Pediatrics Flashcards

Question

newborn hypoglycemia pt

Answer 1

jitteriness, tremors, lethargy, poor feeding

Answer 2

every babe gets a glucose check

Answer 3

if sx = IV glucose | if asx = feed

Answer 4

decrease surfactant = RDS | prolonged damage = scarring

Answer 5

increase O2 demands FiO2 required >28d lung-protective strats

Answer 6

xray = ground-glass opacities

Answer 7

surfactant (post-birth) | steroids (pre-birth)

Answer 8

BPD is to RDS (peds) as DPLD is to ARDS (adult)

Answer 9

neoangiogenesis gone awry | Increase FiO2

Answer 10

premature infant requiring O2

Answer 11

eye exam (all premies)

Answer 12

highly vascular ventricles | labile pressures

Answer 13

``` premie...asx increase ICP (fontanelles) ```

Answer 14

cranial doppler (all premies)

Answer 15

decrease ICP...shunts, drains

Answer 16

intellectual disability, seizures

Answer 17

premie...bloody BM

Answer 18

xray = pneumatosis intestinalis

Answer 19

NPO, IV abx, TPN

Answer 20

no hole on inspection (+/- fistula) | never first temp rectally

Answer 21

visual inspection | cross-table xray

Answer 22

``` mild = repair now severe = colostomy, repair before toilet training ```

Answer 23

``` Vertebra - u/s sacrum Anus - x-ray Cardiac - echo TE Fistula - x-ray with coiled tube Esophageal atresia - xray with coiled tube Renal - VCUG Limb - xray ```

Answer 24

cystic fibrosis

Answer 25

FTPM and... | no prenatal care (undocumented)

Answer 26

x-ray = dilated loops, gas-filled plug | water-soluble contrast (gastrograffin enema)

Answer 27

water-soluble contrast (gastrografin enema)

Answer 28

meconium peritonitis = perf ADEK vitamins pancreatic enzymes short stature

Answer 29

failure of neuron migration = distal colon | absent inhibitor neurons = no relaxation

Answer 30

``` case 1 (90%): FTPM, explosive stool with DRE case 2 (10%): chronic constipation with overflow incontinence ```

Answer 31

x-ray: good bowel = dilated; bad bowel = normal if FTPM: contrast enema if constipation: anorectal manometry -> increased tone best = biopsy = absent neurons

Answer 32

embarrassment or pain | cognitive impairment

Answer 33

toilet training OR school-aged child constipation with overflow incontinence encopresis

Answer 34

``` bowel regimen (stool softener, motility) disimpaction under anesthesia if necessary ```

Answer 35

lipid soluble can cross BBB kernicterus NO urinary excretion

Answer 36

water soluble cannot cross BBB NO kernicterus urinary excretion

Answer 37

onset >/= 72h bilirubin increase <5/d (slow) D. bili <10% total resolves in 1wk (term) or 2wks (preterm

Answer 38

onset <24h bilirubin increase >5/d (fast) D. bili >10% total resolves in >/= 1wk (term) or >/= 2wks (preterm)

Answer 39

NO UDP-glucouronyltransferase | Type 1 die, Type II have unconjugated bili (very rare)

Answer 40

``` decrease UDP-glucuronyltransferase unconjugated bili (mc of these diseases) ```

Answer 41

problem with excretion conjugated hyperbilirubinemia black liver

Answer 42

looks like Dubin-Johnson conjugated, no black liver problem with storage

Answer 43

< 7d of life not enough feeding, slowing of gut, increase bili reabsorption increase feed frequency

Answer 44

>10d of life enzyme inhibition by mother's milk; insufficient conjugation phototherapy (if needed) and continuation of breast feeding OR supplement with formula x1wk

Answer 45

unconjugated causes kernicterus | conjugated implies structural lesion

Answer 46

baby will be yellow

Answer 47

``` transcutaneous sensor (screen) bilirubin level (diagnostic) ```

Answer 48

if unconjugated: use BLUE LIGHT | if conjugated: evaluate for cause

Answer 49

+/- fistula +/- atresia mc type C (blind pouch of esophagus with fistula from distal esophagus to trachea)

Answer 50

nonbiliary emesis day 0 | bubbling, gurgling

Answer 51

NG tube coils on xray

Answer 52

parenteral nutrition NG tube suction surgery

Answer 53

hypertrophy of pylorus | gastric outlet obstruction

Answer 54

2-8wks, normal feeds -> projectile usually a boy * olive-shaped mass * visibel peristaltic waves

Answer 55

``` BMP = decrease Cl, decrease K, increase Bicarb u/s = donut sign ```

Answer 56

FIX ELECTROLYTES FIRST = IVF | pyloromyotomy

Answer 57

failure of rotation

Answer 58

normal uterine course no polyhydramnios no down syndrome

Answer 59

x-ray = double bubble with NORMAL gas pattern beyond | upper GI series

Answer 60

NGT decompression | surgery

Answer 61

volvulus; ischemia

Answer 62

failure to recannulate the duodenum

Answer 63

+ polyhydramnios | + down syndrome

Answer 64

x-ray = double bubble AND no gas beyond

Answer 65

failure to recannulate the esophagus

Answer 66

+ polyhydramnios | + Down syndrome

Answer 67

x-ray = double bubble AND no gas beyond

Answer 68

vascular compromise

Answer 69

mom = cocaine use | NO down syndrome

Answer 70

x-ray = double bubble with multiple air-fluid levels

Answer 71

surgery for baby | confront mom

Answer 72

bowel in chest | hypoplastic lungs

Answer 73

scaphoid abdomen pulmonary distress day 0 bowel sounds in chest

Answer 74

x-ray (babygram)

Answer 75

cardiopulmonary stabilization pulmonary surfactant surgical repair

Answer 76

extrusion of bowel | NO membrane

Answer 77

``` RIGHT of midline NO membrane (loose bowel) ```

Answer 78

fluid shifts big problem

Answer 79

extrusion of bowel | intact membrane

Answer 80

``` MIDLINE YES membrane (contained sac) ```

Answer 81

fluid shifts but not as fast

Answer 82

bladder through the skin

Answer 83

MIDLINE defect wet with urine red or shining no bowel seen

Answer 84

surgically

Answer 85

failure of the biliary tree to recanalize

Answer 86

persistent or worsening jaundice at 2kws | direct hyperbili

Answer 87

u/s = absence of ducts | HIDA scan after phenobarb = no contrast in GI

Answer 88

surgical (hepatoportoenterostomy)

Answer 89

fatal if not corrected

Answer 90

genetic syndromes FOLATE deficiency failure of the caudal neural tube to fuse

Answer 91

occulta: tuft of hair only meningocele: extrusion of meninges without cord myelomeningocele: extrusion of meninges with cord

Answer 92

``` prenatal + AFP screen + u/s in utero no prenatal care + visual inspection ```

Answer 93

chiari type II with myelomeningocele | hydrocephalus can lead to learning disabilities

Answer 94

failure of growth and fusion of the underlying structures

Answer 95

spectrum: lip through uvula spectrum: superficial through transmural spectrum: unilateral, bilateral, midline

Answer 96

surgically

Answer 97

cosmetic deformity | failure to thrive from inability to latch (feed)

Answer 98

gross motor: lift head fine motor: tracks past mid speech: coos social: social smile

Answer 99

gross motor: roll over fine motor: clumsy clap speech: laughs, squeals social: looks around

Answer 100

gross motor: sit up fine motor: rakes speech: babbles social: stranger anxiety

Answer 101

gross motor: walk fine motor: pincer grasp speech: 1-word social: separation anxiety

Answer 102

gross motor: steps fine motor: - speech: 2-word social: 2-step commands

Answer 103

gross motor: trike fine motor: circle speech: 3-word social: -

Answer 104

gross motor: hop fine motor: cross speech: 4-word social: -

Answer 105

gross motor: skip fine motor: triangle speech: 5-word social: -

Answer 106

``` MMRV HepA/B DTaP HiB pneumococcal meningococcal HPV flu ```

Answer 107

head circumference: last to go height: lost between weight: first to go

Answer 108

genetic (CF) cardiac disease pyloric stenosis GERD

Answer 109

formula feeding frequency

Answer 110

suspicious shape suspicious location severity

Answer 111

injured infant comfort from nurses comfort from staff

Answer 112

``` car seats booster seats seatbelts NO trampolines eliminate guns fence pools ```

Answer 113

sleep on back don't share beds smoking cessation

Answer 114

nothing made with eggs except: - influenza *US IM flu no longer made with eggs - yellow fever

Answer 115

no live vaccines - MMRV - live attenuated flu (IN)

Answer 116

never get that vaccine again

Answer 117

prior local reactions, current illness or fever, family history of ____, autism fear

Answer 118

Mom: + Baby: Hep B Ig and Hep B Vax NOW Mom: - Baby: Hep B within 2 mo Mom: ? Baby: Hep B NOW, check mom's HBsAg

Answer 119

``` kids get 5 doses: - 3 doses in 1st year - 2 doses between 1-4y Td (booster) or Tdap at least once in adolescence and q10y need 3 total doses lifetime ```

Answer 120

disease does not confer immunity in those <2y so give Hib vax does not cover nontypeable Hib causes epiglottis and meningitis

Answer 121

vax and booster before school (1 and 4)

Answer 122

two types: 23 and 13 valent complete 13 as infant, add 23 if + risk factors to all immunocompromised and asplenic pt

Answer 123

to everyone vs. meningitis... | required for college and military

Answer 124

all boys and girls 9-26 | prevents cancer

Answer 125

2 doses for A 3 doses for B pick up where you left off

Answer 126

everyone. period. healthcare workers before winter months given annually

Answer 127

clean: Tdap Dirty: Tdap + TIG timing doesn't matter if <3 lifetime doses

Answer 128

clean: - >/= 10y : Tdap - < 10y : Home dirty: - >/= 5y : Tdap - < 5y : home * NO TIG needed if >/= 3 lifetime doses

Answer 129

``` catarrhal stage (inconspicuous) paroxysmal phase (coughing spells, whoops) resolution phase (regular cold symptoms) ```

Answer 130

grey pseudomembrane in oropharynx | airway, antibiotics, antitoxin

Answer 131

dirty wound, lock jaw, spasms TIG (block toxin) and toxoid (vaccinate) lethal dose < immune dose tube, sedate, MTZ

Answer 132

no pox parties -> vaccinate instead kids get MMRV = no chickenpox adults, no "v" = shingles = varicella @ 60

Answer 133

boys and girls aged 9-26 does prevent cancer does not increase sex, STI, pregnancy, etc

Answer 134

oral | contraindicated in intussusception

Answer 135

epidermis only | + pain, + erythema

Answer 136

epi + dermis | + pain, + blisters, + erythema

Answer 137

through dermis | white and painless with surrounding 2nd deg burns

Answer 138

%BSA x kg x 4 - 2nd and 3rd degree only - 50% in 8hrs; 50% in 16hrs

Answer 139

``` head: 9 + 9 = 18 front thorax: 9 + 9 = 18 back thorax: 9 + 9 = 18 Arms: L = 9; R = 9 = 18 Legs: 9 + 9 + 9 = 27 genitals: 1 ```

Answer 140

temple trauma + LOC with lucid interval biconvex 'lens'

Answer 141

major trauma or abuse + LOC, no lucidity concave 'crescent'

Answer 142

major trauma + LOC punctate hemorrhage

Answer 143

``` helmets: in sports and on bikes car safety: - rear facing car seat 0-2y - booster seat until 4'9" and 8-12y/o - seat belts in every car for everyone, every seat eliminate trampolines - nets, soft ground, water don't count ```

Answer 144

limit access: locked gates surrounding all pools supervision: near tubs, pools, and tanks flotation: use life jackets, NOT arm floaties up risk: too young to know; too drunk to remember (adolescents)

Answer 145

best: eliminate them from the home OK: keep them out of reach - store up high; keep them locked in a safe or locked cabinet, do not depend on 'child proof' lids guns: ammo stored separately from weapon; store guns unloaded

Answer 146

``` FND: none LOC: <60sec HA: none, improving amnesia: none No CT d/c home ```

Answer 147

``` FND: positive LOC: >60sec HA: persistent or worsening amnesia: retrograde or anterograde CT scan observe in house ```

Answer 148

step-wise return to play | sleep -> go to school -> homework -> practice -> play

Answer 149

abuse: + sxs, intentional, active neglect: - sxs, absence, passive

Answer 150

intellectual disability premature birth physical disability cognitive disability

Answer 151

those who were abused single parent young parent low SES

Answer 152

skull or clavicle femur, especially spiral rib fractures in infants different stages of healing

Answer 153

different stages of healing

Answer 154

feet, ankles (dunk) buttocks only (dunk) punctate circular burns (cigarettes)

Answer 155

any STD in any child ever | vaginal or anal trauma

Answer 156

not crying in the presence of a parent running from caregiver receiving comfort from healthcare provider rather than caregiver

Answer 157

certainty is NOT required

Answer 158

tell the family why you are doing it and that you are required by law to do so

Answer 159

hospitalize the child if no safe alternative exists

Answer 160

separate abuser from child if obvious | separate parent-child unit from a common abuser

Answer 161

offer resources and support that allows families and caregivers to understand disease process, provide emotional, economic, and physical support

Answer 162

must report

Answer 163

frightened observer plus any combination of: - change in color: red, blue, or pale - change in muscle tone: hypertonic or hypotonic - change in respirations: choking, gagging, or apnea

Answer 164

eye deviation, limb-jerking

Answer 165

temperature instability | fussy baby

Answer 166

difficulty with feeding murmur FTT

Answer 167

evidence of trauma | femur, skull fracture

Answer 168

< 1 y/o + < 1 min duration + ... - change in color: red, blue, or pale - change in muscle tone: hypertonic or hypotonic - change in respirations: choking, gagging, or apnea - change in responsiveness

Answer 169

``` no history no physical no CPR 1st time, non-recurring age, term > 60d age, preterm >32wk GA AND >/= 45wk PC action: reassurance only ```

Answer 170

``` hx suggestive of disease physical suggestive of dz CPR performed multiple, recurring not old enough action: NO SET WORKUP, go after workup based on history and physical ```

Answer 171

back to sleep don't share a bed smoking cessation flatten occiput

Answer 172

parvovirus 19

Answer 173

slapped-cheek rash

Answer 174

aplastic crisis in sickle cell | hydrops fetalis if in utero

Answer 175

measles virus (paramyxovirus)

Answer 176

cough, coryza, conjunctivitis, Koplik spots fever AND rash - starts on face, spreads to extremities

Answer 177

supportive (ppx vaccinate)

Answer 178

subacute sclerosing panencephalitis

Answer 179

fever BEFORE rash starts on face, spreads to toes prodrome of lymphadenitis

Answer 180

supportive (ppx vaccinate)

Answer 181

congenital: heart, deafness, cataracts

Answer 182

fever BEFORE rash (>104) | starts on trunk, spreads outward

Answer 183

febrile seizures

Answer 184

varicella zoster

Answer 185

widespread vesicles on erythematous base different stages of healing

Answer 186

supportive, antivirals for teens and those with lung issues (ppx vaccinate)

Answer 187

reactivated varicella, non-vaccinated adults

Answer 188

pain precedes rash vesicles on an erythematous base does NOT cross midline confined to a dermatome

Answer 189

antiviral if immunocompromised (ppx vaccinate)

Answer 190

postherpetic neuralgia

Answer 191

mumps virus

Answer 192

bilateral swelling | orchitis in pubertal males

Answer 193

infertility

Answer 194

coxsackie A

Answer 195

nonspecific prodrome | vesicle on erythematous base but only on the hands, feet, and mouth

Answer 196

flesh-colored central umbilication trunk, arms, diaper

Answer 197

supportive

Answer 198

group A strep

Answer 199

fever, sore throat desquamating sandpaper rash trunk and spreads outwards

Answer 200

streptolysin O

Answer 201

penicillin prevents rheumatic fever but not post-strep glomerulonephritis

Answer 202

IgE mediated | life threatening

Answer 203

rash (urticarial) AND airway edema | HYPOTENSION

Answer 204

epi 1:1000 IM 'epic-pen' ... then H1/H2 blockers then steroids

Answer 205

avoid triggers

Answer 206

IgE mediated | rash only

Answer 207

rash (urticarial) - erythema - wheal NO hypotension

Answer 208

topical or oral antihistamines avoidance of trigger if anaphylaxis, treat that

Answer 209

non-IgE mediated swelling medication induced C1 esterase deficiency

Answer 210

swelling can involve mouth, throat, tongue which makes it life-threatening

Answer 211

airway protection | stop the offending agent (ACE-i)

Answer 212

C1 esterase deficiency gets FFP | H1/H2 blockers and steroids probably don't help

Answer 213

seasonal (dander/pollen exposure) | perennial (pets, dust, indoor mold)

Answer 214

``` allergic shiners (dark eyes) allergic salute (nasal crease) pale, boggy mucosa polyps cobblestoning ```

Answer 215

``` identify and remove triggers - pets - carpets - parents smoking skin testing if severe or refractory to trigger ```

Answer 216

avoid triggers antihistamines - mild-moderate = 2nd gen (loratadine, fexofenadine, cetirizine) - moderate-severe = intranasal corticosteroids

Answer 217

same as rhinitis

Answer 218

same s rhinitis, except it's the eyes - injection - chemosis - shiners

Answer 219

avoid triggers | mast cell stabilizers and antihistamines instead of intranasal steroids

Answer 220

triggers: - outgrows: wheat, soy, milk, eggs - for life: nuts, shellfish, seafood

Answer 221

atopic dermatitis n/v/d anaphylaxis possible (nuts, shellfish)

Answer 222

food trial

Answer 223

epipen for anaphylaxis | avoidance of trigger

Answer 224

soy/formula

Answer 225

n/v/d bloody bowel movements FTT

Answer 226

cow's milk formula or breastfeed

Answer 227

URI bugs = strep, moraxella, H. flu | middle ear

Answer 228

unilateral ear pain relief of pain on pulling pinna loss of light reflex erythema, tympanic effusion

Answer 229

pneumatic insufflation

Answer 230

1st: amoxicillin recur: amoxicillin-clavulanate re-recur: tympanoplastic PCN allergy: cefdinir -> azithromycin

Answer 231

mastoiditis

Answer 232

outer ear swimmer's = pseudomonas digital = staph aureus

Answer 233

unilateral ear pain NO relief of pain on pulling pinna angry erythematous canal

Answer 234

spontaneously resolves

Answer 235

toxic, malignant otitis externa, use cipro and steroid ear drops

Answer 236

complications of ear infections

Answer 237

acute otitis media AND posterior bulging of mastoid anteriorly rotated ear

Answer 238

clinical... CT scan (not needed)

Answer 239

surgical drainage

Answer 240

URI bugs (same as AOM)

Answer 241

congestion bilateral purulent rhinorrhea facial tap = pain

Answer 242

clinical XR - air fluid levels (not necessary) CT - opacification (not necessary)

Answer 243

``` supportive EXCEPT - temp >/= 38 deg C - worsening - duration > 10d amoxicillin + clavulanate ```

Answer 244

CT scan for recurrence | foreign body for young kid

Answer 245

rhinovirus, transmitted by large droplets

Answer 246

congestion, non-toxic | <10d, no purulence

Answer 247

supportive

Answer 248

viral (mc) | group A strep (rheumatic fever)

Answer 249

``` sore throat, odynophagia Cough (absent) + 1 Exudates + 1 Nodes (adenopathy) + 1 Temp >/= 38 + 1 OR age <14 + 1 OR age > 44 - 1 ```

Answer 250

<1: supportive 2-3: rapid strep (culture or treat) >/=4: treat as strep

Answer 251

amoxicillin or PCN

Answer 252

kids stick things places

Answer 253

unilateral purulent discharge unilateral otitis externa aspiration

Answer 254

clinical, cxr

Answer 255

if insect gets in: | - lidocaine and retrieval

Answer 256

digital trauma (nose picking)

Answer 257

unilateral bleeding, <30mins

Answer 258

ice pack, lean forward cauterize anterior bleeds pack posterior bleeds

Answer 259

atresia or stenosis of passage from nose to throat

Answer 260

blue while feeding, pink while crying, childhood snore

Answer 261

catheter fails to pass through the nose

Answer 262

scope and surgery

Answer 263

parainfluenza

Answer 264

3mo-3y viral prodrome precedes seal-like barking cough interspersed with stridor

Answer 265

clinical | XR - steeple sign

Answer 266

mild: misting moderate: racemic epi, steroids, O2 severe: admit for O2 support

Answer 267

strep and staph

Answer 268

5-7y/o croup that doesn't get any better with croup tx also more insidious

Answer 269

clinical | tracheal culture

Answer 270

ENT to bronch/scope/get tracheal culture

Answer 271

Hib (Hib vaccine has dropped incidence)

Answer 272

``` 6-12 y/o, unvaccinated SICK rapid onset high spiking fevers drooling, tripoding accessory muscles hot-potato-voice ('muffled') ```

Answer 273

clinical direct visualization of cherry-red epiglottitis during airway XR - thumbprint

Answer 274

secure airway in the OR - do not touch the epiglottis IV abx after airway secured = cefuroxime, ceftriaxone

Answer 275

oral flora | URI bugs

Answer 276

``` SICK rapid onset high spiking fevers drooling, neck extended hot-potato-voice ('muffled') * unilateral anterior chain nodes * * tender palpable mass * ```

Answer 277

CT scan max/face/neck

Answer 278

incision and drainage, IV abx

Answer 279

oral flora | URI bugs

Answer 280

> 10 y/o hot-potato-voice ('muffled') drooling, sore throat * uvular deviation *

Answer 281

I&D, IV abx

Answer 282

kids put things places

Answer 283

sudden onset dyspnea unsupervised child stridor = extrathoracic wheeze = intrathoracic

Answer 284

1st: CXR PA and lateral - coin sign AP r/o trachea - coin sign lateral nonspecific best: rigid bronchoscope

Answer 285

high risk: - kids < 3y/o - foods: peanuts, M&Ms, hot dogs

Answer 286

reversible obstructive lung disease

Answer 287

wheezing, dyspnea during attacks normal between attacks asthma, allergy, atopy

Answer 288

PEFTs - decrease FEV1/FVC - reversible with bronchodilators - inducible with methacholine

Answer 289

``` chronic escalation - SABA - SABA + ICS - SABA + incr ICS - SABA + incr ICS + LABA ... add steroids ... LTA are oral adjuncts acute exacerbation - peak flow before and after - albuterol/ipratropium - IV steroids - maybe magnesium - maybe subQ epi ```

Answer 290

remove allergens - pets - carpets - smoking (parents)

Answer 291

typical, atypical, viral

Answer 292

pre-school = viral school or older = bacterial fever, cough, consolidation on CXR

Answer 293

amoxicillin or azithromycin

Answer 294

internal medicine - infectious ID

Answer 295

inflammatory disorder of small airways | viral infection = RSV

Answer 296

very young < 2y/o | trouble feeding

Answer 297

cxr (normal) | rapid antigen testing from a nasopharyngeal swab (yes, but don't)

Answer 298

supportive - IVF/NG feeds, oxygen | NO: steroids, ß-agonists, antibiotics

Answer 299

RSV bronchiolitis is all supportive care | nothing works: just get the kids through it

Answer 300

CFTR or CCTR mutation | autosomal recessive

Answer 301

``` prenatal screen positive - most dx no prenatal screen (immigrant) - FTT - meconium ileus - frequent respiratory infections - baby has salty skin ```

Answer 302

sweat chloride test - >40 neonates - >60 in others

Answer 303

pulmonary toilet pneumonia = pseudomonas vit ADEK pancreatic enzymes

Answer 304

short stature | limited life expectancy

Answer 305

premature neonate in ICU | bloody BM

Answer 306

xray = pneumonitis intestinalis

Answer 307

NPO, IVF, TPN | IV abx

Answer 308

other diseases of prematurity

Answer 309

tear in anal mucosa

Answer 310

visual inspection | iatrogenic in the neonate, well baby

Answer 311

reassurance | babies are incontinent of stool, the stool is soft, and it will heal spontaneously

Answer 312

telescoping of bowel | vascular compromise

Answer 313

``` abrupt onset colicky pain knee-chest position = relief * sausage-shaped mass in RUQ * * currant jelly stool * (too late) ```

Answer 314

xray = perforation, obstruction u/s = target sign (aka donut) air-enema best test

Answer 315

``` air-enema usually curative surgery if: - peritoneal - perforation - failed air-enema ```

Answer 316

90% kids have no lead point | 90% adults have a mass lead point

Answer 317

remnant of the vitelline duct = gastric mucosa | omphalomesenteric duct

Answer 318

``` 'colon caner' at 2 y/o - painless, intermittent hematochezia - iron deficiency anemia - FOBT + rule of 2s - < 2 y/o at dx - < 2% of population - 2x boys:girls - 2ft from ileocecal valve - 2in in length ```

Answer 319

mocker's scan = technetium-99

Answer 320

teenagers get diagnosed with CT scans

Answer 321

swallowed maternal blood = apt test, Selena after delivery swallowed self blood = epistaxis history dietary = iron, beets, medication

Answer 322

watery diarrhea, weight loss, fistulas EGD + colon = skip lesions meds to control surgery only for fistulas

Answer 323

bloody diarrhea colon = continuous lesions hemicolectomy curative @8y/o, q1y colonoscopy until resected

Answer 324

fever and blood BM | lactoferrin, WBC, stool culture

Answer 325

change to hydrolyzed formula

Answer 326

``` increase pulmonary flow increase pulmonary vasculature on xray increase pulmonary pressures RVH Eisenmenger's (reversal to right to left) "D" diseases: ASD, VSD, PDA ```

Answer 327

``` ostium primum (rare) ostium secundum (more common) ```

Answer 328

fixed split S2 | mc murmur > 1 y/o

Answer 329

surgical closure

Answer 330

hole between the two ventricles

Answer 331

harsh holosystolic murmur in a neonate...but the worst defects have no murmur mc congenital heart disease - likely get fixed or die before 1 yr FTT, down syndrome

Answer 332

if CHF, FTT, dyspnea = fix now | if none of those things = fix only if increased pulmonary blood flow

Answer 333

surgical closure likely required, may spontaneously resolve

Answer 334

ductus arteriosus remains open, a connection between aorta and pulmonary artery

Answer 335

continuous machinery-like murmur

Answer 336

if no CHF -> indomethacin = Ends the PDA (preterm infants only) if yes CHF -> surgical closure if cyanotic defect -> prostaglandins to sustain PDA

Answer 337

close as necessary, but many that persist are clinically significant

Answer 338

``` decrease pulmonary flow decrease pulmonary vasculature on xray deoxygenated blood in periphery blue baby syndrome fatal if not corrected the "T" diseases: tetralogy, TGA, TA, TAPVR ```

Answer 339

1. overriding aorta 2. pulmonary stenosis 3. RVH 4. VSD "endocardial cushion defect"

Answer 340

mc cyanotic disease of children because TGA babies die or get fixed 'tet spells' cyanosis relieved by squatting

Answer 341

1st: boot shaped heart on xray best: echocardiogram

Answer 342

surgical correction

Answer 343

associated with Down's syndrome

Answer 344

heart fails to twist pulmonary artery and vein both connected to the left heart and lungs aorta and vena cava both connected to the right heart and periphery TWO separate circulatory systems connected only by ductus arteriosus

Answer 345

blue baby day 1 - you will not miss this | mom is diabetic at the start of pregnancy

Answer 346

clinical: blood pressures in all extremities xray shows rib-notching (not diagnostic) aortogram

Answer 347

surgical correction

Answer 348

clicky hip during the neonatal evaluation, Ortolani and Barlow maneuvers

Answer 349

u/s @ 4-6wks

Answer 350

insidious onset antalgic gait

Answer 351

fat kid going through a growth spurt | non-traumatic knee pain

Answer 352

frog-leg xray

Answer 353

surgery (urgently)

Answer 354

fever and joint pain, especially after another febrile illness or unprotected sex

Answer 355

arthrocentesis (> 50,000 wbc)

Answer 356

drainage and abx

Answer 357

4-6wks after a viral illness | joint pain WITHOUT fever, leukocytosis, inflammatory markers

Answer 358

supportive

Answer 359

osteochondrosis

Answer 360

teenage athlete with knee pain, swelling and eventually palpable nodule on the tibia

Answer 361

rest + cast (aka stop exercising, curative) | work thorugh it (palpable nodule)

Answer 362

``` spinal deformity (left to right) - not lordosis, not kyphosis ```

Answer 363

teenage girl who can present with either: moderate: cosmetic severe: SOB

Answer 364

Adam's test is positive (have the girl lean forward and see asymmetry)

Answer 365

no therapy brace surgery with rods

Answer 366

retinoblastoma gene, associated with retinoblastoma of the eye

Answer 367

bone pain in a pre-teen/teenager | retinoblastoma at birth (neonatal)

Answer 368

1st: xray = distal femur, sunburst pattern then: MRI best: biopsy

Answer 369

fx can occur for any reason trauma, fall, and child abuse you must think of the growth plate, a consideration not in adults

Answer 370

leg pain, trauma

Answer 371

involves growth plate -> ORIF | does not involve growth plate -> cast

Answer 372

translocation t(11;22)

Answer 373

bone pain in a pre-teen/teenager | no risk factor

Answer 374

1st: xray = midshaft, onion-skin pattern then: MRI best: biopsy

Answer 375

closed, simple, aligned | no growth plate

Answer 376

``` comminuted angular displaced open or involves the growth plate ```

Answer 377

HgbSS - autosomal recessive | valine for glutamic acid on 6th position

Answer 378

``` asplenism vasoocclusive crisis chronic pain chronic anemia pigmented gallstones ```

Answer 379

sickle cells on smear | Hgb electrophoresis

Answer 380

hydroxyurea (increase HgbF) iron, folate PCN until age 5

Answer 381

hemosiderosis from transfusions = deferoxamine/deferasirox asplenism = pneumovax avascular necrosis of the hip = conservative attempted -> surgery

Answer 382

sickling cells = ischemia and hemolysis

Answer 383

acute pain elevated bilirubin, elevated reticulocytes jaundice

Answer 384

blood smear = sickled cells

Answer 385

IVF, pain control

Answer 386

``` priapism focal neurologic deficit, stroke acute chest (chest pain, pulmonary edema) ```

Answer 387

``` HgbS-ßo the worst HgbSS sickle cell disease HgbS-ß+ milder HgbSC almost not a disease HubS trait not a disease (carrier) ```

Answer 388

PCN until 5 | vax for strep

Answer 389

deferoxamine

Answer 390

conservative then surgery

Answer 391

hydroxyurea

Answer 392

analgesics (opiates)

Answer 393

staph first, then salmonella

Answer 394

24hrs non-purulent bilateral tx: observation (caused by silver nitrate ppx)

Answer 395

day 2-5 purulent bilateral, check for systemic illness tx: ceftriaxone IM

Answer 396

day 5-14 mucho-purulent unilateral, then bilateral; associated with pneumonia tx: erythromycin PO, no topical antibiotics

Answer 397

Rb gene mutation

Answer 398

newborn screen in the neonatal unit with an abnormal light reflex

Answer 399

``` red reflex (normal) = pure white retina white thing in the back of the eye ```

Answer 400

osteosarcoma

Answer 401

cortical blindness

Answer 402

strabismus, cataracts, another cause, leads to cortical blindness

Answer 403

none | fix the problem that could lead to cortical blindness

Answer 404

baby with one eye that focuses while the other does not | almost ALWAYS a photograph question

Answer 405

light reflects at different points in both eyes

Answer 406

if present at birth - patch the good eye - surgery if all else fails glasses if developed after birth

Answer 407

present at birth -> TORCH infections | not present at birth -> galactosemia

Answer 408

white cloudy lesions in front of their eye 'white thing in FRONT of the eye'

Answer 409

surgical removal

Answer 410

premature baby, oxygen toxicity

Answer 411

suspect in any premature neonate, especially if any of the 'other 3' are present

Answer 412

ophtho exam = growths on retina

Answer 413

laser ablation

Answer 414

the 'other three' - necrotizing enterocolitis - bronchopulmonary dysplasia - intraventricular hemorrhage

Answer 415

difficulty getting urine out | redundant tissue

Answer 416

no urinary output + distended bladder, day 0 of life +/- oligohydramnios (prenatal u/s) +/- incr Cr (mom clears)

Answer 417

``` U/S = hydro catheter = large volume diuresis VCUG = negative reflux ```

Answer 418

``` catheter = relieve obstruction surgery = resolve problem ```

Answer 419

the scrotum 'zips up' lopsided hypo = under = ventral urethra epi = top = dorsal urethra

Answer 420

cosmetic deformity | epi can lead to incontinence

Answer 421

NEVER CIRCUMCISE | rebuild using foreskin

Answer 422

one good ureter = normal function | one janky ureter = consent leak

Answer 423

boys: asymptomatic girls: 'normal' bladder function AND constant leak

Answer 424

U/S: no hydro VCUG: no reflux radionucleotide scan for renal function

Answer 425

retrograde flow to ureters | bacteria ascend

Answer 426

prenatal u/s = hydro | recurrent UTI/pyelo at young age

Answer 427

``` u/s = hydro VCUG = reflux ```

Answer 428

low grade = abx | ultimately = surgery

Answer 429

hydro or no hydro

Answer 430

reflux or no reflux

Answer 431

extraluminal lesions (IV contrast) trauma (IV contrast) nephrolithiasis (no contrast)

Answer 432

intraluminal lesions | stent intervention

Answer 433

never the right answer

Answer 434

likely self-limiting, investigate if persists

Answer 435

glomerulonephritis, lean on the U/A and maybe biopsy (nephritic syndrome)

Answer 436

post-glomerulonephritis | work-up involves CT or cystoscopy or both

Answer 437

rhabdomyolysis

Answer 438

CT scan with IV contrast

Answer 439

undescended testes

Answer 440

absent testes on physical exam

Answer 441

newborn: if undescended by 6mo, surgically bring down prepubertal: surgically tether postpubertal: surgically remove

Answer 442

monitor for testicular cancer | - increase risk x10

Answer 443

hundreds of brief seizures without post-octal state

Answer 444

ADHD symptoms - trouble in school - trouble paying attention

Answer 445

ethosuximide

Answer 446

will outgrow eventually

Answer 447

peak temp/rate of rise (doesn't matter)

Answer 448

``` five months to five years first time seizure fever and a seizure no focal features (simple) fifteen minutes or less (simple) ```

Answer 449

treat underlying cause

Answer 450

around 6mo old bilateral jerking head or extremities NO FEVER

Answer 451

interictal EEG = hypsarrhythmia

Answer 452

psychomotor retardation

Answer 453

comes from other causes | - west, tuberous sclerosis, brain injury of some kid

Answer 454

1-7 y/o; recurrent seizures

Answer 455

interictal EEG: spike and wave

Answer 456

valproate, rufinamide

Answer 457

psychomotor and intellectual disability

Answer 458

brain tubers

Answer 459

< 2 years | afebrile seizures

Answer 460

ash leaf spots on Wood's lamp | CT scan on tubers

Answer 461

organ specific - think seizures

Answer 462

monitor for organ involvement - brain, eyes, heart, psych

Answer 463

x-linked agammaglobulinemia of bruton CVID IgA deficiency Hyper- IgM

Answer 464

leukocyte adhesion deficiency | chronic granulomatous disease

Answer 465

wiskott-aldrich ataxia-telangiectasia SCID

Answer 466

c1 esterase deficiency | C5-C9 MAC attack

Answer 467

x-linked A-Ig-enemia decrease B cells = Boys

Answer 468

sinopulmonary infections, 6 mo

Answer 469

CBC = normal QIg = no IgA, no IgG, no IgM flow = no B cells BTK gene

Answer 470

mild XLA in teenager

Answer 471

``` CBC = normal QIG = decrease 2/3 Ig ```

Answer 472

schedule IgG .... BM transplant

Answer 473

decrease IgA -> decrease mucosal

Answer 474

2. sinopulmonary + GI bugs | 2. asx ... pRBC ... anaphylaxis

Answer 475

CBC = normal | QIG: decrease IgA, increase IgG, increase IgM

Answer 476

anaphylaxis

Answer 477

isotope switching fails

Answer 478

immune decrease, bacterial infections

Answer 479

CBC = normal | QIG: decrease IgA, decrease IgG, dramatic increase IgM

Answer 480

anaphylaxis

Answer 481

wbc can't leave blood

Answer 482

toxic but NO PUS | delayed separation from cord

Answer 483

no respiratory burst, macrophages | eat, but not kill catalase +

Answer 484

staph abscess

Answer 485

** nitro blue ** CBC = increase wbc QIG = Increase IgM, increase IgG

Answer 486

22q11.2 deletion | 3rd pharyngeal pouch

Answer 487

``` wide-spaced eyes low-set ears absent thymic shadow small face fungi + PCP ```

Answer 488

syndrome: clinical | CBC = decrease ALC

Answer 489

TMP-SMX ppx IVIG bridge thymic transplant

Answer 490

decrease calcium, secondary PTH | tetany, seizures

Answer 491

x-linked boys

Answer 492

eczema + decreased platelet + normal infections

Answer 493

``` CBC = decrease wbc, decrease platelet QIG = increase IgA, increase IgE ```

Answer 494

bone marrow transplant

Answer 495

ataxia, telangiectasia, decrease immune | DNA repair, leukemia, lymphoma

Answer 496

no immune system, no defense No B, No T adenosine deaminase

Answer 497

mega-AIDS from birth

Answer 498

``` CBC = decrease wbc QIG = no IgA, no IgM, no IgG ```

Answer 499

isolate from everything ... TMP-SMX against PCP ... BM transplant

Answer 500

angioedema | FFP