PANCE Prep- Peds Flashcards
When do the following reflexes disspear?
- Moro reflex
- Palmar grasp
- Upward Babinski
- Parachute reflex
- Rooting
- Galant
- Moro (startle): 2-4 months
- Palmar: 5-6 months
- Upward Babinski: normal up to 2y/o
- Parachute: appears ~7months old and persists for life
- Rooting: 4 months
- Galant: 4 months
Describe the ortolani and barlow maneuver
Ortolani: push hips anterior/out= reduction of the hip joint (feel a clunk)
Barlow: Posterior force (Back)= dislocation of the hip
- Describe fetal cardiac circulation.
2. Fetal circulation uses __ to __ shunts
R–> L shunts
- Fetus receives nutrients and O2 from placenta–> IVC–> RA–>
- RA–> 2/3rd of blood goes through foramen ovale–> LA–> LV–> aorta–> body
- RA—> RV–> PA–> ductus arteriosus connects aorta w/ PA shunting blood away from lungs–> mixed blood travels to head and body and back to the placenta
- blood arrives via umbilical vein–> Ductus venosus shunts oxygenated blood from placenta away from liver to heart
As baby takes its first breath, __ sided pressures become > than the ___ side pressure promoting closure of the FO and DA
Left > Right
- ___ keeps the ductus arteriosus patent
2. ___ closes the patent ductus arteriosus
- Prostaglandins keep PDA open (ie. PGE1)
2. Prostaglandin inhibitors (ie. indomethacin or ibuprofen) closes PDA
What are the most common functional pediatric murmurs and what causes their sound?
- Still’s (MC)- 2y/o-adolescents: musical, vibratory, high pitched at LLSB and apex, 2/2 vibration of valve leaflets
- Decreases w/ valsalva or sitting (louder supine) - Venous hum (2nd MC)- harsh, systolic ejection or diastolic 2/2 sound of blood flowing from jugular veins to heart
- Decreases supine, or pressure on jugular vein - Pulmonary Ejection- older kids-adolescents: harsh, mid systole in second LICS, 2/2 blood flowing across PV into PA
What are the congenital cyanotic heart diseases
5 T’s
- Truncus arteriosus: 1 vessel instead of 2 (aorta and PA)
- TGA: 2 vessels switch
- Tricuspid atresia: absent tricuspid valve and hypoplastic RV
- Tetralogy of Fallot: RV outflow obstruction, PS, RVH, Overriding aorta, VSD
- TAPVR: (5 vessels involved)- all 4 pulm. veins connect to 2 vessel (SVC) instead of LA
MC type of congenital heart disease
MC type of cyanotic congenital heart disease
VSD (L–> R shunt)
types:
1. perimembransous (MC-80%)
2. Muscular (usually multiple little holes like swiss cheese)
3. inlet (posterior- to TV)
4. Supacristal (outlet)- beneath PV
Tetralogy of fallot
What leads to Eisenmenger’s Syndrome and what is ES?
- Large (nonrestrictive=no pressure difference) VSD
- PDA
- Tetralogy of fallot
ES= when pulm. pressure becomes greater than systemic pressure= R–> L shunt and results in CP, cyansosis*
-results in PHTN
How do you dx and manage VSDs
Dx:
- Echo*
- CXR: RVH
- EKG: LVH w/ mild-mod +/- RVH/LVH
TX:
- small, restrictive VSDs close spontaneously w/in 10 yrs
- surgery for large shunts by 2y/o to prevent PHTN
What are the following CXRs?
- Egg on a string
- Snowman
- Boot shaped heart
- TGA
- TAPVR
- Tetralogy of fallot
Tx of TGA
**2 parallel circulations are incompatible w/ life unless mixing of circulation is present either via VSD, ASD or PDA
TX:
- PGE1 analog to keep PDA open
- Balloon atrial septostomy
- **Surgical repair
70% of patients with coarctation of the aorta also have ___
bicuspid aortic valve
- Wide pulse pressure
- Widely split fixed S2
- Bounding peripheral pulses, loud S2
- Right ventricular heave
- PDA
- ASD
- PDA
- tetralogy of fallot
Hypoplastic L heart syndrome is due to the failure of the development of:
MV, AV or aortic arch leading to small ventricle
What is infant respiratory distress syndrome
(hyaline membrane disease)
-disease of premature infants*** 2/2 to insufficiency of surfactant
*Surfactant production begins __ weeks and by __ weeks enough surfactant is produced
24-28 weeks
35 wks
Risk factors for infant respiratory distress syndrome
- Caucasian males (2x MC)
- C-section (stress causes cortisol production)
- perinatal infections
- multiple births (esp. if prematures)
- Maternal diabetes (high insulin delays surfactant production)
- preterm infant w/ tachypnea, tachycardia, retractions, nasal flaring
- CXR: bilateral diffuse reticular ground-glass opacities + air bronchograms
Infant respiratory distress syndrome
TX: Exogenous surfactant given to open alveoli (via ET tube), CPAP
Corticosteroids is given to mature lungs if premature delivery is expected at ___ wks
24-36 wks
- post-term infant w/ tachypnea, tachycardia, retractions, nasal flaring
- CXR: streaky linear densities, diffuse patchy infiltrates w/ lung hyperinflation (flattened diaphragms, increased AP diameter)
- h/o meconium stained fluid
Meconium aspiration
TX:
- Prevent postmature delivery >41 wks (prevent is most effective therapy**)
- Supportive
Leading cause of death between 1 month and 1 yr in the US
SIDS
*infants sleeping in the prone position is the strongest modifiable RISK FACTOR
MC causes of indirect (unconjugated) hyperbili
- Indirect peaks at 3-5 days and falls in ~1 wk
1. physiologic- immature liver and decreased UGT enzyme
2. Prematurity
3. Breast-feeding (2nd-3rd DOL)
4. Crigler-Najjar
5. Gilberts- G6PD def.
6. Cretinism
7. Hemolytic anemia
- Indirect peaks at 3-5 days and falls in ~1 wk
MC causes of direct (conjugated) hyperbili
- Dubin-Johnson Syndrome
- infection
- Rotor syndrome
Risk of kernicterus and neurotoxicity occurs at Bilirubin level of ____. This is due to irreversible deposition of bilirubin in _____
> 20
basal ganglia, pons, cerebellum
- Non-bilious vomiting that is projectiles
- child remains hungry
- non-tender, moblile hard mass in stomach
- upper GI study w. contrast shows string sign
Pyloric stenosis (increased incidence w/ erythromycin use) **hypertrophy and hyperplasia of the muscular layers of the pylorus causing a **functional outlet obstruction
DX:
1. US
2 UGI contrast= String sign*
TX:
1. rehydration w/ IV fluids then pyloromytomy
Pyloric stenosis is associated w/ what electrolyte abnormalities
Hypochloremic metabolic alkalosis (from vomiting)
**replenish K+ w/ treatment
- Vomiting, abdominal pain, passage of blood per rectum mixed w/ mucus
- Sausage-shaped mass in RUQ or hyppochondrium and emptiness in the RLQ
Intussusception
- Sausage-shaped mass w/ emptiness in RLQ= Dance’s sign
- blood per rectum w/ mixed mucus= Currant jelly stool
DX: Barium contrast enema (diagnostic and therapeutic)
TX: barium or air insufflation +/- surgical resection if refractory
What is the initial screening test for Hirschsprung disease
Anorectal manometry
*rectal biopsy is definitive dx, rectal suction biopsy is less invasive
Esophageal atresia is MC associated w/ ___
tracheoesophageal fistula and polyhydramnios in pregnancy
- Bilious vomiting, abdominal distention
- h/o polyhydramnios in pregnancy
- abdominal XR: distended duodenum and stomach separated by pyloric valve= “double-bubble” sign
Duodenal atresia
*increased incidence with DS
TX: decompression of GI tract, surgical repair
Tx of diaper rash (dermatitis)
- frequent diaper changes q2hr r when soiled
- open air exposure
- Topical zinc oxide or petroleum jelly
- 1% hydrocortisone (use for <2wks)
-High fever 3-5 days but appears well and alert–> fever resolves before onset of a rose, pink maculopapular, blanchable rash on trunk/back–> then spreads to face
Roseola Infantum (Sixth's disease) *HHV-6 or 7
only childhood viral exanthem that starts on trunk
TX: supportive, anti-inflammatory, antipyretics to prevent febrile seizure
Mild fever, URI sx, decreased appetite starting 3-5 days after exposure–> oral enanthem: vesicular lesions w/ erythematous halos in oral cavity (esp. buccal mucosa and tongue)–> exanthem 1-2 days afterwards w/ vesicular, macular or maculopapular lesions on distal extremities including palms and soles
Hand foot and mouth disease (coxsackie A)
TX: supportive
Sudden onset of high fevers, stomatitis: small vesicles on soft palate, uvula and tonsillar pillars taht ulcerate before healing, sore throat.
Herpangina (Coxsackie A)
Cocksackie B primarily causes
- Pericarditis and myocarditis
2. pleurodynia
Low grade fever, myalgias, HA–> parotid gland pain and swelling
Mumps (paramyxovirus)
TX: supportive 7-10 days
Prevention: MMR vx at 12 month and 4-6y/o
Mumps is caused by ____
Complications include:
paramyxovirus
Complications: MC in older patients
- Orchitis in males (usually unilateral)
- Mumps MC cause of acute pancreatitis in children***
- URI prodrome w/ high fever, cough, conjunctivitis, runny nose
- small red spots in buccal mucosa w/ pale blue/white center–> morbiliform (maculopapular) brick-red* rash on face beginning at hair line and spreading to extremities and darkens and coalesces
- Rash lasts 7 days fading top to bottom
Rubeola (measles)
small red spots= Koplik spots
TX: supportive
Comp
Rubeola (measles) is caused by ___
Complications include:
Paramyoxovirus
Complications:
- Diarrhea
- otitis media
- Low grade fever, cough, anorexia, lymphadenopathy (posterior cervical, posterior auricular)–> pink, light-red spotted maculopapular rash on face that spreads to extremities rapidly (rash lasts 3 days*)
- rash does not darken or coalesce
- Small red macules or petechiae on soft palate
- Transient photosensitivity and joint pain
Rubella (german measles)
*3 day rash
small red spots= forchheimer spots
DX: IgM Ab via enzyme immunoassay or clinical
TX: supportive
Rubella infection is teratogenic especially in __ trimester.
It can cause:
1st trimester (TOR*CH)
- congenital syndrome- SN deafness
- cataracts
- TTP (blueberry muffin rash)
- mental retardation
- Coryza, fever–> red “slapped cheeks” on face w/ circumoral pallor 2-4 days –> lacy reticular rash on extremities (esp. upper). Rash resolves in 2-3 days
- Arthroopathy/arthralgias in older kids/adults
Erythema Infectiosum (Fifth disease) – Parvovirus B19
Erythema Infectiosum (Fifth disease) is caused by \_\_\_ Complications include:
Parvovirus B19
- increased fetal loss in pregnancy
- Parvovirus B19 may cause aplastic crisis in pts w/ sickle cell disease or G6PD def.
- Arthropathy/arthralgias
- Small erythematous macules or papules –> pustules on erythematous base 3-5 days after birth
- Does not involve soles or palms
Erythema Toxicum
TX: self limiting
- Tiny, friable clear vesicle (due to sweat in superficial stratum corneum)
- MC in neonates
Miliaria crystallina
*blockage of eccrine sweat glands
-1-2mm pearly white-yellow papules especially seen on the cheeks, forehead, chin and nose on newborn
Milia (due to keratin retention within the dermis of immature skin)
TX: self limiting (may be seen up to 3 months)
Uniformly hyperpigmented macules or patches with sharp demarcation. Either present at birth (or developing early in childhood). Varing colors from light brown to chocolate brown
Cafe au lait macules
*kids w/ 6 or more (esp. w/ axillary or inguinal freckling) should be evaluated for possible neurofibromatosis type 1
- Pink-red sharply demarcated, blanchable macules or papules in infancy. Overtime, they grow and darken to a purple color and may develop a thickened surface
- MC on head and neck
Port-wine stain (ie. capillary malformations, nevus flammeus)
TX: pulse dye laser tx (best if used in infancy for best outcomes)
Facial port wine stain + leptomeningeal angiomatosis + ocular involvement (ie. glaucoma) =
Sturge-Weber Syndrome
*may develop hemiparesis contralateral to the facial lesion, seizures or intracranial calcification and learn disbilities
- Blue or slate gray pigmented macular lesion MC in presacral/sacral-gluteal area (may be seen on shoulders, legs, back and posterior thighs) w/ indefinite borders
- May be solitary or multiple
- MC in Asians, East Indian and AA
Mongolian Spots
TX: typically fade over first few yrs of life (before 10)
- Malaise, fever, irritability, extreme skin tenderness–> cutaneous, blanching erythema- bright skin erythema often starting centrally and around the mouth before spreading diffusely.
- Erythema is worse in flexor areas and around orficies- esp. mouth
- After 1-2 days develops “sterile flaccid blisters”, esp. in areas of mechanical stress–> positive Nikolsky sign: separation of the dermis and rupture of the fragile blisters when gentle pressure is applied to the skin
- Desquamative phase- skin that easily ruptures, leaving moist, denuded skin before healing
- Inflamed conjunctiva
Staphylococcal Scalded Skin Syndrome (Ritter Disease)
TX:
- Abx: Penicillinase-resistant penicillin 1st line- ie. Nafcillin or Oxacillin
- supportive
- fluid and electrolyte replacement
- Sandpaper diffuse erythematous blanchable rash that starts in the groin and axillae and spreads to extremities and desquamates overtime
- Often associated w/ flushed face w/ circumoral pallor and strawberry tongue
- fever, chills, pharyngitis
Scarlet fever (Scarlatina)
TX:
PCN G or VK 1st line
2. macrolid if PCN allergy
Describe the cause and symptoms of Turners Syndrome
Females w/ absent/nonfunctional X chromosome
S/S:
- hypogonadism–> primary amenorrhea or early ovarian failure or infertility
- delayed secondary sex characteristics
- short stature
- Webbed neck, edema, low hairlin
- low set ears, widely spaced nipples
- Coarc (30%), MV prolapse, bicuspid AV
Describe the cause and symptoms of Klinefelter’s Syndrome
Males w/ extra X chromosome, 47XXY
S/S:
- hypogonadism: small testes
- tall stature after puberty onset
What type of mutation causes Fragile X Syndrome
X-linked genetic d/o that is the MC gene related cause of autism
*Macroorchidism in older mlaes
Clinical manifestations of Downs Syndrome (Trisomy 21)
- low-set ears
- flat facial profile/flat nasal bridge
- protruding tongue
- *Brushfield spots: white/gray/brown spots on iris
- palmar simian crease
- AVSD, VSD ,ASD, tetralogy, PDA
- Hirschsprungs disease, duodenal atresia
- Leukemia
- 1st and 2nd toe sandal gap
- Skin hyperextensibility (stretch skin >4cm)
- MV prolapse
- Smooth velvety/doughy fragile skin (bruises easily)
- Upper eyelid everts easily (Metenier’s sign)
- Joint hypermobility
Ehler Danlos Syndrome
*genetic d/o of collagen synthesis leading to fragile CT
*Aneurysm rupture is a common cause of death
Common findings with Marfan Syndrome
- MVP, aortic root dilation w/ AR
- tall stature, over growth of long bones
- pectus carinatum (protrusion) or excavatum (sunken)
- Joint laxity
- Ectopia lentis (malposition or dislocation of lens of eye–> myopia, reduced near vision)
*Autosomal dominant
Neural tube defects are associated with ___. How do you detect NT defects
maternal folate deficiency and can present as spina bifida
Detection: increased maternal serum alpha-fetoprotein via aminocentesis: increase alpha-fetoprotein and acetylcholinesterase
- Prenatal: breech, polyhadramnios
- Neonate: hypotonia, floppy baby, feeding difficulties, cryptorchidism, postnatal growth delay
- Childhood: developmental disabilities, hyperphagia (voracious appetite), obesity
- Adult: sterility
-almond-shaped eyes, high/narrow forehead, thin upper lip
Prader-willi Syndrome
DX: DNA testing
TX: GH replacement, monitor food intake
Beckwith-Wiedemann Syndrome has an increased risk of __ and ___
hepatoblastoma and Wilm’s tumor
MC sites of neuroblastomas
adrenal medulla and paraspinal region
s/s: abdominal mass, ataxia, opsoclonus myoclonus syndrome
Neurofibromatosis type 1 requires at least 2 of the following clinical manifestations
- 6 or more cafe au lait spots
- axillary or inguinal freckling
- Lisch nodules of the iris
- 2 or more neurofibromas or 1 or more plexiform neurofibroma
- Optic pathway glioma
MRI: unidentified bright objects
*autosomal dominant
Neurofibromatosis type 2 clinical manifestations
- Bilateral vestibular schwannomas (CN VIII tumors)
- Optic lesions/cataracts
- skin lesion
- Meningiomas
- premature neuron death and progressive degeneration of neurons
- Infantile onset: increased startle reflex–> decreased eye contact–> seizures–> death
- PE: Cherry red spots w/ macular pallor, macrocephaly
Tay-Sachs Disease
TX: no effective tx
What vaccines are contraindicated w/ an allergy to”
- Bakers yeast:
- Eggs:
- Gelatin:
- Thimerosal:
- Neomycin and Streptomycin:
- Bakers yeast: Hep B (B-B)
- Eggs: live Influenza (Ok to get injectable)
- Gelatin: varicella, influenza
- Thimerosal: avoid multi-dose vx due to preservatives
- Neomycin and Streptomycin: MMR and inactivated polio
What vx are safe to give during pregnancy
diphtheria, tetanus, inactivated influenza, HBV
**Avoid live vx–> MMR, varicella, polio, intranasal flu
sx of lead exposure
- ataxia
- irritability
- personality changes
- vomiting
LATE changes: convulsions
how do differentiate alpha-thalassemia, B-thalassemia major and minor
*electrophoresis
alpha- Bart’s hemoglobin
B major- absent hemoglobin A
B minor- mild anemia 6-12 months old and normal neonatal screen
MC pathogen that causes tonsillitis in the US
adenovirus
What is the most common malignancy of childhood
ALL (25%)
what is the most common cause of bacterial meningitis in pediatrics?
#1 Streptocccus pneumoniae #2 Haemophilus influenzae
Describe tanner staging for females
I- absent breasts and pubic hair
II- small, raised breast buds and spares/fine hair on border of labia
III- further breast enlargement/elevation of breast and alveolar tissue and pigmented and curly and increases in quantity on the mons pubis
IV- areola and papilla forming a secondary mound on breast contour and coarser texture w/ labia and mons pubis well covered
V- mature breast w/ alveolar area as part of the breast contour and mature hair distribution spreading to medial thighs
Common PE findings suspicious of child abuse
- Radial head subluxation esp. if repeated
2. abdominal bruises
What medications are FDA approved for abortive migraine therapy in pediatrics?
- Rizatriptan (6-17 y/o)
2. Almotriptan (12-17y/o)
___, if swallowed by a child is safe to pass on its own as long as the child remains asymptomatic
straight pin
*weighted end allows it to pass normally
In the initial evaluation of a child w/ newly dx HTN, what test will help rule in the most common etiology?
Urinalysis
*Most likely renal dz–> if abnormal then get renal US
MC pathogen of UTI
E. coli
What is the recommended treatment for a 4y/o with presumed bacterial meningitis?
Cefotaxime (Clarforan) or ceftriaxone (Rocephin) + vanco
Tx for infant w/ gonococcal ophthalmia neonatorum
Ceftriaxone
MC cause of gynecomcastia in kids
idiopathic
At what thoracic curvature is indicated for treatment w/ bracing in an adolescent w/ scoliosis
20-40 degrees
> 40= surgery
How do you reduce a nursemaid elbow
place elbow in full supination and moving it slowly from full extension to full flexion
MC causes of Stevens-Johnson Syndrome or Erythema multiforme major
- Meds: sulfonamide, PCN, tetracycline
2. Mycoplasma pneumoniae
According to the DSM-5, sx of ADHD must be present before what age?
12 y/o
When should children be examined alone to allow them to share info freely with the provider
11-12y/o (adolescence years)
Complications of Meckel diverticulum occur most frequently in what population?
3X more likely in males
-50% more likely to occur in kids less than 2y/o
an acutely inflamed swelling and tender area over the lacrimal sac just medial and inferior to the inner canths of the eye
Dacryocystitis (usually secondary to bacterial infection)
What is the recommended treatment for family members in the hosuehold if one is diagnosed with pertussis?
azithromycin (Zithromax)
MC cause of conjunctivitis in the newborn
Chlamydial infection
TX: erythromycin
__ is the presenting sx in 70% of children w/ bipolar disorder
depression
In young children, what is the MC cause of lower respiratory tract infections?
RSV
What are short term and long term complications of anorexia
short term:
- constipation
- pericardial effusion
- superior mesenteric artery syndrome
Long term:
1. loss of brain tissue
In pediatrics, what is defined as
- Obese
- Overweight
- Severely obese
- BMI >95th %tile
- 85-95th% tile
- > 99th
