Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pediatrics > Pediatrics Exam #3 > Flashcards

Pediatrics Exam #3 Flashcards

1
Q

Normal male genitalia for peds and micropenis

A

Normal - 2.8-4.1cm with average of 3.5cm
Micropenis - under 2.5cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Normal peds foreskin

A

Will not retract
Covers glans by 18-20 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Testes in full term infant

A

Should be descended

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Full term scrotum

A

Should have deep, well developed rugae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Earliest sign of male puberty

A

Testicle enlargement folled by pubic hair and THEN penis growth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Timing for circumcision

A

Between ages 1 day and 10 days is best -make sure patient voids/no coagulopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Absolute contraindications to circumcision

A

Hypospadias
Chordee/Curvature of penis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Relative CI to circumcision

A

Buried penis
Bleeding disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Benefits of circumcision

A

Easier genital hygeine
Lower UTI rates during infancy
Decreased penile cancer
Decreased HIV, HSV, HPV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Risks of circumscision

A

Procedural risk -amputation, etc.
Bleeding, Infection
Glans amputation
Epidermal inclusion cysts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Circumcision technique

A

Make sure to do local nerve block with lidocaine w/o epi

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Mogen clamp

A

Blind, outdated circumcision techniche

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

2 good techniques for circumcision

A

Plastibell - more complications
Gonco clamps - Less likely to have infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Post circumcision care

A

Use vaseline at least 3-5 days until healed
Okay to have some oozing but not active bleeding
Clean around left over skin - don’t remove

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

When will you be able to retract the foreskin

A

After 3 years of life

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Phimosis

A

Foreskin adhered to tip of penis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Paraphimosis

A

Foreskin cannot be reduced - emergency
Cuts of glans

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Smegma

A

Epithelial debris under the foreskin - looks like little pearls
Reassure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Tx for phimosis

A

Topical steroid - low potency to lyse adhesions for 1-3 months

Surgery if refractive to tx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Tx for paraphinosis

A

Emergency - retract skin ASAP, surgery if we can’t reduce

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Balanoposthitis

A

Edema and inflammation of glans/Foreskin
Infection (bacterial, viral, fungal), trauma, irritation can cause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Presentation of balanoposthitis

A

Preputial swelling, tenderness, and erythema
Exudate with foul odor
Lymphadenopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Tx for balanoposthitis

A

Sitz baths, avoid irritant
Topical bactrim for general
Clotrimazol for fungi, Amoxicillin for strep

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

MC location for hypospadias

A

Ventral shaft of the penis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

More complicated hypospadias

A

Opening further away from the glan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Presentation of hypospadia

A

May look like already circumcised

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Complications and tx for hypospadias

A

Can interfere with urinary and sexual function
Refer for surgery between 6-12 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Epispadia

A

Dorsal location of urethral meatus - much less common than hypospadia
Surgical correction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Cryptorchidism

A

Undescended testicles
Absent, Undescended, or atopic
May be able to feel and pull down testicles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

MC cryptorchid testicle

A

Left testicle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

When should testicles have descended

A

Between 4-6 months of life

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Five Cryptorchidism indications for referral

A

Bilateral non palpable testes
Unilateral with hypospadias
Ascending testes
Atrophic testes
Not sure if undescended, retractile or atrophic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Work up for cryptorchidism

A

Karytypype if non-palpable
US to look for gonads or uterus
Hormone levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Tx for cryptorchidism

A

Hormonal not recommended
Orchiopexy - surgery to get testes in scrotum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Restractile teste

A

Can feel in scrotum but sometimes goes up

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

When to refer for cryptorchidism

A

Around 6 months, get surgery done before 1 year old (cancer risk)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Complications of cryptorchidism

A

Increased risk for testicular cancer
Infertility
Testicular torsion
Sexual dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

MCC od disorder of sex development

A

Congenital adrenal hyperplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

2 things needed for normal sexual development

A

Right hormones
Tissue responsive to hormones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

When does genetalia become distinguishable in utero

A

9 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Tx for ambiguous genitalia

A

Establish dx
Stabilize infant
Address family concerns

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

4 Ongoing medical concerns with ambiguous genitalia

A

Malignancy in gonads
Altered sex steroid exposure
Decreased bone mineral density
Psychosocial concerns

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Hydrocele

A

Extra fluid buildus in the scrotum - d/t patent processes vaginalis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Communicating v Non communicating hydrocele

A

Non-communicating - trapped fluid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Presentation of hydrocele

A

Edematous scrotum
NO PAIN, No erythema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Dx for hydrocele

A

Dx - Positive Scrotal transillumination or Scrotal US

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Tx for hydrocele

A

Surgery if not resolved by 1-2 year or symptomatic compromise of skin integrity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Inguinal hernia

A

Protrusion down the inguinal canal into the scrotum
Direct - Outside inguinal canal
Indirect - Inside Inguinal Canal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Presentation of inguinal hernia

A

Painless inguinal swelling
May retract when cold, active, agitated
No spontaneous reduction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Incarcerated hernia

A

Cannot reduce hernia
Usually firm and discrete and tender

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Strangulated hernia

A

Affects circulation - necrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Tx for inguinal hernia

A

Surgical repair - emergent if strangulated
May exlore both sides

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Testicular torsion

A

Doppler US to dx
Urgent detorsion in 4-6 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Presentation of testicular torsion

A

Pain relief not achived by testicular elevation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Manual detorsion of testicle

A

Turn laterally - temporary still ned surgery
Will have immediate pain relief

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Acute epididymitis

A

Most common in late adolescents
Caused by STI, Exertion, Trauma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

STD causes of epididymitis

A

Chlamydia - MCC
Gonorrhea
E. coli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Non-STD causes of epididymitis

A

Mycoplasma, Enteroviruses, Adenoviruses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Presentation of epidydimitis

A

Testicular pain
Red scrotum
Present cremasteric reflex and pain relief with testicular elevation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Workup for epididymitis

A

UA/Culture
Urine PCR is often best
Doppler US

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Tx for acute epididymitis

A

Rocephin and Doxy for STD
Levofloxacin for enteric
UTI - non STD - Cefdinir or bactrim

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Vulvovaginitis presentation

A

Burning, pruritis, pain, dysuria with negative urine culture
Cheese discharge in candida
Erythema of area - may not have discharge

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Risk factors for vulvovaginitis

A

Diaper/Tight pant use
Abx use
Bubble baths

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Normal vaginal pH

A

4-4.5
Elevated in bacterial vaginitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Tx for vulvovaginitis

A

Candidal - Fluconazole
BV - Flagyl or Clinda
Topical can be used

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Labial adhesion

A

Fusion of labia minora
Partial or complete
MC in first 5 years of life
My be d/t irritation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Uncomplicated labial adhesion

A

No symptoms
Not complete
May not need to treat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Complicated labial adhesion

A

Accompanying UTI, altered ambulation etc.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Tx for labial adhesion

A

Topical estrogen BID for 2 weeks - if fails surgery
Followed by lubricant for 30 days to ensure healing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Manual labial separation

A

Considered if estrogen not successful after 8 weeks
Will need lubrication for several months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Penile adhesion

A

Fusion of foreskin and corona

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Tx for penile adhesion

A

Gentle traction
Topical steroid if not effective

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Penile skin bridge

A

Adhesion glans to shaft of penis
May cause pain
Refer to urology to have fixed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

UTI MC organism

A

E. coli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Age for uncircumcised boys to have more UTIs

A

Under 3 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Presentation of UTI

A

Babies with Failure to thrive, Jaundice, Sepsis, Urgency or aneuresis
More classic presentation as age increases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

Collecting urine sample in peds

A

Can do directly if potty trained
Suprapubic aspiration
Bladder cath - recommended
Bag specimen not useful in non potty trained pt

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

Urinalysis interpretation for UTI

A

Leukocyte esterase - Sensitive but not specific
Nitrate - Specific but not sensitive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

Urine culture for UTI criteria

A

Clean voided - over 100,000 CFU of 1 pathogen
Catheter sample over 50,000 cfu of 1 pathogen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

3 UTI admission criteria

A

Admit if septic, unable to tolerate PO, dehydration,Under 2 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

Tx for UTI

A

3rd gen cephalosporine:
Cefdinir, Cefpodoxime, Rocephin, Cefotaxime
Fever should abate in 48 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

Tx for UTI with pseudomonas

A

Ciprofloxacin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

Duration of peds UTI tx

A

10 days for febrile
3-5 days for afebrile

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

Imaging for peds UTI - 3 indications

A

Renal US in first febrile UTI for baseline
US if not responding to abx
Hx of kidney disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

VCUG imaging - 2

A

Checks for vesico-ureteral reflux
Children with 2+ febrile UTIs
OR
Children of any age with first febrile UTI and temp 102.2 and non-E coli pathogen, abnormal renal US - must wait until afebrile

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

Vescicoureteral reflux dx

A

Hydronephrosis on US

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

Grades of VUR

A

1 - into ureter
2 -into kidneys
3 - dilation
4 -Blunting of calyces
5 - Tortuous and severe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

Management of grade 1-2 VUR

A

Watchful waiting with no tx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

VUR 3-5 tx

A

Treat when you see dilation of the ureter
Abx
Surgery in 4-5 and noncompliant 3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

Enuresis

A

Pee accident twice per week for 3 consecutive months in a child who is at least 5 years old

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

Monosymptomatic enuresis

A

Only at night - behavioral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

Polysymptomatic enuresis

A

Dribbling during the day as well as bed wetting - more concerning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

Cause of enuresis

A

Polyuria exceeds bladder capacity
Children holding until last minute

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

Tx for enuresis

A

Treat daytime before nightime
Treat UTIs or constipation first
Minimize evening fluids
Positive reinforcement
Bed wet alarm for 3 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

Pharm for eneuresis

A

Desmopressin - patients usually relapse after cessation though

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

Definition of child abuse

A

Failure to act resulting in serious physical harm, emotional harm, etc.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

Neglect

A

Failure to meet childs needs, etc. not due to financial limitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

Sexual abuse

A

Sexual touching, penetration however so slight

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

Medical abuse

A

Substance abuse - exposing child

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

Munchausen by proxy

A

Making child appear physically ill or impaired

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

Who is required to report child abuse

A

Anyone who suspects it
Healthcare people
Teachers
Clergy
EMS
Judges
Film/Print processors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

Failure to resport

A

Misdemenor in 40 states
Felony if child hurt/killed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

RIsk factors for child abuse

A

Young
Single
Low education
Intellectually handicapped
Unstable
Psych illness
Substance abuse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

Risk factors for child abuse victims

A

Under 3
African American/Native american
Unplanned or unwanted
ADHD
Disabled
Adopted

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

HX features or abuse

A

Not feasible for age
Delay in seeking care
Parents don’t seem to care
Increasing severity
Unrealistic expectations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

Child symptoms of abuse

A

Sad or Angry - nightmares
Relationship troubles
Acting out/Risky behavior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

Red flags of abuse

A

Cannot explain injury
Aggression towards child
Refers to child as evil/lyer
Delays/Prevents medical care
Doctor shopping

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

Normal, non-abuse areas of bruising in children

A

Knees to ankles, wrist, elbow
Over bony prominence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

Sentinal injuries for child abuse

A

Trunk, Ear, Neck in any child under 4 months
TEN-4
97% Sensitive and 84% specific for abuse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

Rib fractures and abuse

A

71% indicate abuse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

Burns of abuse

A

Cigarette burns
Water burns

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

Lab workup for potential abuse

A

PT/PTT for hemophilia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

Mongolian spots

A

Can look like bruises of abuse
Common in darker skinned patients - go away by one ish

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

Abuse radiological findings

A

Diaphyseal single fresh fracture of long bones
Corner/Bucket handle fracture
Spiral fx
Rib fx
Spinous process fx

Different stages of healing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

Things that count as sexual abuse

A

Being shown pornography
Sexual contact
Being shown or showing genitals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

Things that are diagnostic of sexual abuse

A

Gonorrhea/Syphillis - post perinatal period
Chlamydia, Trichomonas, HIV not from mother

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

Early childhood sexual abuse response

A

Within 120 hours
Emergency room and CPS
Rape kit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

Late childhood sexual abuse response

A

Over 120 hours
CPS and Abuse Clinic
Check for STDs afterwards

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

Normal vs. Abnormal hymen presentation

A

Should not be totally torn, may be perforated, etc.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
120
Q

STI prophylaxis for abuse

A

Rocephin
Flagyl
Z-max
HBV Ig
HIV prophylaxis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
121
Q

MC perpatrator of muchhausen by proxy

A

Mother

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
122
Q

True emesis

A

Yellow tinge - non-billiary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
123
Q

Billiary emesis

A

Green tinge - can mean a bowel obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
124
Q

GERD in infants

A

Babies that spit up - fed too much
Uncomfortable when eating
Prop up
SHould resolve by 12 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
125
Q

s/s of GERD in infants

A

Spitting up formula after feeds
Excess belching
Cyanosis and choking
Persistent congestion, cough, or wheezing
Arching back while feeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
126
Q

4 risk factors for pediatric GERD

A

Asthma
CF
Developmental delays
Tracheoesophageal fistula

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
127
Q

BRUE

A

Breif Resolved Unexplained Event
Baby found blue at home

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
128
Q

Dx and Tx for BRUE confirmed UGI - infants

A

Look at esophageal pH for reflux
Smaller more frequent feeds
Upright 45 minutes after feeds
THickened feeds
Eliminate milk and eggs for 2-4 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
129
Q

2 Meds for UGI BRUE

A

Famotidine
Prilosec

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
130
Q

Tx for reflux in older children

A

Avoid caffein, spicy foods, late eating
Weight loss and no milk
Famotidine or Prilosec

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
131
Q

NISSEN

A

Fundiplication for severe life threatening GERD
FTT, Esophagitis, Apneic spells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
132
Q

Presentation of gastroenteritis

A

Stomach pain
Fever
Anorexia
Cramps

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
133
Q

Common causes of gastroenteritis

A

Norovirus,Adenovirus, Enterovirus, Rotavirus
Crypto/Giardia
Campylobacter, Clostridium, Salmonella, E. coli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
134
Q

Incubation of viral gastroentritis

A

12 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
135
Q

8 Concerning features with gastroentritis

A

Blood or muscous
Weight loss
Prolonged cap refill
Abnormal vitals
Sunken fontanelle
Decreased urine
Out of country
Daycare

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
136
Q

Tx for gastroentritis

A

Fluids!!! - PO very little at a time or IV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
137
Q

Presentation of appendicitis

A

MC at 7-12
Periumbilical pain migrating to RLQ
Vomiting and anorexia follow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
138
Q

3 signs for appendicitis

A

Rovsing
Obturator
Iliopsoas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
139
Q

8 Factors in an appendicitis risk score (2 ount for 2 points)

A

2 points:
Pain with cough, percussion, or hopping
RLQ tenderness
1 Point:
Anorexia
N/V
Temp over 38 (100.5)
WBC >10K
Neutrophils >7.5K

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
140
Q

Imaging for appendicitis

A

US - 93% sensitive
CT of abdomen - usually follows US

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
141
Q

Tx for appendicitis

A

Surgical consult
1 dose cefoxitin or Cefotan prior to incision

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
142
Q

Presentation of pyloric stenosis

A

Projectile vomiting preceded with spit up
Non bilious vomiting
Very hungry
MC in boys
Under 12 weeks old often at 2-4 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
143
Q

PE for pyloric stenosis

A

Olive shaped mass in RUQ
Dehydration
FTT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
144
Q

Dx for pyloric stenosis

A

Low potassium and alkalosis
Pyloric US is most common

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
145
Q

MC time for presentation of pyloric stenosis

A

2-4 weeks
MC in boys

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
146
Q

Tx for pyloric stenosis

A

Pylormyomyotemy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
147
Q

Reye’s syndrome

A

Encephalopathy due to virus treated with aspirin as well as kidneys and liver issues
Affects children up to 18 years of age
Leads to mitochondrial dysfunction
93% caucasian

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
148
Q

Other risk factors for Reye’s syndrome

A

MCAD deficiency
Fatty acid oxidation disorders
Urea cycle disorders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
149
Q

Presentation of Reye’s syndrome

A

VOmiting and diarrhea
Lethargy
Tachypnea
Confusion, disorientation
Seizures
Paralysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
150
Q

Dx for Reye’s syndrome

A

Consider in any child with AMS and vomiting
High ammonia level
Look for inborn errors - liver bx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
151
Q

Management for Reye’s syndrome

A

Fluids, Diuretics
Vitamin K, Plasma, Platelets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
152
Q

Eosinophilic esophagitis

A

Reflus heartburn and anorexia - unresponsive to reflux drugs
Driven by an internal allergy to food - “asthma of the esophagus”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
153
Q

Presentation of eosinophilic esophagitis

A

Vomiting
Dysphagia - refusal of solid food
Abdominal pain
Heartburn/Chest pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
154
Q

Dx for eosinophilic esophagitis

A

Allergy hx - asthma, eczema
Eosinophilia may be seen on labs
EGD - abnormalities - linear furrowing
Bx with 15+ eosinophils per HPF is diagnostic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
155
Q

Tx for eosinophilic esophagitis

A

Eliminate foods positive on skin prick test
Puff and swallow IN steroids
Esophageal dilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
156
Q

Steroids for EE (2)

A

Fluticasone or Budesonide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
157
Q

Common onset of peanut allergy

A

About 12 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
158
Q

Evaluation for peanut allergy

A

Skin prick or serologic testing
If either positive no need for oral food challenge
Eliminate food

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
159
Q

Prevention for food allergy emergency

A

Educate fam and friends
Bendryl or Zertec for mild
Epi pen for severe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
160
Q

Indication for early peanut introduction

A

Severe Eczema or Egg allergy - at 4-6 months
Moderate Eczema - 6 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
161
Q

Gastric ulcers in peds

A

Pain, bleeding and vomiting
Stool for H pylori

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
162
Q

Tx for H. pylori gastric ulcers

A

Amoxicillin, Clarithromycin, Omeprazole
All for 14 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
163
Q

Technical definition of diarrhea

A

3+ loose stools

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
164
Q

Acute diarrhea

A

5-14 days
No fever or blood
Dehydration
Probiotics may help

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
165
Q

Chronic diarrhea

A

Over 1 month
Abx use
May be d/t fruit juice, milk protein allergy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
166
Q

Viral causes of diarrhea

A

Rotavirus or Norovirus can also be adenovirus or Coronavirus
3-15 months old
12 hour incubation
4-10 day duration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
167
Q

Presentation of viral diarrhea

A

Vomiting followed by diarrhea
No WBCs in stool
Supportive care and fluids - maybe bicarb

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
168
Q

Intussussception

A

Intestine telescopes inside self - emergent
6-12 months MC
MCC of intestinal onstruction in 1st two years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
169
Q

Presentation of intussusception

A

Currant jelly stool
COlicky pain - severe
Vomit
Sausage shaped mass - link

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
170
Q

Tx for Intussusception

A

Barium enema usually diagnostic and curative
Some cases need surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
171
Q

Pseudomembranous Colitis

A

1-14 days after abx therapy
Fever, abd distension, tenesmus, neutrophils and positive stool culture
Flagyl or PO Vanc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
172
Q

Toddler’s diarrhea

A

MCC of diarrhea in kids
No positive stool cultures
Juice makes it worse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
173
Q

Milk Protein allergy

A

Not IgE mediated
Bright red flecks of lood in stool
Take mom off of drinking cows milk, give baby special formula
Disappears by 8-12 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
174
Q

Celiac disease

A

Often shows up in teens
Failure to thrive
Fatty stools, diarrhea, abd distension
Gluten free diet
tTG 99% sensitive for gluten sensitivity
Endoscopy is diagnostic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
175
Q

Peds constipation criteria

A

1 month in infants toddlers
2 months in older children

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
176
Q

Definition of constipation

A

Less than 3 BMs per week
Encoperesis 1+ times per week
Impacted stool
Bulky, painful stool

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
177
Q

3 Main transitions that can present with constipation in children

A

Introduction of solid foods/cows milk
Toilet training
School entry

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
178
Q

Tx for constipation for children

A

Miralax or Lactulose
Increase fiber
Enema for severe
Bathroom training

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
179
Q

Encopresis

A

Fecal incontinence - soft poop around hard poop due to holding poo too long - rectal sphincter is chronically dilated - leaking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
180
Q

Dx and Tx for encopresis

A

Rectal exam and KUB
May take 6+ months to years for rectum to return to normal size

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
181
Q

Encopresis acute treatment

A

PEG/Miralax infants and 6+ months
Fleets enema in 2 yrs +
Ducolax suppository
GLycerin suppository for infants
Rectal stimulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
182
Q

CHronic encopresis tx

A

Timed pottying w/ reward (not as punishment
Laxatives for 6 months to a year
Rescue plan is 3+ days with no BM
Eliminating excess milk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
183
Q

Hirschprung’s disease

A

Absence of ganglion cells in mucosal and muscular layers of the colon
Presents at birth!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
184
Q

Presentation of Hirschprung’s disease

A

No meconium in first 24-48 hours
Bilious emesis
Abd distension
Reluctant to feed
Ribbon like stools that are foul smelling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
185
Q

Dx for hirschprungs disease

A

Rectum void of stool despite impaction on KUB US
Rectal bipsy is gold standard

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
186
Q

Tx for hirschprung’s disease

A

Surgical with diverting colostomy or ileostomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
187
Q

Other disorders of the anus/rectum in peds

A

Anal fissure - constipation, bright red blood
Anal stenosis/imperforate - Ribbon like stools, MC in males

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
188
Q

Dehydration in peds

A

Sunken fontanelle - very sick
Decreased turgor of skin
Thready pulse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
189
Q

Kg weight loss to fluid loss

A

2 L fluid lost for 2 kg lost

190
Q

Tx for peds dehyration

A

Oral rehydration
Pedialyte

191
Q

How much oral rehydration to give at a time

A

Mild - 50mL/kg
Moderate - 100mL/kg
May also give zophran

192
Q

IV rehydration regimen for peds

A

NS given
20mL/kg over 1 hour and repeat up to twice

193
Q

Peds hypothermia/Fever

A

Under 36.5 C
Over 38 C

194
Q

Most accurate way to check temperature

A

Rectal

195
Q

Difference between oral and rectal temp

A

0.5-1 degree F lower in oral

196
Q

Difference between oral and rectal temp

A

1-1.5 F lower than rectal

197
Q

Difference between temporal and rectal temp

A

0.5-1 degrees less than rectal

198
Q

Tympanic temp in peds

A

Not reliable under six months
Have to have proper technique

199
Q

Presentation of peds fever

A

Tachycardia before tachypnea
Glitter in eyes
Hot skin
Sweating
Sleepy

200
Q

MCC of pediatric fever

A

GI or respiratory viral infection

201
Q

When to treat a peds fever

A

Depends on child
Will take time for temp to come down

202
Q

Pharm for peds fever

A

Tylenol safe after 3 months
NSAIDs after 6 months - may use SHORT TERM (like once) under 3 months

203
Q

9 Urgent indications for evaluation of peds patient with a fever

A

Under 3 months
Over 105.8
Inconsolable
Crying when touched
Difficult arousal
Stiff neck
Petechiae
Difficulty breathing
Seizure

204
Q

5 Indications to see peds patient with fever in 24 hours

A

3-6 months unless within 48 hours of dtap
Over 104 but under 105.8
UTI
Subsides for 24 hours then returns
Loinger than 72 hours

205
Q

Risk factors for a invasive bacterial infection

A

Under 28 days
Fever over 104
Not immunized
Previous abx use
Prematurity

206
Q

Workup plan for febrile children

A

Work up ALL febrile infants
Workup selected depending on age group

207
Q

Required workup for 8-21 day old febrile infant

A

UA
Blood culture
LP
HSV swab if at risk

208
Q

Tx for 8-21 day febrile infant and what we are coving for

A

IV abx +/- acyclovir
Ampicillin and Gentamycin to cover E coli, GB Strep, and Listeria
Stop if blood cx comes back positive

209
Q

3 criteria that must be met to d/c febrile peds patient

A

Culture results are negative within 24-36 hours
Infant improving
No other reasons for hospitalization

210
Q

Required workup for 22-28 day old infants w/ fever

A

UA, Blood cx, Inflammatory marker(MUST perform LP if IMs elevated or UA abnormal)

211
Q

Diffierence in work up for 29-60 days old

A

LP not needed if there is a source of infection - blood or urine cultures come back positive
Still start with UA, IMs and Blood cx

212
Q

Minimum time for blood cultures to grow something

A

24 hours min

213
Q

Workup for fever in 61 to 90 day old infant or 3-36 months

A

Full septic workup if toxic appearing, signs of focal infection, and abnormal labs
Workup more case-by-case - no LP for recognizable condition

214
Q

WHen to do a full workup in 3-36 months

A

If they are underimmunized!!

215
Q

Age when febrile seizures are seen

A

6 months to 5 years - does not occur outside that range

216
Q

Simple febrile seizure

A

Tonic clonic
Only one
Under 15 minutes

217
Q

Important hx for febrile seizure

A

What was the temp when the seizure occured and time to onset - lower in either means higher risk of recurrence

218
Q

Workup for febrile seizures

A

LP if under 6 months
Eval for CNS infection
CBC

219
Q

Fever of unknown origin

A

Daily temp over 38.3/101 F with no source identified for 8 days
Often a dx is not established

220
Q

Focus for first 24 hours of FUO workup

A

Focus on infection

221
Q

Focus of FUO workup after 24 hours

A

Consider cancer and autoimmune causes

222
Q

Interventions of FUO

A

Only use abx if they are septic appearing
NSAIDs
Rheum/Onc referral may be considered

223
Q

Bacterial sepsis of newborn risk factors and MC 4 patogens

A

PROM, Maternal infection
Beta hemolytic strep
E coli
Literia
Staph

224
Q

Early onset sepsis

A

First seven days of life

225
Q

Presentation of early onset newborn sepsis

A

GBS presenting with pneumonia
Resp distress
Acidosis
Hypotension

226
Q

Presentation of late newborn sepsis

A

MCC - Staph aureus
Presents like meningitis
Hypotonia, decreased perfusion

227
Q

Workup for bacterial sepsis

A

CBC w/ diff
Blood culture
UA with culture
Spinal tap (excluded in partial sepsis workup)

228
Q

Tx for early onset newborn sepsis

A

Ampicillin and Gentamycin (or Cefotaxime)

229
Q

Tx for late onset newborn sepsis

A

Ampicillin, Gentamycin, Add Vanc

230
Q

Prevention of newborn sepsis

A

Treat GBS+ mothers with PCN or 2nd gen Ceph or Vanc/Clinda if allergic to both - treat 4 hours before birth

231
Q

VIral meningitis presentation

A

Acute onset
Marked fever and lethargy
Vomiting, DIarrhea
Maculopapular rash
Bulging fontanelle

232
Q

Virus to consider in WV for meningitis

A

LaCrosse encephalitis

233
Q

Dx for viral meningitis

A

Close to normal glucose and protein in CSF
PCR test is super helpful

234
Q

Management for viral meningitis

A

Control the fever to prevent seizure
Hydration - IVF
Prophylactic ABX until viral PCR returns positive

235
Q

Course of viral meningitis in peds

A

Usually lasts a week
No need for repeat LP if improvement
CT before repeat LP

236
Q

Indication for acyclovir in viral meningitis

A

Infants under 1 month - suspect HSV

237
Q

Bacterial meningitis v Viral

A

Bacterial is worse - risk of hearing loss

238
Q

Presentation of bacterial meningitis

A

Fever with neck stiffness - B&K signs
Increased protein, decreased glucose on LP
Photo/Phonophobia
Petechial rash

239
Q

Tx for bacterial meningitis

A

Vancomycin and Cefotaxime (Rocephin if IV)

240
Q

Steroids in bacterial meningitis

A

Improtant to save hearing in H flu 1 hour before other abx - give in unvaccinated infants

241
Q

Prophylaxis for neisseria meningitis

A

Anyone with direct droplet contact and same household
Rifampin

242
Q

Abx to decrease endotoxin effect when treating bacterial menigitis

A

Give clinda - be prepared for shock even if patient is stable

243
Q

MC pathogens for bacterial conjunctivitis

A

S pneumo, H flu, Mcat
Consider staph
Pseudomonas for contact wearers

244
Q

Presentation of bacterial conjunctivitis

A

Unilateral
Foreign body sensation
URI associated

245
Q

Tx for bacterial conjunctivitis

A

Fluoroquinolone eye drops or Polytrim (polymixin-trimethoprim)
Refer if not working

246
Q

Presentation viral conjunctivitis

A

Preauricular lymphadenopathy
Bilateral more often

247
Q

Keratoconjunctivitis

A

Keratitis with
Severe and bilateral
Swelling and ptosis

248
Q

Allergic conjunctivitis

A

More seasonal - MC in spring
Itchy, watery, clear drainage

249
Q

Tx for allergic conjunctivitis

A

Olopatadine eye drops BID
Systemic tx for steroids if severe

250
Q

Vernal conjunctivitis

A

Vision threatening allergic conjunctivitis - cobblestoning

251
Q

Atopic conjunctivitis

A

Associated with eczema - burning pain
TOpical/Oral histamine or steroid in severe cases

252
Q

Risk factors for acute otitis media

A

Smoke exposure
Bottle feeding
Pacifier use

253
Q

Presentation of AOM

A

4-7 days after URI
Tugging on Ear
Vomiting

254
Q

Criteria for otitis media dx

A

Acute onset of fever
Bulging TM
Opaque TM - erythema or distinct otalgia - can’t sleep

255
Q

Tx guidlines for AOM

A

Treat immediately under 6 months
6-24 - May choose to observe if mild but will eventually treat
24+ months - Treat if symptomatic

256
Q

Tx for AOM

A

PCN - First line
Cephalosporin First line in non-immunized - 3rd gen

257
Q

Drugs for AOM

A

PCN
Cefdinir
OR - Macrolide, Clinda, Bactrim

258
Q

Indication for systemic rather than topical tx for AOM

A

Perforation of Systemic symptoms
Tympanostomy tubes are OKAY for topical

259
Q

Complications of AOM

A

TYmpanosclerosis
Cholesteatoma - greasy artifact from perfed membrane

260
Q

When to refer for perfed TM

A

If not healed in 3-6 months
Most heal is 2 weeks

261
Q

f/u for AOM

A

48-72 hours if no improvement
8-12 weeks for under 2 years OR language delayed
Not needed over 2

262
Q

Indications for ear tubes

A

3+ episodes in 6 moths or 4 in a year

263
Q

Otitis media with effusion

A

No inflammation - just fluids - clear TM
Do tympanostomy if it lasts over 3 months

264
Q

Presentation of viral rhinitis

A

Sudden onset
Less than 5 days
Congestion
Fever onset after illness is concerning

265
Q

Tx for viral rhinitis

A

NSAID
Supportive - Hydration!!
Suction for infants
No cough syrup

266
Q

Herpetic gingivostomatitis presentation

A

Vesicular lesions - erythematous base
On lips, arounds the mouth, gums
Submandibular lymphadenopathy

267
Q

Management for herpetic gingivostomatitis

A

Clearing up when no new lesions are appearing
Acyclovir use is controversial
Lasts 7-14 days

268
Q

Thrush

A

Gingivostomatitis candadiasis
May be painful
Cottony feeling in mouth

269
Q

TX for thrush

A

Nystatin suspension - cotton swab if they can’t swich and spit
If no response in 3-6 days - fluconazole systemic

270
Q

Cocksacki virus presentation

A

Hand foot and mouth disease
Back of the mouth/ throat lesions (front is more likely HSV)

271
Q

Skin lesions of HFM disease

A

Not itchy
Maculopapular to ulcerative lesions

272
Q

Presentation of Srep throat over 3

A

Over 3 - Sore throat, fever, tonsylopharingitis, no cough
Pharyngeal petechiae
Strawberry tongue

273
Q

Strep throat in children under three

A

Less common
Atypical symptoms
More URI sx
Cervical adenopathy

274
Q

Whom to test for strep throat

A

Pharyngitis
Fever
HA
Cervical lymphadenopathy

275
Q

Tx for strep throat

A

PCN or Amoxil
Ceph, Clinda, Z max for resistant

276
Q

Presentation of mono

A

2-6 week incubation
Fever, sore throat and lymphadenopathy
Very painful sore throat
Palatal petechiae
Hepatosplenomegaly

277
Q

Mono reactive rash

A

Reaction to PCN or Amoxil

278
Q

Monospot restrictions

A

Never order under 5 years (order antibodies instead)

279
Q

Labs for Mono

A

Atypical lymphocytosis with elevated liver enzymes

280
Q

Tx for Mono

A

Bed rest
Supportive
Fluids
No contact sports 4-5 weeks
No antivirals

281
Q

Presentation of adenovirus

A

Every mucous membrane
Inflamed pharyngeal walls
Supportive tx

282
Q

Presentation of croup and MCC

A

Parainfluenza
Barking cough
Inspiratory stridor
Deep brassy cough
Hoarse voice

283
Q

Demographics of croup

A

3months to 3 years
MC in fall

284
Q

Dx of croup

A

Steeple sign on XR

285
Q

Tx for pertussiss

A

Erythromycin or other Macrolide

286
Q

Tx fro croup

A

Steroids - PO if possible

287
Q

MCC of bacterial pneumonia in children under 6mos

A

Chlamydia trachomatis

288
Q

MCC of bacterial pneumonia in children over

A

Strep pneumo

289
Q

Dx for pneumonia

A

Clinical - CXR for continued dyspnea

290
Q

Pneumonia admission criteria

A

Admit if - under 3 months, toxic appearing, can’t keep abx down

291
Q

Tx for pneumonia

A

Under 3 months with Amp and Gent
Z-max 1-6 months
Amoxil OR cefdinir 6 mo - 5 years

292
Q

Mycoplasma pneumonia

A

Kids over 5
Interstitial infiltration rather than consolidation

293
Q

Tx for mycoplasma

A

Z-max 1st line

294
Q

Rubeola

A

Measles

295
Q

Presentation of rubeola

A

Measles
Conjunctivitis
Koplik spot
Photophobia
Rash starting at head

296
Q

Tx for rubeola

A

Supportive

297
Q

RUbella presentation

A

Low grade fever, ocular pain, sore throat, myalgia
Postauricular, suboccipital lymphadenopathy
Rash face down

298
Q

Congenital abnormalities of rubella

A

Growth retardation
Cardiac abnormalities
Deafness

299
Q

Fifths disease

A

Erythema infectiosum, Parvo B19
Slapped cheek rash - spreads to body
Arthritis

300
Q

Roseola

A

HHV 6-7
Major casue of febrile seizure
High fever but looks fine, followed by head to toe rash
6 months to 3-4 years

301
Q

5 Rheumatic fever major manifestations

A

Carditis, Polyarthritis, Chorea, Erythema marginatum, SQ nodules

302
Q

4 Rheumatic fever minor criteria

A

Arthralgia
Prolonged PR
Fever
Elevated ESR/CRP

303
Q

Tx for RF

A

PCN G for GAS
NSAID - Naproxen for arthritis
Long acting PCN G until 21 to 28 days for recurrence prevention

304
Q

Kawasaki disease

A

Multi-system vasculitis - can lead to coronary artery aneurism

305
Q

Criteria for Kawasaki disease - 6 things

A

MUST have fever for >5 days and 4 out of 5 of:
1.Lip/Oral cavity changes
2.Non-purulent bilateral conjunctivitis
3.Unilateral cervical lymphadenopathy
4.Maculopapular exanthem
5.Redness/Swelling of hands/feet with desquamation

306
Q

Labs for Kawasaki

A

WBC>15,000
Thrombocytosis >450,000
Elevated LFT with Albumin<3
CRP> 3mg/dL
ESR>40mm/hr
Pyuria>10WBCs - bag speciment ONLY

307
Q

Diagnosing atypical/incomplete kawasaki

A

Elevated ESR and CRP with 3 other abn lab findings or +Echo
Younger less likely to have an atypical presentation

308
Q

Clinical management of suspected kawasaki not meeting classic or atypical presentation

A

Monitor serial labs if fever persists

309
Q

Tx for kawasaki disease

A

Baseline echo
IVIG infusion
High dose aspirin - send home on low dose after d/c
Steroids if both fail

310
Q

Age for circadian rhythm development

A

4 months
REM/NREM around 3 years

311
Q

MC sleep disorder under 12

A

Difficulty falling asleep

312
Q

Good sleep hygeine

A

Dark, Quiet, Cool
Fed in parents arms then put in bed
Put to bed when tired
No devices

313
Q

When should babies be able to sleep through the night

A

At 12 weeks - after they will learn to not sleep all night
May be ready for solids if waking up genuinely hungry

314
Q

Trained night awakenings

A

Slow time (1-2 minutes) to go check on baby when they cry after 4 months
Bedding with parent scent

315
Q

How long should bedtime routines be

A

30 minutes max!!
Need to set boundaries

316
Q

Tx for refusal to go to bed

A

Put to bed when tired
Don’t nap close to bedtime
Set strict routines

317
Q

Parasomnia

A

Often familial - night terrors and nightmares

318
Q

Presentation of night terrors

A

1st 3rd of night
Pallor, Sweating, Tachycardia, Children may sit up scream, etc.
May run and fight - forget in morning, unresponsive to confort

319
Q

Tx for night terrors

A

Reassure
Empty bladder before bed
95% gone by 8

320
Q

Presentation of nightmares

A

Less vivid - last third of night
Remember the dream
Comfort and reassurance
Low dose trazadone or benedryl in severe cases

321
Q

Tx for peds separation anxiety

A

Surround with familiar people - help get used to new situation
Firm goodbye

322
Q

Stranger anxiety

A

Natural phase around 9 months
Reassure that it will get better
Exposure therapy

323
Q

Treatment for childhood aggression

A

MC in boys -most grow out but MC in learning disabilities
Replace with socially acceptable response
Praise good behavior - consistent discipline
r/o abuse

324
Q

Presentation of temper tantrums

A

MC 1-4 years
Child seeking autonomy
Challenges adapting

325
Q

Tx for temper tantrums

A

6 months - need some parental time away
9-12 - Environmental safety - don’t have to say NO as much
15-18 months - Give more choices in reason, nap before frustration sets in
Time out

326
Q

Cyanotic breath holding spell

A

Child breathes in and holds breath and becomes cyanotic - may pass out or look like seizure

327
Q

Pallid breath holding spell

A

Preceded by minor injury or fear - can be seen with shots

328
Q

Management for breath holding spells

A

No established tx
Reassure parent
Don’t give in

329
Q

Toilet training at 12-18 months

A

Become aware of need to go
Associate fullness with elimination
Mimic others
Pleasure in autonomy

330
Q

Toilet training 18-24 months

A

Can briefly control sphincter
Can sit still
Picture a goal
Understand
Want to please parents

331
Q

Toilet training 24-36 months

A

Able to manage simple clothing
Maintain a routine
Imaginary play
Gender awareness

332
Q

Toilet training 3+ years

A

Gradual maturing of GI system
Ability to break focus to use the restroom
Peer pressure
Sticker cahrts

333
Q

Sequence of training for toilet

A

Urination before BM

334
Q

Methods for potty training

A

2 week immersion
Run aroundnaked
Big-boy underwear
May need a combo approach

335
Q

Tips for potty training

A

Positive rather than negative reinforcement
Patients
Different for everyone

336
Q

Thumb sucking

A

Used to self soothing
Can lead to dental malocclusion
May lead to bullying/psych issues

337
Q

Whining and need for attention

A

Actually indicates increased maturity
Avoid negative situation
Meet basic needs
Let them vent frustrations

338
Q

Children and attention

A

Need it
Negative attention is better than none at all - will misbehave for it
Ignoring bad behavior may be better

339
Q

Exploration in chilren

A

Often masturbation, 2months to 4 years
Reassure parents
Not sexual to the child
Suggest not to do in public
Compulsive may indicate deeper issue

340
Q

Head banging and rocking for peds

A

Self soothing behavior
Compensaotry for excess of stimuli in mentally impaired
Reassure parents - consult if persistant

341
Q

Retentive encopresis

A

Leakage of BM due to holding stool for so long
May cry thingking about BM
Fecal massses felt
Blood on tissue

342
Q

Tx for acute encopresis

A

Need a BM every day
Enema for 2-3 days
Miralax
Combo of both

343
Q

Tx for chronic encopresis

A

Stool softener qd for over 6 months
1-2 BM per day goal

344
Q

Non retentive encopresis

A

Behavior issue
Give incentives for using the toilet
Refer if won’t sit on toilet over 5 or if any issues past 8

345
Q

PDD

A

Pervasive developmental disorders
Intense interests
Struggle socially

346
Q

3 Categories of symptoms of PDD

A

Qualitative impairment in social interaction
Impairment in communication
Stereotyped patterns of behavior or interests

347
Q

DSM V ASD criteria

A

Deficits in all three of:
Social emotional reciprocity
Nonverbal communicative behaviors
Developing, maintaining and understanding relationships
AS WELL AS 2+ of:
Stereotyped movements/speech
Insistance on sameness
Fixated interests
Increased or decreased response to sensory input

348
Q

Levels of ASD severity

A

1 - Requires support with noticeable impairment without
2 - Requires substantial support - defecits still there
3 - Requires very substantial support - limited social interactions

349
Q

Time to report child abuse

A

48 hours

350
Q

What to do for pyloric stenosis initially before surgery

A

Check and correct electrolyte abnormalities

351
Q

Groin pull

A

Injury to the hip adductors - XR may show an evulsion fracture

352
Q

3 types of knee pain

A

Acute, Chronic, or Popping

353
Q

MC knee fracture in peds

A

Tibial spine or osteochondral

354
Q

Ballotment test

A

Knee straight, pressure applied to top of patella - spongy suggests effusion

355
Q

Patellar apprehension test

A

Knee bent, pressure applied to the patella on the side -apprehension indicates may dislocate

356
Q

Presentation of tibial spine fracture

A

Hyperextension if the knee with rotation of femur
Hemarthrosis and joint pain, decreased ROM
Radiographs to dx

357
Q

Osteochondral fracture

A

Fractures to the intra-articular portions of the femoral condyles, tibial plateau, etc. - frequently with meniscal or ligament injuries

358
Q

Potential complication of osteo chondral fractures

A

May have fragments of bone/cartilage resulting in clocking or popping
Refer to ortho

359
Q

Patellar sleeve avulsion fracture

A

Sudden foreceful contraction of the quadriceps -ir. lands on feet after jumping
Hemarthrosis and patellar tenderness, high kneecap
Refer to ortho for MRI

360
Q

Chrinic knee pain in kids

A

Consider osteonecrosis desicans

361
Q

Osteochondritis dessicans

A

Osteonecrosis of sub-chondral bone due to overuse
Starts with foacal areas

362
Q

Dx and management for osteochondritis dessicans

A

XR or MRI
Immobilization for 3-6 months -surgery not needed

363
Q

Tx for popping/meniscal tear in peds

A

Bracing and PT may need an MRI or ortho referral

364
Q

Tx for ankle sprain

A

Brace
Support NSAIDs
Controlled ROM

365
Q

Grades of ligament sprains

A

Grade I - Strain/small tears
Grade II - Incomplete tear
Grade III - Complete tear

366
Q

Transient synovitis

A

Limp after a fever - kid has healed and feels better - non emergent
Tylenol, rest to tx

367
Q

Kosher criteria

A

Differentiates septic arthritis from transient synovitis

368
Q

Aspects of the Kosher criteria

A

Fever over 101.3
ESR>40
WBC>12
No weiht bearing

369
Q

Interpretation of Kosher criteria

A

1 - 3% chance of septic arthritis
2 - 40% chance
3-4 - Almost definite

370
Q

Dx for septic hip

A

Recent infection? surgery?
AP pelvis with frog leg views - shows bone marrow destruction
Labs

371
Q

Tx for septic hip

A

I&D if needed
Abx for Staph aureus

372
Q

Metatarsus adductus

A

Foot in a C shape curving medially

373
Q

Tx for metatarsus adductus

A

Passive ROM with massage - special shoes not needed
Cast for extremely severe

374
Q

Risk factors for metatarsus adductus

A

Breach birth
Twins
Low amniotic fluid

375
Q

Course of metatarsus adductus

A

Majority resolve by 1st bday

376
Q

Club feet

A

Sole of the foot faces the other foot - internal rotation at the ankle
MC in boys
Smoking may be a RF

377
Q

3 features of club feet

A

Plantar flexion
Inversion of heel
Medial deviation of the forefoot

378
Q

Tx for club feet

A

Ponseti method - serial casting to get more and more aligned
Achilles tendon release if needed for walking a 1

379
Q

Genu varus

A

Air between knees -bow legged

380
Q

Genu valgum

A

Knocked kneed - gum sticking together

381
Q

Tibial torsion

A

Internal or external
Bowing of lower leg

382
Q

MCC of in-toeing in Under 1 and 1-3 years

A

Under 1 - Metatarsus adductus
1-3 - Tibial torsion

383
Q

Tx for internal tibial torsion

A

Usually resolves by 5 - refer if it does not or it extremely severe
Not corrected by orthotics

384
Q

Femoral anteversion

A

Hips are rotated in MCC of intoeing after 3 years old
Sit in a W position
Refer of persists past 11

385
Q

Presentation of developmental dysplasia of the hip

A

Unequal fat fold in legs
Hip clicks - may be normal
Difficulty diapering
Limp/Swayback
Trendelenburg

386
Q

Barlow

A

Push hips down (posterior) try to dislocate - adduct

387
Q

Ortelani

A

Pull hips up and abduct to relocate hip joint

388
Q

Subluxated

A

Joint is loose but wont dislocate

389
Q

Dx for Developmental Dysplasia of hip

A

US - Standard for dx for UNDER 6 months
After 6 months - AP, Bilateral hip XR and frog legs XR

390
Q

Tx for DDH

A

Pavick harness before 6 months
6-18 months - Closed reduction and Spica casting
18months to 6 months closed reduction

391
Q

Osgood schlatter disease

A

Inflammation of patellar tendon
Growth spurts of puberty
Pain and tenderness at tibial tubercle
Overuse injury - relieved by rest

392
Q

Tx for Osgood schlatter disease

A

IC, NSAIDs, Stretching
Exercise avoidance NOT recommended

393
Q

Patellofemoral syndrome

A

Runners knee
MC chronic knee pain in athletes

394
Q

Presentation of patellofemoral syndrome

A

Abnormal patellar tracking
Knock kneed and flat feet
Worse with activity and prolonged sitting
Inner and front knee pain

395
Q

Dx and tx for patellofemoral syndrome

A

Ice, NSAIDS, d/c activity
musctle strengthening
Usually clinical - Sunrise view on XR may be used

396
Q

Slipped Capital Femoral Epiphysis

A

Chubby male adolescents
Ball of the upper end of the femur slips off in a backwards direction

397
Q

Presentation of SCFE

A

Months of intermittent hip or knee pain - chronic after 3 weeks
Cannot walk = unstable
Can walk with help = Stable

398
Q

Dx for SCFE

A

AP, PA and Frog leg XR of the hips

399
Q

Management and classification of SCFE

A

Internal fixation with single cannulated screw
Crutches post op
Mild (1) - under 33% disp
Medium (2) - 33-50% displaced
Severe (3) - Over 50% displaced

400
Q

Complication of SCFE

A

Avascular necrosis

401
Q

Legg-Calve-Perthes Disease

A

Bone supply is temporarily disrupted leading to avascular necrosis/breaking
School age children

402
Q

Presentation of LCPD

A

Pain, stiffness and limited ROM
Takes 1-2 months to show on XR

403
Q

TX for LCPD

A

Minimize joint impact
PT
Avoid weight bearing
Surgery is controversial
Ice and pain management

404
Q

Scoliosis

A

S shaped curve - MC
MC in girls

405
Q

Screening for scoliosis

A

At 8-9 years
Adams forward bend

406
Q

Tx for scoliosis

A

Observation only for curve under 20 degrees
Over 20 or rapid progression (over 5 degrees), Refer for bracing or surgery

407
Q

Cobbs angle

A

Used to measure scoliosis curvature

408
Q

Toddler’s fracture

A

Distal half of tibia - spiral
Can’t bear weight
Screen for abuse

409
Q

Osteogenesis imperfecta

A

Many fractures at a young age - with blue sclera
Often a family hx
Hearing loss
Genetic

410
Q

Achondroplasia

A

Autosomal dom
Hips to pelvis are normal, limbs are short

411
Q

Craniosynostosis

A

Premature fusion of the sutures - leading to assymetrical head
Plagiocephaly d/t how baby is laid - tummy time

412
Q

Hypophosphatemic rickets

A

X linked
Impaired growth
Deaf
Calcified tendons
HCTZ and Growth hormone to tx

413
Q

Nursemaids elbow

A

Subluxation of the radial head - due to a tug or pull injury
Holds arm fully pronated and won’t use

414
Q

Reduction of nursemaids elbow

A

Supinate and and flex elbow to reduce

415
Q

MC malignancy in children

A

ALL

416
Q

Dx of ALL

A

Blasts on peripheral smear
Decrease in one cell type on CBC
25+% blasts on bone marrow aspirate - Diagnostic!!

417
Q

Presentation of ALL

A

Bone pain
White from anemia
Petechiae and easy bruising
Hepatosplenomegaly
Fatigue
Diffuse lymphadenopathy

418
Q

CXR for ALL

A

May show mediastinal masses from hilar adenopathy

419
Q

Translocation of ALL

A

Chromosomes 12 and 21

420
Q

Treatment for ALL Phase 1

A

Remission induction Chemo (vincristine, asparaginase) with intrathecal MTX

421
Q

Treatment of ALL phase II

A

Intrathecal chemo and radiation - very intense

422
Q

Treatment of ALL phase III

A

Daily oral chemo, weekly MTX, pulses of IV chemo and oral steroids

423
Q

RF for ALL

A

Down syndrome
Pre/Post natal XR exposure

424
Q

Prognosis for ALL

A

90% cure rate

425
Q

AML

A

2nd most common cancer in children
More aggressive with worse prognosis
Granulocyte precursor disease

426
Q

Presentation of AML

A

Fatigue
Bleeding
Infection
Nontender, hard lymph nodes
Hepatosplenomegaly

427
Q

Dx for AML

A

Low neutrophils
30% or more blasts on smear
Auer rods - only in AML NOT ALL

428
Q

TX for AML

A

Chemo, potential radiation
Bone marrow transplant or cord blood

429
Q

Phase 1 AML tx

A

Remission induction:
1 month, kill as many leukemic cells as possible

430
Q

Phase 2 AML tx

A

Consolidation Preventative therapy
Stop spdread to brain and spinal cord
Intrathecal chemo and maybe radiation

431
Q

Phase 3 AML tx

A

Intensification
1-2 tx lasting two months at a time for 9months total

432
Q

Risk factors for AML

A

Ionizing radiation therapy
Previous chemo
Neurofibromatosis and Down
35-50% long term survival

433
Q

Hodgkins lymphoma

A

Middle and HS kids (as opposed to AML/ALL which is younger)
Exposure to infections decreases risk

434
Q

Presentation of hodgkins lymphoma

A

Painless cervical lymphadenopathy
Mediastinal mass
Fatigue, Anorexia, Weight loss, Night sweats - B symptoms

435
Q

B symptoms for Hodgkins lymphoma

A

Temp over 38
Weight loss 10%+
Drenching night sweats

436
Q

Dx for hodgkins lymphoma

A

Normal CBC
Increased EBV titers
Bx of node to diagnose - reed sternberg cells
May also do a bone marrow biopsy to determine extent

437
Q

Indications to biopsy to look for hodgkin lymphoma

A

Lack of infectious cause
Lymph node over 2 cm
Supraclavicular nodule
Abnormal CXR
Increasing node after 2 weeks abx or failing to decrease in 4-6 weeks

438
Q

Tx for hodgkin lymphoma

A

Chemo - prognosis tied to B symptoms

439
Q

Non-hodgkin lymphoma

A

3rd MC cancer in children
Arises from lympoid cells
MC in males and whites

440
Q

Presentation of non-hodgkin lymphoma

A

Cough, dyspnea, orthopnea, facial edema, abd pain/distension
MC mass in abdomen
2nd Mass in chest

441
Q

MC type of NHL

A

Burkitt

442
Q

Presentation of Burkitt lymphoma

A

Boys 5-10 years - B cells and belly
Intra-abdominal tumor MC
Chromosome 8 abnormality
Can have a bowel blockage

443
Q

Lymphoblastic lymphoma

A

T cells in the thorax
Indistinguishable from ALL except under 25% blasts on biopsy
Type of NHL

444
Q

Large cell lymphoma

A

Least common type of NHL
Under 15% of cases
Abdominal tumor most common
B and T cells

445
Q

Dx for NHL

A

Biopsy
LDH can tell us if active tissue breakdown
CT, CXR, US/Echo incase heart impingement from tumor

446
Q

RF for NHL

A

Radiation exposure
Organ transplant
EBV
HIV

447
Q

Tx and prognosis for NHL

A

Chemo sometimes radiation
5 year survival - those who live after 5 years and are symptoms free are likely cured

448
Q

Triad of brain and spinal tumors in peds

A

Morning HA
Vomiting
Papilledema -vision changes

449
Q

Triad of brain and spinal tumors in YOUNG peds

A

Irritability
FTT
Dev delay

450
Q

Dx for brain tumor in child

A

CT not as diagnostic - want an MRI if possible

451
Q

Location of peds brain tumors

A

50% above tenorium, 50% below

452
Q

Astrocytoma

A

MC brain tumor in kids

453
Q

Tx for astrocytoma

A

Chemo - relatively high survival rate

454
Q

Brain stem glioma

A

Middle of the brainstem
Challenging to treat - most no removal
Only school age children

455
Q

Ependymoma

A

Tumor of ventricle lining of brain
Blocks CSF flow
5 year old peak
Common in neurofibromatosis

456
Q

Medulloblastoma

A

Most common MALIGNANT tumor
In the cerebellum
Mets to the spinal cord

457
Q

Neuroblastoma

A

Tumor of nerve tissue
Extermely malignant
Primarily in adrenal gland
MC in boys

458
Q

Presentation of neuroblastoma

A

Stomach ache
COnstitutional symptoms
Abdominal mass - fills the whole belly
Usually very little

459
Q

Markers and dx for a neuroblastoma

A

VMA and HVA
CT is definitive dx
Biopsy and bone marrow to eval extent

460
Q

Tx and prognosis for neuroblastoma

A

Surgical removal, chemo, radiation
Better prognosis under 1

461
Q

Nephroblastoma

A

Wilms tumor
Bilateral or unilateral
Asymptomatic mass DOES NOT cross the midline
Hematuria
Abd distension

462
Q

Tx for nephroblastoma

A

Nephrectomy, Chemo, Radiation
Lungs MC site of mets

463
Q

Osteosarcoma v. Ewing sarcoma

A

Osteo in metaphysis
Ewing - Diaphysis

464
Q

Presentation of osteosarcoma

A

Bone pain - wake at night
Often in growing children
Taller than peers
Lump on bones
Limp

465
Q

Tx for osteosarcoma and RF’s

A

CHemo, try to save limb
Many will already have mets
Taller males have greater risk

466
Q

Periosteal reaction

A

In bone cancer
Suburst of Codman’s triangle

467
Q

Presentation of ewing sarcoma

A

2nd most common after osteosarcoma
Swollen and tender to touch
Worse with exercise
In the diaphysis

468
Q

Tx for Ewing sarcoma

A

Chemo followed by surgery

469
Q

Retinoblastoma

A

Genetic defect in chromosome 13
One eye is white on picture

470
Q

Presentation of retinoblastoma

A

Leukoria - whit rather than red reflex

471
Q

Dx for retinoblastima

A

CT followed by MRI

472
Q

Tx for retinoblastoma

A

External beam radtiation and removal of eye

Pediatrics (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions