Pediatric Board Review Flashcards
What are signs and symptoms of a central cause of hypotonia
Axial hypotonia, normal-to-slightly decreased weakness, normal DTR, no muscle fasciculation, normal muscle bulk, normal sensation
What is the difference between a brown recluse spider bite and a black widow spider bite?
A brown recluse spider bite will cause localized necrosis and skin break down (redness, itching, hemorrhagic ulcer). Black widow spider bike will cause GI s/s (nausea, pain, parathesias) and more systemic signs and symptoms for acetylcholine and NE release at nerve endings. Typical story will be cleaning an attic or garage
Provide examples of hydrocarbons and how to treat ingestions
Hydrocarbons = lamp oil, nail polish, pine oil, gasolene, lighter fluid, paints, solvents. They can cause MODS (encephalopathy, myocardial dysfunction, arrhythmias, resp distress, liver injury, ATN). Even if they have exposure but no s/s, observe for 6 hrs. Very common to have aspiration event that leads to chemical pneumonitis and should be treated with oxygen and bronchodilator
What are signs and symptoms of hyperventilation syndrome and how do we confirm the diagnosis?
S/s: recent emotional trigger with hyperventilation. This causes metabolic alkalosis which causes decreased ionized calcium (albumin binds the calcium d/t alkalosis decreasing free calcium), and this causes parasthesias. You confirm diagnosis with capillary blood gas.
How do you work-up and evaluate a thyroid nodule?
All get a thyroid US and Thyroid studies. If > 1 cm obtain a fine needle aspiration if they are solid, or if there are other suspicious features: (hypoechogenicity, irregular margins, increased intranodular blood flow, microcalcifications, abnormal cervical lymph nodes)
Describe the differences between ETEC and Entamoeba histolytica.
ETEC - usually starts 1-3 days after exposure, lasts 3-4 days, low grade fever, non-bloody diarrhea.
E. h. more severe, bloody diarrhea, tenesmus, wt loos, high fever, crampy abdominal pain. most common cause worldwide, transmission by fecal-oral route. Both can happen with travelling. Treatment of amoebic colitis is with intravenous (or oral) metronidazole (35-50 mg/kg per day every 8 hours) or oral tinidazole (age ≥3 years: 50 mg/kg, max 2 g orally, once daily for 5 days).
what is the first line antibiotics for acute bacterial lymphadenitis? and what organisms do you suspect?
Unasyn -The most common bacteria isolated in these infections are Staphylococcus aureus, Streptococcus pyogenes, other Streptococcus species, and anaerobes. Ampicillin/sulbactam or clindamycin
What does the AAP recommend for toilet training?
The AAP recommends avoiding: 1) pressure or negative reinforcement, and 2) initiation during times of transition, such as a new school, moving, new caregivers, or new siblings, and 3) keeping toddlers in wet or soiled diapers. The child-directed approach recommends that children should: 1) be encouraged to use the toilet when feeling the urge to go rather than at scheduled times; 2) have a safe, comfortable toilet-training environment, including an accessible toilet or chair at the appropriate size, and 3) use training paints as a transition from diapers to underwear.
How is PPROM managed?
all are hospitalized. If < 32 weeks, expectant management. If 32-39 weeks, fetal lung maturity testing with lecithin/sphingomyelin ratio, phophatidylglycerol level, etc. All get antibiotics if go into labor. If in labor > 48 hrs give GBS ABX for 48 hrs
What is Bloom Syndrome
Blood syndrome is an AR disorder, also called congenital telangiectatic erythema, causes sun-exposed rashes, telangictasias, increased risk for cancer, hypogonadism. Face is long and narrow, prominent ears. Long extremities. Decreased serum IgG, IgM, and IgA. Mutation in BLM causes altered function of DNA helicase activity
What is the newborn test for SCID?
T-cell Receptor Excision Circles (surrogate measure for Naive T-cells)
Differentiate the different types of E.coli infection (ETEC vs STEC vs EPEC vs entero-invasive Ecoli
Reference screen shot
What is bathrocephaly
Prominent occiput with no frontal bossy. It is causes be persisent mendosal suture (that typically disappears in utero). Often confused with sagittal synostosis, but this causes frontal bossing, narrowing of biparietal diameter. Sagittal synostosis should be referred for NSG proc, bathrocephaly is reassurance.
Describe erythema multiforme
Typically triggered by infection (like HSV, EBV, mycoplasma, etc). Dusky center, surrounding pallor, ring of erythema. Involves drunk, extremities, palms. Meds can also trigger (NSAIDs, anit-epileptics, etc)
Describe ectodermal dysplasia
Many different forms, most common is X-linked. Has to effect 2 of the following: hair, teeth, nails, and sweat glands. Common to have hypodontia, hypohidrosis, hypotrichosis (little hair). It is critical to avoid overheating if they do not sweat, remainder is supportive care for body systems involved
What are the indications for ABX ppx for dental procedures?
- prosthetic cardiac valve or prosthetic material used in cardiac valve repair
- previous hx of endocarditis
- Specific congenital heart disease (CHD)
1. Unrepaired cyanotic cardiac lesions, including palliative shunts or conduits
2. Completely repaired CHD (via surgical or interventional procedure) with prosthetic material/device for the first 6 months after the procedure
3. Repaired CHD with residual defects at or adjacent to the site of prosthetic material which would present endothelialization - A history of cardiac transplantation with valvulopathy
What is the best screening test for HIV?
HIV-1/HIV-2 antibody/antigen combination assay. Screen at least once between the ages of 13-64, and annually for those w/ high risk
What sports should be limited in those w/ 1 functional eye? What precautions do they need to take?
- Definition is vision worse than 20/40 corrected
- should wear protective eye wear in all sports, and they should not participate in sports where they cannot wear protective eye wear (i.e. wrestling, boxing, martial arts). Basketball and baseball are high-risk sports for eye-injury, but you can wear protective eye wear
What is spasmus nutans?
A form of fine, horizontal, pendular nystagmus found between 6-24 months that usually resolves with time (months to years). They have a normal brain MRI and development. It is associated with torticollis and slow head nodding
What is Job Syndrome?
Job syndrome is AKA Hyper-IgE syndrome and presents with eczema, eosionphillia, recurrent skin abscesses, lung infections
What is Wisckot-Aldrich Syndrome?
Combination of thrombocytopenia, eczema, and recurrent infections. May have log IgM and elevated IgG and IgE. Can treat w/ IV-IG + platelet transfusions or HSCT in severe cases
What are the diagnostic criteria of Benign Paroxysmal Vertigo in childhood?
- Brief episodes of nausea, vomiting, nystagmus, dizziness, ataxia fearfullness. 2. Normal neuro exam in between episodes 3. symptom free intervals 4. non-attributable to othe disorders. Typically in children age 2-12 yrs, may go on to develop migraines. Middle ear pathology is most common cause of vertigo, so consider this for ddx. Long-term prognosis good, remits by adolescence. Treat with anti-emitics or anti-histamines if long-lasting s/s
Describe characteristics of toxocariasis infections?
s/s: Wheeing, hepatomegaly, anemia, FTT/poor weight gain, pica, eosinophilia
Exposure to dogs or cats (visceral larva migrans)
Dx by Serum IgG to Toxocara
albendazole is the treatment
It is a tissue roundworm infection
Describe cohort vs case-control vs cross-sectional
Cohort: a cohort is observed over time for the development of the outcome of interest.
Case-control: You have “cases” and “controls” and you look for exposures/risk factors. Good for rare diseases
Cross-sectional: looks at exposures and outcomes in a single point in time, not followed longitudinally
Describe indications for antibiotics in a neonate.
If mother meets criteria for intra-amniotic infection (F > 39 + 1 of following: leukocytosis, purulent discharge from cervix, fetal tachycardia) then ABX are recommended in these situations: Signs of sepsis, gestational age < 37 W, maternal PROM, inadequate tx GBS colonization, evidence of maternal chorioamnionitis
What are the Rome IV clinical diagnostic criteria for colic
- younger than 5 months at the start and end of symptoms
- Crying > 3 hrs/day for at least 3 days/week
- No evidence of underlying medical problem
Describe typical characteristics of juvenile polyposis syndrome?
- age 2-6 typically
- Painless hematochezia
- Most polyps are pedunculated w/ narrow stalk
- Tx if removal of polpy, no repeat colonoscopy is needed
- Most common syndromes w/ several polyposis: FAP, JPS, Peutz-Jeghers, hamartoma syndrome (should be suspected when have 5 or more)
Describe the gram stain of shigella vs E coli
Gram-negative rod that is non-lactose fermenting, oxidase negative, and non-hydrogen sulfide producing. Only needs a small amount of organisms for infection
vs
Gram neg rod, ferments lactose
Salmonella produces hydrogen sulfide (red-black center)
What are the birth defects you can see in fetuses exposed to carbamazepine, valproate, and phenytoin?
Carbamazepine and Valproate: spina bifda vs NTD (increased risk in later of 2)
Phenytoin: Fetal hydrantoin syndrome: Growth restriction, delays, craniofacial anomalies, microcephaly, hypoplastic fingers/nails
What are the differences between von Willebrand Disease type 2B and Type 1
Type 2B: can be associated w/ neonatal thrombocytopenia. Tx w/ antihemophilic factor/vWF complex or another factor VIII/vWF concentrate. DO NOT use desmopressin as it can cause a transient decrease in platelets (this is a qualitative defect)
Type 1: Can use desmopression as this increase in factor VIII activity, von Willebrand antigen, and ristocetin cofactor activity. Tx can cause hyponatermia so restric fluids (this is the only type of vWD that can be treated with this, as it is a quantitative defect) - most common type
What is Blau Syndrome?
Familial form of scarcoidosis presents w/ uveitis, “boggy arthritis” and rash
What diseases cause amyloid deposition?
SLE, Bechet disease, Familial Mediterranean Fever, IBD, TB, chronic osteomyelitis. Kidney disease is the most common and serious manifestation of amyloid deposition
Differentiate Type A vs Type As vs Type Ad vs Type B vs Type C tympanograms (reference screen shot pdf for visual)
Type A: normal
Type As: shallwo peak, normal position but low ocmpliance, seen ww/ ossicular fixation, TM scarring or otosclerosis.
Type Ad: (disarticulation) normal peak pressure but highly compliant TM seen w/ ossicular chain discontinuity
Type B: peak that is absent or poorly defined. Poorly mobile TM seen w/ middle ear effusion or perforated ear drums
Type c: Clear peak, but peak shifted to left, indicating negative pressure in middle ear, seen with Eustachian tube dysfunction
What is validity? Internal vs External Validity?
validity evaluates the extent to which a measurement or finding is accurate or true.
Internal validity examines the ability of a tool to accurately measure the intended condition.
External validity or generalizability measure the extent to which the tool can be used in the broader population
What are the 2 types of internal validity
Convergent validity: When you use 2 different tests looking at the same outcome to see if the produce the same results.
Predictive validity: evaluates the accuracy of a tool to measure a future event or outcome
What are the types of reliability?
Test-retest reliability: measures the ability of an instrument or tool to produce the same results w/ repeated measurements.
Interrelator reliability: measures the ability of 2 individuals to independently produce the same results
Internal consistency reliability: is a measure of how consistent the items within a single instrument are with each other
A patient has a sub-mucosal cleft palate, long narrow face with widely spaced eyes, what syndrome could this be and describe it?
Loeys-Dietz syndrome (LDS). AD condition w/ characteristic vascular findings (aortic aneurysms, arterial tortuosity), craniofacial findings (hypertelorism, bifid uvula, cleft palate, craniosynostosis), and musculoskeletal findings (pectus excavatum or carinatum, arachnodactyly, joint laxity). The diagnosis of LDS is made when the characteristic clinical features are present and/or genetic testing. Loeys-Dietz syndrome is associated with pathologic variants in the TGFBR1, TGFBR2, SMAD3, and TGFB2 genes. Individuals with suspected LDS should be screened for aortic root dilatation and monitored for progression and development of aortic dissection. Contact sports and isometric exercises should be restricted due to the risk of increasing systemic vascular resistance.
How does a cryptosporidium infection present? What is the treatment for this?
Cryptosporidium causes watery diarrhea after drinking contaminated water or hanging out at recreational water parks. Treat only w/ severe s/s (>10 episodes/day or s/s > 2 weeks) treat w/ nitazoxanide In a child with HIV infection, prompt initiation of antiretroviral therapy (eg, dolutegravir, emtricitabine, and tenofovir combination) to improve the CD4 cell count results in resolution of diarrheal symptoms.
What are the diagnostic criteria for bacterial vaginosis
- Homogeneous, thin vaginal discharge that smoothly coats the vaginal walls
- Clue cells (vaginal epithelial cells covered with adherent bacteria) on microscopic examination (Item C234A)
- pH of vaginal fluid >4.5 (normal vaginal pH is 3.8 to 4.3)
- Fishy odor of vaginal discharge before or after addition of 10% potassium hydroxide (KOH; ie, the whiff test)
