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pediatrics > Pedi 13 > Flashcards

Pedi 13 Flashcards

1
Q

Pathogenesis of refeeding syndrome?

A

High insulin–Increase cellular uptake of K/Mg/P and thiamin–Low serum k/Mg/P and thiamine
High insulin also increases Na and Water retention

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2
Q

Manifestation?

A 
Arrhythmia and CHF
CNS(Seizure, Treamour..)
Wernicke encephalopathy
MSK(rhabdomyolysis and weakness)
GI(diarrhea and elevated TA)
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3
Q

RTA type?

A

1–distal
2-proximal
4-aldosterone related
D/T based on urine PH and electrolyte(PH is >5.5 in 1 and <5.5 in 2 and 4), serum K high in 4, and low-normal in 1 and 2

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4
Q

CM of RTA?

A

Growth failure
Low bicarbonate
High serum chlorine(help to D/T from MA from Gi causea)
Non Anion GAP metabolic acidosis

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5
Q

T1RTA Cxs?

A 
Poor H secretion in the distal nephron
High urine PH
Low-Normal serum K
Medication disorder
AID(SS and RA)
Family Hx of nephrolithiasis
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6
Q

T2RTA?

A

Defect in proximal Bicarb absorbition
Low urine PH
Low-Normal serum K
Fanconi syndrome(Glucoseuria,Posphaturia and aminoaciduria)

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7
Q

T4RTA?

A

Aldostrone resistant/defect in k/Na antiporte in DCT
Urine Ph <5.5
High serum K
CAH and Obstructive uropathy

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8
Q

DPT component?

A

Diphtheria Toxoid
Tetanus Toxoid
Conjugated/acellular pertussis

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9
Q

Schedule?

A

6 dose
2,4,6 month
15-18 month
4-6 year

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10
Q

C/I?

A

in Px dose
EncephalopathyIAMS, Prolonged seizure, comma…)
Anaphylaxis
Unstable neurologic sign(uncontrolled seizure and infantile spasm)

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11
Q

Reactive attachment disorder (RAD) CM?

A

Occur in children with Hx of neglect/abuse/prolonged institutionalization and inconsistent care
Seldom need comfort
Do not respond to confrontation
Lack of social responsiveness
Lack of positive emotion
Unexpected irritability and sadness to non-treatning situation

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12
Q

What about PTSD?

A

No emotional stunning

No lake of response to the caregiver

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13
Q

Risk factor for methemoglobinemia?

A

Nitrates
Dapsone
Topical/Local anesthetic

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14
Q

CM?

A

Cyanosis
Dark checolate blood
Pulsosimetry–85%

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15
Q

LAB?

A

Normal Po2

>5% d/c in saturation by pulse oximetry and ABG

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16
Q

pathophysiology?

A

Oxidizing agents—Change Fe2+ to Fe 3+–Low O2 affinity and Deacrese 02 release from periphery–Hypoxia/Blood colour and cyanosis did not respond to 100 02 but ABG read normal o2

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17
Q

management?

A 
Methylene blue(reduce MetHb to Hb)
Vit C if MB not available or C/I(G6PDD)
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18
Q

Viral meningitis Cxs?

A 
Viral predoom
Meningeal sign
CSF(WBC(10-500),G(40-70,I.e N) and P(40-150)
Focal NS less likely
MCC is Enterovirus
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19
Q

Enterovirus

A 
part of picorena (NE,IS,SS,RNA)
Poliovirus
Echovirus,
Coxsackievirus 
can cause  aseptic (viral) meningitis
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20
Q

management?

A

Supportive

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21
Q

Important Hx in monoarteritis?

A

Hx of rash(LD, SS, SJA–all three have a rash)

SS and SJA will have a rash

22
Q

Cxs of streaptococal perianal dermatitis?

A 
School-age
Sharpley demarcated perianal erythematous lesion
Pruritis and perianal pain
Fissure--Blood on stooling
Constipation due to pain
Personal or contact pharyngitis
23
Q

Management?

A

Oral antibiotic

24
Q

what about PW(EV)?

A

No significant perianal pain
Night pruritis
No sharp demarcated lesion

25
Q

MA(RKHS) d/t with AIS?

A

AIS
Male with female external genitalia
Absent axillary/pubic hair development

26
Q

CF complication in females?

A

Delay puberty due to malnutrition

Infertility due to cervical mucus thickening

27
Q

Hereditary angioedema pathophysiology?

A

Low C1 inhibitor protein –excessive C1 esterase activation–High bradykinin/Kalerkine activation–Low C4 level

28
Q

CM?

A 
Edema(Face, genitalia, and extremity)
Laryngeal edema
Nu urticaria or pruritis
Abd pain, Vomiting, and diarrhea
Episode Occur in stress, dental procedure, or trauma
29
Q

Management?

A

C1 concentrate

AntiBradykinin (icatibant) and ant Kallerkine(ecallantide)

30
Q

Avascular necrosis etiology?

A 
steroid
Alcohol
SLE
Hemoglinopphaty(SSD)
APS
Infection(osteomyelitis,HIV)
Renal transplant
Decompression sickness
31
Q

Pathophysiology of laryngomalacia?

A

Delayed maturation and NMD
Redundant supraglottic tissue
Recurrent inflammation(reflex)

32
Q

Management?

A

Normally resolve by 18 month
Reassurance +/- GERD therapy
Surgery in severe case

33
Q

Diagnosis?

A

Laryngoscopy
Omega shaped epiglottis
The collapse of the larynx during inspiration

34
Q

Newborn boy with potter sequence(flat face, deformed foot, and pul. Hypoplasia)

A

Posterior urethral valve

35
Q

transient tachypnea of the newborn?

A

Due to retained intrauterine fluid in neonate’s lung

transient RD and cyanosis

36
Q

cause of Trendelenburg sign?

A 
contralateral Gluteus medius and minimus lesion
Cause
NM disorder
Trauma and impediment of SGN
Inflammatory myopathy
37
Q

Lesch-Nyhan-syndrome genetics?

A

X-L-R
Deficiency of HGPRT enzyme
Accumulation of Hypoxanthine and Uric acid

38
Q

CM?

A

Delay in milestone and hypotonia in infancy
Early childhood
–Intellectual D
–Extrapyramidal Sx(e.g dystonia and choria)
–Pyramidal Sx (e.g hyperreflexia and spasticity)
–Self-mutilation
Gouty arthritis in late, untreated disease

39
Q

What to do inpatient with suspect of lead poisoning?

A

Capillary blood lead level
If >5ng/dl do venous sampling B/C CBLL have a high FP rate
If venous sampling >45 ng/dl–chelation
X-Ray–For GI symptomatic patient(constipation,abd pain, and diarrhea)–we see an opaque lesion

40
Q

Cong.Hypothyroidism sx?

A 
neonate normal during early infancy
Hypotonia
Protruding tongue
Umbilical hernia
weakness/sluggish movt
Jaundice
Hypothermia
Refractory Macrocytic anemia
Respiratory difficulty and noisy breath
41
Q

Management?

A

All neonates should be screened with T4 and TSH
dysgenesis(Aplasia, ectopia, and hypoplasia) MCC
Levothyroxine 10 mcg/kg and titrate based on need

42
Q

What to do in a child if parents refuse life-saving therapy like chemotherapy?

A

Seek court order

Hospital EC/RMG and social worker can assist in parent convincing

43
Q

HD sign help to d/t from MI?

A

High rectal tone
Squirt sign
Colonic dilation

44
Q

When will the germinal matrix be involute?

A

At 32 week

I.e the reason why prematurity is the main risk for IVH

45
Q

Aproch in wommen with primery amenoria?

A

Pelvic u/s
1–If uterus present–Do FSH(if high karyotype and if low cranial MRI)
2–If uterus absent—Do karyotype(XX–MA and if XY AIS)

46
Q

But when we consider observation?

A

age 13-15 with development of other SSC(Breast)

47
Q

Why do turner patients will have adrenarche?

A

B/C TS doesn’t affect the Adrenal gland i.e patient will have normal axillary/pubic hair development.

48
Q

Lyme disease prophylaxis Indication?

A 
Deer thick identified
Thich attached for more than 36 hr
Px started before 72 hr of removal
Local LD PV is high>20%
No Doxycycline C/I
49
Q

what to do??

A

Detach Bug by forceps w/o twist

Doxycycline one dose

50
Q

Infantile butulinism CM?

A

Constipation, poor feeding, and hypotonia
Oculobulbar pulsy (absent gag reflex and ptosis)
Symmetric descending paralysis
Aut.Dsfn(dec,salivation and fluctuant Hr/RR

pediatrics (15 decks)

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