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MS3 Year > Pediatrics > Flashcards

Pediatrics Flashcards

1
Q

Essential SIDS safety to educate the parents on?

A

Sleep on back, don’t share beds, stop smoking

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2
Q

When is there a social smile?

A

2 months

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3
Q

When can a kid hop on one foot?

A

4 years

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4
Q

At about what age should a kid be able to walk?

A

1 year

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5
Q

When can a kid skip?

A

5 years

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6
Q

What type of child behavior is indicative of abuse (in regards of child to hospital staff)?

A

Seeking comfort from you rather than parents

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7
Q

When is there separation anxiety?

A

6-12 months (stranger at 6, separation at 12)

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8
Q

Talk about the speech relative to age

A

1:1 (add one word to the sentence for every year)

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9
Q

When is there stranger anxiety?

A

6-12 months (stranger at 6, separation at 12)

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10
Q

Dirty wound with unknown tetanus status. What do you do?

A

vaccine and tetanus immunoglobulin

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11
Q

Dirty wound. Tetanus booster greater than 5 years ago but received full series. What do you do?

A

Booster only

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12
Q

Child has uncontrollable coughing spells with inspiratory “whoop” sound between coughs. What’s the dx?

A

Pertussis

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13
Q

How many doses of MMRV do you need?

A

Two - one at 12-15 months and one at 4-6 years

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14
Q

A child received two doses of the hep B vaccine but then hasn’t been seen in 2 years. Do you need to restart the series?

A

No - finish the series with one time dose (need total of 3)

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15
Q

Dyspnea, dysphagia, grey pseudomembrane, what’s the dx?

A

Diptheria

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16
Q

How do you treat diphtheria (3 A’s)?

A

Airway, antibiotics, antitoxin

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17
Q

What is an absolute contraindication to giving another dose of the DTaP vaccine?

A

encephalopathy within 7 days of a previous dose

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18
Q

Which vaccines are live attenuated?

A

Intranasal flu, MMRV

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19
Q

What group shouldn’t get live-attenuated vaccines?

A

Immunocompromised (or pregnant!)

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20
Q

What are the 3 types of flu vaccines? Name them and their individual contraindication

A

1) Inactivated IM injection: severe egg allergy (though not anymore); 2) live intranasal - immunocompromised; 3) recombinant - anaphylaxis to its components

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21
Q

Vaccines associated with egg allergy?

A

Yellow fever (influenza and MMR ok to use)

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22
Q

Can you give HPV vaccine to a sexually active teen?

A

Yes - it will provide immunity as long as they’re not already infected (start as early as 9)

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23
Q

Post-exposure interventions for varicella. Who gets what?

A

varicella vaccine for all children; VZIG for immunocompromised pts

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24
Q

Difference btwn DTaP and Tdap?

A

DTaP is for kids (big D for big dose)

Tdap is for adults

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25
Q

Mom has hep B and is delivering baby, what do you do?

A

Hep B immunoglobuline and vaccine for baby

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26
Q

Dirty wound, greater than 3 lifetime doses, less than 5 years since the less one - what do you do?

A

Send home

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27
Q

Mom has unknown Hep B status and is delivering baby, what do you do?

A

Hep B vaccine for baby now; check mom’s status; give HBIG to any if cannot obtain in timely fashion

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28
Q

Ill-appearing child with croup that does not respond to racemic epinephrine. What is your likely alternative diagnosis?

A

Bacterial tracheitis

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29
Q

How can you prevent epiglottitis?

A

Hib vaccine

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30
Q

Barking cough, severe dyspnea improved by arrival, organism that causes it?

A

Parainfluenza virus (croup)

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31
Q

If you seen an abscess (retropharyngeal or peritonsilar), what should you do?

A

Incision and drainage (it actually doesn’t matter that it’s an ENT abscess - same tx) + antibiotics

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32
Q

Drooling, tripoding, high fever, very sick looking - what is it and what do you do?

A

Epiglottitis, intubate before anything else

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33
Q

Unvaccinated child with toxic-appearance, drooling, and stridor. Dx? Causative organism?

A

Epiglottitis; Hib (haemophilus influenza)

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34
Q

What does the X-ray show for bacterial tracheitis?

A

steeple sign (sublottic narrowing) - see the same thing in parainfluenza (croup)

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35
Q

Barking cough, severe dyspnea improved by arrival; dx?

A

croup

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36
Q

Hot potato voice (nasal sounding) and you can see the tonsils shifted to the side, dx?

A

peritonsillar abscess

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37
Q

Hot potato voice (nasal sounding) and you can’t see anything in the mouth but neck is swollen and tender - dx?

A

retropharyngeal abscess

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38
Q

How do you make the dx of asthma?

A

PFTs, bronchodilator reversibility, methacholine inducibility

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39
Q

What’s the most common virus responsible for bronchiolitis?

A

RSV (NOT parainfluenza)

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40
Q

How do you treat an acute asthma exacerbation?

A

Albuterol/ipratropium and steroids (maybe Magnesium, maybe subQ epi); get peak flow rates before and after

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41
Q

Immigrant child without any prenatal testing has salty sweat and failure to thrive, what’s the diagnosis?

A

Cystic fibrosis

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42
Q

Child has sudden onset dyspnea after being left alone for “just a few minutes” - what do you do?

A

CXR AP and lateral (foreign body airway obstruction)

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43
Q

What are some things you can tell parents to help their kids with asthma?

A

remove pets, carpets, parental smoking

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44
Q

Cystic fibrosis kids get respiratory infections and there are two big causative pathogens. What are they?

A

Pseudomonas (trending down) and staph aureus (trending up)

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45
Q

How do you diagnose cystic fibrosis?

A

sweat chloride test (gt 40 for neonates, gt 60 for older)

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46
Q

What’s the first step in treating asthma?

A

SABA (albuterol)

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47
Q

What do you add on after a SABA in chronic asthma tx?

A

SABA + ICS (inhaled corticosteroid)

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48
Q

What do you add on after a SABA and ICS in chronic asthma tx?

A

SABA, increase ICS, then can add LABA

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49
Q

A ___ should not be used without an inhaled corticosteroid in asthma prevention, or else asthma related death increases

A

LABA

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50
Q

How do you diagnose BRUE (age, duration, and 4 things)?

A

(brief resolved unexplained event) - combination of change in color, breathing, tone, or responsiveness. Less than 1 year of age. Less than 1 minute. No other causes on H&P.

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51
Q

BRUE age cut off?

A

1 year of age

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52
Q

What’s the difference btwn ALTE and BRUE?

A

ALTE relies on caregiver concern, BRUE relies on timing and duration

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53
Q

Features of ALTE (apparent life threatening events)?

A

combination of change in respiration (choking, gagging, apnea), color change (red, blue, pale), and muscle tone change (hyper or hypotonic); also need parental concern

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54
Q

SIDS isn’t associated with BRUE. What ahs it been associated with?

A

Maternal smoking

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55
Q

Got a BRUE. What is the next step?

A

stratify in to high or low risk

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56
Q

Define a lower risk BRUE (4)

A

Pt older than 60 days (or 45 wks post conception for premie), first occurrence without multiple episodes, no CPR, no concerning findings on H and P

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57
Q

Suspected BRUE except the kid has a confirmed infection?

A

It’s an infection not a BRUE

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58
Q

What can be done to prevent SIDS (3)?

A

place on back for sleep, don’t share a bed, parental smoking cessation

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59
Q

When MUST you report child abuse?

A

Always - even if suspected, confirmation not needed

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60
Q

Name some child risk factors that may promote abuse (3)

A

premature birth, cognitive defect, physical disability

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61
Q

Name some care-giver risk factors that may promote abuse (4)

A

hx of being abused, young/single parent, non biologic care giver, poor

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62
Q

When is an abused child hospitalized (2)?

A

When injuries warrant admission or when no safe alternatives exist

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63
Q

Bilateral burns on the buttocks are?

A

dunk burns (kid picks up legs to escape hot water, buttocks hit first)

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64
Q

Bilateral burns to the feet to the ankles are?

A

Dunk burn

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65
Q

Child from an Asian family with circular burns on the back. They’re associated with?

A

Coining, NOT cigarettes, and should NOT be considered abuse

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66
Q

If you see small circular burns, suspect?

A

cigarette burns

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67
Q

What are some signs of abuse as the child interacts with the caregiver (3)

A

1) not crying around parents despite obviously painful injury; 2) running FROM caretaker; 3) comfort from health care workers

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68
Q

Failing to provide food, shelter, love, and nourishment to a child is classified as?

A

Neglect

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69
Q

Sexually transmitted infection in a child should prompt suspicion for?

A

sexual abuse

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70
Q

Non-purulent rhinorrhea, congestion, no cough, no fever: dx an tx?

A

Common cold - supportive care! (no abx!)

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71
Q

When do you get a CT scan for sinusitis?

A

Recurrent or refractory - looking for anatomic defects or foreign body

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72
Q

Antibiotic management for acute otitis media?

A

Amoxicillin first line, cephalosporin if pen allergic (cefdinir) without anaphylaxis, amoxicillin-clavulanate if recent abx use

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73
Q

Pain when pulling on the pinna, child swimmer. What is it and how to treat?

A

Otitis externa; tx with aural antibiotics (cipro) and aural steroids

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74
Q

Best diagnostic test for otitis media?

A

pneumatic insufflation

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75
Q

Strep pneumo, H flu, and Moraxela can cause which ENT infections?

A

Otitis media and sinusitis (differentiate by ear pain)

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76
Q

Catheter fails to pass through the nose of a young infant, dx?

A

Choanal atresia

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77
Q

Suspected pharyngitis in a 3 year old - first step?

A

rapid group A strep testing (Centor not helpful in preadolescent crowd)

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78
Q

Otitis media symptoms but there’s a bulge behind the ear + it’s rotated forward. Dx and tx?

A

mastoiditis - get a surgeon (and continue with abx)

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79
Q

Purulent rhinorrhea, fever, congestion, facial tenderness, greater than 10 days of symptoms: diagnosis and mgmt?

A

bacterial sinusitis. Amoxicillin-clavulanate 1st line, levofloxacin if pen allergic (it is atypical to use a fluoroquinolone in kids)

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80
Q

Childhood snoring, pink while crying, blue while feeding, dx?

A

choanal atresia

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81
Q

Pharyngitis + enlarged spleen = ? Do what?

A

Mono. Get a monospot test to confirm (EBV ELISA)

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82
Q

3 year old girl with anterior cervical nodes, no cough, tonsillar exudates, and a temp of 40C. Next step?

A

Rapid strep testing (Centor not helpful in preadolescent crowd)

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83
Q

Epistaxis doesn’t stop. Anterior bleed suspected. Tx?

A

cauterize anterior bleeds; pack posterior

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84
Q

What are the CENTOR criteria and how do they work

A 
Cough (absent) + 1
Exudates +1
Nodes (adenopathy) +1
Temp gt 38C +1
OR: age lt 14 +1  OR age gt 44 -1
lt 1: supportive; 2-3: rapid strep (cx or tx); 4 or gt: tx as strep
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85
Q

Penicillin in group A strep prevents __ but not __.

A

rheumatic fever; post-strep glomerulonephritis

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86
Q

What is a sequelae of Measles?

A

subacute sclerosing panencephalitis

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87
Q

Dx if there are vesicles on an erythematous base across a single dermatome?

A

Shingles (varicella zoster)

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88
Q

Cough, coryza, conjunctivitis, koplik spots are symptoms of ?

A

Measles prodrome

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89
Q

What are vesicles on an erythematous base in various stages of healing indicative of?

A

Varicella (chicken pox)

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90
Q

Baby gets parvovirus B19; what are you worried about?

A

Aplastic anemia in baby (hemoglobinopathies); Hydrops fetalis in utero if mom is pregnant. Isolate mom

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91
Q

Vesicles on an erythematous base on hands, feet, and buccal mucosa - dx?

A

Hand-foot and mouth (coxsackie A)

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92
Q

What virus can cause bilateral facial swelling + orchitis?

A

Mumps

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93
Q

Separate measles from rubella clinically

A

Prodrome of cough, coryza, conjunctivitis, koplik spots (measles) vs generalized tender lymph nodes (rubella) - both have rash and fever (rubella has fever before rash, but not different enough)

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94
Q

What pathogen has a rash that starts on the face, spreads to the toes, then clears the same way?

A

Measles (and rubella?)

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95
Q

REALLY high fever, starts on trunk spreads outward - what’s the virus?

A

HHV-6 (roseola)

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96
Q

Empiric antibiotic therapy for meningitis in a 2 year old?

A

vancomycin + ceftriaxone

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97
Q

Empiric antibiotic therapy for meningitis in a baby less than 30 days old?

A

vanc + cefotaxime + ampicillin

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98
Q

Empiric antibiotic therapy for meningitis in a baby 30 days - 2 years?

A

vanc + cefotaxime

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99
Q

When can you trust an ELISA for HIV in a baby?

A

around 6 months when maternal antibodies have worn off

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100
Q

Pruritic rash in fingers, axilla, and multiple family members. Diagnosis and treatment?

A

scabies - permethrin (or lindane)

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101
Q

You see knits in hair, you think and treat with?

A

Lice, treat with permethrin

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102
Q

Itchy butt, positive tape test (there are worms) gets?

A

albendazole

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103
Q

Red hot tender joint in a child gets?

A

Arthrocentesis (the fact that its a child doesn’t change management)

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104
Q

PJP prophylaxis CD4 cutoff? Tx and alternate?

A

CD4 < 200; use TMP/SMX; Dapsone as alternative

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105
Q

Febrile infant with fussiness and bulging fontanelle. Diagnosis?

A

Meningitis

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106
Q

What is the FAILS criteria and how do you use it?

A

Focal neurologic deficit; Altered mental status; Immunocompromised; Lesions over the site of LP; Seizures
If any of FAILS is met, abx first, then CT, then LP
If NOT fails, LP first then abx

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107
Q

Treatment for primary apnea of newborn?

A

Stimulation with towels (rub back, tap feet)

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108
Q

What does APGAR stand for, and what is considered good?

A

Appearance, Pulse (gt 100), Grimace, Activity, Respiration; 7-10 is good

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109
Q

What do you do with a neonate who has hypoglycemia on its first check?

A

Give glucose - recheck; give IV if symptomatic (jitteriness, tremor, lethargy); feed if not symptomatic

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110
Q

What gets 0 points for each component of APGAR?

A

A: blue pale baby; P: pulse absent; G: grimace absent; A: activity absent; R: respirations absent

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111
Q

What gets 1 point for each component of APGAR?

A

A: Acrocyanosis; P: lt 100; G: with lots of tim; A: flexion; R: irregular

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112
Q

What gets 2 points for each component of APGAR?

A

A: pink; P: gt 100; G: with stim; A: resists extension; R: strong

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113
Q

What do you suction in a neonatal resuscitation and in what order?

A

Mouth then nose

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114
Q

What do you do if a neonate’s heart rate drops below 60 in the first ten minutes after birth (3)?

A

Positive pressure ventilation and CPR (3:1 with breaths), epinephrine via umbilical vein if not improving

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115
Q

Neonate in the delivery room with respiratory distress, hyper expanded lungs, and a “wet” chest XR. Dx and tx?

A

Transient tachypnea of the newborn. Treatment is oxygen (if needed) and occasionally CPAP

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116
Q

Neonate in the delivery room with respiratory distress, under expanded, and with atelectasis. Dx and tx?

A

Respiratory distress syndrome; may need surfactant and mechanical ventilation

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117
Q

Baby comes out of mom and isn’t breathing on its own. What’s that called?

A

Primary apnea

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118
Q

Bronchopulmonary dysplasia is caused by RDS due to decreased surfactant production. ___ is required for the diagnose. Xray shows __. How do you tx?

A

FiO2 required greater than 28 days; ground glass opacities; post birth tx with surfactant, pre birth give steroids to mom

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119
Q

Retinopathy of prematurity is caused by ___. It is worsened by __. How do you tx?

A

Oxygen toxicity (neoangiogenesis gone awry). increased FiO2 requirements; tx with laser

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120
Q

Intraventricular hemorrhage is seen in premies due to ___, which causes susceptibility to changes in blood pressure and therefore bleeds. How do you diagnose? Tx? What may result later on?

A

highly vascular ventricles; Cranial doppler (may see bulging fontanelles); Tx by decreasing ICP (shunts, drains); intellectual disability, seizures

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121
Q

Necrotizing enterocolitis is __. Seen in premies as __. Diagnose? Tx?

A

dead gut; bloody BM; XR (see pneumatosis intestinalis); NPO, IV abx, TPN (may need surgery)

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122
Q

What is mechanism of Hirschsprung’s?

A

Failure of neuron to migrate to distal colon

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123
Q

In Hirschsprung’s there is normal looking colon and dilated colon, which do you remove?

A

Normal looking colon (normal is bad - good colon should dilate)

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124
Q

If there is no anal opening on the first day of life…

A

imperforate anus: assess severity with cross table X-ray, consider VACTERL

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125
Q

What is VACTERL and how do you analyze each one?

A

Vertebra (U/S sacrum), Anus (xray), Cardiac (echo), TE fistula and Esophagel atresia (XR w/coiled tube), Renal (VCUG), Limb (XR) (things to rule out if there is no anal opening on the first day of life)

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126
Q

Treat a meconium ileus with?

A

Water-contrast enema

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127
Q

A diagnosis of meconium ileum means what other diagnosis?

A

Cystic fibrosis

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128
Q

Kids at risk for functional constipation?

A

school age or toilet age children

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129
Q

How does the dx of Hirschsprung differ in children and neonates (how it presents and what you do)?

A

Neonates: failure to pass meconium, contrast enema
Children: overflow incontinence or encopresis, anorectal manometry
You will still obtain rectal suction biopsy in both

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130
Q

Xray of Hirschsprung shows ___?

A

dilated proximal colon (normal colon) and normal looking distal colon (bad colon)

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131
Q

Tx when voluntary holding becomes involuntary constipation?

A

behavioral modification and bowel regimen

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132
Q

Explosive bowel movement on DRE in a child = ?

A

Hirschsprung’s (you are unblocking the obstruction)

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133
Q

Male baby, visible peristalsis, projectile vomiting, metabolic alkalosis - what’s the dx?

A

Pyloric stenosis

134
Q

You diagnose pyloric stenosis, what do you do next?

A

assess for electrolyte abnormalities and fix those; then surgery to fix pylorus (pyloromyotomy)

135
Q

Double-bubble sign and no distal air, polyhydramnios in utero - what’s the dx (2)?

A

Duodenal atresia or annular pancreas

136
Q

Double bubble sign and normal gas patter beyond it; what’s the dx?

A

Malrotation

137
Q

The pt obviously has pyloric stenosis. How do you make the diagnosis?

A

Donut sign on US (may also see olive shaped mass and visible peristaltic waves)

138
Q

Multiple loops of bowel with air fluid levels - what’s the dx?

A

Intestinal atresia

139
Q

Multiple loops of bowel with air fluid levels - how did that happen?

A

Mom did cocaine with baby in utero (vascular compromise) = intestinal atresia

140
Q

The pt obviously has pyloric stenosis. What’s the next step?

A

BMP to look for (and correct) electrolyte abnormalities

141
Q

What is an olive-shaped mass, visible peristalsis in a baby?

A

pyloric stenosis (also see non-bilious projectile vomiting)

142
Q

Diagnose esophageal atresia with?

A

Xray with an NG tube in place - tube will be coiled

143
Q

Baby has bubbling or gurgling with breathing, dx?

A

TE fistula

144
Q

A baby looks to be yellow in the nursery - what’s the first step?

A

Check bilirubin - transcutaneous (sensor = screen) vs serum (diagnostic)

145
Q

In the workup of a jaundiced neonate, what does a positive Coombs test mean?

A

Rh or ABO incompatibility

146
Q

How do you diagnose biliary atresia?

A

US

If equivocal, HIDA scan after 1 wk of phenobarbital

147
Q

Baby has an elevated unconjugated bilirubin at day 10 that wasn’t present at birth. Dx and tx? What is the cause?

A

breast milk jaundice - can temporarily interrupt breast feeding and supplement with formula or continue breast feeding - phototherapy if needed; Enzyme inhibition by mother’s milk causes insufficient conjugation

148
Q

In the workup of a jaundiced neonate, what dose a high hemoglobin mean (2 causes)?

A

baby has too much blood - twin twin transfusion or delayed clamping of the cord

149
Q

Persistent conjugated hyperbilirubinemia after aggressive measures to fix - what’s the dx?

A

biliary atresia

150
Q

Baby has an elevated unconjugated bilirubin at day 4 that wasn’t present at birth. Dx and tx?

A

Breast feeding jaundice (not enough feeding, gut slows, increased bili reabsorption) - advice mom how to feed and how often

151
Q

Kernicterus comes from which kind of bilirubin?

A

Unconjugated (lipid soluble so can cross BBB!)

152
Q

How do you confirm an elevated transcutaneous bilirubin?

A

Get a serum bilirubin level

153
Q

A mention of “black liver” in the vignette - what’s the dx?

A

Dubin-Johnson

154
Q

Name 3 causes of increased conjugated bilirubinemia in a neonate

A

1) biliary atresia; 2) sepsis; 3) metabolic (Rotor, Dubin Johnson)

155
Q

Name 4 causes of increased unconjugated bilirubinemia in a neonate

A

1) hemolysis (G6PD, pyruvate kinase defic, sickle cell); 2) hemorrhage (cephalo-hematoma); 3) Transfusion (twin-twin or delayed cord clamping); 4) Reabsorption (breast feeding vs breast milk jaundice)

156
Q

Name 4 findings due to maternal estrogen effects in newborns

A

1) breast hypertrophy (boys and girls); 2) swollen labia; 3) physiologic leukorrhea (whitish vaginal discharge); 4) uterine withdrawal bleeding

157
Q

Bilious vomiting in vignette, a double-bubble with multiple air fluid levels on XR image

A

Intestinal atresia

158
Q

If you find imperforate anus in a newborn, what do you do next?

A

Up-side-down baby gram (Xray)

159
Q

Coiled NG tube in an esophagus in a newborn?

A

Esophageal atresia (look for VACTERL)

160
Q

Intestines are out of baby, in the midline, and are contained in sac. What is the dx and what do you do next?

A

Omphalocele; give a silo

161
Q

Intestines are out of baby, they are to the right of midline and have no membrane. What is the dx and what do you do next?

A

Gastroschisis; give a silo

162
Q

Premature neonate develops bloody diarrhea, what’s the dx? Next step?

A

Necrotizing enterocolitis; get an XR

163
Q

Scaphoid abdomen and bowel sounds in the chest in a newborn, what’s the dx? Next step?

A

Diaphragmatic hernia; XR

164
Q

How do you treat congenital diaphragmatic hernia?

A

give pulmonary surfactant and surgical repair

165
Q

Failure to pass meconium, XR shows dilated proximal colon and distal normal colon. What’s the dx and how do you treat it?

A

Hirschsprung’s; remove the normal looking colon

166
Q

Biliary atresia presents with persistent or worsening jaundice at what age? How do you diagnose it?

A

2 weeks; US shows absence of ducts and HIDA scan after phenobarbital shows no contrast in GI

167
Q

Neural tube defects are caused by what (2)? What would you see in prenatal screen (2)?

A

Folate deficiency and genetic syndromes; visible on US in utero and positive AFP screen

168
Q

Myelomeningocele is associated with ___.

A

chiari type II

169
Q

Cleft lip/palate can be caused by failure of __ or __.

A

growth or fusion of underlying structures

170
Q

Floaties aren’t sufficient for pool safety; why?

A

they hold up arms, not the head (child can still drown)

171
Q

Football player gets knocked out after a big tackle but remembers everything, what does he have?

A

Concussion

172
Q

How do you prevent drowning in pools?

A

supervision, life jackets

173
Q

A teen is involved in a MVA, isn’t wearing his seatbelt, flies through the windshield and suffers LOC with a single lucid interval then LOC. Test and suspicion of dx?

A

CT scan; epidural hematoma

174
Q

A three year old comes in with bruises form her toes to knees, dx?

A

Abuse

175
Q

Football player takes a big hit, wobbles, comes out, but quickly shakes it off and appears ok. Next step and why?

A

Don’t allow return to play - 1) cognitive deficits may not show up immediately; 2) higher incidence of second impact syndrome

176
Q

What is the most effective way to prevent trauma from guns?

A

Eliminate them from the home

177
Q

What are the 4 criteria for deciding mild vs severe concussion? What do you do if it is mild vs severe?

A

FND (none vs positive); LOC (lt vs gt 60 seconds); Headache (none/improving vs present/worsening); Amnesia (none vs retrograde/anterograde);
For mild no CT, d/c home; for severe CT scan to r/o bleed and observe. Both step wise return to play

178
Q

What is the parkland formula for pediatric burns and how do you calculate %BSA?

A 
%BSA x Kg x 4 (2nd and 3rd degree burns only)
Head: 9+9 = 18
Front thorax is 9+9 = 18
Back thorax is 9+9 = 18
Arms are left = 9 and right = 9 = 18
Legs are 9+9+9 = 27
179
Q

Timing of fluids in burn patients?

A

50% of fluid in 8hrs and the second 50% of fluid in the next 16

180
Q

Concussion symptoms (4)?

A
  • Physical (photophobia, nausea, headache)
  • cognitive (memory issues)
  • emotional (moody, depression)
  • sleep problems
181
Q

Infant is in a coma, subdural on CT, dx?

A

shaken baby syndrome, abuse

182
Q

Rear facing car seat for baby until what age?

A

2 years old

183
Q

Kids need a booster seat until?

A

4’9”, 8-12 years old

184
Q

Bee sting with a red wheal around the site. What do you do?

A

Supportive care. You can use antihistamines

185
Q

Young child develops an itchy rash on their face, what’s the first thing to do?

A

Evaluate/withdraw recently added foods to diet

186
Q

Vomiting, bloody diarrhea, failure to thrive in infant on formula - dx and tx?

A

milk-soy protein allergy; switch to hydrolyzed formula

187
Q

A child has rhinorrhea and allergic shiners. How do you evaluate?

A

Take history for triggers and remove them (no skin testing or RAST)

188
Q

What’s the first line treatment for seasonal allergies?

A

H1 blockers (loratidine = fexofenadine = cetirizine)

189
Q

Bee sting with red wheals, hypotension, and wheezing. What is the immediate treatment?

A

IM Epi 1:1000

190
Q

When should you do skin testing for allergies?

A

In the case of severe or refractory disease

191
Q

What can you tell mom and dad about allergens when it comes to household safety for baby?

A

Remove carpets, clean regularly (dust mites), and stop smoking

192
Q

Name the findings associated with allergic rhinitis in children (6)

A

Allergic shiners, allergic salute, pale mucosa, boggy mucosa, polyps, cobblestoning

193
Q

What is the best tx (after avoiding triggers) for allergic rhinitis?

A

Intra nasal steroids!! (anti-histamines are not as good!)

194
Q

A child has ADHD but the question is about seizures - dx? Tx?

A

Absence; Ethosuximide (valproate as back up)

195
Q

What makes a febrile seizure complex (3)? Why does it matter?

A

complex if: 1) not generalized, 2) gt 15 mins, 3) multiple episodes in 24hrs. Simple seizures do not require any additional workup

196
Q

What do you NEVER give to a febrile seizure? What do you give to tx it?

A

Aspirin (reyes syndrome); tx underlying cause (acetaminophen does not tx or prevent recurrence of febrile seizures)

197
Q

Less than 6 months old, bilateral jerking of head and extremeties - dx? How do you treat? What is seen on interictal EEG?

A

Infantile spasms (West syndrome); ACTH; hypsarrhythmia

198
Q

Seizure, ash leaf spot on wood’s lamp - dx? What’s the next step?

A

Tuberous sclerosis; CT head or MRI brain (looking for brain tubers)

199
Q

When do you use bentos to treat a febrile seizure?

A

ANY seizure lasting more than 5 minutes (abortive bentos)

200
Q

What do you do about an anal fissure in a child?

A

Treat constipation if present; check for IBD if older child

201
Q

You’re worried about a GI bleed in a premature neonate - what do you get? What would you see on X-ray?

A

Xray for necrotizing enterocolitis; pneumatosis intestinalis (air in the wall of the bowel)

202
Q

Currant jelly diarrhea in a child, pain relieved by knee to chest position. What’s the dx?

A

Intussusception

203
Q

Sausage shaped mass and currant jelly diarrhea - dx?

A

Intussusception

204
Q

What are the 3 other things you should look for in a pt with necrotizing enterocolitis?

A

1) intraventricular hemorrhage (US w/doppler); 2) retinopathy of prematurity (optho exam); 3) Bronchopulmonary dysplasia

205
Q

What test do you do to investigate intussusception?

A

Air enema (best test and often curative); can also do X-ray (to look for perf or obstruction) and US which would show target sign (aka donut)

206
Q

What is the tx for intussusception? What is the back up and when do you do it?

A

Air enema (surgery if that doesn’t work or if pt has peritonitis, perforation)

207
Q

Diagnostic step for a meckel’s diverticulum?

A

Technetium-99 scan

208
Q

What do you get if you’re worried about a GI bleed in a healthy term neonate right after delivery?

A

Apt test (differentiates fetal from maternal blood - aka alkali test) - baby might have swallowed mom’s blood

209
Q

Warm upper extremities, cool lower extremities in a child, what’s the diagnosis?

A

Coarctation of the aorta

210
Q

You want to keep the patent ductus arteriosus open, what do you give? What do you give to close it?

A

Prostaglandin; indomethacin (anti-prostaglandin)

211
Q

Fixed split at S2?

A

Atrial septal defect

212
Q

What are indications to surgically repair a VSD (4)?

A

right sided hypertrophy, increased R sided pressures, failure to thrive, and heart failure (amongst others)

213
Q

Holosystolic murmur in a neonate - what’s the dx? What’s the dx in an adult?

A

VSD; mitral regurg

214
Q

Cyanotic congenital heart disease at age 3 - what’s the diagnosis?

A

Tetralogy (all others are immediate at birth)

215
Q

Mom has diabetes and the question asks about congenital heart disease

A

Transposition of the great vessels (not gestational diabetes!)

216
Q

Down syndrome baby and a question about congenital heart disease = ?

A

atrioventricular septal defect

217
Q

In most cases how do you diagnose a congenital heart disease?

A

Echo

218
Q

Name 3 associations with VSD, 1 with ASD, and 1 with AV septal defect

A

VSD: Fetal Alcohol Syndrome, Downs, VACTERL
ASD: Downs
AV Septal Defect: Downs

219
Q

Name 1 association each with PDA, coarctation, transposition of the great vessels, tetralogy of fallot, and truncus arteriosus.

A 
PDA: Congenital Rubella
Coarctation: Turners
Transposition: Maternal Diabetes
Tetralogy: DiGeorge
Truncus: DiGeorge
220
Q

Children with tetralogy of fallot can relieve their cyanosis by ___. How does this work?

A

squatting (tet spells) - this increases both venous return and systemic vascular resistance, forcing blood in to the pulmonary artery instead of the aorta

221
Q

Sandpaper rash in a child with fever?

A

Scarlet fever (also will see pharyngitis, tonsillar erythema & exudates, strawberry tongue, tender anterior cervical nodes)

222
Q

Legg-Calve-Perthes disease is idiopathic __ of the __. Classically presents in young children (age __ to __) with progressive __ and/or a __. Physical exam shows these two findings.

A

osteonecrosis; femoral epiphysis; 3-12 (peak 5-7); leg pain; limp; 1) decreased hip range of motion; 2) thigh muscle atrophy
(XR shows flattened and fragmented femoral head)

223
Q

What is the most common heart defect with Down syndrome?

A

Complete atrioventricular septal defect

224
Q

Name 3 features of leukocyte adhesion deficiency

A

1) recurrent skin and mucosal bacterial infxns (omphalitis, periodontitis) (no pus, poor wound healing); 2) delayed umbilical cord separation (gt 21 days); 3) marked peripheral leukocytosis with neutrophilia

225
Q

Fracture in kids that DOES NOT involve the growth plate and is closed. What’s the next step? What if it does involve the growth plate?

A

Cast; Open reduction and internal fixation (ORIF)

226
Q

Teenage athlete, knee pain, nodule on the tibia, diagnosis?

A

Osgood-Schlatter

227
Q

Clicky hip in a newborn in the newborn nursery - dx? What do you do next?

A

Potential developmental dysplasia of the hip - reassess in 4 wks, and if still there US to confirm, then harness

228
Q

Obese teenager with non traumatic hip pain. Test and diagnosis?

A

Xray - slipped capital femoral epiphysis

229
Q

How do you make the diagnosis of scoliosis?

A

Adam’s test (have the child lean forward and see asymmetry)

230
Q

Describe the XR pattern of osteogenic sarcoma?

A

Sunburst pattern in distal bone (often femur)

231
Q

6 year old child with an insidious onset antalgic gait - dx?

A

Legg-Calve-Perthes disease (avascular necrosis) - antalgic = abnormal gait to help avoid pain

232
Q

A girl has retinoblastoma at birth; what cancer should be monitored for?

A

Osteosarcoma

233
Q

A young kid with fever and pain of any joint - most serious diagnosis?

A

Septic arthritis

234
Q

Hip pain in a child after a viral illness - dx?

A

Transient synovitis - can be confused for septic arthritis (may need arthocentesis to rule out)

235
Q

What diagnostic test do you do for slipped capital femoral epiphysis?

A

Frog-leg Xray (XR “plain film” isn’t enough)

236
Q

Fever, swelling, joint pain in a teen - next step?

A

Arthrocentesis (fever + joint swelling = tap)

237
Q

What is the translocation in Ewing’s sarcoma? What is the pattern on XR?

A

t(11:12); onion skin patter on mid shaft

238
Q

What’s the one thing you’ll check for in a long bone fracture in a child?

A

Growth plate involvement (if positive, go straight to surgery)

239
Q

What are the 4 Kocher criteria and what are they used for?

A

Used to detect septic arthritis: +1 for any positives

non-weight bearing, temp gt 38.5/101.3, ESR gt 40, WBC gt 12

240
Q

Other than involving the growth plate, name 4 other considerations for pediatric bone fractures that would make you choose ORIF.

A

Comminuted (fracture in which the bone has broken into several pieces), angular, displaced, open

241
Q

How do you definitively diagnosis a child with sickle cell disease?

A

Hemoglobin electrophoresis

242
Q

How do you treat iron overload in sickle cell disease?

A

Deferoxamine

243
Q

What’s the genetic problem in sickle cell disease?

A

Valine for glutamine in the 6th position on the beta global gene cluster on chromosome 11

244
Q

What medication can help prevent sickle pain crises? How does it work?

A

Hydroxyurea; increased HgbF (which can’t sickle); hydration also helps!

245
Q

How do you treat an acute vaso-occlusive crisis?

A

IVFs, oxygen, and pain control (abx if suspect an infxn)

246
Q

If there is acute chest, what is the treatment? Name 2 other conditions that require the same tx.

A

Exchange transfusion; priapism, stroke

247
Q

Inability to ambulate, hip pain, and in sickle cell pt. What is the diagnosis and diagnostic step?

A

Avascular necrosis of the hip, take an XR

248
Q

Kids with sickle cell auto infarct their spleens - what do you do for them?

A

Vaccinate against encapsulated organisms and give prophylactic penicillin until age 5

249
Q

How can you tell if someone is in a sickle cell crisis (3)?

A

Sickled cells on smear, bili is up from baseline, reticulocytes are up from baseline

250
Q

If you see salmonella osteomyelitis, what disease should you think of?

A

sickle cell

251
Q

What type of anemia are kids with sickle cell likely to get if they aren’t cared for?

A

Folate deficiency (they are actually at risk of iron overload because of transfusions)

252
Q

Treat avascular necrosis in a newly diagnosed pt with?

A

NSAIDs and rest (casting and surgery are also options but will vary based on severity)

253
Q

The most common cause of osteomyelitis in pts with sickle cell?

A

Staph aureus (NOT salmonella - though if you have salmonella osteo you likely have sickle cell)

254
Q

Name 4 B cell immunodeficiencies and 1 T cell.

A

1) Bruton’s X-linked agammaglobulinemia
2) Common variable immunodeficiency
3) IgA deficiency
4) Hyper IgM

1) DiGeorge

255
Q

Name 3 Phagocyte immunodeficiencies

A

1) Leukocyte adhesion deficiency
2) Chronic granulomatous disease
3) Chediak Higashi

256
Q

Name 3 combined immunodeficiencies

A

1) Wiskott-Aldrich (xlinked)
2) Ataxia telangiectasia
3) Severe combined immunodeficiency (SCID)

257
Q

Which set of immunodeficiencies all have normal CBCs?

A

B-cell deficiencies

258
Q

Small chin, small mouth, low-set ears, wide spaced eyes, and ___. What’s the diagnosis?

A

absent thymic shadow; DiGeorge

259
Q

Anaphylactic reaction to a blood transfusion - dx?

A

IgA deficiency

260
Q

When does X linked agammaglobulinemia usually appear and when does common variable immunodeficiency? How do you treat both?

A

6 months; late childhood or early teens
(CVID is less severe - missing about 2 out of 3 Ig’s (A, G, M) instead of all); with both you can give scheduled IgG but to cure they need BM transplant

261
Q

Boys with lots of recurrent infection btwn ages 1-2, dx?

A

Bruton’s X-linked agammaglobulinemia

262
Q

What is the diagnosis if you see low IgA, low IgG, and high IgM?

A

hyper IgM syndrome

263
Q

Boys, eczema, thrombocytopenia with infections. What’s the diagnosis?

A

Wiskott-Aldrich (problem with antigen presentation)

264
Q

What will an immunoglobulin panel look like in Brutons?

A

All down - low IgA, IgG, IgM, IgE

265
Q

Recurrent Neisseria infections, what’s the diagnosis?

A

terminal complement deficiency C5-C9 Mac attack

266
Q

What’s a cause for severe combined immunodeficiency?

A

adenosine deaminase deficiency (causes an autosomal recessive pattern)

267
Q

How do you confirm an XLA diagnosis?

A

Type the BTK gene

268
Q

Delayed separation of cord, dx? Name another symptom

A

Leukocyte adhesion deficiency; toxic but no pus! (WBCs can’t leave blood)

269
Q

Recurrent staph abscesses are seen in what immunodeficiency? How do you diagnose?

A

chronic granulomatous disease (no respiratory burst - will eat bugs but cannot kill catalase + organisms); Nitro blue test will fail to turn blue

270
Q

Disruption of complement pathway that causes angioedema but not associated with immunodeficiency - dx?

A

C1 esterase deficiency

271
Q

Obviously syndromic physical appearance and immunodeficiency - dx? How do you treat these pts (3)? What else should you look out for in these pts.

A

DiGeorge syndrome; TMP-SMX ppx, IVIg bridge to thymic transplant; decreased calcium 2/2 PTH deficiency (3rd pharyngeal pouch absent)

272
Q

Severe immunodeficiency involving both T and B cells. Abscesses and mucosal infxns - dx? How do you treat (3)?

A

SCID; TMP-SMX against PCP, isolate!, BM transplant is curative (no risk of GVHD)

273
Q

Name 3 conditions that qualify you to receive palivizumab for RSV prevention

A

1) preterm birth (lt 29 wks gestation); 2) chronic lung disease of prematurity; 3) hemodynamically significant congenital heart disease

274
Q

Name 3 clinical manifestations of Kartagener’s (primary ciliary dyskinesia)

A

1) recurrent sinopulmonary infxns and 2) bronchiectasis - both due to immotile cilia leading to poor mucociliary clearance; 3) +/- situs inversus (Kartagener’s!)

275
Q

Name 4 clinical manifestations of HSP (Henoch-Schonlein purpura). How do you tx?

A

1) palpable purpura; 2) arthritis/arthralgia; 3) abdominal pain, intussusception; 4) renal disease similar to IgA nephropathy; supportive tx (hydration and NSAIDs) - in severe cases can hospitalize and give systemic glucocorticoids

276
Q

The most common predisposing factor for acute bacterial sinusitis is ____.

A

a viral URI

277
Q

Mucopurulent discharge from one eye 5-14 days into life - dx? Tx? What would the gram stain show?

A

Chlamydia; erythromycin PO; nothing

278
Q

Purulent disharge, bilateral, 2-7 days into life - what would the gram stain show? Tx?

A

gram negative diplococci (gonorrhea) - ceftriaxone IM

279
Q

Unilateral mucopurlent discharge from one eye 5-14 days into life - what should you have used for ppx?

A

Nothing (there is no ppx for baby against chlamydia)

280
Q

Red light reflex shows a bright white thing, dx? Tx?

A

Retinoblastoma; surgery (NEVER radiation)

281
Q

What do you do about congenital cataracts? What are they usually caused by?

A

Remove them before amblyopia sets in; TORCH infections

282
Q

Purulent disharge, bilateral, 2-7 days into life - what should you have used for ppx?

A

Topical erythromycin

283
Q

A baby with cataracts not present at birth is likely caused by?

A

Galactosemia

284
Q

In retinopathy of prematurity how do you diagnose and tx?

A

Diagnose with optho exam showing growth on retina; laser ablation

285
Q

If baby has retinopathy of prematurity, name 3 other conditions you should consider

A

1) necrotizing enterocolitis; 2) bronchopulmonary dysplasia; 3) intraventricular hemorrhage

286
Q

What is the one thing you NEVER do with hypo or epispadias?

A

Circumcision - use the foreskin to reconstruct the penis

287
Q

Intense colicky pain after a teenager first experiments with alcohol, what’s the dx?

A

Ureteropelvic junction obstruction (works at normal urinary flow - problems at increased flow)

288
Q

You want to dx vesicoureteral reflux - what test do you get?

A

voiding cystourethrogram (VCUG)

289
Q

Any UTI in an infant should prompt investigation for what? How do you check it?

A

vesicoureteral reflux; first U/S, the VCUG if abnormal

290
Q

You want the confirmative diagnostic step of a bladder mass, what test do you get?

A

cystoscopy

291
Q

A testicle could not be palpated, what do you do (plan out the boys life)

A

Give it a year (6 mo?) to descend on its own, then bring it down yourself. Take it out after puberty

292
Q

Dysmorphic red blood cells in a child with microscopic hematuria. What is the general name for this condition?

A

Glomerulonephritis

293
Q

A girl who is able to void, is toilet trained, but leaks constantly anyway - dx? Tx?

A

Ectopic ureter (aka low implantation of the ureter); reimplant

294
Q

You’re thinking hydronephrosis or hydroureter, what test do you get?

A

U/S

295
Q

Oligohydramnios in male infant, no urine output on first day of life with palpable bladder. Dx? Tx?

A

Posterior urethral valves; catheter to relieve obstruction and surgery to resolve problem

296
Q

In a pt with posterior urethral valves, what would you see on ultrasound?

A

Hydronephrosis

297
Q

Hearing loss, ocular abnormalities, and renal disease - dx? pathogenesis?

A

Alport syndrome; basement membrane thinning (and splitting) due to abnormality of type IV collagen (hereditary nephritis)

298
Q

In lead chelation, ___ is typically used when lead levels are 45-69. __ plus __ is used on an emergency basis for levels greater than 70 or acute encephalitis

A

Dimercaptosuccinc acid (DMSA, Succimer); Dimercaprol (british anti-lewisite) plus calcium disodium edetate (EDTA)

299
Q

Name 5 clinical features of DiGeorge syndrome (pneumonic!)

A

CATCH: Conotruncal cardiac defects (truncus arteriosus, tetrology of Fallot, interrupted aortic arch, septal defects); Abnormal facies; Thymic aplasia/hypoplasia; Cleft palate; Hypocalcemia

300
Q

Name 3 clinical features of McCune-Albright syndrome

A

1) peripheral precocious puberty; 2) irregular cafe-au-lait macules; 3) polyostotic fibrous dysplasia (recurrent fractures)
(caused by mutation in GNAS gene leading to over production of pituitary hormones)

301
Q

What is the most common cause of pediatric stroke

A

Sickle cell disease

302
Q

___ is a macrocytic pure red aplasia associated with several congenital anomalies such as short stature, webbed neck, cleft lip, shielded chest, and triphalangeal thumbs

A

Diamond-Blackfan syndrome (DBS)

303
Q

A child has many outbursts in class, is started on stimulants for ADHD, the outbursts get worse - dx? Tx?

A

Tic disorder; dopamine antagonists (fluphenazine, tetrabenazine)

304
Q

A child misbehaves at school, appears easily distracted. They’re able to sit quietly at home and watch TV - dx?

A

Troublemaker (not ADHD)

305
Q

Tx: child is fidgety, interrupts theres, is easily distracted, has poor grades, and can’t follow instructions at home

A

Stimulant med (methylphenidate)

306
Q

Child has impaired speech, poor social function, repetitive behaviors, and rocks back and forth - dx?

A

Autism spectrum disorder

307
Q

Child acquired risk factors for intellectual disability disorders (3)

A

lead poisoning, trauma, cerebral palsy

308
Q

Maternal acquired risk factors for child’s intellectual disability

A

Hypothyroid while pregnant, alcohol while pregnant

309
Q

How do you grade an intellectual disability?

A

Based on their adaptive functioning (aka ability to take care of themselves/socialize) - NOT IQ

310
Q

What does an IQ less than 70 mean?

A

Person is 3 SDs below the mean

311
Q

A 6 month old girl has normal developmental progress, but then regresses - dx?

A

Rett syndrome

312
Q

What are the two main symptoms of Autism spectrum disorder?

A

Impaired social communication and Repetitive behaviors

313
Q

Chromosomal causes of intellectual disability (3)

A

Down syndrome, Fragile X, Cri-Du-Chat

314
Q

Lying, cheating, hurts animals, less than 18 yo, dx?

A

Conduct disorder

315
Q

Child yells, talks back to teachers and parents, but isn’t aggressive with peers or animals - dx?

A

Oppositional defiant disorder

316
Q

Older than 7 yo, still bed wetting, frequently cries from embarrassment - tx (5)?

A

Positive reinforcement, alarm blankets, water restriction; medication tx = DDAVP, TCAs are okay

317
Q

Kawasaki disease (aka mucocutaneous lymph node syndrome) is a vasculitis characterized by fever greater than ___ days in addition to gt/= 4 of these 5 findings

A

5 days; 1) conjunctivitis (nonexudative); 2) oral mucosal changes (strawberry tongue, fissured lips); 3) Rash; 4) extremity changes (desquamation of hands and feet); 5) cervical lymphadenopathy (gt 1.5 cm node)

318
Q

How do you treat Kawasaki?

A

IVIg and aspirin!

319
Q

The first step in the evaluation of primary amenorrhea is ___ to determine __.

A

pelvic exam; whether the ovaries, uterus, and vagina are present or absent. Ultrasound is the preferred imaging modality

320
Q

___ is increased laxity of supraglottic structures, which presents as __ that worsens when __. How do you diagnose? What is the peak age?

A

Laryngomalacia; inspiratory stridor; supine; Clinical dx or flexible laryngoscopy; 4-8 months

321
Q

Newborn with bilious emesis - next 4 steps?

A

stop enteral feeds, NG tube decompression, IV fluids, abdominal Xray (to rule out pneumoperitoneum from intestinal perf)

322
Q

Name 4 causes of bilious emesis

A

1) meconium ileus (CF); 2) Hirschsprung disease; 3) Malrotation (volvulus); 4) Duodenal atresia

323
Q

Newborn with bilious emesis, X-ray shows dilated loops of bowel - what’s the next test to determine cause

A

contrast enema - will either show microcolon (meconium ileus = CF) or rectosigmoid transition zone (Hirschsprung)

324
Q

Diagnosis of ___ can be confirmed with eosin-5-maleimide binding test and ___ test.

A

Hereditary spherocytosis; acidified glycerol lysis test

look for triad of combo’s negative hemolytic anemia, jaundice, splenomegaly - and of course spherocytes

325
Q

Causes of meningitis in children less than 3 months of age (4); 3 months - 10 years (2); greater than 11 years (1)

A

Group B strep, E coli (and other gram negs), Listeria, Herpes; Neisseria meningitidis and strep pneumo; N meningitidis

326
Q

Painless hematochezia in a young toddler is most likely due to __. Diagnosis is confirmed with __.

A

Meckel’s diverticulum (if it has ectopic gastric tissue, it secretes HCl, causing mucosal ulceration of surrounding small bowel); technetium-99m pertechnetate scanning

327
Q

Septic arthritis in birth-3months: what organisms (3) and what abx (2/3)

A

staphylococcus, group B strep and gram neg bacilli; antistaph agent (nafcillin or vancomycin) PLUS gentamicin or cefotaxime

328
Q

Septic arthritis in pt older than 3 months: what organisms (3) and what abx (4)

A

staph, group A strep, and strep pneumoniae; nafcillin, clindamycin, cefazolin, or vancomycin

329
Q

Patient has channel atresia - may be isolated or part of this syndrome (name the 6 parts)

A

CHARGE syndrome: Coloboma, Heart defects, Atresia choanae, Retardation of growth/development, Genito-urinary anomalies, Ear abnormalities/deafness

330
Q

___ is characterized by macrosomia, macroglossia, umbilical hernia/omphalocele, hemihyperplasia, and hypoglycemia. Children must be closely monitored for development of these two tumors

A

Beckwith-Wiedmann syndrome; Wilms tumor or hepatoblastoma

331
Q

In pts with primary amenorrhea with confirmed uterus present, the next step is to order ___. If it is increased, do ___. If it is decreased, do __.

A

FSH; karyotyping (peripheral origin); pituitary MRI (look for a lesion in the sella turcica)

332
Q

Pt with combination of neurologic (ataxia, dysarthria), skeletal (scoliosis, feet deformities), and cardiac (concentric hypertrophic cardiomyopathy) manifestations has __.

A

Friedreich ataxia (most common type of spinocerebellar ataxias)

MS3 Year (18 decks)

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