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Clincial Medicine > Pediatrics > Flashcards

Pediatrics Flashcards

1
Q

4 y/o child presented with:
pruritic vesicular eruption on face, neck, trunk, extremities, and scalp. Ulcers in mouth. Febrile and flu-like 3 days prior. Lesions began as papules and then scabbed over.

A

Chicken pox/varicella

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2
Q

6 y/o patient presents with:
sudden onset high fever, body aches prior to rash that was initially macular around tongue and mouth then spread to body and became papular. Second fever within a week with umbilicated pustules. Pitted scars.

A

Smallpox

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3
Q

.Preschooler with a 2 day history of fever, sore throat, malaise. Vesicular lesions on erythematous bases on hands and feet. Ulcerations on throat.

A

Hand, foot, and mouth disease

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4
Q

5 y/o with fever, weepy eyes, HA, cough, rhinitis, pharyngitis, red papular rash on face. Three days rash has become confluent on face, generalized, involves palms and soles. Immunization status UNKNOWN.

A

Measles

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5
Q

.Unimmunized 2//yo with low grade fever, does not appear ill, erythematous maculopapular rash began on face and spread to include toes. Mildly pruritic.

A

German measles (rubella)

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6
Q

.14 month old with red papular morbilliform eruption, mostly on trunk. Rash appeared post-fever with no source. Cranky but WNL.

A

Roseola (exanthem subitum)

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7
Q

.12 month old otherwise healthy and UTD on vaccines, had mild febrile illness accompanied by diarrhea 1 wk ago. Rash is papular, erythematous, involving extensor surfaces of arms and legs as well as cheeks.

A

Gianotti Crosti (papular acrodermatitis)

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8
Q

6 y/o boy with HA, pharyngitis, fever for 48 hrs, fine papular sandpaper-like rash begun in groin and armpits and then generalized. Desquamation of fingers.

A

Scarlet fever

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9
Q

.9 y/o girl with “slapped” red cheeks a week prior to disseminated red, reticulated, lacy rash involving palms and soles. Afebrile, rash became brighter when bathing.

A

Fifth’s disease (parvo)

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10
Q

4 y/o with low grade fever, malaise, vomiting. Generalized, reticulated, lacy rash that was purpuric and appeared on hands and feet.

A

Parvovirus Gloves and Socks syndrome

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11
Q

7 y/o boy, ill-appearing, severe HA, fever, palpable purpuric rash on arms and legs. Nausea and pain in arms and legs.

A

Meningococcemia

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12
Q

Teenager, fever, exudative pharyngitis, fatigue. Morbilliform disseminated eruptions. May develop post amoxicillin?

A

Infectious mononucleosis

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13
Q

.14 month old with unilateral morbilliform eruption in left axilla that spread to upper arms and trunk. Resolved spontaneously within weeks.

A

Unilateral lateral thoracic exanthem

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14
Q

.This three year old developed honey crusted lesions around the nose and mouth following a recent cold. Mom had noticed a small “pimple” under the nose at first.

A

Impetigo

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15
Q

Afebrile two week old was otherwise well-appearing and feeding well, developed flaccid pus filled bullae on his suprapubic area. A mild irritant diaper rash produced the lesions.

A

Bullous Impetigo

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16
Q

.One year old with an erythematous, minimally scaly rash in the diaper area which spared the creases.

A

Irritant diaper dermatitis

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17
Q

Child presents with erythematous scaly diaper rash, most prominent in the creases. He also had a generalized scaly erythematous rash and yellowish scales in his scalp.

A

Seborrheic diaper dermatitis

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18
Q

Rash began after several episodes of diarrhea during a course of antibiotics. It is erythematous and involves the creases of the diaper area and also has satellite lesions.

A

Candidal diaper dermatitis

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19
Q

Teenaged wrestler noticed itchy annular lesion with a crusty border and flesh-colored center a week ago.

A

Tinea corporis

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20
Q

Otherwise healthy adolescent noticed that these hypopigmented scaly patches on his shoulders, neck, back, and chest became more pronounced in the summer months.

A

Tinea versicolor

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21
Q

pruritic papulovesicular rash developed two days after patient was helping with some yardwork.

A

Contact dermatitis

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22
Q

Rash began when infant was about one month old. Erythematous papular and symmetric on the cheeks, forehead, scalp, and trunk, sparing diaper area. Mom noticed rash flared with introduction of new food.

A

Eczema/Atopic

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23
Q

16 year old developed pruritic erythematous edematous papules and confluent plaques after a recent cold. She had all of her immunizations. She was taking ibuprofen for comfort for menstrual cramps and trying an herbal tea for comfort.

A

Urticaria

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24
Q

Initial scaly patch of erythema prior to papulosquamous eruption involving primarily the trunk. Red scaly papules and annular plaques, “christmas tree” distribution.

A

Pityriasis rosea

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25
Q

Papulovesicular lesions, some with burrows noted, found on entire family. Intensely itchy. Noticed lesions months ago.

A

.Scabies

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26
Q

Annular, erythematous lesions that appeared after camping. May see flu-like symtoms.

A

Lyme disease

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27
Q

Tick bourne, red partially blanching papular eruption on hands and feet, including palms and soles. Progressed to trunk over three days. Other symptoms included headache, high fever, arthralgias, myalgias. Progressed to petechial rash within days.

A

Rocky Mountain Spotted Fever

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28
Q

Palpable purpuric rash on buttocks and legs, associated with arthralgias, and abdominal pain. May see microscopic hematuria on urinalysis.

A

Henoch Schonlein Purpura

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29
Q

4 year old with fever for 6 days along with sandpaper-like papular red rash and desquamation in the diaper area. Associated peeling of lips, strawberry tongue, puffy hands and feet, and nonexudative conjunctivitis, and tender anterior cervical LAD.

A

Kawasaki’s Disease

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30
Q

Fever and sore throat one day prior to eruption of red papulovesicular rash involving face, lips, mouth, upper trunk, and distal extremities. Lesions on hands and feet resembled a target configuration. Eyes spared.

A

Steven’s Johnson syndrome

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31
Q

Healthy immunized toddler developed generalized annular target-like plaques after starting antibiotics for infected insect bites. No involvement of mucus membranes.

A

Erythema multiforme (minor

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32
Q

10 year old with pain localized to left side of chest and back two days before eruption of erythematous vesicular rash. Grapelike clustered appears of lesions following dermatome.

A

Herpes zoster

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33
Q

Factors influencing chances of developing congenital heart disease

A

Maternal teratogenic meds
Maternal infection or disease
First degree relative with CHD
Genetic abnormality

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34
Q

Teratogen: Alcohol

Associated heart defect:

A

VSD, PDA, ASD

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35
Q

Teratogen: amphetamine

Associated heart defect:

A

VSD, PDA, ASD, Transposition

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36
Q

Teratogen: Trimethadione

Associated heart defect:

A

Transposition, tetralogy of Fallot, hypoplastic left heart syndrome

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37
Q

Teratogen: Hydantoin

Associated heart defect:

A

Pulmonary or aortic stenosis, coarctation, PDA

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38
Q

Teratogen: Lithium

Associated heart defect:

A

Ebstein’s anomaly, tricuspid atresia, ASD

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39
Q

Teratogen: Thalidomide

Associated heart defect:

A

Tetrology of Fallot, VSD, ASD, truncus arteriosus

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40
Q

Teratogen: Retinoic acid

Associated heart defect:

A

VSD

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41
Q

Maternal disease: Rubella

Associated heart defect:

A

Pulmonary arterial stenosis, PDA, VSD, ASD

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42
Q

Maternal disease: Diabetes

Associated heart defect:

A

Transposition, VSD, coarctation, hypertrophic cardiomyopathy

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43
Q

Maternal disease: lupus

Associated heart defect:

A

Heart block

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44
Q

Maternal disease: PKU

Associated heart defect:

A

Tetralogy of Fallot, VSD, ASD

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45
Q

How much higher is a patient’s chance of having a congenital heart disease if a first degree relative has one?

A

Twice as high

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46
Q

Genetic abnormality: Trisomy 21

Associated heart defect:

A

Endocardial cushion defect (AV canal)

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47
Q

Genetic abnormality: Alagille syndrome

Associated heart defect:

A

Pulmonary stenosis

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48
Q

Genetic abnormality: DiGeorge syndrome

Associated heart defect:

A

Interrupted aortic arch, Truncus arteriosus, VSD, PDA, Tetralogy of Fallot

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49
Q

Genetic abnormality: Turner syndrome

Associated heart defect:

A

Bicuspid aortic valve, coarctation of the aorta

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50
Q

Genetic abnormality: William’s syndrome

Associated heart defect:

A

Supravalvar aortic stenosis, supravalvar pulmonary stenosis

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51
Q

Genetic abnormality: Noonan’s syndrome

Associated heart defect:

A

Pulmonary valve stenosis, hypertrophic cardiomyopathy

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52
Q

Signs of cardiac defects to watch for in infants:

A

Significant birth or maternal history, feeding difficulty, tiring prematurely during feeding, cyanosis, diaphoresis, poor weight gain

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53
Q

Signs of cardiac defects to watch for in children/adolescents:

A

Palpitations, fainting, poor exercise tolerance, chest pain

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54
Q

Family history features suggestive of cardiac defects:

A

Congenital heart defects, deafness, sudden cardiac death

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55
Q

Social history features suggestive of cardiac defects:

A

Drugs of abuse, herbs or performance enhancing drugs

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56
Q

Normal heart, awake, newborn:

A

100 - 180 bpm

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57
Q

Normal HR, awake, 1wk-3mos

A

100 - 220 bpm

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58
Q

Normal HR, awake, 3mos-2yrs

A

80-150 bpm

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59
Q

Norma HR, awake, 2-10yrs

A

70-110 bpm

60
Q

Normal HR, awake, >10 yrs

A

55 - 90 bpm

61
Q

Cyanotic or acyanotic?

Qp/Qs

A

Cyanotic

62
Q

Cyanotic or acyanotic?

Qp/Qs >1:1

A

Acyanotic

63
Q

Cyanotic or acynotic?

VSD, ASD, AVSD, PDA, aortic stenosis, coarctation

A

Acyanotic

64
Q

Name that heart defect:

Blowing, holosystolic at LLSB or apex

A

Small VSD

65
Q

Name that heart defect:
Harsh systolic ejection murmur at LUSB, may have diastolic rumble at apex. Also tachycardia, tachypnea, and hepatomegaly

A

Large VSD

66
Q

Name that heart defect:

Increased precordial activity, widely split and fixed S2, crescendo/descrescendo systoli murmur at LUSB

A

ASD

67
Q

Name that heart defect:
Machine like murmur heard best at apex, trasmission throughout. Bounding pulses, widened pulse pressure. Tachycardia, tachypnea, hepatomegaly

A

PDA

68
Q

Name that heart defect:
Harsh systolic ejection murmur at RUSB radiating to carotids with early systolic ejection click (apex), thrrill at suprasternal notch

A

Aortic stenosis

69
Q

Name that heart defect:

Poor femoral pulses, upper-lower BP discrepancy

A

Coarctation

70
Q

Cyanotic or acyanotic?
Tetralogy of Fallot, Total anomalous pulmonary venous return, transposition, triscupid atresia, truncus arteriosus, hypoplastic left heart syndrome

A

Cyanotic

71
Q

Name that heart defect:

Cyanosis, clubbing, harsh systolic ejection murmur at LUSB

A

Tetralogy of Fallot

72
Q

the PROVe of TOF:

A

Pulmonic stenosis, Right ventricular hypertrophy, Overriding aorta, VSD

73
Q

Name that heart defect:

Cyanosis, respiratory distress, poor perfusion

A

Total anomalous pulmonary venous return

74
Q

Name that heart defect:
Cyanosis, feeding difficulties, heart failure, respiratory distress, may hear murmur, maintained by ASD/VSD/PDA.
Mustard or Jantene procedure for tx.

A

Transposition of the great arteries

75
Q

Name that heart defect:

Cyanosis, harsh holosystolic ejection murmur

A

Tricuspid atresia

76
Q

Name that heart defect:

Cyanosis, gradual respiratory and feeding difficulties, widened pulse pressure, ejection click, to-and-fro murmur

A

Truncus arteriosus

77
Q

Name that heart defect:

Cyanosis, lethargy, shock, PDA murmur, poor pulses, hepatomegaly

A

Hypoplastic left heart syndrome

78
Q

Fractures should be described in terms of the following (5):

A

Anatomic position, direction, type, degree of angulation, degree of displacement

79
Q

A non-displaced spiral fracture of the distal tibia that results from a fall with a twist:

A

Toddler’s fracture

80
Q

A fracture of a long bone due to a bending and incomplete line of breakage (only one side of cortex breaks). Often of the radius and ulna when falling on ouotstretched arm with wrist dorsiflexed.

A

Greenstick fracture.

81
Q

Fractures involving growth plate are classified using:

A

Salter-Harris classification

82
Q

A fracture that is limited to growth plate (6%):

A

Type I Salter-Harris fracture

83
Q

A fracture that involves variable amount of growth plate with extension into metaphysis (75%)

A

Type II Salter-Harris

84
Q

A fracture that involves the growth plate with extension into epiphysis (8%):

A

Type III Salter-Harris

85
Q

A fracture that involves the growth plate with extension into metaphysis and epiphysis (10%):

A

Type IV Salter-Harris

86
Q

A fracture that is a crush injury to the growth plate (1%)

A

Type V Salter-Harris

87
Q

Radial head slips under annular ligament, often due to sudden traction applied to extended arm. MC in children ages 1 - 4.

A

Nursemaid’s elbow

88
Q

Treatment for nursemaid’s elbow?

A

Supinate, extend, apply pressure over radial head

89
Q

Groin pain with decreased range of motion of hip (decreased IR, affected hip will ER when flexed), gait abnormality, Usually unilateral, MC in african-american children.

A

Slipped capital femoral epiphysis

90
Q

Unilateral avascular necrosis of femoral head due to impairment of blood supply during development. Prolonged limp or waddling gait, pain in groin/thigh/knee, thigh muscle atrophy

A

Legg-Calve Perthes disease

91
Q

MC disorder affecting hip in children, females. Diagnosis based on Barlow and Ortalani tests.

A

Developmental dislocation of the hip

92
Q

Complications of DDH:

A

Osteonecrosis, failed reduction-redislocation

93
Q

Rotational deformity of the subtalar joint with os calcis internally rotated beneath the talus. Creates a block to dorsiflexion.

A

Clubfoot (Talipes Equinovarus)

94
Q

Physiologic bowlegs: normal variant of LE configuration between ages 1 - 3. Up to 20* bowing.

A

Genu varum

95
Q

Physiologic knock-knees: normal variant of the LE configuration btw ages 2 - 4.

A

Genu valgum

96
Q

Routine screening with Adams test (forward bending) should be part of all exams in children ages:

A

6 - puberty or longer

97
Q

Tx for idiopathic scoliotic curves

A

repeat x-ray every 6 mos

98
Q

Tx for idiopathic scoliotic curves >10*

A

Referred to orthopedics

99
Q

Tx for idiopathic scoliotic curves 20* or greater with progression:

A

spinal bracing

100
Q

Tx for idiopathic scoliotic curves >40*:

A

Operative intervention

101
Q

MCC URI in children:

A

Rhinovirus

102
Q

What to look for if URI has secondary bacterial infection:

A

Earache, sinus pain not relieved by nasal washes, dyspnea, fever >3d, fever that comes back after 24 hours remission, nasal discharge >2wks, cough >3wks

103
Q

MC disease diagnosed in children

A

Acute otitis media

104
Q

MCCs of Acute OM

A

Strep pneumoniae > H. influenzae > M. catarrhalis > viruses

105
Q

Otoscopic findings for OM:

A

Red/pink/cloudy, bulging/retracted/normal, may have reduced mobility

106
Q

Tx for OM:

A

High dose amoxicillin > amox-clavulanate > cephalosporins

107
Q

Diagnostic features of sinusitis:

A

Persistent sx (congestion or cough >10d), severe sx (temp >38.5 C with purulent rhinorrhea >3d), worsening sx (after 3-4 d improved sx)

108
Q

Diagnostic features unique to GAS pharyngitis:

A

Dysphagia, fever, headache, abd pain, N/V, soft palate petechiae, anterior cervical LAD, scarlet fever rash

109
Q

Diagnostic features unique to viral pharyngitis:

A

Cough, runny nose, hoarse voice, diarrhea, stomatitis, conjunctivitis

110
Q

Tx for GAS pharyngitis:

A

Oral Penicillin VK > amoxicillin > cefdinir > azithromycin

111
Q

Complication following GAS infection, 3 - 4 wks after infection

A

Acute rheumatic fever

112
Q

Complication following GAS infection, occurs 10 days later, hematuria/edema/oliguria/HTN/low c3

A

PSGN

113
Q

Viral infection of glottic and subglottic regions, occurs between ages of 3 - 36 mos in late fall/early winter, narrowed subglottic space due to swelling and edema of respiratory epithelium. Barking cough, stridor, usually at night.

A

Croup (Laryngotracheobronchitis)

114
Q

Viral lower respiratory tract infection, RSV accounts for 65% of cases, virus proliferates in epithelium and causes distal airway obstruction.

A

Bronchiolitis

115
Q

Abrupt onset of fever, headache, myalgia, sore throat, non-productive cough may persist, GI sx. Detect with rapid test and culture.

A

Influenza

116
Q

Onset for viral pneumonia is ____ vs bacterial which is ____

A

Viral: slow
Bacterial: abrupt

117
Q

MCC vertically transmitted bacterial pneumonia in infants 2 - 3 mos

A

Chlamydia trachomatis

118
Q

MCC bacterial pneumonia in children

A

Streptococcus pneumoniae

119
Q

MCC bacterial pneumonia in children >5yrs

A

Mycoplama pneumoniae

120
Q

Local lymphadenitis in fall or winter with red papule at cat scratch site

A

Bartonella henselae

121
Q

Child >12 mos with headache, neck pain, nausea, vomiting, fever, irritability, nuchal rigidity.

A

Bacterial meningitis

122
Q

MCC bacterial meningitis in neonates and tx

A

HBS, gram neg bacilli, listeria

Ampicillin and gentamicin or ampicillin and cefotaxime

123
Q

MCC bacterial meningitis in infants 1 - 24 mos

A

S. pneumoniae, N. meningitidis, Hib

Third gen cephalosporin; add Vancomycin till sensitivities are known

124
Q

MCC bacterial meningitis children >24 mos

A

S. pneumoniae, N. meningitidis, Hib

125
Q

Inflammatory response in joint space that occurs as a result of infection elsewhere in the body.

A

Reactive arthritis

126
Q

Bacterial infection in joint space, children

A

Septic arthritis

127
Q

If the cough is nonproductive, think:

A

Reactive airway disease, bronchitis, irritants

128
Q

If the cough is productive of purulent sputum, think:

A

CF, bronchiectasis

129
Q

If the cough is productive of clear/white sputum, think:

A

Asthma

130
Q

If the cough is productive of blood, think:

A

TB, CF, bronchiectasis, hemosiderosis

131
Q

Hep B vaccine: route of administration, dosing schedule

A

Intramuscular; 0, 1, 6 mos

132
Q

Rotavirus vaccine: valence, route, schedule

A

Pentavalent; oral; doses at 2, 4 , 6 mos

133
Q

DTaP vaccine: route, schedule

A

Intramuscular; primary series at 2, 4, 6, and 15 mos; booster at 4-6 years. TDaP booster every 11 - 12 years.

134
Q

Hib vaccine: route, schedule,

A

Intramuscular; primary series a 2, 4, 6 mos; booster at 12 - 15 mos

135
Q

pneumococcus PCV13: valence, schedule

A

Heptavalent conjugate; doses at 2, 4, 6 and 12 mos

136
Q

Pneumococcus PPV23: valence, schedule

A

23 valent polysaccharide; given to high risk >2 yrs, 5 years after initial dose

137
Q

Polio vaccine: route, schedule

A

Inactivated injection subq; Primary doses at 2 mos and at least 6 weeks later, third dose at 6 - 18 mos, fourth dose at 4 - 6 years.

138
Q

Inactivated influenza vaccine: valence, route, schedule

A

Quadrivalent; inactivated vaccine at 6mos - 3yrs; 2 doses req. for first year children

139
Q

Live attenuated influenza vaccine: valence, route, reason

A

Quadrivalent; intranasal spray; children >24 mos; more efficacious and add’l benefit prevention OM

140
Q

MMR vaccine: route, schedule

A

Subq live vaccine; first dose by 15mos, second dose recommended at school entry

141
Q

Varicella vaccine: route; schedule

A

Subq live vaccine; first dose at 12 mos, second at 4 yrs; children >13 yrs two doses 4 wks apart

142
Q

Hep A vaccine: recommended for, schedule

A

Recommended for children >12mos; 2 vaccines 6 mos apart

143
Q

HPV vaccine: valence; schedule

A

Bivalent, quadrivalent, 9-valent for females; quad and 9-valent for males; initial dose then at 2 then at 6 mos.

144
Q

Meningococcal conjugate vaccine: serogroups, route, schedule, complications

A

Serogroups A/C/Y/W-135; intramuscular; Ages 11 - 55 w booster after 5 yrs, ages 2 - 10 for high risk prophylaxis; Associated with Guillain-Barre syndrome

145
Q

Meningococcal B vaccine: recommendations

A

Short term protection, recommended in ages 16 - 23; 2 - 3 doses.

Clincial Medicine (10 decks)

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