Pediatrics Flashcards
Do you suction the nose first or do the cord ABG?
Suction
How many weeks defines a term neonate?
38
How many weeks defines late preterm?
34-37
What’s a normal RR in a neonate?
40-60 breaths/min
What’s a normal HR in a neonate?
120-160 beats per minute
T/F: a low score on the Apgar is not associated with future cerebral palsy?
True
What are the 5 criteria of the apgar scoring?
- Appearance
- Pulse
- Grimace
- Activity
- Respiration
What’s the most likely cause of conjunctivitis at 1 day after birth?
Chemical irritation
What’s the most likely cause of conjunctivitis at 2-7 days after birth?
Neisseria gonorrhoeae
What’s the most likely cause of conjunctivitis at 7+ days after birth?
Chlamydia trachomatis
What’s the most likely cause of conjunctivitis at 3+ weeks?
Herpes
What’s the mnemonic to remember the causes of newborn conjunctivitis by time after birth?
My chemical romance is gone with the track, herpes
What’s a cause of intracranial bleeding 1 week after birth?
Vit K deficiency (if didn’t receive the shot at birth)
What’s the most common intraocular malignancy of childhood?
Retinoblastoma
Is Rb a tumor suppressor?
Yes
Which chromosome is Rb on?
Chromosome 13
How does retinoblastoma present?
White reflex in a child under age 3
What will show up on dilated opthalmologic exam in retinoblastoma?
White retinal mass with friable consistency
Do you biopsy retinoblastoma?
No, there is risk of seeding
How do anesthetics affect the neonate?
Respiratory and CNS depression
How do barbiturates affect the neonate?
Respiratory and CNS depression, dilated pupils
How does magnesium sulfate affect the neonate?
Respiratory depression
How do sulfonamides affect the neonate?
Displaces bilirubin from albumin
How do NSAIDs affect the neonate?
Premature closure of the PDA
How does warfarin affect the neonate?
Facial dysmorphism and chondrodysplasia
How does isotretinoin affect the neonate?
Facial and ear anomalies, congenital heart disease
How does phenytoin affect the neonate?
Hypoplastic nails, IUGR
How does DES affect the neonate?
Clear-cell adenocarcinoma of the vagina or cervix
How does tetracycline affect the neonate?
Enamel hypoplasia, discolored teeth
How does valproate/carbamazapine affect the neonate?
Intellectual disability, neural tube defects
How do ACE inhibitors affect the neonate?
Craniofacial abnormalities
What bacteria normally helps make vitamin K and clotting factors?
E coli
What’s the inheritance pattern of G6PD deficiency?
XLR
What’s the inheritance pattern of PKU?
AR
What’s the treatment of PKU?
Special diet low in phenylalanine
What’s the treatment of galactosemia?
Cutting out all lactose-containing products
What’s the inheritance pattern of CAH?
AR
What are the 3 main infectious contraindications to breastfeeding?
- HIV
- TB
- Herpes of the nipple
Is splenomegaly a normal finding in newbors?
Yes
What dx presents with tachypnea within a couple hours of delivery, resolves within 1-5 days?
TTN
What dx presents with tachypnea in preterm infants?
RDS
If tachypnea in a newborn lasts more than 4 hours, what should be tested?
Blood and urine cultures
Is an egg allergy a contraindication to MMR, yellow fever, or influenza vaccine?
No
Is a reaction to a previous DPT with fever, or a FH of seizures or SIDS contraindication to vaccinations?
No
What’s the diff between caput succedaneum and cephalohematoma?
Caput is not caput (it crosses suture lines)
Which spinal cord level is Erb palsy?
C5-C6
Which spinal cord level is claw hand?
C7-C8 +/- T1
Can claw hand also have Horner’s syndrome?
Yes
What are the 2 causes of polyhydramnios?
- Werdnig-Hoffman
2. Intestinal atresia
What are the 2 main causes of oligohydramnios?
- Renal agenesis/Potter sequence
2. Prune belly (lack of abdominal muscles)
What neonatal syndrome causes airway obstruction and appears as patchy infiltrates and flattening of diaphragm on CXR?
Meconium aspiration syndrome
Which neonatal dx occurs in premies and presents with abdominal distension, bilious vomiting, rectal bleeding, and diarrhea, with crepitus?
Necrotizing enterocolitis
What’s the tx for necrotizing enterocolitis?
NG tube, broad spectrum abx, surgery if needed
T/F: diaphragmatic hernia can cause respiratory distress in premies?
True, it’s different from a hiatal hernia in adults
What dx is a defect in which intestines and organs form beyond the abdominal wall with a sac covering?
Omphalocele
What syndrome is omphalocele associated with?
Edwards (trisomy 18)
What 2 things does elevated AFP mean?
- Neural tube defects
2. Abdominal wall defects
T/F: 90% of umbilical hernias close by age 3?
True; if not, surgery is needed
What dx is a wall defect lateral to midline with intestines and organs forming beyond the abdominal wall but without any sac covering?
Gastroschisis
“Gasp that’s bad”
What dx is a large, palpable abdominal mass due to hemihypertrophy of one kidney?
Wilms tumor
What’s the most common abdominal mass in children?
Wilms tumor
What’s the best initial study for Wilms tumor?
US
What’s the tx for Wilms tumor?
Total nephrectomy with chemo and radiation
What dx is an adrenal medulla tumor similar to pheochromocytoma but with fewer cardiac presentations, with increased vanillyl mandelic acid and metanephrines on urine?
Neuroblastoma
What congenital dx is characterized by overriding aorta, pulmonary stenosis, RVH, and VSD?
Tetralogy of Fallot
What murmur is present in Tetralogy of Fallot?
Holosystolic murmur at LLS border
What does a CXR show in Tetralogy?
Boot shaped heart
How does squatting help in Tetralogy?
Increased preload and increased SVR (decreased R to L sunt and decreased pulmonary resistance)
Which 3 trisomies commonly have VSD?
- Trisomy 21
- Trisomy 13
- Trisomy 18
There are only 3 holosystolic murmurs:
- Mitral regurgitation
- Tricuspid regurgitation
- VSD
What dx presents with early, severe cyanosis, single S2, and egg on a string on CXR?
Transposition of the Great Vessels
How do you treat Transposition of the Great Vessels?
PG E1 to keep ductus open and 2 surgeries
What’s the prognosis for Transposition of the Great Vessels?
Poor, only 1 in 4 will survive the surgeries
What does pulsus alternans signify?
LV systolic dysfunction
Which dx presents with gray cyanosis (rather than blue), single S2, hyperdynamic precordium, and a globular shaped heart with pulmonary edema?
Hypoplastic L Heart Syndrome
What’s the tx for Hypoplastic L Heart Syndrome?
3 surgeries or a heart transplant
What dx occurs when a single trunk emerges from both L and R ventricles and gives rise to all major circulations?
Truncus arteriosus
What dx presents with severe dyspnea after birth and early and frequent respiratory infex, as well as single S2 and a systolic ejection murmur?
Truncus arteriosus
What’s the tx for truncus arteriosus?
Surgery
What will happen if surgery is not performed in truncus arteriosus?
Pulmonary HTN
What dx causes no venous return between pulmonary veins and the L atrium, and oxygenated blood instead returns to the SVC, dx with echocardiogram and tx with surgery?
Total anomalous pulmonary venous return
What dx presents with severe cyanosis in a newborn with CXR showing decreased pulmonary flow and EKG showing L axis deviation?
Tricuspid valve atresia
What’s the tx for tricuspid valve atresia?
PG E1, surgical aortopulmonary shunt
What type of hypertrophy occurs due to VSD?
RV hypertrophy
Is pansystolic the same as holocystolic?
Yes
Do VSD’s usually close?
Yes within 1-2 years
If it doesn’t close, do VSD’s need surgery?
Yes
What defect can clots pass through in the heart and cause stroke?
ASD
Do ASD’s need to be fixed?
Yes if symptomatic but most close on their own
How do you close a PDA?
Indomethacin
What does a pear shaped heart on CXR indicate?
Pericardial effusion
What does a boot-shaped heart on CXR indicate?
Tetralogy of Fallot
“Tetra is a boot maker”
What does a jug handle appearance on CXR indicate?
Primary pulmonary artery HTN
“Bring a jug of PAH to the lab?
What does a “3”-like appearance or rib notching on CXR indicate?
Coarctation of the aorta
‘3 Coarctee”
What genetic condition often includes a coarctation of the aorta?
Turner’s syndrome
What syndrome presents with cardiac problems and hearing loss?
Congenital long QT syndrome
What’s the best medication for long QT syndrome?
B-blocker
What condition presents with some of the following: migratory polyarthritis, carditis, erythema marginatum, chorea, fever, elevated ESR?
Rheumatic fever
What congenital heart defect has a downwardly displaced tricuspid valve into the R ventricle and is associated with maternal lithium use?
Ebstein anomaly
Why does the Ebstein anomaly have a holosystolic murmur?
Tricuspid regurgitation
What dx presents with respiratory sx that improve with neck extension including biphasic stridor, and a statement from parents that their child is a noisy breather?
Vascular ring
Do vascular rings need surgical correction?
Yes
When is newborn hyperbilirubinemia considered pathological?
- Appears on first day of life
- Rises >5/day
- Rises above 19.5 in a term child
- Direct bili rises above 2 at any time
- Persists after 2nd week of life
What structure in the brain is involved with deposits of bilirubin in untreated hyperbilirubinemia, causing kernicterus?
Basal ganglia
Does kernicterus cause seizures and hearing loss?
Yes
Conjugated or unconjugated bili:? UTI Gilbert Crigler-Najjar Hemolysis Spherocytosis G6PD deficiency
Unconjugated (indirect)
Conjugated or unconjugated bili:?
Cholestasis
Conjugated (direct)
What’s the tx for infants with bilirubin encephalopathy or failure of phototherapy?
Exchange transfusion
What type of gaze palsy is associated with kernicterus?
Upward gaze palsy
What dx is caused by the Uridine diphosphoglucoronic glucoronosyltaransferase 1A1 gene?
Gilbert syndrome
What’s the most common complication of esophageal atresia with tracheoesophageal fistula?
Aspiration pneumonia
What dx presents with vomiting with first feeding, or choking/coughing and cyanosis?
Esophageal atresia
What’s the best test to diagnose esophageal atresia?
CXR
What’s the tx for esophageal atresia
2-step surgical repair
What dx presents with infant projectile vomiting and palpable abdominal mass?
Pyloric stenosis
What dx will reveal a succession splash on auscultation of the stomach?
Pyloric stenosis
What is low chloride and low potassium metabolic alkalosis usually caused by?
Vomiting
What dx has string sign on upper GI series?
Pyloric stenosis
What dx has donut sign?
Intussusception
What dx has bird’s beak sign?
Achalasia or volvulus
What dx has steeple sign?
Croup
What is olive sign?
A palpable mass in pyloric stenosis
“Mike Stennis loves olives”
What’s the best initial test for pyloric stenosis?
US
Does pyloric stenosis require surgical myotomy?
Yes
What dx presents with a child turning blue during feeding and pink when crying?
Choanal atresia
What syndrome often goes along with choanal atresia?
CHARGE syndrome
How is choanal atresia treated?
Surgery to perforate the membrane between the pharynx and the nostrils
What does CHARGE stand for?
Coloboma of the eye Heart defects Atresia of the choanae Retardation of growth Genital urinary defects Ear anomalies
What dx is a congenital lack of innervation of the distal bowel by the Auerbach plexus?
Hirschsprung disease
The lack of innervation of the distal bowel in Hirschsprung disease causes a constant _________ of muscle tone?
Contracture
How does Hirschprung normally present?
No passing of meconium for >48 hours or full failure to pass it (usually it happens within 24 hours)
What will x-rays show in Hirschprung?
Distended bowel loops with lack of air in rectum
What will manometry show in Hirschprung?
High pressures in the anal sphincter
What will full thickness biopsy show in Hirschprung?
Lack of ganglionic cells in the submucosa
What’s the tx for Hirschprung disease?
3 step surgery
What anal condition has a high association with Down syndrome?
Imperforate anus
What dx has a double bubble on CXR?
Duodenal atresia
What dx presents with onset of biliary vomiting within the first 12 hours of birth?
Duodenal atresia
What’s the tx of duodenal atresia?
Surgical duodenostomy
What area of the intestine does volvulus normally occur?
Ileum
“That volvo is ill”
What 2 risk factors is intussusception associated with?
- Rotavirus vaccine
2. HSP
What type of stool is associated with intusussception?
Currant jelly
T/F: a sausage-shaped mass can be palpated in the upper R quadrant in intussusception?
True
What’s the best initial test for intusussception?
US
What are the most important initial steps for any GI issue?
Fluid resuscitation and balancing electrolytes if needed
What’s the best tx for intusussception?
Air or barium enema
What dx presents with massive painless bright red blood per rectum in a male child under age 2?
Meckel diverticulum
What’s the most accurate test for Meckel diverticulum?
Tech99m scan
“Meck 9”
What 3 conditions cause bilious vomiting in the infant?
- Duodenal atresia
- Volvulus
- Intussusception
Meckel diverticulum contains _____ layers of the bowel?
All
How do you differentiate between Rotavirus, Adenovirus, and Norwalk diarrhea?
Rotavirus occurs in the winter and is the most common type; Adenovirus is year-roun, both of those two are <7 days and have fever and emesis; Norwalk is explosive with cramping pain and short-lived (1-2 days)
What does air in the bowel wall often mean?
Necrotizing enterocolitis
If necrotizing enterocolitis is suspected, what’s the best first treatment?
Vancomycin, metronidazole, or gentamicin
T/F: infants of diabetic mothers can be born with hypoglycemia?
True; remember that the answer is not insulin!
What 5 findings can be present in infants with diabetic mothers?
- Macrosomia
- Small L colon
- Cardiac problems
- Renal vein thrombosis
- Metabolic findings and effects
What are the 3 forms of CAH?
- 21-hydroxylase
- 17-a-hydroxylase
- 11-beta-hydroxylase
What dx presents with a hypotensive or hypertensive child with severe electrolyte abnormalities?
CAH
What are the effects of CAH on genitals of males and females?
Females: ambiguous
Males: Normal
What’s the tx for CAH?
Fluid and electrolyte replacement plus lifelong steroids
Which CAH has hypotension?
21
“When you’re 21 you drink and pass out and you get low BP”
Which CAH has elevated aldosterone?
17-a-hydroxylase
“17-aldosterone-hydroxylase”
Which CAH’s have decreased cortisol?
All 3
Which CAH has decreased hormone levels?
17-a-hydroxylase
“When you’re 17 your hormones start decreasing”
Which 2 CAH’s have virilized female sex characteristics at birth and normal male?
11 and 21
Which CAH has normal female sex characteristics at birth and pseudo-hermaphrodite male?
17
Which dx has beading of the ribs on CXR and bowing of tibia?
Rickets
Which pediatric MSK disease has click or clunk in the Ortolani and Barlow maneuver?
Congenital hip dysplasia
What’s the tx for congenital hip dysplasia?
Pavlik harness
Which pediatric MSK disease has a painful limp and x-rays show joint effusions and widening?
Legg-Calve Perthes disease (avascular necrosis of femoral head)
What’s the tx for Legg-Calve Perthes?
NSAIDS and bilateral surgery
Which pediatric MSK disease has an externally rotated leg and x-ray shows widening of the joint space?
Slipped capital femoral epiphysis
What’s the tx for slipped capital femoral epiphysis?
Internal fixation with pinning
What dx presents in a child with recent loss of appetite, intermittent abdominal pain, decreased sleep at night, learning disabilities, and behavioral problems?
Lead poisoning
What’s the best initial test for lead poisoning?
Capillary blood finger-stick
At what level is intervention needed for lead poisoning?
> 10
What’s the treatment for severe lead poisoning (>70)?
IV dimercaprol/BAL
What’s the treatment for moderate lead poisoning (45-69)?
Oral succimer as inpatient
What’s the treatment for mild lead poisoning (<45)?
Lifestyle change and outpatient follow-up
What dx presents in a young athlete with chronic pain over the tibial tubercle, caused by repeated knee extension?
Osgood-Schlatter Disease
What’s the prognosis for Osgood-Schlatter?
Usually resolves in 1-2 years with PT
What dx presents with repeated fractures, blue sclerae, and early deafness?
Osteogenesis Imperfecta
What’s the most accurate test for osteogenesis imperfecta?
Skin biopsy analyzed for collagen synthesis
Is there a cure for osteogenesis imperfecta?
No
What type of bone cancer shows up on x-ray as an onionskin pattern due to lytic lesions, is tested for a t(11;22) translocation, and treated with a multidrug chemotherapy/radiation?
Ewing sarcoma
What type of bone cancer shows up as sclerotic destruction causing a sunburst appearance on x-ray and treatment includes chemo/surgery?
Osteogenic sarcoma
What type of bone condition shows up on x-ray as round central lucency with a sclerotic margin, treated with NSAIDS for pain because it will resolve on its own?
Osteoid osteoma
What type of JIA causes a fever for 2+ weeks along with inflammation in one or more joints?
Systemic-onset JIA
What type of JIA spares the hip and causes uveitis, especially if ANA is positive, and requires an eye exam every 3 mos if ANA+?
Oligoarticular JIA
“Oligo sounds like eye”
Which chromosome is Marfan syndrome on?
15
What’s the inheritance pattern of Marfan syndrome?
AD
What should be done at the time of diagnosis of Marfan’s and then again 6 months later?
Transthoracic echocardiogram
What dx presents with the following 5 criteria:?
- Rash
- Mucositis
- Edema or erythema of hands/feet
- Cervical LAD
- Limbic-sparing bilateral conjunctivitis
Kawasaki disease
What’s the tx for Kawasaki?
IVIg and aspirin
Do you give steroids for Kawasaki?
No, they increase aneurysm formation
What are the two most common causes of neonatal sepsis?
- Pneumonia
2. Meningitis
What are the 4 most common organisms causing neonatal sepsis?
- GBS
- E. coli
- S. aureus
- Listeria monocytogenes
What 2 abx treat neonatal sepsis?
- Ampicillin
- Gentamicin
“Kids get amped so you need to treat them gently”
What are the TORCHes infections?
Toxoplasmosis Other infex such as Syphilis Rubella CMV Herpes simplex virus
Which torch infex presents with chorioretinitis, hydrocephalus, and multiple ring-enhancing lesions on CT?
Toxoplasmosis
What’s the tx for toxoplasmosis?
Pyrimethamine & sulfadiazine
Which torch infex presents with a rash on the palms and soles, snuffles, frontal bossing, Hutchinson 8th nerve palsy, and saddle nose?
Syphilis
What’s the tx for syphilis?
Penicillin
Which torch infex presents with PDA, cataracts, deafness, hepatosplenomegaly, thrombocytopenia, blueberry muffin rash, and hyperbilirubinemia?
Rubella
What’s the tx for Rubella?
Supportive care
Which torch infex presents with periventricular calcifications with microencephaly, chorioretinitis, hearing loss, and petechiae?
CMV
What’s the best tx for CMV?
Ganciclovir with signs of end organ damage
Which torch infex presents with the following pattern of sx:?
Week 1: shock and DIC
Week 2: vesicular skin lesions
Week 3: encephalitis
Herpes
What’s the best tx for Herpes?
Acyclovir
Which red rash of childhood presents with multiple highly priuritic vesicles starting on the trunk and progressing to face, possible fever, an is dx by Tzanck smear showing multinucleated giant cells?
Varicella (VZV)
Which red rash of childhood presents with cough, stuffy nose, and grayish spot on buccal surface; begins on head and moves down?
Measles (rubeola; paramyxovirus)
Which red rash of childhood starts with fever and URI and progresses to rash with slapped cheek appearance?
Fifth disease (erythema infectiosum; parvovirus B19)
Which red rash of childhood starts with fever and URI and progresses to diffuse rash?
Roseola (HSV 6 & 7)
Which red rash of childhood starts with fever and progresses to parotid gland swelling with possible orchitis?
Mumps (paramyxovirus)
What’s the tx for all red rashes of childhood?
Supportive care
Which 2 main conditions can cause strawberry tongue?
- Kawasaki
2. Scarlet fever
What organism is scarlet fever caused by?
Strep pyogenes
Does the rash of scarlet fever blanch easily?
Yes
Which red rash of childhood presents with pink macules and papules that begin at head and move down, followed by desquamating trunk rash and postauricular LAD?
Rubella
Which 2 red rashes of childhood start on the face and move down?
- Measles
2. Rubella
Which 1 red rash of childhood starts on the trunk?
Varicella
Which 2 rashes have vesicles on the palms and soles?
- Syphilis
2. Hand-foot-mouth
Which red rash of childhood has oval shaped vesicles on palms and soles and ulcers in oral mucosa?
Hand-foot-mouth (Coxsackie A)
What are the 3 most common organisms causing meningitis in the newborn 0-6 mos?
GBS
E coli
Listeria
“Newborn brains are like GEL”
What are the 4 most common organisms causing meningitis in children 6 mos-6 years?
S pneumo
H influe
Enteroviruses
N meningitidis
“SHEN”
What are the 4 most common organisms causing meningitis in people age 6 years-60 years?
S pneumo
HSV
Enteroviruses
N meningitidis (teens)
“SHEN with a different H because now that they are older they have herpes”
What are the 3 most common organisms causing meningitis in older adults age 60+?
Gram negative rods
S pneumo
Listeria
“Gramma is negative in her old age and SL”
What dx presents with muffled voice, deviated uvula, and decreased or painful ROM of neck/jaw?
Retropharyngeal abscess
Which dx presents with a seal-like barking cough and a steeple sign?
Croup
“The old-fashioned kids with croup go to the church”
What’s the way to dx croup?
Clinically; you don’t need to do an x-ray
How do you differentiate croup from epiglottitis?
Croup has hypoxia
What’s the tx for mild croup?
Steroids
What’s the tx for moderate and severe croup?
Racemic epinephrine
What dx presents with a fever, hot potato voice, drooling in the tripod position, and refusal to lie flat, and x-rays reveal a thumbprint sign?
Epiglottitis
What vaccine prevents epiglottitis?
HiB
What dx presents with 14 days of severe congestion, followed by severe coughing episodes with an inspiratory whoop followed by vomiting, and then 14 more days of a decreased frequency of cough, with a butterfly pattern on CXR?
Whooping cough (Bordatella pertussis)
What’s the best tx for whooping cough?
Erythromycin or azithromycin in the first 14 days, afterward it doesn’t help
Which dx presents with gray highly vascular pseudomembranous plaques on the pharyngeal wall?
Diptheria
What’s the tx for diptheria?
Antitoxin
What’s the immediate tx for acute pediatric seizure?
Lorazepam or diazepam
What’s the tx for absence seizure?
Ethosuximide
What’s the tx for seizures presenting with jerky movements in the morning with irregular spike and wave pattern?
Valproic acid
What dx presents with infantile spasms during the first year of life?
West syndrome
What’s the tx for West syndrome?
ACTH
What’s the tx for a partial seizure?
Carbamazepine
“Only eat part of your carbs”
What’s the tx for a generalized seizure?
Valproic acid
Which vitamin deficiency presents with Wernicke’s and Beriberi?
B1 (Th1amine)
Which vitamin is folate?
B9
What vitamin deficiency presents with diarrhea, dermatitis, dementia, and death?
Vitamin B3
