Pediatrics Flashcards
Course of action for diaphragmatic hernia during birth of child_____
NG + low pressure intubation until lung maturation
_____ is a midline abdominal wall defect associated with Patau (Trisomy 13), Edward (Trisomy 18) syndromes
Omphalocele
For large defects, have to encage in a Silo, will have to do step wise manual reductions until surgery is possible
Double Bubble Sign (Pediatrics)
______________
_____________
Annular pancreas
Duodenal atresia (bilious vomit)
intestinal atresia is associated with ______
Vascular malformations
Meconium ileum is pathpnemonic for ______
Cystic fibrosis
Tx: Gastrograffin Enema
Infant with progressive jaundice for 6+ weeks, after accounting for breast milk jaundice etc.
Biliary atresia
Dx: Abd US
How to diagnose Hirschprung_____
Rectal biopsy : failure in migration of neural ganglia controlling contracting/relaxation of colon, resulting in megacolon
Ocular infections
1) ______ shows up the earliest : Day 2
2) _____ shows up later : Day 7
Gonorrhea
Chlymidia (Oral erythromycin)
port wine + seizures + retardation + glaucoma _________ syndrome
Sturg Weber (GNAQ mutation, vascular malformation)
_____ skin tags are more concerning, associated with hearing loss, renal injury
Peri-auricular
Umbilical hernia is associated with _____
Hypothyroidism
CHARGE Association
coloboma, heart defect, nasal atresia, GU, Ear
Biliary atresia is associated with ____ syndrome
Downs
blueberry muffin + microcephaly + periventricular calcifications ______
Rubella
Blueberry muffin + sensorineural hearing loss
CMV
Intracranial calcifications + hydrocephalus + chorioretinitis
Toxoplasmosis
Teratogen : IUGR, Hypoplastic nails, typical facies _______
Phenytoin
__________ is the congenital heart lesion most commonly associated with supraventricular tachycardia.
Ebstein anomaly (R atrial enlargement, inferior displacement of tricuspid valve)
______ causes craniofacial abnormalities
ACE inhibitors
_____ causes NTD, mental retardation
Valproate, Carbamazepine
_____ and _____ are cardiac defects associated with Turners syndrome
Bicuspid Aortic Valve
Aortic Co-arctation
________ is associated with single umbilical artery
Patau (Trisomy 13)
Horseshoe kidney associated with________
Klinefelter (XXY), also hypogonadism
Marfan is a defect in _______
Fibrillin (lens displacement , aortic root dissection )
Organ enlargement : macrosomia, macroglossia, hypoglycemia (b cell hyperplasia), reno-megaly + Wilms Tumor __________
Beckett Weidmann Syndrome (IGF-2)
_______ kind of pediatric bone tumor results in sunburst pattern on CXR
osteogenic sarcoma
Rhinorrhea, sore throat, hoarseness, barking cough, inspiratory stridor________
Croup
Age of Croup generally____
3 - 5 years
Treatment of croup
nebulizer epinephrine, steroids
Muffled voice (hot potato), drooling, dysphagia, high fever, inspiratory stridor, tripod positioning (breathing issue), no barking cough_______. Characterized by _____ sign on XR Neck
Epiglottitis
Thumbprint
Two diseases requiring Rifampin prophylaxis to household members
1) N. Meningitides
2) _________
Epiglottitis
Biphasic stridor concerning for _____
vascular ring in trachea
URI, fever, wheezing cough, dyspnea tachypnea in children age <2_______
RSV Bronchiolitis , salvage Prophylaxis for high risk children: Palivizumab
meconium ileus, steatorrhea (pancreatic insufficiency), pneumonia (S.Aureus, H influenzae, Pseudomonas), rectal prolapse, missing vas deferens , are constellations of ___________
Cystic Fibrosis
_____ is a treatment for CF only for G551D mutation
Ivacaftor , unfortunately on 5% of cases are this point mutation
_____ is the feature that distinguishes Neiman Pick vs Tay Sachs
Neiman Pick = Hepatosplenomegaly
Both: Cherry red macula, neuropathy
_____ enzyme is defective in Tay Sachs, resulting in ____ accumulation
_____ enzyme is defective in Neiman Pick, resulting in ____ accumulation
Hexaminidase A, Ganglioside
Sphingomyelinase, Sphingomyelin
_____ is a glycogen storage disorder caused by deficiency in _____ leading to cardiomegaly + hypotonia
Pompe, Lysosomal Acid Maltase
____ is a glycogen storage disorder , caused by deficiency in _____, results in easy fatiguability, second wind phenomena
McArdle
Muscle Phosphorylase
______ is a glycogen storage disorder resulting in neurologic effects (ataxia, dementia), deficiency in _________ enzyme
Metachromatic Leukodystrophy
Arylsulfatase (accumulation of cerebroside sulfate)
Most specific test for PSGN_____
Anti DNA-se B
Most common complication from Minimal change disease, therefore requiring immunization for pneumococcus + varicella____
SBP
Treatment for minimal change disease____
Steroids for 4-6 weeks
Three kinds of rickets
1) Vitamin D deficiency : Calcium elevated, due to high PTH as feedback
2) Vitamin D Dependant (Failure to convert to 1,25 form) : but all labs normal
3______ : Only condition where vitamin D 1,25 is low
X linked hypophos, kidney cannot absorb phosphate for bone mineralization
Treatment for congenital hip dysplasia (Ortolani/Bartlow +)_____
Leg-Calve-Perthes caused by _____ of the femoral head
Pavlik Harness
Avascular Necrosis
Constellation of fever, conjunctivities, erythematous rash, desquamation of fingers, cervical unilateral lymphadenities, strawberry tongue______
Complications_____
Treatment_______
Kawasaki (medium vessel arteritis)
Coronary artery aneurysm, myocarditis
IVIG, high dose aspirin
*Kawasaki looks like Measles (Rubeola) in symptoms
Recurrent pyelonephritis in child, think ______
vesicoureteral reflux : caused by inadequate closure of ureterovesicular junction
Have to start prophylactic bactrim, in setting of multiple prior UTI
Recurrent UTI in child
posterior ureteral valves
_____ is a leading cause of iron deficiency anemia in infants
Cows milk instead of breast milk
Cutoff lead value for initiation EDTA____
Lead lab tests: Peripheral smear (basophillic stippling), microcytic hypochromic anemia like iron deficiency, increased free erythrocyte porpyphrins
45
Treatment of acute pediatric seizure_____
Rectal Benzos
Typically, febrile seizures do not increase risk of epilepsy (T/F)
True, unless <9 months, status epiliptius
Antiepileptics can be stopped after seizure free for ____ years
2
AM jerky movement may be a hint to ______ disorder
Juvenile myoclonic epilepsy (Tx: Valproate)
Best test for Duchenne dystrophy_____
Treatment______
PCR genetic test, not muscle biopsy (fat replacement of muscle), caused by frameshift mutation
Steroids
Empiric therapy for neonatal sepsis
1) Ampicillin + Gentamycin
2) Cefotaxime (meningitis concern)
3) ______, if child <28 days
acyclovir
2 infections requiring rifampin for household contacts
1) _____
2) _____
H.influenzae
N meningitidis
Catscratch disease caused by ________, treatment______
Bartonella
Azithro/Doxy
Most common complication of pediatric meningitis_______
Hearing Loss
Palms and Soles Rash
1) Rocky Mountain Spotted: Starts in the hands
2) Cocksakie; Hand Foot Mouth
3) Toxic Shock Syndrome
4) _________
Secondary Syphillis
Causes of direct bilirubinemia in children sepsis, TORCH, TPN, hypothyroid, ____, _____
Galactosemia, Tyrosinemia
Indirect bilirubinemia
1) Phototherapy if Bili>_____
2) Exchange transfusion if ______
10
Neurological symptoms (concern for kernicterus)
Blueberry muffin rash + sensorineural hearing loss____
CMV
Blueberry muffin rash + cataract + microcephaly + periventricular calcifications_____
Rubella
Hydrocephalus + Chorioretinitis + intracranial calcifications______
Toxoplasmosis
Turners associated with : bicuspid aortic valve, aortic co-arctation, _____
Hypothyroidism
erythromycin mechanism is blockage of ______ activity, used for chlymidia
bacteria ribosome function
Key things for suspected Sturg Weber______
Evaluate eyes
Anti-epileptics
Aniridia in an infant is associated with _______
Wilms tumor (Kidney)
Branchial cleft cyst is ____ positioned, does not move with the tongue, do not have to actively manage
Lateral
____ is an odd test for respiratory distress of a newborn
Cranial ultrasound (Hemorrhage causing respiratory distress)
Surfactant _____ surface tension, produced by type ____ pneumocytes, usually in full swing late in the pregnancy (35 weeks)
Decreased, Type 2
If <34 weeks, give bethamethasone to mother to improve fetal lung maturity, L/S<2.5
Complications of premature lungs
1) _____
2) ARDS
3) Retinopathy
4) Cerebral Hemmorhage
bronchopulmonary dysplasia
Infant with tachypnea immediately after C section______
transient tachypnea of newborn, just suction or watch
TEF fistula results from_____
failure of the division of foregut into esophageal parts
If you suspected VACTERL, you have to find the other shit: ECHO, US Renal, XR Limbs
TEF fistula results from_____
failure of the division of foregut into esophageal parts
If you suspected VACTERL, you have to find the other shit: ECHO, US Renal, XR Limbs
anything that impinges fetal swallowing = polyhydramnios (TE fistula, duodenal atresia, annular pancreas)
Mechanism of annular pancreas______
Failure of the ventral bud to rotate with the duodenum, so it impinges it
Sign of phototherapy success = decrease by____ every q4-6 hours
2 mg/dL
You cannot give naloxone to infants due to _____
Seizure risk for opiate withdrawal in this population
Prenatal exposure of these cause:
1) _____ hypoplastic nails, typical facies, IUGR
2) _____ bone stippling, facial abnormalities
Phenytoin
Warfarin
Cardiac defects associated with downs: VSD, ASD, _____
PDA (Prostaglandins keep the duct open, blockers such as NSAID will close it)
____ renal issue associated with Trisomy 18
polycystic kidneys, ectopic double ureter
WAGR Syndrome characterized by : ____
Wilms, aniridia, GU abnormalities, retardation
Beckett Weidmann Syndrome (IGF-2 dysregulation) is associated with _____ cancer
Wilms tumor, hepatoblastoma (screen with AFP + ultrasound q6 months)
Beckett Weidmann Syndrome (IGF-2 dysregulation) is associated with _____ cancer
Wilms tumor, hepatoblastoma (screen with AFP + ultrasound q6 months)
______ sequence associated with alcoholism, characterized by mandibular hypoplasia, cleft palate. Risk of airway obstruction in first 4 weeks of birth
Pierre Robin
New marfan diagnosis, you should get a _____ to make sure aortic root is stable
ECHO
Both constitutional growth delay and genetic short stature will have parallel normal velocities, BUT ____ has lower bone age
constitutional, also later puberty
Scenarios where weight gain is normal but not lenght gain in a child______
1) Skeletal dysplasia (normal bone age)
2) Thyroid deficiency
3) Growth hormone deficiency
4) Cushings
____ enuresis pattern is likely representative of real physiologic problem (UTI, DI, Constipation, Abuse)
Diurnal, not just at night
Measles has live components, so can only give vaccine after age ___. In contrast Rubella/Mumps have no post exposure prophylaxis
6 months - 12 months
Hep A prophylaxis
1) Age< 12 months____
2) Age>12 months_____
Ig Only, need to be atleast 12 months
Ig + Vaccine
Dont forget ____ during suspected child abuse
dilated eye exam
Steeple sign narrowing on CXR is concerning for _____
Croup
Epiglottitis without drooling or dysphagia_____
Bacterial tracheitis
CXR finding for RSV bronchiolitis_____
Hyper-inflated lungs, hospitalize if RR>60
Most common type of ASD_____
Secundum, primary requires surgical repair
Treatment for pulmonic stenosis______
Balloon valvuloplasty, prostagland (keeps PDA open)
Also give prostaglandin for aortic stenosis
Most common cyanotic heart defect______ found after infancy
Most common cyanotic heart defect found during infancy _____
TOF: R ventricle hypertrophy, over-riding aorta, VSD, outflow tract obstruction
D Transposition: PDA dependent
Tricuspid Atresia: Total loss of RV,RA, relies on ASD/VSD, PDA for survival
____ characterized by VSD, abnormal connection between aorta and pulm artery
Truncus Arteriousus
____ murmur, findings of ebstein anomaly
holosystolic tricuspid regurg murmur, tall P wave, R axis deviation
____ parasite may cause chronic malabsorption
Giardia (duodenal aspirate)
Test for volvulus/malrotation_____
Ultrasound/ Barium enema
Test for volvulus/malrotation_____
Ultrasound/ Barium enema
Pediatric Cystitis Treatment
Pyelonephritis: Ampicillin + Gentamycin + Ceftriox
Tetracyclines after age 7 (Rememeber 8 x2 = 16)
Quinlones after age 16
Treatment of PSGN____
Penicillin + Supportive , antihypertensives if hypertensive
Management after diagnosis of Minimal Change Disease
Normal C3/C4
Steroids
Vaccinations: Varicella/Pneumococcus
Treatment of Kawasaki______
High dose aspirin + IVIG, maybe warfarin Plt high
Very high voltage , slow irregular waves can be a sign of this epilepsy disorder______. Treated with prednisone, B6, ACTH
West Syndrome, associated with downs syndrome
Highly irregular semiology of seizure
Treatment of generalized myclonic seizure____
Topiramate, else Valproate/Carbamazepine
For Duchene, the issue is a frameshift deletion of ______ gene
Dystrophin
Dx: Gene Test
Tx: Steroids, Eteplirsen (miRNA exon binder)
Absolute child safe cephaosporin______
Cefotaxime
Absolute child safe cephaosporin______
Cefotaxime
_____ is a Glycogen storage disorder characterized by neuropathy, leads to accumalation in ceremide
Fabry
