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Pediatrics Flashcards

1
Q

What two things should be provided to the newborn at birth and why?

A 
Erythromycin ointment (ward off bacterial infection)
Vitamin K (prevent hemorrhagic disease)
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2
Q

Before discharging the newborn and mother what additional tests should you complete?

A

Hearing screen
Give mom HBV vaccine if HBsAg negative (admin HBV vaccine and HBV Ig if positive)
Neonatal screening tests

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3
Q

APGAR at 1 minute tells about _______

at 5 minutes tells about ______

A

1 minute: labor and delivery

5 minute: response to therapy

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4
Q

What should you rule out when seeing Mongolian spots?

A

Child abuse

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5
Q

Newborn presents on second day of life with firm papules on an erythematous base. What are these and what is mgmt?

A

Erythema toxicum

Self-limited

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6
Q

What constellation of symptoms may be seen in Sturge-Weber syndrome?

A

Port wine stain
AVM resulting in seizures
Mental retardation
Glaucoma

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7
Q

Mgmt of Sturge-Weber Syndrome?

A

Pulsed laser therapy, AEDs, and evaluate for glaucoma

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8
Q

Treatment for large hemangiomas which are at risk for causing organ dysfunction to shifting cardiac output in a newborn?

A

Steroids or pulsed laser

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9
Q

Preauricular tags in newborn assd with …

A

Hearing loss

GU anomalies

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10
Q

Iris defect in newborn should raise suspicion for what syndrome?

A

CHARGE

Coloboma
Heart defects
Atresia of nasal choanae
Retardatioon of growth
GU  anomalies
Ear abnormalities
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11
Q

Absence of iris is red flag for …?

A

Wilms tumor

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12
Q

What type of surveillance should Wilm’s tumor patients undergo?

A

Abdominal US every 3 months until the age of 8

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13
Q

Newborn presenting with neck mass lateral to the midline is …

A

Branchial cleft cyst

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14
Q

Distinguish omphalocele vs gastroschisis

A

Omphalocele: GI organs outside of body but covered by peritoneum
Gastroschisis: GI organs outside of body with no covering

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15
Q

Umbilical hernia in newborn raises concern for …

A

Hypothyroidism

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16
Q

In newborns with undescended testes what is mgmt?

A

No treatment until 1 year of age

At that time either hormone injections or orchiopexy

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17
Q

Should you circumcise hypospadias?

A

No

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18
Q

What abnormalities are seen in infants of diabetic mothers?

A 
Hypoglycemia
Hypocalcemia
Hypomagnesia
Hyperbilirubinemia
Polycythemia

Cardiac anomalies
Small left colon syndrome

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19
Q

What causes transient tachypnea of the newborn and how long does it generally last?

A

Retained lung fluid in newborns delivered by C-section or with a rapid second stage of labor

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20
Q

What medicine do you provide to prevent respiratory distress in a potentially premature newborn?

A

Antenatal betamethasone when

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21
Q

What are ventilator settings you would use in a newborn with meconium aspiration?

A

High frequency ventilation

PEEP

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22
Q

What is mgmt of diaphragmatic hernia?

A

Immediate intubation and surgical correction

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23
Q

How do you treat meconium plugs and meconium ileus?

A

Get abd xray and give gastrografin enema

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24
Q

What is part of the VACTERL syndrome?

A 
Vertebral defects
Anal atresia
Cardiac anomalies
TEF with ...
Esophageal atresia
Radial and Renal anomalies
Limb Syndrome
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25
Q

What is treatment of newborn born with duodenal atresia (double bubble on xray)?

A

NG decompression and surgical correction

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26
Q

Greatest risk factor of NEC …

A

Premature delivery

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27
Q

Mgmt of NEC

A

Stop feeding
Decompress gut
Broad spectrum antibiotics
Evaluate for surgical resection

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28
Q

Your patient fails to pass stool early in course and upon digital exam a large volume passes. Dx?
What is the next part of the work-up?
What is a confirmatory test?

A

Hirschsprung disease
Barium enema
Rectal biopsy (absence of ganglionic cells)

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29
Q

Mgmt of kernicterus

A

Immediate transfusion exchange

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30
Q

If a newborn presents with jaundice and elevated conjugated bilirubin then what should you consider and the tests you should order?

A

Cholestasis

Get LFTs and consider US and liver biopsy

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31
Q

Early onset sepsis in a newborn is most often from ….

A

PNA (GBS, E. coli, H. influenzae, L. monocytogenes)

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32
Q

Late onset sepsis in newborn is most often from ….

A

Meningitis or bacteremia (S. aureus, E. coli, Klebsiella, Pseudomonas?

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33
Q

What is empiric treatment of sepsis in newborn?

A

Ampicillin and gentamicin

If meningitis possible consider adding cefotaxime

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34
Q

Buzzwords

Hydrocephalus with generalized intracranial calcifications and chorioretinitis

A

Toxo in newborn

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35
Q

What is the best initial test for Herpes dx in newborn? Most accurate?

A

Initial: Tzanck
Accurate: HSV PCR

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36
Q

Best initial test for syphilis in newborn?

Most accurate?

A

Initial: VDRL
Accurate: IgM-FTA-ABS

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37
Q

What tests should be ordered in working up seizures in the newborn?

A 
EEG
CBC, glucose, calcium, magnesium
Amino acid and urine organic acids for inborn errors of metabolism
IgM levels
Blood and urine cultures
LP
Ultrasound head - look for IVH
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38
Q

Tx of seizure in newborn?

A

Lorazepam or diazepam (rectally)

Ethosuximide if absence

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39
Q

Of the following: heroin, methadone, cocaine, amphetamines, and alochol which presents with withdrawal in newborns at 48 hrs and which at 96 hrs to up to 2 weeks?

A

48 hrs: cocaine, heroin, alcohol amphetamines

96 hrs to 2 weeks: methadone

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40
Q

Is it acceptable to give narcan to a newborn?

A

No it may trigger withdrawal. It is acceptable to give small doses of opiates and phenobarbital

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41
Q

Effect on newborn

Phenobarbital

A

Vitamin K deficiency

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42
Q

Effect on newborn

Sulfonamides

A

Displaces bilirubin from albumin and increases risk of kernicterus

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43
Q

Effect on newborn

NSAIDS

A

Premature closure of ductus arteriosus

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44
Q

Effect on newborn

ACEi

A

Craniofacial abnormalities

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45
Q

Effect on newborn

Isoretinoin

A

Facial and ear anomalies, congenital heart disease

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46
Q

Effect on newborn

Phenytoin

A

Hypoplastic nails, typical facies, IUGR

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47
Q

Effect on newborn

Diethylstilbestrol (DES)

A

Vaginal adenocarcinoma

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48
Q

Effect on newborn

Lithium

A

Ebstein’s anomaly (atrialization of RV due to ineffective tricuspid valve leaflets)

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49
Q

Effect on newborn

Warfarin

A

Facial dysmorphism and chondrodysplasia

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50
Q

Effect on newborn

Valproate/Carbamazepine

A

Mental retardation, neural tube defects

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51
Q

Buzzwords

Trisomy with rocker bottom feet and hammer toe; micrognathia; microcephaly

A

Trisomy 18 Edwards Syndrome

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52
Q

Buzzwords

Trisomy with holoproencephaly, cleft lip/palate

A

Trisomy 13 Patau Syndrome

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53
Q

What kind of regular surveillance should you complete in patients with Beckwith-Weideman Syndrome and to look for what?

A

Ultrasound and serum AFP every 6 weeks to look for Wilm’s tumor and hepatoblastoma

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54
Q

What are features of Robin (Pierre Robin) sequence and what complication should you watch for over the first 4 weeks of life?

A

Mandibular hypoplasia and cleft palate
(Assd with Edwards syndrome and fetal alcohol syndrome)

*Watch for airway obstruction in first 4 weeks of life

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55
Q

Height percentile at which age correlates with final adult height percentile?

A

2 years old

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56
Q

Advantages of breastfeeding

A

Passive immunity via T-cell transfer which reduces risk of allergy and GI/respiratory infection

Emotional bonding with mother

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57
Q

Contraindications to breast feeding

A 
HIV
Galactosemia
Active drug use (e.g. cocaine, opiates, heroin)
Systemic illness (e.g. TB)
HSV (if lesions on breast)
Maternal cancer receiving treatment
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58
Q

Until what age is enuresis normal?

A

5 years old

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59
Q

Until which age is encopresis normal?

A

4 years old

60
Q

For retentive encopresis what are appropriate therapies to use in mgmt?

A

Stool softeners
Disimpaction
Behavioral modifications

61
Q

Patients with a known egg allergy should receive which form of influenza vaccine?

A

Trivalent inactivates influenza vaccine

62
Q

Newborn is exposed to Measles in mother. Is 5 months old. What is tx?

A

Just give Ig

If 6-12 months when exposed then give Ig and vaccine

63
Q

Neck Xray showing steeple sign is positive for what disease?

A

Croup (caused by parainflulenza)

64
Q

Mgmt of croup

A

Humidified oxygen

Nebulized epinephrine and corticosteroids

65
Q

Patient presents with drooling and muffled voice. Neck Xray shows ‘thumbprint’ sign. Dx and mgmt?

A

Epiglottitis (often Hib)

Emergency - get anesthesia and ENT
Intubate if needed
Ceftriaxone and steroids
Rifampin ppx to household contacts

66
Q

3 yo patient presents after having a URI last week with fever, cough, and respiratory distress. He is not drooling or has a changed voice. CXR shows subglottic narrowing. Dx, cause, and mgmt?

A

Bacterial tracheitis
S. aureus
Antistaph Antibx

67
Q

What mediates the development of angioedema?

A

Bradykinin

68
Q

Where are the most common sites for foreign body aspiration in kids older and younger than 1 year of age?

A

> 1 yo: larynx

69
Q

Causes of bronchiolitis

A

RSV
Parainfluenza
Adenovirus

70
Q

Most specific test for bronchiolitis dx

A

Viral antigen testing (IFA or ELISA)

71
Q

What is a routine way to prevent bronchiolitis development in young children?

What is used to prevent it in high risk patients?

A

Routine: Breastfeeding which provides IgA which helps prevent respiratory illnesses (disease occurring across mucosal linings)

High Risk: Palivizumab (against RSV F protein)

72
Q

What is the most common pathogen causing PNA in children

A

Viral - RSV

73
Q

What are the most common pathogens causing PNA in children > 5 yo?

A

S. pneumoniae
M. pneumoniae
C. pneumoniae

74
Q

A 2 month old infant presents with staccato cough and peripheral eosinophilia noticed on CBC. Had conjunctivitis at birth. What is Dx?

A

Chlamydia trachomatis pneumonia

75
Q

Are sputum cultures helpful in the dx of PNA in children

A

No

76
Q

For mild cases of PNA handled in outpatient setting what is an appropriate treatment?

A

Amoxicillin

Alternatives are cefuroxime and amoxicillin/clavulanic acid

77
Q

In hospitalized patients with PNA what is appropriate tx?

A

IV cefuroxime

78
Q

In Chlamydia or Mycoplasma pneumoniae what is appropriate tx?

A

Erythromycin

79
Q

Absent vas deferens and allergic bronchopulmonary aspergillosis are assd with what genetic condition?

A

Cystic fibrosis

80
Q

What is the first symptom cystic fibrosis often presents with?

A

Meconium ileus

81
Q

What is the first approved therapy for CF which restores the function of the mutant CF protein given to patients > 6 yo with G551D mutations?

A

Ivacaftor (VX - 770)

82
Q

What are common organisms causing infection in CF?

A

S. aureus
Pseudomonas
H. influenzae

83
Q

For resistant pathogens in CF patients what antibiotics do you use?

A

Inhaled tobramycin

84
Q

In CF patients infected with S. aureus or Pseudomonas what is appropriate treatment?

A

Piperacillin and tobramycin/ceftazidime

85
Q

When is a surgical repair for VSD indicated?

A

Failure to thrive
R: L shunt > 2:1
Pulm HTN

86
Q

How are primary and sinus type ASDs managed?

A

They are closed surgically

87
Q

In newborn with pulmonary stenosis what should they be given at birth and how should they managed in the longterm?

A

Give prostaglandin E1 infusion at birth (keeps PDA open) and attempt balloon valvuloplasty later

88
Q

What drug is used to close a PDA?

A

Indomethacin

89
Q

What drug is used to maintain the ductus arteriosus?

A

Prostaglandin E1 infusion

90
Q

When should you attempt surgical repair of tetralogy of Fallot?

A

4-12 months

*Before that give oxygen, beta blocker, PGE1 infusion

91
Q

Which cyanotic congenital heart disease lesion presents immediately after birth? How is it managed?

A

Transposition of great vessels

Prostaglandin E1 to keep PDA open and attempt surgical repair ASAP

92
Q

Gram negative spiral that is motile with flagella

A

Campylobacter (a cause of bloody diarrhea)

93
Q

Antibx tx of:

Shigella

A

TMP/SMX

94
Q

Antibx tx of:

Salmonella

A

Only treat those

95
Q

What is treatment of HUS from suspected E. coli O157:H7?

A

Do NOT give antibiotics

Supportive, HTN control, aggressive nutrition, early dialysis

96
Q

What is the best initial test for fat malabsorption?

Best confirmatory test?

A

Initial: Sudan black stain
Confirmatory: 72 hour stool for fecal fat

97
Q

Best initial test for protein malabsorption

A

Spot stool alpha-1 antitrypsin level

98
Q

What is the best initial test in pediatric GERD dx?

A

Esophageal pH monitoring

99
Q

What are first line GERD meds in children?

A

H2 receptor blockers (e.g. ranitidine) are first line bc of an improved safety profile

100
Q

Hypochloremic metabolic alkalosis is pathognomonic of what?

A

Pyloric stenosis

101
Q

How can pyloric stenosis and duodenal atresia be distinguished on exam?

A

Pyloric stenosis presents with nonbilious vomitus

Duodenal aresia has bilious vomitus

102
Q

What is both diagnostic and therapeutic in intussuception?

A

Air enema

103
Q

Tx pediatric cystitis

A

Amoxicillin or SMP/TMX

104
Q

Tx pediatric pyelonephritis

A

IV ceftriaxone or ampicillin/gentamicin

105
Q

In patients with vesicoureteral reflux what is provided as ppx against renal scarring?

A

They get multiple UTIs so give TMP-SMX

106
Q

What are the best initial tests in obstructive uropathy?
What is the most common cause in boys?
What is the most common cause in newborns?

A

Voiding cystourethrogram and renal scan
Boys: Posterior urethral valves
Newborns: Hydronephrosis and polycystic kidney disease

107
Q

Acute post-strep glomerulonephritis occurs after what infections?

A

Post strep pharyngitis or impetigo

108
Q

What unique test results are seen in APGN?

What is the most specific test?

A

Low C3 complement, anti-streptococcal antigens

Specific test: Anti-DNase antigen

109
Q

Tx of APGN

A 
Penicillin
Supportive (diuresis, sodium restriction, electrolyte mgmt)
110
Q

20 yo patients presents with hematuria after URI and has a normal complement level. Dx?

A

Berger’s nephropathy (IgA nephropathy)

111
Q

What is tx of infantile (recessive type) polycystic kidney disease?

A

Dialysis and transplant

112
Q

What benign cause of proteinuria should be ruled out before any additional work-up be completed?

A

For transient or orthostatic proteinuria

113
Q

What are two complications of nephrotic syndrome in children?

A

Increased risk of SBP (immunize against pneumococcus and varicella)
Increased VTE risk (prothrombotic)

114
Q

How does 21-hydroxylase deficiency present on a BMP and vitals?

A

Hyperkalemia, hyponatremia, hypoglycemia
Hypotension
*Females will also have ambiguous genitalia

115
Q

Tx of 21-hydroxylase deficiency

A

Hydrocortisone and fludrocortisone

Corrective surgery for females

116
Q

How does Kawasaki disease present?

A 
Fever
Desquammating rash on hands
Lymphadenitis (cervical)
Conjunctivitis
Strawberry tongue/cracked lips
Erythema and swelling of hands/feet
Nonvesicular rash
117
Q

Tx of Kawasaki disease

A

Aspirin and IVIG

*May consider adding warfarin, especially if platelet count high

118
Q

What are major complications of Kawasaki disease?

A

Coronary artery aneurysms

119
Q

Intussusception, arthritis, and glomerulonephritis/nephrosis all may develop in what IgA and C3 mediated disease?

A

Henoch-Schonlein Purpura

120
Q

Increased IgA and IgM
Antiphospholipid or anticardiolipin antibodies
The above may be seen in what disease?

A

HSP

121
Q

What is tx of HSP?

A

If anticardiolipin or antiphospholipid are present then give ASA.
If there are intestinal or renal complications then give corticosteroids

122
Q

When is there a physiological anemia in newborns and why does it occur?

A

At 12 weeks it nadirs at 9-11 mg/dL. This is due to progressive drop in EPO production until tissue oxygen needs are greater than they were at delivery

123
Q

Infants only receiving cow’s milk are at increased risk of which anemia?

A

IDA

124
Q

What types of bacteria are patients with sickle cell disease susceptible to and why?

A

Encapsulated abcteria bc they undergo autosplenectomy by age 5; Strep pneumo, Hib, N. meningitidis

125
Q

What are the most common causes of death in sickle cell?

A

Sepsis and acute chest syndrome

126
Q

Your patient with sickle cell anemia presents with SOB and chest pain. Do you do transfuse blood or do an exchange transfusion?

A

Transfuse

127
Q

In what situations is an exchange transfusion indicated for sickle cell anemia?

A

Life-threatening complications (stroke, acute chest, splenic crisis)
Before high-risk surgery

128
Q

What drug reduces number of recurrent painful crises and needs for exchange of transfusion?

A

Hydroxyurea

129
Q

What is the only definitive treatment of sickle cell disease?

A

BM transplant (but carries a 10% mortality)

130
Q

What ppx measures are taken in sickle cell disease pts?

A

Penicillin ppx from 6 mos until 5 years of age

Regular immunizations but with early pneumococcus and meningitis vaccines

131
Q

When and how does Beta thalassemia major present?

A

At 2 months with severe anemia (Hb

132
Q

What are findings on hemoglobin electrophoresis in a patient with Beta thalassemia major?

A

HbF is increased
HbA2 may be increased
Absent or reduced HbA

133
Q

Low reticulocytes
Microcytosis
Hemolysis consistent labs
Elevated ferritin and transferrin saturation

Dx?

A

Beta thalassemia major

134
Q

How is Beta thalassmeia managed?

A

Transfusion to maintain Hb > 9
Iron chelation (deferoxamine and vitamin C)
Splenectomy
Routine (folate, vaccine, growth hormone)
BM transplant is curative

135
Q

How are mixing studies helpful in diagnosing hemorrhagic disorders?

A

Involves mixing normal plasma to the patient’s plasma and repeating PT/PTT/INR

136
Q

If lab prolongation is not corrected in a mixing study what does that mean?

A

An inhibitor is present (e.g. heparin in hospitalized patients)

137
Q

If a mixing study shows more prolonged bleeding with clinical bleeding what does that mean? What if there is no clinical bleeding?

A

w/ bleeding: an antibody against a clotting factor is present

w/o bleeding: possibly lupus anticoagulant

138
Q

How is minor bleeding in hemophilia A treated?

Major bleeding?

A

Minor: desmopression, transexamic acid or aminocaproic acid
Major: Factor VIII supplemetation

139
Q

What are treatment options in ITP?

A

1st: prednisone
2nd: IVIG

Chronic ITP may benefit from rituximab or splenectomy

140
Q

In what situations is a child with a febrile seizure at higher risk for epilepsy?

A

Atypical seizure (>15mins)
Previous neurologic condition
Abnl development
FHx of epilepsy

141
Q

15 yo has a seizure described as jerky movements in the morning. Dx? Mgmt?

A

Juvenille myoclonic epilepsy

Valproic acid

142
Q

What is hypsarrhythmia? What epileptic syndrome is it seen in? Mgmt?

A 
High voltage slow waves irregularly interespersed with spike and sharp waves.
West syndrome (infantile spasms during 1st year of life)
Tx: ACTH, prednisone, vigabatrin, pyridoxine
143
Q

What is first line medication for generalized seizure in child?

A

Valproic acid

144
Q

What are first line meds for partial seizure in pediatrics?

A

Valproic acid or carbamazepine

145
Q

What is the most common long term complication of meningitis?

A

Hearing loss

Step 3 (19 decks)

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