coryza, conjunctivitis

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76
Q

Koplik spots

A

white spots on buccal mucosa, occur before measles rash begins

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77
Q

Measles Complications

A
  • ADEM
  • Encephalitis
  • Subacute sclerosing panencephalitis
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78
Q

Croup-

A

parainfluenza

6 months to 3 years

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79
Q

Croup Treatment

A

Dexamethasone even if mild symptoms

Race epi if stridor at rest

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80
Q

Croup X ray

A

steeple sign on neck xray, subglottic tracheal narrowing

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81
Q

Racemic Epinephrine

A

reduce stridor in 30 minutes
lasts no longer than 2 hours
observe for 4 hours

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82
Q

Pleural TB

A

primary TB pleuritis in kids
reactivation TB pleuritis in adults
obtain pleural biopsy

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83
Q

ASA in Kawasaki Disease

A

preventing intracoronary thrombosis that could leading to MI in stenotic or aneurysmal coronary artery

84
Q

Peutz-Jeghers Syndrome

A

AD
melanocytic macules of lips, buccal mucosa, digits
GI harmartomatous polyps (rectal bleeding, anemia)

85
Q

DiGeorge Syndrome

A 
CATCH-22 (chromosome 22)
C- cardiac abnormalities
A- abnormal facies
T- Thymic absence or T cell dysfunction
C- cleft palate
H- hypocalcemia
86
Q

Raynold Phenomena- Triphasic

A

1) With vasospasm, the digit exhibits a distinctly demarcated distal pallor coolness (white)
2) cool dusky bluish phase and/or (blue)
3) a bright hyperemic flush (red)

87
Q

Dermatomyositis MOA

A

small vessel vasculopathy

88
Q

Dermatomyositis- muscle symptoms

A

proximal muscle weakness

89
Q

proximal muscle weakness=

A

difficulty getting up out of chair/toilet
climbing stairs
getting on and off the floor

90
Q

Muscle Enzymes =

A

CK
LDH
aldolase
AST

91
Q

Classic KD Symptoms

A

5 days of fever
4/5 CRASH
Conjunctivitis, Rash, Adenopathy, Strawberry tongue/mucositis, Hands and feet

92
Q

Incomplete KD Features

A 
sterile pyuria
anemia
low albumin
thrombocytosis
elevated ALT
leukocytosis
or ECHO findings
93
Q

JIA diagnosis

A

6 weeks of symptoms

before 16th birthday

94
Q

Torticollis on Exam

A

head tilted to one side

chin in opposite direction

95
Q

Klippel-Feil Syndrome

A

fusion of cervical vertebra (alantoaxial instability)
short neck
low posterior hair line

96
Q

Atlantoaxial Rotary Subluxation

A

children, 6-12 after URI or trauma to neck

head tilts AWAY from SCM muscle

97
Q

NF1 Skin Lesions

A

café au lait spots

freckling in axillary or inguinal areas

98
Q

NF Associated Abnormalities

A

Lisch Nodules (harmatomas)
Neurofibromas
Optic gliomas

99
Q

dyshidrotic eczema

A

acute, pruritic, vesicular lesions

often on hands and feet

100
Q

What does Bactrim NOT cover?

A

Streptococcus

101
Q

Differential Symptoms for Preseptal versus Orbital Cellulitis

A

symptoms of increased intraorbital pressure
blurred visionopthlamopegia
proptosis
chemosis

102
Q

Reasons for CT in Orbital Cellulitis

A

unable to perform exam due to edema
CNS involvement (seizures, AMS)
Clinical deterioration or no improvement in 24-48h

103
Q

Correction Factor in T1DM

A

1800 by TDD

how much 1 unit of insulin will drop glucose

104
Q

Insulin to carbohydrate ratio in T1DM

A

500 divided by TDD

105
Q

Hemophilia A

A

Factor VIII def

X linked

106
Q

Hemophilia B

A

Factor ix def

107
Q

Bilirubin production before the liver

A
  • degrade heme to biliveridin then to unconjugated bilirubin
  • binds albumin to arrive to the liver
108
Q

Bilirubin Metabolism in liver

A
  • conjugated w/ glucuronic acids by BUGT

- secreted into bile ducts

109
Q

Enterohepatic Circulation =

A

deconjugated by bacteria or tissue B gluconuridase

110
Q

Conjugation of Bilirubin in intestine

A

conjugated to urobilinogen

90% to feces

111
Q

Jaundice of Face

A

4-8

112
Q

Jaundice of Trunk

A

Upper 5-12

Lower 8-16

113
Q

Physiological Jaundice can due to

A

1) increased break down of RBCs
2) low BUGT enzyme activity
3) lack of intestinal flora to metabolize to urobilinogen

114
Q

Unconjugated Hyperbilirubinemia Differential - Categories

A

increased production
Reduced uptake
Conjugation Defect

115
Q

Conjugated Hyperbilirubinemia Differential - categories

A

biliary obstruction
impaired excretion
intrahepatic

116
Q

Unconjugated Hyperbili: Increased Production

A 
Physiologic
Hemolysis
Polycythemia
Cephalotoma
Infection
117
Q

Unconjugated Hyperbili: Conjugation Defect

A

Gilbert
Crigler-Najjar
Physiologic
Hypothyroidism

118
Q

Unconjugated Hyperbili: Impaired Excretion/Uptake

A

Prematurity

G6PD Deficiency

119
Q

Breastfeeding jaundice

A

inadequate milk intake and dehydration

120
Q

Breastmilk jaundice

A

inhibition of BUGT enzyme

increase enterohepatic circulation

121
Q

Criger Najjar Type I

A
  • absent BUGT
  • liver transplant, prolonged phototherapy
  • AD
122
Q

Criger Najjar Type II

A
  • decreased BUGT

- may improve with phenobarbital

123
Q

Drugs that can cause unconjugated hyperbilirubinemia in neonates

A

sulfonamides
cephalosporins
aspirin

124
Q

Biliary Atresia

A

inflammation on intra and extra hepatic ducts

can have absence of galbladder

125
Q

Alagille Syndrome

A
  • cholestatic jaundice
  • butterfly vertebrae
  • peripheral pulmonary stenosis
126
Q

Pediatric CAP - Blood Culture

A

obtained when hospitalized w/ moderate or severe illness
complicated illness
empyema

127
Q

Pediatric CAP - Length of Therapy

A

Not more than 7 days

128
Q

Steroids in Pediatric CAP

A

Only with asthma, otherwise not studied

129
Q

Recurrent Pneumonia

A

More than two in one year

More than three in lifetime

130
Q

Causes of CAP - Less than 3m

A

GBS, GN enteritis, listeria

HSV, vital

131
Q

Causes of CAP - Infants

A

Viruses!

S pneumo > H flu > Mycoplasma

132
Q

Causes of CAP - Kids Less than 5

A

Viruses! (viral pneumonitis)

S pneumo > H flu > Moraxella, S aureus, GAS

133
Q

Causes of CAP - Kids more than 5

A

S pneumo, Mycoplasma, Chlymadia

134
Q

CAP Complications

A

parapneumonic effusion, empyema, lung abscess

135
Q

Urinary Antigens for CAP in Peds

A

Not recommended, usually false positive

136
Q

When to use Ceftriaxone in Peds CAP

A
  • unimmunized

- consideration with empyema

137
Q

Failure to Thrive Definition

A

dropping two percentiles
OR
weight less than 3rd percentile
below 5th percentile for weight-for-length

138
Q

FTT Broad Categories

A

Inadequate nutritional intake
Malabsorption
Increased metabolic demand

139
Q

FTT Inadequate nutritional intake

A
  • Neglect
  • Emesis/Reflux
  • Oromotor dysfunction
140
Q

FTT Malabsorption

A

CF
Celiac Disease
Hepatobiliary disease
Food Protein Intolerance

141
Q

FTT Increased Metabolic Demand

A

Cardiac, Renal, Endocrine
Congenital Infections
Syndrome

142
Q

Types of HSV in Neonates

A

Disseminated Disease
CNS Disease
Skin, Eye, and Mouth Disease

143
Q

Neonatal Disseminated HSV

A
  • acquired perinatally
  • 20% do not have vesicles
  • hepatitis, pneumonitis, sepsis, DIC
144
Q

BRUE Definition

A

younger than 1 year w/ brief episode associated w/

(1) cyanosis or pallor;
(2) absent, decreased, or irregular breathing;
(3) marked change in tone (hyper- or hypotonia); and
(4) altered level of responsiveness

145
Q

Low Risk Brue Features

A

> 60 days
32 GA w/ >45 weeks PCA
less than 1 minute
no other concerning features

146
Q

BRUE Interventions

A

Should: educate, often CPR
May: EKG, brief monitoring, pertussis

147
Q

pRBCs raise the count by

A

1 for hemoglobin, 3% for hct

148
Q

platelets raise the count by

A

20-25k

149
Q

cryoprecipitate is mainly..

A

factor VIII and fibrinogen

use for DIC

150
Q

Kocher Criteria Septic Arthritis

A 
non weight bearing 
temp >101.3
ESR >40
WBC >12
2 criteria = 40%
151
Q

Acute Hemolytic Transfusion Reactions

A

ABO Incompatibility

fever, flank pain, hypotension

152
Q

Delayed Hemolytic Transfusion Reactions

A

.minor antigens/non-ABO antigens

fever, hemolysis 7-14 days after

153
Q

TACO

A

transfusion associated circulatory overload

respiratory distress within 6 hours of transfusion

154
Q

TRALI

A

transfusion related acute lung injury
pulm edema w/in 6 hours of transfusion
more serious- usually fever, hypotension

155
Q

Febrile Nonhemolytic Transfusion Reaction

A

temperature increase of 1 degree within 4 hours

due to donor leukocyte cytokines

156
Q

Bacteremia from transufions

A

yesrsinia

babeosis

157
Q

When do we see glucosuria (serum value)

A

serum 180-200

158
Q

Ely’s test (peds rheum)

A

lay flat on table and lift legs

if hips come off table sign of muscle tightness

159
Q

Thomas Test (peds rheum)

A

Knees to chest, release one leg and determine whether it relaxes straight or not

160
Q

Early onset sepsis (neonatal)

A

before 7 days of life

usually within first 24-72 hours

161
Q

Late onset sepsis (neonatal)

A

7 days- 3 months

162
Q

Late, Late onset sepsis (neonatal)

A

> 3 months

163
Q

Antibiotic Coverage for Septic Arthritis in Peds

A

Cover Staph + Strept

Kingella coverage in preschool children

164
Q

Rationale for 4 hours Tylenol Level

A
  • absorption has already taken place and now distribution and clearance is occuring
165
Q

ER Tylenol

A

Immediate release of 325, release of addition 325 in 4 hours (will need two nomograms)

166
Q

Osteomyelitis Organisms - Pediatrics

A

Staph Aureus!!

  • Kingella in school age
  • GBS, E coli in neonates
  • Salmonella in SCD
167
Q

Serotonin Syndrome - Triad

A
  • altered mental status
  • autonomic hyperactivity
  • neuromuscular abnormalities (tremor, clonus, hyperreactivity)
168
Q

AOM less than 6 months

A

always treat

169
Q

AOM 6m-2y

A

treat if bilateral, or severe unilateral

observe if mild and unilateral

170
Q

AOM >2 y

A

treat if toxic, otalgia, temp >102.2F

171
Q

Ocular Clonus

A

seen with serotonin syndrome!

172
Q

Treating Pertussis Timeline Pediatrics

A

within 6 weeks if <1

within 3 weeks if >1

173
Q

Klippel-Trénaunay syndrome

A

port wine stain
lymphatic anomalies
variable overgrowth of bones and soft tissue

174
Q

Theory of D5 in Pediatric Patients with Nausea/Emesis

A

prevents ketone formation which can worsen nausea/emesis

175
Q

Post Exposure Prophylaxis (PEP) - Time Course

A

Within 72 Hours

176
Q

Nikolsky Sign

A

Skin sloughs off when touched (cleavage of the epidermis, not dermis)
Happens w/ SSSS

177
Q

Varicella Lesions

A

pruritic vesicles on erythematous base

become pustules, crusted papules

178
Q

Treatment of Staph Scalded Skin Syndrome

A

Clindamycin (for toxin)
Oxacillin or Cefazolin or Vancomycin
(eh, maybe topical mupirocin)

179
Q

Staph Scalded Skin Syndrome - Where to look for source

A

nasopharynx!!

opposite of bullous impetigo where you can culture fluid

180
Q

Aspirin Overdose Treatment

A
  • activated charcoal

- bicarbonate to alkalinize urine

181
Q

Aspirin Acid Base Problems

A

Metabolic Acidosis

Respiratory Alkalosis

182
Q

Galactosemia

A
  • first days after birth w/ milk or breast milk

- liver dysfxn, anemia, acidosis, reducing substances in urine (galactosuria)

183
Q

Random Things associated with Galactosemia

A
  • cataracts

- E coli sepsis

184
Q

Zinc Deficiency

A

alopecia, skin lesions, diarrhea

185
Q

TAR syndrome

A

thrombocytopenia and absent radius

186
Q

Esophageal damage from ingestion caused by..

A

alkaline products –> drain cleaner

187
Q

Infections associated with swimming pools

A

shigella

188
Q

Preauricular Pits and further testing

A

only if other abnormalities are present

189
Q

Mom’s Blood Type for risk of hemolytic anemia

A

O blood types

Rh negative

190
Q

Hemolytic Anemia of Newborn and prior exposures

A

ABO - new prior pregnancy

RH neg - required prior pregnancy

191
Q

Varicella and Skin Infections

A

invasvie GAS

192
Q

Turner Syndrome

A

45X
short stature, webbed neck, normal intelligence
streak ovaries/ovarian failure

193
Q

Congenital vertebral anomalies associated with

A

renal anomalies!

194
Q

Caput succedaneum

A
  • localized superficial edema of the scalp most likely due to venous congestion from cervical pressure
  • above the periosteum
  • cross suture lines
195
Q

Cephalohematoma

A
  • sub periosteal hemorrhage localized to the surface of 1 cranial bone.
  • sharply demarcated boundaries
  • underlying linear skull fracture in small percent
196
Q

Subgaleal hemorrhage

A
  • collection of blood beneath the epicranial aponeurosis and above the periosteum of the skull,
  • fluctuant mass that increases in size soon after birth
  • vaccum deliveries
197
Q

When do c diff colonization in infants become equivalent to adults

A

around 3 years of age

198
Q

VWF function

A

actor that allows functional platelets to bind to connective tissue proteins to form a clot

199
Q

Elevated PT associated with what pathway

A

extrinsic and common pathways

200
Q

Elevated PTT associated with what pathway

A

intrinsic pathways (included VIII)

201
Q

corneal abrasion treatment

A

topical antibiotics

202
Q

double bubble

A

duodenal atresia
dilated stomach and dudodenum
often w/ scaphoid stomach

203
Q

duodenal atresia associated with

A

trisomy 21

vacterl

204
Q

Potter Sequence

A

oligohydramnios, renal abnormalities

  • pulmonary hypoplasia
  • facial abnormalities
  • club feet/hip dislocation
205
Q

Jejunal and Ileal Atresia associated with

A

caused by impaired vascular flow/vasoconstriction

i.e. cocaine, smoking

206
Q

heat exhaustion versus heat stroke

A

mental status changes

207
Q

Bell’s Palsy Treatment

A

steroids

PGY-3 and 4 (13 decks)

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