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Step 2CK > Master the Boards: Pediatrics > Flashcards

Master the Boards: Pediatrics Flashcards

1
Q

What is the most likely cause of neonatal conjunctivitis at each of the following time points?
1d
2-7d
7-14d

A

1d: Chemical irritation
2-7d: Neisseria
7-14d: Chlamydia

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2
Q

What is normal respiratory and heart rate in a newborn?

A

RR: 40-60
HR: 120-160

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3
Q

What types of eye drops must infants receive in the delivery room?

A

Erythromycin or tetracycline ointment

Silver nitrate

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4
Q

What intramuscular injection do neonates receive to prevent bleeding?

A

Vitamin K administration

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5
Q

What is the best initial test to determine cystic fibrosis?

What is the most accurate?

A

Best initial: sweat chloride

Most accurate: genetic analysis of CFTR

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6
Q

If an infant’s mother is HBV positive what should be given to the child?

A 
HBV vaccine (all children should get)
HBV immunoglobulin
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7
Q

Is splenomegaly necessarily an abnormal finding in newborns?

A

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.

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8
Q

What is the cause of transient hyperbilirubinemia in newborns?

A

Spleen is breaking down residual HbF which leads to rise in bilirubin due to breakdown of some residual RBCs

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9
Q

What is caput succedaneum?

Tx?

A

Scalp soft tissue swelling that does cross suture lines

Resolves on own

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10
Q

What is cephalohematoma?

Tx?

A

Subperiosteal hemorrhage on scalp and does not cross suture lines
Resolves on own

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11
Q

What is a neurologic cause of polyhydramnios?

A

Werdnig-Hoffman disease (infant unable to swallow; floppy)

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12
Q

What is prune belly and how does it lead to oligohydramnios?

What are two other causes of oligohydramnios?

A

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
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13
Q

Omphalocele is highly associated with what trisomy?

A

Trisomy 18 (Edwards)

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14
Q

If an umbilical hernia does not close by what age should you be concerned enough to consider surgical closure?

A

4

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15
Q

What is the most common cause for elevated AFP?

A

Error in dating

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16
Q

Describe WAGR syndrome

A

Wilms tumor
Aniridia
Genitourinary malformations
Mental retardation

(deletion on chromosome 11)

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17
Q

What is the best initial imaging for Wilms tumor?

What is the most accurate?

A

Initial: Abdominal US
Accurate: Contrast-enhanced CT

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18
Q

What is a common adrenal medulla tumor found in children?

What are two classic symptoms/findings?
What are findings on urine analysis?

A

Neuroblastoma

Hypsarrhythmia (dancing eyes) and Opsoclonus (dancing feet)

Vanillyl mandelic acid (VMA) and metanephrines

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19
Q

Remnant of the tunica vaginalis may cause _______.

A

Hydrocele

generally resolves within 6 months

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20
Q

What is the treatment of cryptorchidism?

A

Orchiplexy to bring testi back down. An elevated testi places patient at greater risk of malignancy

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21
Q

What is bladder exstrophy associated with, hypospadias or epispadias?

A

Epispadias (urethra comes out on side of penis you can see on yourself)

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22
Q

Tetralogy of Fallot is associated with chromosome ___ deletions.

A

22

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23
Q

Why do children with ToF squat?

A

This increases afterload and reduces the right to left shunt through the VSD and allows better oxygenation

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24
Q

A boot-shaped heart with decreased pulmonary vascular markings indicated what cyanotic heart disease?

A

Tetralogy of Fallot

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25
Q

“Egg on a string” finding on CXR indicated what cyanotic heart disease?

What must be present for the child to oxygenate and live?

A

Transposition of great arteries

A PDA must be present (keep open with prostaglandin)

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26
Q

A slow-rising pulse (pulsus parvus et tardus) indicates ____

A

Aortic stenosis

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27
Q

CXR with cardiomegaly and increased pulmonary findings as well as a single S2 heard indicates what congenital heart disease?

A

Truncus arteriosus

28
Q

What is kernicterus?

How does it present?

A

Elevations in bilirubin leading to deposition in basal ganglia

Seizure, hypotonia, hearing loss, choreoathetosis

29
Q

History of polydramnios
Vomiting with first feeding
Recurrent aspiration pneumonia

These should alert suspicion for what problem?

A

Tracheoesophageal fistula

30
Q

In preparing to repair a TEF what other medical pharmacologic considerations must be made prior to surgery?

A

Antibiotics for ppx of aspiration pneumonia

IVF to prevent dehydration

31
Q

String sign on Barium swallow indicates _____

A

Pyloric stenosis

32
Q

What is choanal atresia?

It is associated with CHARGE syndrome. What does this stand for?

A

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
33
Q

A child which turns blue when feeding but turns pink when feeding indicates _____.

What confirms dx?
What is tx?

A

Choanal atresia

Dx confirmed by CT scan
Tx is surgical intervention

34
Q

What is the pathologic mechanism of Hirschsprung disease?

A

Lack of innervation of distal bowel by Auerbach plexus leads to tonic contraction

Associated with Down’s syndrome

35
Q

Full thickness biopsy of the colon demonstrates a lack of ganglionic cells in the submucosa. What is the dx?

A

Hirschsprung disease

36
Q

What is in VACTERL Syndrome?

A 
V: Vertebral anomaly
A: Anal atresia
C: Cardiovascular anomaly
T: TEF
E: Esophageal atresia
R: Renal anomaly
L: Limb anomaly
37
Q

Where is volvulus most common in children?

A

MIdgut, especially ileum

38
Q

Volvulus may appear as a “_______” on upper GI series.

A

Bird-beak

39
Q

What is the best initial therapy for volvulus?

A

Endoscopic decompression

if that fails the most effective is surgical decompression

40
Q

Rotavius vaccine and Henoch-Schonlein purpura are associated with _______.

A

Intussusception

41
Q

Colicky abdominal pain, currant jelly stool, and bilious vomiting are all seen with _______

A

Intussusception

42
Q

What is seen on ultrasound in intussusception?

What is the both diagnostic and therapeutic treatment?

A

“Target sign”

Barium enema

43
Q

Persistence of the vitelline duct is ______.

A

Meckel’s diverticulum

44
Q

What presents with painless rectal bleeding due to gastric acid secretion?

A

Meckel’s diverticulum (true diverticulum)

*Surgical removal is the only curative therapy.

45
Q

What are the major changes to glucose, calcium, Mg, and bilirubin in infants born to mothers with DM?

A

Hypoglycemia
Hypocalcemia
Hypomagnesia
Hyperbilirubinemia

46
Q

What antibiotic coverage do you select if you’re concerned about neonatal sepsis?

A

Ampicillin and gentamicin

47
Q

Chorioretinitis, hydrocephalus, multiple ring-enhancing lesions

Dx?
Tx?

A

Toxoplasmosis
Pyrimethamine/Sulfadiazine

IgM to Toxo is best initial test; PCR is most accurate

48
Q

Rash on palms and soles, rhinorrhea, frontal bossing, Hutchinson 8th nerve palsy, saddle nose

Dx?
Tx?

A

Syphillis
Penicillin

Best initial test: VDRL, RPR
Most accurate: FTA ABS or dark field

49
Q

PDA, cataracts, deafness, hepatosplenomegaly, thrombocytopenia, blueberry muffin rash

Dx?
Tx?

A

Rubella

Supportive

50
Q

Periventricular calcifications, Petechiase, Microencephaly, Choriorretinitis, Hearing Loss

Dx?
Tx?

A

CMV
Ganciclovir

Best initial test: saliva viral titers
Most accurate: urine or saliva viral PCR

51
Q

Shock and DIC followed by vesicular skin lesions and then encephalopathy

Dx?
Tx?

A

Herpes
Acyclovir and supportive

Best initial: Tzanck smear
Most accurate: PCR

52
Q

What is the presentation of measles?

A

Cough, Coryza, and Conjunctivitis

Koplik spots

53
Q

What is the presentation of Mumps?

A

Fever, parotid swelling, possible orchitis

54
Q

Fever, pharyngitis, sandpaper rash, strawberry tongue, and cervical lymphadenopathy are all signs of ____ caused by ____.

A

Scarlet fever

S. pyogenes

55
Q

What are antibiotic tx for Scarlet fever? (3)

A

Penicillin
Azithromcyin
Cephalosporins

56
Q

What is the cause of Croup (#1 and #2)?

A

Parainfluenza virus first

RSV second

57
Q

Steeple sign is narrowing of the air column in the trachea seen in ____

A

Croup

58
Q

What drug should be given to all close contacts of patients diagnosed with epiglottitis?

A

Rifampin

59
Q

What are the stages of Whooping cough?

What is antibiotic treatment and when is it most effective?

A

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)

60
Q

What is the treatment of Strep pharyngitis?

What if there is an allergy to the primary treatment?

A

Oral penicillin

Macrolides if penicillin allergic

61
Q

What is treatment for Diphtheria?

Should you scrape at the Pseudomembrane?

A

Antitoxin (antibiotics don’t work)

No

62
Q

What is the treatment of avascular necrosis of the femoral head?

A

Rest and NSAIDs followed by surgery on both hips

63
Q

Obese patient presents with painful limp, what is the likely diagnosis?

Tx?

A

Slipped capital femoral epiphysis

Internal fixation and pinning

64
Q

Burning feet syndrome is seen with deficiency of what vitamin?

A

B5 (Pantothenic acid)

65
Q

Peripheral neuropathy is seen with what vitamin deficiency?

What drug must this vitamin be given with?

A

B6 (pyridoxine)

INH

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