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Clinical Disciplines > Peds 1 > Flashcards

Peds 1 Flashcards

1
Q

Viral Particles

A

Small virus particles with no viral DNA

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2
Q

Subunit Vaccine

A

Viral proteins only

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3
Q

Toxoid

A

Inactivated toxin stimulates antibody production

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4
Q

Vaccine Contraindications

A

mod-severe illness regardless of fever, egg or chicken allergy for influenza
Live vaccines: pregnancy and compromised immunity

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5
Q

If you don’t get live vaccines together, how long should you wait between?

A

28 days

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6
Q

Meningococcal Conjugate Vaccine (MCV4) Schedule

A

First dose: age 11-12
Booster: 16
Vaccinate ALL college students in dorms who don’t have it yet

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7
Q

Meningococcal Conjugate Vaccine (MCV4) Contraindications

A

Latex allergy, history of allergy to diphtheria, history of Guillain-Barre

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8
Q

Live-Attenuated Influenza vaccine (FluMist) Schedule

A

Yearly age 2-49 if healthy, better in 2-8 than inactivated

Given intranasally

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9
Q

FluMist Contraindications

A

Severe allergic reaction, taking aspirin and allergic to eggs, pregnant, immunosuppressed, kids 2-4 with asthma/wheezing in past 12 months, taken flu antivirals in last 48 hours

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10
Q

Synagis (RSV prophylaxis)

A

Only given to high risk babies <2

Given monthly through the fall, very expensive

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11
Q

Abnormal Vaccine Reactions

A

Inconsolable >3hours, high fever >104-105, seizure, neurological abnormalities, anahylaxis

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12
Q

Vaccine Side Effects (normal)

A

Fussiness <3 hours, tired, low fever <101.5, injection site pain, redness, swelling

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13
Q

Roseola infantum (erythema subitum) cause and treatment

A 
Caused by herpes virus 6 or 7
Treated symptomatically (fever control, fluids)
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14
Q

Roseola Infantum Presentation

A

6 months-3 years with abrupt high fever for 3-7 days that stops abruptly followed by rosy-pink maculopapular rash that starts on trunk, not itchy and blanches
Adenopathy and URI findings

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15
Q

Erythema Infectiosum (fifth disease) Cause and Treatment

A 
Caused by Human Parvo B-19
Treated symptomatically (fluids, antiemetics, etc)
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16
Q

Erythema Infectiosum Presentation

A

Mild-mod fever, headache, nausea, diarrhea followed in 2-5 days with “slapped cheeks” and lace-like rash on trunk and limbs

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17
Q

Oral Candidiasis (thrush) Casuative agent and treatment

A

Candida albicans

Treated with nystatin suspension, treat mom as needed (if breastfeeding)

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18
Q

Oral candidiasis Presentation

A

Adherent white plaques (thrush won’t brush) with underlying red mucosa that will bleed
Decreased feeding

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19
Q

Enterobiasis (pinworms) causative agent and treatment

A

Enterobus vermicularis

Treat whole family with 100mg Mebendazole once, repeat in 2 weeks, wash sheets in hot water

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20
Q

Enterobiasis Presentation

A

Can be asymptomatic

Anal itching esp at night

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21
Q

Enterbiasis Diagnosis/Prevention

A

Scotch tape test

Prevent with hand washing, short nails, avoid scratching anus

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22
Q

Molluscum Contagiosum Causative Agent and Treatment

A

Poxvirus

Treat with curettage, cryotherapy, cantharidin, podophyllotoxin, retinoids, salicylic acid, lasers

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23
Q

Molluscum Contagiosum Presentation

A

Flesh-colored dome-shaped papule with central umbilication

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24
Q

Bacterial Meningitis

A

Emergency, fatal if untreated

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25
Q

Bacterial Meningitis Pathogen in 1-3 month olds

A

Group B strep

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26
Q

Bacterial Meningitis Pathogen in 3 months-3 year olds

A

S pneumoniae

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27
Q

Bacterial Meningitis Pathogen in3-10 year olds

A

S. pneumoniae

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28
Q

Bacterial Meningitis Pathogen in 10-19 year olds

A

N. Meningitidis

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29
Q

Bacterial Meningitis Presentation

A

High fever, irritable, anorexia, headache, confusion, photophobia, back pain, nuchal rigidity
Petechial rash that does not blanch in N meningitides

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30
Q

Viral Meningitis

A

Presents similar to bacterial-it is bacterial until proven otherwise!

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31
Q

Humoral immunodeficiency

A

Impaired antibody(Ig) production

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32
Q

Presentation of immunodeficiency

A

Recurrent severe respiratory infection (OM, sinusitis, pneumonia), poor growth, failure to thrive, unexplained splenomegaly, chronic diarrhea

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33
Q

What is the most common immunodeficiency?

A

Selective IgA deficiency (w/ normal IgG and IgM in a child >4 years)

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34
Q

Presentation of IgA deficiency

A

Most are asymptomatic
Recurrent sinopulm infections, autoimmune disorders, GI infections (giardiasis), allergic disorders, anaphylactic transfusion reactions, celiac
Refer to immunology

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35
Q

Common Variable Immunodeficiency (CVID)

A

Impaired B-cell, T-cell and dendritic cell production leading to impaired Ig production

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36
Q

CVID Criteria

A

Reduced serum IgA, G and M

Poor response to vaccines, presence of B-cells, absence of other immunodeficiency

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37
Q

CVID Presentation

A

Usually presents around puberty

Chronic/recurrent rest infections, GI infections, Failure to thrive (diarrhea, malabsorption, weight loss), atopic triad

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38
Q

CVID Management

A

Refer to immunologist, IVIG

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39
Q

Severe Combined Immunodeficiency (SCID)

A

Severe defect in both T and B lymphocyte systems leading to early death from infection
X-linked (males only)
Part of newborn screen in all states

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40
Q

SCID Presentation

A

One or more severe infections in first few months of life, may become ill from live vaccines (varicella, MMR, OPV (polio) or RV (rotavirus))
May not have visible thymus on chest xray

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41
Q

SCID Manifestations and Therapy

A

Persistent thrush, P jirvecii infection, lymphoma, death from viral infections
Stem cell transplant, managed by immunology

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42
Q

DiGeorge Syndrome

A

Chromosomal deletion of 22q11.2 affecting multiple body systems
Most prevalent micro deletion syndrome in US

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43
Q

DiGeorge Syndrome Defects/Presentation

A

Cyanosis (tetralogy of fallout, ASD, VSD, interrupted aortic arch)
Immune dysfunction (Cell deficits, hypo plastic thymus)
Cleft palate
Hypocalcemia (parathyroid hypoplasia, tetany, seizure)

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44
Q

Wiskott-Aldrich Syndrome

A

X-linked disorder caused by mutation in WASp protein

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45
Q

Wiskott-Aldrich Presentation

A

Susceptibility to infections, thrombocytopenia, eczema

Can develop malignancy, autoimmune disease

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46
Q

Wiskott-Alsdrich Treatment

A

Stem cell transplant is only curative

Prophylactic antibiotic and antiviral (bactrim+acyclovir), platelet transfusions as needed, Ig if needed

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47
Q

Ataxia-Telangiectasia Presentation

A

Don’t develop fluidity of gait, telangiectasis of conjunctiva, face and neck, swallowing problems/aspiration, malignancy (lymphomas), nystagmus
Treat each manifestation individually

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48
Q

When are the recommended well visits?

A

birth, 1 month, 2mo, 4mo, 6mo, 9mo, 12mo, 15mo, 18mo, 2years and then annually

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49
Q

What percentiles are considered Overweight, obese and underweight?

A

overweight: 85-95%
Obese: >95%
Underweight: <5%

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50
Q

What are the head size percentiles?

A

Microcephaly: <3%
Macrocephaly: >97%

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51
Q

Birthweight classifications

A

Extremely low: <1000g/2.2lbs
Very low: <1500g/3.3lbs
Low: <2500g/5.5lbs
Normal: >2500g

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52
Q

Classification of gestational age

A

Preterm: <37 weeks
Term: 37-42 weeks
Postterm: >42 weeks

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53
Q

Apgar Score

A

Key newborn assessment immediately after birth. Retested every 5 minutes until score is >7

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54
Q

Newborn Screen

A

Heel stick before discharge and at 1-2 weeks to test for metabolic and genetic diseases

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55
Q

What is vernix caseosa?

A

Cheesy white covering made from fetal corneocytes and sebaceous gland activity and risk lipid matrix

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56
Q

Milia

A

Pinpoint white papule without surrounding erythema caused by blocked sebaceous glands, disappears on its own

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57
Q

Mongolian Spot

A

Congenital dermal melanocytes; blue patches of pigment seen over lumbar area, buttocks or extremities, fade with time
Common in Asian, both Indians, Mexicans and blacks

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58
Q

Erythema Toxicum

A

Yellow eosinophilic papule on red base that appear on trunk, face and forehead on day 2-4, disappear within 1 week

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59
Q

What can abnormal fontanelles indicate?

A

Bulging: increased ICP
Sunken: dehydration
Large: hypothyroidism
Raised bony ridge: craniosynostosis

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60
Q

Cephalohematoma

A

Swelling/collection of blood over one or both parietal bones, does not cross suture line, resolves in weeks-months

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61
Q

Caput Succedaneum

A

Edema of the scalp, can cross suture lines, resolves in days

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62
Q

Epstein’s pearls

A

Small, white benign inclusion cysts typically seen on palate between 2-4months
Bohn nodules seen on gingival ridge
Resolve spontaneously

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63
Q

Ankyloglossia

A

Congenital short lingual frenulum that can limit movement of tongue and pain with nursing
Usually see a puckering of the midline tongue tip
Treat with frenotomy/frenulotomy in neonatal period

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64
Q

Congenital Torticollis

A

head tilted with chin pointing in opposite direction, results from bleeding into sternocleidomastoid during stretching process of birth, appears as firm fibrous mass within the muscle, disappears over months

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65
Q

Pectus excavatum

A

sternal depression

M>F (x3)

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66
Q

Pectus carinatum

A

Chicken breast deformity or pigeon chest

M>F (x4)

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67
Q

Findings that may indicate cardiac disease

A

Poor feeding, failure to thrive, irritability, tachypnea, hepatomegaly, clubbing, poor overall appearance, weakness

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68
Q

What is the most common dysthymia?

A

Paroxysmal supra ventricular tachycardia (PSVT)

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69
Q

Hypospadias

A

Abnormal ventral urethral placement-check for this before circumcision

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70
Q

Epispadias

A

Abnormal dorsal urethral placement-check for this before circumcision

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71
Q

What can a sacral dimple indicate?

A

Spina bifida-need to ultra sound if you can’t see the base

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72
Q

What can a single palmar crease indicate?

A

AKA simian crease

associated with trisomy 21

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73
Q

Developmental Dysplasia of the Hips risk factors

A

Breach, 1st born white female, family history, prematurity

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74
Q

Developmental Dysplasia of the Hips evaluation/Treatment

A

Audible click heard with Barlow or Ortolani

Treat with Pavlik harness and ortho eval

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75
Q

Barlow Test

A

Test for ability to sublet or dislocate intact but unstable hip-bring bent leg medial

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76
Q

Ortolani Test

A

Tests for posteriorly dislocated hip-pull bent leg laterally

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77
Q

Age for Palmar Grasp

A

birth to 3-4 months

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78
Q

Age for plantar grasp reflex

A

Birth to 6-8 months

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79
Q

Moro Reflex (startle reflex)

A

“drop” baby while holding supine, arms should flail and legs flex
Birth-4 months

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80
Q

Moro Reflex abnormalities

A

Persistence beyond 4-6 months could be neuro disease

Asymmetric response could be fractured clavicle or brachial plexus injury

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81
Q

Asymmetric Tonic Neck Reflex

A

Baby supine, turn head to one side with jaw over shoulder-arms/legs on that side extend, opposite side flex
Birth-2 months

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82
Q

Asymmetric tonic neck reflex abnormalities

A

Persistence beyond 2 months could be asymmetric central nervous system development

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83
Q

Positive Support Reflex

A

Hold baby and touch feet to surface-hips knees and ankles extend and baby stands
Birth/2 months-6 months
Lack of reflex could be hypotonia or flaccidity

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84
Q

Rooting reflex

A

Stroke personal skin at corners of mouth, mouth will open and baby will turn toward that side
Birth-3/4 months

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85
Q

Trunk Incurvation (Galant’s reflex)

A

Hold baby prone and stroke one side of back from shoulder to butt, spine will curve toward that side
Birth-2 months
Absence could be transverse spinal cord lesion/injury

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86
Q

Placing and Stepping Reflexes

A

Hold baby and have one foot touch table, that hip/knee will flex and other will step forward-alternate stepping
Birth-variable age

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87
Q

What is the most common cause of childhood blindness

A

Amblyopia

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88
Q

When do we start checking BP

A

3 year well visit unless other risk factors (kidney disease, premie, CHD, recurrent UTIs, etc)

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89
Q

When/why to screen hemoglobin?

A

for iron deficiency: 9 or 12 months

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90
Q

When/why to test for lead?

A

Ages 1-2, it could cause learning and developmental delays

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91
Q

When do we screen for autism?

A

18 and 24 months

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92
Q

Fasting Lipid screening ages/recommendations

A

Between 2-10years if risk factors present (FH of hyperlipidemia, early CV, obesity, HTN, diabetes)

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93
Q

When should first dental visit be?

A

Between 12 months-3 years

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94
Q

How long should baby be rear facing in car seat?

A

until 2 years, booster until 4’9”

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95
Q

1 month Milestones

A

fix/follow, some head control, responds to noises spontaneous smile

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96
Q

2 month Milestones

A

Responsive smile, coos, lifts head when prone, follows to midline

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97
Q

4 month Milestones

A

Rolls from tummy to back, good head control, laughs, follows past midline, grasps object

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98
Q

6 month Milestones

A

Sits with support, bears weight on legs, reaches for toys, follows 180 degrees, separation anxiety

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99
Q

9 month Milestones

A

Crawls, says mama/dada, pincer grasp, responds to name, pulls up/walks on furniture

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100
Q

12 month Milestones

A

Can start walking, self feeds with fingers, waves, points

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101
Q

15 month Milestones

A

3-6 words, walks well, climbs stairs, imitates

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102
Q

18month Milestones

A

Some 2 word phrases, scribbles, follows simple commands, uses spoon/fork, runs/walk backwards

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103
Q

24 month Milestones

A

20-50 words, kicks ball, build with blocks, 50% speech understandable

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104
Q

Vaccines at 2 and 4 months

A

RV, Tdap, Hib, PCV13, IPV (polio)

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105
Q

Hep B Vaccine Schedule

A

3 doses: at birth, 1-2 months, 6-8 months

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106
Q

Hep B Vaccine Contraindications/AEs

A

Severe yeast allergy

Can cause fever, injection site pain

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107
Q

Rotavirus Vaccine Schedule

A

Live oral vaccine- 2, 4 and 6 months

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108
Q

Rotavirus Vaccine Contraindications/AEs

A

History of intussusception, infant with SCID, mod-severe gastro
AEs: increased risk of intussusception, vommiting and diarrhea, cough, runny nose

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109
Q

Tdap Vaccine Schedule

A

5 total-2, 4, 6, 15/18 months and 4 years

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110
Q

Tdap Vaccine Contraindications/AEs

A

Encephalopathy, unstable neurological disorders, high fever with previous vaccine
AEs: swelling and redness at sire, fever

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111
Q

HIB Vaccine Schedule

A

4 total- 2, 4, 6, 12/15 months

112
Q

HIB Vaccine Contraindications/AEs

A

<6 weeks, previous allergic reaction

AEs: redness or pain at site

113
Q

PCV13 Vaccine Schedule

A

4 total-2, 4, 6, 12/15 months

114
Q

PCV13 Vaccine Contraindications/AEs

A

Previous allergic reaction, current illness

AEs: fever, local reaction, irritability, decreased sleep, possible febrile seizure

115
Q

IPV Vaccine Schedule

A

4 total-2, 4, 6-18 months and 4 years

116
Q

IPV Vaccine Contraindications/AEs

A

Previous allergic reaction, current illness, pregnancy

AEs: local redness/pain

117
Q

MMR Vaccine Schedule

A

2 at 12-15months and 4 years

118
Q

MMR Vaccine Contraindications/AEs

A

Pregnant, immunocompromised, egg allergy

AEs: Fever, transient morbilliform rash, Guillan-barre

119
Q

Varicella Vaccine Schedule

A

12-15 months and 4 years

120
Q

Varicella Vaccine Contraindications/AEs

A

Pregnancy, previous allergic reaction

AEs: injection site reactions/rashes

121
Q

Hepatitis A Vaccine Schedule

A

12 and 18 months (must be 6 months between)

122
Q

Hep A Vaccine Contraindications/AEs

A

Pregnancy/illness, previous allergy

AEs: injection site reaction

123
Q

Crackles/rales

A

Predominantly on inspiration
Scratchy
Bronchiolitis, pulm edema, pneumonia, asthma

124
Q

Rhonchi

A

Continuous low pitch

Pneumonia, cystic fibrosis

125
Q

Viral Croup Etiology/Presentation

A

Parainfluenza virus

Inspiratory stridor, hoarseness and barking seal-like cough, “steeple sign” on xray

126
Q

Viral Croup Treatment

A

Mild: Supportive therapy, cool mist
Moderate: Corticosteroids (dexamethasone 0.6mg/kg IV), nebulized epinephrine

127
Q

Epiglottitis Etiology/Presentation

A

EMERGENCY
Dysphagia, drooling, distress, tripod posture, sudden onset of high fever, stridor (don’t use tongue blade)
H flu

128
Q

Epiglottitis Treatment

A 
Airway support (ET tube if possible)
Antibiotics (ceft+vanco)
129
Q

Bronchiolitis Etiology/Presentation

A

RSV

Patients <2years, premie, lower res symptoms with wheezing and crackles; peaks in Jan/Feb

130
Q

Bronchiolitis Treatment

A

Symptomatic-O2 if needed, hydration, nutrition, nasal suctioning, mechanical ventilation if necessary

131
Q

Respiratory Syncytial Virus (RSV) Presentation

A

Congestion with lots of mucus, crackles, prolonged expiration, wheezing, retractions, hyperinflation and peribronchial thickening on xray
Peaks in Jan-feb

132
Q

RSV Treatment

A

Ribavirin if immunocompromised
Palivizumab for prophylaxis
Otherwise supportive (fluids, resp support)

133
Q

What is the most common cause of respiratory distress in premies?

A

Respiratory distress syndrome/hyaline membrane disease

134
Q

Respiratory distress syndrome

A

Deficiency of surfactant production and surfactant inactivation by protein leak into airspaces, causes hypoxia, pulmonary edema

135
Q

Respiratory distress syndrome Risk Factors and Treatment

A

Prematurity (esp if <28 weeks), maternal diabetes/old age

Treat with respiratory support, steroids and surfactant replacement

136
Q

Pneumonia Causes by Age

A

Viral if <5 years (RSV<1 year, parainfluenza 2-5 years)

Bacterial >5 years (s. pneumoniae)

137
Q

Most common cause of afebrile infant pneumonia?

138
Q

Atypical Pneumonia causes

A

Mycoplasma or chlamydia

More common >5

139
Q

Pneumonia Bacterial vs Viral

A

Bacterial: consolidation in lobar distribution
Viral: interstitial or peribronchial infiltrates

140
Q

Pneumonia Treatment

A

Admit if <3-6 months or hypoxemic

Amoxicillin 90 mg/kg BID x10 days

141
Q

Pertussis Etiology/Presentation

A

Bordetella Pertussis
3 phases: phase 1-catarrhal URI symptoms and fever for 1-2 weeks
Phase 2: paroxysmal (2-6 weeks) whooping cough, post-tutsis emesis
Phase 3: Convalescent (weeks-months) gradually resolving cough

142
Q

Pertussis Treatment

A

Want to treat in Phase one (catarrhal)

Macrolides or TMP-SMX, prophylaxis for household

143
Q

Pertussis Gold Standard Diagnostic

A

PCR and culture of nasal secretions

144
Q

Cystic Fibrosis Etiology/Presentation

A

Most commonly H flu or staph aureus early, pseudomonas later in life
High salt content in sweat glands (hallmark), recurrent sinus/ear infections, nasalpolyps

145
Q

What is the most common life-threatening genetic disease in whites?

A

Cystic fibrosis

146
Q

Cystic Fibrosis Treatment

A

airway clearance (respiratory failure is most common cause of death), managed by specialist

147
Q

Special treatments in CF

A

Treat respiratory infections/cough early, they’re succesptible to infection
Salty snacks and lots of water to prevent hyponatremic dehydration

148
Q

What neuro diseases are static?

A

Congenital abnormalities or brain injury (cerebral palsy)

149
Q

Which neuro diseases are progressive?

A

degenerative disease or neoplasms

150
Q

Which neuro diseases are intermittent?

A

Epilepsy or migraine syndromes

151
Q

Saltatory neuro diseases

A

Bursts of symptoms followed by partial recovery

Vascular or demyelinating disorders

152
Q

Indications of spina bifida

A

tufts of hair, lipomas, dimpling

153
Q

What can accelerating/decelerating head growth patterns indicate?

A

Accelerating: hydrocephalus
decelerating: degenerative neurologic disorder

154
Q

What does abnormal head shape indicate?

A

Craniosynostosis (premature suture closure

155
Q

When do the posterior and anterior-lateral fontanelles close?

A

post: 2 months

ant-lat: 3 months

156
Q

Signs of lower motor neuron lesions

A

Flaccid paralysis, absent reflexes (lowers everything), weakness
Fasciculations present

157
Q

Signs of upper motor neuron lesions

A

Spastic paralysis, increased reflexes (increases everything), stiffness
NO fasciculations

158
Q

What is the most common cause of headaches in kids?

A

Strep (URI)

159
Q

Life threatening causes of headache

A

meningitis, encephalitis, cerebral abscess, subarachnoid hemorrhage, increased ICP

160
Q

What is the most concerning headache pattern?

A

chronic progressive (usually increased ICP- pseudotumor cerebri, brain tumor, hydrocephalus, etc)

161
Q

Pediatric Migraine symptoms

A

pounding/throbbing for 2-72 hours, received by sleep, N/V, phono/photophobia, abdominal pain

162
Q

Migraine Management in kids

A

NSAIDs, acetaminophen, triptans, antiemetics

163
Q

Migraine prophylaxis

A

Under 6: cryproheptadine

Over 6: propranolol, amitriptyline, topiramate

164
Q

Pseudotumor cerebri

A

idiopathic intracranial hypertension, increased ICP without space occupying lesion or obstruction, usually in 11+year olds

165
Q

Presentation of Pseudotumor Cerebri

A

headache, blurred vision, diplopia, vision loss, papilledema

166
Q

Diagnosis of pesudotumor cerebri

A

Must rule out all other causes of ICP, imaging before lumbar puncture

167
Q

Treatment of pseudotumor cerebri

A

Acetazolamide, topiramate, optic nerve sheath fenestration, CSF shunt, decreased salt intake

168
Q

Cerebral Palsy

A

Non-progressive motor and postural dysfunction resulting from brain injury or malformation

169
Q

4 classifications of Cerebral Palsy

A

Spastic (most common, UMN lesions), athetoid/dyskinetic, ataxic (most rare), atonic

170
Q

Treatment goals of cerebral palsy

A

social/emotional development, communication, education, nutrition, mobility, max independence

171
Q

Spina bifida

A

neural tube disorder associated with folic acid

defective closure of caudal neural tube in gestation

172
Q

Most common type of spina bifida

A

Spina bifida occults-skin intact but defects in bone and spinal canal, may have sinus tract, dimple or tuft of hair

173
Q

Prevention and treatment of spina bifida

A

Prevent with folic acid supplementation

Treat with surgical closure, VP shunt, supportive therapy

174
Q

Chiari Malformation

A

Anomaly of cerebellum, brainstem and craniocervical junction with downward displacement of cerebellum alone or with lower medulla into spinal canal

175
Q

Chiari 2 Malformation

A

Most common- syringiomyelia, myelomeningocele, herniation of cerebellar tonsils

176
Q

Hydrocephalus Presentation

A

Looking down, headache, vomiting, altered mental status, visual changes, increased head circumference, bulging anterior fontanelle, abnormal skull contour, papilledema

177
Q

Treatment of Hydrocephalus

A

symptomatic (diuretic, acetazolamide), surgery (remove obstruction, VP shunt)

178
Q

Spinal muscular atrophy Diagnosis

A

Homozygous deletion of exon 7 of SN1

179
Q

Spinal muscular atrophy

A

Progressive weakness of lower motor neuron with progressive proximal weakness, decreased spontaneous movement and floppiness (loss of head control and leg movement, decreased facial expression/drooling, but normal mental social and language skills and preserved sensation)

180
Q

Diagnosis of spinal muscular atrophy

A

DNA testing (homozygous deletion of exon 7 of SN1), EMG, muscle biopsy

181
Q

Treatment of spinal muscular atrophy

A

symptomatic to improve flexibility, prevent infection, maintain social, language and intellectual stimulation

182
Q

Guillain Barre Syndrome Causes

A

Respiratory or GI infection (campylobacter jejunii)

183
Q

Guillain Barre Presentation

A

Ascending weakness, refusal to walk/leg pain in kids, loss of reflexes

184
Q

Treatment of Guillain Barre

A

IVIG, plasmapheresis

May have residual parasthesia, fatigue and limb weakness

185
Q

Duchenne Muscular Dystrophy Presentation

A

X-linked-boys only with awkward gait, gowers sign

Starts in proximal extremities moves distal (in lower then upper)

186
Q

Duchenne Muscular Dystrophy Diagnosis

A

Muscle biopsy, EMG, serum CK levels (10-20x upper limit), genetic testing

187
Q

Duchenne Muscular Dystrophy Treatment

A

Glucocorticoids, pulmonary and cardiac follow up

188
Q

Neurofibromatosis

A

Genetic disorder where nerve tissue grows tumors that cause nerve/brain damage

189
Q

2 types of Neurofibromatosis

A

Type 1 more common-autosomal dominant (chromosome 17), more peripheral, skin and brain
Type 2 autosomal dominant (chromosome 22), more severe, sinal cord abnormalities, central type

190
Q

Neurofibromatosis Type 1 Presentation

A

Cafe-au-lait spots, Neurofibromas, CNS tumors

191
Q

Neurofibromatosis Type 1 Treatment

A

Surgical removal of tumors, genetic counseling/screening

192
Q

Neurofibromatosis Type 2 Presentation

A

Bilateral vestibular schwannomas, no cafe-au-lait spots

193
Q

Whats the most common neurologic disorder infants and young kids?

A

Febrile seizure

194
Q

Febrile Seizure Presentation

A

Younger then 5years, generalized seizure <15 minutes, high fever (>104)

195
Q

2most common viruses in febrile seizure

A

HHV-6 and influenza

196
Q

Treatment of febrile seizure

A

IV benzos, if no IV access then buccal midazolam

197
Q

Common pathogens in bacterial conjunctivitis

A

S pneumoniae, H flu

in newborns: chlamydia

198
Q

Pathogens causing viral conjunctivitis

A

Adenovirus

199
Q

Most common pathogen of Periorbital cellulitis

A

S aureus and S pyogenes

200
Q

Periorbital symptoms and Treatment

A

redness and swelling, pain, mild fever; NORMAL vision and EOMs
oral/systemic antibiotics (augmentin)

201
Q

Orbital Cellulitis Pathogen, Symptoms and Treatment

A

Staph/strep (s aureus)
Pain w/ EOMs, proptosis, decreased vision
Treat with IV antibiotics and emergent ophtho consult

202
Q

Kawasaki Disease

A

Widespread inflammation of arteries including coronaries-leading cause of acquired heart disease in kids in US

203
Q

Presentation of Kawasaki Disease

A

Fever longer than 5 days, bilateral conjunctivitis, cracked lips, strawberry tongue, perineal rash that spreads, lymphadenopathy

204
Q

Treatment of Kawasaki Disease

A

IVIG and aspirin (the only time we’ll use aspirin in babies!)

205
Q

Complications of Kawasaki Disease

A

Coronary artery aneurysms (MI, stroke, sudden death)

206
Q

Dacryostenosis

A

Nasolacrimal duct obstruction, causes persistent tearing and discharge

207
Q

Dacryocystitis

A

Infection of dacryostenosis (Staphs/streps), treated with IV antibiotics if severe

208
Q

Strabismus

A

Misalignment of the eyes, can cause or be due to amblyopia

209
Q

Treatment of acute otitis media

A

Younger than 2-amoxicillin 90mg/kg BID

Over 2, observe unless high fever, bilateral or >48 hours

210
Q

Treatment of otitis media with tubes

A

Fluoroquinolone (Cipro) drops +/- corticosteroid

211
Q

Otitis Externa Treatment

A 
Antibiotic drops (ciprodex)
if perforated use FQ suspension
212
Q

Allergic Rhinitis Presentation

A

Allergic shiners/salute, blue/boggy mucosa, cobblestoning of pharynx, clear rhinorrhea

213
Q

Allergic Rhinitis Treatment

A

Intranasal steroids (Flonase >4, nasacort >2), antihistamines (if older than 6 months)-diphenhydramine

214
Q

Sinusitis Presentation

A

10-14 days of URI symptoms without improvement, purulent nasal discharge, dental pain

215
Q

Sinusitis Pathogen/Treatment

A

H flu, (S pneumoniae if bacterial)

Augmentin/amoxicillin 90mg/kg BID if bacterial, if viral then symptomatic

216
Q

Pharyngitis Causes

A

Viral is most common (adenovirus, rhino, coxsackie)

Bacterial: group A strep

217
Q

Viral Pharyngitis Presentation/Treatment

A

Red throat, fever, congestion, fatigue, swollen cervical nodes
Treat with analgesics, fluids, rest (symptomatic)

218
Q

Epstein Barr Virus (mono) Presentation

A

Exudative tonsillitis, cervical lymphadenopathy, splenomegaly

219
Q

Epstein Barr Treatment

A

Spleen precautions (no sports6-8 weeks), fluids, airway support, analgesics, steroids

220
Q

Bacterial Pharyngitis Presentation

A

Abrupt onset, headache, nausea, rash, sore throat, palatal petechiae, exudative tonsillitis
if <3-nasal congestion, low fever, an cervical lymphadenopathy

221
Q

Bacterial Pharyngitis Diagnosis/Treatment

A

Gold standard is throat culture, otherwise rapid antigen

Treat with Penicillin>amoxicillin, if allergic then ceft or clindamycin

222
Q

Acute Rheumatic Fever Presentation

A

2-3 weeks post strep- Major: migrating poly arthritis, carditis/valvulitis, chorea, erythema marginatum, subQ nodules
Minor: arthralgia, fever, elevated CRP/ESR, prolonged PR interval
2 major+1 minor

223
Q

1 cause of acquired valve disease

A

rheumatic heart disease

224
Q

Diagnosis and Treatment of Acute rheumatic fever

A

ASO titers with neg strep antigen

Amoxicillin, aspirin, evaluate for carditis

225
Q

Post-streptococcal glomerulonephritis Presentation

A

Edema, hematuria (tea colored urine), proteinuria, hypertension
ASO titer positive

226
Q

Post-strep glomerulonephritis Treatment

A

Self limited, can use diuretics for prolonged htn and edema

227
Q

Peritonsilar Abscess Cause/Presentation

A

S. pyogenes

Hot potato voice, truisms (neck pain/stiffness), deviated uvula, resp distress, drooling, pain with swallowing

228
Q

Treatment of Peritonsillar abscess

A

Airway management, surgical I and D, antibiotics

229
Q

Coxsackie Virus Presentation

A 
Hand, foot and mouth
oral lesions (herpangina), vesicular rash on hands and feet, low fever, sore throat
230
Q

Coxsackie Virus Treatment

A

supportive

231
Q

Herpetic Gingivostomatitis Presentation/Treatment

A

fever, sleeplessness, headache, ulcerated lesion that bleed

Treat with acyclovir, hydration, NSAIDs

232
Q

Measles Presentation

A

Conjunctivitis, coryza, cough, kopek spots, maculopapular blanching rash starting on face

233
Q

Measles Diagnosis and Treatment

A

IgM assay

Supportive treatment, report to health department, prevent spread

234
Q

Mumps Presentation/Treatment

A

Parotitis (tender, swelling, earache), orchitis/oophoritis w/ fever, pain and swelling
Supportive treatment, prevent spread

235
Q

Rubella Presentation/Treatment

A

Fever with post auricular and occipital adenopathy, rash starts on face, disappears in 3 days
Can cause purpuric “blueberry muffin” rash at birth
Supportive treatment

236
Q

Diaper Candidiasis Presentation/Treatment

A

“Beefy red” erythema with satellite lesions, involves skin folds
Treat with clotrimazole or nystatin-NO STEROIDS!

237
Q

Cradle Cap

A

Greasy, yellow scales on scalp-basically baby dandruff

Treat with emollient, remove scales with soft baby brush or toothbrush, topical steroid or ketoconazole if severe

238
Q

Impetigo Cause/Treatment

A

Honey colored crusts, usually on face/extremities
S aureus or strep
Treat with mupirocin (bactroban)

239
Q

Innocent Murmurs

A

Still’s murmur, venous hum murmur, peripheral pulmonary stenosis

240
Q

What is the most common innocent murmur

A

Still’s murmur

241
Q

Still’s Murmur

A

Normal EKG
Low frequency, musical, vibratory sound, loudest in supine and stress, changes intensity with sitting
Outgrow with age

242
Q

Venous Hum Murmur

A

Continuous (R/diastolic>L/systolic), heard at the base, loudest when upright, decreased supine or turning neck

243
Q

What is the most common congenital abnormality causing morbidity/mortality in 1st year?

A

CHD (congenital heart defect)

244
Q

Acrocyanosis

A

Benign variant of peripheral cyanosis with normal pulse, goes away within hours

245
Q

Patent Ductus Arteriosus

A

Stays open for a few hours to mix blood, closes functionally at 12-90 hours, closes anatomically at 2-3 weeks

246
Q

Blue Baby

A

Right to left shunt/obstruction to lungs
PDA is closing early due to CHD
Cyanotic, low oxygen saturations/pulmonary blood flow

247
Q

Grey Baby

A

No mixing of blood-poor perfusion (no pulse or cap refill), PDA is closed (needs prostaglandins to open it), lactic acidosis

248
Q

Purple Baby

A

PDA potency open

249
Q

Types of Congenital Heart Defects

A

Acyanotic (volume issue)
Cyanotic
Obstructive
Complex heart/single ventricle

250
Q

Acyanotic Heart Defects

A

Left to right shunt, volume overload
ASD: R ventricular overload
VSD, PDA, AV: L ventricular overload
No prostaglandins!

251
Q

Symptoms of left to right shunts

A

Tachypnea, poor feeding/failure to thrive, exercise intolerance, poor growth
Large ASDs asymptomatic

252
Q

Atrial Septal Defect Exam Findings

A

Fairly common
Precordial bulge
Fixed split of S2 with grade 2-3 systolic ejection murmur at LUSB with diastolic rumble at RLSB
EKG might show right axis deviation and right ventricular conduction delay

253
Q

Atrial septal defect treatment

A

Observation, usually closes in first few years

Surgery if needed

254
Q

What is the most common congenital heart defect?

A

Ventricular septal defect

255
Q

Ventricular Septal Defect

A

Can cause CHF
Small defect: holosystolic murmur
Large defect: diastolic murmur of aortic regurge with apical diastolic rumble
EKG may have RVH and LVH, xray may show cardiomegaly

256
Q

CHF Symptoms

A

Diaphoresis with feeding, failure to thrive, hepatomegaly

257
Q

Patent Ductus Arteriosus Presentation

A

Most commonly newborns
Continuous machinery-like murmur at LUSB/axilla with diastolic rumble, bounding pulses with wide pulse pressure, CHF, diaphoresis with feeding
Major cause of cyanosis with lower extremity saturations lower than uppers-pulse-ox screening in US in RUE and LLE

258
Q

Patent Ductus Arteriosus Treatment

A

Younger child: NSAIDs and prostaglandins

In older child: coil/device occlusion and ductal ligation

259
Q

Cyanotic Heart Defects

A

Tetralogy of fallot
Transposition of great arteries
Trunctus arteriosus
Require prostaglandins to treat!

260
Q

Tetralogy of Fallot

A

Most common cyanotic defect

Comprised of 4 abnormalities: VSD, PS/RVOT obstruction, overriding aorta, RVH

261
Q

Tetralogy of Fallot Presentation

A

Harsh systolic LUSB
Cyanosis
Boot shape on chest xray

262
Q

TET Spell

A

Cyanotic spell of baby with Tetralogy of Fallot-spasm of RVOT infundibular muscle; loss of murmur, cyanotic
Keep baby calm, give oxygen

263
Q

Transposition of the Great Arteries (TGA)

A

State of parallel circulation-oxygenated blood recirculated through lungs>hypoxemia and acidosis-imminent death unless theres a PFO, VSD or PDA

264
Q

TGA Treatment

A

Arterial switch operation

265
Q

Truncus Arteriosus

A

Heart failure symptoms in first few weeks of life, diagnosed with echo, treated with surgery

266
Q

Obstructive Heart Defects

A

Obstruction to pulmonary blood flow (pulmonary stenosis), and systemic blood flow (coarctation of aorta, aortic stenosis)
All cyanotic and need prostaglandins to treat

267
Q

Pulmonary Stenosis Presentation

A

Harsh systolic ejection murmur at LUSB with click
EKG shows RVH
Treated with balloon valvuloplasty

268
Q

Coarctation of Aorta

A

Narrowing of aortic isthmus
Systolic murmur at precordium, decreased lower extremity pulses, blood pressures off by 20mmHg
Associated with Turner Syndrome
Treated with prostaglandins

269
Q

Aortic Stenosis

A

Systolic ejection murmur at RUSB with a click
EKG and echo shows LVH
Treated with prostaglandins, sx, balloon valvuloplasty

270
Q

Hypoplastic Left Heart Syndrome

A

Complete mixing of blood in atria with obstruction of pulmonary or systemic blood flow
Treated with 3 stages

271
Q

12 categories of Cardiac screening

A 
1-Exertional chest pain/discomfort
2-unexplained syncope
3-excessive dyspnea/fatigue
4- prior heart murmur
5-^systemic BP
6- fam hx of early death
7-fam hx of disability from heart disease
8- fam hx of cardiac conditions
9- heart murmur on exam
10- check femoral pulses
11- check for marfans
12- brachial BP
272
Q

What are the highest risk sports?

A

Basketball, track, football

273
Q

What does Europe include in cardiac screening that US does not?

A

EKG! (echo isn’t recommended either)

274
Q

Hypertrophic Cardiomyopathy

A

Autosomal dominant
Abnormal stiffness of LV with impaired diastolic filling, preserved systolic functioning
Restrict from sports
EKG shows LVH and inverted t waves

275
Q

Marfan’s Syndrome Complications

A

Aortic root dilation or rupture, mitral valve prolapse

276
Q

Commotio Cordis

A

Blunt force trauma to chest in from of heart

277
Q

Pediatric Dyslipidemia

A

Screen between 9-11, can start statins as young as 10

Clinical Disciplines (4 decks)

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