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Pediatrics Flashcards

1
Q

Persistent pulmonary HTN can be suspected in what group - preterm, term, postterm

What does the Xray look like?

A

Term and Post-term neonates with cyanosis

XRay: Clear lungs with decreased pulmonary vasculature

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2
Q

Transient Tachypnea of the Newborn can be suspected in what group - preterm, term, postterm

What does the Xray look like?

A

Term

XRay: Bilateral perihilar linear streaking

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3
Q

Premature infants with grunting, flaring, retractions, central cyanosis immediately after birth =

Treatment?

A

Respiratory Distress Syndrome

Treatment = continuous positive air pressure ventilation

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4
Q

Acrocyanosis =

A

Blue extremities + Pink body

  • common
  • benign
  • may last for 1-2 days
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5
Q

severe coughing paroxysms + apparent subcutaneous emphysema -> need to rule out _

A

Pneumothorax

  • it can also cause other things but a pneumothorax would be the most emergent
  • get a chest xray to rule out

subcutaneous emphysema = gas or air under the skin that usually comes from the chest, feels like rice crispies

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6
Q

How is RSV different in smaller kids vs older kids

A

Can present with URI symptoms (rhinorrhea, nasal congestion) + lower tract symptoms (wheezing, crackles, respiratory distress)

Older kids only get the URI symptoms

Main risks:

  • apnea
  • respiratory failure
  • recurrent wheezing throughout childhood

RSV -> bronchiolitis

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7
Q

Treatment for Epiglottitis

A

First priority is to secure the airway

  • keep child calm
  • endotrachial intubation in the OR
  • if that doesn’t work, emergency trachyotomy
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8
Q

What is epinephrine’s mechanism?

A

Beta-2 agonist = bronchodilation, decreases systemic release of inflammatory mediators
Alpha-1 agonist = vasoconstriction

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9
Q

neonate with scaphoid abdomen (concave), barrel chest, polyhydramnios in utero, no breath sounds on L,, hypoxia on room air =

Management =

A

Congenital Diaphragmatic Hernia

First step in management = endotrachial intubation
Second step = gastric tube - decompresses the stomach and bowel

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10
Q

Are men with CF fertile?

A

No - due to obstructive azoospermia

  • insipissated mucus in the fetal genital tract obstructs the developing vas deferens -> congenital bilateral absence
  • spermatogenesis is normal but the sperm cannot be ejaculated
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11
Q

Genetics of CF?

A

AR

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12
Q

SGA complications for the baby:

A
  • Hypoxia
  • Perinatal asphyxia
  • Meconium aspiration
  • Hypothermia
  • Hypoglycemia
  • Hypocalcemia - caused by decrease Ca transfer across the placenta
  • Polycythemia - caused by increased Epo secretion in response to hypoxia
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13
Q

Pills/tablets that are radio-opaque on XRay

A

-Iron

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14
Q

What to do if parents refuse life-saving treatment for their child?

A

Obtain court order to mandate treatment

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15
Q

Contraindications to rotavirus vaccine: (4)

A
  • Anaphylaxis
  • Hx of intussusception
  • Hx of uncorrected congenital GI malformation
  • SCID

note: Do no give rotavirus older than 8 months 0 days old

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16
Q

Chronic Granulomatous Disease prophylaxis (2)

A
  • TMP/SMX

- Itraconazole

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17
Q
  • Rapid onset of facial edema following infection, trauma, dental procedure without a rash
  • Normal C1q level
  • Depressed C4 level
A

Hereditary angioedema

-C1q levels are depressed in acquired

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18
Q

For stable preterm infants, vaccines should be given based on (chronological/gestational) age.

One exception:

A

Given based on chronological age

Exception: weight should be >2 kg (4 lbs 6 oz) before first vaccine (Hep B)

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19
Q

EKG changes are indicative of what process in a teenager:

  • Tall R wave in aVL + Deep S wave in V3
  • Inverted T waves in I, aVL, V4, V5, V6
A

Hypertrophic cardiomyopathy

Prevalence 1/500

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20
Q

Commotio cordis

A

Development of a fatal V fib after sudden blunt chest wall trauma

  • often seen in basketball
  • occurs in athletes with no prior cardiac disease
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21
Q

On EKG, infants have physiologic findings

-L/R axis deviation?

A

R axis deviation is physiologic
-infants have a larger R ventricle due to the PDA shunting the blood away from the lungs, thus the R ventricle being responsible for pushing blood to the systemic circuit

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22
Q

Tricuspid Valve Atresia requires 2 other structural defects to survive

A
  • ASD: results in increased blood flow to RA -> RA enlargement -> peaked P waves
  • VSD: results in holosystolic murmur loudest at the L lower sternal border
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23
Q

What happens to the Right Ventricle and R sided circulation in Tricuspid Valve Atresia?

A

Lack of blood flow from RA->RV results in a hypoplastic RV and consequently underdevelopment of the pulmonary valve and artery

Will see decreased pulmonary markings on CXR

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24
Q

EKG of a 1 week old

  • L axis deviation
  • small/absent R waves in V1-V3
A

Tricuspid Valve Atresia

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25
Q

“Boot shaped heart” on CXR

A

Tetralogy of Fallot

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26
Q

4 characteristics of Tetralogy of Fallot

A

1) RV Outflow Tract Obstruction - Plumonary stenosis or atresia
2) RV hypertrophy
3) Overriding aorta
4) VSD

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27
Q

Jervell-Lange-Neilsen Syndome

A

Inherited cause of Long QT syndrome

  • molecular defect in K channel
  • AR
  • associated with sensorineurial deafness
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28
Q

3 electrolyte derangements that can cause Long QT Syndrome

A
  • Hypocalcemia
  • Hypokalemia
  • Hypomagnesemia
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29
Q

Romano-Ward Syndrome

A

Inherited cause of Long QT syndrome

  • molecular defect
  • AD
  • NOT associated with deafness
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30
Q

Kawasaki Disease treatment

A

Usually self-limited but treatment is used to prevent cardiac complications
-Aspirin + IVIG

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31
Q

Sandpaper rash that spares the palms and soles =

A

Rash of scarlet fever

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32
Q

Most common cause of secondary hypertension in children =

A

Fibromuscular dysplasia

  • R renal artery worse than L renal artery
  • hum/bruit heard at the costovertebral angle due to well developed collaterals
  • string of beads appearance on angiography
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33
Q

DiGeorge Syndrome clinical features (5)

A

CATCH-22

  • C = conotruncal cardiac defects
  • A = abnormal facies
  • T = thymic aplasia/hypoplasia
  • C = cleft palate
  • H = hypocalcemia
  • 22 = chromosome 22q11.2 deletion
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34
Q

Loud first heart sound + Mid diastolic rumble =

A

Mitral stenosis

-almost always due to Rheumatic Fever

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35
Q

Causes of pediatric viral myocarditis (2)

A
  • Coxsackie B
  • Adenovirus

Viral prodrome -> Heart failure

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36
Q

What effect do these things have on preload?

  • Valsalva
  • Abrupt standing
  • Nitroglycerine
A

Decreases preload

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37
Q

At what grade murmur do you need to do a work up?

A

Grade I-II = no workup needed

Grade III+ = workup

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38
Q

LH and FSH levels in central vs peripheral precocious puberty

A

Central: early GnRH activation -> elevated LH/FSH

Peripheral: gonadal or adrenal release of excess sex hormones -> low GnRH, low LH/FHS

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39
Q

Treatment for idiopathic precocious puberty

A

GnRH agonist therapy

-goal is to increase adult height

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40
Q

15 yo had a URI last week and now is presenting with metabolic acidosis, polyuria, decreased level of consciousness, dehydration, diffuse abdominal pain

A

DKA -> increased release of catecholamines, cortisol, glucagon -> hyperglycemia, ketonemia, osmotic diuresis -> net renal loss of K and K body stores depleted

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41
Q

Isolated premature adrenarche is a risk factor for the development of what 3 syndromes =

A
  • PCOS
  • T2DM
  • Metabolic Sydrome
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42
Q

Virilazation of female infants + Salt Wasting =

A

21 hydroxylase deficiency

-build up of 17 hydroxyprogesterone

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43
Q 
swollen + fluctuant tonsil
uvula deviated to the opposite side
"hot potato" voice
trismus
drooling
A

Peritonsillar abscess

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44
Q

Growth failure + recurrent respiratory infections + steatorrhea =

A

Cystic Fibrosis

-GI manifestation - pancreatic insufficiency - leads to inability to absorb fats and vitamins DEAK

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45
Q

Down Syndrome associated GI defects (3)

A
  • Duodenal atresia
  • Hirschprung disease
  • Imperforate anus
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46
Q

CF associated GI defects (1)

A

Meconium ileus

-usually occurs at terminal ileum

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47
Q

What should be used for IV bolus rehydration in children?

A

20 mL/kg normal saline IV (isotonic fluid)

-add dextrose to maintenance fluid

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48
Q

Patients with Beckwith Weidmann Syndrome are at increased risk for what 2 complications?

A
  • Hepatoblastoma
  • Wilms Tumor

Screening abdominal ultrasounds and alpha-fetoprotein levels are routinely monitored

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49
Q 
Macrosomia
Macroglossia
Hemihyperplasia
Umbilical Hernia/Omphalocele 
Hypoglycemia
A

Beckwith-Weidmann syndrome

  • chr 11p15
  • encodes insulin-like growth factor
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50
Q

Are women with CF infertile?

A

Only 20% of CF women have fertility problems

-secondary amenorrhea from malnutrition + thick cervical mucus obstructing sperm pathway

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51
Q

Describe the dermatitis of pellagra:

A

looks like a sunburn and occurs in sun exposed areas

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52
Q

GI complaints + Glossitis + Watery diarrhea + rash = what vitamin deficiency?

A

Niacin (Vit B3) - Pellagra

  • diarrhea
  • dermatitis
  • dementia
  • death
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53
Q

How to distinguish milk-protein allergy in an infant? (4)

Treatment?

A
  • regurgitation
  • eczema
  • poor weight gain
  • painless bloody stools

Treatment: switched to hydrolyzed formula OR mom should eliminate all dairy and soy from her diet
-NOTE: most formulas are cow milk protein based

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54
Q

What is the only absolute infant contraindication to breastfeeding?

A

Galactosemia

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55
Q

Liver biopsy of Reye Syndrome?

Lab findings?

A

Microvesicular fatty infiltration

Increased AST, ALT, PT, INR, PTT, ammonia

56
Q

Metabolic derangements of pyloric stenosis

A

Hypochloremic, hypokalemic metabolic alkalosis

Before surgical treatment it is important to rehydrate and fix electrolyte abnormalities

57
Q

Intussusception causes:

  • less than 2 yo
  • greater than 2 yo
A

less than 2 yo: most likely idiopathic
greater than 2 yo: most likely a pathological lead point - Meckles diverticulum

if patient had a preceding viral infection (gastroenteritis), inflamed peyer’s patches may serve as lead point

58
Q

Triple bubble sign + gasless abdomen on X Ray =

A

Jejunal atresia

  • occurs often due to vascular accident in utero (ex: cocaine)
  • bilious vomiting
  • abdominal distension
59
Q

pneumatosis intestinalis on Xray

A

extravasation of bowel gas into the damaged bowel wall

  • occurs in Necrotizing Enterocolitis (NEC)
  • may lead to pneumoperitoneum, strictures, short bowel syndrome or death
60
Q

Children with Cyclic Vomiting Syndrome usually have a family history of _

A

migraines

Therapy with anti-emetics and anti-migraine medications (sumitriptan) is often helpful

61
Q

VACTERL

A 
Vertebral anomalies
Anal atresia
Cardiac anomalies
Tracheo-Esophageal fistulas
Renal anomalies
Limb malformation
62
Q

3 risk factors for constipation in children

A
  • dietary changes - solid foods, cow’s milk
  • toilet training
  • school/daycare entry
63
Q

Cause and location of gastroschisis

A 
cause = vascular insult resulting in bowel herniation
location = lateral to umbilical cord

will see elevated maternal serum alpha-fetoprotein

64
Q

CHARGE

A 
Coloboma
Heart defects
Atresia choanae
Retardation of growth/development
Gentio-urinary anomalies
Ear abnormalities/deafness
65
Q

Treatment for and cause of unilateral uncomplicated acute lymphadenitis

A

Most common cause of unilateral is Staph aureus or Strep pyogenes

Treatment is clindamycin

66
Q

Treatment of localized Lyme disease in a 5 year old (rash only)

A

Oral amoxicillin or cefuroxime

Doxycycline is contraindicated in children

67
Q

3 main causes of acute bacterial sinusitis

First line treatment

A
  • Strep pneumoniae
  • Nontypable H flu
  • Moraxella catarrhalis

Treatment = Amoxicillin/Clavulanate

68
Q

neonate who develops rhinorrhea and a desquamating maculopapular rash on buttocks/feet in the first 48 hours has what congenital infection?

A

Congenial syphilis

  • transplacental transmission
  • snuffles (rhinorrhea)
  • maculopapular rash that may involve palms and soles that desquamates or becomes bullous
  • abnormal long bone radiographs (metaphyseal lucencies)

Treatment: penicillin - curative and prevents late manifestations

69
Q

At what size should you be worried about a lymph node?

A

> 2cm

70
Q

antibiotic prophylaxis for a cat bite

A

Amoxicillin/Clavulanate

-covers for Pasturella multiocida and oral anaerobes

71
Q

Most common cause of CF-related pneumonia by age
less than 20 yo =
20+ yo =

A

less than 20 yo - Staph aureus

20+ yo - Pseudomonas

72
Q

Patients with sickle cell disease are at risk for sepsis from what 3 bacteria?

A
  • Strep pneumo
  • H flu
  • N meningiditis
73
Q

Acute onset high grade fever and respiratory distress (impaired inspiration)
Drooling
Muffled voice
Keeping neck hyperextended provides some relief

A

Epiglottitis

  • “hot potato” voice
  • hyperextention of the neck increases airway diameter
  • obstruction is the most concerning complication
  • may require nasotrachial intubation
74
Q

Infant with chlamydial conjunctivitis

  • timing
  • treatment
A 
timing = 5-14 days
treatment = oral erythromycin

note: oral erythromycin in infants increases the risk of pyloric stenosis. this is also the treatment for chlamydial pneumonia (develops at 4-12 weeks).

75
Q

Infant with gonococcal conjunctivitis

  • timing
  • treatment
A 
timing = 2-5 days
treatment = IM or IV ceftriaxone or cefotaxime
76
Q

The erythromycin ointment put on infants eyes within 1 hour of birth is to prevent _

A

Gonococcal conjunctivitis

77
Q

Most common leukemia in children?

A

ALL

78
Q

Most common primary bone tumor in children and young adults?

A

Osteosarcoma

  • Codmann’s triangle - periosteal elevation
  • Sunburst pattern
  • Elevated alk phos and lactate dehydrogenase
79
Q

What bone lesion?
Sclerotic lesion in the cortex of a long bone
Pain worse at night
Pain is relieved with NSAIDs

A

Osteoid osteoma

80
Q

What is the organ most affected by people with sickle cell trait?

A

Kidney

  • painless hematuria
  • isothenuria (nocturia or polyuria - impaired concentrating ability)
  • splenic infarction at high altitudes
81
Q

macrocytic anemia + low reticulocyte count + congenital anomalies (short stature, webbed neck, triphalangial thumbs) + elevated fetal Hb levels + pallor in neonatal period =

A

Diamond-Blackfan Syndrome

  • intrinsic defect in erythroid progenitor cells which results in increased apoptosis
  • therapy = corticosteroids
82
Q

pancytopenia + macrocytosis + cafe au lait spots + absent thumbs + short stature + horseshoe kidney =

A

Fanconi anemia

  • AR
  • caused by chromosomal breaks
  • dx by age 8 yo
83
Q

Treatment of stroke like symptoms in a sickle cell patient

A

exchange transfusion
-it does not reverse the initial sickling/vascular event but it reduces the number of sickled cells in circulation therefore reducing the likelihood of another event

84
Q

neonatal polycythemia is defined by

A

hematocrit greater than 65% in term infants
caused by:
-intrauterine hypoxia
-erythrocyte transfusion

85
Q

Eosin-5-maleimide test (flow cytometry) and Acidified glycerol lysis test are used to dx what?

A

Hereditary Spherocytosis

86
Q

Pharmacotherapy for monosymptomatic enuresis

  • first line
  • second line
A

First line = desmopressin

Second line = TCAs

87
Q

What renal disease is associated with HBV?

A
  • Membranous nephropathy (nephrotic)

- Membranoproliferative glomerulonephritis (nephrotic or nephritic)

88
Q

What renal disease is associated with HIV?

A

Focal Segmental Glomerulosclerosis (nephrotic)

89
Q

5 Kawasaki Disease diagnostic criteria

A

Need 4/5 for dx

  • fever for at least 5 days
  • bilateral conujunctivits - spares limbus, nonexudative
  • rash
  • extremity changes - erythema, edema, desquamation
  • oral mucosa changes - strawberry tongue, fissured lips, erythema
  • cervical lymphadenopathy - greater than 1.5 cm, unilateral
90
Q

child with back pain + progressive neurological dysfunction (new urinary incontinence) + palpable step off at the lumbosacral area

A

Spondylolisthesis

  • forward slip of the vertebrae
  • usually at L5 over S1
91
Q

Down syndrome child who presents with upper motor neuron findings

A

Atlantoaxial instability = excessive laxity in the posterior transverse ligament of the spine which results in increased mobility between the atlas (c1) and the axis (c2)

92
Q

Macrocephaly + feeding problems since birth + numerous café au lait spots + short stature + learning disabilities

A

Neurofibromatosis 1

-Chr 17 = NF1 tumor suppressor gene = protineruofibromin

93
Q

Greatest risk factor for CP

A

Premature birth before 32 weeks gestation

-results in spastic diplegia

94
Q

Teenager who was adopted + myotonia + facial weakness + foot drop + dysphagia + testicular atrophy =

A

Myotonic dystrophy

  • AD
  • CTG repeat in DMPK gene on chr 19
95
Q

Child presenting with sudden onset hemiplegia + hemianesthesia + neck pain. Earlier in the day while brushing his teeth he fell and the toothbrush hit the back of his throat.

A

Traumatic carotid injury resulting in internal carotid artery dissection

  • Internal carotid arteries are located directly posterior and lateral to the tonsillar pillars
  • Caused by minor oropharyngeal trauma, neck strain/manipulation, penetrating trauma
  • Dx confirmed with CT or MR angiography
96
Q

Fever + severe nocturnal or morning headaches + focal neurological changes = classic triad of _

A

brain abscess

97
Q

Medulloblastoma symptoms

A
  • obstructive hydrocephalus = morning/night headaches, night vomiting
  • cerebellar dysfunction = truncal ataxia, incoordination

Medulloblastoma is a posterior fossa tumor. Most often occuring in the cerebellar vermis.

98
Q

T wave inversion ddx: (5)

A
  • Myocardial infarction
  • Myocarditis
  • Old pericarditis
  • Myocardial contusion
  • Digoxin toxicity
99
Q

First line OCD treatment

A

First line = cognitive behavior therapy + high dose SSRI

If resistant to SSRI treatment, then antipsychotic

100
Q

First line Tourette’s treatment

A

First line = second generation antipsychotic (Risperidone)

Second line = alpha adrenergic receptor agonist (Clonadine, Guanfacine)

101
Q

Electrolyte disturbances in anorexia nervosa (2)

A
  • Hypokalemia

- Hypophosphatemia

102
Q

TM with peripheral granulation + skin debris. That same ear has been draining for an extended period of time despite antibiotics.

A

Choleosteatoma = abnormal growth of squamous epithelium in the middle ear

  • congenital
  • acquired - caused secondary to chronic middle ear infections
103
Q

Acute Otitis Media causes (3)

Treatment (2)

A

Causes:

  • Strep pneumo
  • H flu nontyepable
  • Moraxella

Treatment: 10 days

  • oral Amoxicillin
  • oral Amoxicillin/Clavulanate
104
Q

Adolescent boy + nasal obstruction symptoms + nasal mass + frequent nosebleeds + erosion of nasal bone on CT =

A

juvenile angiofibroma

  • composed of many blood vessels that can easily bleed
  • benign but locally invasive
  • needs a specialist
105
Q

infant who has inspiratory stridor only when supine

A

Laryngomalacia

  • chronic stridor in infants
  • caused by floppy supraglotting structures that collapse during inspiration
  • spontaneous resolution by 18 months
  • dx via clinical + flexible laryngoscopy
106
Q

follicular conjunctivitis + pannus (neovascularization) in the cornea

A

Trachoma

  • C. trachomatus serotype A-C
  • major cause of blindness worldwide
  • concurrent infection of nasopharynx leading to nasal discharge
  • treatment: topical
107
Q

Most common predisposing factor for orbital cellulitis is _

A

bacterial sinusitis

108
Q

3 pill emergency contraception options

A
  • Levonorgestrel oral = progestin, delays ovulation [first option]
  • Ulipristal oral = antiprogestin, delays follicular rupture and impairs implantation
  • Combined OCP = progestin, delays ovulation, not as effective
109
Q

moderate to severe bleeding from acute abnormal uterine bleeding (AUB) caused by ovulation dysfunction in an adolescent is treated with

A

high dose IV or oral estrogen

-promotes regrowth of the endometrium over the denuded epithelium

110
Q

cause of a young girl’s irregular menstrual cycles

A
  • immaturity of the hypothalamic-pituitary-gonadal axis

- not enough hormones to induce correct ovulation (too low GnRH)

111
Q

marfanoid habitus + mental retardation + downward lens dislocation + fair complexion + thromboembolic events =

A

Homocystinuria

  • AR
  • deficiency of cystathionine synthase
112
Q

marfanoid habitus + heart issues (aortic root dilation) + upward lens dislocation =

A

Marfan syndrome

  • AD
  • mutation in fibrillin-1 gene
113
Q

Turner syndrome patients are at risk for developing _

A

Osteoporosis - perhaps due to the low E levels from gonadal dysgenesis

114
Q

Gold standard for dx Muscular Dystrophy

A

Genetic testing

  • X linked R
  • deletion of dystrophin gene (Xp21)
115
Q

Kallmann Syndrome genetics

A

Xlinked R

-46 XY

116
Q

How to prevent the spread of salmonella?

A

Cook meats thoroughly

117
Q

Click/clunk of hips in a newborn 2 causes, 4 risk factors

A
  • shallow, poorly developed acetabulum
  • laxity of supporting ligaments

risks:

  • female
  • first born
  • breech
  • family hx of developmental dysplasia of the hip (DDH)
118
Q

mental status changes that occur during ketoacidosis is caused by _

A

cerebral edema

119
Q

J wave on an ekg =

A

hypothermia

120
Q

3yo comes in for rapid breathing and can’t catch his breath. pulse = 100, RR = 30, BP=120/80. lungs clear. slight hyperresonance on right chest. decreased breath sounds on right. x-ray shows slight overexpansion of right lung compared with left. no infiltrates or effusions.

What has happened?

A

aspiration

do a bronchoscopy to evaluate

121
Q

newborn with HIV+ test - what is the treatment?

A

6 weeks of AZT started within 12 hours of delivery

122
Q

age group for legg-calve-perth disease

age group for slipped capital femoral epiphysis

A

4-10 yo

9-14 yo

123
Q

Apt test

A

Distinguishes maternal blood from fetal blood via hemoglobin

124
Q

Treatment for seborrheic dermatitis

A

topical steroids + special shampoo

125
Q

subglotting edema in a child who is having trouble breathing =

A

croup

126
Q

A child has ingested a caustic liquid.

What is the next step after stabilizing airway?

A

fiberoptic endoscopy and nothing NPO

127
Q

testicular swelling + absent cremasteric reflex + scrotal or abdominal pain

A

testicular torsion

treatment: surgery ASAP

128
Q

microscopy of Hashimoto thyroiditis

A

lymphocytic infiltrate

129
Q

child with + PPD skin test + negative CXR + appears well

treatment?

A

Isoniazid only

130
Q

acute otitis media VS otitis media with effusion

A

acute otitis media occurs more rapidly with signs and symptoms of inflammation

otitis media with effusion has no signs or symptoms of acute inflammation, generally asymptomatic

131
Q

blood under the periostium

A

cephalohematoma

132
Q

blood under the galea aponeurotica

A

subgaleal hemorrhage

133
Q

when does infantile colic subside?

A

4 months

134
Q

RBC casts

A

glomerulonephritis

135
Q

MCV less than 80 + anemia + target cells in periphery

A

thalassemia

136
Q

First step in management for a kid in DKA?

A

1) replace fluids and potassium

2) insulin

137
Q

What keeps a PDA open?

A

Prostaglandin E1

Shelf Exams (3 decks)

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