outpatient wks 2-4 Flashcards
1
Q
loop diuretics toxicities
A
OHHH (ototoxicity, hypokal, hypocal, hypomag)
DANG (dehy, all, nephritis, gout)
2
Q
greatest risk for bronchiolitis
A
children under 2 years of age, girls > boys
3
Q
bronchiolitis cxr
A
hyperinflation
patchy infiltrates
atelectasis
4
Q
bronchiolitis treatment
A
supportive
suctioning, bronchodilators, suppl oxygen
5
Q
scarlet fever complications
A
myocarditis
peritonsilar or retropharyngeal abscess
acute GN
rheumatic fever if no treatmetn
6
Q
treatment for croup if not admitting
A
mist inhalation/humidifier
keep child calm
hydration
7
Q
age group/season for croup
A
3month-5 year old
winter
8
Q
croup =
A
inflamm of glottis and subglottis
parainfluenza virus type 1 and 2
9
Q
therapy for moderate to severe croup
A
nebulized epinephrine
corticosteroids
10
Q
barlow
A
dislocate unstable hip
11
Q
ortolani
A
reduce dislocated hip
12
Q
PE findings of developmental dysplasia of hip after one year of age
A
trendelenburg gait
increased lumbar lordosis
leg length discrepancy
13
Q
CXR in CF
A
hyperinflation
bronchiectasis
cyst formation
flattenning of diaphragms
14
Q
GI manifestations of cystic fibrosis
A
- meconium ileus
- distal intestinal obstruction
- rectal prolapse
- duodenal ulcers
15
Q
bacteria that cause lung infections in CF
A
h flu, s auerus
pseudomonas
burkholderia cepacia
16
Q
prenatal u/s findings suscipious for CF
A
meconium peritonitis
bowel dilation
absent gallbladder
17
Q
PE for CF
A
wheezing, digital clubbing
increase AP diameter of thorax
18
Q
presenting symptoms of CF
A
meconium ileus, resp symptoms, FTT
19
Q
pulm complications of CF
A
hemoptysis, bronchiectasis, penumothorax
20
Q
fuo: localized infections to consider
A
UTI, RTI
infective endocarditis
hepatic infection or intraabd abscess
21
Q
Necator americanus infection associated symptoms
A
rash/itching at penetration site
abd pain, diarrhea
iron def anemia
22
Q
necator americaus infection treatment
A
albendazole or mebendazole
23
Q
ascaris lumbricoides infection symptoms
A
fever, cough, abd discomfort, SBO
24
Q
top 4 that cause bacterial gastroenteritis
A
salmonella
shigella
campylobacter jejuni
aeromonas
25
how does necator americanus infection occur
skin contact with contaminated feces
26
trichuris trhicura treatment
mebendazole
27
strongyloides symptoms
nonspecific GI
pulmonary - wheezing
pruritic lesions at site of entry
28
trichuris trichuria associated with
vit a def
29
strongyloides treatment
albendazole or ivermectin
30
When is protein hydrosylate-based formula indicated for infants?
malabsorption issues
| allergies to cow or soy milk
31
When is soy protein-based formula indicated for infants?
galactosemia, lactose intolerance
32
when is high medium-chain triglyceride oil indicated for infants?
tendency toward chylous ascites or chylothorax
33
When is amino acid-based formula indicated for infants?
food allergies or short bowel
34
What are some inappropriate substitutes for infant formula?
cows or goats milk, rice milk, soy milk
35
cows milk deficient in
iron, vit e, essential fatty acids
36
disorders associated with goats milk
- allergies
- low folate and iron
megaloblastic anemia
37
disorder from soy milk fed infants
l-thyroxine depletion
| increased requirement for iodine --> goiter
38
atopic dermatitis =
eczema
chronic inflamm skin disease
unknown etiology
pruritis, scaling, crusting, lichenification of skin
39
eczema complications
scarring, lichenification
2 bacterial infections from scratching
eczema herpeticum - HSV superinfection
40
gilbert syndrome - what drugs may be toxic
acetaminophen
tolbutamide
irinotecan
41
eczema PE
erythematous dry scaly crusted lesions on face and flexural creases
42
eczema treatment
topical steroids
| petrolatum
43
eczema immunomodulators
tacrolimus and pimecrolium - topical
44
medicine used in psoriasis when ocular lesions are present
topical corticosteroids
45
treatment of mild to moderate psoriasis
topical corticosteroids
topical retinoids, vit d
anthralin
46
What complication results from decreased sensitivity due to stretching of the rectal wall?
encopresis
47
psoriasis complications
secondary bacterial infections
psoriatric arthritis
chronic conjunctivitis
blepharitis
48
mod to severe psoriasis treatment
phototherpay
mtx
cyclopsporine
49
psoriasis other symptoms
joint pain, swelling
pruritis
conjuctivitis, conjunctiva dryness, blepharitis
50
peak incidence of constipation
2-4 yr
51
breath holding spells - age
6months-6yers
52
treatment of dermatophyte infections
topical antifungal for weeks
oral antifungal if resistant
oral griseofulvin or terbinafine
53
tinea versicolor treatment
topical ketoconazole
topical selenium sulfide
oral itraconazole
54
dermatophyte/ringworm lesions
pruritic, erythematous, scaly, central clearing
55
intertrigo treatment
topical antifungal
| topical corticosteroids
56
breat holding spell prognosis
good, remit by 4 years
57
how long does roseola rash last
1-2 days (short as 2-4 hrs)
58
lab testing in roseola
unnecessary
| would find neutropenia, lymphocytosis
59
RTA metabolic abnormality
non anion gap
hyperchloremic
metabolic acidosis
alkaline urine
60
clinical features during febrile phase of roseola infantum
LAD, red TM
uvulopalatogloassal junctional macules or ulcers -- Nagayma spots
irriability, anorexica
61
what is mineralocorticoid def RTA
aldosterone def -- hyperkalemia, low urinary pH
62
RTA is...
decrease in urinary excretion of H
| acidification of renal tubules
63
when does roseola occur
7-13mo, before age of 2
64
presenting features of RTA
polyuria/dehydration
vomiting/constipation
hypotonia/FTT
65
what is distal RTA
inability to secrete H into DT and CD
can't generate bicarb
high urinary pH
66
roseola rash progression
blanching, maculopapular
| neck and trunk, spreads to extremities
67
roseola is
sixth disease
3-5d fever, can exceed 104
resolves, rash follows
68
proximal RTA treatment
sodium restriction increases sodium reabsorption
| bicarb follows sodium into urine
69
roseola complications
febrile seizures
aseptic meningitis, encephalitis
thrombocytopenic purpura
70
proximal RTA
lack of bicarb reabsorp
| hypokalemia due to increase na delivery
71
first line for diaper rash
ointments: zinc oxide, petroleum
72
treatment of severe diaper rash
topical corticosteroids
73
distal DTA treatment
sodium bicarb
| phosphate salts
74
RTA that causes kidney stones
distal
| nephrocalcinosis due to increased calcium and phosphate excretion into alkaline urine
75
oral agents for Criggler-Najjar
calcium phos
cholestryamine
agar
76
vancomycin & sepsis
suspicion for s aureus infection (skin, soft tissue) or IV catheter-realted infection
77
antibiotic in concern for GI infection causing sepsis
clindamycin
78
antibiotic for sepsis and meningitis
cefotaxime
79
size of jejunum
first 100-150cm is where absorption occurs
| no signs of malabsorption unless less than 100cm remain
80
duodenum
iron
81
jejunum
carbs, proteins, vitamins, fat
82
ileum
bile acids, b12
83
short bowel syndrome additional management
hydraction
antibiotic therapy to prevent bacterial overgrowth at ileocecal valve
h2 or PPI
84
complications of short bowel syndrome
sepsis, liver failure
85
prognosis of short boewl syndrome
childs SI is 250cm vs 750cm
| time to grow
86
what causes laryngomalacia
hypotonia of supporting structures of larynx
redudant soft tissue in supraglottis
underlying neuromuscular disorder
87
what is laryngomalacia
collapse of supraglottic structures during inspiration
88
orthopedia manifestations of osteogenesis imperfecta
joint hypermobility
short stature
scoliosis
89
inital symptoms of congenital syphilis
rhinorrhea, hsm, jaundice
lesions on palms or soles
hemolytic anemia, thrombocytopenia
90
osteogensis imperfecta 5 treatments
bracing, decrease activity
bisphosphonates, GH
surigcla correction
91
symptoms of congenital toxoplasmosis (triad vs real life)
chorioretinitis
hydrocephalus
intracranial calcifications
- learning and visual dificulties
92
congenital CMV symptoms
microcephaly, MR, deafness, intracranial calcifications, seizures
93
symptoms of congenital syphilis - immediate
rhinitis, hemolytic anemia, thrombocytopenia, rash on palms and feet
94
symptoms of congenital syphilis - long term
intersitial keratitis, saber shins, frontal bossing, deaf
95
testing for rubella
igm antibodies against rubella
96
symptoms of congenital herpes
disseminated - rash, encephalitis, resp and liver failure
cns - seizures, poor feeding
skin-eyes-mouth
97
congenital rubella symptoms
PDA
cataracts
sensorineural deafness
98
testing for maternal toxo
prenatal ultrasound
| PCR of amniotic fluid
99
congenitl toxo treatment
pyrimethamine, sulfadiazine, leucovorin
100
pathophys of allerigic rhinitis
ige mediated mast cell degranulation (type 1 hypersensitivity)
101
outpatient typical pneumonia
amox or amox-clauv
| cefindir
102
inpatient typical pneumonia
ceftoaxmine
cefriaxone
pen + amp
103
outpatient atypical pneumonia
azithro or doxy
104
Complications of pediatric pneumonia
pleural effusion, empyema, pneumatocell, abscess
necrotizing pneumonia
hyponatremia
105
diseases associated with increased risk of pneumonia
heart, CF, sickle cell
premature birth
immunodef, neurmomuscular
106
afebrile pneumonia caused by
chlamydria
| 2 weeks - 2-3 months
107
inpatient atypical treatment
azithro or levofloxacin
108
pneumonia from chlamydia
staccato caugh
| conjunctivitis
109
pneumonia from clamydia findings
intersitial infiltrates
| eosinophilia
110
most frequent complication of peds pneumonia
pleural effusion, pleurocentesis
111
acquired risk factors for pneumonia
low socioeconomic status
cig smoke
alcohol use
acquired immunodef
112
viral pneumonia causes age 1m-5y
RSV, flu a & b, parainfluenza, adenovirus
113
iga def =
failure of differentiation in terminal iga positive b cells
114
iga def increased risk of
GI and resp infections
115
presentation of iga def
sinopulmonary infections, gi tract infections, atopic disorders
116
iga a def associated atopic disorders
allergies, asthma, dermatitis
117
autoantibodies associated wtih iga def
ant-iga in form of igg or ige
118
before IVIG, check for
iga def
| anti-iga ige antibodies
119
varicella and pregnant women
immunity status checked
| immune globulin given if contracted while pregnant
120
when does varicella rash begin
24-72 hrs after symptoms present
121
course of varicella lesions
develop for up to week, resolve a few days later
| infectious until lesions crust over
122
febrile seizure treatment
more than 5 min, IV benzo
| antipyretic
123
febrile seizure presentation
tonic clonic seizure less than 15 min
124
chickenpox treatment
antipruritics - antihistamines, corticosteroids
| if severe, acyclovir, varicella ig
125
varicella complications
pneumonia/severe course in older or pregnant pts
126
febrile seizure typical age
3months-5years
127
What changes can be seen on hepatic pathology in a patient with Reye’s syndrome?
microvesicular fatty changes
| AST, ALT or ammonia 3x normal
128
What finding in the CSF can suggest Reye syndrome in a child with altered mental status rather than infectious encephalopathy or meningitis?
less than 8 leukocytes
129
escribe the symptoms associated with the early stage of Reye syndrome.
vomiting
| if les than 2, diarrhea, resp distress
130
What is the age of peak onset for Reye syndrome?
2-6 (always less tahn 5)
131
treatment of reye
supportive
mannitol, hyperventilate, glycerol
interferon alpha experimentally
132
reye syndrome late stage
lethargy, coma, seizures
133
pathophys of x linked agammaglobulinemia
low/absent mature b cells and plasma cells
134
x linked agammaglobulinemia labs
no b cells in peripheral smear
| low total ig levels
135
transient synovitiis =
reactive arthritis
136
ewing =
small, round, blue cell tumor
137
surgery for club foot
release contractures
138
food allergy testing if too sensitive for skin pricking
```
radioallergosorbent tests (RASTs)
fluorescent enzyme immunoassay tests (FEIA)
```
139
hypersensitivity food reactions symptoms
urticaria and angioedema
140
vaccines to avoid if egg allergy
yellow fever
rabies
influenza
141
food allergies develops
1st or 2nd year of life
142
breast feeding reduces
OM in infant
| breast and ovarian cancer in mom
143
sickle cell trait, most often side effect
painless hematuria
144
minimal change disease
no hematuria
| treat with corticosteroids
145
neonatal tetanus
umbilical stump infection
146
genome of rubella virus
+ ssRNA togavirus
147
what causes birth defects associated with congenital rubella syndrome
damage to blood vessels, resulting organ ischemia
148
rubella transmission
resp droplets or transplacental
| contagious 1 week before rash to 1 week after
149
typical presentation of rubella!!
1) prodrome: malaise, low grade fever
2) maculopapular rash
Also: non-exudative conjunctivitis, forschheimer spots, cervical LAD, coryza
150
forschheimer spots
patchy erythema on soft palate
151
rubella incubation period
14-18d
152
ages for MMR
12-18months
| booster at 4-6years
153
rubella time of year
winter and spring
154
serious complications of rubella
thrombocytopenia
| progressive panencephalitis
155
rubella pattern of rash!!
starts on face, progresses down to extremities
156
duration of rubella rash
3d
157
only host for rubella
humans
158
rubella in adolescent females
polyarthritis
159
kawasaki disease etiology
immun/infec/genetic = unknown
160
What is the role of angiography in the diagnosis of Kawasaki disease?
detecting coronary vessel irregularities
161
What is Kawasaki’s disease?
necrotizing vasculitis affecting small, medium and large sized vessels
162
What immune-modulating therapies are considered second-line in the treatment of Kawasaki disease?
TNF-inhibitiors
| glucocorticoids
163
first line treatment for Kawasaki disease
IVIG
| aspirin
164
Kawasaki - "burn"
fever for at least 5 d
165
Kawasaki - "steam"
sterile pyruia
thrombocytosis
elevated esr and / or crp
aseptic menigitis
166
Kawasaki lab findings
crp, esr
leukocytosis with left shift
thrombocytosis
167
kawasaki - "crash"
```
conjuncitvitis
rash
adenopathy (cervical)
strawberry tongue or other oral cavity findings
hand and foot erythema, edema or desquam
```
168
aspirin in Kawasaki
antiinflamm
| antiplatelete
169
Kawasaki role of echo
detect coronary artery aneurysm
170
kawasaki diagnosis
fever for 5 days and 4/5 crash
171
pathophys of chronic granulomatous disease
defect in NAPDH oxidase enzyme complex
| can't generate oxidative burst
172
what is chronic granulomatous disease
immunodef where neutrophils cannot digest engulfed bacteria
173
presentation of chronic granulomatous disease
first 2 years of life
| recurrent pyodermas
174
inflamm conditions associated with chronic granulomatous disease
granulomatous colitis
| obstructive granulomas in GI or GU tract
175
infections associated with chronic granulomatous disease
recurrent bacterial and fungal
176
usual inheritance of chronic granulomatous disease
x linked recessive, males
177
systemic findings associated with chronic granulomatous disease!!
HSM, osteomyelitis
recurrent pneumonias with abscesses and granulomas
GI - perianal abscesses, oral ulceration
chronic LAD
178
chronic granulomatous disease lab testing
nitroblue tetrazolium test (doesn't turn blue since neutrophils dont work)
179
role of genetic testing in chronic granulomatous disease
detect specific mutations
180
management of chronic granulomatous disease!!
lifelong prophylatctic antiiotics
gamma interferon
corticosteroids
bone marrow transplant
181
Osgood-Schlatter disease physical exam how to provoke pain
extend knee against resistance
182
Osgood-Schlatter disease who is most commonly affected
9-14 yr who have undergone a growth spurt
| active in sports
183
Osgood-Schlatter disease PE findings
enlarged tibial tubercle
| TTP over tibial tubercle
184
Osgood-Schlatter disease xray
rule out other conidtions
| irregularity and fragmentation of tibial tubercle
185
Osgood-Schlatter disease cause
overuse (repetitive strain and avulsion) of secondary ossification center of tibial tubercle
186
Osgood-Schlatter disease presentation
anterior knee pain that gradually increases
187
Osgood-Schlatter disease complications
quadriceps wasting due to cast immbolization
188
what is Osgood-Schlatter disease
apophysitis of proximal tibial tubercle
189
how to exacerbate pain of Osgood-Schlatter disease
have pt kneell
190
bilateral Osgood-Schlatter disease
25-50%
191
Osgood-Schlatter disease first line treatment
nsaids, rest, ice, activity modifications
| strapping/sleeves
192
Osgood-Schlatter disease second line treatment
cast immobliation for 6 weeks
193
Osgood-Schlatter disease surgical treatment
exlcusion of ossicle
| refractory, skeletally mature
194
metabolic defect in phenylketonuria
phenylalanine cannot be converted to tyrosine
195
enzyme deficiency in phenylketonuria
phenylalanine hydroxylase
| small amount of improper tetrahydrobiopterin synthesisis (BH4)
196
symptoms of untreated PKU
hypopigmentation, eczema
mousy body odor
gait abn, hypotonia
197
diagnosis of PKU
elevated serum phenylalanine
198
PKU symptom
intelectual disability
199
inheritance of PKU
AR
200
PKU imaging
white matter injury on MRI
201
PKU treatment
limit dietary phenylalanine, increase dietary tyrosine
202
most common cause of short stature
- short parents/familial
| - constituitonal delay of growth of puberty
203
short stature =
2 SD below average for sex and age
204
how does prolonged steroid use result in short stature
disrupt the hypothalamic pituitary axis
205
how is a child with presumed short stature evlauted
shorts vs determining if height velocity is imapired
206
short stature, symptoms pointing to a specific disease
GI symptoms: celica, ibd
| pulmonary: CF
207
four genetic causes of short stature
turner, prader willi, noonan, achondroplasia
208
work up when height is below
3rd percentile
209
heigh velocity & growth failure
children over 2, curve has deviated across two major height percentile curves
210
treatment of short stature due to genetic causes
exogenous growth hormone
211
pertussis adjunctive therapy
antitussives, corticosteroids, bronchodilators, B. pertussis immunoglobulin
212
pertussis bacteria is
GN
213
how long does pertussis last
incubuation 7-10d
| cough weeks-months
214
pertussis presentation in infants
bradycardia, cyanosis
vomiting,
eye bulging, gagging, gasping
215
tranmission of pertussis
respiratory secretions
216
diagnosis of pertussis
clinically
| leukocytosis
217
rapid changes that neonates have to adjust to
replace alveolar fluid with air
onset of regular breathing
increase in pulmonary blood flow due to increased SVR and decreased PVR
218
first step if nenonate is in distress
cxr, blood gas, cbc, blood culture
219
findings suggestive of transient tachypnea
late preterm or term after c/s
| bilateral perihilar linear streaking
220
findings that suggest RDS
preferm
diabetic mother
CXR - diffuse granular ground glass appearance, air bronchograms, low lung volume
221
What findings should make one suspect persistent pulmonary hypertension as the etiology for neonatal respiratory distress?
bacterial infection, poor IUG, non reassuring fetal heart rate patterns
CXR - clear lungs, decreased pulm vascularity
222
What findings should make one suspect early onset pneumonia as the etiology for neonatal respiratory distress?
lethargy, apnea, tachycarida, poor perfusion
| cxr - bilateral alevolar densities iwth air bronchograms
223
management for suscpected peristent pulm htn in newborn
echo
oxygen at high concentration (reverese pulm vasoconstriction)
fluids, vasopressors
vasodilatory agents - NO
224
What are the first changes seen during puberty for girls?
9-12
breast enlargement
increase in height velocity
menarche
225
What is the more common cause of delayed puberty in girls?
functional gonadotropin deficiency
226
What are the first changes seen during puberty for boys?
10-13
enlargement of testes
pubic hair, penile growth
increse in height velocity
227
What are the cause of primary gonadal failure in girls with delayed puberty?
turner syndrome
total body radiation for malignancy
autoimmune ovarian failure
228
What does the management of delayed puberty involve for girls?
estrogen therapy
229
How is delayed puberty defined for boys?
failure of maturation, measured by enlargement of testes to start by age 14
230
What is delayed puberty usually caused by?
inadequate gonadal steroid secretion (at level of hypothalamic, pituitary or gonadal)
231
What is the testosterone level for boys with delayed puberty?
less than 40
232
What are the causes of gonadotropin deficiency in girls with delayed puberty?
functional gonadotropin def - anorexia, exercise, chronic illness
isolated gonadotropin def (kallman)
multiple pituitary deficiencies
233
What is the management for boys with delayed puberty?
monthly testosterone when levels are below 50
234
What are the LH and estradiol levels for girls who have begun puberty?
LH greater than 0.3
| estradiol greater than 20
235
How is delayed puberty defined for girls?
lack of breast development by age 13
236
What are the physical exam findings in boys with delayed puberty?
heigh less than 10th %
lestes less than 2.5cm
penis less than 7cm
237
What are the physical exam findings in girls with delayed puberty?
absence of breast tissue
| turner syndrome findings
238
What is the most important marker to measure progress in a boy with delayed puberty?
testicular size
239
What does a radiograph of the hand and wrist reveal in a child with constitutional delay of puberty?
delayed by 2 years in children with constitutional delay
240
How is delayed puberty defined?
incomplete development of secondary sexual characteristics at an age at which 95% of children have begun sexual maturation
241
What tests should be ordered to assess delayed puberty?
LH, FSH
total testosterone in boys
estradiol in girls
242
What are the three main causes of delayed puberty in boys and girls?
- Constitutional delay
- Gonadotropin deficiency
- Primary gonadal failure
243
What is the most common cause of delayed puberty in boys?
constituitonal delayed puberty
244
How do patients with constitutional delayed puberty usually present?
short in stature with normal growth rate and a bone age that usually corresponds to their height
245
What does a child with delayed puberty that does not have an elevated LH or FSH indicate as to the diagnosis?
constituional delay or permanent or functional gonadotropin def
246
What are the causes of gonadotropin deficiency in boys with delayed puberty?
kallman syndrome
functional gonadotropin due to chronic illness
multiple pituitary hormone def
247
What does an elevated LH and FSH level with delayed puberty by 10-12 years of age indicate as the diagnosis?
primary gonadal failure
248
What are the causes of primary gonadal failure in boys with delayed puberty?
Radiation to the testes
Post-surgical complications for cryptorchidism
Vanishing testes syndrome
Klinefelter syndrome
249
typical presentation of epiglottis
high fever
difficulty swallowing
drooling
soft inspiratory stridor
250
What infection control measures should be taken in cases of epiglottitis?
rifampicin prophylaxis to close household contacts
251
What clinical features differentiate epiglottitis from croup?
epiglottis - rapid presentation
| croup - proceding coryzal symptoms
252
What are the most common causative organisms of epiglottitis?
non typable haemophilus influenza
| streptococcus species
253
Would you expect a child with epiglottitis to be complaining loudly? Why or why not?
very quiet
| painful inflamm of their throat
254
When and how should you examine the throat of a child with suspected epiglottitis?
isual inspection of the oropharynx should be performed to confirm clinical suspicion, but manipulation of the airway in any way, including tongue depressor, screening for lymphadenopathy or anatomical findings, intubation, and ventilation should be deferred until an experienced otolaryngologist or anesthesiologist is present and prepared for intubation.
255
What signs will be visible on x-ray of a patient with epiglottitis?
thrumbprint sign
256
What are the complications of untreated epiglottitis?s
severe airway obstruction
| resp distress
257
What is the crucial first step in the management of a patient with suspected epiglottitis?
secure the airway
258
epiglottis treatment
IV ceftriaxone or cefuroxime for 2-5d
