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MedStudy Flashcards

1
Q

TSC Brain Changes

A

Cortical and periventricular calcifications

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2
Q

Sturge Weber Brain Changes

A

Unilateral serpiginous parenchymal calcifications with hemispheric atrophy

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3
Q

NF1 Brain Changes

A

Hyperintensity areas in basal ganglia and cerebellum

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4
Q

Vestibular schwannomas symptoms

A

NF2, 8th cranial nerve
tinnitus, unsteady gait, hearing loss, and/or facial weakness
NF2 can have bilateral cataracts (subcapsular lenticular opacities)

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5
Q

Ascorbic acid deficiency

A

vit C
fragmented hair with corkscrew appearance
gingival hemorrhage, FTT, irritability, bone pain
ground glass appearance to bones, sharply outlined metaphyseal ends

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6
Q

Langerhans cell histiocytosis derm symptoms

A

scaly papular seborrheic dermatitis of the scalp and diaper area

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7
Q

Vitamin D deficient rickets XR findings

A

decreased bone mineralization around epiphyses and bowing of LE
widening of wrist and knees
enlarged costochondral junctions “rachitic rosary”

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8
Q

Caffey Disease

A

COL1A1
irritability, fever, anorexia, soft tissue swelling associated with subperiosteal cortical thickening of underlying bone
Average onset: 10 weeks - 6 months
Labs: leukocytosis, elevated ESR and Alk phos
Mandible is affected in 95% of cases
Symptoms usually resolve by 24-30 months of age

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9
Q

Choanal Atresia DDX

A

CHARGE

Treacher Collins - conductive hearing loss, hypoplasia of lower eyelids with lower eyelashes absent/coloboma, cleft lip/palate, mandibular hypoplasia -> respiratory issues 2/2 obstruction

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10
Q

Serotonin Syndrome vs NMS

A

Myoclonus!!!!

SSRI/MAOI/MDMA aka ecstasy/linezolid

Tachycardia, high temp, HTN, confusion, hallucinations

Ecstasy = bruxism and hyponatremia

Tx - supportive, benzo and cyproheptadine

Do not confuse with NMS - will have hard to control BP and HR with muscle rigidity, Tx with benzo, dantrolene, bromocriptine, amantadine

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11
Q

Ingestion with Bezoar

A

Salicylates

ASA
OTC cold Med
Anti diarrheal
Oil of wintergreen
Bismuth
Herbal preparations

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12
Q

Acetaminophen Toxicity

A

Toxicity is mediated by NAPQI (metabolite). It binds to glutathione and if liver levels are depleted, NAPQI causes cellular damage.

NAC is tx -> restores glutathione stores; give within 8 hours of ingestion.

Obtain level at 4 hours to plot on normogram. Activated charcoal can be given at 1-2 hours.

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13
Q

Stages of Acetaminophen Tox

A

Stage I: malaise, lethargy, N/V
Stage II: 24-72 hours; RUQ pain with lab evidence
Stage III: 72-96 hours; peak lab markers including fulminant hepatic failure and prolongation of prothrombin time; most die at this stage
Stage IV: death or recovery

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14
Q

ASA toxicity

A

metabolic acidosis and respiratory alkalosis
Causes shift of K into cells -> kidneys conserve K and dump H+ -> urine is acidic
Fluid loss causes hyper NA2+
Toxicity activates the medullary respiratory center -> increased RR and HR, fever, etc.

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15
Q

DDX Cough, Coryza, Conjunctivitis

A

Measles (rubeola virus): will have classic rash, Koplik spots on buccal mucosa 2-3 days before the rash; splenomegaly and lymphadenopathy are common; college student. Maculopapular rash starts 2-4 days after fever onset and spreads in cephalocaudal direction.

Adenovirus: palatine petechiar, pharygneal/tonsillar enlargement/erythema, periauricular lymphadenopathy; serotypes 3 and 7 most severe. May have sterile hemorrhagic cystitis, PNA, encephalitis, myocarditis, diarrhea. Also can have a Reye like syndrome with bronchoPNA, hepatic failure, seizures, disseminated coagulopathy with serotype 7.

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16
Q

Viruses with Aplastic Crisis

A

Parvo B19
CMV
EBV
Hepatic viruses
HIV

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17
Q

Bacterial Meningitis for <7 DOL

A

GBS
E coli
Listeria

Tx amp + cephalosporin (cefotaxmine)

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18
Q

Hypertrophic Pyloric Stenosis

A

Caused by erythromycin or other macrolides if <6 weeks of age

Can be given to an infant with Chlamydial conjunctivitis or PNA

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19
Q

Gentamycin Toxicity

A

Oto and nephrotoxic

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20
Q

Congenital Syphilis

A

Infants with Treponema pallidum can present with bony lesions including osteochondritis at the metaphyses and periostosis. Decreased bands of bony mineralization and focal areas of destruction. It is painful so most refuse to move the affects areas.

Cutaneous lesions of palms and soles, which are contagious if ulcerated
HSM
Jaundice
Coombs neg hemolytic anemia

> 2 years old presentation
Rhinitis -> saddle nose appearance
Mulberry molars
Hutchinson teeth
Frontal bossing
CN 8 deafness
Anterior bowing of the shins

Screen with VDRL or RPR -> confirm with FTA-ABS or MHA-TP

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21
Q

Congenital Toxoplasmosis

A

Chorioretinitis, microcephaly, diffuse intracranial calcifications, seizures, hearing loss, growth restriction

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22
Q

Ineffective terminal complement cascade infections

A

C5-9 not working well

Neisseria meningitis and meningococcal infections

Tx: MCV4/Menactra if 9 months or older and they do not have asplenia or HIV
Menveo - give at 2/4/6/and 12 months
Boosters of either given q5 years

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23
Q

Bloody, watery diarrhea + Vulvovaginitis Infection

A

Shigella

Tx: ceftriaxone

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24
Q

Varicella Embryopathy

A

VZV infxn before 20 weeks GA
Severe limb malformations including shortening, atrophic, scarring in zig zag pattern
Ocular abnormalities - microphthalmia, cataracts, chorioretinitis, optic atrophy

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25
Q

TCA Toxicity

A

Prolonged QRS/PR/QT -> heart block. ventricular arrhythmias, PVCs, sinus tachy

Hypotension, shock, respiratory depression, seizures. coma
Can have anticholinergic symptoms

Symptoms can present up to 6 hours later

Tx: immediate activated charcoal if reliable airway, gastric lavage with intubation regardless of airway, and alkalization of serum via sodium bicarb to prevent arrhythmias

Monitor ECG 6-8 hours, but if having cardiac symptoms need to monitor 24 hours after no more abnormal patterns

Ex. amitryptilline, imipramine, doxepin

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26
Q

SSRI Overdose

A

Serotonin syndrome - myoclonus and rigidity in LEs, tachy, HTN, sweating
Confusion, agitation, loss of urine/stool
Hyperreflexia, clonus, tremor

Combo of SSRI, opioid, CNS stimulants i.e. MDMA/ecstasy and dextromethorphan, triptans

TX: mostly supportive, but can give serotonin antagonist such as cyproheptadine; benzo and IVF resuscitation

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27
Q

Anti-psychotic Overdose

A

Dystonia and muscle spasticity, eye deviation, trismus, cannot swallow
Chlorpromazine, promethazine

Tx: IV benadryl or IV benzo

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28
Q

Ecstasy (MDMA)

A

Hyperthermia, sweating, SIADH -> may overcompensate and lead to hyponatremia
Confusion, anxiety, paranoid
Muscle spasticity, seizures -> rhabdo
Hepatotoxicity

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29
Q

Beta blocker toxicity tx

A

glucagon

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30
Q

Ca channel blocker toxicity tx

A

IV calcium

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31
Q

Ethylene glycol tox tx

A

fomepizole

Ex. methanol or ethylene glycol

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32
Q

Cholinesterase inhibiting pesticide tox tx

A

pralidoxime

Examples: organophosphates and carbamates

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33
Q

Cyanide poisoning

A

Amyl nitrate

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34
Q

Methemoglobinemia

A

caused by amyl nitrates, aerosols, benzocaine spray

Tx. Methylene blue

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35
Q

PCP

A

tachycardia, agitation, HTN
hallucinations
NYSTAGMUS!! - lateral nystagmus can also be with benzo/barbituates
LE edema
Manic mood
Small but reactive pupils
Rhabdo can cause myoglinuria

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36
Q

ADHD med that can cause pinpoint pupils, decreased HR and RR

A

Clonidine

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37
Q

Malaria PPX

A

Chloroquine (rising resistance)
Doxycycline - daily tx + 28 days after trip
Atovaquone/Proguanil - daily + 7 days after trip
Mefloquine - weekly + 4 weeks post trip; not in Cambodia, Myanmar, or Thailand

Primaquine and tefenoquine - not in G6PD patients

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38
Q

Salmonella Tx

A

None unless high risk or severe disease aka hemoglobinopathies, malignancies, and chronic GI disorders only!

Azithromycin
Amox or Bactrim if susceptibility is known

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39
Q

Early onset (1st week of life) + FT infections vs. Late onset in FT

A

Early onset: Bacteremia/sepsis is most common followed by PNA and meningitis

Late onset: meningitis more common

If premature - more likely to be meningitis

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40
Q

Antibiotics for Meningitis before bacteria known

A

Vanc, ceftriaxone, metronidazole, and acyclovir (especially if viral vs. bacterial unknown)

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41
Q

Infants with Splenectomy/Asplenia and Vaccination

A

Menveo (MenACWY-CRM) at 2/4/6/12 months

Remember:
MenACWY-D (Menactra): ≥9 mos, avoid in those with asplenia or HIV

MenACWY-CRM (Menveo): ≥2 mos,

MenACWY-TT (MenQuadfi): ≥2years

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42
Q

Infant born to an HIV+ mother

A

ZDV (Zidovudine) for 4-6 weeks for ALL infants

PJP ppx with bactrim at 6 weeks of age 3x/week until negative infection is confirmed

Add 3 doses of nevirapine in the 1st week of life if Mom did not take antepartum meds or only received ZDV infusion during delivery (Usually when mom has viral load >1000 or unknown)

The biggest risk of vertical transmission is during delivery

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43
Q

Roth spots

A

Exudative, edematous, hemorrhagic lesions of the retina

associated with bacterial endocarditis

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44
Q

Suppurative thrombophlebitis

A

Usually dental infection with Fusobacterium

Can cause a septic embolus in the lungs

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45
Q

MIS-C

A

elevated troponin, BNP, LFTs, procal/ESR/CRP, triglycerides, ferritin
lymphocytopenia, neutrophilia
thrombocytopenia

Echo: depressed L ventricular function, pericardial effusion

Fever, maculopapular rash, mucus membrane changes, swollen hands and feet, headache, mental status changes

GI symptoms can mimic acute abdomen

Tx: IVIG, TNF inhibitors, IL-1 inhibitors, IL-6 inhibitors

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46
Q

EBV

A

Specific Ab panel - dx
Spot test - many false +

Morbilliform rash, petechial lesions at the junction of the hard and soft palate

Peripheral smear - foamy like cytoplasm

No strenuous exercise for 1-3 months; at least 4 weeks but not until splenomegaly resolves

Ab are only positive in 80% teens, 40% children, and 20% <4 years

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47
Q

Foreign Body Bacteria - Ring Abscess

A

B. cereus - esp contact lenses (Acanthamoeba is also associated with contact lenses, but no ring abscess)
Pseudomonas
Proteus

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48
Q

Discitis

A

narrowing of vertebrae spaces
fever, refusing to bend
ESR and CRP elevated, but WBC normal
Usually children <5 years

Ususally staph aureus

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49
Q

Hib

A

H flu type B
If infected child <2 years and not treated with ceftriaxone or cefotaxime then should be tx with dose of rifampin prior to discharge

If household contacts are not immunized or partially immunized and <2 years or anyone who is immunocompromised = rifampin

If day care contact, if >2 cases in 60 days and other children who are not immunized or partially, then need rifampin

Dose: 20 mg/kg/day or if <1 month 10 mg/kg/day

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49
Q

Arcanobacterium haemolyticum

A

aka diptheria (cornebacterium was old name)

fever, sore throat, pruritic/scarlatiniform rash that goes from extensor surfaces of extremities to the trunk, sparing the face, palms, and soles

Gram positive rod

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50
Q

Testing for C diff <1 year

A

Don’t. Many are colonized with c diff so testing will be a false positive

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51
Q

Parvovirus B19

A

Young children have slapped cheek fever with lacey rash

Adolescents and adults do not usually have a rash but arthritis without fever

Once the rash appears, they are no longer contagious

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52
Q

Boy who returned from lake vacation with very itchy vesicular rash initially on ankle and progressed to his whole calf

A

Ancyclostoma braziliense or Necator americanus aka hookworms

rash has serpentine pattern

Tx with albendazole or ivermectin

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53
Q

Conjunctival granuloma with preauricular lymphadenopathy, painless

A

Bartonella

Tx. azithromycin

Systemic disease: azithro + rifampin + gentamicin

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54
Q

Meningococcal ppx

A

Neisseria type B

Rifampin 10 mg/kg twice daily for 2 days > 1 month old, but 5 mg/kg BID for 2 days <1 month (oral)

Ciprofloxacin 500mg orally x1

Ceftriaxone 125mg if <15 years and 250mg >15 years IM once

Close contacts are those with contact < 7 days prior to onset, >8 hours prolonged contact, and <3 feet proximately

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55
Q

EBV Peripheral smear

A

Absolute lymphocytosis with >10% atypical lymphocytes

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56
Q

Child with pertussis and new baby in the family

A

give azithromycin 10mg/kg/day x 5 days to the newborn

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57
Q

Disorders that affect breastfeeding

A

HIV, HTLV1, HTLV2

Untreated TB - although can if on anti-TB therapy for 2+ weeks and considered non-infectious

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58
Q

Progressive hoarseness with wheezing, can have association with URI. Soft tissue irregularity at level of vocal cords

A

HPV
warts on vocal cords
can be wrongly dx as reactive airway disease
do not place trach

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59
Q

Mosquito bites in the summer causing encephalitis

A

Arbovirus

WNV also suspect if a bunch of birds died in one area

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60
Q

Posterior cervical and suboccipital lymphadenopathy, markedly injected pharynx, rhinitis, and blanching maculopapular rash on the trunk and upper thighs
Fine, discrete, irregular, pinkish-red macules located on the face and trunk

A

Rubella

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61
Q

Shallow painful ulcers in posterior pharynx, posterior cervical lymphadenopathy, cough, rhinitis

A

Herpangina (enterovirus aka coxsackie)

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62
Q

Exudative pharyngitis, anterior cervical lymphadenopathy, and diffuse red sandpaper rash

A

Scarlet fever/group A strep

May be described as a “fine” rash, spares the palms and soles

Strawberry tongue/beefy red tongue

Desquamation of skin 10-14 days after

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63
Q

Cervical lymphadenopathy, painful yellow ulcers of gingiva and anterior pharynx, fever, perioral vesicular erythematous lesions

A

Gingivostomatitis 2/2 HSV-1

64
Q

Non-purulent conjunctivitis, exudative pharyngitis, coryza, cervical and preauricular lymphadenopathy

A

Adenovirus

65
Q

When is tetanus IG given?

A

patient has <3 immunizations or vaccination hx is unknown

DTaP for <7 years
Tdap for > 7 years

66
Q

Tetanus: Dirty wound +patient has <3 immunizations or vaccination hx is unknown

A

Vaccine and IG

67
Q

Tetanus: wound is clean and immunizations UTD, last given <10 years ago

A

No tx

If >10 then give vaccine only

68
Q

Tetanus: Dirty wound + vaccines UTD with last given <5 years ago

A

No treatment

If >5 years, vaccine only

69
Q

Measles post exposure

A

> 1 year and unvaccinated or 1 vaccine = give MMR within 72 hours, can give to 6-12 mos but would not count towards their series

IG in 6 days for those <1 year, immunocompromised, pregnant women without evidence of immunity

70
Q

Stages of Lyme Disease

A

Stage 1: target rash
Stage 2: heart block and Bell’s palsy (CN7)
Stage 3: migratory arthritis, memory issues (several years)

Tx: doxy >8 years and amoxicillin for <8 years
IV ceftriaxone if above does not work

71
Q

Med interactions with flu and varicella vaccines

A

salicyclates (aspirin, anti-diarrheal) -> reye syndrome
avoid for 6 weeks

72
Q

MMR + VZV vs MMRV

A

increased risk for febrile seizures in MMRV

73
Q

Chlamydia trachomatis on CXR

A

hyperinflation with bilateral interstitial infiltrates

Staccato cough
Transmission during delivery and can present at 2-19 weeks (2 weeks - 4-5 months)

74
Q

Phenytoin exposure in utero

A

fetal hydantoin syndrome - IUGR, microcephaly, orofacial clefts, digital distal hypoplasia, and DD

75
Q

Purple lymph node not responsive to abx

A

Mycobacterium avium complex

excise node

76
Q

Babesia

A

Vector is white footed mouse with deer tick (Ixodes)

Infection in asplenia, immunocompromised, Lyme disease

Intracytoplasmic inclusions (intraerythrocyte) on peripheral smear

77
Q

Pertussis ppx

A

Azithro preferred due to daily dosing

78
Q

Papular pruritic gloves and socks syndrome

A

Parvo B19

Acute sudden onset swelling and erythema of the hands and feet
Papules, petechiae, and purpura

79
Q

1st tier testing for adoptees

A

regardless of vaccination records

HIV
Hep C
Hep B
Syphilis
CBC diff
lead level
stool O & P
TST

80
Q

Toxic Shock Syndrome - GAS vs. Staph

A

GAS - penicillin G + clinda -> if penicillin allergic than vanc + clinda
Staph vs GAS - vanc

81
Q

Incubation period for food poisoning

A

Staph aureus - rapid onset within hours; emesis, diarrhea, and profound weakness
Salmonella and E coli - a few days
Norovirus - 24-48 hours

82
Q

Febrile well appearing FT infant 8-60 days old - admit or discharge

A

If LP not done, must admit even if only inflammatory markers were elevated and all other testing was normal

83
Q

Newborn onset conjunctivitis:
0-2 days
2-5 days
5-12 days

A

0-2 days - silver nitrate
2-5 days - Gonorrhea
5-12 days - Chlamydia, most common

84
Q

Mother with TST +, asymptomatic, and neg CXR

A

no need to separate baby, can still breastfeed
mother needs tx only

Household kids: need to be tested, if they also have latent TB, need 4 months rifampin OR 3 weeks isoniazid + rifapentine

Isoniazid can cause B6 deficiency -> peripheral neuropathy and weakness, cardiac arrhythmias, diaphoresis, bowel/bladder dysfunction

85
Q

Mother with TST + and positive CXR

A

separate mom and baby until appropriate tx started, 2 weeks

If baby does not have congenital TB -> tx with 3-4 months isoniazid -> TST neg can discontinue; if + then latent TB

If baby with congenital TB -> both need tx, baby can have breast milk from mom during separation

86
Q

Initial eval for infants with fever 8-21 days

A

blood cx
UA
CSF cx and analysis

87
Q

Hep B Ag+ mother

A

Give Hep B to baby within 12 HOL
Give HBIG at different site as well
If <2000g at birth, should get Hep B that does not count towards the series

If Hep B status unknown for mom -> give Hep B at birth and wait to give HBIG until result returns for mom

If Ab-, give preterm infants HepB at 1 month of age or when discharged, whichever is first

88
Q

Benign paroxysmal vertigo of childhood

A

Occurs in children 1-4 years
Can last 2-3 from onset
Dizziness, ataxia, and vertigo for a few minutes and then self resolves
Increases likelihood of migraine development
Fam hx of migraines

DDX: seizures, but would would not be alert during episodes

89
Q

Dandy Walker Malformation

A

missing the cerebellar vermis
asymptomatic, but can have gait disturbances, headache, or develop hydrocephalus

90
Q

Wound botulism Tx

A

Pip/tazo
Botulism anti-toxin (also for GI botulism)

91
Q

Hypsarrythmia

A

usually in the first year of life, infantile spasms
high voltage, irregular, slow waves on EEG
clusters of muscle spasms >100
Flexed muscles followed by extension
Poor neurocog development
Tx: ACTH, vigabatrin, and PO prednisolone
Eval for TSC

92
Q

Oxcarbazepine

A

Causes hyponatremia
Anti-seizure drug and for mood disorders

93
Q

Idiopathic intracranial HTN

A

Risk factors: OBESITY, vit A excess, corticosteroids, rapid weight gain, OCPs, tetracyclines, isotretinoin

Tx: acetazolamide 1st; diuretics and migraine meds

94
Q

Marcus Gunn Syndrome

A

jaw winking syndrome
trigeminal (mastication) and oculomotor (levator palpebrae) nerves
other eye abnormalities, including strabismus

95
Q

Mononeuritis multiplex

A

associated with DM, arthritis, amyloidosis, SLE
Painful
muscle atrophy and weakness develop

96
Q

Cluster headache tx

A

100% O2
Abortive: triptans
Ppx: verapamil

97
Q

Klippel Feil

A

Noonan like dysmorphology
Fusion of 2 or more cervical vertebrae
Hypoplastic scapulae (Sprengel deformity) where they do not descend completely
Can have NTDs and facial asymmetry
Renal and collecting duct abnormalities
Neurologic issues
VSD, cleft lip/palate, hearing loss, ID

98
Q

MRI + MRV reason

A

cerebral venous thrombosis especially with risk factors of dehydration and infection

99
Q

CN affected with increased ICP

A

6th

100
Q

Sturge Weber MRI

A

serpentine like intracranial calcifications (unilateral, side of port wine stain)
atrophy of the hemisphere also on the same side

101
Q

4-6 hz spike and wave pattern on EEG

A

juvenile myoclonic epilepsy

102
Q

Centrotemporal sharp waves on EEG

A

childhood epilepsy/benign rolandic epilepsy

103
Q

Peds vs adult headache

A

peds have bilateral more often

104
Q

Anti-sz med and acute angle glaucoma

A

eye redness, swelling, and pain
topiramate - can also cause nephrolithiasis, fatigue, somnolence, cognitive slowing

105
Q

Valproate side effects

A

weight gain, hair loss, hyperNH4, pancreatitis, thrombocytopenia

106
Q

Phenobarbital side effects

A

hepatotoxicity, impaired cognition, sedation

107
Q

Phenytoin side effects

A

hirsutism, gum hypertrophy, ataxia, skin rash, SJS, nystagmus, drowsiness

108
Q

Lacosamide side effects

A

cardiac arrythmias, diplopia, nystagmus, dizziness, headaches

109
Q

Migraine PPX for children 12-17 years old

A

Topiramate

110
Q

Early Signs of Autism

A

no social smile by 6 months
no babbling, pointing, or gestures by 14 months
not using single words by 16 months
no 2 word phrases by 24 months
lack of make believe play by 18 months

111
Q

Age that most children gain daytime continence?

A

30 months
Most are fully toilet trained by 3-4 years and without accidents by 5-7 years

Start the convo for training at 12 months but do not try to toilet train unless 18 months and the child is showing interest

112
Q

Every Student Succeeds Act (ESSA)

A

Provides special services to children with disadvantaged backgrounds including poverty, immigration (english as 2nd language)

Requires schools to keep track of performance in math, reading, and science

113
Q

Carotid artery dissection

A

usually occurs after trauma, especially MVA with abrupt stop
Horner syndrome - ptosis, miosis, and anhidrosis

114
Q

MRSA Tx

A

Bactrim - 1st
Doxycycline if >8 years
Clarithromycin but 10% are resistant

115
Q

Influenza tx

A

Neuraminidase inhibitor, antiviral = oseltamivir

Tx in those who are hospitalized, high risk, and children < 5 years regardless of duration of symptoms or vaccination status

Confirmatory dx is not necessary

116
Q

Infantile Seizure Tx

A

1st: ACTH (corticotropin)
Vigabatrin if TSC
Prednisolone

117
Q

Rocky Mountain Spotted Fever

A

generalized symptoms - myalgias, fever, headache

Rash builds starting with hands and feet, wrists and ankles, etc

Systemic vasculitis -> hypoNa2+, thrombocytopenia, elevated LFTs, leukopenia, anemia

Tx: doxy, teeth discoloration <8 years but unlikely to happen

118
Q

MRI Brain with Spina Bifida

A

Hydrocephalus with chiari malformation type II

Remember type I is usually an incidental finding and asymptomatic

119
Q

Osler Nodes vs. Janeway lesions

A

Osler nodes - painful, on palms and soles

Janeway lesions - painless, erythematous macular

120
Q

Perceptual distortions

A

inflectious mono

121
Q

Upper motor neuron vs. lower for innervation of the face

A

Lower motor neuron: impaired wrinkling of forehead, close the eye, or lift corner of mouth; ipsilateral damage causes the same side problems

Upper motor neuron: contralateral innervation of the face; upper part of the face is spared (able to wrinkle forehead) because the ipsilateral lower motor neuron is unaffected

122
Q

Trigeminal vs. Facial nerves

A

Trigeminal: 5th, mastication, loss of sensation; ophthalmic, maxillary, mandibular (opening the jaw)

Facial: 7th, facial movements

123
Q

Acute vs subacute endocarditis

A

acute: rapid progression, new murmur, bad; staph aureus; Janeway lesions

subacute: a couple weeks long, more likely if already have valve problems; strep viridans, Osler nodes, splinter hemorrhages, Roth spots

124
Q

Retropharyngeal abscess

A

Strep pyogenes

125
Q

Non-exudative conjunctivitis, eye granuloma, and preauricular lymph nodes on same side

A

B. henselae

Perinaud oculoglandular syndrome (atypical presentation)

Azithro, bactrim, rifampin, cipro

126
Q

Lead poisoning XR

A

Lead lines, transverse bands around metaphyseal area in tubular bones

127
Q

Simple vs complex febrile seizure

A

Simple: <15 min, generalized, 1 episode in 24 hours; risk for seizures in future 1-2%

Complex: >15 min, >1 episode in 24 hours, focal symptomology, risk for seizures in the future 5-10%

128
Q

AE DTaP

A

prolonged crying and irritability

129
Q

AE MMR-V

A

thrombocytopenia and arthralgia
general macular rash

V- vesicular rash at injection site

130
Q

AE Rota

A

intussusception

131
Q

Bacterial Vaginosis Dx Criteria

A

3/4 of the following:
1. >20% clue cells on wet prep (fuzzy appearing 2/2 bacterial fragments sticking)

  1. pH > 4.5
  2. Amine/fishy odor with KOH
  3. Presence of gray-white milky vaginal discharge

Tx: metronidazole 500mg BID x7 days

132
Q

BV vs. Trich

A

both have pH > 4.5 and + KOH test

Trich will have erythematous vaginal walls, yellow-green discharge, and punctate hemorrhages on vagina and cervix (strawberry cervix)

BV will have clue cells, gray-white discharge

133
Q

Klebsiella granulomatis

A

rod shaped, oval organisms in mononuclear phagocytes aka Donovan bodies (deep purple inclusions, gram neg)
can present with ulcer with raised, rolled margins
more common in India, South Africa, and South America

134
Q

Lymphogranuloma venerum (LGV)

A

Caused by chlamydia L1-3
Tx: doxycycline 100mg PO BID x 21 days

Starts with asymptomatic genital ulcer, can look like a small vesicle, which heals within a few days
Then 2-6 weeks later, constitutional symptoms with erythematous, painful lymph nodes that can burst, groove sign from buboes in inguinal area, can cause proctitis if MSM

135
Q

Hypervitaminosis A

A

Hyperostosis of bones often sparing the metatarsal areas, usually in mid shaft of long bones
Malaise, drying of mucus membranes, anorexia, hair loss
HSP, AMS, and pseudotumor cerebri symptoms may occur
Body builder may be culprit

136
Q

Most common CHD in 1st Year/Overall/2nd

A

VSD in 1st year
Bicuspid is most common overall
2nd most common is pulmonary stenosis

137
Q

XR pattern in Coarc Aorta

A

E sign near isthmus from notching of aorta and may also see notching of ribs on that side from collateral vessels off of the aorta

138
Q

HHV 6

A

Roseola

Presentation: infant 6-15 months, febrile seizure, bulging fontanelle, postauricular and occipital lymphadenopathy, conjunctivitis, high fever

Rash: after fever has resolved; pink, small, slightly raised (papular) blanching lesions on the trunk and can spread to the face

139
Q

Hep B Extrahepatic Cutaneous Manifestations

A

Gianotti Crosti Syndrome: lichen planus, pitted keratolysis, papular acrodermatitis aka multiple symmetrically distributed, small, pink/tan papular lesions that may coalesce into plaques

Face, butt, extensor surfaces, and feet predominately affected

Can also be found in EBV infections

140
Q

Hep A PPX

A

Administer Hep A vaccine to unimmunized close contacts only

141
Q

Benign Rolandic Epilepsy vs. Juvenile Myoclonic Epilepsy

A

Rolandic - usually occurs in kids 3-13 years, peak 7-9 years; will be awake and aware but cannot control; usually resolve by teen years with spontaneous remission; centrotemporal spikes on EEG; mostly occur when just waking up or during sleep; also called focal aware seizures; can have GTCs

JME - start in childhood, requires lifelong tx with valproic acid (depakote), can start at absence epilepsy and progress to this; usually occur within 1-2 hours of sleep/nap, can appear like the child has become clumsy with jerk like movements of extremities or digits, triggered by mental/emotional stress, can also have generalized tonic-clonic seizures

142
Q

Toxic Shock Rash and Tx

A

Diffuse erythrodermal (sunburn like)

Tx if MSSA: clinda + cefazolin or nafcillin

Tx if MRSA: clinda and vanc

143
Q

Vaccines 2/4/6 Months

A

2: Hep B, IPV, Hib, Rota, DTaP, PCV

4: same as above expect no Hep B

6: DTaP, IPV, COVID + flu

3rd Hep B can be from 6 months to 18 months

3rd IPV can be 6 months until 18 months

144
Q

Valsalva/squatting in Heart Murmur

A

Increases venous return

If quieter - HCM
If louder - aortic stenosis

145
Q

Vaccines 12 Months

A

Hib - or at 15 months
PCV - or at 15 months
MMRV - or at 15 months
Hep A - can be 12 - 23 months

146
Q

Vaccines 4-6 years

A

DTaP
IPV
MMRV

High risk: PPSV, Hep A series, MCV
After 7 years, give Tdap x1 then Td thereafter

147
Q

RV1 vs RV5 Rota Vaccine

A

RV1 - has latex applicator

RV5 - latex free

148
Q

Vaccines 11-12 years

A

Tdap
HPV
Meningococcal with 2nd dose at 16 years

MenB - minimum at 10 years, 16-18 years when low risk
Bexsero with 1 month apart for 2 doses

149
Q

Hep A - Return to School

A

1 week after illness onset

150
Q

Measles and Mumps - Return to School

A

Measles - 4 days after rash
Mumps - 5 days after parotid swelling

151
Q

Pertussis - Return to School

A

5 days of antibiotics

152
Q

Rubella - Return to School

A

7 days after rash onset

153
Q

Salmonella Typhi vs Nontyphoidal - Return to School

A

Salmonella typhi - must have 3 negative stool cultures after diarrhea stops and finished antibiotics, obtain 48 hours apart

Nontyphoidal - once diarrhea stops, cultures not mandated

154
Q

Scabies and Head Lice - Return to School

A

Scabies - once Tx started

Lice - do not send home early, may return once Tx started

155
Q

Shiga toxin and Shigella- Return to School

A

Shiga: Includes O157:H7
Once diarrhea markedly improves and 2 negative stool cultures, obtained 48 hours apart

Shigella: markedly improved diarrhea, stools must be contained in diaper/controlled by child, no more than 2 stools more than baseline, some may require 1 negative stool culture

156
Q

VZV - Return to School

A

Lesions crusted over, usually 6 days after onset of rash

157
Q

Strep pharyngitis - Return to School

A

No fever and 12 hours after antibiotics started

Pediatrics Boards (2 decks)

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