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Clerkship > Pediatrics > Flashcards

Pediatrics Flashcards

1
Q

Most frequently diagnosed neoplasm in infants

A

Neuroblastoma

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2
Q

2nd most common abdominal tumour in kids

A

Wilm’s Tumour (aka nephroblastoma)

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3
Q

Anaphylaxis definition

A
  • Need any ONE of the following
    • Acute onset (min-hrs) involving skin/mucosa and at least 1 of respiratory compromise and/or drop in blood pressure
    • 2 or more organ systems – skin/mucosa, respiratory, CVS, or GI rapidly after exposure
    • Drop in BP after exposure to a known allergen
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4
Q

Age limit of asthma dx

A

18 months (not enough smooth muscle yet to cause airway constriction)

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5
Q

Common bacteria for meningitis in newborns

A 
K-LEG 
GBS 
E. Coli
L. monocytogenes
Klebsiella
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6
Q

Common bacteria for meningitis in toddlers

A 
SN-EG 
S. pneumo
N. meningitidis 
E. Coli
GBS
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7
Q

Bacterial meningitis LP findings

A 
Low glucose
High protein
Very high WBC 
Nitrites
Positive or neg gram stain
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8
Q

Viral meningitis LP findings

A 
Normal glucose 
Normal or slightly elevated protein 
High WBC 
Lymphocytes
Neg gram stain
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9
Q

Pyruria definition

A

> 5 WBCs/hpf in centrifuged urine

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10
Q

Gram neg bacteria that cause nitrites

A

E. Coli
Klebsiella
proteus

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11
Q

Most common organism causing pyelonephritis

A

E.coli

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12
Q

Follow-up study for first episode of pyelo

A

Kidney and bladder U/S

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13
Q

Third generation cephalosporins good for broad spectrum antibiotic treatment

A

Cefiixime
Cefotaxime
Ceftriaxone

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14
Q

Epiglottitis typically caused by

A

H. influenza type B

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15
Q

Croup most commonly caused by

A

Parainfluenza Type 1

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16
Q

Most common cause of bronchiolitis

A

RSV

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17
Q

Top 2 most common bacterial causes of otitis media

A
  1. Strep pneumo

2. Haemophilus influenza

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18
Q

Buccal mucosa lesions in initial stage of measles

A

Koplik spots (red lesions with bluish white spots in centre)

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19
Q

Another name for 5th disease

A

Erythema infectiosum

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20
Q

Cause of 5th disease

A

Parvovirus B19

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21
Q

Causes of strawberry tongue (3)

A

Strep pharyngitis
Kawasaki
Toxic shock syndrome

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22
Q

Most common type of congenital diaphragmatic hernia

A

Bochdalek

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23
Q

Insulin sensitive organs

A

Heart, liver, muscle

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24
Q

Most common cause of respiratory distress in premature infants

A

Respiratory distress syndrome

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25
Q

Respiratory distress syndrome

A

♣ Deficiency of lung surfactant and delayed lung maturation
♣ Can occur as late as 37 weeks’ gestation
♣ Increased risk in infants of diabetic mothers

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26
Q

Transient tachypnea of newborn

A

♣ Result of delayed clearance of fluid from lungs following birth
♣ Much more common in infants born to diabetic mothers and in infants born by c-section

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27
Q

CXR findings in RDS

A

Diffuse reticulogranular appearance of lung fields (ground glass) and air bronchograms

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28
Q

CXR findings in TTN

A

Wet looking lungs, no consolidation, no air bronchograms

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29
Q

TORCH infections

A 
Toxoplasmosis
Other (syphillis, varicella, parvo) 
Rubella
CMV 
Herpes
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30
Q

X-ray finding for croup

A

Steeple sign (tapering of upper trachea)

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31
Q

X-ray finding for epiglottis

A

Thumb-print sign

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32
Q

Treatment for severe dehydration

A

Lactated Ringer’s solution or normal saline (isotonic) in 20 mL/kg boluses until urine output is established and mental status improves, then 100 mL/kg oral rehydration solutions over next 4 hours. ntravenous hydration with 5% dextrose ½ normal saline at twice maintenance fluid rates may be substituted for the oral rehydration solution if the child is not tolerating PO intake. To replace ongoing losses, the CDC recommends 60-120mL of oral rehydration solution per diarrheal/emetic episode (through a nasogastric tube, if necessary).

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33
Q

Cushing’s triad

A

Symptoms related to increased ICP

  1. Increased BP
  2. Low HR
  3. Irregular respirations (Cheyne-Stokes)
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34
Q

Most likely pathogens in sepsis <4wk old

A

Streptococcus agalactieae (GBS)
E. coli
Listeria monocytogenes
HSV

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35
Q

First choice abx for sepsis in <4 weeks

A

Ampicillin + Gentamicin or Cefotaxime +/- Acyclovir

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36
Q

Most likely pathogens in sepsis >/= 4 wk old

A

Neisseria meningitides
Strep pneumo
H. influenzae

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37
Q

First choice abx for sepsis in <4 wk old

A

Amp + Gent +/- Acyclovir

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38
Q

Most likely pathogens for meningitis in <4 wk old

A

Streptococcus agalactiae (GBS)
E. coli
Listeria monocytogenes
HSV

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39
Q

First choice abx for meningitis in <4wk old

A

Ampicillin + Cefotaxime + Acyclovir

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40
Q

First choice abx for meningitis in >/= 4 wk old

A

Cefotaxime +Vancomycin +/- Acyclovir

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41
Q

Most likely pathogens for meningitis in >4wk old

A

N. meningitides
Strep penumo
H. influenza

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42
Q

Most likely pathogen for encephalitis

A

HSV

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43
Q

Abx for strep pharyngitis/tonsillitis

A

Penicillin V PO
or Amoxicillin PO
or Penicillin G

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44
Q

Bacterial acute otitis media common pathogens

A

H. influenza
Strep pneumo
Moraxella catarrhalis

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45
Q

Bacterial acute otitis media first line tx

A

Amoxicillin 80-90mg/kg/d PO

or Amox-Clav PO

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46
Q

Sinusitis common pathogens

A 
H. influenzae
Strep pneumo
Moraxella catarrhalis 
Staph aureus 
GAS 
Anaerobic organisms
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47
Q

Sinusitis first line tx

A

Amox PO

Amox-clav PO

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48
Q

Community-acquired PNA <1mo most likely pathogens

A

GBS
E. coli
Listeria monocytogenes

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49
Q

Community acquired PNA <1mo first line tx

A

Ampicillin + Gentamicin or Cefotaxime

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50
Q

Community-acquired pneumonia (1-3 mo) first line tx

A

Cefotaxime +/- Vanco +/- Clarithomycin PO

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51
Q

Obstructive lung disease spirometry

A

Low FEV1/FVC ratio d/t reduction in FEV1

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52
Q

Restrictive lung disease spirometry

A

Normal FEV1/FVC ratio d/t proportionate reduction in FEV1 and FVC

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53
Q

Most commonly heard innocent murmur

A

Still’s murmur, best heard at LLSB in supine position

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54
Q

Most likely pathogen for UTI

A

E. coli

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55
Q

First line empiric abx for <2mo UTI

A

Amp + Gentamicin

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56
Q

First line empiric abx for >/=2mo mild UTI

A

Cephalexin PO

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57
Q

First line empiric abx for >/=2mo severe UTI

A

Cefotaxime OR Gentamicin

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58
Q

Requirements for renal U/S in UTI

A 
<2yo first febrile UTI
Any age with recurrent UTI 
Any age with fam hx of renal dz 
Any age with poor growth, HTN 
Any age with no response to abx
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59
Q

Requirements for voiding cystourethrogram in UTI

A

Any age with >/= 2 febrile UTI
Any age with first febrile UTI and abnormal U/S
Any age with >/= 39C and pathogen other than E. Coli
Any age with poor growth, HTN

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60
Q

Vesicoureteral reflux grades

A

Grade 1: Half way up ureter
Grade 2: All the way up ureter
Grade 3: Up ureter and some dilation of ureter & calyces
Grade 4: Marked dilation of ureter and calyces
Grade 5: Massive reflux, dilated ureter, calyces dilation and loss of renal cortex

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61
Q

VUR grade tx

A

Grade 1/2 - spontaneous resolution (2-5yrs), follow by GP

Grade 3/5 - referred to urologist

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62
Q

Roseola

A

HHV6
Fever 3-5d –> maculopapular rash that starts on trunk and spreads to face/extremities
Tx = Reassurance

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63
Q

Asthma X-ray findings

A

Hyperinflation
Increased interstitial markings
Patchy atelectasis

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64
Q

Pertussis stages

A

Catarrhal (1-2wks) - URTI symptoms
Paroxysmal (4-6wks) - whooping cough
Convalescent - decrease in severity/freq of cough

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65
Q

Pertussis treatment

A

Azithromycin
Clarithromycin
Erythromycin

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66
Q

Turner syndrome

A

45XO

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67
Q

Klinefelter Syndrome

A

47 XXY

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68
Q

Trisomy 13

A

AKA Patau Syndrome

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69
Q

Trisomy 18

A

Edward Syndrome

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70
Q

Fragile X syndrome

A

Expansion of CGG repeats on FMR1 gene on X chromosome

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71
Q

Febrile seizures simple vs complex

A 
Simple: 
- More common 
- <15min 
- Generalized 
- Once in 24h period
Complex:
- Less common
- >15min 
- Focal
- More than once in 24h period
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72
Q

Recurrence rate of febrile seizures

A

<12mo: 50%

>12mo: 30%

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73
Q

Risk of epilepsy after febrile seizure

A

Slightly increased above 0.5-1% baseline population risk

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74
Q

Most common cause of recurrent headache in children

A

Migraine without aura (more common than classic with aura)

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75
Q

Tx for headaches in children

A

TCAs for migraine

NSAIDs for tension

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76
Q

Dx criteria for idiopathic intracranial HTN

A
  1. Increased ICP with associated symptoms
  2. Normal brain anatomy
  3. Normal CSF
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77
Q

Infratentorial brain tumour findings

A

Cerebellar signs and increased ICP

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78
Q

Cerebellar brain tumour findings

A

Change in muscle tone, deep tendon reflexes = hypotonia, hypOreflexia

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79
Q

Supratentorial brain tumour findings

A

Focal motor and sensory abnormalities on side OPPOSITE to lesion

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80
Q

Brain stem brain tumour findings

A

CN and gaze palsies

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81
Q

Most common location for brain tumour

A

Posterior fossa

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82
Q

Most common brain tumours in peds

A

Medulloblastoma, juvenile pilocytic astrocytoma

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83
Q

Measles rash

A

Maculopapular, starts on neck/face then spreads down to feet in 2-3d
Initial Koplik spots in buccal mucosa
Tx: supportive

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84
Q

Rocky mountain spotted fever

A

Tick-borne bacterial infection
Rash on ankles and wrists –> spreads centraly and to palms and soles
Maculopapular –> petechial

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85
Q

Cat scratch disease

A

Bartonella henselae
Axilla > cervical, submandibular, inguinal areas
Subacute/chronic unilateral lymphadenitis
Self-limited
Start empiric abx if suspected coverage for S. aureus and GAS (cephalexin, clinda, septra, amox-clav, etc.) + coverage for cat scratch (azithromycin, rifampin, septra, doxy)

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86
Q

Bacterial cervical adenines most common causes

A 
Staph aureus
Strep pyogenes (GAS)
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87
Q

Kawasaki disease dx

A

Fever >5d
4/5 of the following:
- Conjunctivitis (bilateral, non purulent)
- Rash
- Extremity changes (redness/swelling)
- Adenopathy (unilateral cervical lymphadenopathy)
- Mucosa (strawberry tongue)

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88
Q

Kawasaki stages

A

Acute Onset-10d (fever, clinical findings, serologic evidence of inflamm)
Subacute 10d-3wk (Fever resolves and clinical findings subside, ongoing serologic evidence) coronary artery aneurysm formation
Convalescent 3wk - 6-8wk (clinical findings resolved, cont serologic evidence of inflammation)

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89
Q

Drug to avoid in kawasaki

A

Ibuprofen

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90
Q

Use corrected age in premature babes until age…

A

2yo

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91
Q

Developmental screening tests recommended at…

A

9, 18 and 30 months

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92
Q

Common risk factors for developmental delay in premature infant

A
  • Chronic lung dz
  • Periventricular leukomalacia (damage/necrosis to white matter around ventricles)
  • Retinopathy of prematurity
  • Hyperbilirubinemia
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93
Q

Babinski reflex gone by…

A

Time child is walking

Up to 2yrs

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94
Q

Types of cerebral palsy

A 
Spastic hemiplegia
Spastic diplegia
Spastic quadriplegia 
Ataxic 
Dyskinetic
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95
Q

Spastic hemiplegia CP

A

Leg and arm on one side
Etiology - unilateral UMN abnormalities
Clinical - stroke

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96
Q

Spastic diplegia CP

A

Most common
Legs > arms
Etiology - periventricular white matter abnormality
Clinical - premature

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97
Q

Spastic quadriplegia CP

A

Whole body

Etiology - global brain involvement

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98
Q

Dyskinetic CP

A

AKA Athetoid dystonic
Variable, often entire body
Basal ganglia, cerebellum and/or thalamus
Clinical - perinatal asphyxia, kernicterus

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99
Q

Ataxic CP

A

Entire body
Etiology - Cerebellum
Clinical - Cerebellar hypoplasia, pontocerebllar hypoplasia

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100
Q

Screening tool for ASD

A

M-CHAT

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101
Q

Language milestone at 2yo

A 
50+ words
2 word phrases
50% intelligible
Follows 2-3 commands 
Points to pictures when asked
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102
Q

Language milestone at 3yo

A

200+ words
3 word phrases
75% intelligible
Knows age and gender

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103
Q

Language milestone at 4yo

A

Tells stories, 100% intelligible
400-1500 words
Numbers 1-4
Knows full name

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104
Q

Language milestone at 9-10mo

A

Single words “mama” “dada”

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105
Q

Language milestone at 18mo

A

10-25 words
Names body parts
Follows 1 step commands

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106
Q

Risk factor for speech delay

A

Sex (boys > girls)

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107
Q

Fencing reflex

A

Should be gone by 6mo

Most common primitive reflex that persists in CP

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108
Q

Dx of Trisomy 21

A

Lymphocyte karyotype

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109
Q

Most common familial cause of intellectual disability

A

Fragile X syndrome

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110
Q

Turner syndrome

A

45XO
Physical differences at birth
Webbed neck, edema of hands/feet, low ears, shield chest with wide nipples, coarctation of the aorta
Most have NORMAL IQ

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111
Q

Klinefelter Syndrome

A

47 XXY (male)
Normal at birth
Infertility, gynecomastia, small testicles
Other less obvious symptoms: weaker muscles, greater height, poor coordination, less body hair, decreased libido (most noticeable at puberty)
Typical random mutation
IQ low-normal range

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112
Q

Fragile X clinical

A

Females - asymptomatic (ID, behavioural), may suffer from infertility
Males - large testes, flat feet, long face with large mandible, high-arched palate, hypotonia, connective tissue abnormalities (joint laxity, pectus excavatum)
~1/3 have features of autism (co-occur), usually fertile
Hyperactivity common
Normal-severe IQ

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113
Q

Normal weight gain in newborn

A

20-30g/d average weight gain during first 4mo of life

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114
Q

Weight should double by…

Weight should triple by…

A

4mo of age

1 yo

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115
Q

FTT definition

A

Weight <3rd percentile
Weight for height/length <3rd percentile
Rate of weight gain slows compared with previous growth, crossing 2 more major percentiles in downward direction

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116
Q

Child CPR

A 
100-120 compressions/minute
1/3 AP diameter
Infants = 1.5inches 
Children = 2inches 
Teens = 5cm (adult recommendation)
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117
Q

Neimann-Pick disease

A

Neurodegenerative disorder
6mo-2yrs
GDD, milestone regression, hepatosplenomegaly, interstitial lung dz, macular cherry red spot

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118
Q

Palmar grasp persists until

A

2-3mo

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119
Q

Plantar grasp persists until

A

8mo

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120
Q

Fencing reflex persists until

A

6mo

AKA asymmetric tonic neck reflex

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121
Q

Babinski reflex persists until

A

1-2yrs

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122
Q

Moro reflex persists until

A

4mo

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123
Q

Vitamin D recommendations

A

400IU per day within days of birth to 6 months if child is exclusively breasted or not receiving at least 1L via D fortified formula daily

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124
Q

Birth weight doubles by age…

A

4-5mo

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125
Q

Birth weight triples by age…

A

12mo

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126
Q

Birth length doubles by age…

A

4yo

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127
Q

New food may be added to the diet…

A

every 5-7 days

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128
Q

Wilms tumour often associated with this syndrome

A

Beckwith-Weidemann syndrome = genetic overgrowth (omphalocele, hemihypertrophy, hypoglycaemia, large for GA)

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129
Q

Neuroblastoma lab findings

A

Elevated Urine or serum VMA/HVA (measures metabolites of catecholamines)
Possible anemia/other cytopenias

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130
Q

Target glucose screen in neonate prior to feeds

A

2.6mmol/L

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131
Q

Preterm definitions

A

Extremely preterm <28wks
Very preterm 28-32 wks
Moderate preterm 32-34 wks
Late preterm 34-36wks

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132
Q

Replacement of losses for dehydration

A

<10kg: 60-120mL ORS to each diarrheal stool or vomiting episode
>10kg: 120-140mL ORS for each diarrheal stool or vomiting episode

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133
Q

Rehydration therapy for mild-moderate dehydration

A

ORS 50-100mL/kg over 3-4h

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134
Q

Rehydration therapy for severe dehydration

A

Lactate Ringer’s solution or NS in 20mL/kg until mental status improves THEN 100mL/kg body weight ORS over 4h or D5 1/2 NS IV at twice maintenance fluid rates

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135
Q

Replacement therapy for severe dehydation

A

D5 1/4 NS with 20mEq/L KCl

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136
Q

Surgical abdomen that has bilious vomiting

A

Malrotation with volvulus

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137
Q

Surgical abdomen that has projectile, non-bilious vomiting

A

Pyloric stenosis

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138
Q

Hallmark electrolytes in pyloric stenosis

A

Hypochloremic, hypokalemic metabolic alkalosis with dehydration

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139
Q

Radiological sign of pyloric stenosis via upper GI contrast study

A

String sign (narrow pyloric channel)

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140
Q

Intussusception symptoms

A

Bilious emesis and red current jelly stools

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141
Q

Duodenal intestinal atresia associated with…

A

Trisomy 21

Congenital heart disease

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142
Q

Xray imaging sign for duodenal intestinal atresia

A

Double bubble

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143
Q

Symptoms of intestinal atresia

A

Abdo distention
Bilious emesis
Hyperbilirubin –> jaundice
Possible polyhydramnios in utero

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144
Q

IV fluid bolus

A

Isotonic (0.9%) NS at 20mL/kg over 60min

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145
Q

DKA definition

A

Random glucose >11.1mmol/L AND
pH < 7.3 or bicarb <15mmol/L AND
Moderate or large ketonuria or ketonemia

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146
Q

Diagnosing DM in peds

A

Symptoms of diabetes (polyuria, polydipsia, unexplained weight loss) + random glucose >11.1 OR
Fasting glucose >7 OR
2h post-Oral glucose challenge >11.1
HbA1c not usually used in peds but >/= 6.5% in adult

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147
Q

Isotonic/isonatremic dehydration - time period for fluid replacement

A

Over 12h

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148
Q

Hypotonic/hyponatremic - time period for fluid replacement

A

Over 24h
Risk of central pontine myelinolysis
(ie. patient consumes diluted fluids/water when dehydrated)

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149
Q

Hypertonic/hypernatremic - time period for fluid replacement

A

Over 48h
Risk of cerebral edema
(ie. DKA)

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150
Q

Add dextrose to fluid maintenance once glucose levels drop below

A

16.7mmol/L

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151
Q

Cushing’s triad of increased ICP

A

High BP
Low HR
Irregular respiration

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152
Q

Most common AI diseases associated with DKA

A

AI thyroid disease

Celiac disease

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153
Q

Traditional regimen 2/3, 1/3 insulin

A

2/3 in AM - 1/3 rapid and 2/3 intermediate acting

1/3 in PM - 1/6 rapid with dinner, 1/6 intermediate acting at bedtime

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154
Q

Basal bolus regimen for T1DM

A

Half of total given at bedtime in long-acting form (insulin glargine)
other half split up into 3 doses with meals (rapid)

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155
Q

T2DM screening guidelines in peds

A

Screen all overweight children (BMI >85th percentile) PLUS any 2 of :
- Maternal hx of diabetes or GDD
- Fam hx of T2DM in 1st or 2nd degree relative
- Race/ethnicity
- Signs of insulin resistance (acanthosis nigricans, HTN, dyslipidemia, PCOS)
Screen by fasting plasma glucose starting at 10yo onset of puberty and 13yrs

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156
Q

T2DM treatment

A

Start treating right away if random glucose >13.9mmol/L or HbA1c >9%

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157
Q

Name of enzyme that conjugates bilirubin in liver

A

Glucuronsyl transferase

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158
Q

Kernicterus

A

Pathological consequence of elevated unconjugated bill –> bill staining the basal ganglia and CN nuclei

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159
Q

Physiologic jaundice

A

Total bili = 257umol/L in full term infants who are otherwise healthy
Seen in 2-3 d of life, peaks at 3-4d

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160
Q

Breastfeeding jaundice

A

Early in first week of life
Low breast milk –> slow gut motility –> beta glucuronidase in meconium
2nd most common cause of neonatal jaundice

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161
Q

Breastmilk jaundice

A

Presents after 1st week of life, can persist up to 12 wks

Beta-glucuronidase in breastmilk

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162
Q

2 diseases that are antibody negative hemolytic cause of anemia due to RBC enzyme deficiency

A
  1. G6PD deficiency

2. Pyruvate kinase deficiency

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163
Q

Crigler-Najjar Syndrome

A

Auto-recessive
Causes unconjungated hyperbili
Type 1 - glucuronosyl transferase absence (more severe)
–> Tx = lifelong phototherapy
Type 2 - glucuronosyl transfersation dysfunction
–> Tx = Phenobarbital

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164
Q

Gilbert Syndrom

A

Not as severe, usually presents in adolescence

Dysfunction of glucuronosyl transferase

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165
Q

Biliary atresia

A

Jaundice, dark urine and pale stools presenting at 3-6wks of age
Tx - Kasai procedure

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166
Q

Caput succadaneum

A

Swelling commonly from SVD in vertex position
Serum, crosses suture lines
Does not cause hyperbili

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167
Q

Cephalohematoma

A

Subperiosteal hemorrhage
Blood, does NOT cross suture lines
Causes hyperbili

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168
Q

Photherapy

A

For unconjugated hyperbili
Expect 30-40% decline in first 24h
If no decline, consider HEMOLYSIS as cause

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169
Q

MEC should no longer appear in stool by day…

A

3

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170
Q

Conjugated hyperbili

A 
If >20% of TSB is conjugated
Think obstruction (cholestasis), hepatitis or AI diseases
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171
Q

CPR in child

A

100-120 compressionsmin

Depress chest at least 1/3 AP diameter

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172
Q

Infant Colic

A

Crying for more than 3h/d, for at least 3 days/wk for 3wks

Typically starts after 2wks of age, peaks at 6 wks, lessens by 3-4mo

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173
Q

Brief resolved unexplained event (BRUE)

A

Occurs in infan <1yo when observer reports sudden, brief, now resolved episode that includes on or more of the following:
Cyanosis or pallor
Absent, irregular or decreased breathing
Marked change in tone (hyper or hypo)
Altered level of responsiveness

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174
Q

Distinguishing between restrictive and obstructive lung disease

A 
Restrictive = normal FEV1/FVC ratio (both decrease) 
Obstructive = lower FEV1/FVC ratio
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175
Q

Spirometry finding for asthma dx

A

FEV1/FVC < 80% with 12% improvement in FEV1 after SABA

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176
Q

Scoring system used to assess severity of acute asthma exacerbation

A 
PRAM Score 
O2 sat 
Suprasternal retractions
Scale muscle contractions
Air entry 
Wheezing
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177
Q

Mild acute asthma exacerbation

A

PRAM score of 0-3

Salbutamol q20min x 1-2 doses in first hour

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178
Q

Moderate acute asthma exacerbation

A

PRAM score of 4-7
Salbutamol q20min x 3 doses AND
Ipratropium q20min x 3 doses in first hour

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179
Q

Mild persistent asthma

A

Symptoms >2d/wk but not daily
PM awakenings 1-2x/mo if <4yrs, 3-4x/month if >/= 5mo
SABA use >2d/k but not daily and not more than 1x/day
Minimal limitation of normal activity
FEV1 >80%
FEV1/FVC 80%

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180
Q

Moderate persistent asthma

A 
Symptoms daily 
PM awakenings 3-4x/mo if <4yrs, >1x/wk but not nightly if >/= 5yrs 
SABA use daily 
Some limitation of normal activity
FEV1 60-80% 
FEV1/FVC 75-80%
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181
Q

Severe asthma

A 
Symptoms daily
PM awakenings >1x/wk if <4 yrs, >7x/wk if >/=5yrs 
SABA use several times per day
Extreme limitation of normal activity 
FEV1 <60% 
FEV1/FVC <75%
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182
Q

Mild persistent asthma tx

A

Daily low dose ICS

SABA reliever med as needed

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183
Q

Mod persistent asthma tx

A

Daily med dose ICS
If >12yrs, add LABA (affair, symbicort, salmeterol)
SABA reliever med as needed

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184
Q

Severe asthma tx

A

Refer to specialist

AND/OR Leukotriene receptor antagonist or LABA in combo with med dose inhaled steroids

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185
Q

Vitamin K given to newborns to prevent

A

Hemorrhagic disease of the newborn

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186
Q

Erythromycin eye ointment given to newborns to prevent

A

Ophthalmia neonatarum caused by N. gonorrhoea
Causes globe rupture and blindness
No protection against chlamydia trachoma’s conjunctivitis which is more common

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187
Q

Hearing screen

A

Should be done before 1mo of age (usually as newborn before d/c)
if failed, then repeat at 3mo
If failed twice then needs more formal assessment
Repeat at 4yo

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188
Q

Tx for congenital hypothyroid

A

Levothyroxine ASAP 10-15mcg/kg/d

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189
Q

Juvenile idiopathic arthritis

A

<16yo, arthritis in at least 1 joint for >6wks
Fleeting salmon-coloured rash of discrete macule on trunk and extremities
A/W Iridocyclitis

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190
Q

Oligoarthritis

A

Typically affects knee, onset of arthritis is acute a/w asymptomatic iridocyclitis
Affects = 4 joints for >/= 6 weeks

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191
Q

Slipped capital femoral epiphysis

A

Most common hip d/o in adolescents (boys > girls)
Affected leg is shortened and externally rotated
Months of vague hip or knee symptoms and limp
Tx: Internal reduction of femoral head

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192
Q

Legg-Calve-Perthes Disease

A

Most commonly affects boys btwn 4-10
Avascular necrosis of femoral head
Typically self-resolving, casting and crutches to keep joint ABducted and internally rotated to keep head in acetabulum
Complications - femoral head deformity, degenerative arthritis

193
Q

Developmental dysplasia of the hip

A

Infants where femoral head is not properly aligned with acetabulum
Common in females born by breech with fam hx of DDH
Tx: Newborn wears pavlik harness –> closed reduction and spica cast at 6mo-2yrs

194
Q

Ortolani maneuver

A

Assesses for dislocated hip by abduction of flexed hip with gentle anterior force

195
Q

Barlow maneuver

A

Assesses for dislocatable hip by adduction of flexed hip with gentle posterior force

196
Q

Holosystolic murmur ddx

A

VSD (starting with S1, blowing)
Mitral insufficiency
Tricuspid insufficiency

197
Q

Continuous murmur

A

Patent ductus arteriosus

198
Q

Most common murmur

A

Still’s murmur
3-7 yo
Musical or vibratory
Best heard at LLSB in supine position

199
Q

Atrial septal defect murmur

A

First detected at age 3-5
Systolic murmur caused by increased flow through pulmonic valve
Widely split, fixed S2
Best heard at ULSB

200
Q

Coarctation of the aorta

A

Systolic murmur with loud S2 bet heard at ULSB, L axilla and L unterscapular area
Presents in infancy
Check BPs

201
Q

Ventricular septal defect murmur

A

Most common in infancy
Holosystolic murmur with possible wide split S2
Best heard at LLSB

202
Q

Meds for CHF due to VSD

A

Furosemide
Digoxin
Enalapril (ACEi causes after load reduction –> more bloodflow out to systemic vasculature than through VSD)

203
Q

Eisenmenger syndrome

A

Pulmonary HTN gets so severe that pulmonary pressure > systemic pressure –> R to L shunting –> RV hypertrophy –> cyanosis –> polycythemia –> HF –> death

204
Q

Aortic stenosis murmur

A

Systolic ejection murmur followed by early diastolic murmur of aortic insufficiency

205
Q

Pulmonic stenosis

A

Prominent systolic ejection click just after S1

206
Q

Tetralogy of Fallot

A

R –> L shunt

  1. VSD
  2. RV out flow tract obstruction
  3. Overriding aorta
  4. RVH
207
Q

Henoch-Schonlein Purpurs (HSP)

A

NON-thrombocytopenic purpura
Self-limited, IgA-mediated small vessel vasculitis that typically involves tetrad of RASH, ARTHRALGIAS, ABDO PAIN, RENAL INVOLVEMENT
A/W hematuria (possible progression to renal failure), arthralgias, colicky abdomen pain, intestinal bleeding with FOBT, possible intussusception
Tx: supportive management, steroids controversial

208
Q

Most common cause of isolated thrombocytopenia in otherwise healthy child

A

idiopathic thrombocytopenic purpura

209
Q

Idiopathic thrombocytopenic purpura

A

Most cases follow non-specific viral illness
NOT a/w splenomegaly and hepatomegaly
Isolated thrombocytopenia with normal plt morphology
Tx depends on severity
Ranges from watchful waiting to methylprednisilone (1st line), IVIG (2nd line) and platelet transfusions

210
Q

HEEADSSS

A 
Home
Education
Eating 
Activities 
Drugs 
Sexuality 
Safety
Suicide
211
Q

First and most subtle sign of possible inadequate perfusion

A

Tachycardia

212
Q

Pediatric sepsis treatment

A

20cc/kg NS boluses over 5-20 min to a max of 60cc/kg
Give bolus even in its with relative C/I to receiving large amounts of fluids (ie. meningitis, SIADH)
Once reached max and pt’s perfusion still inadequate, give inotropic support (epinephrine, norepinephrine, dopamine)

213
Q

Leading cause of bacterial meningitis in children

A

Neisseria meningitides

214
Q

Definitive tx for meningococcal disease

A

Pen-G

215
Q

Tx for carrier status of meningococcal disease

A

Adults: Ciprofloxacin
Peds: Ceftriaxone, azithromycin or rifampin

216
Q

Antibiotic choice for Rocky Mountain Spotted Fever

A

Doxy

217
Q

Toddler fracture

A

Subtle, non-displaced oblique fracture of distal tibia in young walking children (9mo-3yrs)

218
Q

Tests to order post-strep

A

Anti-streptolysin-O (ASO)

Low C3

219
Q

Causes or primary nephrotic syndrome from most to least common

A

Minimal change disease
Focal segmental glomerulonephritis
Membranoproliferative glomerulonephritis

220
Q

Most frequent infectious complication associated with nephrotic syndrome

A

Spontaneous peritonitis

221
Q

HTN defined as

A

Systolic OR diastolic >95th percentile measured on 3 or more occasions, preferably several weeks apart

222
Q

Urine protein:creatinine ratio

A

<0.2 = normal in children >2yo
< 0.5 = normal in children <2yo
>1 = suspicious for nephrotic syndrome
>2.5 = dx for nephrotic syndrome

223
Q

Streptococcal infection rash

A 
Scarlet fever rash 
Erythematous, sand-paper rash 
Accentuated at skin creases
Starts on face/neck --> trunk, arms, legs 
Blanchable
224
Q

Erythema multiforme

A

`Symmetrical rash that starts as dusky macule and forms target lesions
Often triggered by infections (HSV)
1-3 wks
Conservative maanagement

225
Q

Erythema migrant

A

A/W early localized Lyme disease

226
Q

Head lice

A

AKA pediculosis capitis

Tx: 1% permethrin lotion, 2-3 repeated applications in weekly intervals

227
Q

Scabies

A

5-10mm curvilinear thread-like lesion (burrow)

TxL 2 applications of permethrin 5% cream, 1 wk apart

228
Q

Tinea capitis treatment

A

Systemic therapy required

Griseofulvin (oral anti fungal )

229
Q

Diaper rash common causes

A

Irritant dermatitis
Diaper candidiasis
Bacterial infection (perianal GAS)

230
Q

Irritant dermatitis diaper rash

A

Most common cause of diaper rash
Typically spares intertriginous creases
Tx: Barrier cream with Zinc-oxide

231
Q

Diaper candidiasis

A

Erythematous papule that become confluent plaques with satellite lesions
Tx: Antifungal nystatin, imidazole antifungals (miconazole, ketoconazole)

232
Q

Bacterial infection causing diaper rash tx

A

Oral abx

233
Q

Neonatal acne associated with…

A

Malassezia species

234
Q

Erythema toxicum

A

Idiopathic benign self-limiting cutaneous eruption of full-term newborns
Blotchy, macular erythema
Progresses to 1-3mm yellow/white papule and pustules
Day 2-10 of life
No tx needed

235
Q

Neurofibromatosis Type 1

A

Need at least 2 of 7:

  1. Cafe au last spots (>/=6, 0.5cm if pre-puberty and >1.5cm if post-puberty)
  2. Axillary/groin freckling
  3. Auto dominant (first-degree relative affected)
  4. Neurofibromas present
  5. 2 or more Lisch nodules (iris hamartomas) - no clinical significance –> seen later in dz
  6. Optic nerve gliomas
  7. Patognomonic skeletal dysplasia
236
Q

Risk associated with tobacco use during pregnancy

A

Low birth weight

237
Q

SGA

A

Diagnosed at birth

<3rd or <5th percentile

238
Q

IUGR

A

Dx during pregnancy
Height and weight <2SD mean for GA
Usually catch-up

239
Q

Symmetric IUGR

A

Growth pattern in which head, length, weight are decreased proportionately
Can be caused by congenital infections
Early pregnancy

240
Q

Asymmetric IUGR

A

Growth pattern in which decrease in size of length and/or weight without affecting head circumference
Can be caused by poor fetal nutrition (i.e. maternal smoking), placental insufficiency
More favourable than symmetric

241
Q

Risk factors for early onset GBS

A

Prolonged rupture of membranes
Prematurity
Intrapartum fever
Previous delivery of infant with GBS disease

242
Q

Prophylaxis against GBS administered if ONE of the following is present and mother is in labour with ruptured membranes

A

Prev infant with GBS dx
GBS bacteriuria during any trimester of current pregnancy
+ve GBS vag-rectal screening culture in late gestation
Unknown GBS status and any of the following:
- <37 wks GA
- Amniotic membrane rupture >/= 18h
- Intrapartum temp >/= 38C
- Intrapartum NAAT +ve for GBS

243
Q

Rubella

A

Prodrome of low grade fever, headache, mild pink eye, myalgia, swollen/enlarged lymph nodes, cough, runny nose
Rash on face that spreads to rest of body, lasts ~3d

244
Q

Caloric requirements for term infant

A

100-120 cal/kg/d

245
Q

Caloric requirements for pre-term infant

A

115-130cal/kg/d

246
Q

Caloric requirements for very low birth weight infant

A

Up to 150cal/kg/d

247
Q

First line imaging for abdo mass

A

U/S

248
Q

Preventing dental caries

A

No bottle use by the time child is 12-15mo

Supplement with fluoride

249
Q

Intoeing in toddlers

A

Caused by tibial torsion

Resolves by ~4yo

250
Q

Intoeing in school-aged children

A

Caused by femoral ante version

Resolves by 8-12yo

251
Q

Common cause of normocytic anemia in children

A

Transient erythoblastopenia of childhood

Post-viral in school-aged children, recovers in 2mo

252
Q

Vision screening begins at

A

3yo

253
Q

Psych condition with highest comorbidity rate with ADHD

A

Oppositional defiant disorder

254
Q

Empiric abx of choice for UTI

A

Cephalexin (Keflex)

255
Q

Antibiotic to be avoided in neonates

A

Ceftriaxone (knocks off bill from Albumin –> risk of kernicterus; also avoid in pregnant women 48h before delivery)
Tetracycline avoid <8yo (teeth staining)
Nitrofuratnoin (hemolytic anemia)
Septra <2mo (risk of G6PD)

256
Q

Abx choice for PNA PO step-down

A

Cefprozil

257
Q

Only cephalosporin with pseudomonas activity

A

Ceftazidime

258
Q

PNA treatment in >3mo (mild)

A

Amoxicillin

259
Q

PNA treatment in >3mo (moderate)

A

Amp +/- Clarithromycin +/- Oseltmavir

260
Q

PNA treatment in >3mo (severe)

A

Cefotax +/- Vanco +/- Clarithro PO +/- Oseltmavir PO

261
Q

GBS treatment

A

Penicillin G mono therapy

262
Q

Most likely pathogens for cervical lymphadenitis

A 
Staph aureus 
Strep pyogenes (GAS)
263
Q

Most likely pathogens for preseptal cellulitis

A

Strep pneumo

Staph aureus

264
Q

Most likely pathogens for orbital cellulitis

A

Staph aureus
Strep pneumo
Other strep spp
Haemophilus influenza

265
Q

Most likely pathogens for community acquired pneumonia in 1-3 months

A 
Strep pneumo
Strep agalactiae (GBS) 
Staph aureus 
E. coli
Chlamydia trachoma's
266
Q

Most likely pathogens for community acquired pneumonia >3mo

A 
Viruses 
Strep pneumo
Haemophilus influenza 
Staph aureus 
Strep pyogenes 
Mycoplasma pneumonia
Chlamydia pneumonia
267
Q

Most likely pathogens for infective endocarditis

A

Viridans strep

Staph aureus

268
Q

Most likely pathogens for PID

A

Neisseria gonorrhoea
CHlamydia trachoma’s
Anaerobic organisms

269
Q

PID tx

A

Cefixime PO Or ceftriaxone IM
+ Doxycycline PO or Azithro PO
+/- Metronidazole PO

270
Q

Most likely pathogens for bacterial gastroenteritis

A 
Salmonella
Shigella
Campylobacter
E. coli 
Plesiomonas shigelloides
Aeromonas hydrophily
271
Q

Tx for bacterial gastroenteritis

A

Not routinely required

If severe then tx according to susceptibilities

272
Q

Most likely pathogens for cellulitis

A

GAS

Staph aureus

273
Q

Tx for mild cellulitis

A

Cephelexin PO or Septra PO

274
Q

Tx for severe cellulitis

A

Cefazolin or Vancouver (if MRSA)

275
Q

Dog/cat/human bites most likely pathogens

A 
Staph aureus
Strep spp 
Eikenella corrodens (human)
Pasteurella spp (dog/cat)
Capnocytophaga cynodegmi (dog/cat) 
Anaerobic organisms 
Usually polymicrobial
276
Q

Dog/cat/human bites tx for mild and severe cases

A

Mild: Amox-clav PO
Severe: Pip-Tazo

277
Q

OM or septic arthritis tx

A

Cefazolin or Vanco

278
Q

Gross motor milestone at 4mo

A

Rolls prone to supine
Able to lie prone and push up onto elbows
Moro reflex may/maynot be present

279
Q

Gross motor milestone at 6mo

A

Sits unsupported

Fencing reflex should disappear

280
Q

Gross motor milestone at 5mo

A

Rolls supine to prone

281
Q

Gross motor milestone at 8mo

A

Crawling

282
Q

Gross motor milestone at 9-10mo

A

Cruising

283
Q

Gross motor milestone at 12mo

A

Walks
Extensor plantar response seen until 12mo
Drinks from a cup

284
Q

Gross motor milestone at 15mo

A

Runs

285
Q

Gross motor milestone at 18 mo

A

Goes up stairs holding adult’s hand

Feeds self

286
Q

Gross motor milestone at 3yo

A

Rides tricycle

Goes up and down stairs with alternating feet

287
Q

Gross motor milestone at 4yo

A

Hops on one foot

Balances on one foot

288
Q

Gross motor milestone at 5yo

A

Skips with alternating feet
Rides 2 wheeler
Plays games with rules
balances for 10s on one foot

289
Q

Fine motor milestone at 1 mo

A

Visual fixation

290
Q

Fine motor milestone at 3mo

A

Brings hands to midline

291
Q

Fine motor milestone at 6mo

A

Puts toys in mouth

Transfers objects hand to hand

292
Q

Ability to follow object visually at age

A

3mo

293
Q

Fine motor milestone at 8mo

A

Pincer grasp

294
Q

Fine motor milestone at 6mo

A

Trying to get things that are out of reach

295
Q

Fine motor milestone at 12mo

A

Copy gestures such as clapping

296
Q

Fine motor milestone at 18mo

A

Handing things to others as play
Stacks 3-4 cubes
Emergence of hand preference
Kicks ball, throws ball

297
Q

Fine motor milestone at 2 yrs

A

Copies a line

Stacks 6 cubes

298
Q

Fine motor milestone at 3yo

A

Buttons and zippers

Copies a circle

299
Q

Fine motor milestone at 4yo

A

Copies a square, uses scissors, chopsticks, brush teeth

300
Q

Fine motor milestone at 5yo

A

Copies a triangle, prints first name, starts tying shoelaces, mature tripod grasp of pencil, cuts along line, copies triangle

301
Q

Fine motor milestone at 6yo

A

Draws man with fingers, 2D arms and legs

Ties shoelaces

302
Q

Cognitive milestone at 4mo

A

Out of sight, out of mind

303
Q

Cognitive milestone at 8mo

A

Aware that if object is out of sight, may still exist and have fallen to ground

304
Q

Cognitive milestone at 12mo

A

Child will search for completely hidden object

305
Q

Toilet training

A

Start at 18mo

Most are toilet-rained by 3yo

306
Q

Independent with ADLs by age

A

5yo

307
Q

Social milestone at 1mo

A

Social smile

308
Q

Social milestone at 5mo

A

Clear preference for primary caretakers

309
Q

Social milestone at 9mo

A

Stranger anxiety develops

310
Q

Social milestone at 18-20mo

A

Starts to pretend

311
Q

Galactogogues

A

Metoclopramide, Domperidone

= DA antagonists

312
Q

Lactational mastitis

A

Most common in first 6wks postpartum
Tx: Cold compresses, anti-inflammatories, good breastfeeding techniques
Abx : No MRSA –> Cephalexin, MRSA risk –> Septra or Clinda

313
Q

Tx for low risk febrile neutropenia

A 
IV mono therapy:
Ceftriaxone 
Pip-Tazo
Cefepime 
Carbapenems
314
Q

Tx for high risk febrile neutropenia

A

Pip-Tazo, add gentamicin if unstable

315
Q

Tx for septic shock febrile neutropenia

A

Vanco + Gentamicin + Meropenem

316
Q

Meds that requires therapeutic drug levels

A

Gentamicin, Vancomycin
Anticonvulsants
Immunosuppresants (tac, cyclosporine)

317
Q

Drugs to avoid with EBV

A

Amoxicillin, Ampicillin

Can cause nonallergic morbilliform rash

318
Q

Oral thrush

A

Most commonly caused by Candida albicans
Pseudomembranous oropharyngeal candidiasis
Tx: Nystatin suspension

319
Q

All pulses poor

A

Myocardial problem

320
Q

Palpable paradoxus

A

Pericardial effusion

321
Q

Bounding pulses

A

PDA, truncus arteriosus, AI, AVM, sepsis

322
Q

Femorals < brachial

A

Coarctation

323
Q

Right racial only pulse palpable

A

Interrupted aortic arch

324
Q

Medication used to keep ductus arterioles open

A

Prostin 0.05mcg/kg/min

325
Q

Transposition of the great arteries

A

Most common heart defect presenting with cyanosis in newborn
Aorta comes off RV, Pulmonry artery comes off LV
Requires ASD, VSD, PDA to survive
Needs intervention right away

326
Q

Features of innocent murmur

A 
Never a/w thrill 
Normal hx 
Normal peripheral exam 
Never in diastole 
normal S2 
Usually low-pitched ejection
Changes with position
327
Q

Common ECG finding in new born

A

Right Axis Deviation

328
Q

Trisomy 21 with LAD

A

AVSD

329
Q

Syndromal look with LAD

A

Noonan’s

330
Q

Normal child with LAD and cyanosis

A

TGA

331
Q

Tricuspid atresia ECG finding

A

LAD (no right AV connection –> uses ASD to send blood to left side and VSD to send blood to pulmonary arteries = LV has to pump blood to pulmonary and systemic systems –> LV hypertrophy –> LAD)

332
Q

Familial short stature

A

Appropriate for mid-parental height
Bone age = chronological age
normal growth velocity

333
Q

Constitutional growth delay

A

Delay at 18mo-3yrs
After 3yrs grow at normal rate –> catch up
May have delayed puberty

334
Q

Clue to chondrodystrophies causing abnormalities of cartilage or bone dz

A

Height:arm span ratio (should be within 3cm of each other)

335
Q

GH and IGF1 levels in malnutrition cases

A

GH levels vary

IGF1 levels low (esp in protein shortage diets)

336
Q

Tx for boys with constitutional growth delay

A

Testosterone 1x/month for 3 months –> induces puberty and increases growth rate –> primes pituitary gland to take over once completed
Does NOT affect end adult height
No tx for girls

337
Q

Tx for child with hypothyroid (ie. Hashimoto’s Thyroiditis)

A

Adolescent/older child –> start low and go slow, if you correct too fast can cause hyperthyroid
Neonate –> load first then work down to maintenance (thyroid hormone necessary for brain myelination)

338
Q

Febrile seizure management

A

Benzo at 5min, 10min
If still seizing, then give phenobarbital at 15min over 20min
If still seizing, call ICU and secure airway

339
Q

Goal SBP

A

(2 x age in years) + 70

340
Q

Inotrope for warm shock

A

Norepinephrine

341
Q

Inotrope for cold shock

A

Epinephrine

342
Q

Parkland formula for burn rehydration

A

Volume of Ringer’s Lactate = 4mL x %BSA x weight (kg) –> half in first 8 h, then half in next 16h

343
Q

IV tx for hypoglycaemia in newborn

A

10% dextrose in 80mg/kg/d
Adjust pen to keep glucose >2.6mmol/L
IDM/LGA –> stop testing glucose when >/- 2.6mmol/L for 12h
Preterm/SGA –> stop testing when >36h of stable glucose and intake achieved

344
Q

Bucket handle fracture

A

Metaphyseal fracture/corner fracture
Caused by torsional/shearing force on limb or violent shaking
Pathognomic for abuse

345
Q

Most common form of child maltreatment

A

Neglect

346
Q

TEN-4

A

Bruising clinical decision rule
TEN = Torso, Ears, Neck (bruising in TEN region?)
Child <4mo?
If yes to one of these, workup for child abuse unless clear accidental cause of bruise

347
Q

Humerus fracture

A

Always concerning for abuse, esp in young infant

348
Q

Rib fracture

A

If abuse, usually in posterior at transverse process articulation (levering from shaking baby)

349
Q

Pittsburg Infant Brain Injury Score

A

Any skin abnormality –> 2pts
Age >/= 3mo –> 1pt
Head circumference >85th percentile –> 1pt
Hemoglobin <112 –>1pt

350
Q

Cyanotic baby ddx

A 
1,2,3,4,5
Truncus arteriosus 
TGA 
Tricuspid atresia, pulmonary atresia 
Tetralogy of ballot 
Total anomalous pulmonary venous return
351
Q

Poor pulses and LVH

A

Aortic stenosis

352
Q

Poor femoral and RVH

A

Coarctation of the aorta

353
Q

Normal ECG with cyanotic babe

A

TGA

354
Q

Ebstein’s anomaly

A

Tricuspid valve sits low and leaflets displaced towards apex of RV –> RA hypertrophy

355
Q

5 features that make it an epileptic event

A 
o	Post-ictal 
o	Not suppressible
o	Reproducible 
o	Stereotyped 
o	Eyes open
356
Q

Tx for idiopathic intracranial HTN

A

Acetazolamide
Optic nerve sheath fenestration
Therapeutic LP

357
Q

Ability to follow object at age

A

3mo

358
Q

Orbital cellulitis features not seen in periorbital cellulitis

A 
Pain with eye movements 
Diplopia 
Proptosis 
Vision impairment 
Chemosis
359
Q

Orbital cellulitis treatment

A

IV ceftriaxone + Vanco
OR Cefotaxime
OR Amp-sulbactam
OR Pip-Tazo
Switch to PO once afebrile and symptoms resolved (3-5d)
PO tx: Clindamycin mono, OR Clindamycin or Septra + amox or amox-clav (continue for 2-3 more wks)

360
Q

Periorbital cellulitis treatment

A

Oral output abx - clinda mono OR septa +amox or amox-clav

Tx for 5-7d

361
Q

Serious ddx to rule out for conjunctivitis

A

Acute angle glaucoma
Iritis
Keratitis

362
Q

Nocturnal enuresis

A

Episodes of urinary incontinence in children >/= 5yo

363
Q

Phimosis

A

Inability to retract foreskin

364
Q

Balanopothitis/Balantis

A

Inflammation of glans penis and foreskin vs Inflammation of glans penis only

365
Q

Phimosis tx

A

Physiological - no tx needed
Pathological (non retractable secondary to distal scarring) –> stretching exercises (gentle retraction), topical corticosteroids (betamethasone), circumcision

366
Q

Balanopothitis tx

A

Proper hygiene
Abx ointment (polysporin, bactrian)
Should resolve in 3-5d

367
Q

Vulvovaginitis abx tx if needed

A

10d amox PO or amox-clav
OR topical metronidazole
OR topical clindamycin

368
Q

Benefits of circumcision

A

Lower rates of STIs, penile cancer, UTI

369
Q

Major complication in circumcised males

A

Meatal stenosis (urine from wet diaper irritates meatus –> chemical dermatitis –> scarring)

370
Q

Most common CFTR gene mutation a/w Cystic Fibrosis

A

Delta F508

371
Q

Physiologic anemia

A

Mean hemoglobin in healthy 2mo = 112g/L
Marrow only stimulated to make new RBCs once 110g/L at 7-9wks of age
Fetal RBCs have short half life –> physiological nadir

372
Q

GERD

A

Peak onset at 1-4mo

Usually resolves by 1yo (more upright)

373
Q

Test to rule out malrotation

A

Barium swallow

374
Q

Major gene a/w celiac disease

A

HLA-DQ2

375
Q

Major complication of untreated celiac disease

A

Osteoporosis secondary to poor calcium and vitamin D absorption

376
Q

Intussusception classic triad

A

Inconsolable pain
Red currant jelly stool
Sausage on palpation

377
Q

Intussusception treatment

A

Barium or air enema

Surgery if failed

378
Q

Antibiotic associated with diarrhea

A

Erythromycin (promotability)

379
Q

Osmotic diarrhea

A

High stool osmolality compared to serum
Problem with absorption
Responds to NPO

380
Q

Secretory diarrhea

A

Stool osmolality equal to serum
Problem with secretion
Does not respond to NPO
Think Cholera

381
Q

Crohn’s disease

A

Regional enteritis - SI, LI, or both
Less likely to cause bloody stool
More likely to cause FTT
Dx: Upper and lower GI endoscopy with biopsy
Tx: Corticosteroids for acute, immunomodulators for maintenance (thiopurines, MTX, anti-TNF), surgery

382
Q

Ulcerative colitis

A 
Colon only 
Diarrhea usually bloody 
FTT less common 
Dx: MRI of SI, fecal calprotectin 
Tx: Corticosteroids for acute, immunomodulators for maintenance (thiopurines, MTX, anti-TNF), surgery
383
Q

Ulcerative colitis antibody marker

A

ANCA

384
Q

Crohn’s disease antibody marker

A

ASCA

385
Q

Stool assay for IBD protein marker

A

Fecal calprotectin

386
Q

Derm condition a/w IBD

A

Erythema nodosum

387
Q

Most common cause of anemia in childhood

A

Fe-deficiency anemia

Low Fe, low retics, high iron binding capacity

388
Q

HTN, oliguria, AKI, edema indicates

A

Acute Nephritic syndrome

389
Q

HTN med choice for child with HTN and edema secondary to acute nephritic syndrome

A

Diuretic (ie. high dose lasix 1mg/kg TID and titrate up)

390
Q

Nephritic vs nephrotic a/w HTN

A

Nephritic

391
Q

Hematuria definition

A

> /= 5 RBCs/hpf on urine microscopy

392
Q

Non-glomerular causes of hematuria

A

Hypercalciuria, stones, sickle cell, cystic disease

393
Q

Glomerular causes of hematuria

A

Post-infectious glomerulonephritis, IgA nephropathy, HSP, HUS, SLE, Familial thin basement membrane dz, Alports

394
Q

Nephrotic syndrome definition

A

Proteinuria (>50mg/kg/d)
Hypoalbuminemia (<25g/L)
Hyperlipidemia
Edema

395
Q

Proteinuria definition

A

> 100mg/m2/d or >22g protein/mol creatinine

396
Q

Treatment for nephrotic syndrome

A

Most likely minimal change disease which responds to steroids
Oral prednisone 2mg/kg to max 60-80mg for 6 wks, then alternate day dosing a 1mg/kg –> wean off over 6mo
na+ restrict
If edema, treat with IV lasix and 25% albumin

397
Q

Seborrheic dermatitis

A

AKA cradle cap
Older patients caused by Malassezia fungus
Tx:
Baby oil and small brush
Frequent shampooing with baby shampoo, if resistant get rx shampoo with ketoconazole or pyrithione zinc
Low potency topical steroid (hydro)
Ketoconazole cream in older children

398
Q

Parvo B19 rash

A 
Stage 1 (2-3d after prodrome): Fiery red facial eruption
Stage 2 (1-4d after facial rash): Lacy reticulated eruption on extremities and trunk 
Stage 3: intermittent waxing and waning of reticular rash 
Not infectious anymore once rash develops
399
Q

Complication of Parvovirus B19

A

In pregnant women can cause fetal hydrous

400
Q

Test solution for nickel

A

Dimethylglyoxime in 10% aqueous solution of ammonia

401
Q

Sturge-Webber Syndrome

A

Port-wine stain on face

Neuro symptoms - seizures, glaucoma

402
Q

Newborn milia

A

Resolves within 3-4 wks

No tx needed

403
Q

Tuberosclerosis

A 
Hypopigmented macule (ash-leaf) spots
Angiofibromas often in malaria region 
Cardiac rhabdomyoma 
Renal angiomyolipomas --> HTN, CKD 
Seizures
404
Q

Pityriasis alba

A

Asymptomatic hypo pigmented scaly patches
Commonly in atopic dermatitis patients
Esp noticeable after summer b/c don’t tan as well
Supportive tx

405
Q

Ataxia telangiectasia

A

Truncal ataxia –> axial ataxia in infancy
Conjunctival telangiectasias
Immunodeficiencies
Predisposition to malignancy

406
Q

Phenylketonuria (PKU)

A

Auto recessive disorder of AA metabolism caused by deficiency in phenylalanine hydroxylase
Detected by newborn screen
Vomiting, hypotonia, musty odor, developmental delay, decreased pigmentation of hair/eyes
Tx: Phenylalanine-restricted diet

407
Q

Sleep through the night by age

A

4-6mo

408
Q

5-2-1-0 Rule

A

5 servings of fruits/veggies per day
= 2h screen time/d (no screen time <2yo)
>/= 1h of physical activity per day
0 sugar sweetened drinks per day

409
Q

ADHD subtypes

A

Inattention
Hyperactive/Impulsive
Combined

410
Q

ADHD Screening Test

A

Vanderbilt Assessment Scale

411
Q

von Willebrand disease treatment

A

Intranasal or IV desmopressin

412
Q

Female puberty stages by age

A 
Puberty during 8-13yo 
10-11: breast buds, pubic hair 
12: growth spurt 
12-13: periods begin
15: adult height
413
Q

Male puberty staged by age

A 
Puberty during 10-15yo 
12: testicles grow, pubic hair 
13-14: Growth of penis/scrotum, first ejaculations 
14: Growth spurt 
17: Adult height
414
Q

Sleep stage GHRH is released during

A

Stage 4

415
Q

Thyroid hormones role in growth

A

Direct effect on growth of epiphyseal cartilage
Needed to release GH from pituitary
Needed for post-natal growth only

416
Q

Sex steroids role in growth

A

Augments GH pulsatility

Does NOT play a role prior to puberty

417
Q

Growth inhibitory peptides

A

Cytokines (ie. TNF) regulate programmed cell death

418
Q

Cortisol affect on growth

A

High levels act on epiphyses to inhibit growth

Affect levels of GH, IGF-1, IGFBP3

419
Q

In utero growth most dependent on

A

Nutrition
Insulin
IGF-2

420
Q

Height deficiency but okay weight gain, think of…

A

Endocrinopathy

421
Q

Graves’ disease

A

Anti TSHr

422
Q

Hashimoto’s disease

A

Anti-TPO (Thyroperoxidase)

423
Q

Thyroiditis

A

Anti-Thyroglobulin (Anti Tg)/Anti-TPO

424
Q

Cortisol testing

A

If suspecting Cushing’s: Dexa suppresion

If suspecting deficiency: AM cortisol

425
Q

Hypopituitarism tx order

A

CORTISOL FIRST > Thyroid > GH

426
Q

Diabetes insipidus test

A

Water deprivation

Deprive water for 8h –> >3% weight loss, serum osmolality increase and UO < 600mosm/kg = DI

427
Q

Nephrogenic vs central diabetes insipidus

A

ddAVP (synthetic ADH) –> if urine osm does NOT increase by much = nephrotic, if urine osm increases to >700mosm/kg = central DI

428
Q

False results from heel stick blood test

A

Hb higher and platelets lower

429
Q

Fe-def treatment

A

3-6mg/kg elemental iron daily for 3 months

430
Q

Fe-def anemia lab work restyle

A 
Low Fe 
Low ferritin
Hb <110 
Low MCV 
High TIBC 
High RDW 
Low relic count 
High transferrin
431
Q

RDW to distinguish thalassemia from Fe-def

A 
Thalassemia = small RDW 
Fe-deficiaency = High RDW
432
Q

Diagnosing Fe-deficiency

A

6-24mo: Fe supplement trial

Older children: Bloodwork

433
Q

Blast smear

A

Leukemia

434
Q

Microcytic hypo chromic smear

A

Fe-deficiency

435
Q

Spherocytes on smear

A

HS or AIHA

436
Q

Schistocytes on smear

A

HUS, TTP, MAHA

437
Q

Blister cells on smear

A

G6PD

438
Q

Transient erythroblastopenia of childhood

A

Post-viral in school-aged children
Otherwise healthy
Recover in 2mo

439
Q

Diamond blackfan

A

Bone marrow disorder where it fails to make enough RBCs

440
Q

Bloodwork supporting hemolysis

A 
Normocytic anemia 
High LDH
High indirect bili
Plasma free Hb
Reduced haptoglobin
441
Q

Hereditary spherocytosis

A

Inherited erythrocyte membrane defect that causes lifespan to be 10-30d instead of 120d
Anemia, jaundice, splenomegaly
Dx: Peripheral blood smear –> spherocytosis
Tx: Supportive, folic acid, possible splenectomy

442
Q

HUS

A

Bloody diarrhea, thrombocytopenia, and microangiopathic hemolytic anemia, AKI
Shiga toxin, Strep pneumo
Tx: Support care

443
Q

MAHA

A

TTP - Thrombotic thrombocytopenia purpura (severely reduced activity of vWF cleaving protease ADAMTS13)
DIC - Activation of coag system from sepsis, trauma, malignancy
Tx - PLEX if feeling unwell, severe anemia, thrombocytopenia, fragmented RBCs, renal failure; anti-complement, transfusion of RBCs/plts

444
Q

Hemophilia A

A

Factor VIII deficiency

445
Q

Hemophilia B

A

Factory IX deficiency

446
Q

Hemophilia C

A

Factor XI deficiency

447
Q

Anticonvulsants during pregnancy can lead to

A 
Cardiac defects
Dysmorphic cranial features
Hypoplastic nails 
IUGR 
Microcephaly 
Mental retardation
448
Q

Chorioretinitis of the newborn may be due to

A

Congenital toxoplasmosis and CMV infections

449
Q

Cocaine use during pregnancy

A

Not typically a/w withdrawal symptoms

Linked to subtle deficits later in childhood - cognitive performance, attention

450
Q

Fetal alcohol syndrome characteristic facial features

A

Thin upper lip
Smooth philtrum
Small palpebral fissures

451
Q

Congenital rubella presentation

A

Sensorineural deafness
Eye abnormalities
PDA

452
Q

Congenital CMV presentation

A

Microcephaly
Jaundice
Low birth weight
Petechiae

453
Q

PKU

A

Auto recessive
Mutation in phenylalanine hydroxyls
Vomiting, hypotonia, musty odor, developmental delay, decrease pigmentation of hair and eyes

454
Q

General ADHD dx requirements

A

6 or more symptoms in 2 or more settings for at least 6 months, several symptoms presenting before age 12

455
Q

Overweight vs obesity definitions

A 
Overweight = BMI 85-95th percentile 
Obese = BMI >95th percentile
456
Q

Treatment for vWF disease

A

Desmopressin

457
Q

Female puberty stages

A

Breast bud > pubic hair > growth spurt > menarche

458
Q

Male puberty stages

A

Testicular enlargement > pubic hair appearance > growth of penis and scrotum > first ejaculations > growth spurt

459
Q

Congenital hypothyroidism

A

Clinically evident at 6wks
Circulating maternal thyroid hormone transmitted from placenta
Feeding problems, large fontanels, hypotonia, large tongue, coarse cry, umbilical hernia
Picked up on neonatal screening
Most often due to aplasia or hypoplasia of thyroid gland

460
Q

Congenital adrenal hyperplasia

A 
Abnormal genitalia (females)
Poor feeding 
Vomiting
Dehydration
Electrolyte changes 
Low Na, High K, low cortisol, low aldosterone 
Elevated 17-OH progesterone 
Presents at 1-2wks
461
Q

Ornithine transcarbamylase (OTC) deficiency

A

Most common urea cycle d/o
Hyperammonemia
Elevated urine orotic acid
X-linked

462
Q

Factors that decrease insensible losses

A

CHF
Renal failure
ADH release
Mechanical ventilation

463
Q

NPO orders for children

A
  • No solids after midnight
  • May have formula until 2AM
  • May have breastmilk until 4AM
  • May have clear fluids until 6AM, complete NPO after
  • Start IV fluids at 6AM
464
Q

NPO orders for neonates

A
  • Higher fluid requirements
  • Term: 60cc/kg/d
  • Pre-term: 80cc/kg/d
  • Increase 20cc/kg/d until day 7 (150ml/kg/d)
  • Ex. For 3kg newborn
    • Day 1 - 180cc/24h = 7.5cc/h
    • Day 4 - 60 —> 80 —> 100 —> 120: 120cc/kg/d x 3d = 360ml/24h = 15cc/h
465
Q

Reasons to NOT add K+ to IV fluids

A

Hyperkalemic
Not voiding
Starting to tolerate PO
IV rate TKVO

466
Q

Symptomatic hyponatremia treatment

A

3% NS at 2cc/kg bolus

467
Q

ECG findings for hyperkalemia

A
  • Peaked T-waves
  • Short QT int
  • Depressed ST segment
  • Wide QRS
468
Q

Hyperkalemia treatment

A
  • Fluids
  • Calcium gluconate to protect cardiac membranes
  • Ventolin neb
    • Beta-agonist role… not really sure how this works
    • Always check K+ if pt is on ventolin!
  • Insulin
  • Bicarb
  • Kayexalate
469
Q

Encapsulated organisms

A

Strep pneumo
H. influenzae type B
N. meningitides

470
Q

Pneumococcal vaccine

A

13-valent pneumococcal conjugate vaccine given in first year of life provides protection against 13 serotypes (all children)
23-valent pneumococcal polysaccharide vaccine given to sickle cell children at 2 and 5yo

471
Q

Vaccines required in sickle cell children

A

H. influenza type b conjugate vaccine at 2, 4, 6 and mo
13-valent pneumo at 2, 4, and 6mo
23 valent pneumo at 2 and 5yo
Meningococcal vaccine at 2yo if functionally/anatomically splenic
Yearly flu shot

472
Q

Esophagus begins at which spinal level

A

C4

473
Q

Lateral neck X-ray rule

A

Pre-vertebral soft tissue should never be more than the AP diameter of the vertebrae behind them

474
Q

Possible complications of retropharyngeal abscess

A

Mediastinitis

Jugular vein thrombosis

475
Q

Most common congenital anomaly of nasal cavity

A

Bilateral choanal atresia

Most are BONY and BILATERAL

476
Q

How to diagnose choanal atresia

A

CT

477
Q

Most common lesion in young child at subglottic region of trachea

A

Hemangioma

478
Q

Bronchial wall thickening with hyperinflation

A

<2yo: Bronchiolitis

>2yo: Reactive airway disease

Clerkship (7 decks)

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