Master the Boards: Pediatrics Flashcards
What is the most likely cause of neonatal conjunctivitis at each of the following time points?
1d
2-7d
7-14d
1d: Chemical irritation
2-7d: Neisseria
7-14d: Chlamydia
What is normal respiratory and heart rate in a newborn?
RR: 40-60
HR: 120-160
What types of eye drops must infants receive in the delivery room?
Erythromycin or tetracycline ointment
Silver nitrate
What intramuscular injection do neonates receive to prevent bleeding?
Vitamin K administration
What is the best initial test to determine cystic fibrosis?
What is the most accurate?
Best initial: sweat chloride
Most accurate: genetic analysis of CFTR
If an infant’s mother is HBV positive what should be given to the child?
HBV vaccine (all children should get) HBV immunoglobulin
Is splenomegaly necessarily an abnormal finding in newborns?
No. There is often transient polycythemia in the newborn due to EPO release 2/2 hypoxia during delivery. This reduces after birth when they take their first breath and increase oxygenation. In any sense, the spleen could be working on extramedullary hematopoiesis.
What is the cause of transient hyperbilirubinemia in newborns?
Spleen is breaking down residual HbF which leads to rise in bilirubin due to breakdown of some residual RBCs
What is caput succedaneum?
Tx?
Scalp soft tissue swelling that does cross suture lines
Resolves on own
What is cephalohematoma?
Tx?
Subperiosteal hemorrhage on scalp and does not cross suture lines
Resolves on own
What is a neurologic cause of polyhydramnios?
Werdnig-Hoffman disease (infant unable to swallow; floppy)
What is prune belly and how does it lead to oligohydramnios?
What are two other causes of oligohydramnios?
Prune belly: lack of abdominal muscles so can’t bear down to urinate
Renal agenesis (e.g. Potter syndrome) Flat facies causing compression of fetus
Omphalocele is highly associated with what trisomy?
Trisomy 18 (Edwards)
If an umbilical hernia does not close by what age should you be concerned enough to consider surgical closure?
4
What is the most common cause for elevated AFP?
Error in dating
Describe WAGR syndrome
Wilms tumor
Aniridia
Genitourinary malformations
Mental retardation
(deletion on chromosome 11)
What is the best initial imaging for Wilms tumor?
What is the most accurate?
Initial: Abdominal US
Accurate: Contrast-enhanced CT
What is a common adrenal medulla tumor found in children?
What are two classic symptoms/findings?
What are findings on urine analysis?
Neuroblastoma
Hypsarrhythmia (dancing eyes) and Opsoclonus (dancing feet)
Vanillyl mandelic acid (VMA) and metanephrines
Remnant of the tunica vaginalis may cause _______.
Hydrocele
generally resolves within 6 months
What is the treatment of cryptorchidism?
Orchiplexy to bring testi back down. An elevated testi places patient at greater risk of malignancy
What is bladder exstrophy associated with, hypospadias or epispadias?
Epispadias (urethra comes out on side of penis you can see on yourself)
Tetralogy of Fallot is associated with chromosome ___ deletions.
22
Why do children with ToF squat?
This increases afterload and reduces the right to left shunt through the VSD and allows better oxygenation
A boot-shaped heart with decreased pulmonary vascular markings indicated what cyanotic heart disease?
Tetralogy of Fallot
“Egg on a string” finding on CXR indicated what cyanotic heart disease?
What must be present for the child to oxygenate and live?
Transposition of great arteries
A PDA must be present (keep open with prostaglandin)
A slow-rising pulse (pulsus parvus et tardus) indicates ____
Aortic stenosis
CXR with cardiomegaly and increased pulmonary findings as well as a single S2 heard indicates what congenital heart disease?
Truncus arteriosus
What is kernicterus?
How does it present?
Elevations in bilirubin leading to deposition in basal ganglia
Seizure, hypotonia, hearing loss, choreoathetosis
History of polydramnios
Vomiting with first feeding
Recurrent aspiration pneumonia
These should alert suspicion for what problem?
Tracheoesophageal fistula
In preparing to repair a TEF what other medical pharmacologic considerations must be made prior to surgery?
Antibiotics for ppx of aspiration pneumonia
IVF to prevent dehydration
String sign on Barium swallow indicates _____
Pyloric stenosis
What is choanal atresia?
It is associated with CHARGE syndrome. What does this stand for?
Choanal atresia: membrane present b/w nostrils and pharyngeal space which prevents breathing during feeding
C: Coloboma of eye, CNS anomaly H: Heart defects A: Atresia of choanae R: Retardation of growth or development G: Genital/Urinary defects E: Ear anomaly/deafness
A child which turns blue when feeding but turns pink when feeding indicates _____.
What confirms dx?
What is tx?
Choanal atresia
Dx confirmed by CT scan
Tx is surgical intervention
What is the pathologic mechanism of Hirschsprung disease?
Lack of innervation of distal bowel by Auerbach plexus leads to tonic contraction
Associated with Down’s syndrome
Full thickness biopsy of the colon demonstrates a lack of ganglionic cells in the submucosa. What is the dx?
Hirschsprung disease
What is in VACTERL Syndrome?
V: Vertebral anomaly A: Anal atresia C: Cardiovascular anomaly T: TEF E: Esophageal atresia R: Renal anomaly L: Limb anomaly
Where is volvulus most common in children?
MIdgut, especially ileum
Volvulus may appear as a “_______” on upper GI series.
Bird-beak
What is the best initial therapy for volvulus?
Endoscopic decompression
if that fails the most effective is surgical decompression
Rotavius vaccine and Henoch-Schonlein purpura are associated with _______.
Intussusception
Colicky abdominal pain, currant jelly stool, and bilious vomiting are all seen with _______
Intussusception
What is seen on ultrasound in intussusception?
What is the both diagnostic and therapeutic treatment?
“Target sign”
Barium enema
Persistence of the vitelline duct is ______.
Meckel’s diverticulum
What presents with painless rectal bleeding due to gastric acid secretion?
Meckel’s diverticulum (true diverticulum)
*Surgical removal is the only curative therapy.
What are the major changes to glucose, calcium, Mg, and bilirubin in infants born to mothers with DM?
Hypoglycemia
Hypocalcemia
Hypomagnesia
Hyperbilirubinemia
What antibiotic coverage do you select if you’re concerned about neonatal sepsis?
Ampicillin and gentamicin
Chorioretinitis, hydrocephalus, multiple ring-enhancing lesions
Dx?
Tx?
Toxoplasmosis
Pyrimethamine/Sulfadiazine
IgM to Toxo is best initial test; PCR is most accurate
Rash on palms and soles, rhinorrhea, frontal bossing, Hutchinson 8th nerve palsy, saddle nose
Dx?
Tx?
Syphillis
Penicillin
Best initial test: VDRL, RPR
Most accurate: FTA ABS or dark field
PDA, cataracts, deafness, hepatosplenomegaly, thrombocytopenia, blueberry muffin rash
Dx?
Tx?
Rubella
Supportive
Periventricular calcifications, Petechiase, Microencephaly, Choriorretinitis, Hearing Loss
Dx?
Tx?
CMV
Ganciclovir
Best initial test: saliva viral titers
Most accurate: urine or saliva viral PCR
Shock and DIC followed by vesicular skin lesions and then encephalopathy
Dx?
Tx?
Herpes
Acyclovir and supportive
Best initial: Tzanck smear
Most accurate: PCR
What is the presentation of measles?
Cough, Coryza, and Conjunctivitis
Koplik spots
What is the presentation of Mumps?
Fever, parotid swelling, possible orchitis
Fever, pharyngitis, sandpaper rash, strawberry tongue, and cervical lymphadenopathy are all signs of ____ caused by ____.
Scarlet fever
S. pyogenes
What are antibiotic tx for Scarlet fever? (3)
Penicillin
Azithromcyin
Cephalosporins
What is the cause of Croup (#1 and #2)?
Parainfluenza virus first
RSV second
Steeple sign is narrowing of the air column in the trachea seen in ____
Croup
What drug should be given to all close contacts of patients diagnosed with epiglottitis?
Rifampin
What are the stages of Whooping cough?
What is antibiotic treatment and when is it most effective?
Cattarrhal: Congestion and rhinorrhea
Paroxysmal: Coughs
Convalescent stage: decreasing cough frequency
Azithromycin or Erythromycin in the catarrhal stage
(Macrolides should be given to all close contacts)
What is the treatment of Strep pharyngitis?
What if there is an allergy to the primary treatment?
Oral penicillin
Macrolides if penicillin allergic
What is treatment for Diphtheria?
Should you scrape at the Pseudomembrane?
Antitoxin (antibiotics don’t work)
No
What is the treatment of avascular necrosis of the femoral head?
Rest and NSAIDs followed by surgery on both hips
Obese patient presents with painful limp, what is the likely diagnosis?
Tx?
Slipped capital femoral epiphysis
Internal fixation and pinning
Burning feet syndrome is seen with deficiency of what vitamin?
B5 (Pantothenic acid)
Peripheral neuropathy is seen with what vitamin deficiency?
What drug must this vitamin be given with?
B6 (pyridoxine)
INH
