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Step 2 CK > Pediatric > Flashcards

Pediatric Flashcards

1
Q

Normal RR and HR in a newborn

A

RR 40-60 bpm

HR 120-160 bpm

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2
Q

What does APGAR stand for?

A

Appearance

Pulse

Grimace

Activity

Respiration

Apgar delineates a quantifiable measurement for the need and effectiveness of resuscitation; does not predict mortality.

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3
Q

Most common cause of conjunctivitis in a newborn at:

1 day

1 week

2 weeks

1 month

A

1 day: chemical irritation (silver nitrate)

2-7 days: N gonorrhea (prevent with ointments, treat with ceftriaxone)

>7 days: Chlamydia (not effectively prevented by ointments, treat with oral erythromycin)

>3 weeks: herpes (treat with systemic acyclovir and topical vidarabine)

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4
Q

What steps do we take to prevent ophthalmia neonatorum

A

2 types of antibiotic drops in each eye:

Erythromycin or tetracycline ointment

Silver nitrate solution

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5
Q

What causes Vit K deficiency in newborns and how do we prevent it?

A

Immature livers do not utilize vitamin K to develop appropriate clotting factors; E coli is not present in sufficient quantities to make enough vitamin K

To prevent VKDB a single IM dose of vitamin K is recommended

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6
Q

Which children should get HBIG in addition to a hepatitis B vaccine

A

THose with HBsAg-positive mothers

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7
Q

Explain transient polycythemia of the newborn

A

Hypoxia during delivery stimulates EPO

Splenomegaly is a normal finding

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8
Q

Explain transient tachypnea of the newborn

A

Newborns delivered via C/S may have excess fluid in the lungs and therefore by hypoxic

If tachypnea lasts more than 4 hours, it is considered sepsis and must be evaluated with blood and urine cultures

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9
Q

Why are over 60% of newborns jaundiced?

A

Infant’s spleen removing excess RBCs that carry Hgb F

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10
Q

What puts infants at risk for subconjunctival hemorrhage

A

Minute hemorrhages may be present in the eyes of the infant due to a rapid rise in ICP as the chest is compressed while passing through the birth canal

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11
Q

3 major types of skull fractures in the newborn

A
  1. Linear: most common
    2: Depressed
  2. Basilar: most fatal
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12
Q

Difference between caput succedaneum and cephalohematoma?

A

Caput: swelling of the soft tissues of the scalp that DOES CROSS suture lines

Cephalo: subperiosteal hemorrhage that DOES NOT CROSS suture lines

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13
Q

Infant unable to abduct the shoulder or externally rotate and supinate the arm

A

Duchenne-Erb Paralysis: C5-C6

“Waiter’s tip” appearance 2/2 shoulder dystocia

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14
Q

Paralyzed hand with ptosis, miosis, and anhydrosis

A

Klumpke Paralaysis: C7-C8 +/- T1

“Claw hand” d/t lack of grasp reflex

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15
Q

What is the most common cause of Facial Nerve Palsy

A

trauma 2/2 forcep use in delivery

surgical repair is necessary if improvement is not seen over a few weeks

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16
Q

Neurological Werdnig-Hoffman

A

Infant is unable to swallow, leading to polyhydramnios

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17
Q

2 types of diaphragmatic hernias

A

Morgagni: defect is retrosternal or parasternal

Bochdalek (most common): defect is posterolateral and commonly occurs on the left side

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18
Q

What is an omphalocele highly associated with?

A

Edwards syndrome (trisomy 18)

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19
Q

What is an umbilical hernia highly associated with?

A

Congential hypothyroidism

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20
Q

WAGR syndrome

A

Wilms tumor

Aniridia (absence of an iris)

Genitourinary malformations

mental Retardation

Syndrome results from a deletion on chromosome 11

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21
Q

Most common cancer in infancy

A

Neuroblastoma (adrenal medulla tumor)

Look for hypsarrhythmia (on EEG) and opsomyoclonus (dancing eyes dancing feet)

Look for increased VMA and metanephrines on urine collection

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22
Q

Remnant of the tunica vaginalis that transilluminates upon inspection

A

Hydrocele (usually resolves within 6 months)

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23
Q

What should you do if you find a varicocele?

A

Ultrasound the other testicle (varicocele is a bilateral disease)

Treatment is indicated for delayed growth of the testes or in those with evidence of testicular atrophy

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24
Q

Exercise intolerance and squatting while playing outside

A

pathognomonic for tetralogy of Fallot

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25
Q

Most common cyanotic heart defect in children

A

TOF: overriding aorta, pulmonary stenosis, RV hypertrophy, VSD

Associated with chromosome 22 deletions

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26
Q

CXR: boot-shaped heart

A

TOF

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27
Q

Only 3 holosystolic murmurs

A
  1. Mitral regurgitation
  2. Tricuspid regurgitation
  3. VSD
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28
Q

The most common congenital heart defect in Down Syndrome

A

endocardial cushion defect of atrioventricular canal

(walls separating all 4 chambers are poorly formed or absent)

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29
Q

CXR: egg on a string

A

Transposition of the Great Vessels

No oxygenation of blood can occur without a PDA, ASD, or VSD

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30
Q

Most common cyanotic condition in neonates vs children

A

Neonates = TOGV

Children = TOF

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31
Q

CXR: globular-shaped heart

A

Hypoplastic left heart syndrome

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32
Q

Treatment for truncus arteriosus

A

Surgery must be done early to prevent pulmonary hypertension

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33
Q

CXR: snowman or figure 8 sign

A

Total anomalous pulmonary venous return (TAPVR): oxygenated blood returns to the SVC

TAPVR with obstruction would just show pulmonary edema on CXR and present early in life with respiratory distress and severe cyanosis

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34
Q

Holosystolic murmur + FTT

A

VSD

Common in Down, Edwards, and Patau

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35
Q

3 major types of ASD

A
  1. Primum defect (concomitant mitral valve abnormalities)
  2. Secundum defect (most common)
  3. Sinus venosus defect (least common)

Look for paradoxical emboli from deep leg veins

36
Q

fixed wide splitting S2

A

ASD

37
Q

Machine-like murmur

Wide pulse pressure

Bounding pulses

A

PDA

Normal finding in the first 12 hours, after 24 hours it is considered pathologic

38
Q

Mitral lesions radiate to…

Tricuspid/pulmonary lesions radiate to…

Aortic lesions radiate to…

A

Mitral = Axilla

Tricuspid/pulmonary = Back

Aortic = Neck

39
Q

CXR: pear-shaped heart

A

pericardial effusion

40
Q

CXR: “3-sign” or rib notching

A

coarctation of the aorta

associated with Turner Syndrome (short girl with webbed neck, shield chest, streak gonads, horseshoe kidneys, or shortened fourth metacarpal)

41
Q

Hearing loss

Syncope

Normal vitals/exam

FHx of sudden cardiac death

A

Long QT Syndrome

42
Q

When is hyperbilirubinemia considered pathologic?

A
  • first day of life
  • rises more than 5 mg/dL/day
  • above 19.5 mg/dL
  • direct rises above 2 mg/dL
  • persists after the second week of life
43
Q

Hypotonia

Seizures

Choreoathetosis

Hearing loss

A

Kernicterus

Choreoathetosis: occurrence of involuntary movements in combination with chorea (irregular migrating contractions) and athetosis (twisting and writhing)

44
Q

Vomiting with first feeding

A

TEF

Likely be a history of polyhydramnios; look for recurrent aspiration pneumonia

45
Q

Nonbilious projectile vomiting with “olive sign”

A

Pyloric stenosis (most common cause is idiopathic)

46
Q

Lab changes seen with vomiting

A

Hypochloremic, hypokalemic metabolic alkalosis

Due to loss of hydrogen ions in the vomitus; potassium loss also worsens from aldosterone release in response to hypovolemia

Look for “string sign” on upper GI series

47
Q

CHARGE Syndrome

A

C: coloboma of the eye (hole), CNS anomalies

H: heart defects

A: atresia of the choana (prevents breathing during feeding)

R: retardation of growth/development

G: genital and/or urinary defects (hypogonadism)

E: ear anomalies and/or deafness

48
Q

Hirschsprung disease, Imperforate anus, and Duodenal atresia are associated with

A

Down Syndrome

49
Q

VACTERL Syndrome

A

V: vertebral anomalies

A: anal atresia

C: CV anomalies

T: TEF

E: esophageal atresia

R: renal anomalies

L: limb anomalies

50
Q

Duodenal atresia is caused by

A

a lack or absence of apoptosis (improper canalization of the lumen)

51
Q

upper GI series showing “bird beak” appearance

A

Volvulus (majority being in the ileum)

52
Q

Most important step for intussusception

A

Fluid resuscitation and balancing of electrolytes, followed by NGT decompression of the bowel

Air/Barium enema is both diagnostic and therapeutic (can be attempted 3 times before surgical intervention is required)

53
Q

painless BRBPR

A

Meckel’s diverticulum (technetium 99 scan)

Rules of 2’s: 2% of the population, 2 feet of ileocecal valve, 2 types of tissue (gastric and pancreatic), age < 2, males 2x more affected, symptomatic in 2% of patients, 2 inches long

54
Q

Abdominal XR showing air within the bowel wall

A

AKA pneumatosis intestinalis

Pathognomonic for necrotizing enterocolitis - seen in premature infants where the bowel undergoes necrosis and bacteria invade the intestinal wall

55
Q

Unique findings in infants of diabetic mothers (IDMs)

A

Small Left Colon Syndrome

Cardiac Abnormalities

Renal Vein Thrombosis

Metabolic Findings and Effects

Macrosomia (all organs enlarged except for the brain)

Sugar Can Really Make Mistakes

56
Q

What is common among all forms of Congenital Adrenal Hyperplasia?

A

Low cortisol, High ACTH, Low aldosterone

21 = relatively low BP, increased androgens

11 = increased BP, increased androgens

17 = increased BP, decreased androgens

57
Q

3 main etiologies of rickets

A
  1. Vitamin D-deficient
  2. Vitamin D-dependent (inability to convert 25-OH to 1,25(OH)2)
  3. X-linked hypophosphatemic
58
Q

Most common causes of neonatal sepsis

A

Pneumonia and Meningitis

Most common organisms: GBS, E coli, S aureus, Listeria

Treatment: Ampicillin and gentamicin (+/- cefotaxime)

59
Q

Chorioretinitis, hydrocephalus, and multiple ring-enhancing lesions

A

Toxoplasmosis

Look for elevated IgM (PCR is most accurate test)

Treat with pyrimethamine and sulfadiazine

60
Q

Rash on palms/soles, snuffles, 8th nerve palsy, and saddle nose

A

Syphilis

VDRL or RPR (dark field microscopy is most accurate)

Treat with penicillin

61
Q

PDA, cataracts, deafness, hepatosplenomegaly, thrombocytopenia, blueberry muffin rash, hyperbilirubinemia

A

Rubella

Supportive care

62
Q

Periventricular calcifications with microencephaly, chorioretinitis, hearing loss, and petechiae

A

CMV

Urine or saliva viral titers (most accurate test is PCR)

Treat with ganciclovir when signs of end organ damage are present

63
Q

Best initial test for Herpes

A

Tzanck smear (PCR is most accurate)

Treat with acyclovir and supportive care

Week 1: shock and DIC

Week 2: vesicular skin lesions

Week 3: encephalitis

64
Q

Pruritic vesicular rash that begins on the face; possible fever and malaise

A

Varicella

Tzanck smear showing multinucleated giant cells

65
Q

Cough, Coryza, and Conjunctivitis with a Koplik spot (grayish macule on buccal surface)

A

Measles (rubeola)

66
Q

Starts with fever and URI and progresses to rash with “slapped cheek” appearance

A

5th disease (parvovirus B19)

67
Q

Fever and URI progressing to diffuse rash

A

Roseola

68
Q

Fever precedes classic parotid gland swelling and possible orchitis

A

Mumps

69
Q

Fever

Pharyngitis

Sand-paper rash over trunk and extremities

Strawberry tongue

Cervical lymphadenopathy

A

Scarlet Fever

Treat with penicilin, azithromycin, or cephalosporins

70
Q

Severe cough

Fever

Coryza

Inspiratory stridor

CXR: steeple sign

A

Croup (most commonly caused by parainfluenza virus types 1 and 2; RSV is the second most common cause)

71
Q

Treatment for mild croup vs moderate-severe

A

Mild = steroids

Moderate-severe = racemic epinephrine to prevent asphyxiation and probable tracheostomy

Croup will show hypoxia on presentation while epiglottitis is worrisome for imminent hypoxia

72
Q

Hot potato voice

Fever

Drooling in a tripod position

Refusal to lie flat

A

Epiglottitis (due to H influenza type B)

CXR (not the right answer) would show a “thumbprint sign”

Intubate in the OR, administer ceftriaxone for 7-10 days, and give rifampin to all close contacts

73
Q

Stages of Whooping cough

A

Form of bronchitis caused by Bordetella pertussis

*Catarrhal stage: severe congestion and rhinorrhea (14 days)

Paroxysmal stage: severe coughing episodes with inspiratory whoop followed by vomiting (14 - 30 days)

Convalescent stage: decrease of frequency of coughing (14 days)

*Erythromycin or azithromycin are only useful in the catarrhal stage

Give macrolides to all close contacts

74
Q

Treatment for congenital hip dysplasia

A

Pavlik harness

75
Q

Treatment for Legg-Calve-Perthes disease

A

Rest and NSAIDs

Follow with surgery on both hips: if one necroses, eventually the other one will

76
Q

Treatment of SCFE

A

Internal fixation with pinning (don’t let them walk out of the exam room)

77
Q

Poor night vision

Hypoparathyroidism

A

Vitamin A deficiency

Vitamin A toxicity = pseudotumor cerebri and hyperparathyroidism

78
Q

Beriberi

Wernicke’s encephalopathy

A

Vitamin B1 (thiamine) deficiency

79
Q

Angular chelosis

Stomatitis

Glossitis

A

Vitamin B2 (Riboflavin) deficiency

80
Q

Diarrhea

Dermatitis

Dementia

Death

A

Vitamin B3 (Niacin) deficiency

81
Q

Burning feet syndrome

A

Vitamin B5 (panthothenic acid) deficiency

82
Q

Peripheral neuropathy

Must be given with INH

A

Vitamin B6 (pyridoxine) deficiency

83
Q

Megaloblastic anemia

Hypersegmented neutrophils

A

Vitamin B9 (folate) deficiency

84
Q

Megaloblastic anemia

Hypersegmented neutrophils

Peripheral neuropathy of the dorsal column tracts

A

Vitamin B12 (cyanocobalamin)

85
Q

Echymoses

Bleeding gums

Petechiae

A

Vitamin C deficiency

86
Q

Rickets in children

A

Vitamin D deficiency

Vitamin D toxicity = hypercalcemia, polyuria, polydipsia

87
Q

Increased prothrombin time/INR

Mild to severe bleeding

A

Vitamin K deficiency

Step 2 CK (18 decks)

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