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Pediatrics Flashcards

1
Q

APGAR criteria

A 
appearance
pulse
grimace
activity
respiration
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2
Q

APGAR: appearance

A 
0 = blue/pale
1 = acrocyanosis
2 = pink
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3
Q

APGAR: pulse

A 
0 = absent
1 = <100
2 = >100
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4
Q

APGAR: grimace

A 
0 = absent
1 = lots of stim
2 = with stim
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5
Q

APGAR: activity

A 
0 = absent
1 = flexion
2 = resist extension
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6
Q

APGAR: respiration

A 
0 = absent
1 = irregular
2 = strong
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7
Q

primary neonatal apnea path

A

understimulation

C-section

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8
Q

primary neonatal apnea pt

A

no respirations from the start

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9
Q

primary neonatal apnea dx

A

clinical

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10
Q

primary neonatal apnea tx

A

stimulate baby

suction

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11
Q

secondary neonatal apnea path

A

uncertain

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12
Q

secondary neonatal apnea pt

A

baby was breathing then stops

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13
Q

secondary neonatal apnea dx

A

ensure patent airway

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14
Q

secondary neonatal apnea tx

A

PPV

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15
Q

neonatal dyspnea causes

A

TTN

RDS

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16
Q

TTN path

A

self-limiting

C-sections

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17
Q

TTN pt

A

near-term

grunting

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18
Q

TTN dx

A

hyperextended

wet

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19
Q

TTN tx

A

PPV

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20
Q

RDS path

A

developmental

deficient surfactant

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21
Q

RDS pt

A

premature

perinatal distress

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22
Q

RDS dx

A

hypoextended

atelectasis

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23
Q

RDS tx

A

intubation and surfactant

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24
Q

newborn hypoglycemia path

A

risk factors

  • LGA, infant DM mother
  • small gestational age, IUGR
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25
Q

newborn hypoglycemia pt

A

jitteriness, tremors, lethargy, poor feeding

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26
Q

newborn hypoglycemia dx

A

every babe gets a glucose check

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27
Q

newborn hypoglycemia tx

A

if sx = IV glucose

if asx = feed

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28
Q

newborn hypoglycemia f/u

A

sepsis

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29
Q

bronchopulmonary dysplasia path

A

decrease surfactant = RDS

prolonged damage = scarring

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30
Q

bronchopulmonary dysplasia pt

A

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

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31
Q

bronchopulmonary dysplasia dx

A

xray = ground-glass opacities

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32
Q

bronchopulmonary dysplasia tx

A

surfactant (post-birth)

steroids (pre-birth)

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33
Q

bronchopulmonary dysplasia f/u

A

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

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34
Q

retinopathy of prematurity path

A

neoangiogenesis gone awry

Increase FiO2

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35
Q

retinopathy of prematurity pt

A

premature infant requiring O2

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36
Q

retinopathy of prematurity dx

A

eye exam (all premies)

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37
Q

retinopathy of prematurity tx

A

laser

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38
Q

retinopathy of prematurity f/u

A

glaucoma

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39
Q

intraventricular hemorrhage (NICU) path

A

highly vascular ventricles

labile pressures

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40
Q

intraventricular hemorrhage (NICU) pt

A 
premie...asx
increase ICP (fontanelles)
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41
Q

intraventricular hemorrhage (NICU) dx

A

cranial doppler (all premies)

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42
Q

intraventricular hemorrhage (NICU) tx

A

decrease ICP…shunts, drains

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43
Q

intraventricular hemorrhage (NICU) f/u

A

intellectual disability, seizures

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44
Q

necrotizing enterocolitis path

A

dead gut

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45
Q

necrotizing enterocolitis pt

A

premie…bloody BM

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46
Q

necrotizing enterocolitis dx

A

xray = pneumatosis intestinalis

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47
Q

necrotizing enterocolitis tx

A

NPO, IV abx, TPN

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48
Q

necrotizing enterocolitis f/u

A

surgery

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49
Q

imperforate anus path

A

VACTERL

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50
Q

imperforate anus pt

A

no hole on inspection (+/- fistula)

never first temp rectally

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51
Q

imperforate anus dx

A

visual inspection

cross-table xray

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52
Q

imperforate anus tx

A 
mild = repair now
severe = colostomy, repair before toilet training
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53
Q

imperforate anus f/u

A 
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
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54
Q

meconium ileus path

A

cystic fibrosis

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55
Q

meconium ileus pt

A

FTPM and…

no prenatal care (undocumented)

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56
Q

meconium ileus dx

A

x-ray = dilated loops, gas-filled plug

water-soluble contrast (gastrograffin enema)

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57
Q

meconium ileus tx

A

water-soluble contrast (gastrografin enema)

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58
Q

meconium ileus f/u

A

meconium peritonitis = perf
ADEK vitamins
pancreatic enzymes
short stature

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59
Q

hirschsprung’s path

A

failure of neuron migration = distal colon

absent inhibitor neurons = no relaxation

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60
Q

Hirschsprung’s pt

A 
case 1 (90%): FTPM, explosive stool with DRE
case 2 (10%): chronic constipation with overflow incontinence
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61
Q

Hirschsprung’s dx

A

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

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62
Q

Hirschsprung’s tx

A

surgery

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63
Q

voluntary constipation path

A

embarrassment or pain

cognitive impairment

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64
Q

voluntary constipation pt

A

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

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65
Q

voluntary constipation dx

A

clinical

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66
Q

voluntary constipation tx

A 
bowel regimen (stool softener, motility)
disimpaction under anesthesia if necessary
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67
Q

unconjugated bilirubin

A

lipid soluble
can cross BBB
kernicterus
NO urinary excretion

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68
Q

conjugated bilirubin

A

water soluble
cannot cross BBB
NO kernicterus
urinary excretion

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69
Q

physiologic jaundice

A

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

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70
Q

pathologic jaundice

A

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

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71
Q

Crigler-Najjar

A

NO UDP-glucouronyltransferase

Type 1 die, Type II have unconjugated bili (very rare)

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72
Q

Gilbert’s

A 
decrease UDP-glucuronyltransferase
unconjugated bili (mc of these diseases)
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73
Q

Dubin-Johnson

A

problem with excretion
conjugated hyperbilirubinemia
black liver

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74
Q

Rotor

A

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

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75
Q

breast-feeding jaundice

A

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

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76
Q

breast milk jaundice

A

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

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77
Q

neonatal jaundice path

A

unconjugated causes kernicterus

conjugated implies structural lesion

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78
Q

neonatal jaundice pt

A

baby will be yellow

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79
Q

neonatal jaundice dx

A 
transcutaneous sensor (screen)
bilirubin level (diagnostic)
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80
Q

neonatal jaundice tx

A

if unconjugated: use BLUE LIGHT

if conjugated: evaluate for cause

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81
Q

tracheoesophageal fistula path

A

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

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82
Q

tracheoesophageal fistula pt

A

nonbiliary emesis day 0

bubbling, gurgling

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83
Q

TE fistula dx

A

NG tube coils on xray

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84
Q

TE fistula tx

A

parenteral nutrition
NG tube suction
surgery

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85
Q

pyloric stenosis path

A

hypertrophy of pylorus

gastric outlet obstruction

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86
Q

pyloric stenosis pt

A

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

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87
Q

pyloric stenosis dx

A 
BMP = decrease Cl, decrease K, increase Bicarb
u/s = donut sign
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88
Q

pyloric stenosis tx

A

FIX ELECTROLYTES FIRST = IVF

pyloromyotomy

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89
Q

malrotation path

A

failure of rotation

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90
Q

malrotation pt

A

normal uterine course
no polyhydramnios
no down syndrome

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91
Q

malrotation dx

A

x-ray = double bubble with NORMAL gas pattern beyond

upper GI series

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92
Q

malrotation tx

A

NGT decompression

surgery

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93
Q

malrotation f/u

A

volvulus; ischemia

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94
Q

duodenal atresia path

A

failure to recannulate the duodenum

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95
Q

duodenal atresia pt

A

+ polyhydramnios

+ down syndrome

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96
Q

duodenal atresia dx

A

x-ray = double bubble AND no gas beyond

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97
Q

duodenal atresia tx

A

surgery

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98
Q

annular pancreas path

A

failure to recannulate the esophagus

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99
Q

annular pancreas pt

A

+ polyhydramnios

+ Down syndrome

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100
Q

annular pancreas dx

A

x-ray = double bubble AND no gas beyond

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101
Q

annular pancreas tx

A

surgery

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102
Q

intestinal atresia path

A

vascular compromise

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103
Q

intestinal atresia pt

A

mom = cocaine use

NO down syndrome

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104
Q

intestinal atresia dx

A

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

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105
Q

intestinal atresia tx

A

surgery for baby

confront mom

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106
Q

intestinal atresia f/u

A

short-gut

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107
Q

congenital diaphragmatic hernia path

A

bowel in chest

hypoplastic lungs

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108
Q

congenital diaphragmatic hernia pt

A

scaphoid abdomen
pulmonary distress day 0
bowel sounds in chest

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109
Q

congenital diaphragmatic hernia dx

A

x-ray (babygram)

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110
Q

congenital diaphragmatic hernia tx

A

cardiopulmonary stabilization
pulmonary surfactant
surgical repair

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111
Q

gastroschisis path

A

extrusion of bowel

NO membrane

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112
Q

gastroschisis pt

A 
RIGHT of midline
NO membrane (loose bowel)
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113
Q

gastroschisis dx

A

clinical

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114
Q

gastroschisis tx

A

silo

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115
Q

gastroschisis f/u

A

fluid shifts big problem

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116
Q

omphalocele path

A

extrusion of bowel

intact membrane

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117
Q

omphalocele pt

A 
MIDLINE
YES membrane (contained sac)
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118
Q

omphalocele dx

A

clinical

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119
Q

omphalocele tx

A

silo

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120
Q

omphalocele f/u

A

fluid shifts but not as fast

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121
Q

exstrophy of the bladder path

A

bladder through the skin

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122
Q

exstrophy of the bladder pt

A

MIDLINE defect
wet with urine
red or shining
no bowel seen

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123
Q

exstrophy of the bladder dx

A

clinical

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124
Q

exstrophy of the bladder tx

A

surgically

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125
Q

biliary atresia path

A

failure of the biliary tree to recanalize

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126
Q

biliary atresia pt

A

persistent or worsening jaundice at 2kws

direct hyperbili

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127
Q

biliary atresia dx

A

u/s = absence of ducts

HIDA scan after phenobarb = no contrast in GI

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128
Q

biliary atresia tx

A

surgical (hepatoportoenterostomy)

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129
Q

biliary atresia f/u

A

fatal if not corrected

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130
Q

neural tube defects path

A

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

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131
Q

NTDs pt

A

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

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132
Q

NTDs dx

A 
prenatal
\+ AFP screen
\+ u/s in utero
no prenatal care
\+ visual inspection
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133
Q

NTDs tx

A

surgery

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134
Q

NTDs f/u

A

chiari type II with myelomeningocele

hydrocephalus can lead to learning disabilities

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135
Q

cleft lip/cleft palate path

A

failure of growth and fusion of the underlying structures

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136
Q

cleft lip/palate pt

A

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

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137
Q

cleft lip/palate dx

A

clinical

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138
Q

cleft lip/palate tx

A

surgically

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139
Q

cleft lip/palate f/u

A

cosmetic deformity

failure to thrive from inability to latch (feed)

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140
Q

developmental milestones: 2 mo

A

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

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141
Q

developmental milestones: 4 mo

A

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

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142
Q

developmental milestones: 6 mo

A

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

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143
Q

developmental milestones: 1 yr

A

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

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144
Q

developmental milestones: 2 yr

A

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

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145
Q

developmental milestones: 3 yr

A

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

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146
Q

developmental milestones: 4 yr

A

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

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147
Q

developmental milestones: 5 yr

A

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

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148
Q

vaccines

A 
MMRV
HepA/B
DTaP
HiB
pneumococcal
meningococcal
HPV
flu
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149
Q

FTT

A

head circumference: last to go

height: lost between
weight: first to go

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150
Q

organic causes of FTT

A

genetic (CF)
cardiac disease
pyloric stenosis
GERD

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151
Q

non-organic causes of FTT

A

formula
feeding
frequency

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152
Q

red flags of abuse: injury

A

suspicious shape
suspicious location
severity

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153
Q

red flags of abuse: child

A

injured infant
comfort from nurses
comfort from staff

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154
Q

safety to prevent trauma

A 
car seats
booster seats
seatbelts
NO trampolines
eliminate guns
fence pools
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155
Q

safety for SIDS

A

sleep on back
don’t share beds
smoking cessation

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156
Q

vaccine contraindications: egg allergy

A

nothing made with eggs except:

  • influenza *US IM flu no longer made with eggs
  • yellow fever
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157
Q

vaccine contraindications: immunocompromised or pregnant

A

no live vaccines

  • MMRV
  • live attenuated flu (IN)
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158
Q

vaccine contraindications: anaphylaxis

A

never get that vaccine again

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159
Q

vaccine contraindications: ok to give vaccine again if…

A

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

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160
Q

hep B vaccines

A

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

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161
Q

DTaP vaccine

A 
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
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162
Q

Hib vaccine

A

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

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163
Q

MMRV vax

A

vax and booster before school (1 and 4)

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164
Q

pneumococcal vax

A

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

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165
Q

meningococcal vax

A

to everyone vs. meningitis…

required for college and military

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166
Q

HPV vax

A

all boys and girls 9-26

prevents cancer

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167
Q

Hep A/B vax

A

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

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168
Q

Flu vax

A

everyone. period.
healthcare workers before winter months
given annually

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169
Q

managing a wound with < 3 lifetime DTaP doses (or unknown)

A

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

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170
Q

managing a wound with >/= 3 lifetime DTap doses

A

clean:

  • > /= 10y : Tdap
  • < 10y : Home
    dirty:
  • > /= 5y : Tdap
  • < 5y : home
  • NO TIG needed if >/= 3 lifetime doses
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171
Q

pertussis

A 
catarrhal stage (inconspicuous)
paroxysmal phase (coughing spells, whoops)
resolution phase (regular cold symptoms)
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172
Q

diphtheria

A

grey pseudomembrane in oropharynx

airway, antibiotics, antitoxin

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173
Q

tetanus

A

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

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174
Q

varicella

A

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

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175
Q

HPV

A

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

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176
Q

rotavirus

A

oral

contraindicated in intussusception

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177
Q

1st degree burn

A

epidermis only

+ pain, + erythema

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178
Q

2nd degree burn

A

epi + dermis

+ pain, + blisters, + erythema

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179
Q

3rd degree burn

A

through dermis

white and painless with surrounding 2nd deg burns

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180
Q

Parkland formula for burns

A

%BSA x kg x 4

  • 2nd and 3rd degree only
  • 50% in 8hrs; 50% in 16hrs
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181
Q

rule of nines for burns

A 
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
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182
Q

epidural hematoma

A

temple trauma
+ LOC with lucid interval
biconvex ‘lens’

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183
Q

subdural hematoma

A

major trauma or abuse
+ LOC, no lucidity
concave ‘crescent’

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184
Q

cerebral contusion

A

major trauma
+ LOC
punctate hemorrhage

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185
Q

head trauma prevention

A 
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
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186
Q

drowning prevention

A

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)

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187
Q

gun and chemical safety

A

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

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188
Q

severity of concussion to treatment: mild:

A 
FND: none
LOC: <60sec
HA: none, improving
amnesia: none
No CT
d/c home
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189
Q

severity of concussion to treatment: severe

A 
FND: positive
LOC: >60sec
HA: persistent or worsening
amnesia: retrograde or anterograde
CT scan
observe in house
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190
Q

treatment for concussion regardless of severity

A

step-wise return to play

sleep -> go to school -> homework -> practice -> play

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191
Q

abuse vs. neglect

A

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

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192
Q

risk factors for abuse: child

A

intellectual disability
premature birth
physical disability
cognitive disability

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193
Q

risk factors for abuse: parental

A

those who were abused
single parent
young parent
low SES

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194
Q

how to spot abuse: fractures

A

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

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195
Q

how to spot abuse: bruises

A

different stages of healing

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196
Q

how to spot abuse: burns

A

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

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197
Q

how to spot abuse: sexual

A

any STD in any child ever

vaginal or anal trauma

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198
Q

how to spot abuse: behavior

A

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

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199
Q

what to do if you suspect abuse: certainty

A

certainty is NOT required

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200
Q

what to do if you suspect abuse: the family

A

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

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201
Q

what to do if you suspect abuse: the child

A

hospitalize the child if no safe alternative exists

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202
Q

what to do if you suspect abuse: the abuser

A

separate abuser from child if obvious

separate parent-child unit from a common abuser

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203
Q

what to do if you suspect abuse: behavior

A

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

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204
Q

what to do if you suspect abuse: CPS

A

must report

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205
Q

ALTE definition

A

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
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206
Q

features by etiology: seizures

A

eye deviation, limb-jerking

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207
Q

features by etiology: infection

A

temperature instability

fussy baby

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208
Q

features by etiology: cardiac

A

difficulty with feeding
murmur
FTT

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209
Q

features by etiology: abuse

A

evidence of trauma

femur, skull fracture

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210
Q

BRUE definition

A

< 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
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211
Q

low risk BRUE

A 
no history
no physical
no CPR
1st time, non-recurring
age, term > 60d
age, preterm >32wk GA AND >/= 45wk PC
action: reassurance only
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212
Q

high risk BRUE

A 
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
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213
Q

SIDS prevention

A

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

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214
Q

erythema infectiosum path

A

parvovirus 19

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215
Q

erythema infectiosum pt

A

slapped-cheek rash

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216
Q

erythema infectiosum dx

A

clinical

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217
Q

erythema infectiosum tx

A

none

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218
Q

erythema infectiosum f/u

A

aplastic crisis in sickle cell

hydrops fetalis if in utero

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219
Q

measles path

A

measles virus (paramyxovirus)

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220
Q

measles pt

A

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

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221
Q

measles tx

A

supportive (ppx vaccinate)

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222
Q

measles f/u

A

subacute sclerosing panencephalitis

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223
Q

rubella path

A

rubella

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224
Q

rubella pt

A

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

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225
Q

rubella tx

A

supportive (ppx vaccinate)

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226
Q

rubella f/u

A

congenital: heart, deafness, cataracts

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227
Q

roseola path

A

HHV-6

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228
Q

roseola pt

A

fever BEFORE rash (>104)

starts on trunk, spreads outward

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229
Q

roseola f/u

A

febrile seizures

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230
Q

varicella chickenpox path

A

varicella zoster

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231
Q

varicella chickenpox pt

A

widespread
vesicles on erythematous base
different stages of healing

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232
Q

varicella chickenpox tx

A

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

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233
Q

varicella chickenpox f/u

A

shingles

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234
Q

varicella shingles path

A

reactivated varicella, non-vaccinated adults

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235
Q

varicella shingles pt

A

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

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236
Q

varicella shingles tx

A

antiviral if immunocompromised (ppx vaccinate)

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237
Q

varicella shingles f/u

A

postherpetic neuralgia

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238
Q

mumps path

A

mumps virus

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239
Q

mumps pt

A

bilateral swelling

orchitis in pubertal males

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240
Q

mumps dx

A

clinical

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241
Q

mumps tx

A

vaccinate

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242
Q

mumps f/u

A

infertility

243
Q

hand-foot-mouth path

A

coxsackie A

244
Q

hand-foot-mouth pt

A

nonspecific prodrome

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

245
Q

hand-foot-mouth dx

246
Q

molluscum contagiosum path

247
Q

molluscum contagiosum pt

A

flesh-colored
central umbilication
trunk, arms, diaper

248
Q

molluscum contagiosum dx

249
Q

molluscum contagiosum tx

A

supportive

250
Q

scarlet fever path

A

group A strep

251
Q

scarlet fever pt

A

fever, sore throat
desquamating sandpaper rash
trunk and spreads outwards

252
Q

scarlet fever dx

A

streptolysin O

253
Q

scarlet fever tx

A

penicillin prevents rheumatic fever but not post-strep glomerulonephritis

254
Q

anaphylaxis path

A

IgE mediated

life threatening

255
Q

anaphylaxis pt

A

rash (urticarial) AND airway edema

HYPOTENSION

256
Q

anaphylaxis dx

257
Q

anaphylaxis tx

A

epi 1:1000 IM ‘epic-pen’ …
then H1/H2 blockers
then steroids

258
Q

anaphylaxis f/u

A

avoid triggers

259
Q

urticaria path

A

IgE mediated

rash only

260
Q

urticaria pt

A

rash (urticarial)
- erythema
- wheal
NO hypotension

261
Q

urticaria dx

262
Q

urticaria tx

A

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

263
Q

angioedema path

A

non-IgE mediated swelling
medication induced
C1 esterase deficiency

264
Q

angioedema pt

A

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

265
Q

angioedema dx

266
Q

angioedema tx

A

airway protection

stop the offending agent (ACE-i)

267
Q

angioedema f/u

A

C1 esterase deficiency gets FFP

H1/H2 blockers and steroids probably don’t help

268
Q

allergic rhinitis path

A

seasonal (dander/pollen exposure)

perennial (pets, dust, indoor mold)

269
Q

allergic rhinitis pt

A 
allergic shiners (dark eyes)
allergic salute (nasal crease)
pale, boggy mucosa
polyps
cobblestoning
270
Q

allergic rhinitis dx

A 
identify and remove triggers
- pets
- carpets
- parents smoking
skin testing if severe or refractory to trigger
271
Q

allergic rhinitis tx

A

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

272
Q

allergic conjunctivitis path

A

same as rhinitis

273
Q

allergic conjunctivitis pt

A

same s rhinitis, except it’s the eyes

  • injection
  • chemosis
  • shiners
274
Q

allergic conjunctivitis dx

275
Q

allergic conjunctivitis tx

A

avoid triggers

mast cell stabilizers and antihistamines instead of intranasal steroids

276
Q

food allergens path

A

triggers:

  • outgrows: wheat, soy, milk, eggs
  • for life: nuts, shellfish, seafood
277
Q

food allergens pt

A

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

278
Q

food allergens dx

A

food trial

279
Q

food allergens tx

A

epipen for anaphylaxis

avoidance of trigger

280
Q

milk protein allergy path

A

soy/formula

281
Q

milk protein allergy pt

A

n/v/d
bloody bowel movements
FTT

282
Q

milk protein allergy dx

283
Q

milk protein allergy tx

A

cow’s milk formula or breastfeed

284
Q

acute otitis media path

A

URI bugs = strep, moraxella, H. flu

middle ear

285
Q

acute otitis media pt

A

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

286
Q

acute otitis media dx

A

pneumatic insufflation

287
Q

acute otitis media tx

A

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

288
Q

acute otitis media f/u

A

mastoiditis

289
Q

acute otitis externa path

A

outer ear
swimmer’s = pseudomonas
digital = staph aureus

290
Q

acute otitis externa pt

A

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

291
Q

acute otitis externa dx

292
Q

acute otitis externa tx

A

spontaneously resolves

293
Q

acute otitis externa f/u

A

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

294
Q

mastoiditis path

A

complications of ear infections

295
Q

mastoiditis pt

A

acute otitis media AND
posterior bulging of mastoid
anteriorly rotated ear

296
Q

mastoiditis dx

A

clinical… CT scan (not needed)

297
Q

mastoiditis tx

A

surgical drainage

298
Q

bacterial sinusitis path

A

URI bugs (same as AOM)

299
Q

bacterial sinusitis pt

A

congestion
bilateral purulent rhinorrhea
facial tap = pain

300
Q

bacterial sinusitis dx

A

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

301
Q

bacterial sinusitis tx

A 
supportive EXCEPT
- temp >/= 38 deg C
- worsening
- duration > 10d
amoxicillin + clavulanate
302
Q

bacterial sinusitis f/u

A

CT scan for recurrence

foreign body for young kid

303
Q

common cold path

A

rhinovirus, transmitted by large droplets

304
Q

common cold pt

A

congestion, non-toxic

<10d, no purulence

305
Q

common cold dx

306
Q

common cold tx

A

supportive

307
Q

pharyngitis path

A

viral (mc)

group A strep (rheumatic fever)

308
Q

pharyngitis pt

A 
sore throat, odynophagia
Cough (absent) + 1
Exudates + 1
Nodes (adenopathy) + 1
Temp >/= 38 + 1
OR age <14 + 1 OR age > 44 - 1
309
Q

pharyngitis dx

A

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

310
Q

pharyngitis tx

A

amoxicillin or PCN

311
Q

foreign bodies path

A

kids stick things places

312
Q

foreign bodies pt

A

unilateral purulent discharge
unilateral otitis externa
aspiration

313
Q

foreign bodies dx

A

clinical, cxr

314
Q

foreign bodies tx

315
Q

foreign bodies f/u

A

if insect gets in:

- lidocaine and retrieval

316
Q

epistaxis path

A

digital trauma (nose picking)

317
Q

epistaxis pt

A

unilateral bleeding, <30mins

318
Q

epistaxis dx

319
Q

epistaxis tx

A

ice pack, lean forward
cauterize anterior bleeds
pack posterior bleeds

320
Q

choanal atresia path

A

atresia or stenosis of passage from nose to throat

321
Q

choanal atresia pt

A

blue while feeding, pink while crying, childhood snore

322
Q

choanal atresia dx

A

catheter fails to pass through the nose

323
Q

choanal atresia tx

A

scope and surgery

324
Q

croup path

A

parainfluenza

325
Q

croup pt

A

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

326
Q

croup dx

A

clinical

XR - steeple sign

327
Q

croup tx

A

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

328
Q

bacterial tracheitis path

A

strep and staph

329
Q

bacterial tracheitis pt

A

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

330
Q

bacterial tracheitis dx

A

clinical

tracheal culture

331
Q

bacterial tracheitis tx

332
Q

bacterial tracheitis f/u

A

ENT to bronch/scope/get tracheal culture

333
Q

epiglottitis path

A

Hib (Hib vaccine has dropped incidence)

334
Q

epiglottitis pt

A 
6-12 y/o, unvaccinated
SICK
rapid onset high spiking fevers
drooling, tripoding
accessory muscles
hot-potato-voice ('muffled')
335
Q

epiglottitis dx

A

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

336
Q

epiglottitis tx

A

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

337
Q

retropharyngeal abscess path

A

oral flora

URI bugs

338
Q

retropharyngeal abscess pt

A 
SICK
rapid onset high spiking fevers
drooling, neck extended
hot-potato-voice ('muffled')
* unilateral anterior chain nodes *
* tender palpable mass *
339
Q

retropharyngeal abscess dx

A

CT scan max/face/neck

340
Q

retropharyngeal abscess tx

A

incision and drainage, IV abx

341
Q

peritonsillar abscess path

A

oral flora

URI bugs

342
Q

peritonsillar abscess pt

A

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

343
Q

peritonsillar abscess dx

344
Q

peritonsillar abscess tx

A

I&D, IV abx

345
Q

foreign body aspiration path

A

kids put things places

346
Q

foreign body aspiration pt

A

sudden onset dyspnea
unsupervised child
stridor = extrathoracic
wheeze = intrathoracic

347
Q

foreign body aspiration dx

A

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

348
Q

foreign body aspiration tx

349
Q

FB aspiration f/u

A

high risk:

  • kids < 3y/o
  • foods: peanuts, M&Ms, hot dogs
350
Q

asthma path

A

reversible obstructive lung disease

351
Q

asthma pt

A

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

352
Q

asthma dx

A

PEFTs

  • decrease FEV1/FVC
  • reversible with bronchodilators
  • inducible with methacholine
353
Q

asthma tx

A 
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
354
Q

asthma f/u

A

remove allergens

  • pets
  • carpets
  • smoking (parents)
355
Q

pneumonia path

A

typical, atypical, viral

356
Q

pneumonia pt

A

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

357
Q

pneumonia dx

358
Q

pneumonia tx

A

amoxicillin or azithromycin

359
Q

pneumonia f/u

A

internal medicine - infectious ID

360
Q

bronchiolitis path

A

inflammatory disorder of small airways

viral infection = RSV

361
Q

bronchiolitis pt

A

very young < 2y/o

trouble feeding

362
Q

bronchiolitis dx

A

cxr (normal)

rapid antigen testing from a nasopharyngeal swab (yes, but don’t)

363
Q

bronchiolitis tx

A

supportive - IVF/NG feeds, oxygen

NO: steroids, ß-agonists, antibiotics

364
Q

bronchiolitis f/u

A

RSV bronchiolitis is all supportive care

nothing works: just get the kids through it

365
Q

cystic fibrosis path

A

CFTR or CCTR mutation

autosomal recessive

366
Q

cystic fibrosis pt

A 
prenatal screen positive
- most dx
no prenatal screen (immigrant)
- FTT
- meconium ileus
- frequent respiratory infections
- baby has salty skin
367
Q

cystic fibrosis dx

A

sweat chloride test

  • > 40 neonates
  • > 60 in others
368
Q

cystic fibrosis tx

A

pulmonary toilet
pneumonia = pseudomonas
vit ADEK
pancreatic enzymes

369
Q

cystic fibrosis f/u

A

short stature

limited life expectancy

370
Q

necrotizing enterocolitis path

371
Q

necrotizing enterocolitis pt

A

premature neonate in ICU

bloody BM

372
Q

necrotizing enterocolitis dx

A

xray = pneumonitis intestinalis

373
Q

necrotizing enterocolitis tx

A

NPO, IVF, TPN

IV abx

374
Q

necrotizing enterocolitis f/u

A

other diseases of prematurity

375
Q

anal fissure path

A

tear in anal mucosa

376
Q

anal fissure pt

A

visual inspection

iatrogenic in the neonate, well baby

377
Q

anal fissure dx

378
Q

anal fissure tx

A

reassurance

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

379
Q

intussusception path

A

telescoping of bowel

vascular compromise

380
Q

intussusception pt

A 
abrupt onset
colicky pain
knee-chest position = relief
* sausage-shaped mass in RUQ *
* currant jelly stool * (too late)
381
Q

intussusception dx

A

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

382
Q

intussusception tx

A 
air-enema usually curative
surgery if:
- peritoneal
- perforation
- failed air-enema
383
Q

intussusception f/u

A

90% kids have no lead point

90% adults have a mass lead point

384
Q

meckel’s diverticulum path

A

remnant of the vitelline duct = gastric mucosa

omphalomesenteric duct

385
Q

meckel’s diverticulum pt

A 
'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
386
Q

meckel’s diverticulum dx

A

mocker’s scan = technetium-99

387
Q

meckel’s diverticulum tx

388
Q

meckel’s diverticulum f/u

A

teenagers get diagnosed with CT scans

389
Q

distractors - reassurance only

A

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

390
Q

Crohn’s

A

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

391
Q

UC

A

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

392
Q

infectious colitis

A

fever and blood BM

lactoferrin, WBC, stool culture

393
Q

milk-protein allergy

A

change to hydrolyzed formula

394
Q

left-to-right shunts

A 
increase pulmonary flow
increase pulmonary vasculature on xray
increase pulmonary pressures
RVH
Eisenmenger's (reversal to right to left)
"D" diseases: ASD, VSD, PDA
395
Q

atrial septal defect path

A 
ostium primum (rare)
ostium secundum (more common)
396
Q

atrial septal defect pt

A

fixed split S2

mc murmur > 1 y/o

397
Q

atrial septal defect dx

398
Q

atrial septal defect tx

A

surgical closure

399
Q

ventricular septal defect path

A

hole between the two ventricles

400
Q

VSD pt

A

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

401
Q

VSD dx

402
Q

VSD tx

A

if CHF, FTT, dyspnea = fix now

if none of those things = fix only if increased pulmonary blood flow

403
Q

VSD f/u

A

surgical closure likely required, may spontaneously resolve

404
Q

PDA path

A

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

405
Q

PDA pt

A

continuous machinery-like murmur

406
Q

PDA dx

407
Q

PDA tx

A

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

408
Q

PDA f/u

A

close as necessary, but many that persist are clinically significant

409
Q

right to left shunt

A 
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
410
Q

tetralogy of fallot path

A
  1. overriding aorta
  2. pulmonary stenosis
  3. RVH
  4. VSD
    “endocardial cushion defect”
411
Q

tetralogy of fallot pt

A

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

412
Q

tetralogy of fallot dx

A

1st: boot shaped heart on xray
best: echocardiogram

413
Q

tetralogy of fallot tx/

A

surgical correction

414
Q

tetralogy of fallot f/u

A

associated with Down’s syndrome

415
Q

transposition of the great arteries path

A

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

416
Q

transposition of the great arteries pt

A

blue baby day 1 - you will not miss this

mom is diabetic at the start of pregnancy

417
Q

transposition of the great arteries dx

A

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

418
Q

transposition of the great arteries tx

A

surgical correction

419
Q

developmental dysplasia of the hip age

420
Q

developmental dysplasia of the hip pt

A

clicky hip during the neonatal evaluation, Ortolani and Barlow maneuvers

421
Q

developmental dysplasia of the hip dx

A

u/s @ 4-6wks

422
Q

developmental dysplasia of the hip tx

423
Q

Legg-Calve-Perthes age

424
Q

Legg-Calve-Perthes pt

A

insidious onset antalgic gait

425
Q

Legg-Calve-Perthes dx

426
Q

Legg-Calve-Perthes tx

427
Q

slipped-capital femoral epiphysis age

428
Q

slipped-capital femoral epiphysis pt

A

fat kid going through a growth spurt

non-traumatic knee pain

429
Q

slipped-capital femoral epiphysis dx

A

frog-leg xray

430
Q

slipped capital femoral epiphysis tx

A

surgery (urgently)

431
Q

septic hip age

432
Q

septic hip pt

A

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

433
Q

septic hip dx

A

arthrocentesis (> 50,000 wbc)

434
Q

septic hip tx

A

drainage and abx

435
Q

transient synovitis age

436
Q

transient synovitis pt

A

4-6wks after a viral illness

joint pain WITHOUT fever, leukocytosis, inflammatory markers

437
Q

transient synovitis dx

438
Q

transient synovitis tx

A

supportive

439
Q

osgood-schlatter’s disease path

A

osteochondrosis

440
Q

osgood-schlatter’s disease pt

A

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

441
Q

osgood-schlatter’s disease dx

442
Q

osgood-schlatter’s disease tx

A

rest + cast (aka stop exercising, curative)

work thorugh it (palpable nodule)

443
Q

scoliosis path

A 
spinal deformity (left to right)
- not lordosis, not kyphosis
444
Q

scoliosis pt

A

teenage girl who can present with either:

moderate: cosmetic
severe: SOB

445
Q

scoliosis dx

A

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

446
Q

scoliosis tx

A

no therapy
brace
surgery with rods

447
Q

osteogenic sarcoma path

A

retinoblastoma gene, associated with retinoblastoma of the eye

448
Q

osteogenic sarcoma pt

A

bone pain in a pre-teen/teenager

retinoblastoma at birth (neonatal)

449
Q

osteogenic sarcoma dx

A

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

450
Q

osteogenic sarcoma tx

451
Q

fx in kids path

A

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

452
Q

fx in kids pt

A

leg pain, trauma

453
Q

fx in kids dx

454
Q

fx in kids tx

A

involves growth plate -> ORIF

does not involve growth plate -> cast

455
Q

Ewing’s sarcoma path

A

translocation t(11;22)

456
Q

Ewing’s sarcoma pt

A

bone pain in a pre-teen/teenager

no risk factor

457
Q

Ewing’s sarcoma dx

A

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

458
Q

Ewing’s sarcoma tx

459
Q

special considerations for peds fractures: external fixation

A

closed, simple, aligned

no growth plate

460
Q

special considerations for peds fractures: open reduction and internal fixation

A 
comminuted
angular
displaced
open
or involves the growth plate
461
Q

sickle cell disease path

A

HgbSS - autosomal recessive

valine for glutamic acid on 6th position

462
Q

sickle cell disease pt

A 
asplenism
vasoocclusive crisis
chronic pain
chronic anemia
pigmented gallstones
463
Q

sickle cell disease dx

A

sickle cells on smear

Hgb electrophoresis

464
Q

sickle cell disease tx

A

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

465
Q

sickle cell disease f/u

A

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

466
Q

vasoocclusive crisis path

A

sickling cells = ischemia and hemolysis

467
Q

vasoocclusive crisis pt

A

acute pain
elevated bilirubin, elevated reticulocytes
jaundice

468
Q

vasoocclusive crisis dx

A

blood smear = sickled cells

469
Q

vasoocclusive crisis tx

A

IVF, pain control

470
Q

indications for exchange transfusion in sickle

A 
priapism
focal neurologic deficit, stroke
acute chest (chest pain, pulmonary edema)
471
Q

sickle variants

A 
HgbS-ßo the worst
HgbSS sickle cell disease
HgbS-ß+ milder
HgbSC almost not a disease
HubS trait not a disease (carrier)
472
Q

consideration of complications in sickle: asplenism

A

PCN until 5

vax for strep

473
Q

consideration of complications in sickle: iron overload

A

deferoxamine

474
Q

consideration of complications in sickle: avascular necrosis

A

conservative then surgery

475
Q

consideration of complications in sickle: sickled HgbSS

A

hydroxyurea

476
Q

consideration of complications in sickle: anemia

477
Q

consideration of complications in sickle: pain

A

analgesics (opiates)

478
Q

consideration of complications in sickle: osteomyelitis

A

staph first, then salmonella

479
Q

chemical conjunctivitis

A

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

480
Q

gonorrhea conjunctivitis

A

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

481
Q

chlamydia conjunctivitis

A

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

482
Q

retinoblastoma path

A

Rb gene mutation

483
Q

retinoblastoma pt

A

newborn screen in the neonatal unit with an abnormal light reflex

484
Q

retinoblastoma dx

A 
red reflex (normal) = pure white retina
white thing in the back of the eye
485
Q

retinoblastoma tx

486
Q

retinoblastoma f/u

A

osteosarcoma

487
Q

amblyopia path

A

cortical blindness

488
Q

amblyopia pt

A

strabismus, cataracts, another cause, leads to cortical blindness

489
Q

amblyopia dx

490
Q

amblyopia tx

A

none

fix the problem that could lead to cortical blindness

491
Q

strabismus path

492
Q

strabismus pt

A

baby with one eye that focuses while the other does not

almost ALWAYS a photograph question

493
Q

strabismus dx

A

light reflects at different points in both eyes

494
Q

strabismus tx

A

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

495
Q

congenital cataracts path

A

present at birth -> TORCH infections

not present at birth -> galactosemia

496
Q

congenital cataracts pt

A

white cloudy lesions in front of their eye ‘white thing in FRONT of the eye’

497
Q

congenital cataracts dx

498
Q

congenital cataracts tx

A

surgical removal

499
Q

retinopathy of prematurity path

A

premature baby, oxygen toxicity

500
Q

retinopathy of prematurity pt

A

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

501
Q

retinopathy of prematurity dx

A

ophtho exam = growths on retina

502
Q

retinopathy of prematurity tx

A

laser ablation

503
Q

retinopathy of prematurity f/u

A

the ‘other three’

  • necrotizing enterocolitis
  • bronchopulmonary dysplasia
  • intraventricular hemorrhage
504
Q

posterior urethral valves path

A

difficulty getting urine out

redundant tissue

505
Q

posterior urethral valves pt

A

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

506
Q

posterior urethral valves dx

A 
U/S = hydro
catheter = large volume diuresis
VCUG = negative reflux
507
Q

posterior urethral valves tx

A 
catheter = relieve obstruction 
surgery = resolve problem
508
Q

hypospadias/epispadias path

A

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

509
Q

hypospadias/epispadias pt

A

cosmetic deformity

epi can lead to incontinence

510
Q

hypospadias/epispadias dx

511
Q

hypospadias/epispadias tx

A

NEVER CIRCUMCISE

rebuild using foreskin

512
Q

ectopic ureter path

A

one good ureter = normal function

one janky ureter = consent leak

513
Q

ectopic ureter pt

A

boys: asymptomatic
girls: ‘normal’ bladder function AND constant leak

514
Q

ectopic ureter dx

A

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

515
Q

ectopic ureter tx

516
Q

vesicoureteral reflux path

A

retrograde flow to ureters

bacteria ascend

517
Q

vesicoureteral reflux pt

A

prenatal u/s = hydro

recurrent UTI/pyelo at young age

518
Q

vesicoureteral reflux dx

A 
u/s = hydro
VCUG = reflux
519
Q

vesicoureteral reflux tx

A

low grade = abx

ultimately = surgery

520
Q

why do u/s for uro

A

hydro or no hydro

521
Q

why do VCUG for uro

A

reflux or no reflux

522
Q

why do CT scan for uro

A

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

523
Q

why do cystoscopy for uro

A

intraluminal lesions

stent intervention

524
Q

why do IVP for uro

A

never the right answer

525
Q

microscopic hematuria

A

likely self-limiting, investigate if persists

526
Q

dysmorphic RBC, RBC casts hematuria

A

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

527
Q

normal RBC, no casts hematuria

A

post-glomerulonephritis

work-up involves CT or cystoscopy or both

528
Q

lots of blood, no RBCs hematuria

A

rhabdomyolysis

529
Q

hematuria and blunt trauma hematuria

A

CT scan with IV contrast

530
Q

cryptorchidism path

A

undescended testes

531
Q

cryptorchidism pt

A

absent testes on physical exam

532
Q

cryptorchidism dx

533
Q

cryptorchidism tx

A

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

534
Q

cryptorchidism f/u

A

monitor for testicular cancer

- increase risk x10

535
Q

absence seizure path

A

hundreds of brief seizures without post-octal state

536
Q

absence seizure pt

A

ADHD symptoms

  • trouble in school
  • trouble paying attention
537
Q

absence seizure dx

538
Q

absence seizure tx

A

ethosuximide

539
Q

absence seizure f/u

A

will outgrow eventually

540
Q

febrile seizure path

A

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

541
Q

febrile seizure pt

A 
five months to five years
first time seizure
fever and a seizure
no focal features (simple)
fifteen minutes or less (simple)
542
Q

febrile seizures dx

543
Q

febrile seizures tx

A

treat underlying cause

544
Q

west syndrome path

545
Q

west syndrome pt

A

around 6mo old
bilateral jerking head or extremities
NO FEVER

546
Q

west syndrome dx

A

interictal EEG = hypsarrhythmia

547
Q

west syndrome tx

548
Q

west syndrome f/u

A

psychomotor retardation

549
Q

lennox-gastaut path

A

comes from other causes

- west, tuberous sclerosis, brain injury of some kid

550
Q

lennox-gastaut pt

A

1-7 y/o; recurrent seizures

551
Q

lennox-gastaut dx

A

interictal EEG: spike and wave

552
Q

lennox-gastaut tx

A

valproate, rufinamide

553
Q

lennox-gastaut f/u

A

psychomotor and intellectual disability

554
Q

tuberous sclerosis path

A

brain tubers

555
Q

tuberous sclerosis pt

A

< 2 years

afebrile seizures

556
Q

tuberous sclerosis dx

A

ash leaf spots on Wood’s lamp

CT scan on tubers

557
Q

tuberous sclerosis tx

A

organ specific - think seizures

558
Q

tuberous sclerosis f/u

A

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

559
Q

B cell immunodeficiencies

A

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

560
Q

phagocytic immunodeficiencies

A

leukocyte adhesion deficiency

chronic granulomatous disease

561
Q

T-cell immunodeficiencies

562
Q

combined immunodeficiencies

A

wiskott-aldrich
ataxia-telangiectasia
SCID

563
Q

complement immunodeficiencies

A

c1 esterase deficiency

C5-C9 MAC attack

564
Q

x-linked agammaglobulinemia of Bruton path

A

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

565
Q

x-linked agammaglobulinemia of Bruton pt

A

sinopulmonary infections, 6 mo

566
Q

x-linked agammaglobulinemia of Bruton dx

A

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

567
Q

CVID path

568
Q

CVID pt

A

mild XLA in teenager

569
Q

CVID dx

A 
CBC = normal
QIG = decrease 2/3 Ig
570
Q

CVID tx

A

schedule IgG …. BM transplant

571
Q

IgA deficiency path

A

decrease IgA -> decrease mucosal

572
Q

IgA deficiency pt

A
  1. sinopulmonary + GI bugs

2. asx … pRBC … anaphylaxis

573
Q

IgA deficiency dx

A

CBC = normal

QIG: decrease IgA, increase IgG, increase IgM

574
Q

IgA deficiency tx

575
Q

IgA deficiency f/u

A

anaphylaxis

576
Q

hyperIgM path

A

isotope switching fails

577
Q

hyperIgM pt

A

immune decrease, bacterial infections

578
Q

hyperIgM dx

A

CBC = normal

QIG: decrease IgA, decrease IgG, dramatic increase IgM

579
Q

hyperIgM tx

580
Q

hyperIgM f/u

A

anaphylaxis

581
Q

leukocyte adhesion deficiency path

A

wbc can’t leave blood

582
Q

leukocyte adhesion deficiency pt

A

toxic but NO PUS

delayed separation from cord

583
Q

leukocyte adhesion deficiency tx

584
Q

chronic granulomatous disease path

A

no respiratory burst, macrophages

eat, but not kill catalase +

585
Q

chronic granulomatous disease pt

A

staph abscess

586
Q

chronic granulomatous disease dx

A

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

587
Q

chronic granulomatous disease tx

588
Q

DiGeorge path

A

22q11.2 deletion

3rd pharyngeal pouch

589
Q

DiGeorge pt

A 
wide-spaced eyes
low-set ears
absent thymic shadow
small face
fungi + PCP
590
Q

DiGeorge dx

A

syndrome: clinical

CBC = decrease ALC

591
Q

DiGeorge tx

A

TMP-SMX ppx
IVIG bridge
thymic transplant

592
Q

DiGeorge f/u

A

decrease calcium, secondary PTH

tetany, seizures

593
Q

wiskott-aldrich path

A

x-linked boys

594
Q

wiskott-aldrich pt

A

eczema + decreased platelet + normal infections

595
Q

wiskott-aldrich dx

A 
CBC = decrease wbc, decrease platelet
QIG = increase IgA, increase IgE
596
Q

wiskott-aldrich tx

A

bone marrow transplant

597
Q

ataxia telangiectasia

A

ataxia, telangiectasia, decrease immune

DNA repair, leukemia, lymphoma

598
Q

SCID path

A

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

599
Q

SCID pt

A

mega-AIDS from birth

600
Q

SCID dx

A 
CBC = decrease wbc
QIG = no IgA, no IgM, no IgG
601
Q

SCID tx

A

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

602
Q

C1 esterase deficiency

A

angioedema

FFP

603
Q

C5-C9 Mac attack

Online Med Ed (18 decks)

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