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Peds > Med Ed Videos > Flashcards

Med Ed Videos Flashcards

1
Q

Transient tachypnea of newborn

A

self-limiting
seen after c-section in healthy babies

-DX: CXR –> hyperexpanded lungs, wet

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2
Q

pathophys, DX of IVH, and TX

A

vascular lining of ventricles bleed –> bleeding and increased ICP

cranial dopplers
TX - decrease ICP (VP shunts, drains)

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3
Q

NEC

A

dead gut –> bloody bowel movement

DX: XR –> air in wall of bowel

TX: NPO + abx (can use TPN for feeding)
–> surgery (f/u short gut)

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4
Q

Causes of failure to pass meconium

A

1) imperforate anus
2) meconium ileus
3) Hirschbrungs

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5
Q

Imperforate anus

A

associated with VACTERL

DX: crosstable XR + f/u on VACTERL abnormalities with U/S sacrum, echo, catheter

TX: mild –> fix now, severe –> colostomy now, fix later

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6
Q

Meconium ileus

A

CF –> decreased H2O in bowel lumen
DX: XR –> transition point with gas filled plug
TX: Water enema
f/u sweat chloride test + ADEK, pancreatic enzymes + pulm tests

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7
Q

Enterobius verbicularis (pinworm)

A

perianal pruritis, especially at night
-vulvovaginal sx may be presenting sx in prepubertal girls

DX: tape test
TX: albendazole or pyrantel pamoate

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8
Q

Complete AV septal defect (CAVSD)

A

most common congenital heart defect in patients with down sydome

–> failure of endocardial cushions to merge –> ASD + VSD

SX: diaphoresis/dyspnea with feeds

  • loud S2 due to pulmonary HTN
  • systolic ejection murmur (increased flow across pulm valve from ASD)
  • holosystolic murmur of VSD
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9
Q

Etiologies of pediatric stroke

A
  • sickle cell disease ** Most common
  • prehtrombotic disorders
  • congenital cardiac disease
  • bacterial meningitis
  • Vasculitis
  • Focal cerebral arteriopathy
  • Head/neck trauma
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10
Q

Diamond-Blackfan Syndrome (DBS)

A

aka congenital hypoplastic anemia

  • MACROcytic anemia, low retic count (NO hypersegmented neutrophils like you would see in B12)
  • congenital anomalies

-defect of erythroid progenitor cells which results in increased apoptosis

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11
Q

Wiskott-Aldrich syndrome

A

X linked disorder characterized by eczema, thrombocytopenia, and hypogammaglobulinemia

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12
Q

Fanconi’s anemia

A

AR defect in DNA chromosomal break repair

1) Aplastic anemia + progressive BM failure
2) Short stature, microcephaly, abnormal thumbs, hypogonadism
3) hypopigmented / hyperpigmented areas + cafe au lait spots and large freckles
4) strabismus, low set ears, middle ear problems (Deafness)
5) predisposition to developing cancer

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13
Q

Choanal atresia

A

suspected with newborn cyanosis aggravated by feeding, relieved by crying

*congenital nasal malformation caused by failure of nasal passage to cannalize

CHARGE syndrome - Coloboma, Heart Defects, Atresia choanae, Retardation of growth/development, GU anomalies, Ear abnormalities (deafness)

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14
Q

Nephrotic syndromes (4)

A

1) Minimal change disease (peds)

2) FSGS
3) Membranous nephropathy
4) Membranoproliferative glomerulonephritis

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15
Q

Nephritic syndrome

A

1) Post strep glomerulonephritis (peds)
2) Hemolytic uremic syndrome (peds)

3) IgA nephropathy
4) Mebranoproliferative glomerulonephritis
5) crescentic glomerulonephritis

TX: hematopoietic stem cell transplantation

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16
Q

Hirschbrung’s

DX?
SX?
TX?

A

failure of migration of inhibitory neurons –> auerbach/meissner’s plexus of DISTAL colon

DX:
-XR (normal colon distended)
-bx –> no plexus
-contrast enema or anometral manometry also works
SX: failure to pass meconium in 48hrs w/explosive stool on DRE

TX: surgical resection

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17
Q

Voluntary holding

A

pain, embarrassment causes kid to hold in stool
-voluntary holding –> overflow incontinence

DX: clinical
TX: behavioral, stool softeners, disimpaction

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18
Q

Causes of bilious emesis (4)

A

1) Malrotation
2) Duodenal atresia
3) Annular pancreas
4) Intestinal atresia

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19
Q

Causes of non-bilious emesis (2)

A

1) tracheoesophageal fistula

2) pyloric stenosis

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20
Q

Malrotation

A

failure of rotation with an otherwise normal uterine course (no polyhydramnios, no DS)

DX: XR (UGI series) –> DOUBLE BUBBLE, nml gas pattern beyond

TX: NG tube –> decompress bowel, and then surgery

f/u: volvulus

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21
Q

Duodenal atresia

A

failure of duodenum to recanalize

associated with DS

DX: XR with DOUBLE BUBBLE + NO gas distally

TX: surgery

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22
Q

Annular pancreas

A

failure of apoptosis of pancreas
associated with DS

DX: XR with DOUBLE BUBBLE + no gas distally

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23
Q

Intestinal atresia

A

vascular accidents in utero
DX: XR with double bubble and multiple air fluid levels
TX: surgery
f/u: short gut

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24
Q

Tracheoesophageal fistula

A

blind pouch +/- fistula

Day 1 presents with nonbiliary emesis

DX: NG tube coild on XR
TX: parenteral nutrition and surgery

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25
Q

Pyloric stenosis

A

hypertrophy of pyloris –> gastric outlet obstruction
presents in males around 2-8wks

SX:

  • PROJECTILE, nonbilious vomit
  • olive like mass
  • visible peristaltic waves

DX: US –> “donut sign”

TX: pyloromyotomy

f/u: metabolic abnormalities: hypochloremic, hypokalemic, metabolic acidosis 2/2 vomiting

*give fluids before surgery

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26
Q

Direct bilirubin (conjugated)

A

charged, water soluble
excreted/trapped in urine –> DARK URINE
CANNOT cross BBB or cell membranes, and thus CANNOT get kernicterus

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27
Q

Indirect bilirubin (unconjugated)

A

fat soluble
NOT excreted in urine –> no dark urine
crosses BBB –> KERNICTERUS

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28
Q

Name the cause of the hyperbili:

1) + coombs
2) - coombs, low hgb
3) - coombs, high hgb
4) - coombs, nml hgb, increased retic count
5) - coombs, nml hgb, nml retic

A

1) + coombs = isoimmunization
2) - coombs, low hgb = hemorrhage (cephalohematoma)
3) - coombs, high hgb = transfusion (twin-twin, delayed clamping, maternal)
4) - coombs, nml hgb, increased retic count = hemolysis (G6PD, pyruvate kinase deficiency, HgbSS)
5) - coombs, nml hgb, nml retic = problem with reabsorption (breast milk jaundice vs. breast feeding jaundice)

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29
Q

breast milk jaundice

A

can present many months later

  • breast milk component inhibits conjugation of bilirubin
  • -> use hydrolyzed formula
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30
Q

breast feeding jaundice

A

presents in first day of life
-also have sx of dehydration

problem with quantity of breast milk –> decreased bowel function and increased absorption of bili

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31
Q

Causes of unconjugated hyper bili

A

hemolysis or hemorrhage

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32
Q

causes of mixed hyper bili

A

Crigler Najar, Gilberts –> problem with uptake
Dubin Johnson, Rotors –> problem with excretion
Hepatitis

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33
Q

causes of conjugated hyper bili

A

biliary atresia
sepsis
metabolic

34
Q

Diaphragmatic hernia

A

hole in the diaphragm –> bowel in chest, lung hypoplastic

SX:

  • scaphoid abdomen
  • bowel sounds in chest
  • on L>R side and post>lat

DX: XR
TX: surgical + steroids for lung development

35
Q

Gastroschisis/omphaloscele

A 
gastroschisis = uncovered, to R of midline
omphalocele = covered, midline
36
Q

extrophy of bladder (appearance?)

A

midline defect, shiny, red, wet w/urine

37
Q

biliary atresia

A

worsening jaundice @7-14 days
-DIRECT hyperbili

DX: US –> no ducts
HIDA after 5-7 days of phenobarbital

TX: surgery

38
Q

common causes of failure to thrive

A

failure to thrive = loss of weight –> loss of height –> then HC

1) genetic dz
2) heart dz
3) pyloric stenosis
4) GERD
5) CF

39
Q 
Developmental milestones:
2 months
4 months
6 months
1 yr
A

2 months - lift head, social smile, noise
4 months - roll over, —-, noise
6 months - sit up, stranger anxiety, noise
1 yr - walk, separation anxiety, 1 word

40
Q 
Developmental milestones:
2 yrs
3 yrs
4 yrs
5 yrs
A

2 yrs - steps, 2 words
3 yrs - tricycle, 3 words, circle
4 yrs - hop, 4 words, cross
5 yrs - skip, 5 words, triangle

41
Q

Epidural hematoma

A

LENS
LUCID interval
middle meningeal artery
+ LOC

“walk, talk, die”
sports, skiing

42
Q

Subdural hematoma

A

+ LOC, CESCENT shaped

ped vs. car, MVA, abuse

43
Q

Severity of concussion:
Mild

Severe

A

Mild - no FND, <60 sec LOC, no HA or improving, no amnesia –> NO TX, go home

Severe - + FND, > 60 sec LOC, + HA or worsening, + retrograde/anterograde amnesia –> CT SCAN, even if negative, admit for obsurvation

44
Q

Parkland burn formula

A

%BSA x4 x kg body weight = total fluids in first 24 hrs

give 50% in first 8 hrs, and 50% in next 16 hrs

45
Q

Erythema infectiousum

SX
F/u?
TX?

A

Parvovirus B19
“slapped cheek”

Fever + rash at SAME time (on cheeks(

TX supportive

f/u: aplastic crisis (sickle cell)
hydrops fetalis

46
Q

Measles

SX
F/u?
TX?

A

parvomixovirus

prodrome (cough, coryza, conjunctivitis, Koplick spots (white dots in mouth))
–> Fever + Rash

BEGIN ON FACE –> trunk/arms, spares hands and soles

TX: supportive

ppx: MMR vaccine

f/u: subacute sclerosing panencephalitis

47
Q

Rubella

A

German measles

rash starts on FACE –> trunk/extremities
+Fever and rash

PRODROME = generalized tender lymphadenopathy

TX: supportive

48
Q

Roseola

A

HHV-6

Prodrome: very high spiking fever (104) –> THEN RASH

rash starts on TRUNK –> expands out

f/u febrile seizures

49
Q

Varicella-Zoster

A

rash w/o fever

diffuse rash, vessicles on erythematous base in different stages of healing

f/u shingles

50
Q

mumps

A

pubertal males
parotid swelling, orchitis

f/u infertility

51
Q

hand-foot-mouth disease

A

cocksackie A

looks like varicella, but on hands, feet, and mouth

52
Q

TX of meningitis

A

if < 30d –> vanc + cefotaxime + ampicillin +/- steroids

> 30d –> vanc + CTX +/- steroids

53
Q

Tx for scabies and lice

A

permethrin

54
Q

causes of acute otitis media

A

strep pneumo, moraxella, h. flu

55
Q

SX, DX, TX of AOM

A

pain relieved by pulling inner ear
NO light reflex
Erythematous, fluid, pnuematic insufflation –> NO TM movement

TX: amoxicillin vs. augmentin (amox/clav) for a recurrence

IF >3x/6months or 4x/12 months, then consider tympanoplasty

IF penicillin allergic use cefdinir or azithro

56
Q

Otitis externa

A

swimmers ear, digital trauma –> staph

unilateral ear pain, worse w/ear pulling

TX: abx (cipro) drops +/- steroid drops

57
Q

Mastoiditis

A

increased risk with otitis media and externa or tympanoplasty

swelling behind ear + ear rotated forward

tX: surgical

58
Q

Sinusitis

A

URI bugs (strep)

SX: BL purulent discharge –> f/u foreign body if recurrent
DX: no imaging - f/u ct scan if recurrent
TX: supportive vs. amox-clav

59
Q

Centaur criteria

A 
NO cough +1
exudates +1
nodes +1
temp > 38 +1
< 14 yrs +1, >44 -1

IF < 1 , do nothing
IF 2-3, test for strep
IF > 4, TX w/abx

60
Q

Laryngotracheobronchitis

A

croup

parainfluenza
usually in 3 month-3yrs of age

VIRAL PRODROME + barking “seal like” cough + stridor

DX: XR –> steeple sign (subglottinc narrowing)
Racemic epi –> improves

TX:
mild –> mist
mod –> racemic epi + steroids + O2
severe –> admit

61
Q

Howell-Jolly bodies

A

nuclear remnants of RBCs that are removed by a functional spleen

if asplenic or functionally asplenic (sickle cell)

62
Q

Bacterial Tracheitis

A

caused by staph aureus

sx: croup that does not improve –> + fever, increased WBC (toxic appearing)
- does NOT improve with racemic epi

TX: IV ABX

63
Q

Epiglotitis

bug?
sx?
dx?
tx?

A

path: H. Flu

sx:
-3-7yr old, SAS, rapid onset, high spiking fever, drooling, tripod +muffled voice + accessory muscle us

DX:

  • thumbprint sign on XR
  • cherry red epiglottis

TX:
-secure airway in OR

64
Q

Retropharyngeal abscess

bug?
sx?
dx?
tx?

A

path: oral flora
sx: SAS, rapid onset, high fever, drooling, neck extended, stiffness, muffled voice

DX:

  • anterior chain, tender lymphandenopathy
  • tender mass (abscess)
  • CT scan

TX: I+D and IV abx

65
Q

Peritonsilar abscess

bug?
sx?
tx?

A

path: oral flora

sx: >10yrs, muffled voice, drooling, sore throat
* *UVULA DEVIATED**

TX: drain + abx

66
Q

Foreign body airway obstruction

A

sx: < 3yo left unattended w/sudden onset SOB

DX:

  • extrathoracic = INSPIRATORY stridor
  • Intrathoracic = EXPIRATORY wheeze
  • XR –> coin sign

TX: abx

  • rigid bronch if in lungs
  • endoscope if in GI
  • laryngoscope if ENT
67
Q

What is the coin sign?

A

coin sign

  • > nml AP, seen on lateral = object in TRACHEA
  • -> seen on AP –> NOT in trachea
68
Q

Intussusception

SX

A

ABRUPT COLICKY abd pain

  • knee-chest relief
  • CURRANT-JELLY stool/diarrhea
  • sausage shaped pass in RUQ
  • age 3 months - 3yrs
69
Q

Intussusception

DX/TX

A

DX:

  • US
  • XR KUB –> r/o perforation/obstruction
  • AIR ENEMA = dx and tx

TX:

  • air enema
  • surgery if peritonitits, perf, failure of air enema
70
Q

VSD

A

common in DS
-often dx <1yr, asx murmur with severe cases can have FTT or CHF

DX: echo
TX: asx –> wait 1 yr, CHF –> repair

71
Q

in what settings can you get congenital cataracts?

A

1) TORCHES infections

2) galactoremia - develop quickly after birth

72
Q

Posterior urethral valves

A

SX: can’t get urine out of bladder due to redundant tissue –> hydronephrosis, oligohydramnios, decreased or no UOP, distended bladder

TX: catheter + surgery

73
Q

X-linked agammaglobulinemia

A

no Ig’s
mostly boys
decreased B cells
sinopulmonray infections at 6 months old

DX: quant Igs (shows none) and flow cytometroy shows no B cells

due to mutation in BTK gene

TX: schedule IgG transfusions

74
Q

CVID

A

onsent in teens, mild XLA

nml CBC with decreased in quantitative Igs (2/3 of Igs lower)

75
Q

IgA deficiency

A

decreaed IgA –> decreased mucosal immunity

sinopulmonary infections
GI bugs
anaphylaxis with transfusions

76
Q

Wiscott Aldrich

A

atopic dermatitis, eczema
decreased platelets

DX: low WBC, low plts, increased IgM and IgG

77
Q

Leukocyte adhesion deficiency (LAD)

A

WBC can’t get out of vessels
pt has increased fever, increased WBCs WITHOUT PUS

delayed cord seperation

TX: BMT

78
Q

SCID

A

no immune defense, no B or T cells

adenosine deaminase deficiency

bubble babies, BM transplant

79
Q

Chediak Higashi

A

giant granules in neutrophils

associated with albinism, neuopathy, neutropenia

80
Q

Chronic granulomatous disease (CGD)

A

no respiratory burst so neutrophils can’t kill gram + organisms

–> staph abscesses

DX: nitro blue, increased WBCs, increased IgM and IgG

Peds (2 decks)

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