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Pediatrics (p268 - 305) Flashcards

1
Q

Moro and grasp reflex

A

Newborn

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2
Q

Hold head up

A

2 mos

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3
Q

Grasps object

A

4 mos

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4
Q

Orient to voice

A

4 mos

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5
Q

Sit upright

A

6 mos

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6
Q

Sleep all night

A

6 mos

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7
Q

Crawl

A

9 mos

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8
Q

Mama Dada name calling (to anyone)

A

9 mos

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9
Q

Mama Dada name calling to parents

A

12 mos

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10
Q

Pulling oneself up to a standing position

A

9 mos

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11
Q

Stand unassisted

A

12 mos

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12
Q

Walk

A

15 mos

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13
Q

Temper tantrum

A

15 mos

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14
Q

Successful toilet training initiation

A

18 mos

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15
Q

4-6 word vocabulary (non sentence)

A

15 mos

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16
Q

Can eat with spoon (solid foods)

A

18 mos

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17
Q

Speak 2 word sentences

A

24 mos

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18
Q

Speak 3 word sentences

A

36 mos

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19
Q

Know first and last name

A

36 mos

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20
Q

Throw ball

A

18 mos

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21
Q

Walk upstairs

A

18 mos

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22
Q

Run

A

24 mos

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23
Q

Ride tricycle

A

36 mos

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24
Q

When do boys go through testicular enlargement

A

11.5 yrs

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25
Q

When do girls develop breast buds

A

10.5 yrs

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26
Q

When do girls undergo menarche

A

12.5 yrs

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27
Q

When do boys undergo peak growth?

A

13.5 yrs

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28
Q

What is the mechanism of botulinum toxin?

A

irreversibly blocks acetylcholine release from the peripheral neurons.

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29
Q

What are the sx of Clostridium?

A

acute flaccid descending paralysis with clear sensorium without fever or parasthesias

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30
Q

How does botulinum toxin spread?

A

ingestion of spores in honey or via inhalation of spores

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31
Q

Whats the danger of botulinum toxin? Tx?

A

respiratory distress, tx by intubation and supportive care.

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32
Q

How is toxo transmitted/

A

Through cat feces and poorly cooked meat

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33
Q

What fraction of moms who have toxo transmit to baby? what fraction of babies are clinically affected?

A

1/3

1/3

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34
Q

What are the sequelae of toxo?

A

intracerebral calcifications, hydrocephalus, chorioretinitis, microcephaly, severe mental retardation, epilepsy, IUGR

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35
Q

How does the chance of rubella transmission change with each trimester?

A

80% chance
50% chance
5% chance

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36
Q

Pt with rubella will present with…

A

IUGR, cataracts, glaucoma, chorioretinitis, PDA, ASD, VSD, microcephaly, myocarditis, BLUEBERRY MUFFIN RASH, HEARING LOSS

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37
Q

How is Dx of rubella confirmed?

A

IgM rubella antibody

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38
Q

What should be the protocol for women with Herpes who are pregnant How to deliver?

A

C-section

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39
Q

What is the number one congenital infection transmitted through bodily fluids and secretions?

A

CMV

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40
Q

How often is syphillis infected from mother to baby during delievery?

A

Nearly 100%

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41
Q

Why is otitis media with effusion common in young children?

A

Because their eustachian tubes are smaller and more horizontal.

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42
Q

What is the first and second line treatments for otitis media?

A

Amoxicillin/Azithromycin is 1st line

Augmented penicillins and TMP-SMX is second line

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43
Q

What are the common pathogens seen in otitis media?

A

S. pneumo, H. influenza and moraxella catarrhalis

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44
Q

Erythematous maculopapular rash that erupts 5 days after onset of prodromal sx. Begins on head an spreads down to body. White spots on buccal mucosa, fever, cough conjunctivitis and coryza. Dx?

A

Measles (Rubeola) Paramyxovirus

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45
Q

Suboccipital lumphadenopathy with maculopapular rash that starts on face and generalizes. Reddish spots on soft palate. Dx?

A

Rubella (German measles)/ Togavirus

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46
Q

Vasicular rash on hands and fee with ulcerations in mouth .Rash clears in 1 wk

A

Hand foot and mouth dz, coxsackie A virus

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47
Q

Abrupt high fever persisting for 1-5 days even though child has no physical sx to account for fever and does not feel ill. When fever drops, macular or maculopapular rash appears over trunk and entire body, lasts 24 hours

A 
Roseola infantum (Exanthum subitum)
HHV-6
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48
Q

Slapped cheeks erythema on chees. Maculopapular rash spreads from arms to trunk and legs forming a reticular pattern. Dx? Dangerous to what population of pts (2)? and in adults this causes what sx?

A

Erythema infectiousum (fifth’s disease)/ Parvovirus B19
Danger to sickle cell–> aplastic anemia and preggos
In adults, migratory polyarthritis

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49
Q

How long are chickenpox lesions contagious?

A

Take 3 days to crust over, and they are contagious until crusting happens.

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50
Q

What should be the management for chronic effusions or repeated OM infections?

A

surgical placement of pressure equalization tubes

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51
Q

What do adults with unilateral serous effusions need to have ruled out?

A

nasopharyngeal mass

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52
Q

One complication of OM and mastoiditis is a Bezold abscess. What is that?

A

infection that penetrates tip of mastoid and pus travels along SCM forming an abscess in the posterior triangle of neck

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53
Q

What is a postauricular abscess?

A

Complication of OM and mastoiditis –> most common subperiosteal abscess that occurs posterior to auricle–> displacing ear forward

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54
Q

What organism is bullous myringitis associated with?

A

Mycoplasma infection

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55
Q

What does bullous myringitis present with?

A

Large blebs on the tympanic membrane

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56
Q

Whats the treatment of bullous myringitis?

A

Azithromycin

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57
Q

How do you diagnose/r/o nasopharyngeal masses in unilateral serous OM in adults?

A

MRI head, endoscopic visualization and biopsy

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58
Q

What age is bronchiolitis mc seen in?

A

Age less than 2

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59
Q

What viruses cause bronchiolitis?

A

50% RSV

also –> parainfluenza virus and adenovirus

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60
Q

How is RSV diagnosed?

A

culture or antigen detection of nasopharyngeal secretions

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61
Q

Tx of bronchioloitis?

A

bronchodilators and O2 as needed.

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62
Q

3 mo-3yrs pt with barking cough worse at night. Dx? xray? tx?

A

Coup by parainfluenza virus (aka laryngotrachobronchitis)
Xray - steeple sign
Tx: O2, cool mist, racemic epi
Steroids if severe. Ribavarin for immunocompromized

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63
Q

What are the 3 stages of pertussis infection and time frames?

A
  1. Catarrhal 1-2 wks
  2. Paroxysmal 2-4 wks with “Whoops”
  3. Convalescent stage 1-2 weeks
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64
Q

Pt with fulminant inspiratory stridor,drooling, sits leaning forward. Hot potato voice. Dx? organism? xray? Tx?

A

Epiglottitis secondary to H.flu B
Thumb print sign on xray
Examine, put in OR, intubate as needed, Ceftriaxone

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65
Q

> 6 mos presents with insspiratory stridor, wheeze, dysphagia. Usually was playing with something, acute onset. Dx? xray? tx?

A

Foreign body aspiration
xray shows hyperinflation on affected side
Endoscopic or surgical removal

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66
Q

Pt with staccato cough and conjunctivitis. Pt afebrile. Dx?

A

Chlamydia

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67
Q

What is the most common pediatric non infectious cause of stridor?

A

Laryngomalacia

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68
Q

What type of stridor would indicate the supraglottis has been affected?

A

inspiratory stridor

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69
Q

What type of stridor would indicate that there’s glottic or subglottic narrowing?

A

Biphasic stridor

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70
Q

Pt with frequent OM episodes, snoring at night, constant mouth breathers and nasal congestion with hypernasal voice. What could he have? key feature? tx?

A

adenoiditis
adenoid facies
tx: surgical removal of adenoids

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71
Q

Commonly called “genu valgum”

A

knock knees

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72
Q

If persistent after what age is genu valgum considered abnormal?

A

after age 4-5 years

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73
Q

Commonly called bow leggedness

A

genu varum

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74
Q

What medical condition can cause genu varum?

A

Rickets - vitamin D deficiency

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75
Q

What is the number one cause of a painful limp in 1-3 years old

A

septic arthritis

76
Q

Pt with acute onset monoarticular hip/knee/ankle pain with limited ROM. Labs show increased WBC, ESR, refusal to walk. Dx? how to make dx? MC etiology? Xray?

A

Septic arthritis
dx by joint aspiration –> WBC>10000 with neutrophil predominance, low glucose
Xray shows joint space widening
MC organism is S. aureus

77
Q

Pt with insidious onset of pain, seen in boy who are 5-10 years old. WBC and ESR normal. No tenderness, warmth, or joint swelling. Xray normal. Dx? how to make dx? Tx?

A

Toxic synovitis
Dx with technetium scan which will show uptake of epiphysis
Rest and anelgesics for synovitis for 3-5 days

78
Q

Aseptic avascular necrosis of head of femur, often involving boys ages 5-9

A

Legg-Calve-Perthes dz

79
Q

Aseptic avascular necrosis of the tibial tubercle

A

Osgood schlatter

80
Q

What bone does Kohler’s bone dz involve?

A

Navicular

81
Q

Seen in obese male adolescents, dull aching pain in hip or knee with increased pain with activity. Dx? Xray? Tx?

A

Slipped capital femoral epiphysis - dx made clinically
xray - ice cream scoop falling off cone
Tx: surgical pinning

82
Q

What is the gold standard for osteomylitis? MC organism?

A

MRI

S. aureus

83
Q

Chronic inflammation of >1 joint in patient

A

Juvenile Rheumatoid arthritis

84
Q

What are the 3 categories of jeuvenile rheumatoid arthiritis?

A

Systemic
Pauciarticular
Polyarticular

85
Q

What is the tx for juvenule rheumatoid arthritis?

A

NSAIDs, low dose methotrexate and prednisone online in acute febrile onset

86
Q

Whats another name for Kawasaki dz?

A

Mucocutaneous lymph node syndrome

87
Q

What does CRASH for Si/Sx in Kawasaki’s stand for?

A 
Conjunctivitis
Rash, primarily truncal
Aneurysms of coronary arteries 
Strawberry tongue, crusting of lips fissuring of mouth and oropharyngeal erythema
Hands and feet show induration.
88
Q

What is the tx for Kawasaki?

A

IVIG and high dose aspirin.

Prednisone is contraindicated

89
Q

What kind of vasculitis is Henoch-Schonlein Purpura?

A

IgA small vessel vasculitis

90
Q

What nephropathy is Henoch Schonlein purpura related to?

A

IgA nephropathy

91
Q

What is the main si/sx of Henoch Schonlein purpura?

A

pathognomonic palpable purpura

92
Q

Proliferation of histiocytic cells resembling Langerhans skin cells

A

Histiocytosis X

93
Q

What are the 3 common variants of histiocytosis X?

A

Letterer-Siwe
Hand-Schuller-Christian
Eosinophilic granuloma

94
Q

Pt with proliferation of histiocytic cells. Also with hepatosplenomegaly, lymphadenopathy, pancytopenia, lung involvement and recurrent infections. Dx?

A

Letterer Siwe dz

95
Q

Pt with proliferation of histiocytic cells a/w classic triad skull lesions, diabetes insipidus and exopthalmus

A

Hand-Schuller Christian disease

96
Q

Pt with proliferation of histiocytic cells a/w extraskeletal involvement generally limited to lung. Best prognosis

A

Eosinophilic granuloma

97
Q

Why does congenital hypothyroidism occur?

A

Secondary to agenesis of thyroid or defect in enzymes

98
Q

What hormone is crucial in the first 2 years of life for normal brain development?

A

T4

99
Q

What si/ sx does congenital hypothyroidism present with? at what age?

A

6-12 weeks with poor feeding, lethargy, hypotonia, coarse facial features, large protruting tongue

100
Q

Why is diagnosis of congenital hypothyroidism crucial by 6weeks?

A

If dx is delayed, child will be mentally retarded.

101
Q

When does physiologic jaundice clinically begin?

A

24-48 hours after birth

102
Q

What kind of bilirubin is elevated during phsyiologic jaundice? Why?

A

unconjugated hyperbilirubinemia

because there is a relative deficiency of glucuronyl transferase in the immature liver

103
Q

What kind of newborn jaundice is always pathologic?

A

Jaundice present at birth

104
Q

What are the 2 diseases caused by congenital deficiency of glucuronyl transferase?

A

Crigler Najjar and Gilberts

105
Q

What are some ways to get congenital hemolytic anemia?

A

spherocytosis
G6PD
pyruvate kinase deficeincy

106
Q

What are some acquired ways to get hemolytic anemia?

A

ABO/Rh isoimmunization, infection
drugs
twin-twin transfusion syndrome, chronic fetal hypoxia
delayed cord clamping, maternal diabetes

107
Q

What are some infectious causes to have conjugated hyperbilirubinemia?

A

sepsis, torch group, syphillis, L.monocytogenes, hepatitis

108
Q

What are some metabolic causes to have conjugated hyperbilirubinemia?

A

galactosemia, a1-antitrypsin defeciency

109
Q

What are some congenital causes to have conjugated hyperbilirubinemia?

A

extrahepatic biliary atresia,
Dubin johnson
Rotor syndrome

110
Q

What is the tx for newborn jaundice

A

phototherapy with blue light (not UV light which can harm the skin and retina) to break down bilirubin pigment

111
Q

Why does new born jaundice need to be urgently treated?

A

to prevent kernicterus (bilirubin precipitation in the basal ganglia)

112
Q

What is the Ddx if jaundice within 24 hours of birth?

A

Hemolysis, sepsis

113
Q

What is the Ddx if jaundice within 48 hours of birth?

A

hemolysis, infection, physiologic

114
Q

What is the Ddx if jaundice after 48 hours of birth?

A

infection
hemolysis
breast milk (liver can’t handle lipids of breast milk)
congenital malformation (biliary atresia)
Hepatitis

115
Q

Acute encephalopathy and fatty degeneration of the liver associated with use of salicylates in children with varicella or influenza-like illness

A

Reye’s syndrome

116
Q

Describe the fever seen in Reye’s syndrome

A

Biphasic course with prodromal fever that rapidly progresses to seizures, coma, death

117
Q

Treatment for Reye’s syndrome?

A

Control of increased intracranial pressure because of cerebral edema - use mannitol with fluid restriction and give glucose because glycogen stores are completely depleted

118
Q

What is the most common convulsive disorder in young children?

A

Febrile seizures

119
Q

What age do febrile sz most commonly occur?

A

3months and 5 years

120
Q

What is the cause of febrile seizures?

A

Usually no CNS infection or defined cause.

121
Q

When in the course of the fever does the febrile seizure occur?

A

during the rise in temperature, not at the peak of temperature

122
Q

how high is the temp in febrile seizure?

A

very high, greater than 102

123
Q

Describe the seizure associated with febrile seizures

A

tonic clonic with most lasting less than 10 minutes with a drowsy post ictal period

124
Q

What should be considered if the seizure lasts longer than 15 minutes?

A

Most likely because of infection or other toxic process, careful workup should follow, consider lumbar puncture to rule out meningitis

125
Q

Define failure to thrive

A

Failure of child to grow and develop because of inadequate calorie intake or because of inadequate calorie absorption

126
Q

What are the three diagnostic criteria of failure to thrive?

A
127
Q

What are some exceptions to the diagnostic criteria of Failure to thrive?

A

short stature children
small for gestational weight children, normally lean infants
really overweight infants whose rate of height gain increases while weight gain decreases.

128
Q

Why is the prognosis so poor when children have failure to thrive in the first year of life?

A

Because maximal postnatal brain growth occurs during the first 6 months of life - 1/3 of children with non organic FTT are developmentally delayed

129
Q

What is the mildest form of craniofacial abnormality?

A

bifid uvula

130
Q

What is the most common malformation of the head and neck? How does this affect feeding? tx?

A

unilateral cleft lip - doesnt interfere with feeding

tx: surgical repair

131
Q

Why do anterior cleft palates occur?

A

because of failure of palantine shelves to fuse with primary plate

132
Q

Why do posterior cleft palates occur?

A

failure of palantine shelves to fuse with nasal septum

133
Q

How do cleft palates affect feeding?

A

Interefere with feeding - requires a special nipple

134
Q

What tongue finding is seen in patients with Down’s sndrome, gigantism, hypothyroid?

A

Macroglossia

135
Q

In what situation is glossitis seen? define glossitis

A

Vitamin B deficiencies

redness and swelling with burning sensation

136
Q

Pt with arrhinencephaly, holoprosencephaly and Rocker bottom feet. Dx?

A

Patau’s syndrome trisomy 13

137
Q

Pt with srrhinencephaly, corpus callosum agenesis, microcephaly and micrognathia. Dx?

A

Edward’s syndrome - caused by trisomy 18

138
Q

Pt with cardiac septal defects, psychomotor retardation, classic down’s facies, increased risk of leukemia, premature alzheimer’s dz. Dx?

A

Down’s syndrome

139
Q

What are Down’s facies?

A

flattened occiput, epicanthal folds, upslanted palpebral fissures, speckled irises (Brushfield’s spots), protruding tongue, small ears, redundant skin at posterior neck, hypotonia, simean crease in palms

140
Q

What is the number 1 cause of primary amenorrhea

A

Turner’s syndrome bc XO genotype

141
Q

What is the treatment for Turner’s syndrome?

A

hormone replacement therapy to allow secondary sex characteristics to develop

142
Q

What is the trinucleotide repeat for Fragile X?

A

CGG

143
Q

What is the number one cause of mental retardation in boys

A

Fragile X

144
Q

Pt with long face, prominnant jaw, large ears, enlarged testes, developmental delay and mental retardation. Dx?

A

Fragile X

145
Q

Congenital disorder in which pt with caudally displaced cerebellum, elongated medulla passing into foramen magnum, flat base skull, hydrocephalus, meningomyelocele and aqueductal stenosis. Dx? Prognosis?

A

Dx - arnold chiari malformation

Prognosis - death as neonate or toddler

146
Q

What marker is elevated in maternal serum if baby has a neural tube defect? Prevent NTD?

A

Alpha feto protein

Give folic acid during pregnancy

147
Q

What are some si/sx in fetal alcohol syndrome?

A

Facial abnormalities, developmental defects, smooth philtrum of lip, microcephaly and ASDs

148
Q

Eye finding: discrete flakes in the anterior and posterior cortex with cortical star shaped opacity.. seen in what kind of pts?

A

Down’s syndrome

149
Q

Autosomal dominant multinodular proliferation of multinucleated astrocytes that form small tubers (white nodules in the cortex and periventricular areas). Dx?

A

Tuberous sclerosis

150
Q

What is the classic skin finding for pts with tuberous sclerosis?

A

adenoma sebaceum - small adenomas on the face in distribution similar to acne.

151
Q

What cancer is tuberous sclerosis associated with?

A

rhabdomyosarcoma

152
Q

Pt with projectile vomiting in the first 2 weeks to 2 months of life. Dx?

A

congenital pyloric stenosis

153
Q

What demographic is congenital pyloric stenosis most common in?

A

Boys who are first born

154
Q

What is the pathognomonic physical finding in congenital pyloric stenosis?

A

palpable “olive” nodule in the mid epigastrium

155
Q

What is the tx for congenital pyloric stenosis?

A

longitudinal surgical incision in the hypertrophied muscle.

156
Q

What heart sound does an ASD make?

A

loud S1, WIDE FIXED SPLIT S1, midsystolic ejection murmur

157
Q

What is the most common congenital heart defecT?

A

VSD

158
Q

What is the heart sound for a VSD?

A

holosytolic murmer over the entire precordium maximally over the 4th left intercostal space.

159
Q

What is eisenmenger’s complex? Sx?

A

Right to left shunt secondary to pulmonary htn

Sx: RV hypertrophy, cyanosis and venous thrombi

160
Q

What are the 4 physical defects comprising of tetrology of fallot?

A
  1. VSD
  2. Pulmonary outflow tract
  3. RV hypertrophy
  4. Overriding aorta
161
Q

What is a Tet spell?

A

Seen in tetrology of fallow where pt has acute cyanosis and panic in child and child adopts a squatting posture to improve blood flow to lungs

162
Q

What does the chest xray of a pt with tetrology of fallot look like?

A

Classic boot shaped contour

163
Q

Aorta comes off RV and pulmonary artery comes off LV. Dx?

A

Transposition of the great arteries

164
Q

What does the chest xray of a pt with transposition of the great arteries look like?Tx? nail finding?

A

englarged egg shaped
surgical intervention
Digital clubbing

165
Q

Pt with decreased BP in the legs, normal BP in arms. Continuous murmer over the collateral vessels in the back. Xray shows ribi notching. Dx?

A

Coarctation of the aorta

166
Q

What is the murmer of PDA? Tx?

A

continuous machine murmer heard best in the 2nd left interspace. Tx: Indomethacin (blocks prostoglandins and induces closure)

167
Q

Are clinical and lab evaluations allowed without parental/gaurdian permission in cases of suspected child abuse?

A

yes

168
Q

What parts of the body are accidental injuries seen?

A

shins, forearms and hips

169
Q

What kind of fractures are suspicious for abuse? (2)

A

damage to the metaphysis

Spiral fractures to the periosteum before child can walk

170
Q

What is a chip fracture?

A

where the corner of the metaphysis of a long bone is torn off with damage to the epiphysis

171
Q

Circular punched out lesions of similar size on hands and feet may indicate..

A

Cigarette burn

172
Q

What kind of burns and appearances are suspicious for abuse in children?

A

summetrical with burn affecting perineum or scalded line on thigh without splash marks, stocking or glove burn on hands/ feet

173
Q

What is a marker for head injury?

A

Subdural hemorrhages, retinal hemorrhages

174
Q

Sexualized behaviors with peers or objects might indicate what?

A

Sexual abuse

175
Q

What might you consider ordering, esp if pt is too young to speak

A

Bone survey (skeletal survey)

176
Q

What other labs might you order for suspected chcild abuse?

A

PT/PTT for bleeding diathesis
Collect specimens of offender’s sperm, blood, hair, nail clippings and clothing.
Get GC cultures from mouth, anus and genetalia

177
Q

What are the indications to admit a child abuse pt?

A

severe enough, dx is unclear or if no other safe placement is available

178
Q

Pt with hypotension and brady cardia, What toxins might have been ingested?

A

Organophosphates or b-blocker

179
Q

What might be the most effective and safest way to prevent absorption?

A

Charcoal.

180
Q

What percent of all deaths in adolecsents are accidental?

A

50%

181
Q

Most likely cause of accidental death in older kids? younger?

A

Older- MVA

younger: drowning and fatal injuries involving weapons

182
Q

Homocide rate is highest for what race?

A

5x higher for african american males

183
Q

What is the second leading cause of adolescent death?

A

suicide, males 5x more likely to succeed

184
Q

What is the average age of first substance abuse?

A

12-14y

185
Q

What age distribution is anorexia mc seen?

A

14.5 years and 18 years

186
Q

What are the exceptions to confidentiality with regards to minors

A

Suicidal or homicidal behavior or sexual/physical abuse

187
Q

What is HEADSSS assessment/screening?

A 
Home environment
Employment/education
Activities
Drugs
Sexual activity 
Suicide
Safety

Boards and Wards Complete (13 decks)

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