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5-EOR-Pediatrics > Pediatrics > Flashcards

Pediatrics Flashcards

1
Q

A 12-year-old boy presented to your office one week ago with complaints of sore throat, bilateral knee pain, and chest pain. Treatment with penicillin was initiated and he has now returned for follow-up. Which of the following laboratory tests is most appropriate to monitor progress of his disease?

A

C-reactive protein

Acute rheumatic fever (ARF) is an inflammatory, autoimmune response that develops after infection with Group A Streptococci (GAS)

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2
Q
A
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3
Q

UGI series= “string sign”

A

Pyloric stenosis

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4
Q

flu-like symptoms

heart failure

tachycardia out of proportion to fever

Elevated troponin

A

myocarditis

gold standard= endomyocardial biopsy

most common cause= enterovirus (coxsackie group B)

ACE Inhibitors

complication=dilated cardiomyopathy

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5
Q

(hips)

ABducted

w/ hips and knees flexed to 90 degrees

A

ORTOLANI (first 3 months of life)

Developmental dysplasia of the hip

Diagnosis is made by ultrasound (< 4 mos of age)

tx: Closed reduction and immobilization in a Pavlik harness
risk: female sex, breech birth position, oligohydramnios, prolonged swaddling, and family history of DDH

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6
Q

involuntary repetition or echoing of one’s own words.

A

Palilalia

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7
Q

MC organism for otitis externa

A

Pseudomonas aeruginosa

tx: ciprofloxacine/hydrocortisone

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8
Q

“rice-water” stool

severe, watery diarrhea flecked with mucus “rice water”

A

Cholera

V. cholerae is a gram-negative curved rod that is highly motile and halophilic

tx: Azithromycin for children

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9
Q

“target sign”

A

pyloric stenosis

risk= first born, male sex, prematurity, and macrolide antibiotic use (erythromycin)

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10
Q

which vaccine has a Small risk of intussusception after receiving vaccine and contraindicated in infants with a history of intussusception

A

Rotavirus vaccine

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11
Q

Tetralogy of Fallot PROVe

A

PROVe::

  1. Pulmonic stenosis,
  2. Right ventricular hypertrophy,
  3. Overriding aorta,
  4. VSD
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12
Q

how do you test for bronchiolitis?

A

bronchiolitis

Respiratory Syncytial Virus (RSV)

dx: Nasopharyngeal swab for fluorescent antibody staining

tx=nasal suctioning/supportive

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13
Q

Osteitis+ acute otitis media

A

Acute mastoiditis

mc organism: Streptococcus pneumoniae.

tx: admission and IV abx

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14
Q

Type of Hypersensitivity reaction

  • Anaphylaxis
  • urticaria
  • angioedema
  • REQUIRES TWO SEPARATE EXPOSURES
A

Type I: Anaphylactic

IgE

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15
Q

Most hydroceles are _______ sided

painless

A

Most hydroceles are right sided

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16
Q

pectus excavatum, ectopia lentis

A

Marfan

defect in fibrillin-1

Risk of aortic aneurysm

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17
Q

double bubble” sign

+

bilious vomiting

Upper GI series: “corkscrew”

A

Midgut volvulus

(intestinal malrotation)

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18
Q

ductal-dependent cardiac lesion

A

Coarctation of the aorta

Ductal Dependent Lesions

Transposition of the great vessels (most common cause in newborns)

Tetralogy of Fallot (most common in children >1 year old)

Tricuspid atresia

Interrupted aortic arch

Coarctation of the aorta

Hypoplastic left heart syndrome

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19
Q

hypochloremic, metabolic alkalosis

A

pyloric stenosis

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20
Q

What is the most common causative organism of meningitis in a 1-week-old child?

A

Group B Streptococci

tx: Cefotaxime + ampicillin or gentamycin + ampicillin

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21
Q

What chromosomal abnormality is Hirschsprung disease commonly associated with?

A

Down syndrome (trisomy 21).

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22
Q

ekg: Infants less than one month normally have a degree of

A

right ventricular hypertrophy because in utero the newborn heart pumps systemic blood from both the left and the right ventricle (through the ductus arteriosus)

(rightward axis)

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23
Q
  • fetal connection between the pulmonary artery and aorta remains open, causing a continuous, “machine-like” murmur that is heard in both systole and diastole
  • acyanotic
A

Patent ductus arteriosus (PDA)

dx: echo
tx: indomethacin/ ligation

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24
Q

“thumb print sign” (x-ray)

A

epiglottitis

MC: Group A streptococcus (GAS)

(enlarged and thickened epiglottis=thumb sign)

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25
Q

compulsive use of obscenities

A

coprolalia

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26
Q

Neonatal conjunctivitis: Age 5 days to 5 weeks

  • Often the first manifestation is watery discharge, which later becomes mucopurulent.
  • Conjunctival chemosis then develops, and the conjunctiva may become so friable that they may bleed.
  • Eyelid swelling may also develop.
A

Rule of 5 for Neonatal Conjunctivitis

0-5 Days: N. Gonorrhoeae (tx: ceftriaxone)

  • gonorrheal conjunctivitis occurs almost exclusively in the first few days of life. The discharge of gonococcal conjunctivitis is copious, and the eyelids may be so swollen that the conjunctiva cannot be visualized.

5 days to 5 weeks: Chlamydia trachomatis (tx: Oral erythromycin)

  • Most common cause of neonatal conjunctivitis
  • Most common: 5-14 days
  • Often the first manifestation of the Chlamydial conjunctivitis is watery discharge, which later becomes mucopurulent. Conjunctival chemosis then develops, and the conjunctiva may become so friable that they may bleed. Eyelid swelling may also develop.

5 weeks to 5 years: Streptococcus or Haemophilus influenzae (tx: Erythromycin ointment)

Otherwise: most common cause of neonatal eye discharge is lacrimal duct obstruction (tx: warm compresses and lacrimal duct massage)

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27
Q

Complex febrile seizures

A
  1. multiple seizures occur during the same febrile illness,
  2. seizures are prolonged (>15 minutes), or
  3. the seizures have a focal component

Note: temp >38C, children 6mos-5yrs

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28
Q

involuntary repetition of words or phrases spoken by others

A

Echolalia

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29
Q

speaking elaborate but meaningless speech, or speaking an unknown language

A

Glossolalia

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30
Q

most common finding is a continuous, systolic and diastolic murmur, commonly called a machinery-like murmur

widended pulse pressure

normal skin color

A

Patent ductus arteriosus

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31
Q

The “figure-3” sign, characterized by prestenotic aortic dilation, coarctation indentation and poststenotic aortic dilation.

A

Aortic coarctation

most commonly around the left subclavian artery

dx=echo

associated with Turner’s syndrome

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32
Q

“sausage-shaped” abdominal mass palpated

A

Intussusception

MC location=ileocolic

dx: ultrasound
tx: air/contrast enema

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33
Q

Peak Sudden Unexpected Infant Death Syndrome age range

A

2-4 months

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34
Q

Enterobiasis

A

pinworm

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35
Q

rash typically starts on the face and spreads downward

rash generally begins on the head and face and progresses downwards (“showering” rash)

prominent lymphadenopathy (occipital, cervical, postauricular)

A

Rubella

German measles

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36
Q

“toddler’s fracture” or childhood accidental spiral tibial (CAST) fracture

Most common location

A

DISTAL two thirds of the tibia

undisplaced

spiral pattern

9mos-3 yrs

Requires cast

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37
Q

“floppy baby syndrome.”

poor feeding, decreased suckling, loss of facial expression, constipation, and noticeable neck and peripheral weakness

A

infantile botulism

associated with ingestion of honey, corn syrup, and vacuum or environmental dust

tx:

If >1 year: Equine serum heptavalent botulism antitoxin

If <1 year: Human-derived botulism immune globulin

Treatment is IV botulism Ig

38
Q

visible dark blue dot present in upper pole of the left testicle

A

Torsion of the appendix testis

39
Q

Type of Hypersensitivity reaction:

  • Autoimmune hemolytic anemia
  • Erythroblastalis fetalis
  • Goodpasture syndrome
  • REQUIRES TWO SEPARATE EXPOSURES TO ANTIGEN
A

Type II: Cytotoxic

IgG or IgM and resultant complement activation

40
Q

often follows a viral illness with thrombocytopenia

petechiae, purpura, and gingival bleeding

A

idiopathic thrombocytopenic purpura (ITP)

tx: Corticosteroids and intravenous immunoglobulin

Observation for platelets >20k

41
Q
  • fever and acute parotid gland inflammation and swelling, and the pain often radiates up to the ear. (infectious parotitis)
  • It is a systemic disease with low-grade fever, involving other glandular tissue, including the pancreas and testicles.
  • elevated serum amylase
A

Mumps

Paramyxovirus

Acute, self-limited

42
Q

organism for hand, foot mouth?

A

Coxsackie

43
Q

Gram-positive cocci in chains

A

Streptococcus

44
Q

“strawberry tongue” (prominent papillae)

A

Scarlet fever

“Second disease,” is caused by Group A Streptococcus

45
Q

dx for pertussis

A

Polymerase chain reaction of nasopharyngeal secretions

tx: azithromycin or erythromycin

46
Q

“bag of worms”

A

Varicocele

47
Q

ADDduct + force posterior

(hips)

A

BARLOW (first 3 months of life)

Developmental dysplasia of the hip

Diagnosis is made by ultrasound (< 4 mos of age)

tx: Closed reduction and immobilization in a Pavlik harness
risk: female sex, breech birth position, oligohydramnios, prolonged swaddling, and family history of DDH

48
Q

Type of Hypersensitivity Reaction

  • Contact dermatitis (poison ivy/oak)
  • TB skin test
  • Transplant rejection
A

Type IV: Cell-mediated (delayed)

Activated T cells against surface bound antigens

49
Q

In addition, an uncorrected left-to-right shunt, such as a ventricular septal defect, atrial septal defect, or patent ductus arteriosus, can eventually become a right-to-left shunt, a phenomenon known as ___________________. This occurs when increased pulmonary blood flow from a left-to-right shunt leads to pulmonary hypertension and compensatory right ventricular hypertrophy, and, over time, right ventricular pressures surpass left ventricular pressures, resulting in a change in direction of the shunt.

A

Eisenmenger’s syndrome

50
Q

Which type of fracture of the leg would be concerning for child abuse?

A

Mid-shaft fracture.

51
Q

The rash typically starts at the hairline, with formation of macules which progress to fluid-filled vesicles (dew drops on a rose pedal).

A

Varicella

tx: If age > 12; acyclovir

otherwise, supportive

52
Q

major cause of perinatal bacterial infection+ maternal UTI

A

Streptococcus agalactiae (Group B Strep/GBS)

tx: penicillin/ ampicillin

53
Q

a skin finding in which the top layers of the skin slip away from the lower layers when rubbed

A

Nikolsky sign

+ for SJS, TEN, and Staph Scalded Skin Syndrome

54
Q

“steeple sign” (x-ray, PA view)

symmetric narrowing of the trachea.

A

Croup/ laryngotracheitis

parainfluenza virus

55
Q

chest X-ray shows a “boot-shaped” heart

Cyanotic

harsh systolic crescendo decrescendo murmur along the left mid-to-upper sternal border

A

Tetralogy of Fallot

tet spell tx: cradling them in a knee-chest position

associated w/ chromosome 22 deletions and DiGeorge syndrome

PROVe:: Pulmonic stenosis, Right ventricular hypertrophy, Overriding aorta, VSD

56
Q

anterior cervical lymphadenitis

A

Staphylococcus aureus and Streptococcus pyogenes

57
Q

Triad:

  1. acute renal failure,
  2. thrombocytopenia, and
  3. microangiopathic hemolytic anemia
A

hemolytic-uremic syndrome (HUS)

Escherichia coli O157:H7 infection

All patients with HUS should be hospitalized

58
Q

“double-bubble” sign on abdominal radiograph

A

characteristic sign of duodenal obstruction

59
Q

“olive shaped mass”

A

pyloric stenosis

risk= first born, male sex, prematurity, and macrolide antibiotic use (erythromycin)

60
Q

draw triangle

A

age 6

Age 3: circle

Age 4: plus sign

Age 5: square

Age 6: triangle

61
Q

” afferent pupillary defect “

decreased extraocular movement, pain with movement of the eye and proptosis

A

Orbital cellulitis

tx=cefuroxime and vancomycin

62
Q

draw square

A

age 5

Age 3: circle

Age 4: plus sign

Age 5: square

Age 6: triangle

63
Q

subglottic narrowing

A

croup

64
Q

(hips) flexing the infant’s hips and knees showing uneven knee heights

A

Galeazzi test (after 3 months)

Developmental dysplasia of the hip

Diagnosis is made by ultrasound (< 4 mos of age)

tx: Closed reduction and immobilization in a Pavlik harness

65
Q

While SJS typically involves __________ of the body surface, TEN involves ________ of the body surface.

A

While SJS typically involves less than 10% of the body surface, TEN involves more than 30% of the body surface.

66
Q

“sandpaper” rash

Begins on face and spreads to trunk/extremities

“Pastia’s lines” (accentuation of linear erythema in the skin folds)

A

Scarlet fever

“Second disease,” is caused by Group A Streptococcus

67
Q

Contraindications to the use of air-contrast enema include

A

hemodynamic instability with shock, free air under the diaphragm, and peritonitis

68
Q

Organism responsible for bronchiolitis

A

Respiratory Syncytial Virus (RSV)

dx: Nasopharyngeal swab for fluorescent antibody staining

tx=nasal suctioning/supportive

69
Q

“telescope bowel”

A

Intussusception

MC location=ileocolic

dx: ultrasound
tx: air/contrast enema

70
Q

female athlete triad

A

eating disorders, amenorrhea, and osteoporosis

71
Q

“currant jelly stool”

A

Intussusception

MC location=ileocolic

dx: ultrasound
tx: air/contrast enema

72
Q

tx for gonorrhea/chlamydia

A

Ceftriaxone 250 mg IM X 1 and azithromycin 1,000 mg PO X 1

73
Q

blood pressure is markedly higher in the arms than legs

skin color is normal

A

Aortic coarctation

most commonly around the left subclavian artery

dx=echo

associated with Turner’s syndrome

74
Q

Type of Hypersensitivity reaction:

  • Serum sickness
  • SLE
  • RA
A

Type III: Immune complex

IgG and complement activation

75
Q

High fever prodrome –>erythematous papular rash on his trunk that extends to his extremities, but spares his face and palms. Began on abdomen and spread to arms and legs

rash that started after the fever went away

A

Roseola infantum

(HHV-6) (Human herpes virus 6)

sixth disease

tx: self-limited; supportive

affects CD4 lymphocytes.

76
Q

Reed-Sternberg cells

A

Hodgkin lymphoma

77
Q

Neonatal conjunctivitis: Age 5 weeks to 5 years

A

Rule of 5 for Neonatal Conjunctivitis

0-5 Days: N. Gonorrhoeae (tx: ceftriaxone)

  • gonorrheal conjunctivitis occurs almost exclusively in the first few days of life. The discharge of gonococcal conjunctivitis is copious, and the eyelids may be so swollen that the conjunctiva cannot be visualized.

5 days to 5 weeks: Chlamydia trachomatis (tx: Oral erythromycin)

  • Most common cause of neonatal conjunctivitis
  • Most common: 5-14 days
  • Often the first manifestation of the Chlamydial conjunctivitis is watery discharge, which later becomes mucopurulent. Conjunctival chemosis then develops, and the conjunctiva may become so friable that they may bleed. Eyelid swelling may also develop.

5 weeks to 5 years: Streptococcus or Haemophilus influenzae (tx: Erythromycin ointment)

Otherwise: most common cause of neonatal eye discharge is lacrimal duct obstruction (tx: warm compresses and lacrimal duct massage)

78
Q

coughing and see a period of peri-oral cyanosis

“whooping cough”

posttussive emesis

A

pertussis

dx; Polymerase chain reaction of nasopharyngeal secretions

tx: azithromycin or erythromycin

79
Q

bright-red “slapped cheek” appearance followed by lacy rash that waxes and wanes over three weeks

A

Erythema infectiosum

(fifth disease)

Human parvovirus B19

80
Q

draw circle

A

age 3

Age 3: circle

Age 4: plus sign

Age 5: square

Age 6: triangle

81
Q

A patent ductus arteriosus is actually beneficial in infants with which other congenital heart diseases?

A

Ductal dependent lesions include transposition of the great vessels, Tetralogy of Fallot, tricuspid atresia, hypoplastic left heart and severe coarctation of the aorta.

82
Q

Neonatal conjunctivitis: Age 0 to 5 days

  • discharge is copious, and the eyelids may be so swollen that the conjunctiva cannot be visualized.
A

Rule of 5 for Neonatal Conjunctivitis

0-5 Days: N. Gonorrhoeae (tx: ceftriaxone)

  • gonorrheal conjunctivitis occurs almost exclusively in the first few days of life. The discharge of gonococcal conjunctivitis is copious, and the eyelids may be so swollen that the conjunctiva cannot be visualized.

5 days to 5 weeks: Chlamydia trachomatis (tx: Oral erythromycin)

  • Most common cause of neonatal conjunctivitis
  • Most common: 5-14 days
  • Often the first manifestation of the Chlamydial conjunctivitis is watery discharge, which later becomes mucopurulent. Conjunctival chemosis then develops, and the conjunctiva may become so friable that they may bleed. Eyelid swelling may also develop.

5 weeks to 5 years: Streptococcus or Haemophilus influenzae (tx: Erythromycin ointment)

Otherwise: most common cause of neonatal eye discharge is lacrimal duct obstruction (tx: warm compresses and lacrimal duct massage)

83
Q

A 2-month-old girl is found to have positive Barlow and Ortolani signs. Which of the follow is the most appropriate diagnostic study?

A

Ultrasound

84
Q

Which of the following congenital heart diseases would benefit from palivizumab administration?

A

prevent respiratory syncytial virus (RSV) infections

Cyanotic congential heart disease

(Children with congenital heart disease (CHD))

85
Q

prodrome of fever cough, coryza and conjunctivitis. Followed by a rash that begins on the face and spreads downward and Koplik spots (pinpoint grayish spots with surrounding red inflammation found on the lateral buccal mucosa)

A

Rubeola

Measles

Koplik spots, pinpoint grayish spots with surrounding red inflammation found on the lateral buccal mucosa, can be found at this point in the illness and are pathognomonic for measles.

86
Q

Rib notching(inferior aspect of the rib) is the classic radiographic finding in

A

Aortic coarctation

most commonly around the left subclavian artery

dx=echo

associated with Turner’s syndrome

87
Q

draw plus sign

A

age 4

Age 3: circle

Age 4: plus sign

Age 5: square

Age 6: triangle

88
Q

The classic finding on X-ray is a “sunburst” pattern

A

osteosarcoma

89
Q

body mass index (BMI) between 85th and 94th percentile

A
  1. Lipid panel
  2. ALT
  3. AST
  4. fasting glucose
  5. CBC
90
Q

A newborn is being evaluated for cyanosis. Physical examination shows a prominent right ventricular impulse and a systolic thrill. A crescendo-decrescendo murmur with a harsh systolic ejection quality is heard along the left upper sternal border. Based on these findings, which of the following is the most likely diagnosis?

A

Tetralogy of Fallot

91
Q
  • Current recommendations to reduce the incidence of and mortality from GBS include screening with vaginal and rectal cultures at the end of the second trimester and between ___________ weeks of gestation.
  • Those women with positive cultures or a GBS urinary tract infection or GBS bacteria should receive intrapartum antimicrobial prophylaxis with intravenous ampicillin.
A

35 and 37 weeks of gestation

92
Q

What are the most common medications that trigger Stevens-Johnson syndrome?

A

Sulfa drugs.

5-EOR-Pediatrics (1 decks)

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