OME Peds (some UWorld) Flashcards
if infant is having vomiting, besides GI etiology what differential must you always keep in mind?
head trauma
baby with bilious vomiting, history of polyhydramnios in utero.
xray shows double bubble and no distal air.
dx? tx?
duodenal atresia
surgical repair needed
(could actually be annular pancreas)
annular pancreas will show double bubble on xray. it’s associated with Down’s and presents as bilious vomiting in a newborn, like duodenal atresia. will there be distal air? what is treatment?
+/- distal air actually. trick question hoho.
tx is surgical.
this presents very similar to duodenal atresia. sometimes you don’t know until you go into surgery
mom had no problems in pregnancy. no polyhydramnios. negative Down screening. but newborn has biliary emesis. xray looks normal! (or has double bubble sign). what do you suspect? what are you worried about
what 2 studies can confirm dx? and what is treatment?
malrotation leading to volvulus -> obstruction and ischemia
upper GI series will show abrupt cutoff.
contrast enema can show abnormal positioning of cecum
fix with surgery
newborn with biliary emesis. mom couldve had polyhydramnios or not. xray shows double bubble and multiple air fluid levels. what is dx and etiology? and tx?
vascular accident (can be from cocaine or tobacco use) -> vasoconstriction all over -> multiple points of atresia -> multiple air fluid levels. = intestinal atresia
tx: surgery. and tell mom to stop drugs.
what’s the other physical exam finding besides olive shaped mass that’s classic for pyloric stenosis?
visible peristaltic waves
first step in management for pyloric stenosis, after diagnosing with US (donut sign)
CMP -> if shows hypochloremic hypokalemic metabolic alkalosis, need to fix with IVF BEFORE SURGERY
how to diagnose Tracheoesophageal fistula?
tx?
insert NG tube and take an xray. if NG tube is coiled and stuck proximally = positive
tx: after diagnosing, you leave the NG tube. for decompression. and start parenteral nutrition. and they will need surgery.
what to do for bowel obstruction while waiting for surgery
IVF
NPO
NG tube for decompression
mass in distal ileum -> intussessception + massive ascites, not super acute onset but pretty fast progression. what is it?
Burkitt lymphoma as a small bowel lymphoma. rapidly growing B cell tumor
kid has measles. (four C’s: cough, coryza, conjunctivitis, Coplik spots) -> later on gets brain problems and encephalitis. what is it?
subacute sclerosing panencephalitis.
it’s a sequelae of measles. potentially lethal.
3 signs/sx of a SCD patient in acute crisis
treat with IVF, O2, and IV Pain control. and don’t forget to look for and treat possible infection
- patient is in pain
- reticulocytes/bili/Hgb are even higher than normal high for a SCD patient
- sickled cells on smear
3 situations that indicate exchange transfusion in an SCD patient (what they are and how they present)
- acute chest - noncardiogenic pulmonary edema
- priapism from cell sickling in penile arteries
- stroke - focal neuro deficits
kid has seizures. on physical exam you see ash leaf spots with Wood’s lap and angiofibromas on the face. what do you suspect? what is next step?
neuroimaging (MRI or CT)
suspect tuberous sclerosis
sunburst/onion skinning pattern on xray at metaphysis/epiphysis of femur = what?
osteogenic sarcoma (btw it’s associated with retinoblastoma)
onion skinning pattern on xray at diaphysis(midshaft) of femur = what?
Ewing sarcoma
t(11;22) translocation
what orthopedic condition in kids requires frog leg position xray to confirm dx, + surgery to correct? who gets this?
slipped capital femoral epiphysis
orthopedic emergency.
adolescents who are either obese or in a growth spurt (mercy if you’re both) with sudden onset hip pain
you suspect septic hip in a kid. what do you order to confirm dx and what’s first step in management?
xray
arthrocentesis (joint aspiration) with Gram stain and culture -> dx and drain
treatment for septic hip???????
supportive! not arthrocentesis like septic hip which looks similar but does not have elevated inflammatory markers
hip dysplasia in newborns. you suspect bc of barlow and ortolani test. what do you order to confirm the dx? what is treatment?
ultrasound at 4-6 weeks (when physiologic hip laxicity should’ve resolved)
tx: harness
6 year old, insidious onset of knee pain + antalgic gait. what do you suspect? how to dx and treat?
peaks at 6 yrs old
avascular necrosis -> Legg Calve perthe Dz
dx by xray -> tx by cast
which immunodeficiency has delayed separation of the cord and no pus (despite toxic infection)?
leukocyte adhesion deficiency (neutrophils can’t get out of blood vessels)
kid has albinism + neuropathy + neutropenia. you see “GIANT GRANULES IN NEUTROPHILS” what is dx?
Chediak Higashi syndrome. autosomal recessive. due to defect in lysosomal trafficking protein/indiscriminate lysosomal fusion
treatment for hereditary angioedema
fresh frozen plasma
sunburst pattern on xray at metaphysis (distal femur, proximal tibia, proximal humerus) + Codman triangle elevation (look up a picture) = what?
+ elevated ESR, ALP, and LDH
osteosarcoma
the 4 diseases/complications of premature neonates
high flow O2 supplement -> retinopathy of prematurity
intraventricular hemorrhage
bronchopulmonary dyspalsia
Necrotizing enterocolitis
in autoimmune hemolytic anemia, what kinds of RBCs would you see on blood smear?
spherocytes
kid has prodrome of vomiting/diarrhea and abdominal pain. a week later he gets petechia, high BUN and Cr and total bilirubin, and you see schistocytes on blood smear. dx and tx?
dx: HUS. from E coli shiga like toxin
tx: fluids, blood transfusion, dialysis (AKI, which is why BUN and Cr are elevated)
3 top pathogens for URI/acute otitis media? for <2 yrs old. and respiratory tract for all kids
- strep pneumoniae
- non typeable H. influenzae
- Moraxella catarrhalis
what is dx and tx for croup? (seal cough + inspiratory stridor + steeple sign/subglottic narrowing on xray)
tx is racemic epinephrine and steroids (dexamethasone) and O2 if they need it, and if patient improves with that there’s your dx
AP film shows thumb print sign in neck/throat
epiglottitis
altho. this is probs useless. bc you actually dx when you intubate the kid and you see the swollen epiglottitis
age range of croup, epiglottitis, bacterial tracheitis
croup 6 months-3yrs
epiglottitis 6-12 yrs
bacterial tracheitis 5-7 yrs
what looks like croup but kid is a little sicker b/c it’s bacterial and doesn’t improve with racemic epinephrine? how to dx and treat?
bacterial tracheitis
dx: tracheal culture + visualize purulence
tx: abx (Staph, GAS, anaerobes, strep pneumo, moraxella, Hib)
kid has drooling and fever + STIFF NECK + muffled voice + UNILATERAL CERVICAL LYMPHADENOPATHY. what do you suspect and what is what is next steps?
retropharyngeal abscess. xray will show increased space anterior to vertebrae (prevertebral space). -> order a CT scan to dx.
+ abx (anaerobes, GAS, Staph) + consult surgery
displaced uvula to one side/uvular deviation
next step?
abx (anaerobes, GAS, Staph) + I and D if needed.
no imaging required! clinical dx! (deviated uvula)
infant pneumonia or sepsis 4 most likely pathogens
- GBS
- E. coli
- Listeria
- HSV
pneumonia xray, could be strep pneumo or mycoplasma. which has lobar pattern and which as diffuse pattern? (besides the fact that mycoplasma is usually atypical pneumonia so clinically they’ll look a lot better)
strep pneumoniae - lobar
mycoplasma - diffuse
fever + tachypnea in baby = _______ until proven otherwise
pneumonia. must get CXR
leukocytosis + cough = _________until proven otherwise. what do you give them?
pertussis. give macrolides
what 3 main pathogens does macrolides cover?
pertussis, mycoplasma, chlamydia
what 2 main pathogens does ampicillin cover?
listeria
enterococcus
Cystic Fibrosis clinical triad for kids presentation
- recurrent sinopulm infections
- steatorrhea (pancreatic insufficiency)
- FTT
intussussception clinical triad for kids presentation
- currant jelly stools
- sausage shaped mass on palpation
- abdominal pain
if you suspect imperforate anus what is next step(s)?
- cross table xray on prone child with radiopaque perineal markings (to determine how close or far the colon ends from the anus, will determine how you manage/fix)
- need towork up for VACTERL (sacral US and xray, VCUG, NG tube passage with xray for TEF, and Echo)
NEED TO DO BEFORE SURGERY bc need tracheal and cardiac clearance for anesthesia
why do you see a microcolon on contrast enema for CF/failure to pass meconium as opposed to dilated colon for Hirschsprung?
bc meconium gets trapped in ileum for CF and so colon isnt even used so it’s small.
whereas Hirschsprung it doesn’t get stuck till end of colon wherever ganglion cell stop.
what does VACTERL stand for?
Vertebral anomalies (butterfly vertebrae, etc) Anal atresia/imperforate anus Cardiac TE fistula, Esophageal atresia Renal, radial limb Limb
complication of meconium ileus that is an emergency
perforation -> meconium peritonitis
for severe cases of Hirschsprungs and imperforate anus, what surgical thing may be required?
colostomy. sad.
name the metabolic abnormalities that can cause conspitation (2 highs, 2 lows, 2 deficiencies/inadequate hormones)
2 highs: hypercalcemia, hypermagnesemia
2 lows: hypoglycemia, hypokalemia
2 hormonal: hypothyroidism, adrenal insufficiency
7 main possible causes of bilious emesis in a newborn
- imperforate anus/anal atresia
- FTPM
- Hirschsprung
- duodenal atresia
- annular pancreas
- malrotation -> volvulus
- intestinal atresia
what is treatment for NEC? + possible later complication from treatment?
- NPO, TPN, IV abx
2. may need surgery to resect if bad enough or worsening -> can lead to short gut syndrome later on
studies to do if you suspect intussusception (currant jelly stools, abrupt onset colicky abdominal pain relieved by knee-chest positioning, sausage shaped mass on palpation)
ultrasound to dx (target sign), or go straight to air-contrast barium enema which is both diagnostic and therapeutic (will need surgery if enema doesn’t fix it)
age that meckels often presents at
around 2 yrs old. note that this is also when intussusception happens, bc of the Meckel’s
IBD presents as weight loss + persistent bloody diarrhea lasting > _____weeks, in people ________ yr olds, and incidence peaking again at 50-80yr old. how to dx (2 ways)?
> 6 weeks
10-20 yr olds
dx by colonoscopy OR double contrast enema
how to treat infectious colitis (bloody diarrhea + fever, positive stool culture)
primarily supportive! hydration + electrolyte management.
don’t treat with antibiotics unless it’s Shigella or pt is immunosuppressed
6 month old with bloody diarrhea, otherwise doing well (+/- FTT, +/-rash). what is dx and how to treat?
milk protein allergy
switch to hydrolyzed formula. usually they grow out of it by 2-3 yrs old
what test tells you if blood in baby’s stool is baby’s blood or mother’s blood? (if mother’s blood then you know baby just swallowed mothers blood and is pooping it out it’s not a true GI bleed)
Apt test = alkali denaturation test.
fetal blood is resistant to denaturation = positive test
if mothers blood its swallowed not true gi bleed no further workup needed
non true GI bleed causes for “blood in stool”
- swallowed blood (newborn swallows maternal blood during birth, kids having bloody noses)
- iron pills (makes stool look like melena but it’s just the iron)
newborn assessment. only 1 umbilical artery instead of 2! what study do you need to do for workup
renal ultrasound. it’s associated w/ ipsilateral renal agenesis
risk factors for transient tachypnea of the newborn (TTN)
C section (fluid can't get pushed out like in vaginal birth) diabetic mother
what do you see on chest xray for TTN vs RDS in newborn?
TTN - wet and hyperexpanded chest
RDS- uniform granular pattern, underexpanded chest
TTN vs RDS pathophys
TTN - delayed clearance of fetal lung fluid. risk factors is C section or super fast vaginal birth and diabetic mother.
RDS - prematurity, surfactant deficiency -> atelectasis
what is hypoglycemia defined as in a newborn (value cutoff). what is immediate tx?
blood glucose <40-45
tx: give 2ml/kg of D10W bolus and recheck
swimmer’s ear otitis externa is most commonly caused by _____which pathogen?
vs otitis media caused by repeated trauma or nonswimmers caused by _________
swimmer’s ear = pseudomonas
nonswimmers/trauma = staph aureus
inspiratory stridor WORSE WHEN SUPINE. pt will have history of noisy breathing. what is dx and what study to do?
laryngomalacia.
laryngoscopy
biphasic stridor that improves with neck extension. what is dx and associated anomaly?
dx: vascular ring
associated w/ cardiac defect like VSD or ToF
what study to diagnose otitits media besides clinically?
pneumatic insufflation = blow puff of air into ear. tense immobile membrane = positive test
first line tx of otitis media is amoxicillin (amox-clavulanate and tympanoplasty ear tubes if recurrent) . what if penicillin allergy? (theres one for anaphylactic allergy and one for non-anaphylactic allergy)
anaphylactic allergy to penicillin -> cephalosporin (like cefdinir)
non anaphylactic -> macrolides (azithromycin)
person has signs of acute otitis media. they also have SWELLING BEHIND EAR AND/OR ANTERIORLY ROTATED EAR. increased risk for this if they have ear tubes! what is next step(s)?
suspect mastoiditis. CT scan if unsure, otherwise prompt surgical evaluation is needed
tx for otitis externa
- most resolve spontaneously. can use topical abx and topical steroids if more symptomatic.
- only need oral abx (cover pseudomonas and staph aureus) if signs of malignant otitis externa
URI stuff (including sinusitis). if viral it’s just supportive tx, if bacterial you need abx. what differentiates between the 2?
10 or more days of symptoms, worsening, +/- higher fever = definitely bacterial
treating GAS pharyngitis with abx will prevent rheumatic fever, but PSGN can still happen. true or false?
trueee
pharyngitis + conjunctivitis = adenovirus
pharyngitis + enlarged spleen = ???
mono. get an EBV panel
how to stop anterior vs posterior nose bleeds via medical intervention
anterior - cauterized with silver nitrate
posterior - ENT needs to do packing + impiric abx
baby is blue at rest, pink up with crying. +/- snoring. you suspect choanal atresia.
what studies to do?
try to PASS CATHETER/tube. if it doesn’t pass you know it’s complete atresia
if it passes, do a FIBER-OPTIC SCOPE to identify the incomplete atresia.
tx: surgery
true or false, patients with mono can develop acute airway obstruction
trueee. treat with corticosteroids
abx:
for typical pneumonia treat with ______
atypical pneumonia (commonly mycoplasma!) treat with ________
typical - amoxicillin
atypical - macrolides. azithromycin
wheezing in asthma is relieved by B-agonists b/c it’s muscle constriction (bronchospasm). whereas in RSV the wheezing is caused by ______ so need to treat with _____
sloughing epithelial cells
