Paediatrics Flashcards
1
Q
Paediatric constipation complications
A
- anal fissues
- hemorrhoids
- enuresis/ UTI
2
Q
recurrent cystitis with suprapubic pain,dysuria, and bacteriuria with anal fissue - what is the cause of urinary infection
A
- think chronic constipation
patient gets urinary stasis
(b/c constipation cause rectal distension which in turn compresses the bladder and prevents complete emptying
3
Q
number one diagnostic choice for VUR
A
voiding cystoourethrogram
4
Q
cause of conjugated hyperbilirinemia
A
biliary atresia neonatal hepatitis TPN cholestasis Rubin johnson Rotor TOURCH
5
Q
initial well appearing infant for 1-8 weeks THEN develops jaundice, pale stool or dark urine, hepatomegaly , high conjugated hyperbilirubinemia and mild elevation in transaminase
A
Biliary atresia
6
Q
Treatment of biliary atresia
A
hepatoportoenterostomy
liver transplant
7
Q
blood smear of sickle cell anemia
A
holly jolly bodies
sickle cell anemia gets functional asplenia
8
Q
basophilic stippling
A
seen in thalssemias
9
Q
heinz bodies and bite cells
A
Glucose 6 P dehydrogenase
10
Q
Helmet cells
A
schistocytes - seen in MAHAS
- DIC,
HUS
, TTP
11
Q
local papule with ipsilateral regional LAD in setting of cat exposure - think?
A
Bartonella henselae (gram negative bacilli)
12
Q
cat or dog bite
A
think pasteruella multicoida - normal oral flow in dogs and cats can cause cellulitis and other safe tissue infections
13
Q
whitish foreign body inside vaginal introits
A
think toilet paper and you want to irrigate it with warm fluids
14
Q
ocular findings in Neurofibromatosis
A
Lisch nodules
15
Q
cafe au lait macules, axillary freckling and monocular eue proptosis and vision changes
A
neurofibromatosis type 1 with optic glioma
15% of NF1 who are <6 will have optic pathway gliomas - decrease visual acuity, color vision , optic nerve atrophy and proptosis
16
Q
Selective IgA deficiency
A
- usually asymptomatic
Recurrent sinopulmonary and GI infections
Ass. w/ AI disorgers ( Celiac) and atrophy (asthma , eczema)
ANAPHYLAXIS during transfusion
17
Q
breastfeeding failure jaundice vs. breast milk jaundice
A
Failure - first week of life - decrease bilirubin elimination - increased enterohepatic circulation Clinical: signs of dehydration
BMJ
- start at age 3-5 days , peak at 2 weeks
- high levels B- glucuronidase in breast milk deconjugate intestinal bill and increase enterohepatic circulations
- normal exam
18
Q
brick - red rate crystals in diaper
A
breast milk failure jaundice
19
Q
hypocellular marrow with decreased megakaryoctytes and precursor of erythroid and amyloid cell lines - what is Dx
A
Aplastic anemia
20
Q
how does AML present
A
lethargy ( anemia) fever unexplained (leucocytosis bleeding ( thrombocytopenia) bone pain Limp
21
Q
Diamond blacken anemia
A
congenital pure red cell aplasia - presents with poor feeding and pallor in first few months of life
22
Q
Falcon anemia
A
pancytopenia and congenital anomalies such as - hyperpigmentaition - neck and intertriginous area - cafe au lait upper limb anomalies hypogonadism skeletal anomalies
23
Q
how do patients with homocystinuria present
A
they have marfanoid body habits
Fair hair and eyes
Developmental delay
Cerebrovascular accident (thromboembolic events)
Lab:
- increase homocysteine and methionine level - vit B6 , folate and vit B12 to lower homocysteine levels
24
Q
treatment of homocystinuria
A
vit B6 , folate, vit B12 - lower homocysteine levels
Antiplatlets - to prevent stroke, CHD, VTE
25
scoliosis, joint laxity and hyper elasticity
Ehlers Danlos
26
Marphanoid pictures PLUS Thromboembolic event
homocystinuria
27
big baby after delivery - crepitus over clavicle, asymmetric moro reflex and pain with passive motion of the affected extremely - how to treat?
```
clavicle fracture
Tx
- reassurance
- gental handling
- analgesics
- place affected arm in long sleeved garnet and put sleeve to check with elbow flexed at 90 degrees
```
Sx is NOT need b/c these fractures heel very quickly in neonates
28
c/i rotavirus
1. anaphylaxis to ingredients
2. history of intussusception
3. hx of uncorrected congenital malformation of GI tract ( deckle's diverticulum)
4. severe combined immunodeficiency
29
peripheral smear shows anisocytosis, spherocytes and polychromatophilia - what is Dx
Dx - hereditary sphercopcytosis
30
Clinical for hereditary spherocytosis
HA , Jaundice and splenomegaly
31
Labs for hereditary spherocytosis
HIGH MCV
Spherocytes
Negative Coombs test
Increase osmotic facility test on acidified glycerol lysis test
Abnormal eosin - 5 - meleimide binding test
32
Treatment for hereditary spherocytosis
folic acid supplementation
blood transfusion
splenomegaly
33
what is Dx by erythrocyte CD55 and CD59 testing
PNH - paroxysmal nocturnal hemoglobinuria
34
low Hg, reticulocytosis and positive Coombs test
warm agglutinin autoimmune hemolytic anemia
35
viral CSF vs TB CSF
VIRAL - glucose normal
- protein > 100
TB
- low glucose
- protein > 250
36
hemolytic anemia, thrombocytopenia, AKI - what is Dx
```
HUS
- the triad
(HA - schistocytes, HIGH bili)
Thombocytopenia
AKI (high BUN, high Cr)
```
37
B1 deficiency
THIAMINE
beriberi ( peripheral neuropathy , heart failure )
Wernicke - Korsakoff syndrome
38
B2 deficiency
RIBOFLAVIN
angular cheilosis, stomatitis, glossitis
normocytic anemia
seborrheic dermatitis
39
B3 deficiency
Niacin
- Pellagra ( dermatitis, diarrhea, delusions/ dementia, glossitis)
40
B6 deficiency
PYRIDOXINE
- cheilosis, stomatitis, glossitis
- irritability , confusion, depression
41
B9 deficiency
FOLATE , FOLIC ACID
- megaloblastic anemia
Neuro déficits ( confusion , paresthesias, ataxia)
42
C ( ascorbic acid)
SCURVY
| - punctate hemorrhage, gingivitis, corkscrew hair
43
reticulocytes and platelets in patients with sickle cell anemia
Increase reticulocytes
| decrease platelets
44
colonization of bacteria in patients with CF by age
Age 2-20 - S. AURES
Age 20 - 45 - Pseudomonas
45
what is the most common type of brain tumour in children
ASTRYOCYTMOA
- supratentorial tumour - presents with seizure, weakness, sensory changes
- increase ICP signs - morningn headache , vomitting , papilledema
46
Craniopharyngiomas
arises in the sella trice
- cystic structure with calcifications on imaging
- visual field defects and hormonal deficiencies ( GH due to compression of surrounding structures - optic chasm, pituitary stalk
47
ependymomas
glial cell tumours - arise in the ependymal cell lining of the ventricle with calcifications on imaging
Symptoms: visual field defects, hormonal deficiencies
48
medulloblastoma
second most common tumour of the posterior fossa in children
- infratentorial tumours - arise from cerebellar vermis and present with vomitting, headache and ataxia
49
worried about an animal bit and patient has neurological signs
think rabies - rat bit
50
neuroblastoma
raise from neural breast cell
- most common cancer in paediatric population ( after leukaemia and CNS tumour)
Most common site - abdomen
- calcifications and hemorrhage on plain x-ray and high levels of HVA and VMA
51
refeeding syndrome
carbohydrate intake stimulates insulin activity --> which promotes cellular uptake of phosphorus, potassium and magnesium
Clinical: arrhythmia, cardiopulmonary failure
52
classic findings of retropharyngeal abscess on x-ray
increase width of pre vertebral soft tissue ( greater than half the width of corresponding vertebral body
53
treatment of heamangiomas
b-blockers (nadolol, propanolol)
```
Others:
- systemic steroids
laser ablation
interferon therapy
embolization
surgical excision
```
54
treatment of chickenpox
supportive in healthy children
if immunocompromised , give acyclovir, VZIg
+/- vaccination depending on immunization status
55
perinatal chicken pox in mom
treat mom - immediate postpartum period with VZIG (if mom gets infection 5 days before delivery OR 2 days after )
Treat baby with IV acyclovir - if it develops varicella
56
treatment of measles
vit A and supportive
| CONSIDER post exposure prophylaxis ( vaccine and immunoglobulin)
57
treatment of candidas diaper rash
stallite lesions with flexure sites involvement
| tx - 1% hydrocortisone cream in clotrimazole cream tid
58
Aspiration of knee joint yeilds yellow colored, translucent fluid with a leukocyte count of 20 000 ( 50% neurtrophils)
NO organism on Gram stain
Hx. Trip to Main with migratory arthralgias
Migratory arthralgia
59
imaginary friends
normal from age 3-6
healthy development
will not affect the childs social relationship
60
peripheral precocious puberty
irregular cafe au lait macules
polyostotic fibrous dysplasia (ex recurrent fractures)
McCune Albright Syndrome
abnormal scar-like (fibrous) tissue in their bones, a condition called polyostotic fibrous dysplasia
scoliosis
cafe au lait
pernicious puberty
61
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Premature puberty (pubic hair , axillary hair, acne, body odor )
NO BREAST DEVELOPMENT
ADRENAL TUMOUR
62
all vacines should be given accroding to
chronological age rather than gestational age
EXCEPTION - weight should be > 2kg ( 4 lb 6 oz) before the first hepatitis B vaccine
63
Preseptal cellulitis vs. Orbital cellulitis
Pre-septal cellulities
- eyelide erythema and swelling
- chemosis
Trreatment: oral antibiotics
```
Orbital cellulitis
- eyelid erythema, swelling , chemosis
PLUS
- pain with EOM , protosis, ophthalmoplegia with diplopia
Tx: IV antibiotics +/- surgery
```
64
clinical allergic conjunctivities
usually b/l conjunctivites
clear discharge
ocular itching
No erythema pre-orbital or fever seen
65
carvenous sinus thrombosis symp
headahce
opthaloplegia
vision loss
papilledema
66
anterior uvitits
optic neuritis
anterior uvitits - red eye, eye pain, blurry vision with history of autoimmune disease
optic neuritis - ass. w/ MS - acute vision loss and pupillary defects
NOT eyelid redness or swelling
67
Laryngomalacia
Pathophysiology
Clinical
Dx
tx
Pathophysiology - increase laxity of supraglottic structures
Clinical
- inspiratory stirdor worsens when supine
peaks age 4-8
Dx
- usually clinical
- confirmation by flexible laryngoscopy for moderate/ severe cases
Tx
- reassurance for most cases
- supraglottioplasty if severe symptoms
68
infants with inspiratory stiador that worsens in supine and improves when patinet is prone
Laryngomalacia
- use laryngoscopy to look for collapse of the supraglottic structures during inspiration
NORMALLY resolves by age 18
69
diffenrece b/w absence vs. focal seziure
Absent sezirue - generalized seziure
NO postictal period , normally reproduced with hyperventilations
Focal seziuer - abnormal neuronal discharges orginating in a single hemisphere can present with motor ( head turning) , sensory ( paresthesias) or autonomic ( sweating)
70
Osteoid osteoma
- scleroitic cortical lesion on imaging with central nidus of lucency
typically causes pain that is wrose at night and unrelated to activity
pain relieved by NSAIDS
71
treatment of hypovolemix HYPERnatremia
normal saline - isotonic solution
b/c half normal saline should NEVER BE USED for inital resusitation measurees
72
what cynotic heart disease will have a single loud S2
transposition of great vessels
tricuspid atresia
truncus arteriosus
73
difference b/w TTN and RDS
TTN
- inadequate alveolar fluid clearance at birth results in mid pulmonary edema
Clinical:
- tachypnea begins shortly after birth and resolves by day 2 of life
X-ray - bilateral perihilar linear streaking
RDS
- surfactant deficiency resulting in alveolar collapse and diffuse atelectasis
- severe resp distress and cyanosis after premature birth
X-ray - diffuse reticulogranular (ground glass) appearance, air bronchograms , low lung volumes
74
X-ray - diffuse reticulogranular (ground glass) appearance, air bronchograms , low lung volumes
RDS
75
X-ray - bilateral perihilar linear streaking
TTN
76
what finding for burns indicate abuse
sparing of flexor surfaces
unifrom burn depth
sharp lines of demarcation
77
d
| maintaince treatment of sickle cell anemia
vaccination
penicillin
folic acid supplement
hydroxyurea ( if recurrent vaso-occlusive disorder)
78
difference b/w hirschspring and meconium ileus disease
ass. disorder
level of obsturction
meconium consistency
squirt sign * forceful expulsion of stool after rectal exam
```
Hirschsprung
ass. w/ DOWN SYNDROME
rectosignmoid
normal meconium
positive squirt sign
```
```
Meconium ileus
- ass/ w CYSTIC FIRBOSIS
ileum
inspissated
negative squirt sign
```
79
narrowing of ileum on laparotomy
meconium ileus
80
right and left cheecks swollen
b/l swelling and tenderness anterior to ears extending into the mandible
what complication is patient greatest risk of development
think MUMPS
risk - aseptic meningitis and ochitis
81
schapoid diagphram
number 1 treatment
think congential diaphramatic hernia
- develop pulmonary hypoplasia
therefore need emergency incubation
THEN nasal or orgastric tube - connected to continuous suction to prevent bowl distention against the lungs
82
x-ray finding for retropharyngeal abscess
widened per vertebral space
83
GERD in 2 month old
provide reassurance
frequent small volume feeds
hold infant upright 20-30 minutes after feeds
84
GERD + FTT treatment
this is more severe
- thicken feeds 9 adding oatmeal)
- antacid Tx (PPI)
- excessive weight gain and PPI increase risk for pneumonia and diarrhea
PPI = unnecessary in physiologic GERD
85
complications of prematurity
1. RDS
2. PDA
3. Bronchopulmonary dysplasia
4. NEC
5. Retinopathy of prematurity
86
dandy walker malformation
congenital brain malformations that cause non communicating hydrocephalus due to the obstruction of CSF flow in
87
treatment of SCFE
surgical pinning of femoral head (helps to prevent the risk of AVN when it heals )
88
radiopaque tables of 3 year old boys
THINK pre-natal vitamins - these are radio-opaque tablets that are seen on x-ray and cause
IRON POISONING
89
clinical presentation of iron poisoning
```
pain
hematemesis
hypovolemic shock
metabolic acidosis
low bicarb hypotension
cool extremities
```
90
treatment of iron poisoning
IV deferoxamine ( antidote for iron poisoning)
91
umbilical cord cut with pair of sizer knife
tetanus
92
infant difficulty with feeding , truisms, spasms and hypertonicity , clenched hands , dorsiflexed feet
tetanus
93
difference b/w botulism and tetanus presentation
botulism
- weakness
- constipation
- poor feeding
- HYPOtonia
tetanus
- HYPERtonia
- spasms
- poor feeding
- trismus
94
most common cause of nephrotic syndrome in children <10
minimal change disease
| - normal findings on light microscopy
95
#1 treatment for septic arthritis in children
arthrocentesis , blood and fungal cultures THEN empirical antibiotics
96
what is the gold standard investigation to diagnose duchenne muscular dystrophy
GENETIC testing
| dystrophin gene Xp21
97
fever, tonsilitis , pharyngitis , cervical LAD, fatigue , HSM , rash after amoxicillin
EBV infection
98
COMPLICAtiON of supracondylar humeral fracture
COMPARTMENT SYNDROME
99
long term complication of undescended testes
sub fertility
100
clinical and treatment for SCID
- recent severe viral fungal or opportunistic infections
- failure to thrive
- chronic diarrhea
( think no T or B cell function)
treatment
- Stem cell transplant
101
what maneuvers increase murmur in hypertrophic cardiomyopathy
VALSALVA, abrupt standing and maul nitrate administration
ALLL of these will decrease LV cavity size by decreasing preload cause LV outflow tract obstruction and increases intensity of murmur
102
what maneuver decrease intensity of hypertrophic cardiomyopathy
squatting , leg raise and hand gripping
increase LV cavity by increase preload
this will decrease outflow obstruction decrease intensity of murmur
103
primary amenorrea - what investigations should be done
FSH
Then MRI pituitary - if FSH is decreased
Then karyotypicing if FSH increase
104
what do you order to evaluate pernicious anemia
gnRH
105
Cause , clinical dx and treatment of scarlet fever
cause : STREPTOCOCCUS PYROGEN
```
CLINICAL:
- fever and pharyngitis
tonissilar erythema
strawberry tongue
tender anterior cervical nodes
sandpaper rash
```
Dx:
- rapid streptoccal antibodies
- throat culture
Treatment;
- penicillin ( amoxicillin)
106
difference b/w KD and SF
SF
- fever and pharyngitis
- tonsillar erythema
- strawberry tongue
- tender anterior cervical nodes
- sandpaper rash
KD
- 5 days of fever
- >/= 4 of the following
1. >1.5ccm cervical node
2. POLYmophous rash - truck and extremities
3. edema of hands and feet
4. conjunctivitis - non exudative
4. mucosal changes ( strawberry tough, dry crackled lips )
107
what is KD patient at risk for?
CAA - coronary artery aneurysm
| MI - myocardial infarction
108
hemophilia A and B - what is the most likely cause of joint pain
heamosiderin deposition and fibroses
109
ddx of laryngomalacia and vascular ring
laryngomalacia - inspiratory stridor most prominent in infant
- worse when supine
- improve prone
Vascular ring
- presents infants
- biphasic stridor that IMPROVES with neck extension
110
vascular rings
results from abnormal development of aortic arch causing tracheal bronchial and or esophageal compression
- age <1 , respiratory ( stridor, wheezing , coughing) and or esophageal ( dysphagia , vomitting , difficulty feeding
111
- distress ( tripod position , sniffing position, stridor )
- dysphagia
- drooling
- high fever
-
epiglottitis
-
112
epiglottis x-ray , treatment and prevention
X-ray - thumbprint sign
manamgent - endotracheal incubation and antibiotics
prevention - immunization
113
turner syndrome - what is the cause of its edema
the cause is congenital lymphedema due to abnormal development of lymphatic system
114
loud S2 with harsh crescendo decrescendo systolic murmur - what is fx
ToF
115
infant failure to thrive , b/l cataracts , jaundice , hypoglycaemia - what enzyme is deficient
patient most likely has a metabolic disorder ( galactosemia) caused by galactose 1 phosphate uridyl transferase deficiency
116
clinical if patient has galactokinase deficiency
cataracts ONLY
117
breath holding spells
cyanosis - crying followed by breath holding cyanosis and loss of consciousness
Pallid - timor trauma follow by breath holding, allow, diaphoresis an d LOC
118
are breath holding spells normal
yes
119
wiskott aldrich syndrome
x-linked recessive defect in WAS preteen gene
| - impaired cytoskeleton changes in leucocytes , platelets
120
eczema
| ircothrombocytopenia ( small platelets , low platelet count , recurrent infection
weskott aldrich syndrome
121
treatment of wiskott aldrich syndrome
stem cell transplant
122
cause of acute rheumatic fever
- strep pyrogens
123
Prader Willi syndrome
deletion of paternal 15q11 q13
124
nocturnal headaches and morning vomitting
think IC pathology - get a CT first
125
best investigation for meconium ileus
contrast edema
126
reye syndrome - what type of liver disae
microvascular fatty infiltrate
- high AST and ALT
high PT , INR , PTT
high NH3
127
Clinical Reyes
acute liver disease and encephalopathy
128
otoscope shows intact left tympanic membrane with peripheral graduation and some skin debris
cholesteatoma
129
cholesteatoma
acquired or congenital
Congenital < 5 years old
Acquired - secondary to chronic mid ear disease
new onset hearing loss OR chronic ear drainage despite antibiotic treatment are typically presenting symptoms of cholestatomas and granulation tissue and skin debris within retraction pockets of tympanic membrane on otoscope
130
difference b/w cholesteatoma and otosclerosis
otosclerosis - bony overgrowth of the stapes footplate that results in conductive hearing loss - NO ear drainage
Cholestatomas - chronic midd ear disease , new onset hearing loss or chronic ear drainage despite antibiotics - granulation tissue and skin debris on otoscope
131
Friedreich ataxia - most common cause of death
cardiomegaly
132
Friedrich ataxia
AR disorder
Gait ataxia, frequent falling and dysarthria
Cardiomegaly , DM , skeletal deformities ( scoliosis and hammer toes)
133
von Gierke disase
deficient glucose 6 phosphate (found in liver, kidney and intestinal mucosa) - impaired conversion of glycogen to glucose leading to glycogen accumulation in affected organs
3-4 months of hypoglycaemia ( often seizure) and lactic acidosis
134
doll like face, thin extremities, protuberant abdomen ( HM ) and short stature
glucose 6 phosphate deficiency ( von gierke disease)
135
what coag factor is affected if you have a prolonged PT
factor 7
136
localized abode pain, hematuria, high reticulocytes, low hct
sickle cell disease
137
what vaccine should patients with sickle cell disease receive
vaccination with a conjugated polysaccharide - b/c patients with SS are susceptible to encapsulated organisms (s. pneuma, H. influenza, N. meningitides)
138
causes of nephrotic vs. nephritic syndrome
Nephrotic - MCD, FSGS, Membrane nephropathy, MPGN
Nephrotic - PSGN, HUS, IgA nephropathy, MPGN, crescentic glomerular nephritis
139
treatment of lyme disease in patient < 8
amoxicillin in children < 8 years of age
Doxycycline is often used but C/I in patients <8
140
complication of patients with sickle cell trait
hematuria
141
difference b/w sickle cell disease and sickle cell trait
Trait: 50-60% HgA, 35-45% hg S , <2% hgF
Disease 0% HgA, 95%hgS, 5-15% hgF
NormalL 99% hgA, ,1% hgF
142
Spondylolisthesis
forward slip of vertebrae ( usually L5, S1) , preadolescent children
Clinical: clinical scenario, back pain ,neurological dysfunction - ex: urinary incontinence and a palpable step off at the lumbrosarcal area
143
management if child < 2 with febrile UTI
first 1-2 weeks antibiotics
2. bladder and renal ultrasound
3. voiding cystourethrogram - not indicated for first febrile UTI
144
traid: pain, jaundice, palpable mass in RUQ think?
biliary cyst
145
DX of biliRY cyst
VISUALIZATION ON US
| ERCP
146
Treatment of binary cyst
surgical resection to relieve obstruction and prevent malignant transformation
147
ALL vs aml
```
ALL - leukemia
age 2-10
infections
LAD
Splenomegaly
Investigation: Lymphocyte , postive PAS
```
AML - aurer rides seen
148
cause of aplastic anemia
Drugs: NSAIDS , sulphonamides
Toxic: benzene glue
Idiopathic
Viral infections HIV, EBV
Immune disorders
Thymoma
149
features of a BENIGN murmur
1. early or mid systolic
2. grade 1 or 2 intensity that decreases on standing and valsalva maneuver
3. low pitches musical pure or squeaky tone at LLSB ( still's murmur ) or high pitched at LUSB ( pulmonary flow murmur)
150
chromosomal makeup for Kallmans
46XX - female
46 XY - male
no gnRH - no smell
151
FSH LOW, LH low and low GNRH
Kallmans syndrome
152
potter sequence
urinary tract anomaly
anuria/ oliguria in utero
oligohydraminios
Pulmonary hypoplasia, flat facies, limb deformities
153
cause of potter sequence
posterior urethral valve
154
webbed neck, cleft lip, shielded chest , triphalangeal thumb , pale mucous membrane and conjunctive
diamond blacken anemia
155
pan systolic murmur that is loudest at the lower left sternal boarder and a diastolic rumble at the apex
LARGE vid
| not ToF
156
murmur for ToF
ejection murmur over the upper sternal boarder from the pulmonary stenosis
loud S2
157
Beckwith Weidemann syndrome
- deregulation of imprinted gene expression in chromosome 11p15
Fetal macrosomia, rapid growth, until late childhood, Macroglossia, hemihyperplasia
Complications: wilms tumour , heaptoblastoma
Surveillance - serum alpha feta protein
abdo / renal US
158
for androgen insensitivity syndrome - when do you gonadectomy
AFTER puberty (helps maintain adult height) and decrease risk of gonadal malignancy
159
heart condition in Down syndrome
CAVSD
- loud S2 due to pulm HTN
- systolic ejection murmur from increase flow across pulm valve
- holosystolic murmur of VSD that may be soft or absent if defect is large
160
most common posterior fossa tour in children
1. astrocytoma
| 2. meduloblastoma
161
meduloblastoma clinical findings
1. truncal or gait instability
2. fine motor dysfunction
3. dysdiadochokinesia
4. obstructive hydrocephalus (due to proximation of 4th ventricle)
5. high ICP - headache, vomitting
162
hair pulling disorder
trichotillomania
163
Parinaud Syndrome
limited upward gaze
upper eyelid retraction ( Coller sign)
Pupils non reactive to light
active to accommodation
164
Obstructive hydrocephalus
papilledema
headache vomitting
ataxia
165
multiple 1mm vesicles on anterior tonsillar pillars with greyish ulcerated lesions
coxackie virus
166
tine capita
most common in African American children
scaly erythematous patch with hair loss on scalp , blacks dots in affected area, tender lymphadenopathy
167
treatment of tinea wapitis
oral griseofulvin or terbinafine
168
difference b/w absence seizure and inattentive staring spells
absence seizure
- occurrence during all activities
- length < 20 seconds
- lack of response to vocal or tactile stimulation
- presence of automatisms
Inattentive staring spell
- occurrence primary during boring activities
- length >1
- response to vocal or tactile stimulation
- lack of automatisms
169
automatisms
eye lid fluttering
| lip smacking
170
metatarsus adducts and congenital clubfoot
```
metatarsus adducts
- flexible positioning
- medial deviation of forefoot
- neutral position of hind foot
Tx: reassurance
```
Congenital clubfoot
- rigid positioning
- medial / upward deviation of forefoot and hind foot
- hyper plantar flexion of foot
Tx; serial manipulations and casting , surgery if refractory cases
171
myotonic dystrophy inheritance
AD
172
presence of exudates , edema , palatal pmetchiae and absence of viral symptoms - what is your next step?
rapid antigen test
Negative - throat culture
Postive- Strep Pharyngitis (oral amoxicillin)
Negative - viral
173
Caustive agent - initial test
airway
breathing
circulations
THEN discontamination - remove of contaminated clothing and visible chemicals
CXR
Endoscopy within 24 hours
174
what should be tested at every well child check
VISION
- evaluated by checking fixation and tracking
(cover uncover test - to assess from strabismus
(visual acuity test - age 3 )
175
normal age limit for bedwetting
Age 5
176
complication of HSP
INTUSECEPTION ( due to intestinal bleeding and edema 0
177
normal vs. abnormal lymph nodes
normal:
- soft
- mobile
- <2cm
- no systemic symptoms
Abnormal:
- firm and hard
- immobile
- >2cm
- systemic simp ( fever, night sweats, WL)
178
pathophysiology of coarctation of aorta
thickening of tunica media in aortic arch
179
oestrogenesis imperfecta
- CT disorder
- AD mutation
Osteopenia
blue sclerae
recurrent fractures - easy nursing , hypotonia , hearing loss
opalescent blue gray to yellow brown discolouration caused by disclosed dentin shining through the translucent and weak enamel
180
putussis post exposure prophylaxis
macrolides antibiotics to all household contacts
181
gradual onset hemiplegia , aphasia , neck pain and thunderclap headache in 5 year old - what do you think
carotid artery dissection
182
hypersensitivity reactions type 1
IgE mediated
Anaphylaxis
Urticaria
183
Hypersentivitiy reaction type 2
autoimmune hemolytic anemia
| good pasture syndrome
184
type 3 hypersensitivity reaction
antigen complex
serum sickness
PSGN
Lupus nephritis
185
Type 4 hypersensitivity reaction
T cell and macrophage mediated
- contact dermatitis
- tuberculin skin test
186
risk factor for intussusception
- recent viral illness or rotavirus
- Mockers diverticulum
- HSP
- Celiac disease
- intestinal tumor
- polyps
187
PJP , failure to thrive , chronic diarrhea , LAD
HIV in infancy
188
clinical presentation of methemoglobinemia
Hx: exposure of oxidizing substances ( dispose, nitrites, topical / local anesthetic)
Clinical:
- cyanosis
- O2 sats - 85%
- dark chocolate coloured blood
Lab: Sat gap > 5% b/w O2 sats on ABG vs. pulse ox
- normal PaO2
Tx: methylene blue
189
lead overdose tx
dimercaprol
190
ethylene glycol or methanol injection
fomepizole
191
leech nyhan syndrome
deficiency of hypoxanthine guanine phophoribosyl transferase ( HPRT)
- compulsive self injury - bitting extremity
- uric acid excess - gouty arthritis , typhus formation and obstructive nephropathy
Tx: intake of fluid, allopurinol
192
massive hematuria with episode that is mild and resolves spontaneously
think: sickle cell trait --> papillary necrosis
193
comorbidities with absent seizure
ADHD
| Anxiety
194
clinical features of necrotizing enterocolitis
systemic: vital sign instability , lethargy
GI: vomitting, bloody stools, abode distension, tenderness
195
RF for necrotizing enterocolitis
1. prematurity
2. hypotension
3. congenital heart disease
196
hyper IGM syndrome
Recurrent or severe sinopulmonary infections with viruses and encapsulated bacteria
Normal B cells
LOW IgG and IgA
HIGH IgM
197
CVID
recurrent sinopulmonary infections with viruses and encapsulated bacteria
normal B cells
low IG levels
198
X-linked agammaglobulinemia ( Brutons )
Recurrent sinopulmonary infections with viruses and encapsulated bacteria
Low or absent B cells
low IgG
199
management of parapneumonic effusion
small effusion and no rest distress --> oral antibiotics, close monitoring
Moderate effusion OR resp distress OR hypoxia --> US, Iv antibiotics, draining
200
most common cardiac issue in edwards syndrome
VSD
201
neonatal polycytemia
hematocrit > 65% in term infants
Cause:
- increase EPO from intrauterine hypoxia, smoking, HTN , IUGR
- Delayed cord clamping
- Genetic / metabolic disease - hypothyroidism , trisomy ( 13,18,21)
202
if capillary blood shows high lead - what do you do?
VENOUS BLOOD for lead levels
- this will determine if patient requires treatment
203
treatment for lead toxicity
Mild: 5- 44 - no meds, repeat level in one month
Moderate 45-69 : dimercaptosuccinic acid ( DMSA)
Severe > 70 - dimercaprol PLUS EDTA
204
how do you prevent gonococcal conjunctivitis
give erythromycin ophthalmic ointment
205
most common cause of congenital hypothyroidism
thyroid dysgenesis
206
seborrheic dermatitis
peaks in infancy and adulthood
erythematous plaques + yellow , greasy scales
Located on scalp, face , umbilicus and diaper area
207
excess cow milk consumption
> 24 onces 700ml per day
- results in iron deficiency anemia
Fe deficiency anemia can be differentiated by thalassemia with ELEVATED RCDW
208
ONLY intention and repeated fire setting behaviour
Pyromania
differs from conduct - b/c conduct will also have lying, theft, cruelty etc
209
if you suspect DDH - what do you do?
GET ULtRASOUND of the hip
- not an x-ray of hip
210
proteinuria in a child - what do you do next?
repeat dipstick testing on two subsequent occasions
b/c may just be an incidental or transient proteinuria - which can occur with excerise streets or change in position, volume depletion
211
GBS - how do you evaluate respiratory invovlemtn
do serial measurements of FVC - spirometry
212
bone pain with SCD - what is the cause
microvascular occlusion
213
dactylics
early manifestation of faso-occlusive disease in SCD - presents with acute onset of bilateral hand and foot swelling and tenderness
214
if you suspect their child has autism - what do you say to the parents
explain the spectrum of development disorders and recommend further evaluations
215
treatment of hydrocele
observations and rasurrance
- normally resolves by age 1
216
patients with SCD are at increase risk of what
OSTEONECROSIS OF PROXIMAL FEMUR
| avascular necrosis
217
Asians with elevation of UCB - what is cause
decrease hepatic uridine diphosphogluconurate glucuronosyltransferase
218
hypothermic neonate
think sepsis
| - do blood cultures and start antibiotics
219
when does chlamydial conjunctivitis occur
day 5- 14
Treat with ORAL macrocodes - since topical treatment are not affected
220
what is topical eyrhtomycin used for?
prophylaxis for
| gonococcal conjunctivitis
221
treatment of gonococcal conjunctivitis
Prophylaxis : topical erythromycin
Treatment: IM 3rd gen cephalosporin
222
CVID Dx
LOW LOW LOW IgG
Low IgA/ IgM
No response with vaccines
223
CVID - treatment
IVIg replacement
224
suspect heamarthrosis in child - what test do you do?
want to do CBC and coag testing
225
acute onset of joint effusion - is concerning for what?
HEMARTHOSIS - bleeding disorger
226
patient falls out of bed and found unconscious on the floor with blue discolouration of his lips, resolves in a few seconds but consciousness takes a few minutes and patient is sleepier than normal after, does not remember event
think generalized seizure
| episode of Unconsciousness and feeling sleepy after
227
potential serious S/e of infective mononucleosis
Acute airway obstruction
228
potential d/e of cellulitis of the sublingual or submandibular
ludwig angina
229
isolated thrombocytopenia after viral infection
- what is it?
- what do you do?
probably immune thrombocytopenia
- children usually recover spontaneously within 6 months and require ONLY observations regarding their platlet count
If bleeding - want to give ivIg or glucocosteroids
230
cyanosis in infant and turns pink with crying - what do they have
choanal atresia
231
what happens to the murmur in ToF when squatting
if child squats - increase murmur but cyanosis improves
232
Complication of sickle cell trait
Hematuria and Papillary nervous
Hyposthenuria
Splenic infraction , VTE , priapism
Exceptional rhabdomyolysis
233
most common cause of osteomyelitis in children
s. aures
234
Early secondary sexual characteristics with advanced bone age - what do you do next
check LH
If low LH
- GnRh stimulating test
- if low LH still - peripheral precocious puberty ( do adrenal CT)
If high Lh - central precocious puberty
If high LH
- due to central precocious puberty ( do MRI brain)
235
early secondary sexual characteristics with normal bone age
isolated breast development - premature thelarche
isolated pubic hair development - premature adrenarche
236
low LH and Low FSH - with secondary premature sexual characteristics and advanced bone growth
think peripheral precocious puberty
| - do adrenal CT
237
if high LH, early Secondary premature sexual characteristics and advanced bone growth
think central precocious puberty
| - do MRI
238
treatment for cat bites
copious irrigation and cleaning
prophylactic amocillin and calvulanate
tentanus booster - if indicated
avoid closure
239
treatment of tourette
```
1st: alpha 2 against
antispcyhotic agents ( risperidone) - better s/e
```
2nd gen - clozapine
240
Diagnosis of aDd requires several symptoms and for them to be present before what age
age 12
241
congenital toxoplasmosis
diffuse intracerebrale calcifications and ventriculomegly
macrocephaly
Cause
- car feces or undercook meet
242
pika virus - transmission and se to baby
transmission - mosquito or sexual transmission
Causes: MICRCEPHALY
243
dental caries or abscess particularly in maxillary teeth should predispose to what
orbital cellulitis
244
multiple episodes of gastroenteritis - increase risk for what ?
so gastroenteritis is thought to cause hypertrophy of the peter patches in lymphoid rich terminal ileum - which as a nidus for telescoping - increase risk of intussception
245
pyloric stenosis treatment
always make sure you replace fluid loss and potassium before surgery ( pyloromyotomy) - b.c this will decrease risk of posop apnea
246
chronic VUR symptoms and complications
recurrent or chronic pyelonephritis
Complications
- scarring
- HTN
- renal insufficiency
247
primary dysmenorrhea
is pelvic cramping in the first few days of menses in the context of a normal physical exam - caused by increase prostaglandin release from endometrial sloughing during menses
248
suspect hydrocephalus in infant what test do you do ?
CT brain
249
asymptomatic abdominal mass that is find accidentally by the caretaker or physician - what is the most likely diagnosis
wilms tumor
- usually Dx age 2-5
- affects single kindey
250
mass in abdomen , HTN, hematuria and fever - what is Dx
wilms tumor
- it is the most common primary renal neoplasm in children - usually Dx 2-5 years of age
- affects single kindly
251
treatment of impetigo
topical mupirocin
252
painful clear vesicles over retyematous skin and both cheeks as well as a few scattered lesions overlying the dark red crusting - submandibular LAD - what is cause?
this patient most likely has a HSV infection
due to a complication of atopic dermatitis = eczema herpeticum
253
short vagina, no uterus normal ovaries
mullarin genesis
254
absent uterus and upper vagina , cryptorchid testes
androgen insensitivity syndrome
255
sexually active women < 24 should get what screenig
chlamydia trachoma's testing
256
what rash spares the palms and soles
rubella
257
disseminated gonococcal infection - what kind of rash
usually vesiculopustular and rarely involves the face
258
how does hydroxyurea help SCD patients
it increases the amount of HbF in circulations which dilutes the number of sickled cells and reduces vasooclussive episodes
259
sudden LOC, loss of postural tone and delayed return to baseline - should raise suspicion for
seizure
| - look for tongue lacerations
260
well appearing neonate with painless bloody stools - dx?
milk- soy protein proctocolitis
( milk protein induced enterocolitis )
- - rectal bleeding should stop in 2 weeks once eliminating material dairy and soy protein products or switching to hydrolyzed formula
261
risk factor for cerebral palsy
```
prematurity
IUGR
intrauterine infection
Antepartum haemorrhage
placental pathology
maternal alcohol consumption
maternal tabacco
```
262
suspect constipation in child - what should you do?
start ORAL laxative regime
don't have to confirm with x-rya
263
what ovarian timor can secrete estrogen and cause premature puberty
granulose cell timor of the ovary
- child: pernicious puberty
Dx:
- increase estrogen and mass on ovary
264
sertoli leydig cell tumour causes what
this timor produces androgen and therefore masculinization features
265
most common cause of meningitis if 3 months - 10 years oldd
n. meningitiis
s. prnumonia
(>11 - think neisseria
(< 3 months - GBS, ecoli
266
define aplastic crisis compared to splenic sequestrating crises
Aplastic crisis:
DECREASE reticulocytes
- transient arrest o ferytropoiesis , secondary to parovrius B 19)
Splenic sequestration crisis
- INCREASE reticulocyte
- splenic vaso-oclussive --> rapidly enlarging spleen
- occurs in chid with autosplenectomy
267
acute chest syndrome define
it is pulmonary vas occlusion or infection and is characterized by fever, chet pain and a new infiltration of chest radiography
- fever, cough , chest pain, and findings on chest auscultations
268
trachoma
child conjunctival injection, tarsal inflammation and pale follicles
269
neonatal absteigende syndrome - due to exposure of what
HEROIN, metadone , opiods
| not cocacine - withdrawal symptoms are not as sever with cocaine
270
patient presents like measles but has had the vaccine 2 weeks ago - what do you do?
reassurance - b/c small precent of patients may develop fever and mild rash 1-3 weeks after immunization - resolves without treatment
271
musty odor- what is it and how do you dx
think PKU
- quantitative amino acid analysis
```
AR mutation
Clinical
- severe ID
- musty body odour
hypo pigmentation skin eyes and hair and brain nuclei
```
- treat with restriction of phenalyanine
272
what protects you from malaria
sickle cell trait
273
first line management for epiglottis
endotracheal intubation in a controlled setting
if failed then you can consider emergent tracheostomy
274
tay sachs patology
b- hexosaminidase A deficiency
275
difference b/w tay sachs disease and neimann pick disease
- neiman picks - HSM
Both will have hypotonia , loss of motor milestones, hypotonia and feeding difficulties and cheery red macula
276
patients with referring syndrome - why do they get hypokalemia
Carbohydrates stimulate INSULIN activity and this promotes cellular uptake of K+, phosphorus , and Mg
patients will develop arrhythmia and Cardiopulmonary failure
277
patients who get cardiac surgery are at increase risk post op
pericardial effusions
| - distant heart sounds , hypotension and distended jugular veins
278
patients with bronchiolitis are at increase risk of what
apnea
| resp failue
279
treatment of androgen insensitivity syndrome
do a gonadectomy - BUT WAIT TILL AFTER PUBERTY ( helps maintain height)
280
vicious meconium - what does this suggest
meconium ileus
