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Step 2 CK > Pediatrics 2 > Flashcards

Pediatrics 2 Flashcards

1
Q

Treatment of herpes simplex conjuntivitis?

A

systemic acyclovir and topical vidarabine

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2
Q

if tachypnea in a newborn lasts >4 hours it is considered _____ and must be evaluated with _____ tests?

A

sepsis, blood and urine culture

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3
Q

most fatal infant skull fracture?

A

basilar

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4
Q

most common infant skull fracture?

A

linear

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5
Q

Caput succedaneum

A

swelling of soft tissues of scalp that do cross suture lines (edema)

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6
Q

Cephalohematoma

A

subperiosteal hemorrhage (does NOT cross suture lines)

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7
Q

Duchenne-Erb Paralysis: C5-C6 presents as

A

“Waiter’s tip” appearance. secondary to shoulder dystocia

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8
Q

Klumpke paralysis C7-C8/T1

A

Claw hand due to lack of grasp reflex (paralyzed hand with horner syndrome- ptosis, miosis, anhydrosis)

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9
Q

Forcep delivery can cause damage to?

A

facial nerve- facial nerve palsy.

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10
Q

Werdnig-Hoffman

A

spinal musclar atrophy in infant

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11
Q

Causes of polyhydramnios?

A

Werdnig-Hoffman (infant cant swallow), Intestinal atresias

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12
Q

Causes of oligohydramnios?

A 
Prune belly (no abdominal wall muscles so unable to bear down and urinate)
Renel agenesis (potter syndrome)
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13
Q

Omphalocele is associated iwth what chromosomal abnormality?

A

trisomy 18

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14
Q

Aniridia is?

A

absence of iris

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15
Q

aniridia is most valuable clue to what diagnosis?

A

Wilms Tumor

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16
Q

Most common abdominal mass in children?

A

Wilms Tumor

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17
Q

Best initial study to diagnose Wilms tumor? Most accurate study to diagnose wilms tumor?

A

Ultrasound

Contrast-enhanced CT

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18
Q

Wilms tumor, GU malformations, mental retardation, aniridia is known as what syndrome? what chromosome?

A

WAGR - chrom 11

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19
Q

Most common extracranial solid malignancy?

A

neuroblastoma

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20
Q

most common cancer in infancy?

A

neuroblastoma

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21
Q

Hypsarrythmia on EEG and opsomyoclonus are hallmark findings of?

A

neuroblastoma

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22
Q

How do you diagnose neuroblastoma?

A

Increased VMA and metanephrines on urine collection

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23
Q

hydrocele

A

remnant of tunica vaginalis

painless, swollen, fluid filled, transilluminates on inspection

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24
Q

If you see varicocele on one side…?

A

always ultrasound the other side

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25
Q

Does surgical correction of cryptorchidism reduce cancer risk?

A

no (associated with malignancy regardless of surgical intervention)

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26
Q

hypospadias has a high association with ?

A

cryptorchidism and inguinal hernias

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27
Q

epispadias is associated with?

A

urinary incontinence, bladder extrophy

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28
Q

4 characteristic traits of tetralogy of fallot

A

overriding aorta
pulmonary stenosis
RVH
VSD

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29
Q

Cxray showing boot shaped heart and decreased pulm vascular marking is suggestive of?

A

Tet of Fallot

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30
Q

Name the 3 holosytolic murmurs

A

mitral regurg
tricuspid regurg
VSD

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31
Q

most common congenital heart defect in Down Syndrome?

A

endocardial cushion defect of AV canal

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32
Q

A single S2 is heard in this congenital heart defect?

A

transposition of great vessels

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33
Q

most common cyanotic condition in kids ?

A

Tet of Fallot

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34
Q

most common cyanotic condition in neonatal period?

A

TOGV

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35
Q

pulsus paradoxus suggests?

A

cardiac tamponade and tension pneumo

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36
Q

pulsus bisferiens?

A

aortic regurg; (double peaked pulse)

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37
Q

pulsus bigeminus?

A

sign of HOCM;

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38
Q

pulsus alternans

A

left ventricular systolic dysfunction

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39
Q

Gray rather than blue cyanosis, absent pulses, single S2, increased RV impulse?

A

hypoplastic left heart syndrome

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40
Q

most severe sequela of truncus arteriosus?

A

pulmonary hypertension

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41
Q

total anomalous pulm venous return?

A

no venous return between pulmonary veins and left atrium. oxygenated blood returns to the SVC

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42
Q

before surgery for VSD what are some medical treatments?

A

Diuretics and Digoxin

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43
Q

PDA is a normal finding in the first ____ hours of life. It is considered pathologic after the first ____ hours

A

12, 24

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44
Q

Best initial test for murmurs? most accurate?

A

Echo, cardiac cath

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45
Q

Pear-shaped cardiac x-ray?

A

pericardial effusion

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46
Q

jug handle cardiac xray?

A

primary pulm artery htn

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47
Q

hearing loss, syncope, normal vitals and exam and a fam history of sudden cardiac death =

A

long QT syndrome

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48
Q

when is hyperbilirubinemia considered pathological?

A
  • appears on first day of life
  • bilirubin rises >5mg/dL/day
  • bii > 19.5 in term child
  • direct bili > 2 anytime
  • hyperbili persisting into 2nd week of life
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49
Q

string sign is seen with?

A

pyloric stenosis

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50
Q

best initial test to diagnose pyloric stenosis? most accurate test?

A

ultrasound

upper GI series

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51
Q

first step in management of choanal atresia?

A

secure airway

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52
Q

how will an infant with choanal atresia present?

A

difficulty with feeds- cyanosis during feeds. membrane between nostrils and pharyngeal space

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53
Q

choanal atresia is associated with?

A

CHARGE syndrome

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54
Q

CHARGE syndrome?

A 
C: coloboma of eye (hole), CNS anomalies
H: heart defect
A: atresia of nasal concha
R: retardation of growth/deelopment
G: genital/urinary defects
E: ear anomlie/deaf
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55
Q

how do you confirm a clinical diagnosis of choanal atresia?

A

CT scan

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56
Q

imperforate anus has a high association with?

A

down syndrome

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57
Q

VACTERL syndrome?

A 
V: vertebral anomalie
A: anal atresia
C: cardio anomalie
T: TE fistula
E: esoph atresia
R: renal
L:limb
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58
Q

diagnosis of imperforate anus?

A

complete failure to pass meconium and physical exam. (do NOT perform barium study or rectal manometry)

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59
Q

Duodenal atresia is associated with?

A

annular pancreas and down syndrome

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60
Q

Intussusception is associated with?

A

previously used rotavirus vaccine and HSP

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61
Q

best initial test for intussusception?

A

ultrasound- doughnut sign or target sign

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62
Q

what is both diagnostic and therapeutic for intussuception?

A

barium enema

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63
Q

when should you not perform a barium enema in case of intussusception?

A

peritonitis, shock, perforation

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64
Q

Best initial test for duodenal atresia and volvulus?

A

AXR

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65
Q

Rotavirus is most commonly seen in what season?

A

Winter

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66
Q

antibiotics of choice in nec enterocolitis?

A

vanc, gent, metronidazole

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67
Q

first step in management when nec enterocolitis is diagnosed?

A

antibiotics

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68
Q

small left colon syndrome is found in?

A

infants born to moms with DM (can be diagnosed by barium study. can cause distension from constipation)

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69
Q

90% or more cases of CAH are due to?

A

21-hydroxylase deficiency

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70
Q

hypotensive child with severe electrolyte abnmlites?

A

CAH

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71
Q

In CAH describe common genitalia findings in girls/boys?

A

ambiguous in girls. boys typically normal- but can lose defining sex features as they age.

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72
Q

most common organisms causing neonatal sepsis?

A

GBS
E.coli
S. aureus
Listeria monocytogenes

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73
Q

treatment for neonatal sepsis

A

ampicillin, gentamicin

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74
Q

treatment for Toxo?

A

pyrimethamine and sulfadiazine

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75
Q

Roseola is caused by? presents as?

A

herpes virus 6+7. fever and URI progressing to diffuse rash.

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76
Q

Mumps presents as?

A

fever, parotid swelling, orchitis

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77
Q

Initial management of patietn with Croup who presents in respiratory distress?

A

racemic epinephrine to decrease swelling

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78
Q

croup is caused by?

A

parainfluenza types 1 and 2

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79
Q

how can you differentiate croup from epiglottitis?

A

croup- hypoxia on presentation

epiglottitis- hypoxia imminent

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80
Q

first step in management of epiglottitis?

A

intubation

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81
Q

management of epiglottitis?

A
  1. inubate in OR incase you need a tracheostomy
  2. ceftriaxone 7-10 days
  3. rifampin to all close contacts
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82
Q

severe coughing followed by vomiting is suggestive of?

A

paroxysmal stage of whooping cough (bordetella pertussis)

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83
Q

erythromycin and azithromycin are beneficial for whooping cough when?

A

only during catarrhal stage (first 14 days of runny nose and congestion)

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84
Q

treatment for diptheria?

A

antitoxin. abx dont work.

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85
Q

management for legg calve perthes disease?

A

rest and nsaids

eventual surgery on both hips

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86
Q

painful hip and externally rotated leg?

A

SCFE

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87
Q

calcified intracranial tumors in the suprasellar region?

A

craniopharyngioma

88
Q

how can you differentiate pituitary adenoma from craniopharyngioma?

A

pituitary adenoma not calcified

89
Q

Todd paralysis

A

transient, focal neuro deficit (hemiparesis) that occurs after a seizure

90
Q

onset of hemiplegic migraines?

A

adolescence often with positive family history

91
Q

Children < 2 with first febrile UTI should have what done?

A

1-2 weaks abx

renal and bladder US

92
Q

when is a VCUG indicated after a UTI in babies?

A

if hydro/scarring is seen on US

newborns < 1 month, children < 2 with recurrent UTIs or UTI with organism other than e.coli

93
Q

most common predisposing factor for orbital cellulitis?

A

bacterial sinusitis

94
Q

most common cause of neonatal sepsis?

A

GBS

95
Q

does GBS screening and prophylaxis decrease GBS sepsis risk after 7 days?

A

no

96
Q

most common cause of pediatric stroke?

A

sickle cell disease

97
Q

only absolute contraindication to breastfeeding?

A

galactosemia

98
Q

breastfeeding reduces the risk of which types of cancer?

A

ovarian and breast

99
Q

painful vesicles with punches out erosions and hemorrhagic crusting along with fever and lymphadenopathy =?

A

eczema herpeticum

100
Q

eczema herpeticum is associated with?

A

atopic dermatitis

101
Q

Diamond-Blackfan syndrome (congenital hypoplastic anemia)

A

macrocytic anemia, low retic count, congen anomolies

102
Q

syndrome with eczema, thrombocytopenia, hypogammaglobulinemia?

A

Wiskott-Aldrich

103
Q

pellagra

A

niacin (B3) deficiency: diarrhea, dermatitis, dementia

104
Q

Fetal macrosomia, rapid growth, omphalocele or umbiical hernia, macroglossia, hemihyperplasia?

A

Beckwith-Wiedemann syndrome

105
Q

patients with beckwith-wiedemann are at sig increased risk for?

A

hepatoblastoma and wilms tumor

106
Q

what tests should occur every 3 months in kids with beckwith-wiedemann?

A

abd ultrasound and AFP levels

107
Q

clinical trials have shown that what 3 drugs have equivalent efficacy for lyme disease?

A

doxy, amoxicillin, cefuroxime

108
Q

Treatment for chlamydia conjunctivitis?

A

PO macrolide!! (not topical)

109
Q

neonatal sepsis often presents as?

A

fever or hypothermia, poor feeding, decreased activity

110
Q

severely low T cells and hypogamaglobulinemia with recurrent infections, absence of lymphoid tissue suggests

A

SCID

111
Q

normal T cells, absence of B cells, hypogammaglobulinemia- absence of lymphoid tissue

A

Bruton’s

112
Q

recurrent skin and soft tissue infections with normal lymphocyte and immunoglobulin concentrations?

A

chronic granulomatous disease

113
Q

presents at a later age with normal T and B cell counts and hypogammaglobulinemia?

A

CVID

114
Q

bleeding post circumcision, bleeding from umbilical stump, eczema- should make you think of?

A

Wiskott-Aldrich

115
Q

All close contacts of a patient with Bodetella Pertussis should be given?

A

macrolide antibiotics

116
Q

Treatment for pertussis if <1 month?

Treatment for pertussis if > 1 month?

A
  1. Azithro X 5 days

2. Azithro X 5, Clarithro X 7, Erythro X 14

117
Q

erythromycin use in infants < 1 month is associated with?

A

pyloric stenosis

118
Q

how do you confirm diagnosis of duchenne muscular dystrophy?

A

absent dystrophin gene on genetic testing. undetectable dystrophin protein on muscle biopsy

119
Q

myotonic discharges on electromyography is indicative of?

A

Myotonic dystrophy

120
Q

in addition to elevation in inflammatory markers, what is also seen in juvenile idiopathic arthritis?

A

anemia (elevated hepcidin decreases iron abs across small intesting and decreases release of iron)

121
Q

contrast aplastic anemia with aplastic crisis?

A

aplastic anemia = pancytopenia due to bone marrow failure

122
Q

Patient with SS with acute anemia, low retic count, no splenomegaly?

A

aplastic crisis

123
Q

rotavirus is contraindicated in patients with a history of?

A

intussusception

124
Q

ovarian tumor that secretes LDH and B-hcg?

A

dysgerminoma

125
Q

most common benign ovarian neoplasm

A

serous cystadenoma

126
Q

when does visual acuity testing begin?

A

Age 3

127
Q

gold standard diagnostic test for malrotation with midgut volvulus?

A

upper GI contrast study

128
Q

finding of ligament of treitz on right side of abdomen reflects what? what do you see with volvulus?

A
  • malrotation

- Volvulus: corkscrew pattern on barium swallow

129
Q

differentiate pyloric stenosis from volvulus?

A

pyloric stenosis is not billious

130
Q

cataracts, PDA, sensorineural hearing loss?

A

congenital rubella

131
Q

fever, rash with cephalocaudal spread and post auricular and occipital lymphadenopathy and arthralgias?

A

rubella

132
Q

how to differentiate measles from rubella?

A

koplik spots, higher fever (>104), cervical rather than post-aur lymphadenopathy, rash spreads over multiple days, no arthralgias in measles

133
Q

Treatment for kids with previous history of rheumatic fever?

A

benzathine penicillin G every 4 weeks to prevent recurrent infection with GAS (which they are at risk for)

134
Q

Sphingomyelinase deficiecny?

A

Niemann-Pick disease

135
Q

Difference between Tay-Sachs and Niemann-Pick?

A

No hepatosplenomegaly or areflexia in Tay-Sachs

Hyperreflexia in tay-sachs

136
Q

B-hexosaminidase deficiency

A

Tay-Sachs

137
Q

Mentzer index?

A

MCV/RBC

138
Q

Mentzer index in thalassemia? MCV/RBC < ?

A

13

139
Q

Mentzer index in iron deficiency anemia?

A

MCV/RBC > 13 (due to decline in RBC count)

140
Q

Complications of cryptorchidism and orchiopexy?

A

Inguinal hernia
testicular torsion
subfertility
testicular cancer

141
Q

patients with cryptorchidism are at greatest risk for developing?

A

subfertility

142
Q

rapid diagnosis and treatment for intussuseption is done with?

A

ultrasound guided air contrast enema

143
Q

should centor criteria be used for children (preadolescent) ?

A

no

144
Q

why is a knee to chest position helpful in the case of tetrology of fallot?

A

increases systemic vasc resistance, increases pulmonary blood flow, improves hypoxia

145
Q

what determines the severity and clinical presentation of Tet of Fallot?

A

Degree of RVOT obstruction

146
Q

sterile pyuria and elevated ESR, c-RP can be supportive evidence if presentation of this illness in child is not convincing enough?

A

Kawasaki

147
Q

Treatment for kawasaki

A

aspirin and IVIG

148
Q

major protein source in breast milk and major protein source in formula and the difference between the 2?

A

breast: whey
formula: casein

whey is more easily digested and helps to improve gastric emptying

149
Q

a patient with history of sore throat, writhing and jerking of arms and hands and subcu nodules has ______ caused by _____?

A

acute rheumatic fever caused by strep pyogenes

150
Q

JONES criteria for myocarditis?

A 
J: joints (mig arthritis)
O: carditis
N: nodules
E: erythema marginatum
S: sydenham chorea
151
Q

most common cause of sepsis in SCD patients

A

s. pneumo

152
Q

maintenance for SCD patients?

A

vaccination, penicillin (until age 5), folic acid

153
Q

how does HSP increase risk for intussusception?

A

small bowel hematoma from autoimmune vasculitis

154
Q

describe potter sequence

A

urine tract anomaly (commonly posterior uretheral valve) -> anuria, oliguria -> oligohydramnios -> pulm hypoplasia, flat facies, limb deformities

155
Q

what abnormality in Turner’s syndrome might lead to edema?

A

abnormal development of the lymphatic system

156
Q

lymphadema is generally pitting or non-pitting?

A

non-pitting

157
Q

pain in a 6 year old boys legs - bilaterally, mostly at night, without systemic symptoms?

A

growing pains

158
Q

In a patient with down syndrome who presents with upper motor neuron findings- suspect?

A

atlantoaxial instability

159
Q

most common presenting symptom of cerebral palsy?

A

delayed motor development

160
Q

hand preference before 1 year of age is a red flag for?

A

cerebral palsy

161
Q

define complex seizure

A

long duration > 15. or focal. or multiple seizures in 24 hour period. or not returning to neuro baseline.

162
Q

Infants less than 6 months of age need _____ for febrile seizures? do kids > 18 moa need a work up for first time feb seizure?

A

sepsis work up ; no

163
Q

Work up for complex febrile seizure?

A

full seizure work up. MRI, EEG, electrolytes.

164
Q

most common childhood malignancy in white boys 2-5?

A

ALL

165
Q

most common childhood malignancy in black boys throughout childhood?

A

AML

166
Q

young child with bone pain, refusal to bear weight, anemia, ecchymoses, petechia, hepatosplenomegaly?

A

think leukemia

167
Q

greenish soft tissue tumor on skin or spinal cord can be odd presentation of?

A

AML

168
Q

What imaging study do you need after diagnosis of ALL is made?

A

Cxray

169
Q

neuroblastoma is associated with?

A

neurofibromatosis, hirschsprung, n-myc oncogene

170
Q

Differentiate Ewing and Osteosarcoma

A

Ewing: systemic symptoms common
Osteosarcoma: systemic symptoms rare

E: midshaft of long bones
O: Metaphysis of long bones (mets to lungs 20%)

E: lytic lesion with “onion skin” and increase ESR
O: increase alk phos, sunburst lytic lesions

171
Q

cxray for RDS

A

air bronchograms, ground glass

172
Q

cxray TTN

A

perihilar streaking

173
Q

meconium aspiration

A

coarse, irregular infiltrates, lung hyperextension, pneumothorax

174
Q

congenital pneumonia

A

nonspecific patchy infiltrates

175
Q

chorioretinitis, hydrocephalus, intracranial calcification?

A

toxoplasma

176
Q

PDA, cataracts, deafness

A

Rubella

177
Q

hearing loss, seizure, periventricular calcification, petechial rash?

A

CMV

178
Q

leukocoria can indicate what 3 things?

A

retinoblastoma, congenital cataracts, retinopathy of prematurity

179
Q

Patients who have life threatening allergies to eggs may not receive what vaccine?

A

MMR

180
Q

Treatment for lead poison < 45 and asymptomatic?

A

retest at 1-3 months, remove sources of lead

181
Q

Treatment of lead 45-69?

A

chelation with EDTA (inpatient) or outpatient (oral succimer- DMSA)

182
Q

Treatment of lead >70?

A

inpatient EDTA and BAL (IM dimercaprol)

183
Q

3 P’s of McCune-Albright syndrome?

A

precocious puberty, pigmentation (cafe au lait spots), polyostotic fibrous dysplasia ( bone defects)

184
Q

Treatment for HUS?

A

fluid and electrolyte managment
blood transfusions
dialysis

185
Q

most common type of brain tumor in kids?

A

pilocytic astrocytoma

186
Q

A patient with primary amenorrhea and no pubic hair, breast development is found to have a uterus. what is next test?

A

FSH

187
Q

Isolated amenorrhea with well developed sex characteristics can be considered normal up to age?

A

16

188
Q

If amenorrhea is determined to be of peripheral origin (with measurement of high FSH) what is next study?

A

karyotype
XX- likely abnormal mullerian development

XY- likely androgen insensitivity

189
Q

primary dysmenorrhea is caused by?

A

prostaglandin release from endometrial sloughing

190
Q

bulky, globular, tender uterus that may cause dysmenorrhea and bleeding?

A

adenomyosis

191
Q

vitamin deficiency in malnourished patient with angular chelitis, stomatitis, glossitis anemia, seborrheic dermatitis

A

B2 riboflavin

192
Q

petechia, bleeding gums, hyperkeratosis, coiled hair?

A

Vitamin C deficiency

193
Q

patients with androgen insensitivity syndrome should have gonadectomy done when?

A

electively after puberty so that they may reach adult height potential

194
Q

eosin-5-maleimide binding test and the acidified glycerol lysis test are gold standard for?

A

spherocytosis

195
Q

treatment for HS?

A

folic acid, blood transfusion, splenectomy

196
Q

most common pathogen of otitis externa? 2nd most?

A

Pseudomonas aeruginosa

staph aureus

197
Q

kartagener syndrome

A

primary ciliary dyskinesia, with triad of situs inversus, recurrent sinusitis, bronchiectasis

198
Q

limited upward gaze, upper eyelid retraction (collier sign), pupils non-reactive to light, reactive to accomodation is characterisric of what type of tumor?

A

Pineal

Perinaud syndrome

199
Q

when are varicella vaccines given?

A

1+4

200
Q

most common pathogen isolated from infants and young children until about age 20?

A

staph aureus

201
Q

most common cause of CF related pneumonia in adults?

A

pseudomonas

202
Q

The treatment for clubfoot should be started _______

A

immediately

203
Q

new onset hearing loss or chronic ear drainage despite abx therapy with skin debri and granulation tissue are typical presenting symptoms of?

A

cholesteomas

204
Q

children with HSP are at an increased risk for?

A

ileo-ileal intussusception

205
Q

palpable purpura, arthritis, abd pain, intussusception, renal disease (IgA), scrotal swelling?

A

HSP

206
Q

FTT, bilateral cataracts, jaundice, hypoglycemia, hepatosplenomegaly, mental retardation, jerking?

A

Galactosemia

207
Q

why does maternal diabetes increase risk of RDS?

A

high levels of circulating insulin antagonize cortisol and block maturation of sphingomyelinase (component of surfactant)

208
Q

abnormal uterine bleeding in adolescents who have just started their periods might be due to?

A

immature HPGA (most cycles are anovulatory and present as painless, irregular, heavy bleeding)

209
Q

Treatment of AUB due to immature HPGA axis?

A

progestin only or combo OCP

210
Q

a fall with object in mouth (toothbrush/pencil) can cause traumatic?

A

carotid injury

211
Q

radioopaque tablets in stomach of child with abd pain, hematemasis? cause? treat with?

A

lead poisioning

deferoxamine

212
Q

management of hydrocele?

A

most can be observed as they often dissapear spontaneously by the age of 12 months

213
Q

how do you manage battery stuck in esophagus? distal to esophagus?

A

remove immediately under endoscopic guidance to prevent mucosal damage.

batteries distal to esophagus pass uneventfully in most cases and are observed with stool exam / follow up x-ray

214
Q

orthostatic hypotension is a common side effect of?

A

amitriptyline

215
Q

Beckwith-Wiedemann syndrome

A 
fetal macrosomia, rapid growth until late childhood
omphalocele, umbilical hernia
macroglossia
hemihyperplasia
wilms tumor
hepatoblastoma
216
Q

how do you monitor beckwith-wiedeman?

A

US, AFP

Step 2 CK (26 decks)

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