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STEP 2 CK FIRST AID > Pediatrics > Flashcards

Pediatrics Flashcards

1
Q

Is gonnorhea on vag cx of a kid evidence for child abuse?

Is chlamydia?

A

Gonn - yes

Chlamydia - no. Could have gotten it at birth from mom, it can take up to 3 years to present

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2
Q

What type of shunt?

cyanotic congenital heart disease
acyanotic congenital heart disease

A 
cyanotic = R-->L shunt
acyanotic = L-->R shunt (VSDs, ASD's, PDA's)
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3
Q 
What type of heart defect is associated with:
Rubella?
Turners?
Kawasaki's?
SLE?
Lithium?
maternal DM?
A 
Rubella = PDA
Turners = Coarctation of Aorta
Kawasaki's = Coronary Artery aneurysms
SLE = Congenital heart block
Lithium = Ebsteins anomoly
maternal DM = Asymmetric septal hypertrophy AND transposition of great vessels
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4
Q

What is the tx for a PDA?

When do you not treat?

A

Indomethacin (closes the PDA) - can use up to 6-8 months old

Keep open w/ PGE! Don’t close it in case of transposition of great vessels, coarctation of aorta, tetralogy of Fallot, hypoplastic left heart disease, or if indomethacin is contraindicated (intraventricular hemorrhage.)

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5
Q

Where does a coarctation of aorta normally occur>?

A

Just below the subclavian artery (causes HTN in upper extremities and normal BP below the coarctation

Interestingly, more than 2/3 these pts have a bicuspid aortic valve

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6
Q

What are the risk factors for transposition of great vessels?

WHat additional abnormalities must these kids have to stay alive?

A

DM and Digeorge Syndrome

Must have an ASD/VSD and a PDA

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7
Q

If kid turns blue after a few years vs few hours?

A 
years = tetralogy of fallot
hours = transposition of vessels
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8
Q

What are the risk factor for tetralogy of fallot?

A

DiGeorge and maternal PKU

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9
Q

Infant is asymptomatic until 4 months when he is diaphoretic with feeding and tachypnic

Dx?
Tx?

A

Tetrology of Fallot

CXR shows Boot Shaped Heart

Tx with PGE (like transposition of great vessels) but will ultimately need surgery.

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10
Q

Explain tet spells?

A

kids squat to increase vascular resistance so that they can breath with tet of fallot. (pulmonary stenosis, overriding aorta, RVH, VSD)

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11
Q

What 2 genetic abnormalities can cause down syndrome?

Other issues to worry about in DS?

A 
#1 = meiotic nondisjunction
#2 (4%) = robertsonian translocation

Duodenal atresia, Hirschprung’s disease, atrioventricular cushion defects, ALL, hypothyroidism, Alzheimers

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12
Q

What genetic abnormality do PKU kids have? Sx?

A

decreased phenylalanin hydroxylase or decreased THB cofactor.

After a few normal months, the kids present w. MR, fair skin, blonde, eczema, musty urine. Tx w/ tyrosine and low phenylalanine

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13
Q 
Match disease w/ deficiency:
Fabry's disease
absent galactosylcermidase
Gaucher's disease
absent sphingomyelinase
Tay-Sachs
absent Arylsulfatase A
Hurler's
Absent iduronate sulfatase
A

Fabry’s disease = galactosidase A (telangiectasias, angiokeratomas)
absent galactosylcermidase = Krabbe’s disease (CNS issues)
Gaucher’s disease = Glucocerebrosidase (crinkled cells, TCP, anemia)
absent sphingomyelinase = Neimann-Pick (cherry spot and HSM)
Tay-Sachs = hexosidase (cherry spot, no HSM)
absent Arylsulfatase A = Metachromatic Leukodystrophy (ataxia)
Hurler’s = a-L-iduronidase (corneal cloud, MR, gargoyl)
Absent iduronate sulfatase = Hunter’s (no corneal cloud, X-linked)

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14
Q

Colicky pain in healthy kid. Flexed knees and vomiting. Current jelly stool w. sausage shaped RUQ mass. Dx? Risk factors? Tx?

A

Intussusception

Risks = lymphoma, LAD, H.u.S., Meckels Diverticulum

Tx: air contrast barium enema

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15
Q

What Abx can be a risk factor for pyloric stenosis?

What abnormal acid state is seen in PS?

A

Erythromycin

pt will have hypochloremic hypokalemic metabolic alkalosis (persistent emesis of HCl)

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16
Q

Healthy kid with sudden, intermittent painless rectal bleeding. Dx?

A

Meckel’s diverticulum, can lead to diverticulitis, volvulus, or intussuss.
FAILURE OF OMPHALOMESENTERIC/VITELLINE DUCT TO DISAPEAR.

Use the 99 scan to check for ectopic gastric tissue

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17
Q

What GI disease is associated with MEN type 2?

A

Hirschprungs Disease

Dx needs rectal bx (will show absence of myenteric (aurbachs) plexus and submucosal (meissners) plexus

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18
Q

What is the dx of choice for malrotation (kid shows up with bilious vomiting)

A

An EGD, although an XR will show a birds beak

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19
Q

Newborn with feeding intolerance that has intramural air bubbles in the GI?

A

Necrotizing Entericolitis (bubbles are made by bacteria)

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20
Q 
Tx for:
Brutons Agammaglobulinemia
CVID
IgA def
DiGeorge
A

Brutons Agammaglobulinemia = IVIG (B’s are low, tonsils maybe gone)
CVID = IVIG (Low T’s and plasma’s. B’s normal)
IgA def = tx infections (no IVIG as it can cause anti-IgA Abs)
DiGeorge = BM transplants & IVIG (thymic aplasia()

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21
Q

Tx for:
Ataxia-Telangiectasia
SCID
Wiskott-Aldrich

A 
Ataxia-Telangiectasia = no specific (DNA repair defect)
SCID = BM transplant, PCP prophylaxis, IVIG (bubble boy)
Wiskott-Aldrich = supportive, die by adults. (infections, purpura, eczema, low IgM, TCP)
22
Q 
Tx of:
Chronic Granulomatous Disease
Leukocyte Adhesion Deficiency
Chediak Higashi Syndrome
Job's Syndrome
C1 esterase def (hereditary angioma)
Terminal Complement Def (c5-c9)
A

-Chronic Granulomatous Disease = nitroblue test, tx: TMPSMX (cat+ infections)
-Leukocyte Adhesion Deficiency: BM transplant. (umbilical cord)
-Chediak Higashi Syndrome: BM Tx (occulo-albinism, neuropathy, neutropenia.)
Job’s Syndrome: Abx & IVIG (FATED - facies, abscesses, small teeth, hyper-IgE, dermatologic)
C1 esterase def (hereditary angioma): C1 esterase. (edema)
Terminal Complement Def (c5-c9): mening vaccine & Abx (recurrent N.Men infections.)

23
Q

Kid with painless conjunctivitis and painful unilateral LAD with truncal rash and strawberry tongue w/ desquam of fingertips. Dx? Tx?

A

Kawasaki Disease
Tx = high dose ASA, IVIG

SCARLET FEVER LOOKS LIKE THIS TOO, BUT HAS NORMAL LIPS AND NO CONJUNCTIVITIS

24
Q

WHAT will labs look like for Juvenile Idiopathic Arthritis?

Tx?

A

ANA+
RF-

Tx = NSAIDs and strengthening exercises

25
Q

High fever (>102) with HSM and a salmon colored macular rash?

A

Still’s disease (systemic-onset)

RF and ANA negative

26
Q

Young kid comes in tugging on his ears. What bugs? Tx?

A

S. pneumo
nontypable H flu
Moraxella catarrhalis
Viruses: influenza A, RSV, paraflu

Tx = amox

27
Q

Kid gets sick in the Winter. Dx? Bug? Tx? PPx?

A

Bronchiolitis!
RSV is most common, other = paraflu, influenza
Tx = supportive, maybe nebs. NO CTSDs. Ribavarin for tx in high risk infants w/ heart/lung dz
PPx = poly/monoclonal antibodies in winter for kids

28
Q

Kid comes in with seal cough. Dx? Bug?

CXR? Tx?

A

Croup
Paraflu 1
CXR = steeple sign indicating subglottic narrowing
Tx = mild: cool mist, worse: CTSDs, race epi

29
Q

Kid comes in with a fever, dysphagia, and drooling. Dx? Bug? CXR? Tx?

A

Epiglottitis
If NOT immunized = H.Flu, if immunized = nontypable H.flu, strep
DO NOT EXAMINE THROAT AS IT MAY COLLAPSE, MAY HAVE TO INTUBATE. Look for cherry red epiglotis on fiberoptic
CXR = swollen epiglottis obliterating the valleculae (thumbprint sign)
Tx: secure airway, IV Cef.

30
Q

What is the most common cause of viral meningitis in kids?

A

Enteroviruses

31
Q

What meningitis medicine do you NOT give to neonates?

A

Ceftriaxone! It will cause increased biliary sludging and kernicterus. Use cefotaxime or Gent instead

also include Amp and +/- acyclovir for those neonates as well (listeria and herpes)

32
Q

Kid comes in with sore throat and acute onset of HIGH fiver, muffled potato voice. Dx?

What if his uvula was displaced to the opposite side of the pain?

A

Retropharyngeal abscess

Displaced uvula = Peritonsilar abscess

Bot hare caused by G.A.S. or Staph

33
Q

Kid comes in with paroxysmal cough causing him to vomit b/c he can’t breath. Dx? Bug? Tx?

A

Pertussis. DTap (5) protects against this but by teenage years, the immunity can wane. Infection is mild in adults and kids but can be severe in teens!

Bordella Pertussis. 3 stages, whoop in stage 2, but most contageous in the 1st stage (the catarrhal stage.)

Tx = Erythromycin to pts and contacts for 2 wks

34
Q

Kid comes in with slapped cheek rash that worsens with sun exposure. Dx? Bug? Complications?

A 
Fifths disease (erythema infectiosum)
Parvovirus

Can cause joint pain in kids
If congenital infection, can cause hydrops fetalis and death
Can cause aplastic anemia in Sicklers or H.sperocytosis

35
Q

Keys to differentiating measles from rubella?

A

Rubella has a lower fever, the rash progresses quicker, and has posterior auricular lymphadenopathy

36
Q

Kid comes in with a really high fever (>104) and then gets a rash on trunk after the fever breaks. The rash spreads to the face and lasts

A

Roseola Infantum

HHV-6 and 7

37
Q

Kid comes in with oral ulcers, vesicular rash on hands, feet, and butt. Dx? Bug?

A

hand Foot Mouth

Coxsackie A - self limited disease

38
Q

Juandiced newporn presents with lethargy, poor feeding, and high pitched cry

A

Kernicterus, result of really high unconjugated bili

39
Q

Direct hyperbilirubinemia is always pathologic. Also, jaundice during the first 24h of life is most likely pathological, not physiological.

A

Also, can’t treat it with phototherapy! Only do this with unconjugated

40
Q

Pathophys of respiratory distress syndrome?

A

No surfactant leads to poor lung compliance and alveolar collapse and atalectasis. Occurs in 48-72h of life.

CXR = ground glass w/ air bronchograms

41
Q

Imaging of:

  1. Transient tachypnea of newborn (amniotic fluid retention)
  2. Meconium Aspiration
  3. Congenital PNX
A
  1. Perihilar streaking in interlobular fissures. Tx - O2
  2. Course, irregular infiltrates w/ hyperexpansion
  3. Nonspecific patchy infiltrates, neutropenia
42
Q

What is an intrauterine risk factor for tracheoesophageal fistula?

A

Polyhydramnios

actually, polyhydramnios is a risk factor for this, gastroschisis, and duodenal atresia

43
Q

Gastroschisis vs Omphalocele

A

Gastro = intestine only through the wall (no sac)

Omphalocele = herniation of abdominal viscera through the abdominal wall covered by peritoneum and amniotic membrane. Need c-section to prevent sac rupture

44
Q

Kid presents with toe walking, scissor gait, and delayed motor development. Dx?

A

Cerebral palsy
Pyramidal - spastic paresis of any/all limbs - 75% of cases
Extrapyramidal - damage to extrapyramidal tracts. different subtypes that range in severity of muscle movement disorders

45
Q

Is there a risk of recurrence of febrile seizures?

A

yes,

46
Q

Kid who refuses to bear weight on his leg and has a green soft-tissue tumor on his skin?

A

AML

ALL is the most common kid cancer

Tx w/ CXR to rule out lung metz and BM biopsy showing hypercellular w/ increased lymphoblasts

47
Q

Kid with ALL starts chemo but gets hyperkalemia, hyperphos, and hyperuricemia. Dx? Tx?

A

Dx = Tumor Lysis syndrome

Tx = Hydrate, diuretics, allopurinol, alk the urine, reduce phosphate in diet

STAY AWAY FROM CTSDs as they can cause tumor lysis syndrome

48
Q

What does a neuroblastoma look like on histo?

Where do these originate from?

A

Small blue tumor cells w/ rosette patterns

Pts will have elvated VMA/HVA

Originate from neural crest cells

49
Q

Wilms tumor vs Neuroblastoma

A

Both are palpable stomach masses in kids

Wilms = NO IRIS, hemihypertrophy, Mental retardation, and does NOT cross midline

Neuroblastoma = opsoclonus/myocloonus and MAY cross midline

50
Q

When can a kid face forward in the carseat?

A

Age 2 and weighs more than 40 lbs

51
Q

What tissue do Ewings sarcoma and Osteosarcomas come from?

A

Ewings = neuroectoderm (sarcoma)

osteosarcoma = mesenchyme (osteoblasts)

STEP 2 CK FIRST AID (15 decks)

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