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Pediatrics Flashcards

1
Q

Type I HSR

A

IgE mediated

anaphylaxis

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2
Q

type II HSR

A

cytotoxic, antibody mediated

HA

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3
Q

type III HSR

A

serum sickness

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4
Q

type IV HSR

A

delayed T cell mediated rxn

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5
Q

conjunctivitis timeline of newborn

A

immediate - chemical
2-7 days - gonoccal
7-14 days chlamydia

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6
Q

tx of gonoccocal conjuctovitis

A

ceftriaxone

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7
Q

tx of chlamydia conjuctivitis

A

oral erythromycin

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8
Q

Necrotizing fascitis

A

symptoms that are out of proportion compared to the PE

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9
Q

PKU

A

AR
deficiency in phenylalinine hydroxylase
mental retardation

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10
Q

CF

A 
AR 
thick mucous 
nasal polyps 
pseudomonas 
recurrent URIs
pancreatic insufficiency
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11
Q

MC skull fractures

A

linear - depression can cause further cortical damage

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12
Q

caput succedaneum

A

crosses the midline

swelling of the soft tissues of the scalp

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13
Q

cephalohematoma

A

subperiosteal hemorrhage

does NOT CROSS the suture lines

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14
Q

causes of polyhydramnios

A

werdig hoffman syndrome - cant swallow

intestinal atresias (dbl bubble)

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15
Q

diaphragmatic hernia

A

bowel sounds in the chest
air fluid lvels are seen on CXR
concave abd
barrel shaped chest

associated with polyhydramnios

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16
Q

ophalocele

A

link to edwards trisomy 18
intestines with sac covering
increased AFP on screening

due to the failure of the GI sac to retreat at 10-12 wks gestation

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17
Q

umbilical hernia

A

associated with congenital hypothyroidism
weakness of rectus abdominus
allows protrusion of vessels and bowel

most spontaneously resolve

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18
Q

gastroschisis

A

intestines outside abdomen without sac
usually lateral to midline

tx- sx intervention - aggressive reintroduction of bowels –> infarction of bowel

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19
Q

causes of elevated AFP

A

neural tube defects
abdominal wall defects

MCC - incorrect dating

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20
Q

nephroblastoma

wilms tumor

A

large palpable abdominal mass
aniridia - absence of iris
hemihypertrophy of 1 kidney due to increased vascular demand

tx chemo

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21
Q

WAGR syndrome

A

chromsome 1 deletion

wilms tumor
aniridia
genitourinary malformations
retardation

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22
Q

neuroblastoma

A

MC of cancer in infancy
extracranial solid malignancy
blue spots in eyes

cross midline
CT calcification

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23
Q

dx of neuroblastoma

A

increased VMA
increased Metanephrines
(similar to pheochromocytoma)

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24
Q

hydrocele

A

painless swollen fluid filled sac
transluminates
remnant of tunica vaginalis

self resolving typically

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25
Q

varicocele

A

bag of worms
swelling of pampiniform plexus
heaviness in scrotum

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26
Q

cryptochordism

A

absence of 1 testicle usually found in inguinal canal

must be removed to prevent cancer risk (after 1yr)

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27
Q

hypospadies

A

urethra found on ventral surface of penis (bottom)
associated with inguinal hernias and cryptochordism

Circumcision = C/I

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28
Q

epispadies

A

opening of urethra dorsal (top)

associated with urinary incontinence and bladder exstrophy

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29
Q

TOF

A 
chromosome 22 deletion 
pulmonary stenosis 
rvh 
overriding aorta
vsd
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30
Q

tet spells

A

TOF - kids squat to increase preload - increases svr - decreases R>L shunting - increases pulmonary blood flow - which increases blood O2 saturation.

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31
Q

types of holosystolic murmurs

A

mitral regurgitation
vsd
tricuspid regurgitatioin
pda

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32
Q

transposition of great vessels

A

maternal DM kids
MC cyanotic lesion during neonatal period
aorta and pulmonary artery switched

requires PDA to stay alive - prostaglandin E1 to keep it open

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33
Q

CXR of transposition of great vessels and auscultation

A

egg on a string

s2 heard

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34
Q

causes of otitis media

A

viral - adenovirus

bacterial - strep pneumonia, h influenza , m catarrhalis

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35
Q

child received 5% dextrose in water for a prolonged period of time and has seizure, whats the cause

A

hyperosmotic hyponatremia

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36
Q

point tenderness of a joint
increased uptake by bone scan
increased ESR

dx = ?

A

osteomyeletis

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37
Q

lens shaped cranial hemorrhage

A

epidural hematoma

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38
Q

BUN to creatine ratio greater then 15:1

A

acute renal failure

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39
Q

pt with abdominal cramps relieved by BMs and arthritis

A

Ulcerative Colitis - manifests with GI and arthritic symptoms

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40
Q

reducing substance in urine
jaundice
poor weight gain
neonatal period

dx = ?

A

galactosemia

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41
Q

anemia
target cells
MCV <70
asian

dx = ?

A

thalessemia

decreased synthesis of globulin chains

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42
Q

DKA TX

A

IVF first then insulin

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43
Q

antibodies to proteus vulgaris = what test

A

weil felix test which is for ricketssia

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44
Q

borrelia = what type of organism

A

spirochete

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45
Q 
atelectasis 
hyperinflation 
recurrent resp problems infancy 
hyperexpanded chest 
clubbing

dx = ?

A

cystic fibrosis

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46
Q

digital clubbing differential

A

cystic fibrosis
malignancy
R>L Shunt

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47
Q

brown urine after a cold 1-2 days after

A

IgA nephropathy

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48
Q

features of cor pulmonale

A 
peripheral edema
raised jvp 
loud S2
right sided heave 
pulsatile liver 
hepatomegaly
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49
Q

absence of cremasteric reflex

unilateral testicular pain

A

testicular torsion

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50
Q

young boy recurrent bacterial infections from encapsulated organisms (otitis media, sinusitis, pneumonias)

small lymphoid tissue

A

brutons

XLA

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51
Q

felt syndrome

A

rheumatoid arthritis
splenomegaly
neutropenia

anemia of chronic disease

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52
Q

diarrhea causes what metabolic disorder

A

metabolic acidosis - losing bicarb

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53
Q

gait ataxia
bilateral papilledemea
abducens palsy in a kid

dx = ?

A

medullobastoma

majority occur in the cerebellar vermis - truncal ataxia
block 4th ventricle - > hydrocephalus

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54
Q

oropharyngeal candidiasis tx

A

nystatin
invasive fungal tx
intestinal candidiasis tx

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55
Q

topical mupirocin treats

A

impetigo

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56
Q

MCC of hypothyrodisim in infants

A

thyroid dysgenesis - appear normal at birth but gradually develop apthy, weakness hypotonia and large tongue

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57
Q

mechanisms behind hashimotos

A

lymphocytic thyroiditis

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58
Q

large dense consolidation and fixed effusion on cxr - what bug

A

description = abscess caused by old pna now staph causing abscess plus new pna

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59
Q

tricuspid atresia

A 
left ventricular hypoplasia 
LAD
mitral valve atresia
absent pulses with a single s2 
increased RV impulse 
gray cyanosis
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60
Q

truncus arteriousus

A 
1st few days of life 
severe dyspnea 
early and frequent infections 
single S2 heard 
systolic ejection murmur 
bounding peripheral pulses
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61
Q

CXR of truncus arteriosus

A

cardiomegaly with increased pulmonary markings

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62
Q

VSD

A

dyspnea with resp distress
loud pulmonic S2
high pitched holosystolic murmur over the L sternal border
apical diastolic rumble - increased flow across mitral valve

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63
Q

CXR of VSD

A

increased vascular markings

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64
Q

complications of VSD

A

pulmonary HTN

CHF

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65
Q

ASD

A

Fixed wide splitting of S2

systolic ejection murmur at Left upper sternal border

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66
Q

complications of ASD

A

dysrhythmias

perodoxical emboli from DVT

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67
Q

PDA

A

machine like murmur
wide pulse pressure
bounding bulses

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68
Q

complications of PDA

A

recurrent resp infections and infective endocardatitis (MC complication)

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69
Q

EKG presentation of a PDA

A

LVH secondary to increased systemic resistance

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70
Q

presentation of coarctation of the aorta

A

severe CHF and resp distress within first few months of life

LE and UE pulses vary

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71
Q

presentation of prolonged QT syndrome

A

hearing loss
syncope
normal vital signs
normal PE

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72
Q

Tx of prolonged QT syndrome

A

metoprolol

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73
Q

Rheumatic heart disease

A

complication of rheumatic fever

mitral stenosis - MC

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74
Q

major criteria for rheumatic fever

A 
migratory polyarthritis 
carditis 
erythema marginatum 
subcutaneous nodule 
chorea
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75
Q

minor criteria for rheumatic fever

A 
fever
antecedent strep infection 
arthralgias
elevated ESR
prolonged PR Interval 
heat block on EKG
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76
Q

criteria needed to dx rheumatic fever

A

2 major

or

1 major and 2 minor

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77
Q

when is hyperbilirubinemia pathologic

A

day 1 of life
increase of 5mg/day
above 19.5 in term child
direct bili above 2mg at ANY time

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78
Q

complications of hyperbilirubinemia

A 
kernicterus - 
hypotonia
seizures 
hearing loss 
choreoarthritis
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79
Q

choanal atresia

A

blue when feeding
pink when crying
resp distress caused by the: buccopharyngeal membrane - between the nostrils and pharyngeal space

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80
Q

esophageal atresia

A

esophagus ends in blind pouch

recurrent ASPIRATION PNA early on
vomiting with 1st feed
choking/coughing
cyanosis

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81
Q

dx of esophageal atresia

A

coiling of the NG tube
gastric air bubble
esophageal air bubble

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82
Q

pyloric stenosis

A

1-6 month old BOY typically
NONbilious PROJECTILE vomit
hypochloremic hypokalemic metabolic ALKALOSIS

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83
Q

dx of pyloric stenosis

A

olive sign - palpable mass epigastric

abd US - string sign (barium leaking thru)

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84
Q

tx of pyloric stenosis

A

1) IVF and electrolytes
2) NGT decompress the bowel
3) Sx

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85
Q

best initial step for choanal atresia

A

pass the NGT tube

then secure airway

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86
Q

CHARGE accroynm

A 
coloboma of eye, CNS 
heart defects
atresia of choanae 
retardation 
genital and lower urinary tract issues 
ear anomalies
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87
Q

duodenal atresia

A

down syndrome
double bubble on CXR

no resp distress
BILIOUS VOMITING

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88
Q

best first step for duodenal atresia

A

IVF

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89
Q

hirschsprung disease basics

A

congenital lack of innervation of distal bowl by the auerbach plexus

constant contracture of muscle tone

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90
Q

hirschsprung disease presentation

A

DOES NOT pass meconium within 48 hrs
large bowel obstruction
tight rectal sphincter
+ squirt sign

if older child - hx of constipation and poor weight gain

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91
Q

dx of hirschsprung dz

A

X-Ray - distended bowel loops with lack of air in the rectum

biopsy with lack of ganglion cells

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92
Q

VACTERL

A 
Vertebral anomalies
Anal atresia
Cardiovascular abnormalies
TEF
Esophageal atresia
Renal anomalies
Limb anomalies
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93
Q

volvulus

A

bowel obstruction leading to loop of bowel twisted on itself

vomiting + colicky abd pain

complications sepsis/necrosis

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94
Q

dx of volvulus

A

Upper GI series - multiple air fluid levels

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95
Q

intussusception definition and causes

A

telescoping of bowel into another

causes: polyps, hard stool, lymphoma, virus, rotavirus vaccine, HENOCH SCHLOEN PURPURA

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96
Q

odd complication of henoch schloen purpura

A

intussusception

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97
Q

presentation of intussusception

A

colicky abd pain INTERMITTENT
bilious vomiting
RQ sausage shaped mass
currant jelly stools

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98
Q

dx of intussusception

A

US - dough sign or target sign (concentric alternating mucosa and submucosa bands)

Barium Enema or air Enema are both dx and tx

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99
Q

tx steps for intussusception

A

1) IVF
2) NGT decompress bowel
3) Barium or air Enema
4) Sx if needed

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100
Q

meckel diverticulum

A

only true diverticulum

vitelline duct persists in small intestine tract

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101
Q

presentation of meckel diverticulum

A

painless rectal bleeding 2y/o M typically (rule of 2’s)

  • bleeding is from gastric acid secretion from ectopic tissue
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102
Q

dx of meckel diverticulum

A

techenium 99 scan

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103
Q

Rotavirus diarrhea

A 
MC 
winter months 
Fever, emesis, NO BLOOD
< 7 days 
viral prodrome
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104
Q

adenovirus diarrhea

A 
year round 
fever emesis 
NO BLOOD 
<7 days 
viral prodrome
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105
Q

norwalk virus diarrhea

A

epidemic
EXPLOSIVE diarrhea
cramping pain
short lived = 1-2 days

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106
Q

timeline of Fever and Rash in measles and rubella

A

Measles = fever + rash

Rubella = fever —> –> Rash

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107
Q

Necrotizing enterocolitis

A

premie infants who have blood in stool
low birth weight
vomiting and abd distension

bacteria invade intestinal wall

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108
Q

dx of NEC

A

ABD x-ray - pneumatosis intestinalis or AIR in the bowel

air in the portal vein on CT

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109
Q

tx of NEC

A

1) Feedings stopped - REST BOWELS
2) IV fluids
3) NGT for bowel decompression
4) sx if needed

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110
Q

antidote to methhemoglobin

A

methylene blue - acts as an electron acceptor for NADPH and is reduced to a substance that then in turn –>

reduces methemoglobin back to hemoglobin

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111
Q 
new born with large posterior fontanelle 
large tongue 
hypotonia 
nml agpar scores 
nml pregnancy and delivery

cause = ?

A

thyroid dysfunction

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112
Q

tx of afib in a newborn

A

ice pack to chest

then adenosine

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113
Q 
fresh newborn hours old with 
cyanosis of arms and legs 
feeding well 
no distress 
cap refill time delayed 
low body temp 
bradycardia
dx = ? 
tx = ?
A

neonatal hypothermia

place under warming lights

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114
Q

scaly puritic rash on flexor surfaces in a kid
occurs during episodes of resp distress and wheezing

dx = ? 
tx = ?
A

atopic dermatitis (eczema)

tx:
emolients (petrolatum or aquaphor)

topical steroids
triamcinolone
betamethasone valerate

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115
Q

what type of shunting do you see in a PDA

A

left –> right shunt allows blood from systemic circulation to the pulmonary circulation

pulmonary blood flow is excessive

prominent apical impulse

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116
Q

at what age do you start worrying about puberty in female and male

A

15 years old

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117
Q

serous otitis media

A

middle ear effusion without the evidence of acute infection

dull (blueish grey) TM that is hypo mobile

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118
Q

MOA of post strep glomerulonephritis

A

type III HSR

antigen antibody immune commplexes

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119
Q

Timeline if IgA nephropathy h

A

1-2 days after URI

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120
Q

Volvulus dx

A

corkscrew appearance on KUB

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121
Q

C diff presentation

A

s/p abx use and occasionally can be bloody (rare)
fever
abd pain

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122
Q

BUN: Cr greater than 20:1

A

prerenal injury

- decreased renal perfusion

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123
Q

direct hyperbilirubinemia

A

> 20% of total bili

decreased excretion of bilirubin

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124
Q

indirect hyperbilirubinemia

A

decreased conjugation of bilirubin

hepatic enzyme deficiency

increased production of bilirubin

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125
Q

pale stools are caused by

A

obstructive jaundice

increased direct bilirubin

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126
Q 
4 month old with increased BP right > left 
pronounced S2
precordial heave
hepatomegaly 
RVH 
RAD
wheezing occasionally heard

dx = ?

A

bronchopulmonary dysplasia

leads to pulmonary HTN

  • hepatomegaly
  • edema RVH
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127
Q

dx of PSGN

A

elevated ASO abs
decreased C3 concentration in plasma

pedal edema

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128
Q

Sequela of PSGN

A

nothing full recovery without any complications

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129
Q

VSD on PE

A

4/6 holosytolic murmur with thrill heard along the left sternal boarder

P2 is accentuated

2/6 mid diastolic murmur is heard at the apex

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130
Q

tx of chemical ingestion

A

stabilize airway

fiberoptic endoscopy (see damage)

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131
Q

17 alpha hydroxylase def

A

increased aldosterone and cortisol
decreased K+
decreased sex hormones
HTN

nml girls
boys - pseudohermaphrodism

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132
Q

21 hydroxylase def

A

decreased cortisol and aldosterone
increased K+
increased sex hormones

girls - virilized
boys - nml

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133
Q

legg calve perthes dz

A

avascular necrosis of the femoral head
painless limp
2-8 y/o
nml weight

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134
Q

dx and tx of legg calve perthes

A

dx - x-ray joint effusion and widening

tx - NSAIDS and rest

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135
Q

slipped capital femoral epiphysis

and risk

A

adolecents 10-15
OBESE
painful limp
externally rotated

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136
Q

tx of slipped capital femoral

A

internal fixation with pinning

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137
Q

2 sources of milk that are low on Vit D

A

goats milk and breast milk

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138
Q

lead poisoning

A

vomiting, abd pain
fatigue
loss of appetitie
decreased sleep

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139
Q

path behind Osgood Schlatter

A

repeated knee extensions leading to microalvusions of the tibial tubercle

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140
Q

ewing sarcoma

A

onion skinning - lytic lesions causing laminar peristeal elevation

midshaft
systemic symptoms
local pain and swelling

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141
Q

osteosarcoma

A

sunburst pattern - sclerotic destruction
metaphysis of long bones

increased alk phos
local pain and swelling

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142
Q

osteoid osteoma

A

round central lucency with a sclerotic margin
adolescent boy
proximal femur site - worst at night
unrelated to activity

NSAIDS will spontaneously resolve

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143
Q

tx for neonatal sepsis order

A

IVF
cultures
ampicillin and gentamicin

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144
Q

causes of early neonatal sepsis

A

e coli

listeria

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145
Q

causes of late neonatal sepsis

A

e coli

GBS

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146
Q

presentation of toxoplasmosis

A

chorioretinitis
hydrocephalus
multiple ring enhancing lesions

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147
Q

dx and tx of toxoplasmosis

A

dx - (initial) increased IgM to toxo , PCR (most accurate)

tx - pyrimethamine and sulfadiazine

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148
Q

syphilis presentation of a neonate

A

desquamation of the palms and soles
frontal bossing
sniffles

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149
Q

rubella presentation

A

fever –> –> rash
sensoneuronal deafness
PDA

cataracts
hepatomegaly
blueberry muffin rash

hyperbilirubunemia
thrombocytopenia

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150
Q

CMV presentation

A

periventricular calcifications with microcephaly
chorioretinitis
petechiae

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151
Q

varicella presentation

A

vesicles on an erythematous base
START on face
possible fever and malaise

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152
Q

rubeola (measles) presentation

A

4’Cs - cough, conjuctivities, coryza (stuffy/running nose), C(k)oplik spots (buccal surface)

cephalocaudal spread

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153
Q

5th dz or erythema infectiosum presentation

A

parvob19

fever and URI –> –> slapped cheek rash

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154
Q

complication of 5th disease

A

aplastic anemia

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155
Q

Herpes 6 roseola presentation

A

HIGH fever –> goes away –> diffuse lacy rash

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156
Q

mumps presentation

A

fever that precedes parotid gland swelling

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157
Q

complications of mumps

A

orchitis

aseptic meningitis

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158
Q

scarlet fever presentation 3-6 days

A 
fever 
pharyngitis 
SANDPAPER rash 
strawberry tongue 
cervical lympadenopathy
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159
Q

kawasakis disease presentation

A 
FEVER >5 days 
mucositis 
conjuctivitis 
rash 
edema of hands and feet
cervical lympadenopathy
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160
Q

complication of kawasakis dz and tx

A

complication - coronary artery aneursym

tx - IV Ig and aspirin

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161
Q

malignant otitis externa

A

exquisite otalgia and otorrhea

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162
Q

retropharyngeal abscess

A

decreased ROM of neck and jaw
muffled voice

younger kid 4years old

fever dysphagia

lateral neck soft tissue x-ray - widened prevertebral space

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163
Q

croup presentation

parainfleunza virus

A 
barking cough 
inspiratory stridor 
difficulty breathing while lying flat 
signs of hypoxia 
hoarse voice
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164
Q

tx of croup

A

mild .- steroids

mod-severe = racemic epinephrine

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165
Q

epiglottis

A

due to H influenza type B (unvaccinated kid)
fever
QUICK ONSET
muffled voice/ drooling
TRIPOD position/refusal to lie flat - hyperextended neck

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166
Q

whooping cough - bordetella pertussis

A

catarrhal stage - severe congestion and rhinorrhea (14 days)

paroxysmal stage - severe coughing episodes with vomiting, gasp for air, inspiratory wheeze (14-30 days)

convalescent stage - decrease freq of coughing (14 days)

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167
Q

tx of pertussusis for pt and close contacts

A

macrolide for close contacts

erythromycin or azithrymycin during catarrhal stage or with kids IV Ig

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168
Q

pharyngitis presentation

A

cervical adenopathy
petechiae
fever >104

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169
Q

Diptheria

A

membranous inflammation of the pharynx
gray highly vascular pseudomembranous plaques on a pharyngeal wall
DO NOT SCRAPE

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170
Q

tx of diptheria

A

antitoxin

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171
Q

riboflavin vit b2 def

A 
anuglar cheilosis 
stomatitis 
glossitis 
normocytic anemia
seborrhic dermatitis
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172
Q

vit b6 pyridoxine def

A

peripheral neuropathy

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173
Q

vit D toxicity

A

increased Ca2+
polyuria
polydipsia

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174
Q

von gierkes dz

A

glucose 6 phosphatase deficiency
liver hepatomegaly
ketotic hypoglycemia
ketones

increased TGLs and Uric Acid
Doll Face adn thin extremeties

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175
Q

tay sachs

A 
hexosaminidase A def 
increased gangliosides 
cherry red macula 
mental retardation 
seizures

lysosome onion whorled membrane

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176
Q

gaucher dz

A

beta glucoererbrosidase def
hepatosplenomegaly
aseptic necrosis of femur head

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177
Q

fabry dz

A

alpha galactosidase A def
x-linked
peripheral neuropathy

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178
Q

nieman pick dz

A

cherry red macula
neurodegeneration
hepatosplenomegaly
increased sphingomyelin

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179
Q

metachromatic leukodystrophy

A

arysulfatase A def

dymelination with ataxia and dementia

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180
Q

patient with subcutaneous emphysema secondary to severe coughing paraxysms what is the first test done

A

CXR in order to rule out pneumothorax

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181
Q

what can cause methemoglobuniemia

A

exposure to oxidizing substances
dapsone
nitrites (meats)
local/topical anesthetic

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182
Q

presentations of methemoglobunemia

A

cyanosis
pulse Ox 85%
dark chocolate blood

saturation gap between pulse ox and PaO2 >5% on ABG

decrease O2 delivery to peripheral tissues - supp O2 does not help

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183
Q

blue green discoloration of blood and mucocutaneous surfaces

cause = ?

A

sulfhemoglobinemia - exposure to sulfur meds such as:

sumatriptan
sulfasalazine

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184
Q

antidotes for lead poisoning

A

dimercaprol

EDTA

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185
Q

tx of ethylene glycol or methanol ingestion

A

fomepizole - inhibits alcohol dehydrogenase - preventing the metabolism of these alcohols to their toxic metabolites

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186
Q

antidote for beta blockers

A

glucagon - activates adenylate cyclase -> increased Ca2+ –> improves cardiac contractility

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187
Q

antidote for acetominephen toxicity

A

N-acetylcysteine

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188
Q

cause of Howell Jolly bodies

A

asplenic pts

nuclear remnants within the RBCs that are typically removed via the spleen

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189
Q

chylothorax

A

milky white fluid

increased TGLs

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190
Q

galactose 1 phosphate uridyl transferase def

A 
failure to thrive 
bilateral cataracts 
jaundice 
hypoglycemia 
vomiting 
hepatomegaly 
mental retardation

increased risk for neonatal sepsis via E coli

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191
Q

galactokinase def

A

cataracts only

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192
Q

complication of hereditary spherocytosis

A

cholelithiasis

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193
Q

initial test for asthma

A

spirometry

if not available methemacholine test

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194
Q

other symptoms associated with juvenile idiopathic arthritis

A

anterior uveitis so perform a slit lamp examination

dx of JIA - elevated ESR,ANA ab, pain in AM

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195
Q

testicular torsion PE

A

absence of cremasteric reflex

epididymitis will have a nml cremasteric reflex

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196
Q

precocious puberty ages

A

Males <9

Females <8

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197
Q

croup edema location

A

subglottic edema which improves with the vasoconstriction effects of cold air

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198
Q

lethargy
complexion darkening
height weight nml
decreased BP

dx test ?

A

plasma cortison - since this is a decreased of ACTH

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199
Q

young boy with GBS infection HIB infection leukocytosis
and low lymphoctes

dx = ?

A

agammaglobulinemia - infec form encapsulated bugs that normal ppl are immune too

tx - abx and IV Ig

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200
Q

fat kid bowing legs

dx = ?

A

tibia vara

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201
Q

neurofibromatosis type 1

A

cafe au lait spots
seizures
skin tags (lisch nodules)
clustered freckles

nerve sheath tumors
optic gliomas

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202
Q

prophylactic tx of TB

A

Isoniazid

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203
Q

sudden onset of constipation, bilious vomiting, squirt sign neg and blood in stool in 1 month

A

shows its below the level of duodenum this dx = volvulus until proven otherwise

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204
Q

neuroblastoma presentation

A 
young kid 
racoon eyes (blue underneath eyes)

HTN
fatigue
posterior mass
weight loss

mets to the bone

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205
Q

sinusitis presentation

A

long term fever, ha, yellow green nasal discharge

posterior pharyngeal wall is erythematous and covered with gray mucus

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206
Q

aspirin ABG findings

A

mixed metabolic acidosis and respiratory alkalosis

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207
Q

hyperglycemia causes osmotic shifts of water from intracellular to the extracellular space leading to

A

dilutional hyponatremia

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208
Q

low BMI and no periods put you at risk for what?

A

osteoperosis

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209
Q

biliary cyst

A

extrahepatic mass –> dilation of the bile duct

scerlal icterus
palpable abd mass
abd pain
dark urine

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210
Q

conjugated bili =

unconjugated bili =

A

conj = direct

unconj = indirect

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211
Q

breast feeding jaundice

A 
1st week of life 
SUB OPTIMAL FEEDING
decreased bili elimination 
increased enteroheptic circulation 
signs of dehydration

tx = increase feedings

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212
Q

Heavy irregular mentsrual bleeding in a young teenager cause = ?

A

immature hypothalamic pituitary axis - causing anovulation

tx = high dose OCPs - stabilize endometrium

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213
Q

complication of repeated otits media

A

conductive hearing loss

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214
Q

tx of strabismus

A

cover up the good eye to strengthen the bad eye

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215
Q

presentation of neonatal herpes

A

temporal lobe hemorrhage/ edeme

mucucutaneous vesicles
keratoconjuctivitis
seizures
fever, lethargy

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216
Q

guillane barre syndorme

A

follows URI

ascending paralysis - concerned about resp compromise so perform spirometry to check

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217
Q

chronic sickle cell hemolysis can lead to what def

A

folate deficiency

papillry necrosis

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218
Q

pathological murmur

A

diaphoretic fatigue with feeding or exercise poor growth , dizzy poor weight gain

harsh holosystolic, diastolic
increased intensity on standing and valsalva manuever

strong family hx

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219
Q

acute causes of hemiplegia in kids

A

seizures - todd paralysis
intracranial hemorrhage - vomit, brady
hemiplegic migraine - family Hx

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220
Q

Measles Virus precautions

A

airborne transmission

vitamin A for hospitalized patients

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221
Q

causes of impetigo

A

staph auerus

strep pyogenes

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222
Q

causes of vit K def

A 
malnutrition 
CF 
IBD
Biliary atresia
celiac dz
frequent abx use
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223
Q

homocystinuria

A

marfanoid habitus
intellectual disability
megaloblastic anemia

thrombosis
lens dislocation

joint hyperlaxity
skin hyperelasticity
scoliolisis

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224
Q

generalized seizure presentation

A

LOC
post ictal state
tongue laceration

+/- preceding aura

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225
Q

vasovagal syncope

A

preceding lightheadnes
pallor
diaphoretic

IMMEDIATE return to baseline mental status

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226
Q

cardiogenic syncope

A

sudden LOC without prodrome

IMMEDIATE return to base line mental status

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227
Q

dissemenitaed gonoccal infection

A

fever
rash - vesiculopustular (no facial involvement)
polyarthritis

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228
Q

rocky mountain spotted fever

A

febrile prodrome –> –> erythematous macular rash that STARTS on the wrists and ankles and spreads centrally

229
Q

selective IgA def

A

recurrent sinupulmonary and GI infections
associated with celiac and atopy

anaphylaxis during transfusion

230
Q

milk or soy induced colitis

A

FmHx of eczema, allergies, asthma

2-8wks old regurgitation or vomiting

can have painless blood stools

tx = resolves in one year - hydrolyzed formula

231
Q

Chronic Granulomatis disease

x-linked

A

recurrent pulmonary and cutaneous infections

susceptibility to CATALASE + organisms (staph, serratia, brukholeria)

dx = nitroblue tetrolium, dihydrodium test

defect in intraccellular killing due to impaired resp burst

232
Q

beckwith wiedeman syndrome

A

deregulation of imprinted gene expresssion on chr 15

fetal macrosmia
hemihypertrophy
rapid growth until late childhood
umbilicated hernia

233
Q

complications of Vesicoureteral reflux

A

pyelonephritis –> parenchymal scarring, HTN and renal insufficiency

234
Q

pediatric causes of stroke

A 
sickle cell dz 
prethrombotic disorders
congenital cardiac dz
bacterial meningitis 
vasculitis 
head/neck trauma
235
Q

Werdnig hoffamn syndrome

A

degeneration of anterior horn cells and cranial nerve motor nuclei

other cause of floppy baby syndrome and associated with polyhydramnios (due to inability to swallow)

236
Q

myotonic congential myopathy

A

muscle weakness and atrophy (distal muscles of UE and LE)
testicular atrophy
baldness

hand grip myotonia
dysphagia

237
Q

atopic dermatitis

A

itchy red scaly crusted lesions
extensor and flexor surfaces
(lichenified plaques)

risks with low humidity

tx - emollients and topical steroids

238
Q

complications of atopic dermatitis

A

eczema herpeticum
cellulitis
abscesses

239
Q

septic arthritis presetnation

A

acute onset of fever and joint pain
fatigue and refusal to bear weight

erythema, warmth, swelling and pain with ROM

increased WBCs, ESR, c-react
synovial fluid = wbcs >50,000

240
Q

retinal hemorrhage seen on a baby =

A

shaking baby syndrome - acceleration deceleration injury

241
Q

bronchiolitis presentations in a small children

A

low grade fever
rhinorrhea/congestion
cough/ wheezing + respiratory symptoms
RSV cause

tx = supplemental O2

242
Q

vit A toxicity can lead to

A

Increased cranial pressure
uric acid stones
headaches

243
Q

what type of PNA bug do HIV patients get

A

pneumocystis jerovecii

244
Q

patients of diabetic mothers that have prolonged QT and then seizures due to

A

hypocalcemia due to suppressed PTH

245
Q

tuberosclerosis presentation

A 
ash leaf spots (hypopigmentation)
pariventricular masses sare sub ependymal nodules 
seizures
forehead plaques
mental impairment 
renal angiomyolipoma (benign)
246
Q

young girl with peristent diarrhea multiple episodes of oral thrush failure to thrive
viral infections and heart murmur

dx = ?

A

SCID

T lymphocyte def

247
Q

SCID basics

A

Fungal infection
Viral Infection
Bacterial Infection

T lymphocyte deficiency

failure to thrive
chronic diarrhea

248
Q

culprit for salmonella diarrhea

A

uncooked bbq chicken

249
Q

how to prevent rotavirus outbreak

A

strict hand washing protocol

250
Q

palpable suprapubic mass

A

distended bladder

251
Q

CVID

A

susceptible to encapsulated organisms due to impairment of the humoral system

so gets infected with strep pnumo and Hib while nml ppl are protected with the vaccines

252
Q

serum glucose –> decrease plasma osmolarity –> fluid goes back into cells –>

A

cerebreal edema

253
Q

shunt reversal of VSD leads to

A

pulmonary artery HTN leading to polycythemia

254
Q

tx for septecemia in neoneate

A

cefotaxime

255
Q

fundoplication can tx

A

stage 4 GERD

256
Q

shigellosis presentation

A 
bloody stool 
young child 
tonic clonic seizure 
high fever
dehydration
257
Q

adam strokes attack presentation

A

attack occurs without warning leading to sudden LOC and generalized tonic clonic seizure activity

258
Q

what causes a J wave on an EKG

A

hypothermia <90degrees F
hypercalcemia
brain injury
v fib

259
Q

chemical ingestion presentation in a kid

A

drooling
ulcers involving the lips annd the tongue
vomiting

260
Q

newborn male not urinated since birth and abdomen is distended with a midline mass

dx = ?

A

posterior urethral valves

midline mass = bladder from not urinating

261
Q

hodgkin lymphoma presentation

A

painless lymphadenopathy - usually cervical, axillary or inguinal - rubbery

mediastinal mass on CXR

teenagers

262
Q

hematocrit 50-60% in a neonate = ?

A

normal in a neonate

263
Q

test for addisons

A

measurement of morning serum fasting cortisol concentration

264
Q

HIV presentation in infancy

A

failure to thrive
lymphadenopathy
opportunistic infections
severe thrush

selective loss of CD4 cells

265
Q

thalessemia minor presentation

A

microcytic anemia
normal red cell distribution width

increased reticulocyte count

266
Q

hereditary spherocytosis

A

jaundice, splenomegaly

increased reticulocyte count
increased Mean corpuscular Hgb concentration
increased osmotic fragility on acidifed glycerol lysis test

nml MCV, nml RDW

267
Q

tx of erythema migrans

A

< 8/o = amoxicillin
> 8 y/o = doxycycline

> stage 1 = ceftriaxione

268
Q

hypertrophic cardiomyopathy physio behind increasing murmurs and decreasing murmurs

A

manuevers that increased preload or afterload (squatting, leg raise, hand grip) will increased LV cavity size and decreased Lv outflow obstruction –> decreasing murmur intensity

things that decreased preload will increase murmur intensity (standing up)

269
Q

causes and tx of otitis externa

A

pseudomonas and staph auereus

ototopical abx - fluoroquinolone +/- glucocorticoid

270
Q

aplastic crisis in a sickle cell patient

A

decreased reticulocytes - due to a transient arrest of erythopoesis secondary to infection (parvo b19)

271
Q

splenic sequestration crisis

A

increased reticulocytes
splenic vaso-occlusion –> rapidly enlarging spleen

occurs in children prior to autosplenectomy (sicklers)

272
Q

aplastic anemia lab values

A

thrombocytopenia
leukopenia
anemia

273
Q

viral meningitis causes and basics

A

majority caused by enteroviruses - coxsackie b

spread by fecal oral transmission

274
Q

pathogenesis of refeeding syndrome

A

starvation -> decreasd insulin increased glucagon increased cortisol -> decreased ketone bodies in muscles + increased ketones in brain -> increased glycogenlysis incresde lipolysis increased protein catabolsm -> depleted fat and protein

start refeeding -> increased insulin -> increased glycogen synthesis, increased protein synthesis, -> decreased thiamine, decreased K+ , decreased PO4, decreased Mg -> seizures, CHF

275
Q

causes of QT prolongation

A

decreased Ca, K , Mg

macrolides, fluoroquinolones
antipsychotics, TCAs, SSRIs

opiods (methadone, oxycodone)
antimetics (zofran)

quinidine, procainamide, flecanamide, amiodarone, sotalol

276
Q

complications of prolonged QT syndrome

A

torsades de pointes

277
Q

Wiskott aldrich syndrome

x-linked

A

imparied cytoskeleton changes in leukocytes, platelets

eczema
microthrombocytopenia
recurrent infections

278
Q

ataxia telengectiasias

A

T- cell def associated with a defect in DNA repair

progressive cerebellar degeneration

279
Q

congenital clubfoot

A

rigid positioning
medial/upward deviation of forefoot and hindfoot
hyper plantar flexion of the foot

280
Q

MC complication of a patient with sickle cell trait

A

painless hematuria

281
Q

FB aspiration

A

MC -infants and toddlers

acute onset of inspiratory stridor +/- wheezing without infectious symptoms

perform an endoscopy or bronchoscopy

282
Q

laryngolamalacia presentation

A

inspiratory stridor most prominent in infants

stridor is worse when supine
stidor improves when prone

283
Q

vascular ring presentation

A

infants

biphasic stridor that improves with neck extension

284
Q

primary nocturnal enuresis age and tx

A

> 5 y/o

tx - alarms, routine adjustment, and then desmopressin therapy if needed

285
Q

levonorgestrel pill > OCPs for what use

A

emergency contraception (plan B)

286
Q

risk factor for henoch schonlein purpura

A

intussussception risk

287
Q

erythema toxicum neonatorum def and tx

A

asymptomatic scattered erythematous macules, papules, pustules throughout the body

tx - reassurance

288
Q

neonatal HSV presentation and tx

A

vesicular clusters on skin, eyes, mucous membranes
CNS infections

fulminant, disseminated multi organ disease

tx = acyclovir

289
Q

tx of neonatal varicella

A

acyclovir

290
Q

staph scalded syndorme

A

fever, irritability
diffuse erythema followed by blistering and exfoliation
+ nikolsky’s sign

tx = naficillin, oxacillin or vanco

291
Q

friedrich ataxia

A

neurodegenerative disease - presents with progressive ataxia and loss of positional and vibratory senses

genetic test - excessive # of tri nucleotide repeats

292
Q

cerebral palsy risk factors

A

prematurity (that leads to hypoxia induced damage)

low birth weight

293
Q

cerebral palsy clinical features

A 
delayed motor milestones
abnormal tone
hyperreflexia
comorbid seizures 
intellectual disability
294
Q

craniopharyngioma

A

calcified intracranial tumors that occur in the suprasellar region

295
Q

craniopharygioma presentation

A

bitemporal hemaniopsia

pituitary hormonal deficiencies (DI, GH def)

296
Q

pityriasis rosea clinical features

A

+/- viral prodrome
annular pink herald patch on trunk
oval lesions in x-mas tree pattern
pruritus

tx = reassurance and antihistamines for pruritus

297
Q

acrocynasosis

A

typically normal during newborn period

298
Q

MC pathogen associated with kids with CF

A

staph aureus - while pseudomonas is more associated with adults with CF

299
Q

cystic hygromas

A

congenital malformation of the lymphatic system - located in the posterior triangle of the neck

fluctulant mass that transuluminates with light

associated with turners syndrome

300
Q

clavicle fx presentation in a newborn

A

crepitus
swelling
decreased ROM of UE (ipsy)

301
Q

congenital muscular torticollis

A

posterior neck deformity
SCM mass
ispy head tilt
contra chin deviation

302
Q

presentation of viral conjunctivitis

A

unilateral/ bilateral
1-2 wks
watery/mucoid
viral prodrome

303
Q

presentation of bacterial conjunctivitis

A

uni/bilateral
1-2wks
unremitting ocular discharge
purulent

304
Q

allergic conjunctivitis

A

ocular pruritus*
always bilateral
<30min or annually (certain time of year)

305
Q

asian babies have what def

A

decreased UGT activity –> increased total Bili and increased unconjugated bili

306
Q

sturge weber syndrome

A

mutations in GNaq gene

port wine stain 
leptomenengial capillary venous malformations 
seizures +/- hemiparesis 
intellectual disability 
visual field defeceits 
glaucoma
307
Q

ALL

A 
MC childhood cancer, 2-5 y/o, M>F 
bone pain 
lymphadenopathy 
hepatosplenomegaly 
pallor 
petechiae
308
Q

Common Variable immunodefeciency

A

recurrent resp infections (sinusitis, pna, otitis)
reccurent gi infections (salmonella, campylobacter

autoimmune diseases (RA, thyroid dz)
chronic lung disease (bronchiectesis) 
GI disorders (chronic diarrhea,)
309
Q

dx of CVID

A

decreased IgG
decreased IgA/IgM

no response to vaccinations

310
Q

tx of CVID

A

Ig replacement therapy

311
Q

antifungal and antiviral prophylaxis is important for what patients

A

CGD
SCID
transplant patients

312
Q

rett syndrome

A

girls - loss of speech and purposeful hand use
gait disturbance
stereotypical hand movements
seizures

313
Q

landon klefer syndrome

A

regression of language skills due to severe epileptic attacks

3-6 years old

314
Q

presentation of reactive arthritis

A

injected conjuctivae with mucopurulent discharge

pain swelling and rash over a joint

315
Q

otitis media with effusion physical exam

A

observable air fluid levels (which may be vertically oriented)

serous middle ear fluid

translucent membrane with diminished mobility

316
Q

otitis media without effusion

A

bulging erythematous
purulent discharge
limited mobility

317
Q

tinea capitis

A

MC in black children
transmission via direct contact or from fomites

scaly erythematous patch with hair loss on scalp

318
Q

tx of tinea capitis

A

oral grisefulvin or terbinafine

319
Q

langerhans cell histiocytosis

A 
lytic bone lesions (skull, femur, jaw) 
skin lesions (purpleish papules, eczematous rash) 
lymphadenopathy
hepatosplenomegaly 
pulmonary cysts/ nodules

central DI

320
Q

elevated glutamyl transpeptidase

A

alcoholics

321
Q

wilson disease

A

copper accumulation - > leak from damaged hepatocytes -> deposits in tissues (basal ganglia, cornea)

acute liver failure, chronic hepatitis, cirrhosis
neuro - parkinsonisms, gait disturbances, dysarthria
psych - depression, personality changes, pyschosis

322
Q

tx of wilsons disease

A

chelators
- D penicillamine
zinc (messes with copper absorption)

323
Q

preseptal orbital cellulitis

A

PAIN to palpation
eyelid swelling

No pain with EOM

324
Q

postseptal orbital cellulitis

A

PAIN with palpation
eyelid swelling

PAINFUL and difficulty with EOMs

325
Q

minimal change disease

A

MCC of nephrotic syndrome in children <10 y/o

T cell mediated injury to podocytes caused by increase molecular permeability to albumin

326
Q

minimal change disease presentation

A

edema
fatigue
NO hematurial
proteinuria >3g

327
Q

tx of minimal change disease

A

corticosteroids

328
Q

leukocyte adhesion deficiency

A

recurrent skin and mucosal bacterial infections
No PUS - lack of neutrophils at the inflammation site

delayed umbical cord separation
marked peripheral leukocytosis with neutrophilia

329
Q

steps for precious puberty workup in a female

A

bone age - if >2yrs –> Baseline LH –> if elevated = central precocioys puberty –> MRI

330
Q

lab values for iron def anemia

A

low -MCV
low - Fe
low -ferritin
low - transferrin

high - TIBC

331
Q

lab values for thalessemia

A

low low - MCV
low - TIBC

high - ferritin
high - transferrin

332
Q

lab values for anemia of chronic disease

A

mcv - normal
low - Fe
low - TIBC

333
Q

presentation of juvenille idopathic arthtritis

A

subacute/chronic - pain that is worse in the am but able to bear weight
long standing fever
arthritisi > 1 joint
pick macular rash

increased WBCs, thrombocytosis, high ESR

334
Q

antidote to protect from cardiac damage in hyperkalemia

A

calcium gluconate

335
Q

hypertrophy of peyers patches is a risk for

A

intussception

336
Q

MC type of CNS tumor in kids

A

astrocytoma

337
Q

complications of otitis media

A

facial nerve palsy

mastoiditis

338
Q

dx test of choice for DMD

A

genetic testing

339
Q

presentation of HSP

A

IgA mediated leukocytoclastic vasculitis

palpable purpura
arthitis/ arthalgias
abd pain/ intussecpetion
renal disease - IgA nephropathy

340
Q

reactive attachment disorder

A

pattern of emotional and social withdrawal

lack of positive response to. attempts to comfort

341
Q

disinhibited social engagment disorder

A

overfamiliarity and an unhesistant approach to unfamiliar adults

outcome of early neglect

342
Q

MCC of proteinuria in kids

A

transient proteinuria - make sure to obtain at least 2 dipsticks to r/o whether its a more serious cause of proteinuria

343
Q

PKU presentation highlights

A

fair complexion

musty odor

344
Q

mcCune albright syndrome

A

cafe au lait spots
precocoious puberty
fibrous dysplaisa of the bone

345
Q

tx of bullous impetigo

tx of non bullous impetigo

A

tx of bullous = cephalexin, dicloxicillin, clindamycin

tx of non bullous = mupirocin

346
Q

mastoiditis

A

complication of AOM
strep pneumo
fever otalgia
inflammationof mastoid

deviation of ear

needs CT or MRI

347
Q

dactylitis

A

earliest manifestion of a vasoocclusive crisis in sicke cell patient

symmetrical swelling of the hands and feet

caused by: mcrovascular occlusion

348
Q

compliactions of bacterial meningitis

A

intellectual/behavioral disablity
hearing loss
cerebral palsy
epilespy

349
Q

complications of. prematurity

A

resp distress syndrome/ PNA
bronchopulmonary dysplasia

intraventricular hemorrhage
NEC

retinopathy of prematurity

350
Q

what accumulates in a 21 hydroxylase def

A

17 hydroxy progesterone

351
Q

avascular necrosis - risks

A 
steroid use 
alcohol abuse
SLE - antiphospholipid syndrome 
sickle cell dz 
infections 
decompression sickenss
352
Q

presentation of avascular necrosis

A

groin pain on weight bearing
pain on hib abduction and internal rotation

no erythema, swelling or point tenderness
NML - WBCs, ESR, CRP

353
Q

meconium ileus

A

ileum obstruction
meconium inspissated

negative squirt sign
associated with CF

354
Q

congenital lymphedema

A

occurs due to dysgenesis of the lymphatic system and presents at birth with non pitting carpal and pedal edema

eventually leads to the webbed neck - seen in turners syndrome

355
Q

immune thrombocytopenia

A

platelet autoantibodies
preceding viral infection

petechia, ecchymosis mucosal bleeding

tx- observe

356
Q

serous OM vs AOM

A

lack of inflammatory signs = serous

357
Q

absence seizures on EEG

A

3hz spike and wave pattern

358
Q

juvenille myoclonic epilepsy

A

generalized seziures during adolescence

myoclonic jerks that are more prominent in the first hour after awakening

359
Q

alport syndrome

A

recurrent episodes of hematuria

sensorineural deafness and family hx of renal failure

360
Q

first line tx for ADHD non stimulant

A

atomoxetine

361
Q

neonatal sepsis

A 
temp instability 
poor feeding 
jaundice
CNS signs 
abnormal WBCs
left shift
362
Q

choleostoma

A

peripheral granulation and severe skin debris visualized in the ear

363
Q

spondylolisthesis

A 
forward slip of vertebrae 
MC - L5 over the S1 
preadolescent children 
back pain
neurological deficit
364
Q

viral myocarditis

A

cosackie B virus
Adenovirus

prodrome 
HF 
resp distress 
murmur 
hepatosplenomegaly
365
Q

dx of viral myocarditis

A

CXR - cardiomegaly, pulmonary edema
ECG - sinus tachy
Echo - decreased Ejection Fraction

366
Q

suspicious burns

A

buttocks and back of legs

sparing of the flexor surfaces
sharp lines of demarcation
uniform burn depth
delayed medical treatment seeking

367
Q

growing pains

A

primarily occurs at night and resolves by morning
affects the LE bilaterally
Normal PE and activity level

tx = reassurance and NSAIDs

368
Q

hemophilia knee joint microscopic exam

A

hemosiderin deposition and fibrosis

369
Q

transient tachypnea of the newborn

A

resp distress and fluid in the intralobular fissures from a neonate that has been delivered via C-section

370
Q

path behind coarctation of the aorta

A

thickening of the tunica media of aortic arch near the ductus arteriosus

371
Q

hyposthenuria

A

inability of the kidney to concentrate urine and can occur in pats with sickle cell trait

polyuria
decrease urine specific gravity
nml serum Na

372
Q

central Diabetes insipidus

A

polyuria

increased Na in serum

373
Q

primary pyschogenic polydipsia

A

decreased Na due to dilutional

374
Q

brain abscesses

A

HA
vomiting
fever
focal neuro deficits (stroke like)

riing enhancing lesions on CT

375
Q

Congenital heart defect increases risk for NEC due to

A

decreased mesenteric perfusion

376
Q

pneumatosis

A

extravasation of bowel gas into the damaged bowel

377
Q

breath holding spell

A

cyanosis
LOC
nml pe

378
Q

risks for hip dysplasia

A

breech position
Fhx
excessive tight swaddleing

379
Q

graves dz

A

transplacental TSH receptor antibody

tachy
weight loss
jittery
poor feeding

380
Q

atlantoaxial instability

A

pts with down syndrome who present with upper motor neuron findings

excessive laxity in the posterior transverse ligament causing increased mobility between C1 and C2

381
Q

fanconis anemia

A

dna repair defect
Bone marrow failure
short stature
hypo/hyper pigmented macules GU malformations

382
Q

lab avlues in fanconis anemia

A

low WBCs
low RBCSs
low platelets

383
Q

benzene exposure leads to

A

chromosomal breakage

aplastic anemia

384
Q

scabies

A

spread by direct perosn to person contact
extremely pruritic

small erythematous papules
rash located on interdigital web spaces, felxor wrists, extensor elbows, axillae, ubilicus, genitals

385
Q

tx of scabies

A

topical 5% permethrin or oral ivermectin

386
Q

midgut volvulus

A

neonates with bilious vomiting and abdominal distension

dx - upper GI study

387
Q

HUS

A 
shigella toxin (serotype O157H7) 
vascular damage and microthrombi formation
388
Q

HUS clinical features

A

hemolytic anemia (schistocytes increased bili)
thrombocytopenia
acute kidney injury (Increased BUN and creatine)

389
Q

tx of perinatal hep B

A

HBV and HB Ig

390
Q

symptoms of. bacterial sinusitis

A

nasal congestion
drainage and cough
that are all persistent

most common predisposing factor = viral URI

391
Q

comorbidites that go along with tourrette synrome

A

OCD and ADHD

392
Q

parinaud syndrome

A

pineal gland tumor
limited upward gaze
upper eyelid retraction

pupils non reactive to light
pupils reactive to accommodation

393
Q

subdural hemorrhage neonates

A 
convulsions
period of apnea
resp depression 
altered muscle tone
fontanelles may be tense and bulging
394
Q

eczema herpicum

A

complication of atopic dermatitis
painful vesicles - punched out erosions
hemorrhagic crusting along with fever
lymphadenopathy

395
Q

membranous nephropathy

A

edema proteinuria hypoalbuminemia in adolescents and adults

active hep B infections - important risk factor

396
Q

pneumococcal vaccine

A

conjugate capsular polysacharride

397
Q

antibodies to dsDNA

A

SLE

398
Q

hydroxyurea ADR

A

myelosuppresion

399
Q

Serum sickness like rxn

A

caused by beta lactams and sulfa drugs
Ic formation
acute hep B infection

1-2 weeks after exposure

400
Q

myotonic muscular dystrophy

A 
grip myotonia 
delayed muscle relaxation 
facial weaness 
foot drop 
dsyphagia
401
Q

tx of tourrettes

A

antidopaminergic medication

402
Q

pinworm

A

school aged children
nocturnal perianal pruritus
spread by itching to other areas

helminth infection

403
Q

celiac disease

A

autoimmune disorders increase the risk
abd pain, bloating, diarrhea
failure to thrive/short stature

dermatitis herpitiformis
Iron deficiency

404
Q

vitamin d deficiency

A 
increased skin pigmentation 
delayed fontanelle closure 
enlarged skull frontal bossing 
enlarged costochondrial joints
long bone joints

genu varum

405
Q

language disorder

A

common and characterized by persistent difficulties in the acquisition and use of language due to defects in comprehension and/or production

limited vocab sentence structure and functional use of language

406
Q

iron toxicity

A

radioopaque pills
abd pain
vomiting
hematemesis

metabolic acidosis

407
Q

aspirin poisoning

A 
tinnitus 
resp alkalosis and metabolic acidosis 
fever 
hyperapnea
pills not RADIOOPAQUE
408
Q

anemia of prematurity

A

usually asymptomatic
tachy
poor weight gain
apnea

normocytic, normochromic
low reticulocyte count
low hgb and low hct

409
Q

premature adrenarche

A

early activation of adrenal androgens
obese children

precocious puberty development of pubic and axillary hair, acnes and body odor in a child with normal bone age

410
Q

eosinophilic esophagitis

A

chronic immune mediated inflammation

dysphagia 
chest pain/ epigastric pain 
reflux, vomiting 
food impaction 
associated atopy
411
Q

sickle cell provides decrease morbidity when it comes to what disease

A

malaria

412
Q

MCC of lymphadenitis in kids

A

staph aureus followed by group A strep

413
Q

lab values of turners sydndrome

A

increased FSH and LH

due to negative feedback of estrogen

414
Q

renal tubular acidosis

A 
poor hydrogen secretion into urine 
urine pH  > 5.5 
serum K low 
high Cl
low HCO3

nml anion gap + failure to thrive

415
Q

lactic aidosis metabolic panel

A

high anion gap metabolic aidosis

416
Q

DKA

A

polyuria/ nocturia, polydipsia, polyphagia
vomiting, abd pain, weight loss
fatigue, dehydration
kaussmaul respirations

gucose > 200
bicarb < 15
pH < 7.3
anion gap >14

urine ketones
increased FFAs

falsely normal K - due to decreased insulin –> K. shift to ECF

417
Q

reye syndrome biopsy

A

microvesicular fatty steatosis

418
Q

complication of friedreich ataxia

A

cardiac dsyfunction - hypertrophic cardiomyopathy

419
Q

seborrheic dermatitis

A

peaks in infancy and adulthood

erythematous plaques and/or yellow greasy scales
located on scalp face eye area, posterior ears umbilicus/ diaper area

420
Q

tx of seborrheic dermatitis

A

emollient

then topical antifungals or low potency glucocorticoids

421
Q

infant botulism

A

ingestion of botulinum spores from environmental spores

422
Q

ringworm

A

tinea corporus

tx - topical clotrimazole

423
Q

jejunum atresia

A

risk factors = vasoconstrictive meds, cocaine use in mom

dx - triple bubble sign and gasless colon

424
Q

risks seen in a small for gestational age infant under 10%

A 
hypoxia 
polcythemia 
hypoglycemia
hypothermia
hypocalcemia
425
Q

MCC of conductive hearing loss

A

repeated OTITIs media infections

426
Q

congenital torticollis can lead to

A

positional plagiocephaly

427
Q

MCC of childhood bloody diarrhea

A

entamoeba histolyticum

428
Q

dx of ALL via

A

bone marrow biopsy

429
Q

central DI labs

A

increased Na

430
Q

recommendation for diabetic athletes

A

lower there dose of insulin 10 to 15% on practice days

431
Q

ADR of ceftriaxone

A

hyperbilirubenmia

432
Q

tx for neonatal meningitis i kids < 30 days

A

ampicillin
steroids
cefotaxime

433
Q

testing for HIV in baby <18months

A

DNA PCR

434
Q

testing for HIV in baby > 18months

A

ELISA

435
Q

CD4 count diseases
<200
<100
<50

A 
<200 = PCP - tx - TMP-SMX +/- dapsone 
<100 = toxoplasmosis - tx - TMP-SMX +/- atovaquone 
<50 = mycobacterium avium - tx - azithromycin
436
Q

tx for kid with latent TB

A

INH + vitamin b6

437
Q

TB test for kid <5 and > 5

A

< 5 = PPD

> 5 = quantiferon

438
Q

Peritonsilar abscess

A

approx 10 years old

displaced uvula to one side

sore throat, muffled hot potatoe voice
drooling

439
Q

tx of angioedema

A

FFP

440
Q

tx of scabies

A

topical permethrin

441
Q 
urine pH >5.5 
\+ 
metabolic acidosis 
= 
dx?
A

renal tubular acidosis

442
Q

physio of transient tachypneic of the newborn

A

delayed resorption and clearance of aleolar fluid

443
Q

diamond blackfan anemia

A

weird tripharyngeal thumbs
craniofacial abnormalities
increased risk of malignancy

macrocytic anemia
reticulocytopenia
normal platelets, white

tx corticosteroids

444
Q

erythematous plaques and yellow, greasy scales located on scalp, nasolabial folds

A

seborrheic dermatitis

tx - emollients

445
Q

difference between angioedema and anaphylaxis

A

anaphylaxis has hypotension angioedema does not and you treat with securing airway vs anaphlyaxis you give IM epi

if c1 eserase def tx with FFP

446
Q

tx of allergic rhinitis

A

avoid allergen + intranasal steroids

447
Q

presence of gamma tetramers (hemoglobin barts ) should make you suspicious for

A

alpha thalassemia - associated with hydrops fetalis

elevated reticuloctye count
low MCV

target cells seen on peripheral smear

448
Q

heavy regular bleeding in menses in an adolescent with normal cogulation profile =

A

Von WIllebrand disease

449
Q

hemophilia A patient develops increased bleeding frequency or has become refractory to treatment =

A

inhibitor development - body recognizes factor 8 being infused as foreign and rejects it

450
Q

fever, irritability
generalized erythema, blisters

epidermal shedding (nikolsky sign)

A

staph scalded skin syndrome

tx - nafcillin, vancomycin

451
Q

neruoblastoma can be associated with what disorders

A

neurofibromatosis

hirchsprung disease

452
Q

nurse maids elbow

A

radial head subluxation

tx - reduction

453
Q

supracondylar humerus fracture

A

MC pedaitric elbow fx
5-8 yrs old
increased risk of volkmann contracture - due to compartment syndrome

beware of brachial artery entrapment - check radial pulse

454
Q

compication of scolioiss

A

restrictive lung disease

455
Q

what live attenuated vaccine can HIV patients take

A

MMRV

456
Q

male in fant with a distended palpable bladder and low urine output

A

posterior urethral valves - MC congenital urethral obstruction

457
Q

dx step of croup

A

give raecmic epi and they get better

458
Q

croup that does not improve
slightly more toxicity
raecemic epi doesnt help

A

bacterial tracheitis - caused by staph aureus
do a tracheal culture

tx - iv abx

459
Q

unilateral anterior chain lymphadenopathy

mass
drooling

A

peritonsillar abscess

460
Q

VSD can lead to what

A

RVH

461
Q

CXR of ASD

A

increased vascular markings and cardiomegaly

462
Q

complications of ASD

A

dysrhythmias

paradoxical emboli and DVTs

463
Q

pear shaped heart

A

pericardial effusion

464
Q

jug handle appearance

A

primary pulmonary artery HTN

465
Q

adverse rxn of working with plastics

A

hydrogen cyanide poisoning - ha, confusion, sudden LOC, metabolic acidosis

466
Q

diluting formula leads to

A

hyponatremia –> seizures

467
Q

nevus flammeus =
nevus simplex
salmon patch

A

flat vascular lesions that occuri n the beck/base of scalp

appear more prominnent during cyring or exerise

468
Q

pustular melanois

A

benign self limited newborn dz
more common in blacks

1-2mm pustules that result in hyperpigmented lesions encircles by scale

469
Q

sebacceous nevi

A

small sharply demarcated lesions that occur more commonly on the head and neck of infants

yellow -orange in. color
slightly elevated
hairless

470
Q

cold panniculitis

A

destruction of fate cells caused by expposure to cold weather or cold object

self resolving

471
Q

tx for aspirin overdose

A

sodium bicarbonate

472
Q

teratogeneic effects of ACE-I

A

oligohydramniosis

renal dysgenesis

473
Q

tx of inflammed lesions in seborrheic dermatitis

A

topical corticosteroids

474
Q

neonatal SLE exposure can lead to

A

heart block –> heart failure

475
Q

testing for digeorge syndrome

A

intradermal skin test using candida albicans

NO RESPONSE in patients with T cell defect

476
Q

fecal occult blood test + in a newborn

A

meckels diverticulum

dx - meckels scan = technium 99

or if a teenager = ct scan

477
Q

baby swallows moms blood what test

A

apt test

478
Q

Ulcerative colitis basics

A

bloody diarrhea
surgery is curative
continous damge in the colon

479
Q

crohns basics

A

skip lesions
watery diarrhea
medications - tx
weight loss

480
Q

kid with fever and bloody BM what is the next step

A

stool culture

481
Q

milk protein allergy tx

A

hydroylzed formula

482
Q

metabolic acidosis effects on bilirubin

A

reduces its binding similiar to. sulfa drugs

483
Q

phenobarbital has what effect on bili pathway

A

kickstarts gluconuryl transferease

484
Q

neonatal sepsis has what effect for bili

A

interrupts the BBB incresing risk for kernicterus

485
Q

hyperalbuminemia has what effect on bili

A

will aid in reducing excess bili by binding to it

486
Q

what drugs are C/I in breast feeding

A 
amphetamines 
lithium 
cyclosproin 
drugs 
bromocrptine
487
Q

what symptoms follow in a newborn delivered by maternal diabetes mom that has finally got insulin and glucose under control

A

hypocalcemia –> tetany

hypomagensia

488
Q

smaller for dates infants have a higher incidence of

A

major congenital anomalies and at increased risk for future growth retardation

489
Q

in premature infants apnea is thought to be secondary to

A

an incompletely developed respiratory center

490
Q

early tx of galactosemia =

A

soy formula feeding

491
Q

polycythemia in a newborn can lead to what complication

A

seizures

492
Q

goats milk is deficient in

A

vit d

folate

493
Q

newborns with cleft lip and cleft palate are at greater risk for

A

recurrent otitis media and hearing loss

speech issues

494
Q 
2 week old newborn with: 
enlarged fontanelles 
jaundice 
lethargic
feeding difficulties 
edema of extremities and gentials 
bradycardia

dx =

A

congenital hypothyroidism

495
Q

cxr of transient tachypnea of the newborn

A

increased pulmonary vascular markings

496
Q

most common type of PNA in kids , 5 y/o

A

viral

497
Q

1 day old infant fronto occipital head circumference that is 2cm larger than it was initially several hours ago and the scalp is no squishy and the infant is now tachy

A

subgaleal hemorrhage

subaponeurotic hemorrhage

498
Q

intraventricularhemorrhage (germinal matrix hemorrhage)

A

small premature infants

can lead to hydrocephalus –> tx = vp shunt

499
Q

caput succedaneum

A

soft tissue swelling - presenting in the delivery portion of the head
can CROSS suture line edema may be. pitting
resolves in the first few days

500
Q

tx of SVT in infant

A

carotid massage

complicaitons = hydrops fetalis

501
Q

pulsus parodoxus in a kid cna be seen in what autoimmune disease

A

JIA

muffled heart sounds
increase pulsus parodoxus
spindle shaped swelling of finger joins

502
Q

tricupsid atresia

A

RVH
LAD
LVH

503
Q

unilateral nasal obstruction with foul smelling discharge in young kid

A

FB

504
Q

complication of staph and other types of pna - signs

  • acute worsening over minutes
    markedly increased work of breathing
    increased O2 requirements
    hypotension
A

tension pneumothroax - tx - needle aspiration

505
Q

tx and management of bacterial tracheitis

A

maintain airway

506
Q

lens shaped hemorrhage

A

epidural

507
Q

crescent shaped hemorrhage

A

subdural

508
Q

punctate hemorrhages seen on a head CT

A

concussion

509
Q

car safety

A

car seat - rear facing 0-2yrs old

booster seat until 4’9’’

510
Q

hypertrophied tonsils and adenoids lead to what metbaolic condition

A

respiratory acidosis with metabolic compensation - due to chronic upper airway obstruction

511
Q

cause of. mono

A

ebv

512
Q

dx of lactose intolerance can be made via

A

hydrogen breath test

513
Q

first teeth to form in a newborn are

A

mandibular central incisors

514
Q

prolonged bottly use in an infant can lead to

A

tooth decay

515
Q

other lab values that can occur during nephrotic syndrome

A

incerased cholesterol and TGLs

516
Q

complication of spina bifida

A

recurrent UTIs
hypotnia o LE
muscle atrphy of LE

517
Q

FB and expiratory wheeze

A

intrathroacic airways - bronchioles since they collapse when breathing out

518
Q

FB and inspritory wheeze

A

extrathroacic airways since the air has to push to get around object

519
Q

+ coin sign on lateral x-ray FB is located

A

in the trachea

520
Q

Athsma taper tx

A

1) SABA + rescue inhaler (RI)
2) above + inhaled corticosteroid (ICS)
3) above + leukotriene antagonist
4) above + increased dose of. ICS
5) above + LABA
6) above + oral steroid

521
Q

tx of RSV

A

supportive care
O2
IVF

522
Q

complete lack of acid beta galactosidase actvity

A

niemman pick

523
Q

B cell def diseases

A

XLA
CVID
IgA DEF
hyper IgM

524
Q

T cell def

A

dieorge syndrome

HIV

525
Q

Combined b cell and t. cell def diseases

A

Wiskott aldreich
ataxia telengectasias
SCID (mega aids)

526
Q

phagocytosis diseases

A

LAD
CGD
chediak higashi

527
Q

XLA - LAB VALUES

A

CBC -. NORMAL
NO IgG
No B. cells

no RTK gene

528
Q

CVID lab values

A

mild form of XLA
teenager

normal CBC
decreased 2/3 of Igs’s

529
Q

diegorge syndorme

A

22q11.2 - 3rd pharyn pouch

wide spaced eyes, low set ears, small face
absent thymic shadow

fungi + PCP infection

530
Q

digeorge lab values

A

CBC = decreased absolute lymphocytes

decreased Ca

531
Q

wiskott aldrich lab values

A

CBC = decreased WBCs, decreased platelets

increased IgM
increased IgG

532
Q

SCID lab values

A

CBC = decreased WBCs

decreased IgG, IgM, IgA

533
Q

CGD lab values

A

CBC = increased WBCs
increased IgM, IgG

recurrent staph abscesses

534
Q

LAD lab values

A

CBC = increased WBCs
Increased temp

no pus
delayed cord separation

535
Q

tx of c1-esterase def

A

FFP

536
Q

rubeola =

A

measles

537
Q

test for scoliosis

A

adams test

538
Q

signs of botulism

A 
constipation 
poor feeding
absent gag reflex
ptosis 
hypotonia
descending paralysis
539
Q

when is chelation therapy needed

A

> 45 lead levels

540
Q

tx of diabetes insipidus

A

desmopressin

541
Q

excessive milk intake can lead to

A

iron def anemia
microcytosis
increased red cell distribution width

542
Q

langerhan histiosytosis

A

lytic bone lesions
skin lesions
lyphadenopathy
pulmonary cyst/nodules

tx - vinblastine + prednisone

543
Q

neuroblastoma can also present with

A

spinal cord compression from epidural invasion

544
Q

serous otitis media basics

A

non bulging

545
Q

biliary atresia

A

direct bili increased
7-14 days after birth

US- no ducts

HIDA scan 7 days after phenobarbital is given

546
Q

dysmorphic RBC casts in urine =

A

glomerular damage = nephritic syndromes

547
Q

ectopic ureter presenttion

A

young girl who is never dry

548
Q

tx of ringworm

A

topical clotrimazole

549
Q

migraine HA presentation in predtriacs

A

mcc of acute and recurrent hAs
unilateral or bilateral
photophobia
n/v

550
Q

biphasic stridor that improves with neck extension

A

vascular ring

551
Q

rickets labs

A

low Po4 and normal Ca

552
Q

osteogenesis imperfect

A

normal PO4

normal Ca

553
Q

medulloblastoma

A

2nd mcc tumor of brain
cerebellar vermis - ataxia
ha
n/v

554
Q

simple seizures in newborns

A

require no workup

  • less than 15min
    only 1 in 24hr
    gnerlaized
555
Q

risk factor for RDs

A

maternal diabetes

556
Q

non classical congenital adrenal hyperplasia

A

premature secondary se characteristics
accerlaerated growth and bone age
low/normal LH levels

557
Q

periventricular calcifications in newborn

A

CMV

558
Q

intracerebeal calcifcations

chorioretinitis

A

toxoplasmosis

559
Q

fredriech ataxia

A 
mri cervical spinal cord atrophy 
loss of position sense and decreased vibratory sense 
progressive weakness in LEs 
wide based gait 
kyphoscoliosis

complications - hypertrophic cardiomyopathy

560
Q

tx of acute bacterial rhinosinusitis

A

amoxicillin +/- clavulanuate

561
Q

premature adrenarche

A

caused by early activation of adrenal androgens
more common in obese children
nml bone age

562
Q

primary cause of toxo

A

undercooked food

563
Q

cxr of transient tachypnea

A

lung hyperexpanded
wet
increased pulmonary vascular markings

564
Q

viral myocarditis

A

can be caused by coxsackie b and adenovirus

viral prodrome 
heart failure 
resp distress 
murmur 
hepatosplenomegly
565
Q

dx workup of precocious puberty

A

advance bone age –> LH test

if low –> gnrh stimulation test

if high –> MRI - central precocious puberty

566
Q

shigellosis

A

bloody diarrhea
seizures
fever
dehydration

567
Q

s3 gallop
hypotension
recent URI

A

myocarditis

568
Q

ADR of TMPSMX

A

neutropenia

569
Q

+ ppd
- cxr

dx =

A

latent TB - tx - INH + B6

Step 2 Rotation Cards (14 decks)

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