Pedia Topnotch Flashcards
0
Q
Immediate goal of immunization
A
Prevention of disease
1
Q
Ultimate goal of immunization
A
Eradication of disease
2
Q
Two types of immunization
A
Active and passive
3
Q
Types of antigen for active immunization
A
- Live attenuated
2. Inactivated
4
Q
What are the live vaccines? List 7.
A
BCG Measles MMR Varicella Rotavirus Influenza intranasal Typhoid fever
5
Q
Peak of passive immunization for IM injections
A
48-72 hrs
6
Q
System for ensuring the potency of a vaccine from the time of manufacture to the time it is given to a child
A
Cold chain
7
Q
When can combination vaccines be given simultaneously?
A
- Equal or >2 inactivated vaccines
2. Inactivated and live vaccines
8
Q
What is the rule in giving live vaccines in combination?
A
28-day minimum interval if not given simultaneously
9
Q
What is the principle in lapsed immunization?
A
does not require reinstitution of the entire series. subsequent immunizations should be given at the next visit as if the usual interval has elapsed.
10
Q
Only vaccine given intradermally
A
BCG
11
Q
When is BCG usually given?
A
earliest possible age after birth preferrably within the first 2 months
12
Q
If BCG is not given in the first 2 months what do we do?
A
PPD vaccination is NOT recommended prior to vaccination.
PPD is however required if the following conditions are present:
- suspected congenital TB
- history of close contact to know TB case
- clinical findings suggestive of TB or xray suggestive of TB
13
Q
What is a positive PPD test in those requiring PPD before vaccination?
A
> 5mm induration
14
Q
What is the dose of BCG?
A
12 mos - 0.1 ml
15
Q
Measles vaccine is given through what route
A
SQ
16
Q
Measles vaccine is given at
A
9 months
17
Q
Measles vaccine can be given as early as ___ in cases of outbreaks as declared by PH officials
A
6 months
18
Q
Common adverse effects of BCG vaccine
A
Abscess or ulcers at site
Axillary Lymphadenopathy
19
Q
Dose of measles vaccine
A
0.5ml
20
Q
Common adverse effect of measles vaccine
A
fever 5-12 days after vaccination
rash
21
Q
A 14 year old male presents with joint pains and morning stiffness for the past 3 months. The joint pain is present in both hands and feet bilaterally. On PE, joints are tender to palpation, warm, and swollen. What is the most likely diagnosis?
A
Juvenile Rheumatoid Arthritis
22
Q
3 prinicipal types of onset of JRA
A
- Oligoarthritis (pauciarticular)
- Polyarthritis
- Systemic-onset disease
23
Q
HLA subtypes in JRA
A
HLA DR4 (Polyarticular) HLA DR8 and DR5 (Pauciarticular)
24
Criteria of classification of JRA
Age <16years
Arthritis (2 or more of the following) limitation of ROM, tenderness or pain on motion, increased heat in one or more joints
25
Onset type of JRA is defined by disease characteristic in the first _months
6 mos
26
JRA classifications, differentiate each:
1. Polyarthritis - 5 or more inflamed joints
2. Oligoarthritis: <5 inflamed joints
3. Systemic arthritis: with characteristic fever
27
Characteristic of fever in systemic onset JRA
quotidian fever with daily high spikes and rapid return to baseline usually associated with a faint red macular rash (salmon pink rash)
28
Treatment of JRA
NSAIDs
Methotrexate and immunosuppresive agents
Steroids for overwhelming systemic illness
Physical and occupational therapy
29
Inflammation if the joints of the axial skeleton and limbs, presence of enthesitis (inflammation of the sites of attachments of ligaments, tendons, fascia, and capsule to bone), absence of Rheumatoid factor
Ankylosing spondylitis
30
Demographic of people with ankylosing spondylitis
older boys, adolescents, young adults
31
HLA type found in >90% of people with ankylosing spondylitis
HLA-B27
32
Forms of ankylosing spondylitis (3)
1. Juvenile (oligoarthritis legs>arms, enthesitis, hip joint arthritis, back pain, loss of spinal flexibility
2. Psoriatic (oligoarthritis, asymmetric, nail pitting, dactylitis, FH of psoriasis)
3. Reactive (Reiter syndrome: arthritis, conjunctivitis, urethritis), lower limb arthritis
33
Eye complication of ankylosing spondylosis
Anterior uveitis (Iridocyclitis) 25%
34
Treatment for ankylosing spondylosis
NSAID and may add sulfasalazine
| Intraacrticular triamcinolone
35
Criteria for diagnosis of SLE
4 out of 11
SOAP BRAIN MD
Serositis (Pleuritis, Carditis)
Oral Ulcers (painless)
Arthritis (2 or more joints)
Photosensitivity
```
Blood Changes (anemia, leukopenia, thrombocytopenia)
Renal Disorder (persistent proteinuria,cellular casts)
ANA abnormal titer
Immunological Changes (anti dna, Ab, Anti Sm)
Neurologic signs (seizures, frank psychosis)
```
Malar rash
Discoid rash
36
screening for SLE
ANA
37
more specific marker for lupus and reflects degree of disease activity
anti dsdna
38
Complement low in lupus
low C3, C4
39
marker only found in SLE
anti Smith Ab
40
Route of rotavirus vaccine
oral
41
RV1 and RV5 number of doses, schedule, interval between doses and brands
RV1 (monovalent) Rotarix 2 doses
RV5 (pentavalent) RotaTeq 3 doses
between 6 weeks and 32 weeks (8mos)
interval between doses: 4 weeks
42
MMRV:
Route?
How many doses?
Schedule between ?
Minimum interval between doses?
Route? SQ
How many doses? 2 doses
Schedule between ? 12 mos-12 years
Minimum interval between doses? 3 mos
43
Definition of hematuria
More than 5 rbcs/hpf
44
Dipstick test for hematuria is based on what chemical reaction?
Peroxidase reaction with hemoglobin
46
Is cloudy urine always abnormal?
No. It can be due to crystal formation at room temp.
47
Tea colored urine usually points out to a ___ problem
Glomerular
48
Normal specific gravity
1.015-1.025
49
What crytals form in acidic urine?
Uric acid
50
What crystals form in basic urine?
Phosphate crystals
51
Positive dipstick but absent rbcs in urine. What is the usual cause?
Myoglobinuria from rhabdomyolysis
52
Primary treatment in SLE
Prednisone 1-2mg/kg/day
Severely ill: Pulse IV steroids (30 mg/kg/dose max 1 gm over 60mins OD for 3 days)
Severely ill: pulse IV cyclophosphamide to maintain renal function and prevent progression
53
Most common of the pediatric inflammatory myopathies
Dermatomyositis
54
HLA subtype association in Dermatomyositis in >80%
HLA Ag DQA1*0501
55
Systemic vasculopathy with cutaneous findings and focal areas of myositis resulting in progressive muscular weakness that is responsive to immunosuppressive therapy
Dermatomyositis
56
Usual risk factor and infection triggers of Dermatomyositis
Sun exposure
| Enterovirus (Coxsackievirus B) and GABHS
57
Periorbital violaceous erythema common in Dermatomyositis
Heliotrope rash
58
Skin finding over the metacarpal and proximal interphalangeal joints that is hypertrophic and pale red with a papular, alligator-skin like appearance seen in dermatomyositis
Gottron papules
59
Severe prognostic sign in dermatomyositis
Dysphagia
60
A chronic disease characterized by fibrosis affecting the dermis and arteries of the lungs, kidney, and GIT
Scleroderma
61
Pathophysio of Scleroderma
Injury of vascular endothelium leading to fibrosis
62
Earliest manifestation of scleroderma and may precede skin and internal organ involvement by months or years.
this is not however limited to scleroderma but can also herald other diseases such as connective tissue disorders, rheumatic disorders and other immunologic conditions
Raynaud phenomenon
excessively reduced blood flow in response to cold or emotional stress, causing discoloration of the fingers, toes, and occasionally other areas
63
Components of CREST Syndrome
Calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly and telangiectasia.
64
Is a systemic connective tissue disease.
Characteristics include essential vasomotor disturbances; fibrosis; subsequent atrophy of the skin, subcutaneous tissue, muscles, and internal organs (eg, alimentary tract, lungs, heart, kidney, CNS); and immunologic disturbances accompany these findings.
Systemic sclerosis (SSc)
65
Diagnostic Criteria of Systemic Sclerosis
Major criterion or 2 of the 3 Minor criteria
Major Criteria:
1. Proximal scleroderma: typical skin changes (tightness, thickening, non-pitting induration excluding localized forms) involving areas proximal to the MCP or MTP joints
Minor Criteria
1. Sclerodactyly
2. Digital pitting scars from digital ischemia
3. Bibasilar pulmonary fibrosis not attributable to primary lung disease
66
Antibody finding mostly suggestive for scleroderma
Anti-SCL70 specific for topoisomerase 1 and anticentromere autoantibodies
67
Drug used that may prevent ulcerations in scleroderma
ACE inhibitors
68
Imunosuppresive agents used in scleroderma
Methotrexate and steroids
69
How many percent of coronary aneurysms in Kawasaki disease resolve after 1-2 years?
50%
70
IgA mediated vasculitis of the small vessels
HSP
71
Typical Prodrome of HSP
typically follows after an URTI
72
Pathophysio of HSP
IgA deposition in blood vessels that cause leaking --> purpura and petechiae
73
HLA subtype common in HSP
HLA-DRB1*07
74
Organ systems primarily affected in HSP
Skin, GI, Kidney
75
Hallmark rash of HSP
palpable petechiae or purpura that evolve from red to brown that last from 3-10 days
usually found on dependent areas
76
Renal involvement in HSP is seen in __%
25-50%
77
Odynophagia vs. dysphagia
Odynophagia - pain during swallowing
| Dysphagia - difficulty swallowing
78
Most common type of TEF (Nelsons)
Type A (EA and distal fistula)
For Robbins, Type B
79
50% of those who have TEF have associated syndrome of anomalies called
VATER/VACTERL
Vertebral, anorectal, trachea, esophagus, cardiac, renal, radial limb syndrome
80
Most common esophageal disorder in children of all ages
GERD
81
Major mechanism of GERD
Transient LES Relaxation
82
Main stimulus for transient relaxation of LES in GERD
Gastric distention
83
Surgical management for intractable GERD
Nissen Fundoplication
"gastric fundus (upper part) of the stomach is wrapped, or plicated, around the lower end of the esophagus and stitched in place, reinforcing the closing function of the lower esophageal sphincter"
84
Most common esophageal foreign body in 6 months to 3 years old
COINS
85
What is the management in cases of asymptomatic esophageal foreign bodies (blunt objects)?
May be observed up to 24 hrs in anticipation of passage in the stomach.
86
Indication for urgent endoscopy in esophageal foreign bodies
Sharp objects
Failure to visualize+symptomatic patient
87
True or False. Absent oral lesions mean that there is no significant esophagogastric injury.
False.
88
Liquid alkali in caustic ingestion causes what type of necrosis?
Liquefaction necrosis
89
Most common cause of non-bilous vomiting in children
Pyloric stenosis
90
Physical exam finding in pyloric stenosis
Firm, movable, olive shaped mass
91
Ultrasound findings in pyloric stenosis
pyloric thickness >4mm or length >14mm
92
Barium enema signs in pyloric stenosis
shoulder sign- bulge of the pyloric muscle in the antrum
| double tract sign - streaks of barium in the narrowed channel
93
Atresia vs. Stenosis
Atresia - complete obstruction
| Stenosis - partial block of luminal contents
94
Triad of Volvulus
S-I-R Volvulus
1. Sudden onset severe epigastric pain
2. Inability to pass tube in the stomach
3. retching with emesis
95
X ray findings in volvulus
Bird's beak sign
Inverted U sign
Coffee bean sign (midline crease corresponding to mesenteric root)
96
Management of volvulus
Decompression and derotation using a rectal tube or colonsocope if with no signs of bowel ischemia or perforation.
Lap derotation +/- bowel resection
97
48 hr old boy at 34 weeks AOG noted to vomit greenish material after feeding. PE revealed non-distended abdomen with hyperactive bowel sounds. Diagnosis?
Duodenal atresia
98
Incomplete rotation of the intestine during fetal development
Malrotation
99
Most common type of malrotation
failure of the cecum to move into the RLQ
100
Diagnostic and sign seen in duodenal atresia
Xray abdomen
Double bubble sign
101
Remnant of the omphalomesenteric duct which connects the yolk sac to the gut in the embryo and provides nutrition
Meckel Diverticulum
102
Most frequent GI congenital anomaly
Meckel Diverticulum
103
Most common cause of lower GI obstruction in neonates
Hirschprung's Disease
104
Pathophysio of Hirschprung's
arrest of neuroblast migration from proximal to distal bowel
absence of ganglion cells in the bowel wall beginning in the internal anal sphincter
105
The Currarino syndrome (also Currarino triad) is
iInherited congenital disorder where
(1) the sacrum (the fused vertebrae forming the back of the pelvis) is not formed properly,
(2) there is a mass in the presacral space in front of the sacrum, and
(3) there are malformations of the anus or rectum.
It can also cause an anterior meningocele or a presacral teratoma.
106
Diagnostic of choice for Hirschprung's
Rectal suction biopsy
107
Portion of the alimentary tract is telescoped into an adjacent segment
Intussusception
108
Most common cause of intestinal obstruction between 3 months to 6 years old
Intussusception
109
Most common risk factors in intussusception
Rotavirus vaccine after 8 mos, adenovirus
110
Intussusception happens usually in what segments?
Ileocolic and Ileoileocolic
111
Characteristic of stool in intussusception
Currant Jelly Stools
112
Abdominal PE findings of intussusception
sausage-sahped mass in the RUQ which may increase in size and firmness during paroxysms of pain
113
Imaging findings in intussusception?
Xray, Barium enema, ultrasound
Xray - increased density
Barium enema - coiled spring pattern
Ultrasound - tubular mass, donut shaped, or target sign
114
Diagnostic of choice of peptic ulcer disease
Endoscopy
115
Test done to determine the presence of H. pylori
Rapid urease test
116
Treatment of H. pylori
PPI + Clarithromycin + Amox/Metronidazole
117
Definition of diarrhea
>3 episodes in 24 hours
118
2 types of acute infectious diarrhea
Inflammatory and Non-inflammatory
119
Mechanisms of diarrhea
```
Secretory
Osmotic
Reduction in surface area
Alteration in motility
Mutations in apical membrane transport proteins
```
120
Fluid deficit in SOME Dehydration
50-100ml/kg
121
Parameters to classify a patient with some signs of dehydration
```
General condition: iriitable
Eyes: Sunken
Thirst: Thirsty, drinks eagerly
Skin turgor: slow
Weight loss %: 5-10%
Fluid deficit: 50-100ml/kg
```
122
Treatment for patients with no signs of dehydration
give ORS after every loose stool
123
Treatment for patients with some dehydration
75ml/kg ORS over 4 hrs
124
Treatment for patients with severe dehydration
give a total of 100cc/kg pLR IV
- first 30cc/kg over 1 hr for infants, 30 mins for children
- next 70cc/kg over 5 hrs for infants, 2.5 hrs in children
125
Chronic or persistent diarrhea definition
>14 days duration
126
Reduced osmolarity ORS components and total osmolarity
```
Glucose 75
Na 75
Cl 65
K 20
Citrate 10
TOTAL OSMOLARITY 245
```
127
Cornerstone in the management of AGE
Management of dehydration
128
Give the causative organism of AGE:
Presentation: watery diarrhea 7-10days
Treatment: supportive
Rotavirus
129
Give the causative organism of AGE:
Presentation: from nurseries and daycare
Treatment: TMP-SMZ
Enteropathogenic E. coli
130
Give the causative organism of AGE:
Presentation: hemorrhagic colitis HUS
Treatment: TMP-SMZ
EHEC
131
Give the causative organism of AGE:
Presentation: eggs milk and poultry
Treatment: ?
Salmonella
Treatment: treat only if <3mos old
132
Give the causative organism of AGE:
Presentation: person to person contact through contaminated food
Treatment: Cefixime, Erythromycin
Shigella and Campylobacter
133
Give the causative organism of AGE:
Presentation: Hx of antibiotic use
Treatment: ?
C. difficile
Metronidazole or Vancomycin
134
Give the causative organism of AGE:
Presentation: within 12 hours due to a preformed toxin with a common food source
Treatment: ?
S. aureus
no treatment
135
Give the causative organism of AGE:
Presentation: infects the colon, acute bloody diarrhea
Treatment: ?
E. histolytica
Metronidazole
136
Give the causative organism of AGE:
Presentation: cysts are ingested from contaminated food and water; watery diarrhea
Treatment: ?
G. lamblia
Metronidazole
137
Give the causative organism of AGE:
Presentation: profuse watery diarrhea; rice water consistency of stool with fishy odor; Washer woman's hands
Treatment: ?
Cholera
Tetracycline
138
Amylase and lipase levels in acute pancreatitis (days elevated)
Serum amylase- elevated up to 4 days
| Serum lipase - rises by 4-8 hrs, peaks at 24-48 hrs, elevated 8-14 days longer than amylase
139
Criteria for acute pancreatitis used in adults
Ranson's criteria and APACHE
not suitable for children
140
In EINC, the significance of delayed cord clamping is to
decrease the incidence of anemia
141
Series of time bound chronologically-ordered standard procedures that the baby receives after birth
Essential Newborn Care
142
Most important component of the APGAR
Pulse
143
The best description of the APGAR Score is that it
assesses neonates in need of resuscitation
5 min - initial resuscitation
144
Components of newborn screening
```
CH
CAH
Galactosemia
Phenylketonuria
G6PD
```
145
Cheese like material that covers the normal term infant in varying amounts
Vernix caseosa
146
purplish reticulated pattern noted on the neonate when exposed to cold
cutis marmorata
147
Newborn PE: small white occasionally vesicopustular papules on an erythematous base develop after 1-3 days. Contains eosinophils
erythema toxicum
148
Newborn PE: vesiculopustular eruption over a dark macular base around the chin, neck, back, and soles, contains PMNs
pustular melanosis
149
Newborn PE: cysts appearing on the hard palate composed of accumulations of epithelial cells
Epstein pearls
150
Newborn PE: pearly white papules mostly seen on the chins and around the cheeks
Milia
151
Term infant with severe respiratory distress and a scaphoid abdomen on PE. Diagnosis?
Congenital diaphragmatic hernia
152
Most common type of congenital diaphragmatic hernia
Bochdalek
153
Term infant born with extrusion of abdominal viscera. Initial management?
Decompression and wrapping
154
Which is associated with more congenital anomalies? Omphalocoele or gastroschisis?
Omphalocoele
155
Gastroschisis is common on which side of the umbilicus
Right side
156
A preterm baby won't stop crying. Baby has abdominal distention with abdominal erythema. Baby cries more when touched. Diagnosis?
Necrotizing enterocolitis
157
Xray of a newborn showed thickened bowel walls and air in the bowel wall. This is called? Intervention?
pneumatosis intestinale
supportive - hydrate and antibiotics
158
On CXR of a newborn, findings of "bubbly lungs" (cystic lucencies) with irreular denses strands and aearation. Diagnosis?
Bronchopulmonary dysplasia
159
CXR differences between TTN and RDS
RDS or HMD: finely granular lungs, ground glass appearance, air bronchograms, air filled esophagus
TTN: prominent pulmonary vacular markings
fluid lines in fissure, overaeration
160
On CXR of a newborn, coarse streaking granular pattern on both lungs is usually suggestive of what?
Meconium aspiration syndrome
161
Most common cause of jaundice in neonates?
Physiologic
162
Most serious complication of hyperbilirubinemia in newborns
Kernicterus
163
Amount of serum bilirubin on physiologic vs pathologic jaundice
Physiologic: peaks at 5-6mg/dl on 2-4 days
Pathologic: rate is rising faster than 5mg/dl/24hrs
164
Chart used for fast assessment of Jaundice?
Kramer's chart
165
Fast serum bilirubin levels based on Kramer's chart
head 6-8mg/dl
chest 9-12mg/dl
abdomen 12-14mg/dl
whole body >18 mg/dl
166
Most likely etiology of jaundice in the first 24 hrs.
Key clue: first born child
ABO incompatibility
167
Most likely etiology of jaundice in the first 24 hrs.
Key clue: second born child
Rh incompatibility
168
Most likely etiology of jaundice in the first 24 hrs.
Key clue: history of prolonged second stage of labor, no prenatal check up
Sepsis
169
Most likely etiology of jaundice in the first 24 hrs.
Key clue: history of maternal infection during pregnancy
TORCH infection
170
Most likely etiology of jaundice after the first 24 hrs.
Onset of jaundice: 2-3 days
Key clue: baby otherwise normal
Physiologic
171
Most likely etiology of jaundice after the first 24 hrs.
Onset of jaundice: 3-4 days
Key clue: mother supplements breastfeeding with sugar water
Breastfeeding jaundice
172
Most likely etiology of jaundice after the first 24 hrs.
Onset of jaundice: >1 week
Key clue: baby purely breastfed
breastmilk jaundice
173
Breastmilk versus breastfeeding jaundice?
Breastfeeding jaundice - "lack of breastfeeding jaundice," is caused by insufficient breast milk intake resulting in inadequate quantities of bowel movements to remove bilirubin from the body.
This can usually be ameliorated by frequent breastfeeding sessions of sufficient duration to stimulate adequate milk production.
Breastmilk jaundice - breast milk jaundice is a biochemical occurrence and due to a lot of factors, there is inefficiency in bilirubin removal by gut bacteria or liver enzymes.
174
Staining in kernicterus usually occurs in the
basal ganglia and brainstem
175
Kernicterus is rare in infants with serum levels that are ___?
below 25mg/dl
176
Phases of kernicterus
Phase 1 - poor sucking, stupor, hypotonia
Phase 2 - hypertonia, opisthotonus, fever
Phase 3 - hypertonia
177
The most important risk factor that predisposes a neonate to sepsis
Prematurity
178
TORCH infection in the newly born.
Case. An IUGR baby born to a mother with history of infection during pregnancy
Key clue: vesicular lesions on the face and mouth
HSV
179
TORCH infection in the newly born.
Case. An IUGR baby born to a mother with history of infection during pregnancy
Key clue: Purpuric hemorrhagic lesions all over the body
rubella
180
TORCH infection in the newly born.
Case. An IUGR baby born to a mother with history of infection during pregnancy
Key clue: maculopapular rash, periostitis of the bone
syphilis
181
TORCH infection in the newly born.
Case. An IUGR baby born to a mother with history of infection during pregnancy
Key clue: chorioretinitis, periventricular calcifications
CMV
182
TORCH infection in the newly born.
Case. An IUGR baby born to a mother with history of infection during pregnancy
Key clue: chorioretinitis, microcephaly, hepatosplenomegaly, imaging: intracerebral calcifications
Toxoplasmosis
183
TORCH infection in the newly born.
Case. An IUGR baby born to a mother with history of infection during pregnancy
Key clue: cutaneous scars, cortical atrophy
Varicella
184
Colostrum is produced over the first few days of lactation. This is rich in what immunoglobulin?
IgA
185
Whey to casein ratio of mature human milk?
3:2
