MISC PREP facts Flashcards
Ca + Phos Supplementation dose?
1300 IU daily each
Cutoff NAS score that requires pharmacology
8
Reason for anuria in prune belly? Pre/Renal/Post?
Post renal (hydroureter) / bladder outlet obstrx
major tx for salicylate poisoning (2)
When dialysis?
minimize acidosis: alkalinize!
Get it out w/ charcoal: q4h until asx and salicylate conc < 30
Dialysis if >100 level
selenium deficiency causes what?
cardiomyopathy, skin and hair pigment loss, macrocytosis
NA range
135-145
treatment for an ethylene glycol or methanol toxicity?
ethanol or Fomepizole
number for low urine sodium
<20
number for elevated urine osmolality
> 600
Urine osm number for inability to concentrate urine?
<300
Typical numbers of urine Na and urine OSM in SIADH?
Hi urine Na >40
Hi urine Osm > 600
heart issue in Friedrich ataxia?
hypertrophic cardiomyopathy
trick about tinea capitus dx and what is the tx
doesn’t fluoresce in woods lamp
need PO Griseofulvin
why no ptu for hyperthyroid
liver tox, use methimazole
normal post puberty male adol hemoglobin?
14-18
Cold shock drugs (incr HR, low BP, decr pulses)
Epi or Dopamine
Warm shock drugs for incr HR, low BP, bounding pulses?
NE
Drugs for cardiogenic shock?
Dobutamine, milrinone
puberty U:L length ratio?
0.85-0.95
infant U:L length ratio?
1.7 *short legs
Age when arm/leg length ratio is the same = 1
10 yrs
Treatment of congenital toxo
sulfadiazine, pyrimethamine, leucovorin supp
Formula for serum osm
Normal value
2(Na) + 10 + (Gluc/18 + BUN/3)
Normal is <10 for gap, 290 for osm
Equation for FeNa
UNa x PCr
_____________ x 100
PNa x UCr
Vincristine s/e
SIADH, periph neuropathy
Procarbazine s/e
CNS effects
mouth abscesses and sulfur granules
bug and drug?
Actinomyces
IV PCN G / Amp 4-6 wks
Morulae, intraleukocyte inclusions, petechiae after camping
TCP, anemia
?Arkansas
Bug and Drug
Ehrlichiosis, Doxycycline
Rash less impressive than w/ RMSF
bug to think of in toddlers who eat pork shitterlings and has diarrhea
Tx
Yersinia Enterocolitis
Cefotax, Gent, Bactrim, doxy…
bug to think of after pork who has periorbital edema and conjunctival hemorrhage
Trichinella spiralis = tissue nematode
drug to use for Malassezia, Tinea Versicolor
Itraconazole
Bug to think of in intestinal obstruction, Drug?
Ascaris Lumbricoides (roundworm) Mebendazole, Albendazole, Ivermectin
Bug not killed by chlorine in swimming pools, causes diarrhea
Drug to tx with?
Cryptosporidium
Nitazoxanide
school of fish / painful ulcer
Bug and Drug
H. Ducreyii
CTX, Azithro, or Emycin
Dose to treat Trichomonas with?
2g Flagyl for everyone
2 bugs that can cause PNA and splenomegaly
Chlamydia psittaci or Coxiella Burnetti (Q fever: Doxy)
Urine Na if dehydrated?
<10
Hypocalcemia EKG change
Long QT
Low magnesium EKG change
Long QT or Long PR
The bad nephrotic (if not steroid responsive minimal change)
Focal segmental glomerulosclerosis
BAD Nephritic / Nephrotic syndrome and low complement that requires biopsy and NO steroids.
Membranoproliferative GN
Protein/Creatinine ratio indicative of renal disease
> 0.2
In post strep GN, Complement C3 normalizes when?
w/in 2 mos
EKG Axis with
I up
II up
avF up
NORMAL
EKG Axis with
I up
II and AVF down
LAD
EKG Axis with
I down
II and AVF up
RAD
serum iron level that is okay vs very bad
< 50 ok
>350 bad
Define cliteromegaly? Indicates what?
> 3mm
Exposure to strong androgen (tumor, CAH?)
Drug for methanol or ethylene glycol tox?
Fomepizole
newborn / TPN kid with scaly dermatitis, alopecia, TCP
Lineolic acid def (essential FA)
Quick fluid replace: 20kg?
1500 cc/d
vitamin def in hemolytic anemia, edema, elevated platelets, weakness
Vit E def
Vit def with anemia, angular stomatitis, seborrheic dermatitis
Riboflavin B2
Normal weight gain for term and preterm babies
Term 20-30g/day
Preterm 15-20g/day
Newborn / TPN kid with neutropenia, metaphyseal irregularity, irritability, poor feeding?
Copper def
The thing mature breast milk doesn’t have much of compared to colostrum and formula?
protein
prepubertal testes vs mature stage 5 testes?
< 4cc / < 2.5
20cc after puberty
Drug with both sympathomimetic and cholinergic (flushing, diaphoresis) effects?
Pupils?
PCP, pupils probably actually small!
Mechanisms in Scarlet fever vs ARF?
Scarlet fever: Toxin
ARF: Immune complex
Dairy farm bug gram neg coccobacilli and treatment
brucellosis
LONG tx with Doxy or BActrim AND Rifampin
GAS throat infx if PCN Allergic?
Clinda or Emycin
Drug for aspergillus?
Ampho B or Vorixonazole
Drug needed for CMV retinitis?
Foscarnet
s/e of Pyraxinamide
hyperuricemia
s/e of Ethambutol
optic neuritis
When do babies fixate?
6 wks
Level to chelate for lead?
> 45
LAb predictor of Uveitis in JIA?
ANA
Surgery for scoliosis
Surgery for kyphosis?
scoliosis > 40-45
Kyphosis > 60
baby that squeals and laughs, imitates socially
4 mos
baby with peek a boo games?
9 mos
3 block tower
15-18 mos
overhand throw
2y
alternates feet walking up stairs with railing
30 mos
8 cube tower
30-36 mos
down stairs alternating feet and railing
5y
NAS score requiring morphine
8+
antidote for anticholinergic OD
physostigmine
Antidote for OP or muscarinic SLUDGE poisoning
Atropine, may also need pralidoxime for the nicotinic stuff
Stimulant + hallucination effect
LSD
amt of kids who have 2nd febrile seizure?
More than 2?
1/3 have 2
<10% have more than that
Treatment for shigella
BActrim, Azithro if young
Cipro ok for older kids
septic joint w/ no growth on culture
bug and drug
Kingella, CTX
terrible aches, fever, LFTs, TCP
Dx?
Dengue “breakbone” fever
IF you really think EBV or GAS throat, but negative cultures
Bug and Drug?
Arcanobacterium hemolyticum, Emycin is tx
Malaria tx
primaquine
Test if you suspect CVID?
Ig levels (normal B and T cells, but low Ig levels)
PCP without HIV, think what?
Hyper IgM: X linked, CD 40 ligand absence
Tx for CGD
Interferon Gamma
recurrent staph, large granules on WBC, partial albinism, peripheral neuropathy
Chediak Higashi
What is elevated in ataxia telangiectasia
AFP
Retinoblastoma has increased risk of what future cancers?
osteosarcoma, melanoma, sarcoma
Chest mass tumors?
Hodgkins, Neuroblastoma
HbA1c indicative of DM?
> 5.7 predm
DM > 6.5
chronic thrush, hyper PTH, Addison, Gonadal failure, Vitiligo, hepatitis, pernicious anemia, IDDM
Dx?
Type 1 autoimmune polyendocrinopathy
Describe Type 2 polyendocrinopathy?
More classic female DM1 w/ incr risk of Addison, hypothyroidism, and HLA D3 and D4
color blind, hearing issues, clefts, no puberty, anosmia
Kallman hypogonadotropic hypogonadism
Drug to use in hyperthyroid
Methimazole
avulsion with separation of proximal patellar tendon from bony insertion overuse
What is this and what do you see on exam?
osgood schlatter: tibial tuberosity swelling
tennis elbow vs little league elbow
tennis: lateral epidondylitis
pitching: medial apophysitis
level of aortic stenosis gradient that is mild, moderate?
Restrictions?
mild < 25
moderate 25-50 - no wt lifting
Maintenance fluids per day rule
100,50,20
magic number of tylenol ingestion for badness in od?
> 150 mg/kg
seems like pancreatic exocrine insuff like in CF, but not CF, also infections and skeletal anomalies?
Schwachman Diamond syndrome
The bug that comes through contaminated water or slaughter house through skin / mucus membranes and causes liver disease. How do you treat?
Leptospirosis: PCN G
immune levels in Ataxia telangiectasia
Low IgE, No IgA
CHARGE:
Coloboma Heart Choanal Atresia Retarded growth (Charge them) GU anomalies Ear anomalies
VACTERL
Vertebral Anal Atresia Cardiac (VSD) TEF Radial hypoplasia / Renal Limb *Single umbi artery *Normal IQ
CATCH-22
Cardiac (Ao arch) Absent THymus T cell defects Clefts Hypocalcemia
Angelman syndrome
-what id duplicated and what is lost / imprinted
Paternal 15q11 present
Maternal imprinted / deleted
normal baby weight gain per day?
remember 20g/day
premies 15-20, term 20-30
vitamin def with metaphyseal/bone issue, neutropenia, poor feeding, irritability
copper
intoxication causing sympathomimetic and cholinergic effects?
(incr HR, BP, but also flushing, diaphoresis, miosis)
PCP
ABx for Hflu
CTX
weird bug from dairy farm that needs prolonged Abx w/ Doxy and Bactrim + Rifampin
Brucellosis
surgery for scoliosis
surgery for kyphosis
scoliosis >45
kyphosis > 60
Bald,
itchy rash, neurologic / MS deficits / ataxia
Biotin deficiency
Infections and LOTS of neutrophils
Dx and tx?
CGD, IFN gamma
Risk of PCP without HIV
Hyper IgM
nephrotic syndrome and calcium?
low (low alb, so low bound Ca)
The bad renal syndrome with low C3
membranoproliferative glomerulonephritis
Best estimate of serum osms?
2Na + 10
Single S2 - two cardiac CHDs, and difference
TOF: incr pulm vasc
TGA: decr pulm vasc
Egg shaped heart
CHD
TGA
Prophylaxis for congenital Toxo
Spiramycin for mom
Treatment of congenital toxoplasmosis
Pyrimethamine
Sulfadiazine
Folinic Acid
petechiae, HSM, jaundice in newborn
CMV
normal birthweight
2500-3900g
above or below is SGA / LGA
think of this in baby newborn who looks like a BPD/CLD kid with cystic lungs, but no neonatal hx to suggest it?
Wilson Mikity syndrome
hypoglycemia in baby tx
3mL/kg of D10 (100mg/ml)
CXR in RDS
air bronchograms, ground glass appearance, decreased lung volume
Mec aspiration CXR
large lung volumes- hyperinflation, patchy atelectasis, hazy opacifications
CXR showing no air bronchograms, perihilar haziness, good lung volumes, fluid in fissures
TTN
The endocrine thing with calcified basal ganglia
Pseudohypoparathyroidism with high PTH but low Ca, moon face, and calcified BG due to maternal imprinting hereditary osteodystrophy
radioactive uptake in Graves vs Hashimoto vs subacute thyroiditis
high in Graves, low in Hashimoto and subacute thyroiditis
parotid swelling, dry mouth, no tears
Dx
Mikulicz disease
Abx for Shigella
Bactrim
Abx for Campylobacter?
Erythromycin, Azithromycin
Acid vs Base ingestion and type of necrosis and area of most damage
ACid: CoAgulation - stomACh (Acid / stomach)
ALkali: Liquefaction: esophagus
water park bug not killed by chlorine
tx
cryptococcus
Tx nitazoxanide
diarrhea, liver and brain abscesses.
Entamoeba Histolytica
5 drugs for pseudomonas coverage
Ceftaz, Cefepime, Gent, Tobra, Zosyn
Bugs and tx for spontaneous peritonitis
Strep pneumo
3rd gen ceph + gent
possible treatment for urea cycle disorder vs organic acid disorder
urea: Arginine
Organic Acid: Biotin
acroparesthesia in what disease, transmission, enzyme
Fabry - x linked dom
alpha galactosidase A
metabolic d/o that looks like CP, ID, with icythosis
Sjogren Larsson syndrome
sweaty feet metabolic disorder, tx
isovaleric Acidemis (protein restrict)
metabolic disorder causing leukodystrophy
Krabbe
drug needed in MSUD
thiamine
+ reducing substances in urine, hepatomegaly, hypoglycemia
galactossemia
cbc s/e in macrolides
neutropenia
nmyc and age prognosis in Neuroblastoma
<1 good
nmyc bad
ALL age that is good
> 2y
cancer risk after neuroblastoma, and where doesn’t it met to?
osteosarcoma,
NB doesn’t go to lung
Hb with two alpha and two delta is what in what disease
HBA2 in beta thal
Fanconi anemia vs Schwachman Diamond
- age
- platelet issue
*both incr risk of what?
AML in both
Fanconi is in toddlers, has renal issues, and LOW PLTS
DS is in babies, normal plts, but exocrine pancreas probs
TEC vs Diamond Blackfan anemia
- age
- in TEC? retic / MCV
TEC in 1-4 year old, no retic (stopped production), nl MCV
DB in infant w/ no precursors in marrow
tumor lysis syndrome and calcium?
low calcium (all other things are high)
Reed Sternberg Cells in what Ca?
Hodgkins
Wiskott Aldrich IG levels?
Hi IgA, low IgM
think of this in bleeding from umbi stump
Factor 13 def (Unlucky Umbi)
Think of this in incidental long aPTT and clotting
Factor 12 def
hemolytic anemia with high MCHC but normal osmol fragility test and increased exercise tolerance?
pyruvate kinase def
Factor not made in liver (when looking at liver failure vs DIC)
Factor VIII
s/e of chemo with clots and pancreatitis
Aspariginase
ETT size rule
[Age / 4] + 4
ETT depth rule
[Age/2] + 12
normal baby sized tube uncuffed, and normal depth
term: 3.5 uncuffed (3 cuffed)
Depth x 3 = 10ish
antidote for methanol or ethylene glycol tox
Fomepizole
OP sludge antidotes
pralidoxime (nicotinic) / Atropine (musc)
Anticholinergic antidote (MAD HOT)
physostigmine
transient vs congenital MG in neonate
transient doesn’t involve eyes
The wormy that comes from pork and causes fever, myalgia, periorbital edema, red eyes/conjunctival injection/hemorrhage
Trichinosis
birth weight rule at 3 time points
BW 3500g
doubles 5 mos
triples 1 yr
quadruples 2y
length rule at 3 age marks
50cm
incr 50% at 1 yr
doubles 4 yrs
triples 13 yrs