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x Pediatrics Clerkship Misc > Miscellany > Flashcards

Miscellany Flashcards

1
Q

Criteria to Dx ADHD?

A

6 or more sx in 2 or more settings

in areas of hyperactivity, impulsivity, inattention

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2
Q

Patients with renal artery stenosis will have what lab findings?

What physical symptoms?

A

Labs: elevated AtII, aldosterone (as kidneys attempt to compensate for the HYPOtension they are seeing)

Physical Sx: may be asx, may have abdominal bruits

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3
Q

Coarctation of the aorta: what s/s?

A

If severe: symptoms include chest pain, cold lower extremities, dizziness, syncope, exercise intolerance, failure to thrive, poor growth, headache, and dyspnea.

Distal to the coarctation, pulses and BP will be diminished (BP lower in LEs than in UEs).

Murmurs may also be heart on auscultation. May be associated with other congenital heart defects (bicuspid aortic valve in 50% of patients) and chromosomal abnormalities (Turner syndrome).

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4
Q

Symptoms include headache, diaphoresis, palpitations, tremor, nausea, weakness, anxiety, nervousness, irritability, and weight loss, among other symptoms. On physical examination, patients typically present with tachycardia and severely elevated blood pressure.

A

Pheochromocytoma

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5
Q

For laboratory studies, the patient will have elevated urinary VMA, urinary HVA, urinary metanephrines, and serum glucose.

A

Pheochromocytoma

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6
Q

May be associated with various syndromes, such as multiple endocrine neoplasia and Von Hippel-Lindau disease.

A

Pheo

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7
Q

Symptoms include heat intolerance, frequent bowel movements, increased appetite, diaphoresis, nervousness, restlessness, weight loss, tremor, hair loss, and palpitations, among others.

On examination, patients typically present with tachycardia, hypertension, hyperreflexia, and goiter. The patient will have elevated T3, T4, and serum glucose, and TSH may be depressed or elevated depending on the etiology.

A

Hyperthyroid

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8
Q

Why are UTIs predispose a kid to HTN and renal insufficiency?

A

Due to renal scarring post-UTI

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9
Q

How do steroids raise BP?

A

Mimic endogenous cortisol –> SYMPATHETIC fight or flight response.

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10
Q

How does NF-1 contribute to HTN?

A

NF-1 can be associated with hypertension as a result of vascular malformations that affect blood supply to the kidneys; however, this child does not present with any signs of NF-1 (café au lait macules, neurofibromas, optic gliomas, lisch nodules).

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11
Q

How do amphetamines cause HTN?

A

mimic norepinephrine, stimulating alpha and beta adrenergic receptors, causing an overall increase in blood pressure.

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12
Q

Rett’s Disorder, s/s

A

X-linked pervasive developmental disorder seen only in females; affected males die in utero or at birth.

The characteristic symptoms involve regression of language and development, mental retardation, ataxia and hand-wringing. This disorder is typically diagnosed much sooner, at about age 1-4.

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13
Q

IV Amp + Gent gives what kind of coverage?

A

Good empiric coverage

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14
Q

When is cipro used for UTIs?

A

Reserved for patients > 1 year with complications such as resistant organisms or urinary tract anomalies

(Can cause adverse reactions in young kids)

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15
Q

Benadryl: age when it is ok to start using?

A

>6months

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16
Q

Ceftriaxone is what generation?

A

3rd gen

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17
Q

Ceftriaxone covers what?

A

Excellent gram-neg coverage except for pseudomonas

Good for Pyelonephritis

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18
Q

Why would you/would you not use IV Pip + Taz for a UTI?

A

IV piperacillin + tazobactam has excellent gram negative coverage with added Pseudomonas coverage,

but it is highly expensive and Pseudomonas is unlikely to be the cause of a UTI in a child who is not regularly catheterized.

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19
Q

Kiddo with low WBC (suspicious for sepsis), UA suggestive of UTI –> before culture is back, start empiric therapy for what orgs?

What drug?

A

Common orgs: E Coli, Proteus, Klebsiella

Cefotaxime is good empiric therapy.

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20
Q

Kiddo with pyelonephritis: what is always recommended?

A

Renal ultrasound is recommended for all infants with pyelonephritis to assess for renal structural abnormalities or signs of obstructive uropathy (hydronephrosis).

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21
Q

Kiddo with recurrent UTI or abnormal renal ultrasound - what is the next study?

A

VCUG

Voiding Cystourethrogram - study of urinary reflux. Fill bladder with radiocontrast material, see if it passes past bladder. (Vesicoureteral reflux)

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22
Q

10 day old kiddo, sleepy, poor feeding, temp to 38.5, hydronephrosis - what to do generally?

A

Send CSF and UA for culture, begin parenteral abx.

Don’t mess around with young kids because they have immature immune systems

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23
Q

Measles course?

A

Prodrome with 3Cs: cough, coryza (rhinitis), conjunctivitis

Then fever >104, malaise, anorexia

Day 2-4: rash starting on face/neck, spreading downward

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24
Q

Leukocytosis with elevated bands suggests what?

A

bacterial infection.

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25
Q

Presentation of bacterial meningitis?

A
  • toxic appearing
  • bulging fontanel
  • extreme irritability
  • leukocytosis with elevated bands
  • lethargy, respiratory distress or signs of ICP

On infant, classic meningeal signs will often not be present or will be difficult to appreciate.

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26
Q

Female infant with

  • high fever, fussiness, and decreased appetite.
  • leukocytosis and elevated bands

Most likely Dx?

A

UTI.

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27
Q

Roseola presentation?

A
  • high fever
  • often with a viral prodrome
  • diagnosis of exclusion at this point and should not preclude obtaining a urine sample in this child.
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28
Q

What is a viral prodrome?

A

incubation period….

viral genomes are replicating and the host is responding, producing cytokines such as interferon that can have global effects, leading to the classical symptoms of an acute infection (e.g., fever, malaise, aches, pains, and nausea).

29
Q

Obtaining urine specimen in infants/toddlers: Is a bag catch enough? what is the next step?

A

Bag catch may be contaminated by perineal flora

For a clean catch have to catheterize.

30
Q

Ddx for wheezing?

A

Common: Asthma, viral bronchiolitis, foreign body, GERD.

Uncommon: tracheomalacia, external compression (vascular ring), Cystic Fibrosis

31
Q

5 causes of cough?

A

Viral upper respiratory tract illnesses
Pneumonia
Post-nasal drip due to allergies and/or sinusitis
Foreign body aspiration, or
GE reflux.

32
Q

fever, incr resp rate, rales, crackles - what is the dx?

what bug?

A

pneumonia

strep pneumo

33
Q

low grade temp, slight tachypnea, inflamed nasal turbinates, inflamed mucosa

what is the dx? what bug?

A

common cold

Rhinovirus

34
Q

pneumonia, epiglotittis (sx: drooling, high fever, difficulty breathing).

dx? bug?

A

epiglotittis

Haemophilus inf, Type B

35
Q

Common cold sx that then progress into coughing fits and post-tussive emesis

A

Pertussis (catarrhal phase -> paroxysmal phase)

Bug = pertussis

36
Q

Child with OM has been immuniSzed against Hep B, Rotavirus, DTap, H Inf Type B, Pneumococcus, and Polio. What is the most likely cause of her OM?

A

Strep Pneumo (50% but falling)

H Inf - untypeable - unencapsulated strains not covered by vac (30%)

Moraxella catarrhalis (15%)

Strep Pyogenes (5%)

Rhinovirus (but most likely to be bacterial, not viral)

37
Q

Sx: neurologic dysfunction

fever, headache, nausea, vomiting, photophobia, altered level of consciousness, seizures, and possibly focal neurologic signs

A

encephalitis

38
Q

Sx: clear, thin nasal secretions

“shiners”

cobblestoning of the posterior pharynx

edematous turbinates

usually not associated with fever and malodorous breath.

A

allergies

39
Q

Sx: “cold” for the past two weeks, fever of 38.7°C, purulent nasal secretions, malodorous breath, and a nocturnal cough three days ago.

A

sinusitis

40
Q

Which sinuses are large enough to harbor infection at what age?

Frontal, Maxillary, Sphenoid, Ethmoid

A

Infancy: Maxillary, Ethmoid

Sphenoid: age 3 (will not drain pus from nose)

Frontal: age 6

41
Q

Most common heritary bleeding disorder?

What is the inheritance battern?

A

vWD (1% of population)

Most common types are I and II, inherited as AD.

42
Q

gingival bleeds, menorrhagia, epistaxis - what is the dz?

A

vWD

43
Q

how to confirm a dx of vWD?

what is the treatment?

A

confirm via vWF antigen, platelet function analysis, F VIII levels

Tx = intranasal desmopressin

44
Q

breasts have no glandular tissue. no pubic hair at all. what Tanner stage?

A

Tanner I

45
Q

breast buds form and the areola begins to widen. A small amount of long, downy hair with slight pigmentation appears on the labia majora. Tanner stage?

A

Tanner II

46
Q

breast buds are elevated, no secondary mound.

pubic hair distribution extends laterally, does not extend onto the mons pubis. Tanner stage?

A

Tanner III

47
Q

breasts are increased in size and elevation. The areola and papilla form a secondary mound that projects from the contour of the rest of the breast.

pubic hair extends across the mons pubis and spares the medial thighs. Tanner stage?

A

Tanner IV

48
Q

breasts: areola returns to the contour of the surrounding breast while the central papilla remains projecting.

Pubic hair extends to the medial surface of the thighs.

Tanner stage?

A

Tanner V

49
Q

Why is Vit K given to neonates?

A

given clinically as a one-time IM dose for neonates to assist in clotting factor formation until the gut microbiome is sufficient to provide Vitamin K.

50
Q

what is in Cryoprecipitate? what is it used for?

A

blood product containing fibrinogen, factor VIII, factor XIII, and von Willebrand factor. It is most commonly used to replace fibrinogen.

51
Q

Order these events for girls:

Growth Spurt, Menarche, Breast Bud, Pubic Hair

A

Breast Buds, Pubic Hair, Growth Spurt, Menarche

52
Q

Order these events for boys:

Growth of penis, Growth of testicles, Growth spurt, first ejaculations, Pubic Hair

A

Growth of testicles, Pubic Hair, Growth of penis, first ejaculations, Growth spurt

53
Q

what needs to be done to evaluate syncope or near-syncope?

A

history, physical exam, EKG

54
Q

Facial cyanosis, aura, frothing at the mouth, tongue biting, slow recovery or postictal drowsiness and prolonged mental status changes or confusion after the event, syncope in the supine position; convulsion before LOC; warm, flushed or cyanotic skin color rather than pallor and diaphoresis

All suggest what?

A

seizure rather than syncope

55
Q

what is the difference between syncope and near-syncope?

A

near-syncope: has syncopal sx, but does not lose consciousness.

56
Q

Can cause syncopal episodes in late childhood or adolescence. Leads to arrhythmias, like ventricular fibrillation.

This condition is often associated with other abnormalities, including severe congenital sensorineural deafness

What is the condition?

A

Prolonged QT syndrome

57
Q

By what age does the Moro reflex extinguish?

A

4-5 months

58
Q

What shots do we first give at 12m?

A

Varicella, MMR, Hep A

Vaccination MmeHMorizing

59
Q

What shots do we first give at 12 years?

A

Tdap (rather than Dtap), HPV, MCV4

60
Q

Most common neoplasm of infancy? Presentation?

A

Neuroblastoma

PE: painless mass in neck, chest, abd

sx: fever, pallor, wt loss, bone pain from mets

may be asx

61
Q

Nephroblastoma: presentation?

A

PE: RUQ mass, smooth, does not cross midline

Sx: in 50% of pts, abd pain, vomiting, HTN.

Other 50%: asx

62
Q

should we use acetominophen after vaccines?

A

only if absolutely necessary - may cause a lesser response to vaccine.

63
Q

Wilms’ tumor is commonly associated with what syndrome? what are the other findings?

A

Beckwith-Wiedemann syndrome.

Genetic overgrowth syndrome: omphalocele, hemihypertrophy, hypoglycemia, large for gestational age, and other dysmorphic features.

64
Q

How might hyperparathyroid hormone show up on a skeletal survey?

A

Would look like generalized demineralization/decr bone density

(not fractures)

65
Q

what is physiological anemia?

A

After birth, Hgb lowers and reaches a nadir around 8w old

Due to short half-life of fetal RBCs. Hgb will subsequently rise with arrival of new RBCs

66
Q

TIBC?

A

total iron-binding capacity

indirectly measures transferrin

HIGH in iron-deficiency anemia (liver trying to make use of all Fe)

LOW in anemia of chronic disease (try to keep Fe away from pathogens)

67
Q

Treatment for Crohn’s disease?

A

Mild: Immunomodulators. azathioprine, 6-mercaptopurine, methotrexate, mesalamine, aminosalycilic acid

Mod - Sev: Steroid + immunomodulator, enteral nutrition, anti-TNF (infliximab, adalimumab)

68
Q

baby is noted to have a high-pitched cry, tremulousness, hypertonicity, and feeding difficulties. what drug did mom use?

A

Heroin

Cocaine not associated with withdrawal.

x Pediatrics Clerkship Misc (1 decks)

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