Pediatrics Flashcards
1
Q
Properly timed cord clamping
A
1-3 mins after birth or until pulsation stopped whichever comes first
2
Q
This prevents neonatal hypothermia and increases protective bacterial colonization
A
30 minutes of uninterrupted skin-to-skin contact
3
Q
Sequence of thorough drying in newborn and duration
A
Face-head-trunk-back-arms-legs
5 sec each
4
Q
What’s the 2nd step in EINC in CS delivery?
A
Delayed cord clamping
5
Q
The purpose of this step in EINC is to initiate breastfeeding within the 1st hr of life
A
Non-separation of mother and baby
6
Q
Target temperature of newborn
A
36.5-37.5
7
Q
Room temp in DR
A
25-28C
8
Q
Transfer of heat to cooler surrounding AIR
A
Convection
9
Q
Heat transfer to nearby cooler OBJECTS
A
Radiation
10
Q
34 to 37 weeks newborn
A
Late-preterm
11
Q
This chart compares the BW to gestational age
A
Lunchenko chart (SGA, LGA)
12
Q
Weight, height, HC equally small, high morbidity mortality
A
Symmetric SGA
13
Q
> 90th percentile and at risk for hypoglycemia and polycythemia (maternal obesity and diabetes)
A
Large for gestational age
14
Q
This procedure has no proven benefit in meconium-stained amniotic fluid
A
Suctioning!! Not routinely done!
15
Q
Apgar score
Grimaces
Active movement
Cries loudly
Acrocyanosis
HR 130
A
1
2
2
1
2
Total: 8
(Grimace word used, always 1 point haha)
16
Q
Priority in resuscitating newborn
A
AIRWAY (all others CAB)
17
Q
RA 9288, done at 24-48 hrs of life
A
NBS Act
18
Q
NBS original diseases detected
A
Congenital hypothyroidism
Congenital adrenal hyperplasia
Galactosemia
Phenylketonuria
G6PD deficiency
MSUD
19
Q
If NBS done less than 24 hrs from delivery,
A
repeat after 2 weeks
20
Q
Congenital adrenal hyperplasia most common pathway affected
A
21 hydroxylase enzyme (90%)
21
Q
Injury in 11B hudroxylase deficiency in CAH results to
A
Delayed puberty
22
Q
What enzyme affected in congenital adrenal hyperplasia that leads to delayed puberty
A
17a-hydroxylase deficiency
23
Q
Given to female fetus 6 wks AOG; suppresses androgens and prevent virilization
A
Dexamethasone
24
Q
galactose accumulates in galactosemia injuring what primary organs
A
BLK
brain
liver
kidneys
25
Fava beans are one of the contraindicated in this condition; symptoms manifest 1-2 days after exposure
G6PD deficiency
26
Only protection of RBCs to oxidative stress
Glutathione
27
Patients with this congenital condition are immune to malaria
G6PD deficiency
28
This is similar to galactosemia but only has brain damage effects which leads to developmental delay
Phenylketonuria
29
Unpleasant musty odor
PKU
30
Also has brain damage effects like phenylketonuria but has more abrupt effect and more toxic
MSUD (sweet odor of urine)
31
Transient purplish reticulated pattern on neonate when exposed to cold; mottling; cobblestone
Cutis marmorata
32
Half of body of neonate becomes red
Harlequin color change (temporary; observe and reassure mom)
33
Bluish discoloration on buttocks and back
Mongolian spots (BBB)
34
Vesiculopapular; Erythematous base, Eosinophils
Erythema toxicum (EEE)
35
Vesiculopapular; dark macular base, neutrophils
Melanosis (NM)
36
Cysts on hard palate
Epstein pearls
37
Pink macular rash on nape, glabella, nasolabial area
Nevus simplex (not elevated, if elevated hemangioma)
38
Lanugo distribution on lower back
(sparse or thinning)
Thinning
Growth starts on upper back to lower
39
Absent moro reflex, arm adducted, pronated, internally rotated, INTACT hand grasp reflex
Erb-Duchenne palsy (C5-C6)
waiter's tip deformity
40
Absent moro reflex, arm adducted, pronated, internally rotated, absent hand grasp reflex
Klumpke palsy (C8-T1)
Claw hand deformity (ulnar)
41
Head of newborn assymetric bump, crosses midline, with redness, disappears after 2-3 days
Caput succadaenium
42
Head butig disappears after 2-3 weeks, localized and does not cross suture lines, no discoloration
Cephalhematoma (subperiosteal layer)
43
A neonate born through forceps delivery developed raccoon eyes hours after delivery; head of baby is asymmetric but no redness. You noted this is due to rupture of emmisary veins
Subgaleal hemorrhage (progressive but disappears after 2-3 weeks; aponeurosis location)
44
Most common congenital anomaly of esophagus and type
Type C esophageal atresia with DISTAL fistula
45
TEF type with Double fistula
Type D (DD)
Type A no fistula
B proximal
C distal (most common)
D
E H-type (parang H talaga)
46
Esophageal atresia is commonly diagnosed clinically by
Inability to pass NGT/OGT
47
Scaphoid abdomen, PMI shifted near sternum, decreased breath sounds bilateral
Congenital diaphragmatic hernia
48
Most common type of diaphragmatic hernia
Bochdalek hernia (back-the-left)
Morgagni (posterior)
49
Bowel loops eviscerates on the neonate on Right side of umbilicus
GastRoschisis
50
Bowel loops eviscerates with sac intact, easily repaired surgically but associated with congenital anomalies
Omphalocele
anomalies: OEIS complex
Omphalocele
Exstrophy
Imperforate anus
Spinal defects
VACTRL
Vertebral defects
Anal atresia
Cardiac defects
TEF
Renal anomalies
Limb abnormalities
51
35 week old neonate suddenly deteriorates and had toxic, stormy course after given formula milk
Necrotizing enterocolitis - greatest risk factor is prematurity
dont umbicath!!!
52
1 day old neonate with bilious vomiting, non-distended abdomen, no stool
Duodenal atresia (early onset vomiting)
53
Absence of cecum in RLQ, SMV located on the left of SMA
Malrotation
54
Lecithin/sphingomyelin ratio should be __ in lung maturity
>2
55
AOG where surfactant is found at amniotic fluid
28-32 weeks (still immature)
56
Mature surfactant present AOG
>35 weeks
57
65% of surfactant
Phosphatidylcholine (lecithin)
58
Ground-glass opacity in xray, fine reticular granularity of lung parenchyma and air bronchograms
Respiratory distress syndrome
59
1 minute of birth the Spo2 is 65%, what to do?
Stimulate and observe (adjusting and closing of shunts pa, normal)
10 min - 85-95% target sats na
60
Term neonate, HR 190s, retractions, CS delivery
Transient tachypnea of newborn
-due to slow absorption of lung fluid
61
Post term neonate, NSVD prolonged labor, grunting, nasal flaring, retractions, meconium aspiration, persistence of shunts in heart
Persistent pulmonary hypertension
do 2D echo
62
Free radicals damage the lungs due to prolonged intubation; bubbly lungs or cystic lucencies findings; COPD like in preterm
Bronchopulmonary dysplasia
63
Coarse streaking granular pattern in bilateral lung field
Meconium aspiration syndrome
64
Converts bilirubin into isomers that's less toxic to be excreted in the urine
Photoisomerization/phototherapy
65
Level of bilirubin that's high risk in Bhutani chart, needs phototherapy
>/=15 mg/dL
66
bilirubin levels needing DVET (double volume exchange transfusion)
=/> 20mg/dL (also high chance of kernicterus)
67
inTracranial calcifications in CT scan
(ano sa TORCH)
Toxoplasmosis (TT)
68
Periventricular calcifications
(ano sa TORCH)
CytomegaloVirus (VV)
69
Most serious complication of hyperbilirubinemia in neonate
Encephalopathy/kernicterus
-deposition of bilirubin in basal ganglia and brainstem
70
Most common cause of neonatal jaundice
Physiologic (but a diagnosis of exclusion!)
71
Type of bilirubin that crosses BBB, usually checked in neonatal jaundice
Indirect/unconjugated
72
Direct bilirubin >2mg/dL
Cholestatic jaundice (always pathologic pag direct tos >2!)
73
Maternal infection in pregnancy, possible infection in newborn
TORCHeS
Toxoplasmosis
Others (varicella, HIV)
Rubella
Cytomegalovirus
Herpes
Syphilis
74
Only physiologic jaundice that lasts 3 wks-3 months
Breastmilk jaundice
-appears >1 week
75
Found in breastmilk and recycles bilirubin in the body, attributed to breastmilk jaundice
Glucoronidase
76
1st born child:
ABO or RH incompatibility
ABO
Rare lang sa asian ang RH-neg and di rin naga Rh neg ang 1st born, 2nd born lang arut kasi like me
77
According to Kramer's chart for bilirubin assesment, what is the estimate value if the jaundice extends to palms/soles of the neonate
>20mg/dL
Face 5
Nipple 10
Umbilicus 15
Knees 20
Palms and soles >20
78
In neonatal sepsis, what medication is prescribed that has coverage for the 3 MCC
Penicillin:
ampicillin
+aminoglycoside (protein synthesis inhibitors:
Gentamicin/amikacin
-has more gram neg coverage and has synergistic effect with penicillin
79
Coomb's positive
Either ABO or Rh incompatibility
80
MCC of hemolytic disease of newborn
ABO incompatibility
Type O mom, type A or B baby or AB
81
neonate has Retinitis, PDA, purpuric hemorrhage all over body, mentally retarded growing up
Congenital rubella syndrome
Bulag, bingi, basag ang puso, bobo, pangit color
82
90% of Rh incompatibility are due to ___ antibody response
D antigen
83
What drug is not given to <8 yo due to bones and cartilage damage
Ciprofloxacin
84
Most important risk factor predisposing neonate to sepsis, PDA, duodenal atresia, NEC
Prematurity
85
Type of herpes more common in neonates
HSV-2 kasi from genital tract of mom
86
Coomb's test with normal Hgb means
Either enclosed hemorrhage or physiologic (BF vs BM)
87
Maculopapular rash in newborn, periostatis of bone
Syphilis
88
Cutaneous scars kn neonate, with cortical atrophy
Varicella
89
Fluid accumulates in the tunica vaginalis of neonate
Hydrocele
-resolves on its own by 12 months
90
Risk factor for testicular cancer
Undescended testes
91
Infection acquired in utero
Congenital infection
92
Infection acquired at the time of delivery
Perinatal infection
93
Hernia medial to epigastric vessel and projects thru abdominal wall
Direct inguinal
94
Lateral to epigastric vessel and protrude thru inguinal ring
Indirect inguinal
95
Has higher protein and lower fat and lactose than mature human milk
Colostrum
96
Responsible for cow's milk allergy
Casein (casey-cow)
97
Whey-to-casein ratio
3:2 (wh3y is better than casein)
98
Breast milk has always more compared to formula milk EXCEPT for
KID
Vit K
Iron
Vit D
99
Creamy, more fat content
(Foremilk or hindmilk)
Hindmilk (sa huli)
Foremilk (nauna, watery, high carbs)
100
Component of breastmilk responsible for brain development
Phospholipid
101
Breastmilk lasts for 6 months long when stored in what temperature?
Freezer -20C
Ref 4C - 8 days
Room temp <25C - 4 hrs
102
103
GERD peaks in 4 months and usually resolves by __
12 months
104
When can you start breastfeeding in a TB mom?
2 weeks after initiating meds
105
How do you breastfeed babies with HIV mom
Shortest duration possible and exclusive BF only!
Relative contraindication ang HIV UNLESS no other choice
106
Alopecia, generalized dermatitis, thrombocytopenia
Essential fatty acids deficiency
107
Diarrhea, dementia, casal neck
Pellagra/Vit B3
4 Ds
+ Death
Dermatitis
108
Alopecia, hypotonia
Biotin/B7 deficiency
109
Night blindness, keratomalacia, xeropthalmia, bitot spot
Vitamin A deficiency
110
Oval or triangular spot if keratinizing epithelium in conjunctiva
Bitot spot
111
Chostochonral junction widening in Vit D deficiency, craniotabes, harrison groove, windswept deformity
Rachitic rosary in Rickets
112
Vit K coagulation factors
1972
113
Classic hemorrhagic disease of newborn due to poor intake and no intestinal synthesis
Early VKDB
114
maternal taking warfarin, newly born bleeds after cord cutting in the DR
3rd form of VKDB
115
Beri-beri
Vit B1 deficiency
116
Perleche and magenta tongue
B2 deficiency
117
Mom used estrogen-riched pills for 10 years prior to pregnancy. Baby at risk for
Pyridoxine deficiency
118
Vegetarian mother, baby has hypotonia, persisting and other severe neuro damage signs
Megaloblastic anemia/B12
Folate deficiency - only megaloblastic, no neuro sx
119
Poor wound healing, sharp scorbutic rosary pattern in chest, ground glass appeance of distal long bones ends
Scurvy
Vitamin C
Scorbutic
Sharper
120
Minerals unaffected by maternal status, has enough fetal supply for 1st 6 months
Iron
Zinc
121
Vitamin and minerals affected by maternal diet
Iodine
Vitamin D
122
Corn as staple food, what vitamin deficiency?
B3/p3llagra
123
Most seriously compromised immune function in malnutrition
Antibody production
think of kwashiorkor kunuh, protein problems=antibody problems
124
Hyperostosis
Increased ICP
no metaphyseal changes
what vitamin?
Vitamin A Intoxication
125
Skin ulcers, hypogonadal dwarfism, decreased immune response
what mineral/vitamin
Zinc - very potent immunomodulator
126
Protein energey malnutrition, Protuberant abdomen, edematous
Kwashiorkor
Mas toxic sa marasmus (spelling pa nga lang)
127
Age duration greated risk for malnutrition
First 1000 days (0-24mos)
128
Most important parameter for detecting wasting
Weight-for-height/length
Others:
MUAC
BMI
129
Severe wasting in MUAC
<11.5cm
130
Weight for height score for SAM
-3 SD
131
Process by which fat stores are used, protein mobilized, inflammatory and immune response are decreased in SAM
Reductive adaptation
132
When to give iron in SAM patient?
After treating gram-neg infections (iron may exacerbate these cuz immunicompromised)
133
What to WOF in managing SAM?
Refeeding syndrome
134
What is the hallmark in refeeding syndrome?
Severe hypophosphatemia (
135
Normal weight in BMI percentile
5th-84th percentile
>94 overweight
136
Leading cause of pediatric hypertension
Obesity
137
Hypertension, glucose intolerance, hypertriglyceridemia, decrease HDL, central obesity
Metabolic syndrome
138
Polycythemia, hypoxemia, cyanosis in extreme obesity
Pickwickian syndrome
lose weight as rapidly as possible
139
Weight management in obesity
Weight MAINTENANCE (tatangkad pa sila)
140
Pharmacologic for severe obesity
Orlistat -decreases fat absorption for >12 yo .marginal value
141
ultimate goal of immunization
disease eradication
142
only exception for vaccines allowed to be administered simultaneously
yellow fever and cholera
3 weeks interval to prevent diminished antibody response
143
how do you give measles and varicella vaccines to a patient?
either simultaneous or 4 weeks interval
144
5 days after immunization, the child had sudden seizure. What vaccine would you suspect was given?
pertussis vaccine - adverse effect is encephalopathy
145
EPI with 6,10,14 weeks sched
3 Ps + rotavirus
pentavalent
poliovirus
pneumococcal
rotavirus
6 mos - flu
9 mos - japanese encephalitis/measles
12 mos - MMRubellA, varicellA, hep A
146
only vaccine that cannot be given to babies aged >4 months old or later than 8 months
rotavirus - high risk of intussusception
147
vaccines not given if child is >5 years old
HiB and pneumococcal
148
unimmunized 2 year old child was brought to the clinic for immunization, what is the dosage of the BCG to be administered?
0.1 ml
0.05 ml if <12 mos
149
in pertussis EPI schedule, when can you say the child is fully immunized?
received 5 doses of DTaP or 4 doses if 4th dose was given on his 4th birthday
150
when do you give hepa b vaccine for a preterm newborn?
at 30 days of life
151
baby born from a HBsAg (+) mother, when should post-exposure prophylaxis be given?
within 12 hours after birth
(HBIg no late than 7 days)
152
pre-exposure rabies prophylaxis, how many doses?
2 doses day 0 and 7
153
patient was scratched by his dog on the face. He received PrEP rabies 2 months ago, what should you administer?
none
if more than 3 months, give vaccine only, no need RIG
154
how many doses ang verorab?
2 doses day O and 3 OR
4 site ID day 0 one dose lang
kasi WHO-approved vaccine
155
antibiotic of choice for Cat III animal bites
co-amoxiclav 40mg/kg/day for 7 days
156
in tetanus prophylaxis, what do you give for a clean cut wound if the patient received 3 doses of tetanus vaccines in the past and last dose was 6 years ago?
none
ATS/TIG only given for contaminated wound or if dose uncertain
Td booster given every 10 years cos it can accentuate adverse effects if frequent
157
what COVID-19 vaccine can be given to a 7 year old
Pfizer for 5-11, moderna and pfizer for 12-17
158
varicella immunoglobulin should be given when after exposure?
within 96 hours 1 vial/10kg IM, never IV
Vaccine within 3-5 days
159
prophylaxis for exposure to diptheriae
erythromycin or benzathine Pen G
160
Deworming should be every
6 months
161
danger signs
inability to drink/breastfeed
lethargy/unconsciousness
convulsions
vomits everything
162
In IMCI plan A for diarrhea management, how much oresol will you order?
100-200ml per stool
163
what antibiotic given to a child with dysentery?
co-trimoxazole
or
ciprofloxacin for 5 days
164
in plan B management for diarrhea in IMCI, oresol is to be given how long?
4 hours
weight x 75 = ___ given in 4 hrs
165
in plan C management for diarrhea in IMCI, how do you administer fluids?
30ml/kg in the first 30 min
70ml/kg in the next 2.5 hrs
166
osmolarity in reformulated ORS
245 lesser chance of pulling water to intestinal lumen
glucose: Na is 75:75
better Na-gluc-cotransport)
167
zinc therapy for diarrheal patients decreases bouts of diarrhea for the next __
2-3 months
168
allowance for G&D milestones for a child <12 mos before considering pathological condition
+/- 2 months
+/- 4 months if >12mos
169
what age can a child sit without support?
8 months
4 months rolls over
170
what reflexes should first disappear prior to voluntary actions to develop
primitive reflexes:
moro
landau
rooting..
171
formula for 1-6 yo for weight
age in yrs x 2 + 8
other technique:
1 year - 10kg
2 12kg
3 14kg
4 16kg
5 18kg
6 20kg
172
height formula
ht in cm=age in yrs x 5 + 80
173
if still no teeth by 13 months, what will you consider?
thyroid disorder
174
pincer grasp, object permanence
8 months
175
can build 2-3 tower blocks
15 months
176
can speak 20-50 words
2 years (language explosion)
177
knows own name, age, sex
3 years
178
stranger anxiety
6 months (stranger muna bago ka magsepanx)
12 mos- sepanx
179
can speak mama/dada
9-10 months (daming nangyayari)
crawls
cruises
pincer grasp
object permanence
180
can draw a square
5 months
remember the lady wearing a skirt drawing
circle 3
cross 4
square 5
triangle 6
181
toilet trained, dry by night
3 years
182
ties sh6es
6 years
183
age interested in basic sexuality
4-5 years
184
primitive reflex that persists throughout life
parachute reflex
185
average sleep hours of a 3 year old
15 hours hayst natanong daw to
186
asymmetric moro reflex
fractured clavicle
brachial plexus injury
hemiparesis
187
moro reflex disappears by
5-6 months
rooting - 1 month
palmar - 2-3
tonic neck - 6-7
188
poor eye contact, repetitive arrangements of toycars
ASD
189
ADHD age onset
several symptoms (6 or more) before age 12
190
Gold standard diagnostic for biliary atresia
Direct cholangiography
191
>14 days increase of conjugated bilirubin in a neonate
Neonatal cholestasis
192
Mechanical obstruction of bile in a 2 day old newborn
Biliary atresia
193
neonatal disease of bile duct proliferation with intact basic hepatic lobular architecture
biliary atresia
194
distorted lobular architecture with less bile duct alteration in newborn
neonatal hepatitis
195
procedure for biliary atresia where there is 90% success rate if done <8 weeks
kasai hepatoportoenterostomy
196
definitive management for biliary atresia
liver transplant
197
profuse diarrhea after eating raw oysters or undercooked shellfish
vibrio parahaemolyticus
198
best test for salmonella at any time of illness
bone marrow aspirate
199
greasy stool,gassy
giardiasis (GGG)
200
toxin of cholera
enterotoxin A and B subunit
201
purpose of giving doxycycline to cholera
to shorten duration
202
great mimicker disease and has weird symptomatology
typhoid/enteric fever
203
chronic carriers of typhoid can occur if stool excretes S.typhi __
>3 months
204
trophoizoites with ingested RBCs
amoebiasis (entamoea cysts seen is not indicative of amoebiasistenesmus, ab kasi dapat tropho)
205
abundant pus and WBCs in stool
shigella
206
bloody diarrhea after eating hamburger
EHEC
207
shiga-toxin producing E. coli, bloody diarrhea
EHEC
208
bloody, mucoid stools, shiga-toxin causing HUS
Shigellosis
209
bloody diarrhea differentials
SEECSY
Shigella
E.coli EIEC
Entamoeba
Campylobacter
Salmonella
Yersinia
210
MCC of obstruction in 3 mos-6 yrs, currant jelly stool, sausage-shaped mass in RUQ, knees flexed, loud crying, well between episodes, donut-ring or target sign in UTZ, coiled-spring sign in barium enema
Intususception
211
postprandial non-bilious vomiting, olive-shaped movable mass; shoulder or double-tract sign in barium
pyloric stenosis
212
double bubble sign xray; jaundice , bilious vomiting no distention on 1st day
duodenal atresia
213
Constricted portion in recrosigmoid vault, no feces on examining finger, absence of ganglion cells beginning in internal anal sphincter
Hirschsprung's disease
214
Meconium passage should occur within
48 hours
215
Omega sign/coffee bean sign
Volvulus
216
2 types of common ectopic tissues in meckel's diverticulum
Gastric and pancreatic
Rule of 2s
2 inches long
2% of pop
2 yo
2x more males
2 ft from ileocecal valve
217
Voluntary/involuntary passage of stool in inappropriate places
Encopresis
218
Encopresis 1 episode per week, large diameter stools clogs the toilet, hard stools causing distress to patient
Functional constipation
219
Duration of giving lactulose therapy to functional constipation
4-6 months
220
Diarrhea type that stops when fasting
Osmotic diarrhea (lactose intolerance)
221
Diarrhea that persists during fasting
Cholera/secretory
222
Foreign body ingestion failure to visulatize, with respiratory distress, what to do?
Urgent endoscopy
223
In caustic ingestions, liquid alkali is more dangerous because it is prone to
Perforation due to liquefaction necrosis
224
Safest to do in caustic ingestion is
Dilute with water and milk.
NEVER induce emesis and lavage!!!
225
MCC of acute pancreatitis
Trauma - blunt injury
226
Criteria to diagnose acute pancreatitis in paraclinical
Serum lipase - 3x increase
rises faster 4-8 hrs
peaks faster 24-48 hrs
lasts longer 8-14 days
Amylase readily available
227
Best Imaging modality for pancreatitis
CT scan
228
Criteria for early refeeding in pancreatitis
Amylase falling
Symptoms resolving
No vomiting
229
1st clinical evidence of hepa B virus infection
Elevated ALT
230
Only positive in window period of HBV, acute infection
Anti IgM HBcAg
231
First serologic marker of HBV infection, coincides with symptoms
HBsAg
232
Acute, resolved, or chronic HBV infection
Anti-HBc
233
Calculation for BP estimate
Age in years x 2 + 90
234
Most important sign in nephritic syndrome
Hematuria
HOHA
Hypertension
Oliguria
Hematuria
Azotemia
235
May cause false positive protein in urine
Hematuria
236
Decreased in PSGN
C3
237
Given to eradicate strep in PSGN and decrease risk of transmitting to others but it does not alter the disease
10 day course penicillin
238
>5 RBCs/hpf in urine
hematuriaa
239
brown, tea-colored urine, proteinuria >100mg/dl, acantrocytes
glomerular/upper urinary tract injury
240
MCC of hematuria in children
UTI
241
bacterial cause of PSGN
strep.pyogenes (group B strep)
242
Acute PSGN is what type of hypersensitivity reaction
Type III - immune complex deposition
243
ASO titer, serotype 12, PSGN occurs 1-2 weeks after
strep throat infection
244
anti-DNAse B, serotype 49, PSGN 3-6 weeks after
skin infection
245
Top 3 causes of renal insufficiency causing decreased C3
PSGN
MPGN
lupus nephritis
246
renal insufficiency + hemoptysis + severe respiratory distress
Goodpasture syndrome
247
wears thick glasses, sensorineural hearing loss, incidental finding of hematuria, same sx with uncle who develop ESRD befor 30 yo
Alport syndrome
248
hematuria, hypertension, purpuric rash on buttocks, SVI 3 wks ago
Henoch-Schonlein purpura
249
hematuria, hypertension, renal insufficiency, ate hamburger, bloody diarrhea
HUS
250
normal C3, gross hematuria, increase serum IgA, diffuse mesangial IgA deposits
IgA nephropathy
251
persistent microscopic hematuria and thinning of GBM
thin BM disease
252
crescenteric GM, 90% nephritic, (+) ANCA
RPGN
253
most important marker of nephrotic syndrome
proteinuria
PALE
proteinuria
albumin low
lipidemia high
edema
254
1st morning void on 3 occasions UPCR >2
fixed proteinuria
255
upper limit of protein in urine
150mg/day
3+ 300mg/dl
4+ >2g/dl
256
more accurate test for proteinuria
24-hr urine protein - hassle
nephrotic range >40mg/m2/hr
UPCR +/>2
257
3+or 4+ proteinuria, low albumin c3 normal, diffuse effacement of podocytes
minimal change disease
258
management for minimal change disease
steroids
prednisone for 4-6 weeks then alternate for 8 weeks to 5 months
biopsy not required
259
renal biopsy required in
gross hematuria
hypertension
renal insufficiency
hypocomplementenemia
<1 yo, >12 yo
260
symptoms alleviate in 4 weeks after steroid therapy in MCD
response
261
UPCR >2 or >3+ protein for 3 consecutive days after steroid therapy in MCD
relapse
262
major complication of MCD
spontaneous bacterial peritonitis
263
renal pathology associated with HBsAg
membranous glomerulonephritis, MPGN, polyarteritis nodosa
264
spike and dome appearance
membranous GN
265
tram-track apperance
MPGN
266
loss of foot processes
focal segmental glomerulosclerosis - if MCD did not respond to steroids
267
asymptomatic bacteriuria do not need antibiotic treatment except in
pregnant
268
most serious bacterial infection in <2 yo
pyelonephritis
269
urinary frequency, urgency, dysuria, UA findings, no culture
presumptive UTI
270
method of urine collection in <2 yo
clean catch
>2 midstream
271
gold standard to diagnose UTI
urine culture
272
1st time presumptive UTI needs to have __ to detect any anatomical abnormalities
KUB UTZ
273
Renal injury
Anemia, microangiopathic
Thrombocytopenia
most common cause of ARF in children
HUS
274
Fever
Anemia
Thrombocytopenia
Renal failure
Neurologic signs
Thrombotic thrombocytopenic purpura - occurs in older children
275
renal injury, anemia, thrombocytopenia + began 3 weeks after acute bloody diarrhea
confirmed HUS
276
in HUS, magtransfuse ba ng platelets and antibiotic?
NOOO
platelets- worsen by immediate consumption by coagulation factors
antibx - increases toxin release
277
more rapid decline of hgb (7-9g/dl), shortened RBC lifespan 40-60 days, preterm
physiologic anemia of prematurity
278
microcytic anemia causes
TAILS
thalassemia
anemia of chronic disease
iron def
lead poisoning
sideroblastic anemia
279
in IDA, what hgb level produces symptoms of irritability, anorexia, tachycardia
5mg/dl
280
MC sign is pallor (7-8g/dl), and MCC is poor dietary intake
IDA
281
low retics, microcytic, hypochromic RBCs, low ferritin, high RDW, high TIBC
IDA
282
low retics, microcytic, hypochromic RBCs, normal RDW
thalassemia
283
low retics, microcytic, hypochromic RBCs, low TIBC
anemia of chronic disease
284
duraton of iron therapy
2-3 months (iron stores repletion in 3 months)
285
in IDA, repeat CBC after
4 weeks (increase in hgb 1-2g/dl)
286
pancytopenia, all cell lines mababa
aplastic anemia
287
type of a-thalassemia incompatible with life
hydrops fetalis (4/4 traits affected)
288
target cells and heinz bodies in PBS
thalassemia (si heinna may thalassemia)
289
cooley anemia
B thalassemia major
290
therapy if too much iron
chelation
291
eats up free iron
yersinia enterocolitica
292
decrease RBC survival
low retics
high B1
high LDH
hemolytic anemia
293
high MCHC
normal MCV
spherocytosis
294
gives the biconcave shape to RBCs
spectrin/ankyrin
295
painful crisis, crew-cut or hair-on-end appearance on xrays
sickle cell disase
296
autosplenectomy leads to
increased susceptibility to encapsulated bacteria
strep pneumoniae
klebsiella
haemophilus
pseudomonas
neisseria meningitidis
salmonella
group B strep
some killers have pretty nice & shiny bodies
297
howell-jolly bodies on PBS
sickle cell anemia
298
isolated thombocytopenia
ITP
299
isolated PTT derangement, ankle swelling, hematoma
hemophilia
300
function of platelets
bleeding time
301
hemophilia A affects what pathway
intrinsic (factor A8)
302
christmas disease
factor IX (hemophilia B)
303
both PT and PTT derangement
Vit K deficiency or warfarin toxicity
304
hallmark of hemophilia
prolonged bleeding
305
earliest joint hemorrhages in hemophilia
ankles
306
MC hereditary hypercoagulable disorder
factor V Leiden
307
most common hereditary bleeding disorder; high PTT, high BT, normal or low plt
Von willebrand disease
si Von nagsuka ng dugo haha high bleeding time and PTT
308
carrier for factor VIII
vWF
309
medication that facilitated release of vWF from endothelial cells
desmopressin
310
all high, low plt
DIC
311
MCC of childhood malignancy y'all!
Acute lymphocytic leukemia y'all! (<4 weeks)
312
pancytopenia + hypocellularity
no signs of infiltration
aplastic anemia
hypercellularity y'ALL
313
signs of infiltration in y'ALL
bone pain
lymphadenopathy
splenomegaly
314
single most important prognostic factor of y'ALL
treatment response
3 important predictive factors:
age at time of dx
initial leukocytes
treatment response speed
315
where y'ALL spread
LIVER spread
spleen
lymph nodes
316
sites of relapse of y'ALL
CNS
BM
testes
317
poor prognosis of y'ALL
<1, >10
male
>50000 leukocyte
CNS leukemia
mediastinal mass
318
2nd MC malignant abdominal tumor, does not cross midline
wilm's tumor/nephroblastoma
319
wilm's tumor staging where it extends beyond kidney but completely resected with negatiive margins
stage II
320
hematogenous spread or LN (wilm's tumor stage)
STAGE IV
321
bilateral renal tumor, malignant (stage)
V
322
abdominal mass that crosses midline
neuroblastoma - MCC of abdominal tumor
323
MCC site of nuroblastoma
adrenal glands
324
dancing eyes. dancing feet
opsoclonus/myoclonus (mets sign of neuroblastoma)
325
good prognostic age of neuroblastoma
the younger the better (83% for infants)
326
staging of neuroblastoma where tumor extends beyond midline
III
327
staging of neuroblastoma, <1 yo patient, liver, skin or BM with no bone involvement
4S (100% survival amost)
328
site of lymphadenopathy which almost always indicate malignancy
supraclavicular
329
B symptoms
weight loss
fever
night sweats
330
ann arbor staging of lymphoma
2 LN both sides
stage 3
stage 2 - 2 LN same side
331
weight loss in lymphoma
>10% in 3 mos
332
reed-sternberg cell
hodgkin lymphoma
333
type of hodgkin lymphoma with best prognosis
mixed cellularity lymphocyte
334
60% of childhood lymphomas
non-hodgkin
335
aplastic anemia with microcephaly, microphthalmia, hearing loss, limb anomalies
fanconi anemia
336
drop attacks seizure
atonic seizure
337
seizure involving one cerebral hemisphere with impairment of consciousness
complex partial
338
10 month old previously able to sit without support now cannot; seizure in infancy with developmental regression; hypsarrythmia
west syndrome
339
3 year old child suddenly having twitching of one side of face and drooling; contemporal spikes on EEG
benign childhood epilepsy with contemporal spikes/rolandic epilepsy
-outgrown in adolescence
340
brief staring spells <15sec
absence/petit mal seizure
341
seizure in childhood with visual aura, migraine headache, with developmental delay, no remission
lennox-gestaut
342
if seizure occur in this age group, it is usually lifelong but with good control
adolescence
343
15 yo, jerky arms 1-2 hours after waking up or nap
Janz syndrome (adolescent na si Janz), usually lifelong
344
1st line medication for benign epilepsy with contemporal spikes
oxcarbazepine
345
complex partial seizure with vomiting, retching, spitting
panayiotopoulus type - early childhood
346
rescure medication for seizure
rectal diazepam for seizure >5 mins
347
risk of febrile seizure to develop to epilepsy
2-7%
348
medications acting on sodium channels, for what type of seizure?
partial
349
medications acting on T-type calcium channels, for what type of seizure?
absence
350
most common seizure disorder in childhood
simple febrile seizure
351
recommended for first febrile seizure in <18 months
LP
<6mos in Nelson's
352
EEG should be done in 1st febrile seizure. T or F
False
353
risk factor for subsequent epilepsy
neurodevelopmental abnormalities
354
continuous seizure activity w/o regaining consciousness >5mins
status epilepticus
355
seizure type failed to respond to at least 2 meds
refractory seizure
356
Normal CSF composition
pressure 50-80 mmH20
<5 mm3 lukocytes, >75% lymphocytes
protein 20-45mg/dl
glucose >50
357
in bacterial meningitis, all elements in CSF are high EXCEPT for
glucose (low)
358
CSF 150mmH20
300 mg/dl protein
1000 PMNs
20 glucose
chronic cough
infiltrates ang lung cavitations bilateral CXR
TB meningitis
same with bacmen, but history suggestive of TB
359
CSF parameters not influenced by traumatic LP
gram stain
glucose
culture
360
in meningococcemia, patient is communicable until how many hrs after initiating antibx
24 hours
361
fulminant type of mningococcemia with diffuse hemorrhage on adrenals
waterhouse-friedrichsen syndrome
362
prophylaxis for physician who performed the ET intubation on a meningococcemic patient
Ciprofloxacin 500mg SD PO - for >18 yo
children: rifampicin 4 doses
363
neural tube defects develop when there is failure of neural tube to close in __ in utero
3rd or 4th week
364
most severe form of neural tube defect
myelomeningocele
365
G3P2 mother is asking how to prevent neural tube defect in her pregnancy
4mg folic acid OD (subsequent preg)
0.4mg for primi
366
arnorld chiari malformaataion type with craniolacuna and polymicrogyria, elongation of cerebellar vermis, brainstem
II
I - cerebellar tonsils
III- bony defect, cerebellar herniation into encephalocele
367
recurrent headache with symptom-free intervals, fam hx +
migraine
368
throbbing, unilateral headache more than 3 days duration
status migranosus
369
headache perceived as bandlike tightness around head
tension headache
370
indication for surgery on brain abscess
multiloculated abscess
+ gas
posterior fossa
fungal
371
high protein, normal glucose, no pleocytosis on CSF; landry ascending paralysis
albuminocytologic dissociation in GBS
372
variant of GBS with acute ophthalmoplegia
ataxia
areflexia
Miller-Fisher syndrome
373
management for GBS
IVIG for 5 days
374
tubers in subependymal region
tuberus sclerosis
375
affected chromosome in neurofibromatosis/von reckinghousen
17 letters for chromosome 17
376
generalized cafe au lait macules sparing the face and iris lisch nodules
NF-1
377
MC malignant brain tumor in children causing obstructive hyrocephalus
medulloblastoma
it invades 4th venrtricle
378
brain tumor causing bitemporal hemianopsia
craniopharyngoma - pressure on optic chiasm
379
large head relative to body
weakness of cervical muscles
large subarachnoid space
high water content of brain
shaken baby syndrome - abusive head trauma
380
MC artery affected in arterial ischemic stroke (AIS)
MCA
381
thunderclap headache, LOC, nuchal rigidity, focal neuro signs
hemorrhagic stroke
382
MCC of childhood subarachnoid and intraparenchymal hemorrhagic stroke
AV malformation
383
barking cough, steeple sign, family member sick
Croup/LTB
MCC: parainfluenza
384
brassy cough, ragged air column sign, detachment of pseudomembranes
bacterial tracheitis
(staph.aureus, HiB for unvax child)
385
muffled voice, hyperextended neck, drooling thumbprint sign on lateral neck xray
epiglottitis
386
MC obtained foreign body from respiratory tract of children
nuts
387
MCC of sinusitis
strep.pneumoniae
HiB
moraxella catarrhalis
*same with OM
388
cough and colds >14 days predisposes to this condition
sinusitis
389
catarrhal nasal discharge in congenital syph
snuffles
390
1st time wheezing, cough, colds. fever in 1st 2 years of life
bronchiolitis by RSV
391
chronically inflamed airways, increase mucus production
bronchial asthma
392
normal RR in 6-10 yo
<30bpm
1-12mos <50
1-5 <40
6-10 <30
11-18 <20
393
target SpO2 in adolescents with asthma exacerbation
93-95%
394
add on therapy in the 1st hour of severe exacerbation/status asthmaticus
MgSO4
395
medication that prevents future severe exacerbations and hosp, reduces death
ICS
396
triad of fever, cough, and tachypnea
pneumonia
397
causative agent for staccato cough, unrelieved by common antibx for pneumonia, eats/drinks well, LG-fever
chlamydia pneumoniae (atypical)
398
medication for staph pneumoniae
clindamycin
399
medication for viral pneumonia
oseltamivir BID for 5 days
400
adjunct therapy for severe PCAP
vit A
bronchodilator
zinc, mucolytics, and Vit D not adjunct tx
401
most infectious stage of pertussis
catarrhal
402
communicability period of pertussis
7 days after exposure to 4 weeks after paroxysms onset
403
MCC of lobar consolidation
pneumococcus
404
test that ca distinguish between LTBI and previous BCG
IGRA
405
if a child cannot still expectorate, what other method can you get sample for Xpert MTB
gastric aspirate 40-100% sensitive
406
TB test to monitor progress while on tx and confirms cure
SM
407
basic screening tool for TB in children esp <5yo
TST
408
duration of TB treatment for DR-TB
9-20 mos
409
Jaundice adverse effect of what TB meds
all esp INH, Rif, PZA
410
oliguria, albuminuria adverse effect of what anti-tb drug
rifampicin
411
psychosis and convulsion (TB drug)
INH
412
thrombocytopenia, anemia, shock (what anti-tb drug)
rifampicin
Orifampicin urine and BLood
413
bactericidal TB drug, inhibits mycolic acid synthesis
INH
414
inhibits DNA-dependent RNA polymerase
Rif
415
disrupts membrane energy metabolism tb drug
PZA
416
management for LTBI in <5yo
INH for 6 mos - (+) mantoux test and normal CXR
417
asymmetric tonsilar bulge with displaced uvula
peritonsilar abscess - adolescents
418
bulging posterior pharynx, hot potato voice, 3-4 yo
retropharyngeal abscess
419
generalized joint pain, all normal labs
FIBROMYALGIA
420
7yo, joint pains at night relieved by rubbing
growing pains
421
5 days of fever, strawberry tongue,cervical LAD, conjunctivitis, rash, brawny edema
kawasaki disease
criteria: 5 days fever + 4 of CRASH
Hand changes - brawny edema and peeling on nail bases
422
kawasaki disease phase at highest risk of death
subacute
423
5 days fever, perineal erythema and desquamation, coronary artery lesions
incomplete KD
424
history of SARS-COV2 infection, multiple organs affected, heart most commonly affected
Multisystem Inflammatory Syndrome in Children (MIS-C)
425
MC inflammatory myopathies, alligator skin on hands, shawl signs, puts hands on thighs to stand
juvenile dermatomyosistis
gottron papules
gower sign
426
MCC of nonthrombocytopenic purpura, IgA mediated vasculitis of small vessels, palpable purpura on dependent areas
Henoch-Schonlein purpura
427
HSP requires serial __ every 6 months
urinalysis
428
involves swelling on right knee, and left ankle
oligoarthritis/pauciarthritis OR juvenile idiopathic arthritis
429
fever, salmon-colored rash, joint pains, symmetrical
systemic juvenile RA
430
dactylitis, nail pittting, same symptoms with mother
psoriatic arthritis
431
DMARDs
disease modifying anti-rheumatic drugs:
Methotrexate
Sulfasalazine
432
only test specific for diiagnosing SLE
anti-smith antibody
433
what is the entry criterion for SLE that if it is absent it is not considered as SLE
ANA titer of >1:80
434
medication given in SLE regardless of severity
hydroxychloroquine
435
grade of murmur with thrill
4/6
after 3 u have thrill!
436
primitive heart tube is formed by
22 days gestation
iheart22 by TS
437
when is the AV and SV formed?
3 months gestation
438
ductus arteriosus functional closure
10-15 hrs after birth
439
ductus arteriosus anatomic closure
2-3 weeks of age
440
the patency of ductus arteriosus depends on __ and __
low o2 levels and high PG produced by placenta
441
murmurs that coincide with ejection of blood from SV
ejection murmur (systolic)
AS
PS
442
murmurs that begins with S1 with SV closed
regurgitant murmur
MR
TR
VSD
443
murmurs that are always pathologic
diastolic murmur
444
murmur best heard on 4th-5th ICS, LSB, mid-to-late diastolic
tricuspid stenosis
445
murmur that varies with position, up to grade 3/6
functional/innocent murmurs
446
most common congenital heart disease overall
VSD
447
MC CHD in newborn
ToGA
448
MC cyanotic CHD in infants and young children
TOF
449
what do you expect in a premature neonate with PDA
spontaneous closure bcos of normal structure DA unlike in term with PDA that persists beyond 1st week of life
450
VSD causes enlargment on what chamber/s?
left sided enlargement
451
sequelae of VSD leading to cyanosis due to pulmonary hypertension which results to R to L shunt
Eisenmenger syndrome
452
systolic eejection murmur, widely split S2 due to delayed PV closure due to delayed ventricular contraction
ASD
453
machinery like murmur at 2nd L infraclavicular area
PDA
454
systolic, 2nd L ICS murmur radiating to back
PS
455
cardiac pathology common in Down syndrome
AVSD or ECD (endocardial cushion defect)
456
marfan syndrom cardiac pathology
MVP (M4M)
457
cardiac pathology common in Noonan syndrome
PS
"Noonan sa PunSo"
458
test that distinguishes cyanotic CHD from pulmonary disease
Hyperoxia test - 100% FiO2 in 10-15 mins
459
4 deformities in ToF
large VSD
RVOT obstruction/PS
RVH
overriding aorta
460
couer en sabot on CXR
TOF (boot-shaped heart)
461
a child with this condition assumes this position in hypoxic episodes to find comfort
knee-chest position - decreases systemic venous return
462
surgical procedure in TOF to augment PBF
Blalock-Taussig shunt - systemic to pulmonary
463
congenital heart diseases with increased PBF
3Ts
TGA
TAPVR
Truncus arteriosus
464
congenital heart disease with hypoxemia that is unresponsive to o2 inhalation
TGA
465
egg-on-a-string sign
TGA
466
PA arise from aorta, always with VSD, both ventricles eject to a common vessel
truncus arteriosus
467
all PV drain to RA leading to RV overload
TAPVR
468
snowman sign on CXR
TAPVR
469
weak femoral pulses. UE hypertension, rib notching, systolic murmur 4th-5th LICS radiating to infrascapular area
CoA
470
given to reopen ductus arteriosus in CoA
PGE2
471
472
Inverted E sign on CXR
CoA
473
loud, blowing holosystolic murmur
VSD
474
all left side of the heart is severely underdeveloped, RV burdened to pump blood both to lungs and to body via PDA
holoplastic left heart syndrome
475
this should be performed in all suspect/confirmed cases of ARF
2D-echo
476
non-pruritic erythematous serpiginous annular rash in RF
erythema marginatum
nawawala in cold exposure
477
systolic regurgitation at apex that radiates to axilla
MR
ang VSD hindi
478
spontaneous purposeless movements common in prepubertal girls with RF followed by motor weakness
sydenham chorea
479
ASO titer in children confirming previous strep infection
333 Todd units
250 in adult
elevated for 2 weeks, peaks 4-6 weeks, decreases after 2 weeks (2 months total)
also a 4 fold rise in 2 samples 10 days apart
480
criteria to dx ARF
2 major + 1 minor
1 major + 2 minor
EITHER BASTA WITH PREVIOUS STREP EVIDENCE
major JONES
minor FRAPE
481
antibiotic therapy for ARF
10 days penicillin/ IM SD Pen G
482
Prophylaxis for RF
Pen G IM every 21 days
483
Duration or prophylaxis if there is carditis with no valvular involvement
10 years or until 21 yo whichever is longer
if meron both, 10 years or until 40 years old
if wala both, 5 years or until 21 years old
484
fishmouth buttonhole deformity; causing LA and R sided hypertrophy
MV stenosis
485
bounding waterhammer pulse/corrigan pulse; high-pitched diastolic murmur at 3rd-4th LICS more audible when leaning forward
AR
486
CHD patients are most susceptible to develop this vegetations due to turbulent blood flow
Infective endocarditis
487
tender, pea-sized intradermal nodules in fingerpads and toepads in IE
osler nodes
488
painles small hemorrhagic lesions in palms and soles in IE
janeway lesions
489
infective endocarditis developed after dental procedure
viriDENs strep
490
IE post GIT/GUT manipulation/procedure
group D strep (enterococcus faecalis)
491
IE after open heart procedure
fungal
492
IE in prosthetic valve
staph epidermidis
493
IE in GI malignancy
strep bovis
494
IE in drug abusers
staph
495
MC valve affected in IV drug abusers
TV (but in others mas common ang MV)
496
Intracytoplasmic inclusions, in-turned eye lashes, corneal scarring
Chlamydia
497
Maculopapular rashes for 3 days, posterior CLAD, forscheimer spots in mouth
Rubella
498
Given to patients with measles to decrease mortality
Vit A 50,000 U <6 mos
499
Warthin-finkeldey cells found in patient who died due to a fatal complication of rubeola
Bronchiolitis obliterans
500
Post exposure prophylaxis for measles
Active vaccine within 72 hrs
Ig within 6 days
