Med Study 1 Flashcards
Antidote for tylenol toxicity
N-Acetyl Cysteine
All glandular secretions, aka the parasympathetic nervous system, is blocked in this toxidrome
anticholinergic
Dry mouth, dry axilla, tachycardia, goofy (mad as a hatter).
Mumbling, picking at things often as well….
= what toxidrome?
= anticholinergic
Anticholinergic meds do what to your pupils?
dilate them
Is benadryl anticholinergic?
YUP
Mad a as a hatter
Hot as a hare
Dry as a bone
Blind as a bat
= what toxidrome?
anticholinergic
Name the anticholinergic side effects aka toxidrome:
dry (dry mouth, dry axilla) dilated pupils--blurry vision tachycardic mad as a hatter urinary retention constipation
Tinnitus is a symptom of this toxidrome
salicylates (aspirin)
The feared side effects of aspirin (salicylate) overdose:
Cerebral edema
Non-cardiogenic pulmonary edema
Why put aspirin overdose patients on a bicarb drip?
Helps keep the aspirin in the blood and out of the brain, and increases aspirin elimination in the urine
Acid base derangement seen in aspirin toxicity:
Anion gap metabolic acidosis
Describe the TCA (tricyclic antidepressant) toxidrome and how they cause such severe problems:
- anticholinergic effects
- TCAs are potent sodium channel blockers (cause cardiac arrhythmia–specifically widened QRS, decreased contractility)
- they are also alpha blockers–> cause hypotension and shock
- and the provoke seizures, can even develop status
How to treat TCA overdose:
- -the anticholinergic part – supportive
- -the seizures – benzos
- -the cardiac stuff – give sodium bicarb (the sodium will help unblock the sodium channels a little bit that the TCAs are blocking, this will help narrow the QRS a bit)
- -alpha agonists (like norepi) for the hypotension
Name some toxic alcohols:
methanol
ethylene glycol
How does methanol poisoning present?
Methanol is a toxic alcohol. It gets converted to formic acid, which makes you blind and damages the basal ganglia.
Presents with AG metabolic acidosis, blurry vision and altered mental status.
How does ethylene glycol toxicity present?
Ethylene glycol = another toxic alcohol
Metabolizes into oxalic acid, which combines with calcium to form calcium oxalate crystals
AG metabolic acidosis
And elevated creatinine
Calcium oxalate crystals think
ethylene glycol
4-methylpyrazole
= a potent inhibitor of alcohol dehydrogenase
used to treat methanol and ethylene glycol poisoning
because it will block alcohol dehydrogenase from converting this alcohols into their toxic metabolites (formic acid and oxalic acid, respectively)
or could actually use ethanol to treat these
ethylene glycol is found in
it’s antifreeze
used in cars
urine floresces
ethylene glycol
Where is methanol found?
wind shield wiper fluid
or like restaurant candle light things
or if you are trying to make your own ethanol
Ex of a hydrocarbon
gasoline
Lamp oils, gasoline, kerosenes… can cause this type of poisoning in kids
hydrocarbon
How hydrocarbon poisoning presents
Kids can aspirate it very easily, even through a closed glottis
hydrocarbons wipe out surfactant
causes horrible pneumonitis
How does organophosphate poisoning present?
Think kid on a farm
It’s the opposite of anticholinergic poisoning
Its over the top extreme cholinergic poisoning
So all the glandular glands are over active
so the kid will be: salivating, lacrimating, vomiting, diarrhea, sweaty, etc
small pupils
and bradycardia*** but actually could also be tachy
Pilocarpine
= cholinergic agonist aka a parasympathetic agent
used to treat dry mouth
so it makes the mouth wetter
and causes small pupils
What is the thing that will kill you in organophosphate poisoning?
Pulmonary edema
from pulmonary secretions
and bronchospasm
and seizures/status epilepticus
and paralysis–yikes–from overstimulation of receptors on muscles (just like how succinylcholine works)
How to treat organophosphate poisoning:
Give atropine (an anti cholinergic drug) to dry the excessive secretions, including pulmonary secretions
And, give an oxene, which will literally take the organophosphate off of the acetylcholinesterase enzyme
How do organophosphates work?
they bind to acetylcholinesterase and block it
that’s how they cause organophosphate aka cholinergic poisoning
MOA of CO poisoning:
CO is a potent mitochondrial inhibitor
It prevents ATP formation
Symptoms of CO poisoning:
First, affects the organs that use ATP the most – the heart and the brain. You get headaches, nausea, ataxia….. progresses to tachycardia, hypotension, coma, seizures, death
How to treat CO poisoning
OXYGEN oxygen and more oxygen
Keep kids away from prenatal vitamins because of this severe danger:
acute iron toxicity
Symptoms of iron toxicity:
First, you get GI symptoms, because iron is a potent GI irritant. So after you eat it, you get severe nausea, vomiting, diarrhea, bad GI symptoms.
Then once it’s absorbed into the body, you get hypotensive, metabolic acidosis, coma, organ damage
because lots of free iron has no where to bind, causes free radicals to form and lots of organ damage
When free iron hits the mitochondria, what happens?
You stop making ATP
How to treat acute iron poisoning:
deferoxamine (iron chelator)
A normal lead level should be
under 5
At what level do you think about giving chelation therapy for lead toxicity?
45 or higher
When lead levels are WAY too high, you worry about this toxic effect of lead:
cerebral edema
Chelator we use to treat lead toxicity at a level of 45 or higher, but without acute encephalopathy:
Succimer or also called DMSA (dimercaptosuccinic acid)
makes you pee out the lead
What is Succimer, or DMSA?
= an oral lead chelator
If a child is acutely encephalopathic from lead toxicity, how do you need to treat them?
In this case, need to use these two agents together: BAL (British anti lewisite, a painful IM med) and EDTA
Most common bacterial cause of diarrhea is
E. coli
What type of E.coli causes common traveler’s diarrhea?
ETEC (enterotoxigenic e.coli)
What kind of E.coli causes infantile diarrhea outbreaks in daycares?
EPEC (enteropathogenic E.coli)
p for puny
the little ones get it
What type of E. coli diarrhea is associated with HUS?
EHEC (enteroHEMORRHAGIC e.coli) aka 0157
HUS = hemolytic uremic syndrome
Name two bacterial causes of diarrhea other than E.coli:
Yersinia
Shigella
How does Yersinia sometimes present?
As “pseudoappendicitis”
aka diarrhea + RLQ pain
Is the BRAT diet (bananas, rice, applesauce and toast) necessary for kids who have bacterial diarrhea?
nope
4 most common bugs that causes sepsis and meningitis in neonates:
GBS
E. coli
Strep pneumo
Staph
(in infants 1 - 12 months of age, it’s this same list, + also salmonella)
This syndrome is caused by loss of gene activity on the maternally acquired chromosome 15 in the 15q11-13 region:
Angelman syndrome
If the deletion or inactivation of this same area came from the FATHER’s side, then the child will have Prader-Wili syndrome
How does Angelman syndrome present?
Microcephaly and developmental delays starting at 6 months of age
near absent speech wide based, ataxic gait easily excited and laughing child hand flapping protruding tongue and unique facial features
What causes cri-du-chat syndrome?
A deletion of part of chromosome 5
How does SCFE (aka slipped capital femoral epiphysis) present?
Usually in a pre teen or young teenager who is at peak linear growth velocity, has several weeks to months of hip/thigh/groin/knee pain and a painful limp
Which endocrine conditions are associated with SCFE?
hypothyroidism
obesity
hypogonadal conditions
What are brush field spots and who commonly has them?
Seen in patients with Trisomy 21
= small, whitish-gray spots on the iris
What is Mullerian aplasia, and what is the other name for this condition?
Other name: Mayer-Rokitansky-Kuster-Hauser synrome)
it’s when the mullerian duct, aka vagina, uterus and fallopian tubes, don’t develop
However, the rest of the female anatomy and all hormones and chromosomes are normal
How does mullerian aplasia usually present?
With primary amenorrhea
In a teen found to then have no uterus
However external female anatomy is normal
and breasts and pubic hair will still be tanner stage 5
Long term side effect of etoposide
can induce high risk AML or ALL within 3 years of exposure
True or false: Breast cancer is increased in survivors of Hodgkin lymphoma.
True (chest radiation is part of treatment).
Perinatally acquired HPV warts can show up until this age:
up to 20 months
If two live vaccines (for ex varicella and MMR) are not given on the same day, they need to be separated by at least this much time:
4 weeks or more
this is because if the second vaccine is given less than 4 weeks later, the antibody response to the first vaccine may decrease the efficacy of the immune response to the 2nd vaccine
(why is this only the case with live vaccines? hmm)
Iron absorption is enhanced by
ascorbic acid (aka vitamin c)
What is the most specific lab finding for iron deficiency?
a low serum ferritin (like less than 15)
If a permanent tooth is avulsed, how do you save it?
Hold it by the crown and rinse with water
Then reimplant it and hold it in place on way to dentist if child is cooperative
If child is not cooperative and might aspirate the tooth, then instead put the tooth in cold cow’s milk (safe, isotonic, does not harm the root)
the tooth will remain viable for 1- maybe 2 hours
Job of IgA
to provide local defense against infections in the respiratory, GI and GU tracts
What type of antibody is the first type of antibody produced after/during an infection?
IgM
Blank is the predominant type of antibody in the serum, and the predominant type that crosses the placenta
IgG
What are Roth spots?
Roth spots = exudative, edematous, hemorrhagic lesions of the retina seen in patients with bacterial endocarditis
Most common skin manifestation of bacterial endocarditis:
Petechiae on the mucous membranes and extremities
The majority of subacute bacterial endocarditis cases are caused by these bugs:
staph aureus
strep viridans
less commonly–coag neg staph
Most common skin manifestation of SBE
petechiae
What are splinter hemorrhages?
Linear reddish brown lesions found under the nail beds seen in SBE
What are Osler nodes?
= painful, violaceaous nodules on the tips of the fingers and toes seen in SBE
What are Janeway lesions?
= painLESS, erythematous macules on the palms and oles seen in SBE
New name for Henoch-Schonlein purpura
IgA vasculitis
How does IgA vasculitis (aka HSP) present?
a purpuric rash on the legs and butt
What is SMA syndrome?
= when there is loss of mesenteric fat, allowing the second 2/3 of the duodenum to get compressed between the SMA and the abdominal aorta – presents as duodenal obstruction
What conditions lead to SMA syndrome?
Any condition that causes rapid weight loss, where you rapidly lose the fat between the SMA and abdominal aorta
Seen in anorexia, severe weight loss post op, etc
What makes the pain in SMA syndrome better?
Lying in the left lateral decub position with knees to chest, or prone
Blank syndrome causes copper deposition in body tissues
Wilson syndrome
Eczematous dermatitis is a classic sign of this nutritional deficiency
Essential fatty acid deficiency
What IS essential fatty acid deficiency?
= low levels of linoleic and alpha linoleic acid, levels that are so low it messes up fatty acid metabolism
(linoleic acid is the main omega-6 fatty acid, and alpha linoleic acid is the main omega 3 fatty acid)
What are the symptoms of essential fatty acid deficiency, aka EFAD?
reduced growth velocity
delayed neurodevelopment
scaly dermatitis
increased susceptibility to infection
Who gets EFAD, or essential fatty acid deficiency?
Kids with CF
With hepatobiliary disease
Anyone on TPN without lipids
An extra lack of omega-3 and omega-6 acids =
essential fatty acid deficiency
Other name for omega fatty acids
linoleic acids
Blank acid is the main essential fatty acid.
Linoleic acid
A reddish black skin lesion with irregular borders would be highly concerning for
melanoma
What do subcutaneous nodules associated with neuroblastoma look like?
dark bluish subcutaneous nodules
Tumor markers associated with testicular cancer:
AFP (alpha fetoprotein)
B-hCG
Acute cardiovascular side effects of marijuana
marijuana causes release of catecholamines –> tachycardia, hypertension, vasoconstriction
Oh….. but apparently can also make you bradycardic. okkk
Is gynecomastia in men a side effect of marijuana?
yup! apparently it is
so is infertility, oligospermia and decreased testosterone
What is fibrous dysplasia?
= a disorder where there are radiolucent regions of immature woven bone that do not differentiate into mature lamellar bone like they should
Can be clinically silent, or can present with pain and/or pathologic fractures
Is a feature of McCune Albright Syndrome
3 clinical features of McCune Albright syndrome:
- cafe au lait spots
- precocious puberty
- fibrous dysplasia
Lens dislocation and joint laxity are associated with
Marfan syndrome
Brownish-gold discoloration of the limbus of the cornea and emotional lability are associated with
Wilson disease
Facial angiofibromas and intellectual disabilities are associated with
Tuberous sclerosis
Blank is a genetic condition that affects your bones, skin and endocrine system, causing café-au-lait skin pigmentation, scar tissue forming on bones (fibrous dysplasia) and irregular function of growth-regulating glands that produce hormones.
McCune-Albright Syndrome
BLANK is an x-linked disease that presents with the classic triad of thrombocytopenia, eczema, and susceptibility to infections from encapsulated bacteria
WAS (Wiskott-Aldrich syndrome)
Wiskott-Aldrich syndrome only occurs in
boys
because it is x-linked recessive
Microcephaly, congenital cataracts, and a PDA =
Congenital Rubella syndrome
Clinical features of congenital rubella
PDA cataracts microcephaly sensorineural hearing loss purpuric "blueberry muffin" rash
A neonate is born with limb hypoplasia, micropthalmia, and scarring in a dermatomal distribution. Which congenital infection are they affected by?
Varicella
This virus causes bone marrow suppression and subsequent non immune fetal hydrops
Parvovirus B19
Neonate with microcephaly and periventricular calcifications =
congenital CMV
Most common cause of non-inherited deafness is
Congenital CMV (progressive sensorineural hearing loss)
“Blueberry muffin” rash can be seen in these congenital infections
CMV
Rubella
Clinical features of congenital CMV:
microcephaly PERVENTRICULAR calcifications chorioretinitis hepatosplenomegaly jaundice intrauterine growth restriction blueberry muffin rash progressive sensorineural hearing loss
Almost all congenital infections will include these clinical features:
IUGR
hepatosplenomegaly
Which age groups most common get Neisseria meningitidis?
Infants under age 1
And teenagers age 15-21
How to treat meningococcal (Neisseria) meningitis:
ceftriaxone or cefotaxime initially as empiric tx, then can switch to penicillin once Neisseria is confirmed
Which type of Neisseria causes the majority of neisseria meningitis cases in infants?
Serotype B
What is lupus anticoagulant?
= a prothrombotic, antiphospholipid antibody that despite being prothrombotic, actually inhibits a bunch of clotting factors and leads to a prolongation in the PTT (kind of paradoxically)
it can be the first sign of Lupus
and can predispose to clots
Pathophys of how Factor 5 Leiden causes clotting
activates protein C resistance
Do low protein C levels lead to increased clotting, or increased bleeding?
Low protein C levels = increased risk of thrombosis
If you have protein C deficiency, are you at risk of the formation of clots or at risk of bleeding?
At risk for the formation of clots
Blank deficiency may cause hemolysis in premature infants
Vitamin E
Symptoms of vitamin E deficiency
hemolysis
hyporeflexia progressing to ataxia and severe muscle weakness
limitations in upward gaze
Symptoms of zinc deficiency
poor growth diarrhea impaired sense of smell (and taste) decreased immune function dermatitis alopecia hypogonadism
Dermatitis, failure to thrive and alopecia are symptoms of blank deficiency
zinc deficiency
Irritability, poor wound healing, gingival bleeding, petechiae, bruises, and tenderness and swelling of the lower extremities =
Scurvy
Thiamin is also called
B1
Riboflavin is also called
B2
Pyridoxine is also called
B6
Cobalamin is also called
B12
What is pellagra and how does it present?
Dermatitis, diarrhea and dementia
3 Ds
from niacin deficiency
happens if you don’t eat enough nicotinic acid (or its precursor, tryptophan)
Diarrhea, dementia, and dermatitis that gets worse in the sun =
pellagra
aka niacin deficiency
Niacin is also called
B3
The sudden appearance of rash following defervescence of fever =
Roseola
Describe the rash in Roseola
Occurs AFTER the fever goes away
starts on the trunk, then quickly spreads to the face, neck and extremities from there
“widespread erythematous blanching macules”
Viruses that cause Roseola
Herpesviruses 6 and 7
most commonly 6
Peak age for getting Roseola
6-15 months
Roseola is rare after this age
36 months
Common ish complication of Roseola
febrile seizure
Fever, slapped-cheek erythema, and a lacy-like rash on the extremities (that all occurs at the same time) =
Parvovirus B19
Is the Roseola rash pruritic?
nope
What is the Berliner sign?
Palpebral/periorbital edema that occurs in Roseola
A fixed, split S2 is a classic finding associated with ….
an ASD
RV volume blank with inspiration
increases
On inspiration, what happens to the blood volume in the RV?
increases
In a normal healthy heart, the duration of RV ejection always stays the same or varies?
Varies with respiration
On inspiration, RV volume increases, so takes longer for the blood to all go through the RVOT across the pulm valve
peaked P waves indidcate
right atrial enlargement
Why do you eventually get a murmur with an ASD?
Because you will get L–>R shunting, extra blood volume going to the R heart which is immediately seen by the RV and causes more blood to have to go through the RVOT with each beat, so you get a systolic murmur of “relative pulmonary stenosis”
Explain the heart sounds you would hear in a teenager with a clinically significant ASD:
Systolic murmur from increased blood flow across the RVOT
and
a wide, fixed split S2, because there is increased blood flow across the RVOT with every single beat, causing the closing of the pulmonic valve to always be a little delayed (normally, it just varies with respiration)
(you CAN also hear a soft mid diastolic rumble from increased flow across the tricuspid valve)
A widely split S2 that does not vary with respiration should make you think of
an ASD
Why does the pulmonary valve close later during inspiration?
Because on inspiration there is increased RV volume
Loud, narrow split S2 think
pulmonary hypertension, causing early closure of the pulmonary valve
How to differentiate severe pulmonic stenosis from an ASD on auscultation:
Pulmonic stenosis will have an ejection click, caused by the thickened and doming pulmonary valve
Harsh systolic ejection murmur, ejection click best heard over the LUS border, and an S2 that stays split but still varies with respiration =
severe pulmonic stenosis
can also have a systolic thrill (vibration from blood going across severely stenosed valve)
What is the most common type of TEF?
Esophageal atresia (proximal pouch) with a distal TEF
87% of patients with a TEF will have this anatomy
What does CHARGE syndrome stand for?
Coloboma Heart anomalies Atresia of the nasal choanae Retardation of growth and/or development Genital anomalies Ear anomalies
What causes dental caries?
Strep mutans, a group of bacteria that adhere to dental enamel
Bacterial fermentation of carbs does what to the pH of dental plaque?
lowers it
think soda carbonated acidic
that lower pH leads to demineralization and formation of dental caries
Bottle feeding beyond 1 year of age puts you at risk of
dental caries
Strep mutans is associated with
dental caries
and reduced pH of dental plaque
MUDPILES stands for:
Methanol Uremia DKA Paraldehyde Iron, isoniazid Lactic acid Ethanol and Ethylene glycol Salicylates
= the causes of anion gap metabolic acidosis
A mature cystic teratoma is also called
a dermoid cyst
it’s a benign ovarian tumor
Infants with galactosemia specifically are at increased risk for sepsis due to this bug
E.coli sepsis
Eye exam of infant with galatosemia will show
cataracts
The tilt table test is used to diagnose this type of syncope
neurocardiogenic
if you go flying from supine to standing and get bradycardic with HR < 40 or hypotensive and or pass out, then you have vasovagal syncope
wow what a fun and kind test
Abdominal complication that can occur in Kawasaki disease
acute distension of the gallbladder aka “gallbladder hydrops”
can be felt as RUQ mass on exam and typically self resolves
Sensitivity =
TP / (TP + FN)
1st line treatment for cluster headaches
oxygen and triptans
