Pediatrics 2 Flashcards
Treatment of herpes simplex conjuntivitis?
systemic acyclovir and topical vidarabine
if tachypnea in a newborn lasts >4 hours it is considered _____ and must be evaluated with _____ tests?
sepsis, blood and urine culture
most fatal infant skull fracture?
basilar
most common infant skull fracture?
linear
Caput succedaneum
swelling of soft tissues of scalp that do cross suture lines (edema)
Cephalohematoma
subperiosteal hemorrhage (does NOT cross suture lines)
Duchenne-Erb Paralysis: C5-C6 presents as
“Waiter’s tip” appearance. secondary to shoulder dystocia
Klumpke paralysis C7-C8/T1
Claw hand due to lack of grasp reflex (paralyzed hand with horner syndrome- ptosis, miosis, anhydrosis)
Forcep delivery can cause damage to?
facial nerve- facial nerve palsy.
Werdnig-Hoffman
spinal musclar atrophy in infant
Causes of polyhydramnios?
Werdnig-Hoffman (infant cant swallow), Intestinal atresias
Causes of oligohydramnios?
Prune belly (no abdominal wall muscles so unable to bear down and urinate) Renel agenesis (potter syndrome)
Omphalocele is associated iwth what chromosomal abnormality?
trisomy 18
Aniridia is?
absence of iris
aniridia is most valuable clue to what diagnosis?
Wilms Tumor
Most common abdominal mass in children?
Wilms Tumor
Best initial study to diagnose Wilms tumor? Most accurate study to diagnose wilms tumor?
Ultrasound
Contrast-enhanced CT
Wilms tumor, GU malformations, mental retardation, aniridia is known as what syndrome? what chromosome?
WAGR - chrom 11
Most common extracranial solid malignancy?
neuroblastoma
most common cancer in infancy?
neuroblastoma
Hypsarrythmia on EEG and opsomyoclonus are hallmark findings of?
neuroblastoma
How do you diagnose neuroblastoma?
Increased VMA and metanephrines on urine collection
hydrocele
remnant of tunica vaginalis
painless, swollen, fluid filled, transilluminates on inspection
If you see varicocele on one side…?
always ultrasound the other side
Does surgical correction of cryptorchidism reduce cancer risk?
no (associated with malignancy regardless of surgical intervention)
hypospadias has a high association with ?
cryptorchidism and inguinal hernias
epispadias is associated with?
urinary incontinence, bladder extrophy
4 characteristic traits of tetralogy of fallot
overriding aorta
pulmonary stenosis
RVH
VSD
Cxray showing boot shaped heart and decreased pulm vascular marking is suggestive of?
Tet of Fallot
Name the 3 holosytolic murmurs
mitral regurg
tricuspid regurg
VSD
most common congenital heart defect in Down Syndrome?
endocardial cushion defect of AV canal
A single S2 is heard in this congenital heart defect?
transposition of great vessels
most common cyanotic condition in kids ?
Tet of Fallot
most common cyanotic condition in neonatal period?
TOGV
pulsus paradoxus suggests?
cardiac tamponade and tension pneumo
pulsus bisferiens?
aortic regurg; (double peaked pulse)
pulsus bigeminus?
sign of HOCM;
pulsus alternans
left ventricular systolic dysfunction
Gray rather than blue cyanosis, absent pulses, single S2, increased RV impulse?
hypoplastic left heart syndrome
most severe sequela of truncus arteriosus?
pulmonary hypertension
total anomalous pulm venous return?
no venous return between pulmonary veins and left atrium. oxygenated blood returns to the SVC
before surgery for VSD what are some medical treatments?
Diuretics and Digoxin
PDA is a normal finding in the first ____ hours of life. It is considered pathologic after the first ____ hours
12, 24
Best initial test for murmurs? most accurate?
Echo, cardiac cath
Pear-shaped cardiac x-ray?
pericardial effusion
jug handle cardiac xray?
primary pulm artery htn
hearing loss, syncope, normal vitals and exam and a fam history of sudden cardiac death =
long QT syndrome
when is hyperbilirubinemia considered pathological?
- 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
string sign is seen with?
pyloric stenosis
best initial test to diagnose pyloric stenosis? most accurate test?
ultrasound
upper GI series
first step in management of choanal atresia?
secure airway
how will an infant with choanal atresia present?
difficulty with feeds- cyanosis during feeds. membrane between nostrils and pharyngeal space
choanal atresia is associated with?
CHARGE syndrome
CHARGE syndrome?
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
how do you confirm a clinical diagnosis of choanal atresia?
CT scan
imperforate anus has a high association with?
down syndrome
VACTERL syndrome?
V: vertebral anomalie A: anal atresia C: cardio anomalie T: TE fistula E: esoph atresia R: renal L:limb
diagnosis of imperforate anus?
complete failure to pass meconium and physical exam. (do NOT perform barium study or rectal manometry)
Duodenal atresia is associated with?
annular pancreas and down syndrome
Intussusception is associated with?
previously used rotavirus vaccine and HSP
best initial test for intussusception?
ultrasound- doughnut sign or target sign
what is both diagnostic and therapeutic for intussuception?
barium enema
when should you not perform a barium enema in case of intussusception?
peritonitis, shock, perforation
Best initial test for duodenal atresia and volvulus?
AXR
Rotavirus is most commonly seen in what season?
Winter
antibiotics of choice in nec enterocolitis?
vanc, gent, metronidazole
first step in management when nec enterocolitis is diagnosed?
antibiotics
small left colon syndrome is found in?
infants born to moms with DM (can be diagnosed by barium study. can cause distension from constipation)
90% or more cases of CAH are due to?
21-hydroxylase deficiency
hypotensive child with severe electrolyte abnmlites?
CAH
In CAH describe common genitalia findings in girls/boys?
ambiguous in girls. boys typically normal- but can lose defining sex features as they age.
most common organisms causing neonatal sepsis?
GBS
E.coli
S. aureus
Listeria monocytogenes
treatment for neonatal sepsis
ampicillin, gentamicin
treatment for Toxo?
pyrimethamine and sulfadiazine
Roseola is caused by? presents as?
herpes virus 6+7. fever and URI progressing to diffuse rash.
Mumps presents as?
fever, parotid swelling, orchitis
Initial management of patietn with Croup who presents in respiratory distress?
racemic epinephrine to decrease swelling
croup is caused by?
parainfluenza types 1 and 2
how can you differentiate croup from epiglottitis?
croup- hypoxia on presentation
epiglottitis- hypoxia imminent
first step in management of epiglottitis?
intubation
management of epiglottitis?
- inubate in OR incase you need a tracheostomy
- ceftriaxone 7-10 days
- rifampin to all close contacts
severe coughing followed by vomiting is suggestive of?
paroxysmal stage of whooping cough (bordetella pertussis)
erythromycin and azithromycin are beneficial for whooping cough when?
only during catarrhal stage (first 14 days of runny nose and congestion)
treatment for diptheria?
antitoxin. abx dont work.
management for legg calve perthes disease?
rest and nsaids
eventual surgery on both hips
painful hip and externally rotated leg?
SCFE
calcified intracranial tumors in the suprasellar region?
craniopharyngioma
how can you differentiate pituitary adenoma from craniopharyngioma?
pituitary adenoma not calcified
Todd paralysis
transient, focal neuro deficit (hemiparesis) that occurs after a seizure
onset of hemiplegic migraines?
adolescence often with positive family history
Children < 2 with first febrile UTI should have what done?
1-2 weaks abx
renal and bladder US
when is a VCUG indicated after a UTI in babies?
if hydro/scarring is seen on US
newborns < 1 month, children < 2 with recurrent UTIs or UTI with organism other than e.coli
most common predisposing factor for orbital cellulitis?
bacterial sinusitis
most common cause of neonatal sepsis?
GBS
does GBS screening and prophylaxis decrease GBS sepsis risk after 7 days?
no
most common cause of pediatric stroke?
sickle cell disease
only absolute contraindication to breastfeeding?
galactosemia
breastfeeding reduces the risk of which types of cancer?
ovarian and breast
painful vesicles with punches out erosions and hemorrhagic crusting along with fever and lymphadenopathy =?
eczema herpeticum
eczema herpeticum is associated with?
atopic dermatitis
Diamond-Blackfan syndrome (congenital hypoplastic anemia)
macrocytic anemia, low retic count, congen anomolies
syndrome with eczema, thrombocytopenia, hypogammaglobulinemia?
Wiskott-Aldrich
pellagra
niacin (B3) deficiency: diarrhea, dermatitis, dementia
Fetal macrosomia, rapid growth, omphalocele or umbiical hernia, macroglossia, hemihyperplasia?
Beckwith-Wiedemann syndrome
patients with beckwith-wiedemann are at sig increased risk for?
hepatoblastoma and wilms tumor
what tests should occur every 3 months in kids with beckwith-wiedemann?
abd ultrasound and AFP levels
clinical trials have shown that what 3 drugs have equivalent efficacy for lyme disease?
doxy, amoxicillin, cefuroxime
Treatment for chlamydia conjunctivitis?
PO macrolide!! (not topical)
neonatal sepsis often presents as?
fever or hypothermia, poor feeding, decreased activity
severely low T cells and hypogamaglobulinemia with recurrent infections, absence of lymphoid tissue suggests
SCID
normal T cells, absence of B cells, hypogammaglobulinemia- absence of lymphoid tissue
Bruton’s
recurrent skin and soft tissue infections with normal lymphocyte and immunoglobulin concentrations?
chronic granulomatous disease
presents at a later age with normal T and B cell counts and hypogammaglobulinemia?
CVID
bleeding post circumcision, bleeding from umbilical stump, eczema- should make you think of?
Wiskott-Aldrich
All close contacts of a patient with Bodetella Pertussis should be given?
macrolide antibiotics
Treatment for pertussis if <1 month?
Treatment for pertussis if > 1 month?
- Azithro X 5 days
2. Azithro X 5, Clarithro X 7, Erythro X 14
erythromycin use in infants < 1 month is associated with?
pyloric stenosis
how do you confirm diagnosis of duchenne muscular dystrophy?
absent dystrophin gene on genetic testing. undetectable dystrophin protein on muscle biopsy
myotonic discharges on electromyography is indicative of?
Myotonic dystrophy
in addition to elevation in inflammatory markers, what is also seen in juvenile idiopathic arthritis?
anemia (elevated hepcidin decreases iron abs across small intesting and decreases release of iron)
contrast aplastic anemia with aplastic crisis?
aplastic anemia = pancytopenia due to bone marrow failure
Patient with SS with acute anemia, low retic count, no splenomegaly?
aplastic crisis
rotavirus is contraindicated in patients with a history of?
intussusception
ovarian tumor that secretes LDH and B-hcg?
dysgerminoma
most common benign ovarian neoplasm
serous cystadenoma
when does visual acuity testing begin?
Age 3
gold standard diagnostic test for malrotation with midgut volvulus?
upper GI contrast study
finding of ligament of treitz on right side of abdomen reflects what? what do you see with volvulus?
- malrotation
- Volvulus: corkscrew pattern on barium swallow
differentiate pyloric stenosis from volvulus?
pyloric stenosis is not billious
cataracts, PDA, sensorineural hearing loss?
congenital rubella
fever, rash with cephalocaudal spread and post auricular and occipital lymphadenopathy and arthralgias?
rubella
how to differentiate measles from rubella?
koplik spots, higher fever (>104), cervical rather than post-aur lymphadenopathy, rash spreads over multiple days, no arthralgias in measles
Treatment for kids with previous history of rheumatic fever?
benzathine penicillin G every 4 weeks to prevent recurrent infection with GAS (which they are at risk for)
Sphingomyelinase deficiecny?
Niemann-Pick disease
Difference between Tay-Sachs and Niemann-Pick?
No hepatosplenomegaly or areflexia in Tay-Sachs
Hyperreflexia in tay-sachs
B-hexosaminidase deficiency
Tay-Sachs
Mentzer index?
MCV/RBC
Mentzer index in thalassemia? MCV/RBC < ?
13
Mentzer index in iron deficiency anemia?
MCV/RBC > 13 (due to decline in RBC count)
Complications of cryptorchidism and orchiopexy?
Inguinal hernia
testicular torsion
subfertility
testicular cancer
patients with cryptorchidism are at greatest risk for developing?
subfertility
rapid diagnosis and treatment for intussuseption is done with?
ultrasound guided air contrast enema
should centor criteria be used for children (preadolescent) ?
no
why is a knee to chest position helpful in the case of tetrology of fallot?
increases systemic vasc resistance, increases pulmonary blood flow, improves hypoxia
what determines the severity and clinical presentation of Tet of Fallot?
Degree of RVOT obstruction
sterile pyuria and elevated ESR, c-RP can be supportive evidence if presentation of this illness in child is not convincing enough?
Kawasaki
Treatment for kawasaki
aspirin and IVIG
major protein source in breast milk and major protein source in formula and the difference between the 2?
breast: whey
formula: casein
whey is more easily digested and helps to improve gastric emptying
a patient with history of sore throat, writhing and jerking of arms and hands and subcu nodules has ______ caused by _____?
acute rheumatic fever caused by strep pyogenes
JONES criteria for myocarditis?
J: joints (mig arthritis) O: carditis N: nodules E: erythema marginatum S: sydenham chorea
most common cause of sepsis in SCD patients
s. pneumo
maintenance for SCD patients?
vaccination, penicillin (until age 5), folic acid
how does HSP increase risk for intussusception?
small bowel hematoma from autoimmune vasculitis
describe potter sequence
urine tract anomaly (commonly posterior uretheral valve) -> anuria, oliguria -> oligohydramnios -> pulm hypoplasia, flat facies, limb deformities
what abnormality in Turner’s syndrome might lead to edema?
abnormal development of the lymphatic system
lymphadema is generally pitting or non-pitting?
non-pitting
pain in a 6 year old boys legs - bilaterally, mostly at night, without systemic symptoms?
growing pains
In a patient with down syndrome who presents with upper motor neuron findings- suspect?
atlantoaxial instability
most common presenting symptom of cerebral palsy?
delayed motor development
hand preference before 1 year of age is a red flag for?
cerebral palsy
define complex seizure
long duration > 15. or focal. or multiple seizures in 24 hour period. or not returning to neuro baseline.
Infants less than 6 months of age need _____ for febrile seizures? do kids > 18 moa need a work up for first time feb seizure?
sepsis work up ; no
Work up for complex febrile seizure?
full seizure work up. MRI, EEG, electrolytes.
most common childhood malignancy in white boys 2-5?
ALL
most common childhood malignancy in black boys throughout childhood?
AML
young child with bone pain, refusal to bear weight, anemia, ecchymoses, petechia, hepatosplenomegaly?
think leukemia
greenish soft tissue tumor on skin or spinal cord can be odd presentation of?
AML
What imaging study do you need after diagnosis of ALL is made?
Cxray
neuroblastoma is associated with?
neurofibromatosis, hirschsprung, n-myc oncogene
Differentiate Ewing and Osteosarcoma
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
cxray for RDS
air bronchograms, ground glass
cxray TTN
perihilar streaking
meconium aspiration
coarse, irregular infiltrates, lung hyperextension, pneumothorax
congenital pneumonia
nonspecific patchy infiltrates
chorioretinitis, hydrocephalus, intracranial calcification?
toxoplasma
PDA, cataracts, deafness
Rubella
hearing loss, seizure, periventricular calcification, petechial rash?
CMV
leukocoria can indicate what 3 things?
retinoblastoma, congenital cataracts, retinopathy of prematurity
Patients who have life threatening allergies to eggs may not receive what vaccine?
MMR
Treatment for lead poison < 45 and asymptomatic?
retest at 1-3 months, remove sources of lead
Treatment of lead 45-69?
chelation with EDTA (inpatient) or outpatient (oral succimer- DMSA)
Treatment of lead >70?
inpatient EDTA and BAL (IM dimercaprol)
3 P’s of McCune-Albright syndrome?
precocious puberty, pigmentation (cafe au lait spots), polyostotic fibrous dysplasia ( bone defects)
Treatment for HUS?
fluid and electrolyte managment
blood transfusions
dialysis
most common type of brain tumor in kids?
pilocytic astrocytoma
A patient with primary amenorrhea and no pubic hair, breast development is found to have a uterus. what is next test?
FSH
Isolated amenorrhea with well developed sex characteristics can be considered normal up to age?
16
If amenorrhea is determined to be of peripheral origin (with measurement of high FSH) what is next study?
karyotype
XX- likely abnormal mullerian development
XY- likely androgen insensitivity
primary dysmenorrhea is caused by?
prostaglandin release from endometrial sloughing
bulky, globular, tender uterus that may cause dysmenorrhea and bleeding?
adenomyosis
vitamin deficiency in malnourished patient with angular chelitis, stomatitis, glossitis anemia, seborrheic dermatitis
B2 riboflavin
petechia, bleeding gums, hyperkeratosis, coiled hair?
Vitamin C deficiency
patients with androgen insensitivity syndrome should have gonadectomy done when?
electively after puberty so that they may reach adult height potential
eosin-5-maleimide binding test and the acidified glycerol lysis test are gold standard for?
spherocytosis
treatment for HS?
folic acid, blood transfusion, splenectomy
most common pathogen of otitis externa? 2nd most?
Pseudomonas aeruginosa
staph aureus
kartagener syndrome
primary ciliary dyskinesia, with triad of situs inversus, recurrent sinusitis, bronchiectasis
limited upward gaze, upper eyelid retraction (collier sign), pupils non-reactive to light, reactive to accomodation is characterisric of what type of tumor?
Pineal
Perinaud syndrome
when are varicella vaccines given?
1+4
most common pathogen isolated from infants and young children until about age 20?
staph aureus
most common cause of CF related pneumonia in adults?
pseudomonas
The treatment for clubfoot should be started _______
immediately
new onset hearing loss or chronic ear drainage despite abx therapy with skin debri and granulation tissue are typical presenting symptoms of?
cholesteomas
children with HSP are at an increased risk for?
ileo-ileal intussusception
palpable purpura, arthritis, abd pain, intussusception, renal disease (IgA), scrotal swelling?
HSP
FTT, bilateral cataracts, jaundice, hypoglycemia, hepatosplenomegaly, mental retardation, jerking?
Galactosemia
why does maternal diabetes increase risk of RDS?
high levels of circulating insulin antagonize cortisol and block maturation of sphingomyelinase (component of surfactant)
abnormal uterine bleeding in adolescents who have just started their periods might be due to?
immature HPGA (most cycles are anovulatory and present as painless, irregular, heavy bleeding)
Treatment of AUB due to immature HPGA axis?
progestin only or combo OCP
a fall with object in mouth (toothbrush/pencil) can cause traumatic?
carotid injury
radioopaque tablets in stomach of child with abd pain, hematemasis? cause? treat with?
lead poisioning
deferoxamine
management of hydrocele?
most can be observed as they often dissapear spontaneously by the age of 12 months
how do you manage battery stuck in esophagus? distal to esophagus?
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
orthostatic hypotension is a common side effect of?
amitriptyline
Beckwith-Wiedemann syndrome
fetal macrosomia, rapid growth until late childhood omphalocele, umbilical hernia macroglossia hemihyperplasia wilms tumor hepatoblastoma
how do you monitor beckwith-wiedeman?
US, AFP
