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PANCE > PANCE Prep- Peds > Flashcards

PANCE Prep- Peds Flashcards

1
Q

When do the following reflexes disspear?

  1. Moro reflex
  2. Palmar grasp
  3. Upward Babinski
  4. Parachute reflex
  5. Rooting
  6. Galant
A
  1. Moro (startle): 2-4 months
  2. Palmar: 5-6 months
  3. Upward Babinski: normal up to 2y/o
  4. Parachute: appears ~7months old and persists for life
  5. Rooting: 4 months
  6. Galant: 4 months
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2
Q

Describe the ortolani and barlow maneuver

A

Ortolani: push hips anterior/out= reduction of the hip joint (feel a clunk)

Barlow: Posterior force (Back)= dislocation of the hip

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3
Q
  1. Describe fetal cardiac circulation.

2. Fetal circulation uses __ to __ shunts

A

R–> L shunts

  1. Fetus receives nutrients and O2 from placenta–> IVC–> RA–>
  2. RA–> 2/3rd of blood goes through foramen ovale–> LA–> LV–> aorta–> body
  3. 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
  4. blood arrives via umbilical vein–> Ductus venosus shunts oxygenated blood from placenta away from liver to heart
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4
Q

As baby takes its first breath, __ sided pressures become > than the ___ side pressure promoting closure of the FO and DA

A

Left > Right

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5
Q
  1. ___ keeps the ductus arteriosus patent

2. ___ closes the patent ductus arteriosus

A
  1. Prostaglandins keep PDA open (ie. PGE1)

2. Prostaglandin inhibitors (ie. indomethacin or ibuprofen) closes PDA

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6
Q

What are the most common functional pediatric murmurs and what causes their sound?

A
  1. 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)
  2. 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
  3. Pulmonary Ejection- older kids-adolescents: harsh, mid systole in second LICS, 2/2 blood flowing across PV into PA
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7
Q

What are the congenital cyanotic heart diseases

A

5 T’s

  1. Truncus arteriosus: 1 vessel instead of 2 (aorta and PA)
  2. TGA: 2 vessels switch
  3. Tricuspid atresia: absent tricuspid valve and hypoplastic RV
  4. Tetralogy of Fallot: RV outflow obstruction, PS, RVH, Overriding aorta, VSD
  5. TAPVR: (5 vessels involved)- all 4 pulm. veins connect to 2 vessel (SVC) instead of LA
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8
Q

MC type of congenital heart disease

MC type of cyanotic congenital heart disease

A

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

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9
Q

What leads to Eisenmenger’s Syndrome and what is ES?

A
  1. Large (nonrestrictive=no pressure difference) VSD
  2. PDA
  3. Tetralogy of fallot

ES= when pulm. pressure becomes greater than systemic pressure= R–> L shunt and results in CP, cyansosis*
-results in PHTN

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10
Q

How do you dx and manage VSDs

A

Dx:

  1. Echo*
  2. CXR: RVH
  3. EKG: LVH w/ mild-mod +/- RVH/LVH

TX:

  1. small, restrictive VSDs close spontaneously w/in 10 yrs
  2. surgery for large shunts by 2y/o to prevent PHTN
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11
Q

What are the following CXRs?

  1. Egg on a string
  2. Snowman
  3. Boot shaped heart
A
  1. TGA
  2. TAPVR
  3. Tetralogy of fallot
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12
Q

Tx of TGA

A

**2 parallel circulations are incompatible w/ life unless mixing of circulation is present either via VSD, ASD or PDA

TX:

  1. PGE1 analog to keep PDA open
  2. Balloon atrial septostomy
  3. **Surgical repair
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13
Q

70% of patients with coarctation of the aorta also have ___

A

bicuspid aortic valve

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14
Q
  1. Wide pulse pressure
  2. Widely split fixed S2
  3. Bounding peripheral pulses, loud S2
  4. Right ventricular heave
A
  1. PDA
  2. ASD
  3. PDA
  4. tetralogy of fallot
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15
Q

Hypoplastic L heart syndrome is due to the failure of the development of:

A

MV, AV or aortic arch leading to small ventricle

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16
Q

What is infant respiratory distress syndrome

A

(hyaline membrane disease)

-disease of premature infants*** 2/2 to insufficiency of surfactant

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17
Q

*Surfactant production begins __ weeks and by __ weeks enough surfactant is produced

A

24-28 weeks

35 wks

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18
Q

Risk factors for infant respiratory distress syndrome

A
  1. Caucasian males (2x MC)
  2. C-section (stress causes cortisol production)
  3. perinatal infections
  4. multiple births (esp. if prematures)
  5. Maternal diabetes (high insulin delays surfactant production)
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19
Q
  • preterm infant w/ tachypnea, tachycardia, retractions, nasal flaring
  • CXR: bilateral diffuse reticular ground-glass opacities + air bronchograms
A

Infant respiratory distress syndrome

TX: Exogenous surfactant given to open alveoli (via ET tube), CPAP

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20
Q

Corticosteroids is given to mature lungs if premature delivery is expected at ___ wks

A

24-36 wks

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21
Q
  • 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
A

Meconium aspiration

TX:

  1. Prevent postmature delivery >41 wks (prevent is most effective therapy**)
  2. Supportive
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22
Q

Leading cause of death between 1 month and 1 yr in the US

A

SIDS

*infants sleeping in the prone position is the strongest modifiable RISK FACTOR

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23
Q

MC causes of indirect (unconjugated) hyperbili

A
    • 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
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24
Q

MC causes of direct (conjugated) hyperbili

A
  1. Dubin-Johnson Syndrome
  2. infection
  3. Rotor syndrome
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25
Q

Risk of kernicterus and neurotoxicity occurs at Bilirubin level of ____. This is due to irreversible deposition of bilirubin in _____

A

> 20

basal ganglia, pons, cerebellum

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26
Q
  • Non-bilious vomiting that is projectiles
  • child remains hungry
  • non-tender, moblile hard mass in stomach
  • upper GI study w. contrast shows string sign
A 
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

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27
Q

Pyloric stenosis is associated w/ what electrolyte abnormalities

A

Hypochloremic metabolic alkalosis (from vomiting)

**replenish K+ w/ treatment

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28
Q
  • Vomiting, abdominal pain, passage of blood per rectum mixed w/ mucus
  • Sausage-shaped mass in RUQ or hyppochondrium and emptiness in the RLQ
A

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

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29
Q

What is the initial screening test for Hirschsprung disease

A

Anorectal manometry

*rectal biopsy is definitive dx, rectal suction biopsy is less invasive

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30
Q

Esophageal atresia is MC associated w/ ___

A

tracheoesophageal fistula and polyhydramnios in pregnancy

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31
Q
  • Bilious vomiting, abdominal distention
  • h/o polyhydramnios in pregnancy
  • abdominal XR: distended duodenum and stomach separated by pyloric valve= “double-bubble” sign
A

Duodenal atresia
*increased incidence with DS

TX: decompression of GI tract, surgical repair

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32
Q

Tx of diaper rash (dermatitis)

A
  1. frequent diaper changes q2hr r when soiled
  2. open air exposure
  3. Topical zinc oxide or petroleum jelly
  4. 1% hydrocortisone (use for <2wks)
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33
Q

-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

A 
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

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34
Q

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

A

Hand foot and mouth disease (coxsackie A)

TX: supportive

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35
Q

Sudden onset of high fevers, stomatitis: small vesicles on soft palate, uvula and tonsillar pillars taht ulcerate before healing, sore throat.

A

Herpangina (Coxsackie A)

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36
Q

Cocksackie B primarily causes

A
  1. Pericarditis and myocarditis

2. pleurodynia

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37
Q

Low grade fever, myalgias, HA–> parotid gland pain and swelling

A

Mumps (paramyxovirus)

TX: supportive 7-10 days
Prevention: MMR vx at 12 month and 4-6y/o

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38
Q

Mumps is caused by ____

Complications include:

A

paramyxovirus

Complications: MC in older patients

  1. Orchitis in males (usually unilateral)
  2. Mumps MC cause of acute pancreatitis in children***
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39
Q
  • 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
A

Rubeola (measles)

small red spots= Koplik spots
TX: supportive

Comp

40
Q

Rubeola (measles) is caused by ___

Complications include:

A

Paramyoxovirus

Complications:

  1. Diarrhea
  2. otitis media
41
Q
  • 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
A

Rubella (german measles)
*3 day rash

small red spots= forchheimer spots

DX: IgM Ab via enzyme immunoassay or clinical

TX: supportive

42
Q

Rubella infection is teratogenic especially in __ trimester.
It can cause:

A

1st trimester (TOR*CH)

  1. congenital syndrome- SN deafness
  2. cataracts
  3. TTP (blueberry muffin rash)
  4. mental retardation
43
Q
  • 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
A

Erythema Infectiosum (Fifth disease) – Parvovirus B19

44
Q 
Erythema Infectiosum (Fifth disease) is caused by \_\_\_
Complications include:
A

Parvovirus B19

  1. increased fetal loss in pregnancy
  2. Parvovirus B19 may cause aplastic crisis in pts w/ sickle cell disease or G6PD def.
  3. Arthropathy/arthralgias
45
Q
  • Small erythematous macules or papules –> pustules on erythematous base 3-5 days after birth
  • Does not involve soles or palms
A

Erythema Toxicum

TX: self limiting

46
Q
  • Tiny, friable clear vesicle (due to sweat in superficial stratum corneum)
  • MC in neonates
A

Miliaria crystallina

*blockage of eccrine sweat glands

47
Q

-1-2mm pearly white-yellow papules especially seen on the cheeks, forehead, chin and nose on newborn

A

Milia (due to keratin retention within the dermis of immature skin)

TX: self limiting (may be seen up to 3 months)

48
Q

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

A

Cafe au lait macules

*kids w/ 6 or more (esp. w/ axillary or inguinal freckling) should be evaluated for possible neurofibromatosis type 1

49
Q
  • 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
A

Port-wine stain (ie. capillary malformations, nevus flammeus)

TX: pulse dye laser tx (best if used in infancy for best outcomes)

50
Q

Facial port wine stain + leptomeningeal angiomatosis + ocular involvement (ie. glaucoma) =

A

Sturge-Weber Syndrome
*may develop hemiparesis contralateral to the facial lesion, seizures or intracranial calcification and learn disbilities

51
Q
  • 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
A

Mongolian Spots

TX: typically fade over first few yrs of life (before 10)

52
Q
  • 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
A

Staphylococcal Scalded Skin Syndrome (Ritter Disease)

TX:

  1. Abx: Penicillinase-resistant penicillin 1st line- ie. Nafcillin or Oxacillin
  2. supportive
  3. fluid and electrolyte replacement
53
Q
  • 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
A

Scarlet fever (Scarlatina)

TX:
PCN G or VK 1st line
2. macrolid if PCN allergy

54
Q

Describe the cause and symptoms of Turners Syndrome

A

Females w/ absent/nonfunctional X chromosome

S/S:

  1. hypogonadism–> primary amenorrhea or early ovarian failure or infertility
  2. delayed secondary sex characteristics
  3. short stature
  4. Webbed neck, edema, low hairlin
  5. low set ears, widely spaced nipples
  6. Coarc (30%), MV prolapse, bicuspid AV
55
Q

Describe the cause and symptoms of Klinefelter’s Syndrome

A

Males w/ extra X chromosome, 47XXY

S/S:

  1. hypogonadism: small testes
  2. tall stature after puberty onset
56
Q

What type of mutation causes Fragile X Syndrome

A

X-linked genetic d/o that is the MC gene related cause of autism

*Macroorchidism in older mlaes

57
Q

Clinical manifestations of Downs Syndrome (Trisomy 21)

A
  1. low-set ears
  2. flat facial profile/flat nasal bridge
  3. protruding tongue
  4. *Brushfield spots: white/gray/brown spots on iris
  5. palmar simian crease
  6. AVSD, VSD ,ASD, tetralogy, PDA
  7. Hirschsprungs disease, duodenal atresia
  8. Leukemia
  9. 1st and 2nd toe sandal gap
58
Q
  • Skin hyperextensibility (stretch skin >4cm)
  • MV prolapse
  • Smooth velvety/doughy fragile skin (bruises easily)
  • Upper eyelid everts easily (Metenier’s sign)
  • Joint hypermobility
A

Ehler Danlos Syndrome
*genetic d/o of collagen synthesis leading to fragile CT

*Aneurysm rupture is a common cause of death

59
Q

Common findings with Marfan Syndrome

A
  1. MVP, aortic root dilation w/ AR
  2. tall stature, over growth of long bones
  3. pectus carinatum (protrusion) or excavatum (sunken)
  4. Joint laxity
  5. Ectopia lentis (malposition or dislocation of lens of eye–> myopia, reduced near vision)

*Autosomal dominant

60
Q

Neural tube defects are associated with ___. How do you detect NT defects

A

maternal folate deficiency and can present as spina bifida

Detection: increased maternal serum alpha-fetoprotein via aminocentesis: increase alpha-fetoprotein and acetylcholinesterase

61
Q
  • 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

A

Prader-willi Syndrome

DX: DNA testing

TX: GH replacement, monitor food intake

62
Q

Beckwith-Wiedemann Syndrome has an increased risk of __ and ___

A

hepatoblastoma and Wilm’s tumor

63
Q

MC sites of neuroblastomas

A

adrenal medulla and paraspinal region

s/s: abdominal mass, ataxia, opsoclonus myoclonus syndrome

64
Q

Neurofibromatosis type 1 requires at least 2 of the following clinical manifestations

A
  1. 6 or more cafe au lait spots
  2. axillary or inguinal freckling
  3. Lisch nodules of the iris
  4. 2 or more neurofibromas or 1 or more plexiform neurofibroma
  5. Optic pathway glioma

MRI: unidentified bright objects

*autosomal dominant

65
Q

Neurofibromatosis type 2 clinical manifestations

A
  1. Bilateral vestibular schwannomas (CN VIII tumors)
  2. Optic lesions/cataracts
  3. skin lesion
  4. Meningiomas
66
Q
  • 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
A

Tay-Sachs Disease

TX: no effective tx

67
Q

What vaccines are contraindicated w/ an allergy to”

  1. Bakers yeast:
  2. Eggs:
  3. Gelatin:
  4. Thimerosal:
  5. Neomycin and Streptomycin:
A
  1. Bakers yeast: Hep B (B-B)
  2. Eggs: live Influenza (Ok to get injectable)
  3. Gelatin: varicella, influenza
  4. Thimerosal: avoid multi-dose vx due to preservatives
  5. Neomycin and Streptomycin: MMR and inactivated polio
68
Q

What vx are safe to give during pregnancy

A

diphtheria, tetanus, inactivated influenza, HBV

**Avoid live vx–> MMR, varicella, polio, intranasal flu

69
Q

sx of lead exposure

A
  1. ataxia
  2. irritability
  3. personality changes
  4. vomiting

LATE changes: convulsions

70
Q

how do differentiate alpha-thalassemia, B-thalassemia major and minor

A

*electrophoresis

alpha- Bart’s hemoglobin
B major- absent hemoglobin A
B minor- mild anemia 6-12 months old and normal neonatal screen

71
Q

MC pathogen that causes tonsillitis in the US

A

adenovirus

72
Q

What is the most common malignancy of childhood

A

ALL (25%)

73
Q

what is the most common cause of bacterial meningitis in pediatrics?

A 
#1 Streptocccus pneumoniae 
#2 Haemophilus influenzae
74
Q

Describe tanner staging for females

A

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

75
Q

Common PE findings suspicious of child abuse

A
  1. Radial head subluxation esp. if repeated

2. abdominal bruises

76
Q

What medications are FDA approved for abortive migraine therapy in pediatrics?

A
  1. Rizatriptan (6-17 y/o)

2. Almotriptan (12-17y/o)

77
Q

___, if swallowed by a child is safe to pass on its own as long as the child remains asymptomatic

A

straight pin

*weighted end allows it to pass normally

78
Q

In the initial evaluation of a child w/ newly dx HTN, what test will help rule in the most common etiology?

A

Urinalysis

*Most likely renal dz–> if abnormal then get renal US

79
Q

MC pathogen of UTI

A

E. coli

80
Q

What is the recommended treatment for a 4y/o with presumed bacterial meningitis?

A

Cefotaxime (Clarforan) or ceftriaxone (Rocephin) + vanco

81
Q

Tx for infant w/ gonococcal ophthalmia neonatorum

A

Ceftriaxone

82
Q

MC cause of gynecomcastia in kids

A

idiopathic

83
Q

At what thoracic curvature is indicated for treatment w/ bracing in an adolescent w/ scoliosis

A

20-40 degrees

> 40= surgery

84
Q

How do you reduce a nursemaid elbow

A

place elbow in full supination and moving it slowly from full extension to full flexion

85
Q

MC causes of Stevens-Johnson Syndrome or Erythema multiforme major

A
  1. Meds: sulfonamide, PCN, tetracycline

2. Mycoplasma pneumoniae

86
Q

According to the DSM-5, sx of ADHD must be present before what age?

A

12 y/o

87
Q

When should children be examined alone to allow them to share info freely with the provider

A

11-12y/o (adolescence years)

88
Q

Complications of Meckel diverticulum occur most frequently in what population?

A

3X more likely in males

-50% more likely to occur in kids less than 2y/o

89
Q

an acutely inflamed swelling and tender area over the lacrimal sac just medial and inferior to the inner canths of the eye

A

Dacryocystitis (usually secondary to bacterial infection)

90
Q

What is the recommended treatment for family members in the hosuehold if one is diagnosed with pertussis?

A

azithromycin (Zithromax)

91
Q

MC cause of conjunctivitis in the newborn

A

Chlamydial infection

TX: erythromycin

92
Q

__ is the presenting sx in 70% of children w/ bipolar disorder

A

depression

93
Q

In young children, what is the MC cause of lower respiratory tract infections?

A

RSV

94
Q

What are short term and long term complications of anorexia

A

short term:

  1. constipation
  2. pericardial effusion
  3. superior mesenteric artery syndrome

Long term:
1. loss of brain tissue

95
Q

In pediatrics, what is defined as

  1. Obese
  2. Overweight
  3. Severely obese
A
  1. BMI >95th %tile
  2. 85-95th% tile
  3. > 99th

PANCE (17 decks)

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