Pediatrics Kaplan USMLE Flashcards
Time in APGAR that gives an idea what was going on during labor
1 min
Time in APGAR that gives an idea of response to therapy (resuscitation)
5 mins
Cervical level affected in Erb Duchenne and the movement affected
C5-C6
Abduct shoulder, externally rotate and supinate forearm
Brachial palsy that affects the C7-C8 +- T1 and may give rise to Horner syndrome
Klumpke
Injury to what nerve is the entire side of face with forehead affected due to forceps delivery or in utero pressure
Facial nerve injury
Injury during delivery that is characterized by diffuse edematous swelling of soft tissue of scalp and CROSSES suture line
Caput succedaneum
Injury during delivery that is characterized by subperiosteal hemorrhage and does NOT CROSS the midline
Cephalhematoma
PE finding in NB characterized by lacy reticular vascular pattern over most of body when baby is cooled
Curis marmorata
PE finding in NB characterized by firm white papules with inclusion cyst on palatenmidline; epstein pearls
Milia
PE finding in NB characterized by palenpink vascular macules found in nuchal area, glabella, eyelids and usually disappears
Salmon patch (nevus simplex)
PE finding in NB characterized by blue to slate gray macules seen on presacral, back, posterior thighs; arrested melanocytes
Mongolian spots
Ddx of mongolian spot
Child abuse
PE finding in NB characterized by firm yellow whitebpapules/pustules with erythematous base; peaks on second day of life and contains eosinophils and is benign
Erythema toxicum neonatorum
Superficial hemangioma mostly appear at what age and involutes at what age
1st 2 months
5-9 y/o
PE finding in NB characterized by erythematous papules on face and associated with high maternal androgen
Neonatal acne
PE finding in NB characterized by cleft at six o’clock position; kst with other eye abnormalies; CHARGE association
Coloboma iris
PE finding in NB characterized by hypolasia of iris; defect may go through to retina; association with Wilms tumor
Aniridia
Enzyme deficiency of Classic Galactosemia
Gal-1-P uridylyltransferase
Classic manifestations of classic galactosemia
Jaundice (often direct), hypoglycemia, cataracts, MR
Infection associated with Classic Galactosemia
E.coli
Most common presentation of PKU
MR
Likely associations of PKU
Fair hair, fair skin, blue eyes
T/F PKU normal at birth
T
Type of IUGR whose etiologies are genetic syndromes, chromosomal abnormalities, congenital infections, teratogens, toxins
Symmetric
Type of IUGR whose etiologies are uteroplacental insufficiency secondary to maternal diseases and/or placental dysfunction
Asymmetric
Weight of LBW
<2,500gms
Weight of LGA
> 4,500gms
Major fetal growth hormone
Insulin
Maternal hyperglycemia is associated with
Fetal hyperinsulinemia
Major metabolic effect is at birth with placental separation
Hypoglycemia
Metabolic abnormalities with infants of diabetic mothers
Hypoglycemia, hypocalcemia, hypomagnesemia
Common findings in infants of diabetic mothers
Birth trauma, tachypnea, cardiomegaly, polycythemia, renal vein thrombosis, increased congenital anomalies (cardiac, small left colon syndrome, caudal regression syndrome)
Specific cardiomegaly finding in infants of diabetic mothers
Asymmetric septal hypertrophy
Cardiac anomalies in infant of diabetic mother
VSD, ASD, transposition
Pulmonary finding for RDS
Decreased FRC and atelectasis
Primary initial pulmonary hallmark in RDS
Hypoxemia
Radiologic findings of RDS
Ground glass appearance, atelectasis and air bronchograms
Most accurate dx test in RDS done on amniotic fluid prior to birth
L/S ratio
Best initial treatment in RDS
Oxygen
Most effective treatment in RDS
Intubation and exogenous surfactant administration
Disease of the NB characterised by slow absorption of fetal lung tissue leading to decreased pulmonary compliance and tidal volume with increased dead space
TTN
Condition common in term infant delivered by CS or rapid stage of labor
TTN
Radiologic finding of TTN
Air trapping, fluid in fissures, perihilar streaking
Radiologic findings of meconium aspiration
Patchy infiltrates, increased AP diameter, flattening of diaphragm
Prevention of Meconium aspiration
Endotracheal intubation and airway suction of depressed infants with thick meconium
Treatment of Meconium aspiration
Positive pressure ventilation
NB born with respiratory distress and scaphoid abdomen
Diaphragmatic hernia
Best test to diagnose diaphragmatic hernia
Postnatal xray
Greatest risk factor to develop Necrotizing Enterocolitis
Prematurity
NEC symptoms usually related to _______
Introduction of foods
Pathognomonic radiologic finding of NEC
Pneumatosis intestinalis
Condition wherein there is deposition of unconjugated bilirubin in the basal ganglia and brainstem ganglia
Kernicterus
Features of kernicterus
Hypotonia Seizures Opisthotonus Delayed motor skills Choreathetosis Sensorineural hearing loss
Physiologic jaundice Appears \_\_to\_\_\_ DOL (term) Disappears by \_\_\_\_DOL (term) to \_\_\_\_DOL Peaks at \_\_\_\_to \_\_\_\_\_DOL Peak bilirubin
2nd to 3rd 5th to 7th 2nd to 3rd 13 5
Breast feeding jaundice appears how days of life?
First
Breast milk jaundice appears in what week of life?
2nd week
Main problem in breast milk jaundice
Glucoronidase
Syndrome that occurs with direct hyperbilirubenemia manifested by dark and grayish-brown discoloration of the skin (photo-induced change in porphyrins which is present in cholestatic jaundice)
Bronze baby syndrome
Treatment in hyperbilirubenemia wherein bilirubin continues to rise despite intensive phototherapy and/or kernicterus
Double volume exchange transfusion
Familial nonhemolytic hyperbilirubinemia is also known as
Crigler-Najjar syndrome
Type I familial nonhemolytic hyperbilirubinemia
Absence of glucoronyl transferase
Type II familial nonhemolytic hyperbilirubinemia
Small amount of inducible glucoronyl transferase
Most common organisms causing neonatal sepsis
Group B streptococcus, e.coli and listeria monocytogenes
Treatment in neonatal sepsis when there is no evidence of meningitis
Ampicillin and aminoglycoside until 48-72hour cultures are negatively
Treatment in neonatal sepsis when there is evidence of meningitis
Ampicillin and third generation cephalosporin (not ceftriaxone)
TORCH infection
Toxoplasmosis Other (syphilis, varicella, HIV and parvovirus B19) Rubella Cytomegalovirus Herpes
TORCH infection that came from ingestion of water or food with oocytes that have been excreted by infected cats
Toxoplasmosis
Common findings in Toxoplasmosis
Chorioretinitis, hydrocephalus, intracranial calcifications
Common outcome in patients with Toxoplasmosis
Visual impairments
Treatment in infants for Toxoplasmosis
Pyrimethamine, sulfadiazide, leucovorin
Congenital cataract is a classic finding when this TORCH infection occurs in first 8weeks of gestation
Congenital rubella
Findings for congenital rubella
Blueberry muffin spots (extramedullary hematopoiesis)
Cardiac such as PDA and pulmonary artery stenosis
Cataracts
Congenital hearing loss
TORCH infection causing periventicular calcifications, IUGR and microcephaly
CMV
Outcomes of CMV
Sensorineural hearing loss
MR
Best treatment for Herpes simplex
IV acyclovir
When does skin problems manifested in herpes simplex during the NB period?
5-14 days
When does CNS problems manifested in herpes simplex during the NB period?
3-4 weeks
When does disseminated problems manifested in herpes simplex during the NB period?
5-7 days
Best dx modality in Herpes Simplex infection
PCR
Prevention of outcomes in Herpes simplex in the delivery
Elective CS when active disease or visible lesions are identified; however not 100% effective
Early findings of congenital syphilis (birth-2 y/o)
Snuffles, maculopapular rash (palms of soles, desquamates), jaundice, periostitis, osteochondritia, chorioretinitis, congenital nephrosis
Late findings of congenital syphilis (>2 y/o)
Hutchinson teeth, clutton joints, saber shins, saddle nose, osteochondritis, rhagades (thickening and fissures of corners of mouth)
Neonatal varicella is observed when delivery occurs ______week before/after maternal infection
<1 week
Outcomes of congenital varicella
Limb malformations and deformations, cutaneous scars, microcephaly, chorioretinitis, cataracts, cortical atrophy
Most likely presentation of toxoplasmosis
Hydrocephalus with generalized calcifications and chorioretinitis
Most likely presentations of congenital rubella
Cataracts. Deafness and heart defects
Most likely presentation of Congenital CMV
Microcephaly with periventricular calcifications
Most likely presentation of syphilis
Snuffles (mucopurulent rhinits)
Maternal major illicit drug use that increases risk of SIDS and stillborns
Opiates
Maternal major illicit drug use that has high degree of polysubstance abuse
Cocaine
Maternal major illicit drug use that causes CNS ischemia and hemorrhagic lesions
Cocaine
Most common pattern of human malformation
Trisomy 21
Speckling of iris is also known as _____which is also seen in Trisomy 21
Brushfield spots
Findings of Down Syndrome
Upward slanting palpebral fissures Speckling of iris (Brushfield spots) Inner epicanthal folds Hypotonia Hearing loss Cardiac anomalies Gastrointestinal anomalies Atlanti-axial instability Hypothyroidism ALL MR
Most common cardiac anomaly in Trisomy 21
Endocardial cushion defect > VSD > PDA, ASD also MVP
Most common GI anomalies in Trisomy 21
Duodenal atresia, Hirschprung disease
Early onset of this disease is seen in Trisomy 21
Alzheimer disease
2nd most common pattern of malformation
Trisomy 18
Findings of Trisomy 18 or Edward Syndrome
MR
Low set, malformed ears, microcephaly, micrognathia, prominent occiput
Clenched hand - index over third, fifth over fourth
Rocker-bottom feet, hammer toe
Omphalocele
Trisomy 13 is also known as ______
Patau syndrome
Defect of midface, eye and forevrain development leading to single defect in 1st 3 weeks development of prechondral mesoderm
Trisomy 13 (Patau Syndrome)
Findings in Patau Syndrome
Holiprosencephaly and other CNS defects Severe MR Microcephaly; microphthalmia Severe cleft lip, palate or both Postaxial polydactyly
Single umbilical artery
WAGR syndrome is also known as __________
Aniridia-Wilms Tumor Association
WAGR is defined as deletion kn what gene
11p13
T/F: highest risk of aniridia compared to wilms
False
Highest in wilms compared to independent aniridia or GU defect
Most common findings of Klinefelter syndrome (XXY)
MR (average IQ 85-90)
Behavioral problems
Long limbs (decreased upper:lower segment ratio); arm span>height
Hypogonadism and hypogenitalism
Turner syndrome is also known as _______
XO
Findings of Turner syndrome (XO)
Congenital lymphedema, residual puffiness over dorsum of fingers and toes
Broad chest, wide spaced nipples
Low posterior hairline; webbed posterior neck
Cubitus valfus and other joint problema
Horseshoe kidney and other renal defects
Cardiac: bicuspid aortic valve and coarctation
Number 1 cardiac anomaly in Turner syndrome
Bicuspid aortic valve
Treatment for Turner syndrome
Estrogen
GH: may increase height by 3-4cm
Molecular diagnosis of Fragile X syndrome
Variable number of repeat CGG
Most common cause of inherited MR
Fragile X syndrome
Findings of Fragile X syndrome
Mild to profound MR; learning problems
Large ears, dysmorphoc facial features, large jaw, long face
Macroorchidism
Genetic cause of Beckwith-Wiedemann syndrome
IGF-2 disrupted at 11p15.5 (imprinted segment)
Findings of Beckwith-Wiedmann syndrome
Macrosomia Macroglossia Pancreatic beta cell hyperplasia leading to hypoglycemia Omphalocele Hemihypertrophy
Hemihypertrophy in Beckwith-Wiedemann syndrome is attributed to what condition
Wilms tumor
Management of Beckwith-Wiedemann Syndrome
UTZ and serum AFP every 6 months through 6 years of age to look for Wilms and hepatoblastoma
Chromosome responsible for Prader-Willi syndrome
Paternal chromosome
Genetic defect seen in Prader-Willi syndrome
Deletion at 15q11-q13-imprinted segment
Findings of Prader Willi
Obesity
Mild to severe MR
Binge eating
Small hands and feet, puffy; small genitalia
Hypothalamic-pituitary dysfunction hypogonatropic-hypogonadism
Angelmann syndrome is also known as
Happy puppet syndrome
Genetic defect of Angelmann syndrome
Deletion of 15q11q13 but MATERNALLY DERIVED (imprinted segment)
Findings of Angelmann Syndrome
Severe MR
Paroxysms of inappropriate laughter
Absent speech or <6 words; most can communicate with sign language
Ataxia and jerky arm movements resembling a puppet’s movement
Facial feature defect characterized as mandibular hypoplasia in utero
Robin sequence (Pierre Robin)
Findings of Pierre Robin
Micrognathia
Retroglossia
Cleft soft palate and other abnormalities
Jaw growth over first years of life
Autosomal dominant Osteochondrodysplasia with mutations in gene for FGFR3
Achondroplasia/Hypochondroplasia
Findings of Achondroplasia
Short stature
Proximal femur shortening
Megalocephaly, small foramen magnum, small cranial base, prominent forehead
Lumbar lordosis
Natural history of Achondroplasia
Normal intelligenxe
Tendency of late childhood obesity
Small eustachian tube
CTD Autosomal dominant with wide variability; mutations in fibrillin gene (FBN1)
Marfan syndrome
Findings of Marfan Syndrome
Tall stature with long, slim limbs and little fat
Arachnodactyly
Joint laxitt with kyphoscolios
Lens subluxafion (upward)
Ascending aortic dilatation with or without dissecting aneurysm
Most common cardiac problem in Marfan Syndrome
Ascending aortic dilatation with or without dissecting aneurysm
Lens subluxation in Marfan is directed upward as a defect in what ligament?
Suspensory ligament
Chief cause of death of Marfan syndrome
Vascular complications
Most common type of Ehler Danlos syndrome
Type 1
CTD characterized by droopy ears, hyperextensible skin, fragile, easy bruisability, poor wound healing, joint hyperlaxity, blue sclera, ectopia lentis
Ehlers-Danlos syndrome
Most common cardic problem in Ehler Danlos syndrome
Aortic root dilatation
Most common teratogwn to which fetus can be exposed
Alcohol
Findings of Fetal Alcohol Syndrome
Pre- (symmetric IUGR) and postnatal growth deficiency (short stature)
MR, microcephaly
Hyperactivity in childhood
Behavioral abnormalities
Mid-face dysmorphism (abnormal frontal lobe development)
Joint annormalities
Cardiac anomalies
Most common cardiac anomaly in fetal alcohol syndrome
VSD>ASD
Condition with similar features (FAS) with prenatal exposure to carbamazepine, valproate, primidone, and phenobarbital
Fetal hydantoin syndrome
Unique findings in fetal hydantoin syndrome
Hirsutism
Cupid’s bow lips
Fetal valproate syndrome is characterized by:
Midfave hypoplasia
Cardiac decects
Meningomyelocele
Findings of retinoic acid embryopathy
Bilateral microtia/anotia; facial nerve paralysis ipsilateral to ear
Conotruncal malformations
CNs malformations
Decreased intelligence
How many days is isotretinoin stopped so that no problems will be observed natally?
Before 15th postmenstrual day
Etiology of Potter Sequence
Renal agenesis/dysnesis
Findings in Potter Sequence
Pulmonary hypoplasia
Potter facies
What is potter facies?
Hypertelorism, epicanthal folds, low set flattened ears, micrognathia, compressed flat nose
Cause of mortality in potter sequence?
Respiratory insufficiency (hypoplasia)
Most common Coloboma?
Retinal
Infant doubles BW by ____mos, triple by ______year
6 months
1 year
At what age does myelination is completed?
7 y/o
Boys’ highest growth stopsnat what age?
18 years old
Girls’ average height peak at what age?
11.5 years
Girls’ height stops at what age?
16 y/o
How many percentage does a NB loses in the first week of life?
10%
Best tool to determine patterns of growth
Growth chart
How to get the bone age?
Xray of left hand and wrist (non-dominant)
If BA < CA
Constitutional delay
Chronic illness, nutritional deficiencies, endocrine disorders
If BA=CA
Normal growth velocity
Abnormal growth velocity
Familial short stature
Genetic syndromes associated with short stature
If BA>CA
Normal growth velocity
Abnormal growth velocity
Familial tall stature, obesity
Genetic syndromes, endocrine disorders, CNS lesions
T/F: height percentile at 2 years correlates with final adult height percentile
True
Single best growth curve indicator for acute malnutrition
Weight/height <5th percentile
Accepted as best clinical indicator for measure of under and overweight
BMI
Skeletal maturity is linked more to _________than ___________
Sexual maturity
Chronilogic age
How many months does a normal NB has sufficient stores of iron to meet requirements?
4-6 months
What particular protein does human milk have?
Whey dominant
What particular protein does cow milk have?
Casein dominant
When to introduce iron-fortified cereal?
4-6 months
Staple product of given in the first year of life will develop infant botulism
Honey
When to introduce table foods?
9-12 months
What do you call when the child is short prior to onset of delayed adolescent growth spurt; parents are of normal height; normal final adult height is reached; growth spurt and puberty are delayed; bone age delayed compared to chronological age?
Constitutional growth delay
What is familial short stature?
Patient is parallel to growth curve; strong family history of short stature; chronological age equals bone age
What is pathologic short stature?
Patient may start out in normal range but then starts crossing growth percentiles
Most common reason in all age group for non-organic failure to thrive
Psychosocial deprivation
What is diagnostic of obesity?
BMI > 95% for age and sex
It is defined as performance significantly below average
Developmental delay
How is MR characterized?
IQ 70-75 plus related limitation in at least 2 adaptive skills
Tool used for screening the apparently normal child between ages 0-6 years old
Denver II Developmental Assessment
What are the areas Denver II developmental assessment screen?
Gross motor, fine motor, language, personal-social
For infants born <38 weeks AOG, correct age for prematurity up to what age
2 y/o
How many delays are needed to tell if there is failure in the development?
2 delays
Parachute reflex appears at what age?
6-8 months
Disappearance age of parachute reflex?
Never
Asymmetric tonic neck appears at what age?
Birth to 1 month
Trunk incurvation disappears at what age?
6-9 months
Root reflex originates from what part of the CNS?
Brainstem
Trigeminal system
Placing reflex originated from what part of the CNS?
Cerebral cortex
Trunk incurvation originates from what part of the CNS?
Spinal cord
When does the baby coos?
4 months
When does the baby babbles?
6 months
When does the baby recognises the parent?
2 months
When does the baby uses the words mama and dada indiscriminately?
9 months
When does the baby sits alone?
6 months
When does the baby develop the raking grasp?
6 months
When does the baby starts to site without support?
7 months
When does the baby develop immature pincer grasp?
9 months
When does the baby develop mature pincer grasp?
12 months
When does the baby develop object permanence?
12 months
When does the baby develop 1-2 words other than mama and dada?
12 months
When does the baby cooperates with dressing?
12 months
When does the baby scribbles and builds towers of 2 blocks in imitation?
15 months
When does the baby develop 4-6 words?
15 months
When does the baby follows 1 step command with gestures?
15 months
When does the baby uses cup and spoon?
15 months
When does the baby scribbles spontaneously?
18 months
When does the baby build tower of 3 blocks?
18 months
When does the baby know 15-25 words and knows 5 body parts?
18 months
When does the baby starts parallel play?
24 months
When does the baby build tower of 7 blocks?
24 months
When does the baby develops 50words, 2 word sentences?
24 months
When does the baby follows 2 step command?
24 months
When does the child uses pronouns inappropriately?
24 months
When does the child pedals a tricycle?
3 y/o
When does the child copies a circle?
3 y/o
When does the child develops >250 words?
3 y/o
When does the child develop 3 word sentences?
3 y/o
When does the child starts group play?
3 y/o
When does the child hops and skips?
4 y/o
When does the child plays cooperatively?
4 y/o
When does the child tell tall tales?
4 y/o
When does the child copies a triangle?
5 y/o
When does the child copies a square?
4 y/o
Square has 4 sides
When does the child answers all “wh” questions?
5 y/o
What is the first problem you should consider if there is language delay?
Conductive hearing loss
ASD must occur at the age
3 y/o
Formula of developmental quotient
Developmental age/chronological age x 100
Repeated or chronic ingestion of non-nutritive substances?
Pica
Main predisposing factor of pica
MR and lack of parenting nurturing
Pica increased risk for:
Lead poisoning, Fe deficiency, parasitic infections
It is defined as voluntary or involuntary repeated discharge of urine after a developmental age when bladder control should be present
Enuresis
Typically, enuresis is seen at what age
5 y/o
Most common type of enuresis characterised by no significant dry period and usually nocturnal
Primary
Type of enuresis when there is hyposecretion of ADH and/or receptor dysfunction
Primary
DOC for failed behavioral therapy in nocturnal enuresis
Imipramine
Type of enuresis which occurs after a period of dryness >=6 months
Secondary enuresis
Children with both diurnal and nocturnal enuresis are most likely to have
Abnormalities of the urinary tract
It is defined as passage of feces into inappropriate places after a chronological age of 4 years or equivalent developmental level
Encopresis
Most common type of encopresis
Retentive encopresis
Rectal exam of retentive encopresis
Hard stool
Primary encopresis is seen especially in ______associated with globalndevelopmentalndelays and enuresis
Boys
Secondary encopresis has been documented to have high levels of _________stressors and ________disorder
Psychosocial
Conduct
It is defined as episodic nocturnal behaviors that often involve cognitive disorientation and autonomic and skeletal muscle disturbance
Parasomnias
Nightmares against sleepwalking and sleep terrors have
Daytime sleepiness
Low arousal threshold
No familial history
Does not require treatment
Live attenuated bacterial vaccines are
BCG, oral typhoid
Live attenuated viral vaccines are
MMR, varicella, yellow fever, nasal influenza, smallpox, oral rotavirus
Whole inactivated virus vaccines are
Polio, rabies, hep A
Fractional inactivate protein based are
Subunit: hep B, parenteral influenza, acellular pertussis
Inactivated fractional polysaccharide based vaccine that are toxoid are:
Diphteria, tetanus
Inactivated fractional polysaccharide based vaccine that are pure are:
Pneumococcal, Hib, meningococcal
Inactivated fractional polysaccharide based vaccine that are conjugate are:
Hib, pneumococcal, meningococcal
Live vaccine is delayed for how many months if gamma globulin is given
3-11 months
Where is MMR derived from?
Chick embryo fibroblast tissue cultures
How many doses of DTaP is recommended before school entry?
5
Tdap (childhood tetanus) is given at what age?
11-12 y/o
Td (adult tetanus) is given every?
10 years
How many IPV should be given?
4 doses
HiB conjugate vaccine does not cover what specific organism
Nontypeable Haemophilus
HiB conjugate vaccine is not given after what age in normal children?
5 years
What pneumococcal vaccine confers additional protection to the PCV13 in some high risk children such as functional/anatomic asplenia age >2 years?
23-valent pneumococcal polysaccharide
Varicella vaccine is given at what age for healthy person who have not had varicella illness?
12 months or older
Second dose of varicella is given at what age?
4-6 years
First dose of MMR is given at what age?
12-15 months
Second dose of MMR is given at what age?
4-6 y/o
Hep A vaccine is recommended at what age?
12-23 months of age
How many doses and interval of hepatitis A vaccine?
2 doses, 6 months apart
MCV 4 or meningococcal conjugate vaccine is given at what age and booster at what age?
11-12 y/o
16 y/o
What is the older pure polysaccharide meningococcal vaccine?
MPSV4
Route of administration of live influenza vaccine?
Intranasal
Age of the patients that can be given with live influenza vaccine?
2-49 y/o who are not pregnant and healthy
No dose of rotavirus shall be given after what age?
8 months
It is defined as abusive actions or acts of commission and lack of action, or acts of omission that result in morbidity or death
Child maltreatment
It is defined as intentional injuries to a child by a caregiver that results in bruises, burns, fx, lacerations, punctures or organ damage; also may be accompanied by short- or long-term emotional consequenxea
Physical abuse
It is defined as intentionally giving poisons or toxins or any other deceptive action to stimulate a disorder
Factitious disorder
Most common cause of underweight infants
Nutritional neglect
Syndrome suggested by bruises, scars, internal organ damage, and fractures in various stages of healing
Battered child syndrome
Fracture developed from wrenching or pulling an extremity
Corner chip or bucket handle fracture of metaphysis
Inflicted fracture of bone shaft is more likely what type of fracture
Spiral fracture
Most common burn in infant
Immersion burn
Skeletal survey is recommended if you suspect abuse child of what age?
<2 y/o
Most common reported sexual abuse
Daughters by fathers or stepfathers
Most common overall sexual abuse
Brother-sister incest
Inflammation of subglottic area
Croup
Inflammation of epiglottis and supraglottis
Epiglottitis
Laryngoscopic finding of epiglottitis
Cherry-red, swollen epiglottis
Most accurate test for Croup
PCR for virus
Not needed clinically
Most accurate test for epiglottits
C and S from tracheal aspirate
Best initial test for epiglottitis
Laryngoscopy
Definitive treatment for croup
Dexamethasone
Definitive treatment for Epiglottitis
Tracheostomy (if needed) + broad spectrum antibiotics
Most common laryngeal airway anomaly and most frequent cause of stridor in infants and children
Laryngomalacia
Laryngomalacia starts in ____weeks of life then symptoms increase up to ____months
First 2 weeks of life
6 months
2nd most common cause of stridor
Congenital subglottic stenosis
Common presentation of congenital subglottic stenosis
Recurrent/persistent croup
3rd most common cause of stridor
Vocal cord paralysis
Vocal cord paralysis is associated with what conditions:
Meningomyelocele, Chiari malformation, hydrocephalus
Bilateral vocal cord paralysis is manifested as
Airway obstruction, high pitched inspiratory stridor
Unilateral vocal cord paralysis is manifested as
Aspiration, cough, choking, weak cry and breathing
Dx test in vocal cord paralysis
Flexible laryngoscopy
Most common site of foreign body aspiration in children <1 y/o
Larynx
Radiologic finding of foreign body obstruction
Airtrapping (ball-valve mechanism)
Definitive diagnostic in foreign body aspiration
Bronchoscopy
Most common organism in brochiolitis
RSV
Bronchiolitis lasts how many days?
Average of 12 days (worse in first 2-3 days)
DOC in bronchiolitis for high risk patients
Palivizumab
Major pathogen in pneumonia younger than 5 y/o
RSV
Most common organism producing local infiltrate in children of all ages
S. Pneumoniae
Most common nonviral cause of pneumonia older than 5 y/o
M. Pneumoniae and C. Pneumoniae
Pneumonia manifested by staccato cough and peripheral eosinophilia
Chlamydia trochomatis pneumonia
Organisms caused by bronchopneumonia
Chlamydia and mycoplasma
Radiologic finding of viral pneumonia
Hyperinflation with bilateral interstitial infiltrates and peri bronchial cuffingi
Radiologic finding of pneumoccal pneumonia
Confluent lobar consolidation
Radiologic finding of Chlamydia pneumonia
Interstitial pneumonia or lobar
Radiologic finding of Mycoplasma pneumonia
Unilateral or bilateral lower lobe interstitial pneumonia
Titer to be obtained for mycoplasma pneumoniae
IgM
If S. aureus is suspected in pneumonia, what drug should be added?
Vancomycin or clindamycin
Major cause of severe chronic lung disease and most common cause of exocrine pancreatic deficiency in children
Cystic fibrosis
Most common life-limiting recessive trait among white
Cystic fibrosis
Gene mutation occurs at what chromosome in patients with CF
Long arm chromosome 7
Usual location of CF
Intestinal tract
Radiologic finding of CF in the abdomen
Dilated loops, air fluid levels, “ground-glass” (bubbly appearance) material in lower central abdomen
Clinical presentation of CF in the rectum and usually presented with steatorrhea, malnutrition and cough
Rectal prolapse
Chief determinant of mortality and morbidity of Cystic Fibrosis
Rate of progression of lung disease
Common findings in CF
Meconium ileus Frequent, bulky, greasy stools and failure to thrive ADEK deficiency Acute pancreatitis Rectal prolapse
Organism associated with rapid deterioration and death in CF
Burkholderia cepacia
Male reproductive manifestation of CF
Azoospermia
Female reproductive manifestation of CF
Seconda amenorrhea, cervicitis, decreased fertility
Sweat gland manifestation of CF
Salty taste of skin
Diagnostic criteria of CF
Any of the following:
Typical clinical feature
Hx of a sibling with CF
Positive NBS
Plus any of the following
2 increased sweat chlorides on separate days
Identification of 2 CF mutations (homozygous)
Increased nasal potential difference
Best test to dx CF
Sweat test >60 mEq/L
If sweat test is equivocal:
Increased potential difference across nasal epithelium
Pancreatic function
Pulmonary function test finding of CF by age of 5 years
Obstructive pulmonary disease then restrictive
Early respiratory tract presentation of CF during the 1st year
Cough, purulent mucus, extensive bronchiolitis
Respiratory organism responsible in CF
Non-typeable H.influenza and S.aureus then pseudomonas then burkholderia cepacia
Organism initially seen in sputum of CF
S. Aureus then pseudomonas (virtually diagnostic)
Aerosolized antibiotic in CF
Tobramycin
SIDS is frequently observed at what age?
2-4 months of age
Ddx of eosinophilia
Neoplasms Asthma/Allergy Addison disease Collagen vascular disorder Parasites
Best test for allergic rhinitis
Skin test
Most effective method for allergic rhinitis
Environmental control plus removal of allergen
Most effective medication for AR but not first-line
Intranasal corticosteroid
Major indication of immunotherapy
Duration and severity of symptoms are disabling in spite of routine treatment (for at least 2 consecutive seasons)
Treatment of choice for insect venom allergy
Immunotherapy
Immunotherapy for AR should not used due to lack of proof for the following:
Atopic dermatitis Food allergy Latex allergy Urticaria Children <3 y/o
Most notorious insect responsible in insect venom allergy as characterized by aggressive, ground-dwelling, linger near food
Hymenoptera (yellow jacket)
Indication for venom immune therapy
Severe reaction with +skin tests (highly effective in decreasing risk)
What foods are most infant and young children outgrow in the half in first 3 years?
Milk and egg allergy
Most common cause of anaphylaxis seen in emergency rooms
Food allergic reactions
Most common skin manifestation of food allergy
Acute urticaria/angioedema
Condition that presents with bloody stool/diarrhea (most cow milk or soy protein allergies)
Food protein-induced enterocolitis
Best test for food allergy
Food elimination and challenge tear
Duration of acute mediated IgE urticaria
<6 weeks
Causes of non-IgE mediated urticaria but stimulates mast cells
Radiocontrast
Viral agents (especially EBV, hep B)
Opiates, NSAIDS
Autosomal dominant that has deficiency of C1 esterase inhibitor manifested as recurrent episodes of non-pitting edema
Hereditary angioedema
Treatment for chronic refractory angioedema/urticaria
IVIg or plasmapharesis
Most common food presenting with Anaphylaxis
Peanut
Reactions from ingested allergens are delayed for how many minutes/hours?
Minutes to 2 hours
If allergen is injected, reaction is immediate with what system often manifested?
GI symptoms
What drug classification is used if patient has respiratory symptoms from anaphylaxis?
Short acting beta 2 agonist
Atopic dermatitis starts at what age?
Half at age 1 year
Acute presentation of atopic dermatitis?
Erythematous papules
Intensely pruritic
Serous exudate, excoriation
Subacute presentation of atopic dermatitis?
Erythematous, excoriated, scaling papules
Chronic presentation of atopic dermatitis
Lichenification
What is the distribution pattern of atopic dermatitis in infancy?
Face, scalp, extensor surfaces of extremities
What is the distribution pattern of atopic dermatitis in older and long-standing disease?
Flexural aspects
Higher potency classes of topical corticosteroid are not used on what body parts?
Face and intertriginous areas
Drug classification of Tacrolimus that is used safely on the face for atopic dermatitis
Calcineurin inhibitor
Treatment for atopic dermatitis in descending order
Antihistamine
Glucocorticoid
Cyclosporine
Interferon
Most common complication of atopic dermatitis from recurrent viral skin infections?
Kaposi varicelliform eruption (eczema herpetiform)
Organisms increased incidence as a cause of complication of atopic dermatitis from secondary bacterial infection
T.rubrum and M.furfur
What type of hypersensitivity reaction is contact dermatitis categorized?
Type IV
Most asthma starts at what age and resolves at what period?
<6 y/o
Late childhood
Gold standard in diagnosing asthma
Spirometry during forced expiration
What is the result of FEV1 in exercise challenge for asthma?
15%
Daytime symptoms/Nighttime symptoms of Intermittent Asthma
<2x/week
<2x/month
Daytime symptoms/Nighttime symptoms of Mild persistent Asthma
> 2x/week
>2x/month
Daytime symptoms/Nighttime symptoms of Moderate persistent Asthma
Daily
>1x/week
Daytime symptoms/Nighttime symptoms of Severe persistent Asthma
Continual
Frequent
DOC for rescue and preventing exercise-induced asthma
Short-acting beta 2 agonist
Much less potent than beta agonist and mostly added tx of acute severe asthma
Ipatropium bromide
Recommended drug for asthma in the hospital
Methylprednisolone
DOC for persistent asthma
ICS
Long-term controller medication only used mild-moderate asthma and required to be administered frequently
Cromoglycates
Only approved ICS by the FDA for <1 year duration
Nebulized budesonide
Six approved inhaled steroids
1st generation: beclomethasone, flunisolide, triamcinolone 2nd generation (better therapeutic index): budesonide, fluticasone, mometasone
LABA such as Salmeterol and formoterol should be used with this drug
ICS
What are the 2 classes of leukotriene modifying agents?
Inhibitor of synthesis (zileuton) and receptor antagonist (montelukast and zafirlukast)
Controller of asthma that has a narrow therapeutic index hence needs to be routinely monitored
Theophylline
Patient can be discharged in the ER for asthma exacerbation if:
Sustained normal PE findings and SaO2 >92% after 4 Hours in room air and PEF >70% of personal best
What are the adjunctive treatment to prevent intubation and ventilation from asthma?
IV beta agonist
IV theophylline
Heliox: decreased airway resistance and clinical response in 20 minutes
IV MgSO4: smooth muscle relaxant
Normal values of the following may exclude a particular diagnosis
Absolute lymphocyte count
Absolute neutrophil count
Platelet count
T-cell defect
Congenital or acquired neutropenia and both forms of leukocyte adhesion deficiency
Wiskott-Aldrich syndrome
Complement deficiency results in susceptibility to what organism?
Neisseria
Phagocyte deficiency often leads to multiple infections with what organism?
Catalase positive organisms such as staph
Best test to check neutrophil respiratory burst
Rhadamine dye
X-linked disorder of the B-cell characterized by the absence of circulating B-cell, significant decrease in all immunoglobulin, and lymphoid hypoplasia
Bruton agammaglobunemia
B-cell defect characterized by hypogammaglobunemia with phenotypically normal B cells, normal or increase lymphoid tissue, significant autoantibody production and significant increase in lymphomas
Common variable immune deficiency
Most common B-cell defect
Selective IgA deficiency
B-cell defect wherein one or more of the 4 subclasses are decreased despite a normal or even increased total IgG
IgG subclass deficiency
CATCH-22
Cardiac Abnormal facies Thymic hypoplasia Cleft palate Hypocalcemia
T-cell defect wherein there is dysmorphogenesis of the 3rd and 4th pharyngeal pouches
DiGeorge syndrome
Characteristic features of DiGeorge syndrome
Thymic hypoplasia
Parathyroid hypoplasia
Anomalies of the great vessels (e.g. Right aortic arch)
Other CHD (conotruncal lesions, ASD, VSD)
Dysmorphic features: mandibular hypoplasia
Treatment of DiGeorge syndrome
Transplantation of thymic tissue of MHC-compatible sibling or half-matched parenteral bone marrow
IgA, CD3 and absolute lymphocyte count in DiGeorge syndrome are _________while IgE is _______
Decreased
Increased
X-linked Combined antibody and cellular defect condition characetrized by absence of all adaptive immune function and perhaps natural killer function
Severe combined immunodeficiency
Most common genetic type of SCID
X-linked
Considered to be a true pediatric emergency wherein bone marrow transplant is a necessity or else death by 1 year of age
SCID
Autosomal recessive Severe Combined Immunodeficiency has deficiency in what particular substance?
Adenine deaminase
X-linked combined immunodeficiency oftentimes seen in prolonged bleeding from circumcision
Wiskott-Aldrich syndrome
T-cells in Wiskott-Aldrich syndrome is moderately (increased/decreased)
Decreased
Combined immunodeficiency disorder characterized by A-T mutation on chromosome 11, moderate decreased in response to B and T cell mitogens, features such as mask-like facies, progressive ataxia, oculotelangiectasias with higher incidence of malignancies
Ataxia-Telangiectasia
Phagocytic defect X-linked and autosomal recessive disease with neutrophils and monocytes can ingest but not kill catalase-positive microorganisms
Chronic granulomatous disease
Most common cause of ectopia lentis
Trauma
Location of ectopia lentis in Marfan syndrome?
Superior and temporal; bilateral
Location of ectopia lentis in homocystinuria?
Inferior and nasal
What reflex test is considered as the most rapid and easily performed to check for strabismus?
Hirschberg corneal light reflex
Chemical conjunctivitis is most common in first ____hours of life
24 hours
Incubation period of Neisseria gonorrhea in developing ophthalmia neonatorum?
2-5 days
Incubation period of Chlamydia trachomatis in developing ophthalmia neonatorum?
5-14days
Treatment of Neisseria gonorrhea in developing ophthalmia neonatorum?
Ceftriaxone
Treatment of Chlamydia in developing ophthalmia neonatorum?
Erythromycin PO
Topical erythromycin does not prevent chlamydia conjunctivitis
Epidemic keratoconjunctivitis is caused by what organism?
Adenovirus type 8
Keratitis is commonly caused by what organisms?
H.simplex and adenovirus
Most common primary malignant intraocular tumor
Retinoblastoma
Average age diagnosis of retinoblastoma
Bilateral
Unilateral
15 months
25 months
Initial sign of retinoblastoma
Leucokoria
2nd most common sign in retinoblastoma
Strabismus
Inflammation of pida and periorbital tissue without signs of true orbital involvement; insidious onset; low-grade fever; no toxicity
Perioribital cellulitis
Infection of orbital tossue including subperiosteal and retrobulbar abscesses
Orbital cellulitis
Most common organism in otitis externa
Pseudomonas aeruginosa
2nd most common cause of otitis externa
S.aureus
Otitis externa that invades the temporal bone and skull base with facial paralysis, vertigo, other cranial nerve abnormalities
Malignant otitis externa
Most common organism in bacterial OM
S.pneumoniae
Nontypeable H.influenzae (25-30%) Moraxella catarrhalis (10-15%)
Factor that is most sensitice and specific to determine presence of middle ear effusion with the use of pneumatic otoscopy
Mobility
First line DOC in patients with OM
High dose Amoxicillin
If allergic to penicillin, what is the alternative drug for OM?
Azithromycin
2nd-line drug for OM if continued pain after 2-3 days
Amoxicillin-clavulanic acid
If unsatisfactory to good second-line drug in treating OM, what is the next step?
Myringotomy or tympanoscentesis
Complications of Otitis Media with effusion
Acute mastoiditis acquired cholestoma (progressively expands and intracranially)
Most common area of epistaxis
Anterior septum or Kiesselbach plexus
Most common cause of epitaxis
Nose picking
