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Pediatrics Flashcards

1
Q

What are contraindications to breast feeding?

A

HIV, active TB (until 2 weeks of completion of therapy), chemotherapy/nuclear medicine, high dose metronidazole, illicit drug use

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2
Q

How often should newborns be fed throughout the night?

A

Every 3 hours
More frequent if premature or loss of > 10% birth weight

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3
Q

What should delayed passage of meconium make you think of?

A

Hirschsprung
Meconium plug/ileus
CF
Anal stenosis or atresia

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4
Q

What condition is caused by absence of ganglion cells in the distal bowel?

A

Hirschsprung
Causes absence of peristalsis and intestinal obstruction
Can present with failure to pass meconium, constipation, abd dist, vomiting
Treat by removing the affected portion of the bowel

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5
Q

What supplement should an exclusively breast fed child receive?

A

Vitamin D with a minimum of 400 IU/D
AND iron

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6
Q

What tests would you do in a neonate with fever?

A

Sepsis workup:
CBC
blood C&S
urinalysis
urine C&S
lumbar puncture
+- CXR

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7
Q

What are some practical guidelines for preventing SIDS in a newborn?

A

Back to sleep in empty crib for first year of life
Room sharing
BED sharing INCREASES risk of SIDS

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8
Q

What is normal infant growth?

A

Up to 10% weight may be lost in first week of life but should return by 10d
180 gram/week until 4-5 mo
2x BW at 4-5 mo
3x BW at 1 year
4x BW at 2 year

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9
Q

What is the most important risk factor for infant mortality?

A

Low birth weight

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10
Q

What is a significant determinant of infant and childhood morbidity?

A

Low birth weight

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11
Q

What are some complications of a child being small for gestational age?

A

Difficult cardiopulmonary transition
Respiratory distress syndrome
Retinopathy of prematurity
Impaired thermoregulation
Hypoglycemia
Polycythemia
Impaired immune function
Perinatal mortality

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12
Q

What are some complications of a child being large for gestational age?

A

Increased risk during C-section
Severe postpartum hemorrhage
Birth injuries such as brachial plexus or shoulder dystocia or clavicular fractures
Respiratory distress syndrome
Perinatal asphyxia
Hypoglycemia
Polycythemia
Hip subluxation
May be more prone to adult obesity

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13
Q

What is the single best test to screen for and diagnose SGA/IUGR?

A

Prenatal U/S estimation of fetal weight and amniotic fluid volume

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14
Q

What are doppler studies of the umbilical artery used for?

A

NOT good for IUGR screening/diagnosis
ARE good to identify small fetus at risk for adverse perinatal outcomes (preterm, NICU admission, asphyxia)

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15
Q

What is kernicterus and what part of the brain does it affect?

A

Kernicterus is the neurologic outcome of bilirubin deposition in the basal ganglia and brainstem nuclei

Result of unconjugated hyperbilirubinemia

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16
Q

What medication can be given if inadequate milk production?

A

Domperidone

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17
Q

What medications are given for enhancement of pulmonary maturity in preterm labor?

A

Dexamethasone IM
Betamethasone IM

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18
Q

What are the indications for Rhogam? (RhIgG)

A

Rh negative women @ 28 weeks
Within 72 h of Rh+ fetus birth
Positive Kleihauer-Betke
Any invasive procedure in pregnancy
Ectopic pregnancy
Antepartum hemorrhage
First trimester bleeding
Miscarriage
Therapeutic abortion

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19
Q

What medication is first line for nausea and vomiting in pregnancy?

A

Doxylamine succinate (Diclectin) oral
Contains vitamin B6

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20
Q

What would you worry about in a newborn with bulging anterior/posterior fontanelle?

A

Increased ICP, fever, meningitis, neurological deficits
Do head U/S, CBC, blood/urine cultures, glucose, electrolytes, urea, creatinine

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21
Q

A newborn presents with a firm, diffuse, fluctuant head/neck mass that increases in size after traumatic birth. What are you suspicious for?

A

Subgaleal hemorrhage
Monitor with frequent vitals, assessment of perfusion, head circumference, hypotension, hyperbilirubinemia, blood loss, coagulopathy (DIC)
Can occur after vacuum extraction

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22
Q

What condition is important to rule out in a newborn with weak femoral pulses?

A

Coarctation of the aorta
Do 4 limb BP, ECHO, cardiology consult

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23
Q

What should be ruled out in a newborn with increased respiratory rate but no increased work of breathing?

A

Rule out congestive heart failure , acidosis, sepsis
Do VBG, lactate, CXR

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24
Q

What is the definition of fever in a neonate?

A

38 C rectal
37.3 axillary

Do full septic workup: CBC, blood/urine C+S, urinalysis, LP, ± CXR

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25
Q

What are the complications associated with small for gestational age (SMALL BABY)?

A

Bad cardiopulmonary development
Persistent pulmonary HTN
Retinopathy of prematurity
Respiratory distress
Bad thermoregulation
Low sugar
Polycythemia
Bad immune system
Increased mortality

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26
Q

What specialized tests are done in a neonate with jaundice?

A

G6PD
Sickle cell screen
Hemoglobinopathy screen
Reticulocyte screen
Sepsis workup (urine/blood/CSF culture)
Metabolic evaluation
Abdominal U/S
Hepatobiliary iminodiacetic acid (HIDA) scan

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27
Q

What are the three types of immunizations?

A

Live attenuated: contain whole/weakened bacteria or viruses

Whole inactivated: contain whole or partially killed bacteria or viruses. Usually requires more than one dose.

Subunit: organism part or protein or toxoid

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28
Q

Which vaccines are live attenuated?

A

Bacteria: BCG, oral typhoid
Viral: Intranasal influenza, MMR, rotavirus, varicella, yellow fever

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29
Q

Which vaccines are inactivated?

A
  • Whole virus: such as polio, hep A, rabies
  • Whole bacterial: cholera
  • Fractional protein based: Tetanus, diphtheria
    Hep B, acellular pertussis
    Influenza
  • Fractional polysaccharide: pneumococcal, parenteral typhoid, HiB, meningococcal
  • Fractional virus like: HPV
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30
Q

Name three benefits of immunization that could be used to communicate their benefit to parents?

A
  • Prevent serious childhood infection that may result in severe illness or death such as meningitis, epiglottitis, whooping cough, tetanus
  • Decreases chance of transmission and infection in those who are unable to be immunized (herd immunity)
  • Mass immunization may lead to eradication of vaccine preventable diseases such as small pox
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31
Q

What vaccines are given at 2 months of age?

A

DTaP IPV HiB
Rotavirus
Men C
Pneumo C 13

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32
Q

What vaccines are given at 4 months of age?

A

DTaP IPV HiB
Rotavirus
Men C
Pneumo C 13

Same as 2 months

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33
Q

What vaccines are given at 6 months of age?

A

DTaP IPV HiB
Rotavirus
Men C
Pneumo C 13

Same as month 2 and 4

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34
Q

What vaccines should be suggested at 12 months?

A

MMR
varicella
Men C
pneumo C

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34
Q

What vaccines should be suggested at 12 months?

A

MMR
varicella
Men C
pneumo C

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35
Q

What vaccines should be considered for a traveler?

A

Rabies, typhoid, yellow fever, hep A, cholera

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36
Q

What vaccine is indicated for children under 24 months with prematurity (born < 32 weeks gestation), chronic heart or lung disease or living in a rural location?

A

RSV immune globulin

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37
Q

What vaccines do you not give in pregnancy?

A

Live vaccines: BCG, typhoid, intranasal influenza, MMR, rotavirus, varicella, yellow fever

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38
Q

How long does an infant cry on average?

A

~1-3 hr/day for first 3 months of life

~1 hr/day by 6 months

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39
Q

What is colic? How is it treated?

A

Severe fluctuating pain in the abdomen caused by intestinal gas or obstruction

No clear etiology, proposed that it is GI dysfunction caused by milk protein allergy

Diagnosis of exclusion that begins in the first week of life and peaks at 2-3 months

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40
Q

What are of the brain is responsible for maintaining body temperature?

A

Thermoregulatory centers in the hypothalamus

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41
Q

What portion of viruses or bacteria is responsible for producing fever?

A

Lipopolysaccharide

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42
Q

What is Reye’s syndrome and what causes it?

A

Rare condition causing encephalopathy and fatty degeneration of the liver
Exact etiology unknown, most commonly affects children/young adults recovering from a viral infection
Thought to be associated with ASA ingestion

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43
Q

What are the clinical signs of meningitis?

A
  1. Nuchal rigidity
  2. Kernig sign: severe stiffness of the hamstrings causing inability to straighten leg when the hip is flexed to 90 degrees (tests for presence of neurological irritation of the lumbar meninges or nerve roots)
  3. Brudzinki’s sign: forced flextion of the head upwards causes involuntary flexion of hips
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44
Q

What is included in a full septic workup of a child or neonate?

A

CSF culture (meningitis)
Blood culture (bacteremia)
Urine culture (UTI, pyelonephritis)
CXR (pneuomonia, empyema)

Consider nasopharyngeal swabs for viruses, throat/stool swab for virology, bacteriology, parasitology

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45
Q

What is the diagnostic criteria for Kawasaki disease?

A

Minimum 5 days of fever and at least 4/5:
1. Bilateral, nonpurulent conjunctivitis
2. Mouth/oropharyngeal changes ie strawberry tongue, dry/cracked/erythematous lips
3. Polymorphous rash
4. Edema of hands and feet, in later stages can see peeling of periungual (around nailbeds) skin
5. Unilateral cervical adenopathy > 1.5 cm

The mainstay of treatment for Kawasaki disease is intravenous immunoglobulin (IVIG) administered within the first 10 days of illness onset, along with high-dose aspirin therapy. IVIG helps reduce the risk of coronary artery complications, while aspirin helps manage fever and inflammation. Aspirin is typically continued in low doses after the acute phase to prevent clot formation.

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46
Q

When is LP indicated in children and neonates?

A

Any neonate with fever and majority of infants < 90 d old with fever
Do in children if toxic appearance or altered level of consciousness

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47
Q

What test should you do in a child with swollen, erythematous joint with fever?

A

Joint aspiration in consultation with rheumatology or orthopedics

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48
Q

What is the best imagining test if you suspect osteomyelitis in a child?

A

MRI

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49
Q

What are signs of early and late sepsis?

A

Early: Tachycardia, bounding pulses, warm extremities, adequate capillary refill

Late: Cool extremities, delayed capillary refill, altered mental status, decreased urine output

Shock: Occurs when there is inadequare organ function or perfusion. Presents as altered level of consciousness, hypoxemia, oliguria <0.5 mL/kg/h

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50
Q

What is the recommended dosages of acetaminophen and ibuprofen in children with fever?

A

Acetaminophen 10-15 mg/kg q4h to a max of 4 g or 75 mg/kg/d whichever is less
Ibuprofen 10 mg/kg q6h to a max of 40 mg/kg/d

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51
Q

How do you test for GAS pharyngitis? What complications do you need to be worried about?

A

15-30% of pharyngitis in school aged children
Diagnose by throat culture (gold standard) or rapid antigen detection test
Treat with Penicillin or Amoxicillin, if allergy then cephalosporin or macrolide

Watch out for acute rheumatic fever

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52
Q

What are the Jones criteria?

A

Used to diagnose acute rhematic fever
Require: 2 major or 1 major + 2 minor AND evidence of GAS

Major Diagnostic Criteria
* Carditis
* Polyarthritis
* Chorea
* Erythema marginatum
* Subcutaneous Nodules

Minor Diagnostic Criteria
* Fever
* Arthralgia
* Previous rheumatic fever or rheumatic heart disease
* Elevated acute phase reactant (ESR or CRP)
* Long PR interval

Evidence of GAS:
* ASO
* Step AB
* Throat culture
* Recent scarlet fever
* Anti deoxyribonuclease B
* Anti hyaluronidase

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53
Q

What antibiotics are contraindicated in children?

A

Fluoroquinolones: impair bone/cartilage growth
Tetracyclines: stain teeth, damage growing cartilage

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54
Q

What two medications are generally good for empiric treatment in neonates and infants < 90 days old?

A

Ampicillin and cefotaxime

Read page 543 table 18.10 and 18.11 for more info

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55
Q

How would you approach the assessment of circulation in a child?

A

Establish two sites of IV access
Continuous cardiac monitoring
Palpate peripheral pulses
Check extremities for warm vs cold
If poorly perfused push 20 mL/kg normal saline x 3 then vasopressors then transfer to ICU

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56
Q

What symptoms should make you suspicious for GAS pharyngitis in a child?

A

Fever > 38
Absence of cough
Tonsillar exudates
Tender anterior cervical lymphadenopathy
3-14 yo

REMEMBER THROAT CULTURE IS GOLD STANDARD

Treat with penicillin or amoxicillin

57
Q

What should be included in your differential for sore throat/rhinorrhea in a child?

A
  • Bacteria: GAS
  • Viral: EBV, adenovirus, influenza, parainfluenza, coxsackie A
  • Fungal: C albicans in immunosuppressed pts
  • Other: Kawasaki, foreign body, irritative
58
Q

Explain the presentation, investigation and treatment of croup

A
  1. Common viral illness in children causing throat swelling (including around vocal cords) and trachea (causing harsh cough). Look for URTI, hoarse voice, barking cough, fever and stridor
  2. Lateral neck X-ray to look for subglottic narrowing or frontal (AP) neck film to look for subglottic steeple sign
  3. Supportive treatment OR nebulized epi for stridor OR you can give single dose systemic steroid
59
Q

Explain the presentation, investigation and treatment bacterial tracheitis

A
  1. Bacterial infection of the trachea. Look for muffled cough, toxic child, dysphagia, stridor, retractions on breathing, high fever
  2. CXR look for the same subglottic narrowing as croup AND do tracheal aspirate
  3. Rapid treatment is essential. Do EMERGENT intubation. Give cefuroxime IV
  4. Endoscopy is gold standard for diagnosis

“Barking cough, high fever, and hoarseness, oh geez!
Bacterial tracheitis is the disease that brings you to your knees.
Treat with antibiotics (cloxacillin) and airway support,
Or else respiratory failure will be the final resort.”

60
Q

Explain the presentation, investigation and treatment of epiglottitis

A
  1. Inflammation and swelling of the covering of the trachea that causes blockage of airflow to the lungs. QUICK symptoms. Fever, lethargy, drooling, dysphagia, SEVERE stridor, airway obstruction
  2. Direct visualization in OR or thumbprint sign on lateral neck radiograph
  3. Position comfortably, intubate, give IV AB cephalosporins (4th gen), do not need steroids
61
Q

A child presents with sore throat, ipsilateral ear pain, fever and hot potato voice. On exam they have deviated uvula and cervical adenopathy. What do you suspect and how will you treat?

A

Peritonsillar abscess
Treat with IV AB and surgical drainage or tonsillar aspiration

62
Q

Complications of GAS pharyngitis

A

Rheumatic fever, poststreptococcal glomerulonephritis, retropharyngeal or peritonsillar abscess, scarlet fever

63
Q

Treatment for GAS pharyngitis

A

Penicillin G or amoxicillin for 10 days
Erythromycin if allergy

64
Q

What are the signs of increased work of breathing in a child?

A

Head bob, nasal flare, tracheal tug, substernal and intercostal retractions, subcostal recessions, paradoxical thoraco adbo movement

65
Q

Name some upper airway causes of pediatric respiratory distress

A

Croup
Epiglottitis
Larygneal edema (post extubation)
Laryngomalacia
Foreign body
Retropharyngeal abcess
Tracheitis

66
Q

Name some lower airway causes of pediatric respiratory distress

A

Bronchiolitis
Asthma
Allergy/anaphylaxis
Acute infection (bacterial or viral)
Chronic infection (TB)
Cystic fibrosis
Bronchopulmonary dysplasia

67
Q

What is bronchiolitis? What is it caused by and how is it treated?

A

Lower respiratory tract infection caused by viruses (most commonly RSV) causing inflammation and obstruction of the small airways leading to cough, wheezing, and difficulty breathing. Treatment is supportive only.

10% of patients are hospitalized

May present as URTI followed by increased WOB/wheeze in children 1 mo - 2 yo

68
Q

How would you investigate respiratory distress in a child?

A

CBC and diff
Electrolytes
Creatinine
Urea
Glucose
Ammonia
ABG or VBG

AP/lateral chest xray is only if suspect pneumoia, empyema, pulmonary edema, pneumothorax, cardiomegaly, rib fracture, mediastinal mass, etc. NOT for asthma/bronchiolitis
Lateral neck radiograph (RPA, epiglottitis)
Forced expiratory or bilateral decubitis chest radiograph (foreign body)

ECG or echo

69
Q

On x-ray of a child if you see increased width of the prevertebral soft tissue (greater than half the width of the corresponding vertebral body) what should you consider?

A

Retropharyngeal abscess

May present with fever, neck pain, torticollis, refusal to eat

70
Q

Management of asthma exacerbation

Mild, moderate, severe

A

Mild: Supplemental O2 + SABA (Salbutamol) ± systemic steroids

Moderate: Supplemental O2 + SABA ± Ipratropium bromide + systemic steroids

Severe: Supplemental O2 + SABA + Ipratropium bromide + steroids (consider IV if not tolerating oral)
+ IV fluid with potaassium
+ magnesium sulfate if no improvement
+ admit to ICU if not improving
+ rapdi sequence intubation if not improving

Steroids = Pred 1-2mg/kg/d max 60 or Dex 0.15-0.3mg/kg/d max 10 x 3-5d

SALBUTAMOL SHIFTS POTASSIUM INTO CELLS SO MAKE SURE YOU MONITOR FOR HYPOKALEMIA

71
Q

What is the treatment for foreign body aspiration?

A

Bronchoscopy

72
Q

What is croup and how is it treated?

A

Infection of larynx and trachea
Secondary to viral infections (parainfluenza most commonly)
Children 1-6 yo
Barking couch, inspiratory stridor, preceding URTI

Treat with systemic steroids and nebulized epinephrine

73
Q

What is the most common rash in neonates?

A

Erythema toxicum

Clusters of non infectious papular rash that can evolve into vesicles

Self limiting - usually resolve in 1 week but may reoccur

74
Q

A neonate presents with papules and pustules on an erythematous base around their nose. What is the most likely diagnosis?

A

Miliaria
Secondary to eccrine sweat duct obstruction
Self limiting but also try to minimize excessive wrapping of child

75
Q

Large benign blue purple patch on neonate

A

Most likely congenital dermal melanocytosis (Mongolian blue spot)

MUST RULE OUT NON ACCIDENTAL INJURY AS CAUSE

76
Q

How do hemangiomas present? What complications should you consider? How are they treated?

A

Newborn: pale macules with thin telangiectasia
Older child: red, elevated, non compressible plaque sometimes with blue tinge

Complications are rare but can include infection, hemorrhage, scarring. If located in critcal area then U/S to differentiate bascular malformation or neoplasm

Treat with betablockers (apparently decreases rate of growth but mechanism unknown) but generally you can leave them alone. They can be surgically removed or laser ablated if problematic but depends on depth, location, etc

77
Q

What pediatric rashes are infectious?

A
  1. Viral exanthem: morbilliform (splotchy little red spots) and non itchy, REALLY common, caused by viruses (rubella, roseola, enterovirus, mono). Usually on trunk ± extremities. SELF LIMITING
  2. Chicken pox (varicella zoster): Abrupt itchy vesicular rash. Stays latent in dorsal root ganglia and can cause SHINGLES later. Primary infection usually results in life long immunity. Trasmitted by respiratory secretions or direct contact with lesions. Contagious 1-2 days prior to rash and until crusting of lesions is done. You can send scrapings for direct fluorescent antigen/EM/PCR if you want but usually diagnosed clinically. If immunocompromised may need acyclovir, VZIG ± vaccination
  3. Hand Foot and Mouth: cause by Coxsackie A16. Has viral illness first then rash on mouth, palms and feet. Trasmitted by direct contact. Can give lidocaine mouthwash but mostly treatment is supportive.
  4. Measles: cough, coryza, conjunctivitis, Koplick spots (spots on inside of cheeks). Trasmits via droplets. Rash starts on face and moves down. Risk of death from resp/neuro complications. Treat with vitamin A. NOTIFY PUBLIC HEALTH
  5. Erythema Infectiosium (5th or Parvo B19): Slapped cheek with trunk rash that moves peripherally. Can also present with join pain, anemia, aplastic crisis or hydrops
  6. HSV 1&2: Primary infection usually asymptomatic, recurrence can cause grouped vesicles periorally or genitally with conjuncitivis or herpetic whitlow. Tramistted by direct contact with secretions from lesions or sex. Will make other card with more info.
  7. Roseola Infantum (baby measles HHV6): High fever then 3-5 d later generalized rash from trunk to arms/legs SPARING THE FACE with NO FEVER. Transmits via droplets.
  8. Tinea: affects head, body, feet, face, groin. Look for scaling, alopecia, black dots (broken hair), kerion and pustular areas for tinea capitis. Scrape for KOH and send for fungal culture. Give oral terbinafine for capitis, give topical terbinafine, ciclopirox, clotrimazole, ketoconazole for all others
78
Q

What do you do if a pregnant woman develops skin lesions consistent with chicken pox 5 days before delivery or 2 days after?

A

Give VZIG immediately postpartum
IV acyclovir if baby developes varicella

30% neonatal mortality rate due to encephalitis

79
Q

What are the stages of progression of HSV rash in neonates?

A

SEM (skin eyes mouth) presentation: check for neuro

CNS disease: seizures, do EEG because it will be abnormal earlier than CSF and neuroimaging

Disseminated: can affect multiple organs, often presents as early sepsis in neonate. Sometimes wont have rash at all. 8% mortality

RX Acyclovir but monitor for renal tox and neutropenia (absolute neutrophil < 500)

80
Q

Yellow, greasy plaques on base of erythema on a child

A

Seborrheic dermatitis
“Cradle cap”
Can be on scalp, armpits, trunk, flexural surfaces
Rx hydrocortisone cream

81
Q

Child with beefy red patches with peripheral scales in the flexural sites

A

Candida
Give hydrocortisone powder in clotrimazole cream

82
Q

Triad of dermatitis, alopecia and diarrhea in a child weaning off breast feeding

A

Acrodermatitis enteropathica
Seen in zinc deficiency
Can cause red discoloration of hair “zebra hair”
Rx zinc sulfate

83
Q

Well demarcated papules or plaques with thick silvery scale on trunk, extremities, nails, scalp and flexural surfaces

A

Psoriasis
Rx medium potency steroids

84
Q

What is the most emergent pathology to be considered in a child with abdominal pain?

A

Midgut volvulus aossciated with malrotation

85
Q

What should be considered on your list for differentials in dull, poorly localized midline pain?

A

Splanchnic visceral pain
Pain sensed in the areas corresponding to embryonic origin of affected structure
Foregut: epigastric, midgut: periumbilical, hindgut: suprapubic/hypogastic

86
Q

OPQRST

A

Onset
Progression palliating provoking
Quality
Radiation
Severity
Timing

87
Q

For abdominal pain made worse by movement think

A

Peritoneal irritation

88
Q

For abdominal pain made worse by meals think

A

Pancreatitis, cholecystitis, gastric ulcer or GERD

89
Q

For abdominal pain made better by emesis think

A

Small bowel involvement

90
Q

For abdominal pain made better by pooping

A

Think colonic conditions

91
Q

For abdominal pain made better with meals think

A

Duodenal ulcers

92
Q

Celiac screening lab tests

A

Antitissue transglutaminase and IgA levels

93
Q

CT in patient with abdominal pain could show what conditions?

A

Appendicitis, pancreatitis, intra abdominal abcess, mesenteric ischemia, abdominal mass

94
Q

Ultrasound in child with abdominal pain could show what conditions?

A

Cholelithiasis, cholecystitis, intussusception, appendicitis, hydronephrosis, obstruction

95
Q

Double bubble on abdominal XR

A

Duodenal atresia

  • “Double Bubble, Toil and Trouble
    Bilious Vomiting, Can’t Feed Your Baby’s Muzzle
    Down Syndrome Link, Surgery On The Double”

Explanation:

  • “Double Bubble, Toil and Trouble” refers to the characteristic finding on abdominal X-ray, which shows two air-filled bubbles in the stomach and duodenum due to the obstruction caused by duodenal atresia.
  • “Bilious Vomiting, Can’t Feed Your Baby’s Muzzle” indicates one of the common symptoms of duodenal atresia, which is vomiting of bile-stained fluid and the inability to feed normally due to intestinal obstruction.
  • “Down Syndrome Link” highlights the increased incidence of duodenal atresia in infants with Down syndrome.
  • “Surgery On The Double” emphasizes the need for surgical intervention to correct the obstruction and restore normal bowel function.

Still do upper GI series preop to r/o malrotation with midgut volvulus

96
Q

Child with delayed meconium, failure to thrive, bilous vomiting and chronic constipation since birth

A

Think Hirschsprung’s disease
Definitive diagnosis by rectal biopsy to look for absence of ganglion cells
Barium enema could show delated colon proximal to aganglionic segment
DRE may show tight anal sphincter and “blast sign” (expulsion of gas and stool after DRE)

97
Q

3-8 wk old child with failure to thrive and projectile non bilous vomiting right after feeding

A

Think pyloric stenosis
Look for palpable epigastic mass
Do U/S to look for hypertrophic pylorus
HYPOchloremic, HYPOkalemic metabolic acidosis

98
Q

What stomach condition is associated with trisomy 21?

A

Duodenal atresia

Bilous vomiting within hour of birth. If later think stenosis.

99
Q

Intussusception mnemonic

A

SUSCEPTION
Sausage shaped mass
URTI
Stool - currant jelly
Season - more common in spring/winter
Contracts - mass contracts under palpation
Empty right iliac fossa
Pincer end on barium enema (Claw or coiled spring sign)
Abdominal pain
Target sign on ultrasound - bowel within bowel
Iliocolic is most common
dOnut sign on Doppler
Normal between episodes

Occurs when one segment of bowel telescopes into the adjacent segment

100
Q

Tests to do in UTI (child)

A

Urine routine and microscopy (WCB, nitraites, leukocyte esterase)
Urine culture and sensitivity

Consider VCUG (voiding cystourethrogram) o renal ultrasound

101
Q

What is VCUG?

A

VCUG, or a voiding cystourethrogram, is a minimally invasive test that uses a special x-ray technology called fluoroscopy to visualize your child’s urinary tract and bladder

VCUG can help: diagnose vesicoureteral reflux, a condition in which urine flows the wrong way, from the bladder back up to the kidneys

102
Q

How can pneumonia present in a child?

A

Respiratory tract symptoms (obvious) but can also include nausea, vomiting, and/or upper abdominal pain

Do CXR to look for consolidation or pleural effusion (atypical pneumonia with patchy diffuse opacifications)

Do CBC to look for possibly increased WBC

103
Q

Abrupt bloody diarrhea 5-10 d after fever and gastroenteritis in a child

A

Think hemolytic uremic syndrome caused by Ecoli 0157:H7 or Shigella

Do CBCD, blood smear, haptoglobin, bilirubin, creatinine (increased in ARF), urinalysis (proteinuria/hematuria) and stool C&S

104
Q

Hemolytic uremic syndrome triad

A

Acute kidney injury
Thrombocytopenia
Microangiopathic hemolytic anemia

105
Q

Treatment for HUS

A

Monitor fluids and electrolytes
Red cell and platelet transfusions as needed
Strict control of nutrition and hypertension
Possible dialysis
Antibiotics contraversial because may cause release of more toxins

106
Q

Surgical treatment for pyloric stenosis

A

Condition where the muscles of the lower part of the stomach that connects to the intestine are enlarged which cause narrowing of the pylorus opening which then prevents food from moving from the stomach to the rest of the intestine

Surgery: pyloromyotomy

107
Q

Which neoplasms can cause diarrhea in a child?

A

Gastrinoma, VIPoma, systemic mastocytosis, neuroblastoma

108
Q

What can cause foamy, floating, foul smelling stool?

A

Steatorrhea (80% pancreatic insufficiency or 15% mucosal disease)

109
Q

Investigations for Hirschspring Disease

A

Gold standard: rectal biopsy
Other: anorectal manometry to evaluate response of internal anal sphincter after rectal balloon inflation and assess for rectoanal inhibitory reflex (absent in HD)

110
Q

Pharmacologic treatment of constipation/impaction

A

First line: high dose oral PEG (polyethylene glycol)
Second line: rectal enema

111
Q

Pharmacological treatment for maintenance therapy of constipation

A

First line: PEG (polyethylene glycol)
If PEG not available: lactulose
Others: osmotic laxatives (milk of magnesia), fecal softeners (milk of magnesia), stimulants (bisocodyl, senna, sodium picosulfate)
Use for minimum 2-6 months with symptoms resolution at least 1 month

Enemas are not used for maintenance

112
Q

Define failure to thrive

A

Drop below the 5th percentile for age and sex or a drop in weight that crosses two major percentile lines on a standardized growth chart in a 6th month period

MCC in primary care is inadequate nutritional intake

113
Q

MCC of pediatric non traumatic hip pain

A

Transient synovitis

Self limiting non specific inflammation of the synovial membrane

114
Q

How do you rule out septic arthritis in a child with limp?

A

Do synovial fluid analysis and cultures

115
Q

What is first line imaging in a child with a limp?

A

X-ray

Do CT/MRI in special cases of spine pathology, malignancy, osteomyelitis

116
Q

Developmental milestone for newborns

A

Rasies head slightly
Hands fisted - tight grasp
Primitive reflex

Alert to sound

Regards face
Positively respond to feeds

117
Q

Developmental milestone for 2-3 mo

A

Holds head midline, lifts chest, supports on forearms
Waves at toys, tracks past midline
Searches for sounds with eyes
Recognizes parents, social smile, anticipates feeds

118
Q

Developmental milestone for 4-5 mo

A

Rolls, sits propped up, supports on wrist
Moves arms in unison to grab objects
Orients to voice
Enjoys environment, laughs, reaches for toys

119
Q

Developmental milestone for 6-8 mo

A

Sits unsupported
Raking grasp
Babbles
Recognizes strangers
Looks at people talking at them

120
Q

Developmental milestone for 8-12 mo

A

Creeps, crawls, cruises
Pincer grasp, holds bottle
Understands no
Waves
Explores
Object permanence

121
Q

Developmental milestone for 12-18 mo

A

Walks alone, can go up stairs
Throws objects, scribbles
2-4 block tower
Uses words
Runs
Imitates
Cooperates with dressing
Indicates wants

122
Q

Developmental milestone for 18-24 mo

A

Run, throws, kicks ball
Turns pages 2 at a time
Spoon feeds self
4-6 block tower
> 20 words
Copies tasks
Plays alongside others

123
Q

Developmental milestone for 2-3 yo

A

Walks up and down staris
Throws ball overhand
Turns pages of a book
Has over 50 words and can make 2 word sentences
Parallel play
Gender aware
Imaginary friends

124
Q

Developmental milestone for 3 yo

A

Tricycle
Alternates feet up stairs
Dresses and undresses with less help
Can draw circle
3 word sentence
Minimum 250 words
Knows own name
Largely intelligible

125
Q

Developmental milestone for 4 yo

A

Hop, skip
Colors, prints name
Asks questions
Tells stories
Plays with others

126
Q

Developmental milestone for 5 yo

A

Skips and jumps over obstacles
Ties shoes
Copies triangle
Prints first name
Plays competitive games and follows rules

127
Q

First line investigations in child with developmental delay

A

Full blood count, ferritin, vit b12
Urea, electrolytes, creatinine kinase
Lead
Thyroid function tests
Urine metbolic screen
Molecular karyotype

128
Q

Approach to pediatric status epilepticus

A

Initial: maintain ABC (give 02, apply 02 sat and cardiac monitor, establish IV access)
Consider: rapid glucose, critical labs (Na, Ca, Mg), CBC, blood culture, tox screen, serum AED levels

After 5 minutes of seizure: SL/PR/IV Lorazepam or IV/PR Diazepam or IM Midazolam
Within 10 minute: give dextose

After 15 minutes: IV fosphenytoin or IV phenytoin

After 20 minutes: prepare to intubate, IV/IM phenobarb, consider PR paraldehyde

After 30 minutes: rapid sequence intubation, admit to PICU for continuous AED infusion

129
Q

Medical treatment for focal partial seizures

A

Carbamazepine
Oxcarbazepine

130
Q

Medical treatment for generalized seizures

A

Valproate

131
Q

Medical treatment for childhood absence seizure

A

Ethosux, valproic acid

132
Q

Medical treatment for infantile spasms

A

Vigabatrin, ACTH

133
Q

Medical treatment for unclassified epilepsy

A

Valproate

134
Q

Medical treatment for juvenile myoclonic epilepsy

A

Valproate, lamotrigine

135
Q

What cardiac abnormality is associated with Turner’s Syndrome?

A

Coarctation

136
Q

If upper extremity BP is greater than lower extremity what should you think of?

A

Coarctation of the aorta

Differential pulses

137
Q

Steps to treat acute symptomatic hypertension in the pediatric population

A

Exclude increased ICP
then Nifedipine PO
then Hydralazine intraosseous
then consider ICU admission -+ labetalol IV or nitroprusside IV

138
Q

High arched palate and shield chest is associated with what condition

A

Turner’s

139
Q

Most common acquired bleeding disorder

A

ITP

140
Q

MCC female ambiguous genitalia

A

Congenital adrenal hyperplasia

A/w life threaning adrenal insufficiency in first few weeks of life

MC 21 hydroxylase deficiency (AUTOREC CYP21A2 gene mutation)

141
Q

What lab do you do to rule out congenital adrenal hyperplasia as the cause of ambiguous genitalia?

A

17 hydroxyprogesterone (to r/o CAH due to 21 hydroxylase deficiency)
OR
DHEA, androstenedione, testosterone levels

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