Pediatrics Flashcards
When does neonatal conjunctivitis from Chlamydial infections occur? Treatment?
5-14 days after delivery?
Treatment: ORal erythromycin
Linear lesions with pruritus and erythematous streaks with edema and vesicles after camping?
Poison Ivy- Contact Dermatitis
Complications of hemophilia A and B
Hemophilic arhropathy -> iron/hemosiderin deposition leading to sunovitis and fibrosis
Todd paralysis
self-limited, focal weakness that occurs after focal or generalized seiure; presents in the postictal period with partial or compelte hemiplegia involving ipsilateral arm
Herpetic Gingitcostomatitis: Cause, Signs
Cause: HSV1
Signs: Fever, Pharngitis, Erythematous gingiva, Clusters of small vescicles on anerior oropharynx
Signs of Diamond-Blackfan syndrome?
Macrocytic anemia, low reticulocyte count, congenital anomalies
Average age of onset is 3 months
Painful vescibles with “punched out” erosions and hemorrhagic crusting superimposed on a child with atopic dermatitis?
HSV
Legg-calve-perthes disease
Average onset 4-10, incisious onset, antalgic gait (less time on one side), long-term pain
Most common bacterial infection in children with CF?
S. Aureus, especially with concurrent influenza.
Ehlers-Danlos syndrome
scoliosis, joint laxity, skin hyperelasticity
Signs on leukocyte adhesion deficiency?
Recurrent skin and mucosal infections, no pus, poor wound healing
Most common cause of sepsis in sickle cell patients?
S. pneumoniae
X-linked agammaglobulemia?
Alternative name?
Low B-cells, low Ig levels
AKA: Bruton’s agammaglobulinemia
First step in the evaluation of a neonate with emiesis?
Cessation of enteral feeds, NG tube decompression, IV fluids, XRay to rule out pneumoperitoneum
When should you suspect tricuspid atresia?
Cyanotic infant with left axis deviation, small or absent R waves,
Signs of vitamin D deficiency in an infant?
Delayed fontanel closure, enlarged skull, costochondral joints (achitic rosary), long-bone joint widening, genu varum (bowed legs)
Children under 8 years of age should be treated for erythema hronicum migrans from lyme disease with?
Over 8?
Under 8: Amoxicillin
Over 8: Doxycycline
What is spondylolisthesis? Signs?
Developmental disporder characterized by forward slip of vertebrae (L5 over S1)
Signs: Chronic back pain, neurological dysfunction, palpable step-off
Job syndrome?
Normal levels of B-cells, Ig, except with hyper IgE
Acute management of a sickle cell patient with signs of stroke?
Exchange transfusion, dilutes amount of sickled cells in blood
Developmental milestones at 12 months?
Stands well, walks first steps, 2-finger pincer, says first words, separation anxiety, comes when called
Early adolescent obese male that presents with hip or knee pain of insidious onset that causes limping? Treatment?
Slipped capital femoral epiphysis
x: surgical pinning
Fibrosarcoma
Malignant spindle cell neplasm found in patiens 30-60. Painful mass. Osteolytic lesion whose margins can be well-defined or ragged and moth-eaten
Congenitial CMV infections signs? Treatment?
Growth restriction, microcephaly, periventirular calcification, hepatosplenomegaly, thrombocytopenia
Treatment: Valganciclovir
Osteosarcoma
Findings: Soft tissue mass, “sunburst pattern”, periosteal elevation (Codman traingle)
Beckwith-Wiedemann syndrome: Cause? Clincal Manifestations? Complications? Surveillance?
Cause: Desregulation of imprinted gene expression on 11p15
Manifestations: Fetal meacrosomia, rapid growth, macroglossia, hemihyperplasia, medial abdominal wall defects
Complications: Wilms tumor, hepatoblastoma
Surveillance: Serum AFP, abdominal/renal US
Signs of sepsis?
Fever, chills, hypotension, leukocytosis, bandemia
How to diagnose Laryngomalacia?
Confirmation by flexible laryngoscopy for moderate-severe cases
VACTER
Vertebral, anal atresia, cardiac abnormalities, radial (skeletal) and renal
What findings of a pediatric burn would suggest child abuse?
Sparing flexor surfaces
Diagnostic test for Chronic Granulomatous disease?
Neutrophil function testing
- Dihydrohodamine 123 test
- nitroblue tetrazolium test
Heinz bodies
Aggregates of denatured hemogobin, seen in patients with hemolysis due to G6PD deficiency and thalassemia
Total anomalous pulmonary venous return
4 pulmonay veins fail to make the normal connection to the left atrium. Righ atrium received blood from both pulmonary and systemic venous system.
Signs: right venticle hypertrophy, and right axis deviation
Pyridoxine (B6) deficiency
Cheilosis, stomatitis, glossitis, irritability, confusion, depression
Acute Rheumatic fever: Major and minor signs
Major: Migratory Arthritis, Carditis, Subcutaneous nodules, Erythema marginatum, Sydenham Chorea
Minor: Fever, arthralgias, Elevated ESR, CRP, Prolonged PR interval
condensed nuclear chromatin, small nucleoli with scant agranular cytoplasm
Lymphocytes
Herpangina: cause, signs
Cause: Coxachie A virus
Signs: Feverm pharyngitis, gray vesicles/ulcers on posterior oropharynx, hands, feet
Clincal signs of glucose-6-phosphatase deficiency?
Lab Findings?
Doll-like face, thin extremities, short stature, protuberant abdomen
Lab findings: Hypoglycemia, high blood uric acid, total cholesterol, triglymerides, lactic acid levels
What is the next step in management after capillary samples tested positive for increased lead?
Venous blood lead level
Tests used to diagnose DM type 1?
glytamic acid decarboxylase (GAD65), IGF-1, IGFBP
Aldolase B deficiency causes?
Fructose intolerance- vomiting, poor feeding, lethargy, serizures or enxephalopathy
Hemolytic uremic syndrome: Signs? Lab findings? Treatment?
Signs: Diarrhea, lethargy, irritability, pallor, bruising or petechiae, oliguria, edema
Lab findings: Hemolytic anemia, thrombocytopenia, Incresed hematuria, proteinuria, casts, increased bilirubin
Treatment: Fluid/electrolyte management, blood transfusion, dialysis
What is a small for gestations age newborns at risk for developing?
Hypoxia, perinatal asphyxia, meconium aspiration, hypoglycemia, hypothermia, hypocalcemia, and polycythemia (due to hypoxia)
What congenital heart defects are present in patients with Down syndrome? Presentation?
Complete atrioventricular septal defect
Signs: Loud S2 d/t pulmonary hypertension
Systolic ejection murmur (increased flow across pulmonary valve from left to right shunt)
Holosystolic murmur of VSD (soft or absent if defect is large)
When does alloimmune hemolytic disease occur?
“A” and “B” offspring of “O” mothers
What cardiovascular abnormalities are in turner’s syndrome?
Bicuspid aortic valve
Findings suggestive of hypertrophic adenosis?
Postnasal drip, elongated facial heatures, mucopurulent nasal discharge, loud mouth breathing
VSD murmur description?
Pansystolic murmur hear loudest at the left lower sternal border and a diastolic rumble at the apex due to increase flow across mitral valve
Hereditary spherocytosis
Inc. mean corpuscular hemoglobin concentration
Spherocytes on peripheral smear
Negatove coombs test
Increased osmotic gragility on acidiied glyceral test
Abnormal eosin-5-meleimide binding test
Child has a desire to kill his mother and must recite a prayer 10-12 times to overcome it. Diagnosis? Treatment?
Diagnosis: Obsessive-compulsive disorder- can be obsessive (symmetry), or compulsive (must hurt mother)
Treatment: First-line: SSRI (Fluoxetine) or CBT
Second-line: Clomupramine and antipsychotic augmentation
Third-line (refractory): Deep-brain stimulation
Severe combined innumodeficiency: Signs
lymphopenia, recurrent infections, and failure to thrive,
ADA deficiency
Defect in Prader-Willi syndrome
Deletion of the paternal copy of chromosome 15q11-q13
Most effective form of emergency comtraception?
Copper IUD
Tetralogy of Fallot murmur?
Harsh systolic ejection murmur over the left upper sternal border, single S2
Workup for a newborn with bilious vomiting without a bowel movement?
Abdominal Xray -> contrast enema
Methylphenidate-Use?
ADHD
High blast count with strongly positive periodic acid schiff (PAS) reaction, in a 2-10 year old?
Lymphoblastic leukemia
What type of vaccination prevents S. pneumoniae?
Conjugate capsular polysaccharide
Kallman Syndrome
X-linked recessive disorder of migration of fetal gonaotropin-releasing hormoes and olfactory neurons.
Clincal Signs: short stature, delayed or absent puberty, normal genotype and internal reproductive organs, anosmia/hyposmia
Red flags for type 1 DM
Polyuria, polydipsia, enuresis (increased urinary incontinence)
When should gonads be removed in complete androgen insensitivity?
After puberty, the benefits of gonad-stimulated puberty outweigh the risk of malignancy
Alternative name for laryngotracheititis?
Croup
Signs of increased intracranial pressure?
Morning vomiting and noctural headaches
Erythema marginatum of Rheumatic fever
What disorders are commonly associated with mitral valve prolapse?
Connective tissue disorders (Marfan, Ehlers-Danlos sundrome, osteogenesis imperfecta, etc)
Infants born to diabetic mothers are at risk for?
Hypoglycemia, hypocalcemia, hyperbilirubinemia, polycythemia
Cardiomyopathy, GI atresia, urinary malformations, hyaline membrane disease
Most common cause of abnormal uterine bleeding in adolescents?
Immature hypothalamic-pituitary-ovarian axis -> anovulation cycles
Signs of pinworm infections?
Perianal puritus, especially at night, may extend into the volvula in pre-pubertal women
Cyanotic when stressed and asymptomatic at rest?
Tetralogy of Fallot
Chediak-Higashi syndrome
AR disorder characterized by oculocutaneous albinism and recurrent cutaneous infections
Staph. aureus and Strep pyogenese are most common
Components of DiGeorge’s Syndrome?
Conotruncal cardiac defects
Abnormal Facies
Thymic aplasia/hypoplasia
Cleft palate
Hypocalcemia
(t-cell lymphopenia is present)t
Burton agammaglobulinemia- Lab findings
Normal T-cells, absent B cells, low serum immunoglobulin, absent lymphoid tissue
When is a murmur benign?
Normal activity levels, early of mid-systolic, Grade I or II, low-putched muscicle or squeaky tone at LLSB (still’s murmur) or high-pitched at LUSB (pulmonary flow murmur)
Signs of botulisism?
Bilateral bulbar palsies (ptosis, sluggish pupillary response to light, poor sucking), constipation, drooling, and summetric descending flaccid paralysis
Caput seccedaneum
diffuse, sometimes ecchymotic swelling of the scape. Usually involved the portion of the head presenting during vertex delivery. May extend across midline and suture lines
Most common cause of orbital cellulitis?
Bacterial sinusitis
OsGood-Schlatters Disease; traction apophysitis
What are pink stains or “brick dust” in neonatal diapers?
Uric Acid crystals
Seborrheic dermatitis:
Erthematous plques and/or yellow, greasy scales
What are turner’s syndrome at increased risk for?
Osteoporosis- they lack protective estrogen production -> increased bone reabsorption
Cause of intussusception in children younger than 2? Older?
< 2: recent viral illness or rotavirus vaccination
>2: Meckel’s diverticulum, HSP, Celiac disease, intestinal tumor, polyps
Non-classical congenital adrenal hyperplasia (late-onset)
Premature adrenarche/pubarche, sever cystic acne (resistent to treatment), accelerated linear grwoth, advanced bone age
In a child less than 24 months, what should occur after the treatment of her first febrile UTI?
Renal and bladder ultrasound
Signs of fetal alcohol syndome
Small head, small palebrl fissures (eyes), smooth philtrum, thin vermilion border (lip)
What gross motor milestones should occur at 18 months?
Run, kicking a ball
Adolescent male
Benign bone tumor, osteoid osteoma
Pain is relieved by NSAIDS
Treatment for Impetigo?
Oral cephalexin (widespread)
mupirocin (topical, localized)
Fetal exposure to cocaine
Jitteriness, excessive sucking, hyperactive moro reflex
What should all sexually active women under 24 be screened for?
Chlamydia trachomatis and neisseria gonorrhoeae
Risks of maternal diabetes?
Macrosomic getus, shoulder dystocia (crepitus, asymmetric moro reflex), clavicle fracture, brachial nerve palsies, perinatal asphyxia, neonatal hypoxic encephalopathy, polycythemia
Heroin intoxication in a fetus, signs?
Interuterine growth retadation, irritability, high-pitched cry, poor sleeping, tremors, sweating, sneezing, diarrhea
What type of vasculitis is Henoch-Schlnlein purpura? Complications?
Immunoglobulin A-mediated
Complications: renal involvement; microscopic or macroscopic hematuria, red cel casts, mild to moderate proteinuria, with normal-slightly elevated serum creatinine
**Can lead to nephrotic syndrome, HTN, acute renal failure
Heart defect associated with Edwards Syndrome? Murmur description?
VSD
Holosystolic murmur that is heard beast at the lower left sternal border
Purpose of the CH50 test?
Determines total complement levels
Risk of gonad-derived cancer in turners syndrome compared to general population?
10-30 times higher (15-30%). Gonad development should be closely monitored and an earlier gonadectomy could be required.
Clinical manifestations of Prader-Willi? Common complications?
Poor suck and feeding problems in infancy, compulsive binge-eating and obesity-related problems
Complications: Sleep Apnea, DM type II
What can cause flaccid paralysis? How?
Infant botulism- ingestion of C. botulinum spores from dust
Foodborne- C. botulinum toxin from food
Guillain-Barre syndrome- Autoimmune peripheral nerve demyelination
Tinea Capitis, dermatophyte infection
Tx: Oral terbinefine, friseofulvin, itraconazole, fluconazole
Measles vs Rubella
Measles: High fever (>104), cephalocaudal rash over multiple days , cervical adenopathy
Rubella: maculopapular cephocaudal rash over 24 hours (sparing palms and soles), polyarthralgia
Patient with meningitis and petechial rash?
Neisseria meningtides
What solutions should be used to resusitate an infant that is hypovolemia, but hypernatremia?
0.9% NS
Niacin (b3) deficiency
Pellegra (dermatitis, diarrhea, delusions, glossitis)
Riboflavin deficiency signs:
Angular choelosis, stomatitis, glossitis, normocytic anemia, seborheic dermatitis
Treatment for migraines in pediatric populations?
Acetaminophen or NSAID and supportive mangement (dark room, etc)
Clinical features of medulloblastomas?
Ataxia and truncal instability
Alternative name for Wilms tumor?
Nephroblastoma
Henoch-Schonlein purpura: Signs?
transient migratory arthritis (lower extremities) and rash (puritic)
What is the generic name for the plan B pill? MoA
Levonorgestrel
MoA: Delays ovulation
Primary dusmenorrhea? Treatment?
Lower abomdinal cramping with menses in the absense of other pathology
**pain during the first few days of menses is cause ny uterine contractions triggered by prostaglandins
Treatment: NSAIDS
Wiskott-Aldrich syndrome: Clincal manifestations? Defect? Problem?
Eczema, recurrent infections, thrombocytopenia
Defect: WASP protein
Conequence: Impaired cytoskeleton changes in leukocyte, platelet
How to treat a patient with a “barky” cough?
Racemic epinephrine and corticosteroids
What signs should suggest possible child abuse
Abrupts onset of mood changes, bedwetting, and/or academic difficulties
Erythrocte CD55 and CD59 are present in which disease?
Paroxysmal noctural hemoglobinuria
What diseases can lead to a vitamin K deficiency?
Cystic fibrosis, IBS, Celiac, biliary atresia, frequent Abx use, malnutrition
Signs on Gonadotropin-independent precocious puberty?
Boy under 9 with severe facial ance, advanced pubic and axillary hair, normal testicular volume
Signs of refeeding syndrome? Cause?
Arrhythmia, congestive heart failure, seizures, wenicke encephalopathy
Cause: Increased insulin secretion -> decreased phosphorus, magnesium, potassium, thiamine, with increased water and sodium
Galactosemia
“mouse-like” odor, hyperbilirubin, elevated liver function tests, low glucose, cataracts, ascities
Increased risk for E. Coli sepsis
Signs of hemophilia?
Hemarthrosis and Deep tissue hematomas
Increased aPTT
2 days fever and facial swelling with delayed vaccination schedule? Most common complication?
Mumps
Common complication: Aseptic meningitis, orchitis, parotitis
Howell Jolly bodies?
nucleated remnant of red blood cells
What are the catecholamines?
homovanilic acid and vanillylmandelic acid
Aeur rods are found in which type of cancer/
Acute myelocytic leukemia`
What factors increase the risk for intraventricular hemorrhages?
Preterm and loss birth weight
How to diagnose intraventicular hemorrhage?
transfontanel ultrasound
Myotonic musculodystrophy-Onset? Inheritance? Comorbidies? Prognosis?
What increases the murmur n Hypertrphic cardiomyopathy? Decreases?
Increases: Decreased preload: Valsava, abrupt standing, nitroglycerine
Decreases: Increased afterload/preload: Sustained hand grip, squatting, passive leg raises
In which population in the cyclic vomiting syndrome the highest?
Children of parents who have a history of migraines
abdominal pain, palpable mass, jaundice
Biliary cyst
47 XXY
Klinefelter syndome, male phenotype with small testicles.
What is the most common event prior to a seizure? During?
Prior: Aura
During: Tongue Laceration
What type of CT should be ordered for head trauma?
Non-contrast
What substance maintains the PDA? Closes it?
Maintains: Prostoglandin E2
Closes: Indomethicine
Clincal manifestations of medulloblastoma?
increased intracranial pressure, trucal and gait ataxia
How to assess pulmonary function in a guilllain-barre patient?
Spirometry, peak flow could be used as an alternative
What prophylaxis should be used for cat bites in children?
Amoxicillin/Clavulanate due to activity again pasteurella multocida
Primary vs.Secondary dysmenorrhea
Primary- normal physical examination
Secondary - abnormal physical examination
Signs of congenital CMV?
pericentricular calcifications (microcephaly, if severe)
What infections are common in sickle cell patient?
H influenza, N meningitidis, S. pneumoniae
Al
Signs of Turner’s Syndrome?
Narrow, high arched palate, low hairline, webbed neck , broad chest, coarctation of the aorta, bicuspid aortic valve, horse-shoe kidney, streak ovaries, amenorrhea, infertility
Signs of Tetralogy of Fellot?
Tet spells-sudden hypoemia and cyanosis during exertion or agitation
What are risk facors of Henoch-Schonlein purpura?
Gastrointestinal hemorrhage or intussusception: Cause by bowel edema and hemorrhage
Common complication of individuals with sickle cell trait?
Hematuria
Cephalohematoma
subperiosteal hemorrhage, not visable until several hours after birth
Triad of brain abscesses
Headaches (noctural and/or morning), focal neurologic changes, fever
Maple syrup urine disease
dystonia, poor feeding, lethargy, vomiting, ketouria
What is the treatment for mild lead levels?
Moderate lead levels?
Severe lead levels?
Mild: No medication, retest in <1 month (5-44mcg/dL)
Moderate: DMSA (Meso-2,3-demercapto-succinic), (45-69mcg/dL)
Severe: Dimercaprol (British anti-lewisite) plus EDTA (>69mcg/dL)
Aplastic anemia vs aplastic crisis?
Aplastic anemia: pancytopenia due to bone marrow failure
Aplastic crisis: Chronic anemia with compensatory reticulocytosis
Signs of syphilis in a newborn?
Profuse rhinorrhea, desquamating skin rash, abnormal long-bone radiographs (metaphyseal lucencies)
How should a urine sample be collected in infants with diapers?
Urethral catheterization, urinalysis, urine culture
Mental retardation, pronounced startle reflex, serizures, hyperacusis, loss of vision, macrocephaly
Tay sachs disease, beta-hexosaminidase A
Cause of chronic nasal obstruction refractory to conventional treatment?
Adenoid hypertrophy
How to follow-up an incidental urine proteinuria in an adolescent?
Repeat dipstick testing on two subsequent occaisions to determine orthostatic, persistent, or transient proteinuria
Alternative name for strawberry hemoangiomas?
Superficial infantile hemangioma
Phenttoin exposure in-utero
Fetal hydantoin syndrome- nail and digit hypoplasia, dysmorphic facies, mental retardation
Celiac disease risk factors?
First-degree relative
Autoimmune thyroiditis
Type 1 DM
Down syndrome
Selective IgA deficiency
What is the squirt sign?
Explosive gas and stool associated with Hirsprung Disease
Biliary atresia
Obstructive jaundice, acholic stools, presents early in infancy
Inability to extend the beck and widened prevertebral space suggests?
Retropharyngeal abscess
Gold standard for confirming muscular dystrophies?
Genetic analysis
Cough, coryza, conjunctivitis with subsequent exanthema?
Measles
Why are menstral cycles in pubertal girls irregular?
Immaturity of the hypothalamic-pituitary-honadal axis -> decreased gonadotropin secretion
Mongolian spots, beling flat, blue-grey patches
Fade spontaneously, reassure parents
recurrent sinusitis, point of maximal impulse displaced to the left, bronchiectasis?
Primary ciliary dyskinesia (Kartagener syndrome,
How do you confirm the type of leukemia?
Bone marrow biospy
Meconium obstruction at th level of the ileum and narrow, underdeveloped colon?
Cystic fibrosis
Tinea Corporis
Ornithine transcarbamylase deficiency
vomiting and poor feeding, seizures, increased ammonia, altered mental status
Ewing Sarcoma
“onion skin”, “moth eaten”, extension into soft tissue
Selective mutism
Refusal to speak in a specific social situation, but engaged in normal communications where she feels comfortabe.
Diagnosis required 1 month or more in situations where they are required to talk (school), despite speaking in other situations
Characteristics of oppositional defiant disorder?
Angry/urrutale mood and argumentative/defiant behavior towards authority figures
Diagnosis?
Eczema Herpeticum-complication of atopic dermatitis
Short statute, primary amenorrhea, abscent thelarche
Turner’s Syndrome
Treatment for Tinea Corporis?
First line (localized): Topical (clotrimazole, terbinafine)
Second-line (generalized): Oral antifungals (terbinafine, griseofulvin)
Cafe au lait spots, precocious pubert, multiple bone defects (polyostotic fibrous dysplasia)?
McCune Albright syndrome, remember the 3 P’s: Precocious puberty, pigmentation, polyostotic fibrous dysplasia
Neimann-Pick vs. Tay sachs
Neimann-pick: Sphingomyelinase deficiency with hyporeflexia/areflexia and hepatosplenomegaly
Tay Sachs: beta-hexosaminidase A with hyperreflexia without hepatosplenomegaly
Whem should PEEP be employed in a newborn? Chest Compressions?
Heart rate less than 100, irregular breathing
Chest compressions: Less than 60bpm
Treatment for vaicella zoster exposure in an individual without complete immunity?
Postexposure prophylais with VAV vaccines (if within preceeding 5 days)
If unable to receive live vaccine: varicella immunoglobulin (includes individuals less than 1 year of age)
Signs of Meckel’s diverticulum? Diagnosis? Treatment?
Asymptomatic incidental finding, painless hematochezie, intussusception, intestinal obstruction, volvulus
Diagnosis: Technetium-99m pertechnetalte scan
Treatment: Surgey for symptomatic patients
Difference between iron deficiency anemia and thalassemia?
Iron deficiency: Increaed RDW, decreased MCW, RBC #
A-thalassemia: Normal RDW, RBC #; decreased MCV, normal hemoglobin electrophoresis
B-thalassemia: Normal RDW, RBC #; decreased MCV, increased hemoglobin A2 with electrophoresis
What is a patient with recurrent infections and congenital heart disease at risk for?
Brain abscess
Edema, hypoalbuminemia, markedly elevated urine protein in a teen with Hep. B? Pathogenesis
Membranous nephropathy (nephrotic syndrome)
Pathogenesis: Deposition of HbeAb and its corresponding antibody in the glomeruli
How to granulosa cell tumors present in children?
Post-menopausal woman?
Diagnostic findings?
Children: Precocious puberty, Large adnexal mass
Post-menopausal: bleeding/endometrial hyperplasia
Diagnostic findings: Inc. estrogen,
Pelvic US: ovarian mass, thickened endometrium
Signs of hypothyroidism? Lab?
Decreased activity, horse cry, jaundice
*However, majority are asymptomatic at birth
Lab: Increased TSH, decreased T4
Clincal manifestation of Edwards Syndrome?
Trisomy 18
Signs: Closed fists, with overlapping fingers, micrognathia, prominent occiput, rocker-bottom feet, severe intellectual disability
Early onset puberty iwth high basal LH? Next step?
Gonadotropin-dependent precocius puberty
Next step: Brain MRI wtih contrast
Signs of HIV in infancy?
Failure to thrive, chronic diarrhea, lymphadenopathy, pneumocystis pneumonia
Breath-holding spells
Types?
Episodes of apnea precipitated by frustration, anger, pain.
Types
Cyanotic: crying followed by breath-holding, cyanosis and loss of consciousness
Pallid: Minor trauma followed by breath-holding, pallor, diaphoresis, and loss of consciousness
Signs of breastfeeding faliure jaundice?
1st week of life,
Filaure of transition to yellowish or green stools (inadequate milk ingestion), decreased wet diapers
Cyanosis that is aggrevated by feeding and improved by crying
Choanal Atresia
Urinary in ontinence in children over 5?
Workup: Urinalysis, urological imaging
Management: Avoid caffeine, void regularly, drink fluids early, reward system, enuresis alarm (1st line after behavioral, pharmocotherapy (desmopressin, tricyclic antidepressants)
What causes the trendelenburg sign?
Weakness of the gluteus medius and gluteus minimus muscles, where are innervated by the superior gluteal nerve
What type of rash spares the palms and soles? What type of precaution should be used for this infection?
Measles, should use airborne precaution
ill-appearing neonate with bilious emesis and poor apetite?
malrotation with mid-gut volvulus
What is the defect in duchenne and becker muscular dystrophy?
Deletion of dystrophin on chromosome Xp21
What complications are CF patients at risk for?
Infertility (95% of men, 20% of womeN)
Pancreatitis (~10%)
Clincal features of pineal gland masses?
Limited upward gaze, upper eyelid retraction, puils non-reactive to light, reactive to accomidation
Signs of ADHD?
Inattentive, hyperactive/impulsive symptoms, prior to age 12
Marfan syndrome vs Homocystinurea
Marfan: AD, normal intellect, Aortic root dilation,
upward lens dislocation
Homocystinurea: AR, intellectual disability, thrombosis, downward lens dislocation, megaloblastic anemia, fair complexion
Extraintestinal signs of Celiac disease?
Short stature, weight loss, iron deficiency anemia, dermatitis herpetiformis
Risk factors for ARDS in a newborn?
Prematurity, maternal diabetes, male sex, perinatal asphyxia, c-secton without labor
Clincal features of Epiglottitis?
Abrupt onset Distress (“tripod”, stridor), dysphagia, drooling, thumbprint sign on Xray
What can cause isolated adrenarche? Clincal manifestations? Lab findings?
Adrenal angrogen secretion in obese individuals
Signs: oily hair/skin, acne, pubic hair, axillar hair
Lab findings: Increased DHEA-S, low testosterone
How do you management Autism spectrum disorders?
Early diagnosis and intervention (speech, behavioral), adjunct pharmacotherapy for psychiatric comorbities
Clinincal manifestations of PNH?
hemolytic anemia, cytopenias, and hypercoagulability
Family history of sudden death, congenital sensorineural deafness, and QT interval of 600ms?
Jervell and Lange-Nielsen syndrome
Signs of cardiac temponade?
Distant heart sounds, distended jugular veins, (scalp veins in infants) and hypotension
Glomus tumor triad
severe intermittent pain, tenderness, sensitivity to touch
benign tumor of vascular system
When should formula supplementation be considered?
Greater than 7% loss of birth weight
Varicella immunization protocol
2 doses, 1st at 1 year, 2nd at 4 years
Signs of intraventricular hemorrhage?
Hypotension, cyanosis, seizures, focal neurological signs, bulding or tense hontamel, anpea, and bradycardia; however, may be asymptomatic
Most common cause of pneumonia in children?
Adults?
Children: S. aureus
Adults: Pseudomonas
Hemiparesis, aphasia after injury tot he posterior pharync
Cervical internal cartid artery
**Can occur when falling with an object in mouth
Murmur in Tetralogy of Fallor?
crescendo-decreasendo systolic murmur with a single S2 in left upper sternal border
How to diagnose hereditary spherocytosis?
Osmoti gragility on acidified glycerol lysis test
Clinical manifestations of congenital diaphragmatic hernia? Managemtn?
Pulmonary hypertension, polyhydramnios, barrel-shaped chest, concave abdomen
Management: Emergency intubation with caution ventilation
Signs of hyper-IgM syndrome?
Normal B cells, decreased IgG/IgA, increased IgM
Cause of edema in a child with turners syndrome? Type of edema?
Dysgenesis of the lymphatic network
Type: Non-pitting
Pyloric Stenosis: Onset age? Characteristics?
Onset: 3-5 weeks
Clinical presentatin: Nonbilious, hugry vomiter, poor weight gain, dehydrated, “olive-shaped” abdominal mass
Congenital Toxoplasmosis infection signs?
Macrocephaly, diffuse parenchymal calcifications
Signs on defective intracellular killing?
No neutrophilia, infections with catalse-positive organisms
Signs on Shigella infection?
Rapid onset, high fever, abdominal pain, watery diarrhea with mucous +/- blood, +/- seizures in children
Type 1 RTA?
Defect: Poor hydrogen secretion into urine
pH: > 5.5
Potassium: Low-normal
Cause: Genetic disorder, medication toxitiy, autoimmune
Trachoma? Signs?
Chlamydia trachomatis serotype A-C, major cause of blindness
Signs: follicular conjunctivitis and pannus (neovascularization) of the cornea
What are cholesteatoma? Cause? Complications?
retraction pocket in the tympanic membrane that fills with granulation tissue and skin debris
Cause: Chronic middle ear infections or congenital in nature
Complications: Hearing loss, cranial nerve palsies, vertigo, brain abscesses or meningitis
Infectious mononucleosis, signs?
Test?
Fever, Tonsillitis/pharyngitis, psterior or diffuse cervical lympadenopathy, significant fatigue, hepatosplenomegaly
Test: Heterophile antibody test
Focal Serizures
Originated from 1 cerebral hemisphere +/- loss of consciousness
Cannot respond to stimuli during episodes with confusion afterwards
>2-3 minutes in length
Severe combined immunodeficiency- lab findings? Treatment?
Failure of T-cell development, b-cell dysfunction due to low T-cells, absence oflymphoid tissues
Treatment: Stem cell transplant
Causes of aplastic anemia?
Most common in children?
Acquired causes: Drugs (NSAIDS, sulfonamides)
Toxic chemicals (benzene, glue)
Idiopathic
Viral infecitions (HIV, EBV)
Immune Disorders
Thymoma
Most comon in children: Fanconi anemia (chromosomal break)
How to determine B lymphocytes from total lymphocytes?
Subtract T-lymphocytes from total lymphocytes
How to manage epiglottitis?
Endotracheal intubation, antibiotics
Croup vs Epiglottitis
Croup: Bark-like cough, stridor, hoarse voice
Epiglottitis: Unvaccinated children, sore throat, dysphagia, drooling, tripod position
Signs of pancreatic deficiency?
Bruises (vitamin K), Vitamin D deficiency, poor growth
Head tilt to one side with chin deviation away
Congenital muscular torticolis
Most common cause of otitis externa?
P. Aeruginosa, S. aureus
Tx: Fluoroquinolone
When should IV ceftriaxone be used to treat lyme disease?
Lyme meningitis and heart block
Diagnosis?
Treatment?
Diagnosis: Atopic dermatitis
Treatment: Emolients +/- steroid topicals
Medication treatment of abnormal uterine bleeding?
High-dose IV or oral estrogen
High-dose combined oral contraceptive pills
High-dose progestin pills
Tranexamic acid
Presentation of immune throbocytopenic purpura?
Thrombocytopenia and purpura, no anemia or renal invovlement
Tests used to screen for DM Type 2?
Hemoglobin A1c, fasting glucose, 2 hour oral glucose, 1,5-anhydroglucitol
First step in management for a harsh, holosystolic murmur best heart at the left lower sternal border?
Echocardiogram to evaluate ventricular septal defect
Signs on congenital rubella infection?
Sensorineural hearing loss
cataracts
PDA
Meniere’s disease?
Ear condition associated with fluid in the inner ear that leads to hearing loss, vertigo, tinnitus
Drugs used to treat Tourette disorder?
Haloperidol, pirmozide, risperidone (preferred), clonidine, guanfacine
Signs of renal tubular acidosis?
Normal anion gap acidosis, failure to thrive, alkalotic urine without known etiology of acidosis, low serum bicarb and hypercalemia
Eczema, regurgitation/vomiting, and painless bloody stools
Milk protein-induced enterocolitis
What homronal imbalances causes polycystic ovary syndrome?
Excess LH secretion
Differences in blood pressure in coarctation of the aorta?
Hypertension in the upper body and hypotension in the lower
Signs of hydrocephalus
Tense and bulging fontanelle, prominent scalp veins, poor feeding, irritability, rapidly increasing head size
What is the management of an adolescent with suspected fibroadenoma?
Observation and reassurance (follow-up shortly after next menses
Neuroblastoma?
Most common extracranial tumor of childhood
- Adrenal gland or retroperitoneal ganglia
- Calcifications and hemorrhages are seen on xray/ct
How does a person with a volvulus present?
vomiting (often bilious)
Signs of orbital cellulitis?
Abrupt onset of fever, proptosis, restriction of extraocular movements and swollen, red eyelids
Signs of foreign body ingestion?
Difficulty swallowing, feeding refusal, vomiting
When should chilren be toilet trained?
daytime: around 3
Nighttime: Any time up until 5 is considered normal
How to manage a hydrocele in a newborn? 2 year old?
Newborn: Observation
2 year old: Surgical correction
**Most spontaneously recover within 12 months
What is the first step in evaluating primary absence of menarche by age 15?
Pelvic US, to detect ovaries, uterus, and vagina
When legal guardians of a patient deny a life-saving procedure, how do you proceed?
Obtain a court order to force compliance
Adolescent with nasal obstruction, visible nasal mass, frequent nosebleeds, and bony erosions on hte back of the nose, suspect?
Angiofibroma
Lennox-Gastaut syndrome
Presents by age 5, intellectual disability and sever seizures of varying types. EEG demonstrated a slow spike-wave pattern
What are signs of turner syndrome?
Coarctation of aorta, broad chest, short stature, horse-shoe kidney, streak overies
Baby that is cyanotic when feeding, pink when crying? Associated abnormalities?
Choanal atresia
Associated: CHARGE: Coloboma, heart defects, retarded growth, GU abnormalities, ear abomalies, deafness
Big tongue, umbilical hernia?
hypothyroidism
Tetralogy of Fallot components?
VSD + RA hypertrophy + over riding aorta, pulmonary stenosis
