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Peds Flashcards

1
Q

streptococus occurs secondary infection with

A

GRoup A strep

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2
Q

symptoms for mono

A

fever, tonsillar enlargement and exudates, cervical lymphadenopathy, and fatigue

  • *posterior cervical adenopathy (differentiate b/w this and strep)
  • *possible generalized lymphadenopathy
  • **splenomegaly ((not happen with strep))
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3
Q

Symps for strep

A

fever, tonsillar enlargement and exudates, cervical lymphadenopathy, and fatigue

*tender bilateral anterior cervical adenopathy (differentaite b/w this and mono

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4
Q

what medication do we avoid with MONO (if mistaken for strep) and what happens if administered

A

amoxicillin

-maculopapular rash

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5
Q

DX test done for Mono

A

heterophile antibody test aka mononuclear spot test

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6
Q

Bronchiolitis pathogen causes

  • when to refer?
  • s/s
A 
RSV MC 
Hameohpilous influenza 
Rhino 
Ecovirus 
Flu

S/S: 
tachypnea 
cough 
wheezing 
mild fever

TX:

  • fluids (textbook)
  • nebulizer (dr. georgy)
  • *when to refer to ER:
    1. <3 MO
    2. sp02 under 92
    3. RR >70
    4. any underlying disease
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7
Q

1) inability to retract foreskin
2) inability to reduce foreskin to anatomical position
* *which is the emergency

A

1) phimosis

2) paraphimosis–>EMERG

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8
Q

phimosis

  • s/s
  • tx
A

urinary outlet obstruction, glans ischemia, and infarction

TX
hygiene, 
topical steroids, 
dorsal slit (if signs of ischemia), 
circumcision
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9
Q

CROUP

  • mc age groups
  • pathogen
  • tx for mild, mod, severe (and s/s)
A

MC b/w 6MO-36MO—uncommon >6YO
parainfluenza virus

MILD: symptomatic tx, single dose of PO/IM/IV dexamethasone,
MOD: nebulized epi, single dose PO/IM/IV dexamethasone,
SEV:
*barking cough, stridor at rest, marked retractions, and significant distress and agitation
*tx: inpt admission, single dose PO/IM/IV dex, neb epi

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10
Q

fever, malaise, rash, cough, coryza, and conjunctivitis

A

measles

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11
Q

incubation period for measles

A

6-19 days

MEDIAN 13

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12
Q

period of contagiousness measles

A

5 days before onset of rash-four days after appearance of rash

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13
Q

rash for measles–where does it start and then spread to

-other pathopneumonic PE finding found

A

starts on forehead/head—>towards trunk—>feet

red spots with blue or white center on buccal mucosa (Koplik spots)

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14
Q

Kawasaki

  • affects?
  • s/s—which is last to show up?
  • lab findings
  • tx
  • comps
A

affects medium sized BVs—>like coronary arteries

S/S: fever lasting more than 5 days, bilateral nonexudative conjunctivitis, mucositis with fissured lips and a “strawberry tongue”, and edema of the dorsal aspect of the hands and feet (LAST to show up). +/- rash
+/- lymphadenopathy

Labs: elevated inflammatory markers and reactive thrombocytosis

TX:

1) IVIG + ASA
2) need complete cardiac WU + cardiac monitoring

COMPS

  • MI
  • HF
  • coronary artery aneruysm
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15
Q

Adenovirus can cause

A

***common cause of febrile illness + self limiting

  • conjunctivitis
  • Tonsilitis
  • OM
  • Gastroenteritis
  • Pnma
  • cystitis
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16
Q

what can present with strawberry tongue

A

Kawasaki

Scarlet fever

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17
Q

uncontrolled high fever* think what?

A

kawasaki

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18
Q 
ophthalmia neonatorum
-cause?
-s/s
-dx
tx
A
  • aka neonatal conjunctivits
  • MCC=gonorhea during vaginal delivery

S/S: conjunctivitis and discharge typically begins in the first two to five days after birth
*****chlamydia starts to show later like 5 days-5 weeks

dx= culture

tx–> IV ceftriaxone

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19
Q

What is a common side effect of ceftriaxone in neonates?

A

hyperbilirubinemia

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20
Q

TOC for neonatal conjuncitvitis due to chalmydia

A

erythromycin PO

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21
Q

In the neonatal period, the most likely cause of lower gastrointestinal bleeding is

A

swallowing maternal blood

either from delivery or cracked nipples during breastfeeding

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22
Q

Meckle diverticulum MC at what age?

s/s?

A

painless hematochezia

2 years old——-rules of 2

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23
Q

What is the most common cause of neonatal hemorrhage?

A

Failure to administer vitamin K in the immediate postpartum period (associated with home births).

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24
Q

Barlow test vs Ortolani Test descriptions

A

BARLOW:
1) flex and ADDuct hips

ORT:
-abduction hips

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25
MC pathogens for OM
- strep pneumoniae - Haemophilus ***** - Moraxella catarrhallis
26
What is the first-line antibiotic treatment for uncomplicated acute otitis media? *according to ROSH*`
High-dose amoxicillin at 80–90 mg/kg/day. | ****according to rosh******
27
tx for recurrent or persistent OM
augmentin | PCN allergy: Clinda + Cefixime or Cedinifir
28
stage 1 acne
small, inflammatory bumps from clogged pores - Open comedones (blackheads): incomplete blockage - Closed comedones (whiteheads): complete blockage
29
stage 2 acne
Stage II: Inflammatory: papules or pustules surrounded by inflammation
30
stage 3
: Nodular or cystic acne: heals with scarring
31
how to differentiate between acne and rosacea
rosacea does not have comodomes
32
Treatment for acne - mild - mod - severe
MILD--->topical – azelaic acid, salicylic acid, benzoyl peroxide, retinoids, Tretinoin topical (Retin A) or topical antibiotics [Clindamycin or Erythromycin with Benzoyl peroxide] MOD--->above + oral antibiotics [Minocycline 50mg PO qd or Doxycycline 100 mg PO qd], spironolactone SEVERE---->e (refractory nodular acne): oral Isotretinoin 0.5-1.0 mg/kg/d BID x15-20 weeks Isotretinoin: affects all 4 pathophysiologic mechanisms of acne • Adverse effects: dry skin and lips (MC), highly teratogenic, increased triglycerides & cholesterol, hepatitis
33
4 main pathophys for acne
4 main factors – follicular hyperkeratinization with plugging of sebaceous ducts, increased sebum production, Propionibacterium acnes overgrowth within follicles, & inflammatory response
34
mcc of bronchiolitis
RSV
35
acute bronchiolitis - age range - s/s - dx how and findings
clinical syndrome mc <2 YO S/S: * *fever, cough, and respiratory distress (eg, increased respiratory rate, retractions, wheezing, crackles). * *often occurs following a 1 to 3 day history of an upper respiratory tract infection ``` XR: -hyperinflation -peribronchial thickening - TX -most of the time self limiting--esp in healthy kids -supportive ```
36
Children develop clinical signs of dehydration during progression to ___-____% loss of body weight.
3-9%
37
other name for croup
Laryngotracheitis
38
SE isotretinoin
causes dry lips, liver damage, increased triglycerides/cholesterol, pregnancy category X
39
treatable causes of alopecia
thyroid--TSH anemia ---CBC autoimmune---ANA
40
TX alopecia
Topical: Minoxidil/Rogaine 2%, %5; *hair loss first before regrowth Finasteride 1mg ⇒ inhibits T and DHT Spironolactone ⇒ blocks DHT
41
flexor surfaces
atopic dermatitis - AC and popliteal folds - wrist - hands - feet
42
extensor surfaces
Psoriasis | -elbow
43
what type of hypersensitivity is atopic dermaitits
1 IGE mediated ****atopic individuals--- asthma
44
burns caused by acid s/s
coagulation, necrosis, eschar; irrigate
45
burns caused by alkaline s/s
liquefaction necrosis, deep damage
46
first degree burns
Erythema of involved tissue, skin blanches with pressure, the skin may be tender **sunburn
47
2nd degree burns | -
partial thicknes | Skin is red and blistered, the skin is very tender
48
3rd degree
full thickness | Burned skin is tough and leathery, skin non-tender
49
4th deg burn
Into the bone and muscle
50
allergic contact dermatitis type of hypersensitivity | -exs
4 * *poison ivy * *nickle
51
tx for diaper rash
TX: Keep area dry to allow airflow Barrier creams zinc oxide/petroleum jelly Candidiasis: Nystatin, Clotrimazole, Econazole x 2 wks. Discuss proper diaper changes, disposable, avoid tight-fitting
52
``` Young women. Papulopustular, plaques, and scales around the mouth Lip margin (vermillion border) is spared ```
perioral dermatitis
53
tx for perioral dermatitis - mild - moderate
TX: Topical metronidazole, avoid steroids ``` Mild: topical ALONE 1st line Topical Pimecrolimus 0.1% Erythromycin solution q12h Metronidazole 0.75% gel q12h Clindamycin lotion q12 hours Oral ABX: Doxycycline if necessary - no gels, solutions, or lotions on eye ``` Moderate: topical + oral ABX
54
what drug is not effective for dermatophyte infections aka any tinea
nystatin
55
RF for devleop hip dysplasia
- female - breech **** - fam hx ***** - firstborn - oligohydraminos - race----less common in black ****
56
clinical dx of AOM
1. bulging TM or 2. other s/s of inflammation----erythema, fever, ear pain, middle ear infussion
57
MC bugs for AOM
Strep pneumoniae 25% H influenzae 20% M catarrhalis 10%
58
define recurrent AOM
3 episodes in 6 MO or 4 in 12 with clearings in b/w
59
tx for AOM and age groups and duration - kids - adults
1. high dose amoxicillin or Augmentin or cephalosporin (PCN allergic) * ** <6 MO- up to 6 MO 2. Azithromycin or clarithromycin in kids who have immediate hypersensitivity rxn or delayed rxn to amoxicillin or other beta-lactam agents UNDER 2--- 10 days OVER 2--- 5-7 days adults--> Augmenetin PO 5-7 days -cant tollerate augmenitn-- then just use amoxicillin
60
tx for recurrent AOM
tympanostomy, tympanocentesis, myringotomy
61
complications from AOM
mastoiditis, bullous myringitis
62
Acute Pharyngotonsilliits - s/s - Mc bugs
***NO COUGH ***NO RHINORRHEA +fever MC viral--> Adenovirus mc *mononucleosis: EBV, fever, sore throat, lymphadenopathy, splenomegaly, + heterophile aggulintation test STREP * Group A hemolytic streptococci * **not suggestive of strep= coryza, hoarseness and cough
63
Centor Criteria
1. no cough 2. exudates 3. fever > 100.4 F 4. cervical lymphadenopathy 3 out of 4---->get rapid strep test sensitivity >90%
64
TX for pharyngitis | *all bugs
STREP * Penicillin first line * azitrhomycin if penicillin allergic VIRAL= supportive MONO= supportive, avoid sports (three weeks from onset), amoxicillin or ampicillin can cause rash FUNGAL * clortrimazole * miconazole * nystatin GONORRHEA * IM ceftriaxzone 250 mg * azitrhomycin
65
comps of strep pharyngitis
rheumatic fever | glomerulonephritis
66
how long to use intranasal decongestants and for why
no more than 3-5 days | can cause rhinitis medicamentosa
67
mcc of viral conjunctivitis mcc for bacterial Newborns? do what test for it
adenovirus bacterial * s. pneumonia * s aureus (common) NEWBORN *chlamydia----- do a Giemsa stain-->inclusion body, scant mucopurualt discharge
68
cobbelstone mucosa on inner/upper lid
allergic conjuncivitis
69
Bacterial conjuncivitis tx - non contact users - contact users
0.5 inch (`1.25 cm) of ointment or 1-2 drops 4x daily for 5-7 days of: NON CONTACT 1. Gentamicin/tobramycin (TOBREX) * *aminoglycoside abx for gram- coverage * most cases will respond to this 2. Erythromycin oinment (E-MYCIN) 3. Trimethoprim and polymyxin B (POLYTRIM) 4. Ciprofloxacin (CILOXAN) CONTACT USERS **pseudomonas TX=fluoroquinolones ---ciprofloxacin/Ciloxan drops * *Neisseria= prompt referral * chlmydial= systemic tetracycline or erythromycin x3 weeks
70
when do you give HIB vaccine
2 4 6 12-15 MO
71
3 D's of eppiglottitis
drooling dysphagia resp Distress
72
what is this
thumbprint sign | epiglottitis
73
if outpatient tx is option for stable epiglottits what is tx
ceftriaxone
74
anterior causes of nosebleed and four aspects of the area posterior causes of bleeds
kesselbach's plexus/Littles area ---- MC Site 1. anterior ethmoid 2. superior labial 3. sephnopalatine 4. greater palatine Woodruff's plexus -sphenopalatine
75
OM with effusion | -define
***middle ear fluid that is NOT infected -also called serous, secretory or nonsuppurative OM -precedes development of AOM or follows resolution **very common in young kids--> 90% will get it before school age MC 6MO-4 YO
76
effusion + fever + ear pain with bulging + erythema of TM
ACUTE om
77
perforated TM + persistent or recurrent purulent ottorrhea, otalgia, ear fullness, varyig degrees of conductive hearing loss
chronic OM
78
asymptomatic effusion + no s/s of inflammation (fever, ear pain, red or bulging TM)
serous OM or OM with effusion
79
describe eustation tube of kids vs aadults
shorter, narrower and horizontal
80
when do we do tympanocentesis
recurrent OM
81
describe recurrent for OM
3 episodes in 6 MO OR 4 episodes in 12 MO with clearing in b/w episodes
82
nasal packing to tx epistaxis must also get ____ and why
abx-- to avoid TSS | -cephalopsorin
83
weber test | rene test
WEBER--> tuning fork placed on center of head---- see if sound lateralizes---- 1. it will lateralize to AFFECTED ear in conductive loss 2. will lateralize to unaffected ear in SENSORInerual loss RINNE--- tuning fork placed on mastoid and then up to ear (should continue to hear) 1. conductive hearing loss if B > A 2. sensoruneural A > B
84
mcc for conductive hearing loss | -describe weber and rene findings
OM mcc Other: cerumen impaction, OE, exostoses, TM perf, neoplasms WEBER-->hear in BAD ear RINNE--> B > A
85
sensorineural loss describe rinne and weber findingd | mcc
MCC= presbycusis---- gradual, symmetric hearing loss assoc with aging other causes noise induced, infection, drug-induced, meniere disese, CNS lesion wber: hear in good ear Rinne: A > B
86
describe otoscopy findings for OM with effusion
effusion with TM that is RETRACTED or FLAT | Hypomobility with insufflation
87
PE shows edema of external auditory canal producing an anterior and inferior displacement of auricle with percussion tenderness posteriosly
mastoiditis
88
mastoiditis - bugs - s/s and PE - dx ******and the findings for the test
Organisms: S. pneumoniae, H. influenzae, M. catarrhalis, S. aureus, S. pyogenes fever, otalgia, erythema posterior to ear and foward displacement of external ear DX *CT scan with contrast is first line test for ill appearing PTs or complicated mastoiditis-- scan the temporal bone FINDINGS: Radiographic findings would be the destruction of the mastoid air cell septa with an accumulation of pus -MRI TX -PO abs for simple IV ABX like ceftriaxone complicated
89
does candidia plaques bleed when scraped?
yes
90
tx for thrush
Nystatin | PO fluconazole
91
swollen and erythematous eyelid, proptosis, pain with movement of the eye, and an inability to adduct or abduct his eye.
orbital cellulitis
92
what is orbital cellulitis - how does pt presnt - assoc with? or compl of? - mc age population - mc bug - dx - tx ******
infection of orbital muscles and fat behind the eye---- DIFF FROM PERIOBRITAL WHICH IS ONLY INFECTION OF THE SKIN pt presnts with decr extraocular movement--- pain with movement of eye and proptosis (bulging of eyeball) aossc with untreated sinusitis kids >>> adults 7-12 YO MCC- staph aureus dx--- TOC is CT with contrast ``` TX 1. admission 2. optho eval 3. IV broad spectrum abx---- VANCO*** PLUS one of the following: creftri or cefotaxmine this will cover MRSA ```
93
OE -weber test will show? -rinne test tx
weber test= lateralizes to affected ear rinne= B > A ``` pseuodomonas aeruginosa** (swimmers ear) staph A (digital trauma) ``` ``` TX *ABX DROPS ---- aminoglycoside or fluoroquinoline +/- corticosteroids + avoid mositure ***ciprofloxacin + dexamethasone OR Neomycin ***/Polymyxin-B/Hydrocotrisone ``` * **DO NOT USE AMINOGLYCOSIDES IF TM PERF or TM CANT BE VISUALIZED BC THEY ARE OTOTOXIC - neomycin - tobramycin - gentamicin
94
malignant OE is seen in who | -tx
diabetics TX= hosp and IV ABX due to aspergillus fungus
95
trismus and muffled voice
peritonsilar absces
96
bug involved with peritonsilar abscess | -tx
strep pyogenes TX -I/D -ABX: amoxicillin, ampicillin-sulbactam, and clindamycin IV!!! -
97
tx for TM perf
Most TM perforations are nonurgent and do not require immediate evaluation by an otolaryngologist. ``` If going to use abx---ABX drops-- only class of abx that are non otoxic are the FLOXIN drops--- should heal on its own with few days A significant portion of TM perforations heal spontaneously without intervention because of the TM’s regenerative abilities. ``` SURGERY indicated if persists > 2 MO
98
what are vestibular signs
- nystagmus - vomiting - ataxia
99
acid-fast bacilli on Ziehl-Neelsen staining
mycobacterium
100
tx for Mycobacterium Avium complex (MAC) 1st 2nd
Clarithromycin + Ethambutol + a rifamycin (either rifabutin or rifampin) second line *ethambutol + rifamycin + aminoglycoside
101
Atypical Mycobacterial infections in children are most frequently located in?? mc age group ? transmission route
superior anterior cervical or in submandibular nodes-- 91% * swelling in painless, firm and not erythematous * s/s rarely ocur in immunocompetent patients MC 1-5 YO transmitted via soil and water-- not person to person
102
Mycobacterium MArinum | -tranmission
* **AQUARIUM - fresh and saltwater - infection occurs after inoculation of skin via abrasion or puncture in PT with contact of aquarium, saltwater or marine animals tx= tetracyclines, fluroso, marolides, sulfonamides 4-6 wks
103
EBV - tranmission - triad - dx - do not give ___ because ____
* *part of human herpes family * *saliva-- kising disease 15-25 YO Fever + lymphadenopathy (esp posterior) + pharyngitis (can be exudative) * splenomegaly * hepatomegaly DX= + heterophile antibody screen (monospot)----TOC do not give AMPICILLIN bc it will cause diffuse maculopapular rash TX - supportive - s/s can last for months - no sports for 3-4 weeks if splenomegaly present COMPS - hodgkin lymphoma - burkitt lymphoma - CNS lymphoma - Gastric carcinoma - Nasopharyngeal ca
104
erythema infectiosum - also called - bug - tx
slapped cheek or fifths disease s/s= low grade fecer, HA, ST, bright red rash on cheeks---spreads to trunk, arms and legs ** parvovirus B19 tx is supp
105
HFM disease - s/s - rash
LGF, loss of appetite, rash: small tender erythematous papules or vesicles on pharynx, mouth, hands and feet * palms * soles Coxsackievirus type A
106
Influenza -s/s bug -tx***
SUDDEN fever, chills, malaise, ST, HA, coryza +/- myalgia (legs and lumbosacral)+/- cervical lymphadenopathy * othomyxovirus-- A, B, C * ** A assoc with severe outbreaks everyone over 6MO get vaccinated *avoid: egg allergy, previous rxn, GBS, <6MO TX * **** antivirals within 48 hours of symptom onset---- only for PT who are hospitalized or at risk of complications 1. Tamiflu or oseltamivir--- fights A and B--- neuraminidase inhibitor 2. inhaled relenza (zanamivir) 3. IV Rapivab (peramivir) 4. PO baloxavir
107
indications for antiviral tx for influenza
``` hospitalized OUTPT: -severe progressive illness, immunocomp >65+ Pregnant or 2 wks PP ```
108
fever, conjunctivitis, runny nose and cough
measles
109
mumps | -bug
paramyxovirus
110
MCC of pancreatitis in kids?
mumps
111
when is MMR given
12-15 MO 4-6 YO
112
severe hacking cough followed by a high-pitched intake of breath
whooping cough aka pertussis
113
bug for pertussis
gram negative bordetella pertussis | VERY Contagious
114
stages of pertussis | tx
1. Catarrhal stage: cold like s/s, anorexia, sleepy 2, Paroxysmal stage: high pithced inspiratory whoop 3. Convalescent stage: residual cough (can be up to 100 days) tx= macrolides... azitrhomycin or clarithromycin, supportive care with steroids/ albuteol
115
what is the vaccine for pertussis
DTaP 2, 4 ,6, 15-18 MO ,and 4-6 yrs (5 doses) 11-18 YO= 1 dose of TdAp preg should get one dose during each pregnancy at 27-36 weeks
116
tx for pinworms
albendazole or mebendazole
117
Roseola - caused by> - age group - s/s - assoc with? - tx
HHV 6-- also called sixth disease or roseola infantum 6MO-2 YO s/s * SUDDEN high fever (102-104) and child appears normal * few days after fever---> red rash appears assoc with Nagayama spots---- red/papules uclers on soft palate ONLY VIRAL EXANTHEM TO START ON TRUNK ******** tx=supportive
118
high fever for few days----- then as pt gets better rash appears *PT only s/s is fever.. they appear genrally well
roseola
119
3 day rash
rubella or german measles
120
rubella - s/s - when can s/s be bad
``` s/s often mild **rash **fever **lymphadenopathy RASH Starts on face-- spread caudially--discrete maculipapular exanthems--- and dissapers in 3 days---- ``` *can be bad during pregnancy--- teratogenic-- deafness in infant
121
-month old infant presents with a three-day history of a mild respiratory tract infection with serous nasal discharge, fever of 38.5 C (101.4 F), and decreased appetite. Physical exam reveals a tachypneic infant with audible wheezing and a respiratory rate of 65. Flaring of the alae nasi, use of accessory muscles, and subcostal and intercostal retractions are noted. Expiratory wheezes are present.
acute bronchilolitis | caused by RSV
122
Bronchiolitis - s/s - mc age group - MCC - time of year - how to dx ** - tx
s/s * mild resp tract infection to severe * serous nasal discharge * fever * decr appetite * wheezing * tachypnic <2 YO MCC=RSV fall and winter DX= nasal washing for RSV culture and antigen assay CXR will show hyperinflation and peribronchial cuffing tx * supportive * nasal suctioning * humidified oxy ----- only tx demonstrated to improve!!! ************ * antipyretics
123
CXR shows hyperinflation and peribronchial cuffing
bronchiolitis aka RSV
124
indications for hospitalization for bronchiolitis
1. spo2 under 95 % RA 2. toxic apperance---poor feeding, lethargic, dehydrated 3. mod-sev resp distress: nasal falring, retractions, RR >70, cyanosis 4. apnea 5. parents unable to take care for them at home
125
MCC of lower resp tract infections in kids
RSV ``` s.s Rhinorrhea Wheezing and coughing can persist for several months Low-grade fever Nasal flaring and retractions Nail Bed cyanosis ```
126
when do we give Palivizumab prophylaxis
speical populations | once per month for 5 months beg in november
127
what is MC in a hhistory for pt with asthma
eczema and seasonal rhinitis
128
pt is taking deep slow breaths to try and catch his breath. He has diminished breath sounds in all lung fields with prolonged, expiratory wheezes.
cute asthma
129
lack of wheezing in an acute asthma attack means
IMPEDING RESP FAILURE | EMERGNECY
130
dx for asthma
GOLD STANDARD= peak expiratory flow rate Spirometry with pre and post-therapy (albuterol inhalation) readings Decreased FEV1/FVC (75-80%) > 10% increase of FEV1 with bronchodilator therapy
131
croup | *steeple sign
132
croup - bug - age group - tx
parainfluzena virus 6MO-3yrs--- winter months steeple sign on PA CXR **narrowing of the trachea in subglottic region mild=supporitve with air humidifier and antipyreitcs severe= IVF and neb recemic epi, steroids
133
Cystic fibrosis--- transmission + patho - maintenance tx - extra pulm complications - bugs invovled
autosomal recessive gene mutation on CFTR gene ---cystic fibrosis transmembrane conductance receptor--->leads to abnormal chloride and water transport across exocrine glands--- causing thick and viscous secretions of lungs, pancreas, sinuses, intestines, liver and GU tract **EXOCRINE LGLANDS*** MC in whites maintenance= chest physio, high fat diet, supplement fat soluble vits A, D E K, pancreatic enzyme replacement, acute exacerbations- ABX like. macrolides **can cause pancreatitis and steatorrhea-- why we need to supp fat sol vits mean survival about 31 ***Initially in the first few months of life, respiratory infection is common with staphylococcus aureus and Haemophilus influenzae After that pseudomonas aeruginosa becomes the major causative organism for infections
134
a 4-year-old boy with unilateral purulent, foul-smelling nasal discharge for three days. The child has no other respiratory symptoms.
FB
135
tx for FB in bronchus
bronchoscope - rigid bronchoscopy pref in kids - flexible bronchoscope in adults
136
tx for FB In nose
before removing--- use oxymetazoline drops to shrink mucous membrane
137
what to do with insect before removal in ear
drown it/immobilize it with mineral oil or viscous lidocaine
138
hyaline membrane disease - another name - age - dx and finding - tx
ALSO CALLED NEWBORN RESPIRATORY DISTRESS SYNDROME *premature infants--- under 30 weeks gestation-- born before the lungs are producing enough surfactant-- this helps prevent lungs to collapse---atelectasis and poor lung compliance CXR-- ground class apperance and diffuse bilateral atelectasis and air bronchograms tx - betamethasone IM x2 - aritifiical surfactant via ETT - intubtion with PP
139
MCC of respiratory disease in preterm infant
hyaline membrane disease
140
ground glass apperance on cxr
hyaline membrane disease
141
when does surfactant production begin
24 weeks
142
cold hemagglutinin titer is elevated
mycoplasma pnemonia
143
PE findings for typical pneumonia | atypical
signs of consolidation: dullness to percussion, bronchial breath sounds, increase tactile fremitus, egophony, crackles/rales, atypical will have no pulm PE findings
144
who does mycoplasma pneumonia usually affect - s.s - comps - dx
young teens living in dorms aka walking pnma RF= young healthy school aged kids, college students S/S: Extra pulonary: URI prodrome with pharyngtis--- followed by persistent dry non prod cough---PE normal *bullous myringitis---blisters on TM----rare *COMPS= SJS, TEN, erythema multirforem, cold autoimmune hemoltic anemia IgM DX + cold hemagluttiin titer ---PCR is TOC CXR= atypical pattern---reticulonodular pattern MC tx - macrolides---Azitrho - doxycycline * *LACKS CELL WALL SO RESISTENT TO BETA LACTAMS
145
viral pnemonia-- mcc | and s/s
RSV fever, nonprod cough, otalgia, anorexia, dyspnea. wheeze, rale and rhonchi OTHER COMMOM CAUSE OF VIRAL = parainfluenxa virus
146
tx for RSV pnemonia
Ribavirin only effective antiviral tx
147
Causes for CAP 1st MC 2nd MC
``` 1st = strep pneumoniae 2nd= Haemophilis influenzae --- <6 YO can get very sick --- gram - rod ```
148
outpt tx and inpt tx for bacterial pnemoniae
OUTPATIENT=doxy, macrolides** INPT= cefrtri + azitrhomycin/respiratory floruo
149
s/s of RSV
Rhinorrhea, wheezing/coughing that persists for months, low-grade fever, nasal flaring/retractions, nail bed cyanosis
150
rheumatic fever affects what valve MC? 2nd?
MC= mitral valve---- stenosis 2nd=aortic valvue 3rd= tri
151
what causes rheumatic fever peak incidence dx tx
follows strep infection with GABH strep --- 2-4 weeks after M protein is most virulent factor for GABH strep---> anti-M antibodies against the strep infection that cross react with heart tissue 5-15 YO dx= ASO + titer jones criteria 2 major or 1 major 2 minor tx * PCN * ASA
152
Jones Criteria major minor
*need two major or 1 major and 2 minor req for dx ``` MAJOR carditis chorea erythema marginatum polyarthritis subcutaneous nodules ``` ``` MINOR arthralgia elevated ESR or CRP fever prolong PR leukocytosis ```
153
what is commonly seen with coarcttion of aorta
bicuspid valve---- increase incidence of cerebral berry anerurysms too
154
tx for coarcation of aorta
prostaglandins E1 | surgical repaiar
155
hypertrophic cardiomyopathy | -transmission
autosomal dominant
156
murmur due to HCM will increase in intensity with ___ and decrease intensity with____
anything that decrease blood volume in LV INCREASES--- standing or valsalva DECREASES---squatting
157
tx for HCM
Beta-Blockers + Disopyramide (Norpace®) Calcium channel blockers Diuretics should be avoided
158
a lasting fever is the first sign of
kawasaki
159
s/s of kawasaki
CRASH and BURN (fever) ``` C--conjunctival injection--spares limbus R---rash all over body--flakes A--- adenopathy S--- strawbery tongue H--- hand and foot rash ``` Fever--- 5+ days doesnt resolve with antipyretics
160
cardiac sequelase of kawaski
Coronary artery aneurysm-- 25% myocarditis mi
161
5 days or more of high fever; arthritis may be reported Bilateral non-purulent conjunctival injection Erythematous morbilliform rash with desquamation on the trunk that may spread red tongue and or cracked lips
kawasaki
162
DX for kawasaki *****
four of five CRASH symptoms + high fever lasting 5 days -vasculitis in coronary arteries= definitive sign LABS *incr inflam markers---- CRP, ESR, incr plats, incr wbc ECHO *at the time of diagnosis and again at 6-8 wks after dx
163
machine like murmur
PDA
164
rough and continuous murmur
pda
165
what wil close a PDA
prostaglandin E-2 inhibitors--- bc the prostaglandings keep the PDA open so NSAIDs are tx
166
why are NSAIDs contraindicated in pregnancy
bc it keeps PDA open
167
tx for PDA
indomethacin aka NSAIDs
168
what makes up tetrollogy of fallot
PROVe P--- pulmonary stenosis R---right ventric hypertrophy O--- overriding aorta V----ventricular septa defect
169
cxr shows boot shaped heart
tetrollagy of fallot
170
Difficult feeding, failure to thrive. "tet spells" ⇒ a baby with cyanosis and loss of consciousness with crying
tetrollagy of fallot
171
mc pathologic murmur in childhoood
VSD
172
RLQ pain with internal rotation of hip
obturator
173
RLQ pain with hip extension
psoas
174
rules of 3 for colic
3 hrs/day 3 days/wk for 3 months
175
define constipation
<2 BM per week | >1 episode of encopresis per week---- poop in rectum, loose stool leaks
176
diagnosis for constipation
ROME III *at least 2 of the following < 4YO: - two or fewer BM per week - at least one episode of incontinence per week after potty training - hx of excessive stool retention - hx of painful or hard BM - large fecal mass in rectum - hx of large diameter stools that may obstruct toilet
177
sunken eyes dry mucous mems generalized skin hyperpigmentation
dehydration
178
define dehydration -mild mod severe
mild= 3-5% mod=6-9% severe= >10%
179
the most accurate signs of moderate or severe dehydration are
prolong cap refill poor skin tugor abnormal breathing **others-- sunken eyes, decr activity, lack of tears, dry mouth
180
AXR shows double bubble apperance with total absence of distal bowel gas
duodenal atresia
181
what can duodenal atresia cause in pregnancy
polyhydraminos--- incrs aminotic fluid
182
increased assoc of duodenal atreis with?
down's syndrome
183
early biliary vomiting in newborn
duodenal atresia
184
encopresis define
Fecal incontinence, also known as encopresis or soiling, refers to the repetitive, voluntary or involuntary, passage of stool in inappropriate places by children four years of age and older, at which time a child may be reasonably expected to have completed toilet training and exercise bowel control.
185
encopresis is always assoc with
severe constipation | M> F
186
what would be radio-lucent on xray in terms of FB
wood plastic glass fish/chicken bones
187
what would be radio-opaqe on xray in terms of FB
coins, screws, button batteries, small toy parts
188
what is indicated for all PTs with suspected inhaled FB
bronchoscopy-- diagnostic and therapeutic---even if CXR is normal
189
what to do if acid or alkali ingested
DO NOT induce emesis ABCs edoscopy 2-3 weeks later to assess damage
190
MCC gastroenteritis
rotavirus
191
_________ occurs in 1% of people following infections with Campylobacter species
Reactive arthritis
192
comps from GERD
ailure to thrive, aspiration pneumonia, esophagitis, choking or apneic episodes, hematemesis, anemia, and fussiness
193
MCC of GERD
overfeeeding----
194
GERD health maintenanc
INFANTS-small frequent feedings in upright positioin and kept prone head up for at least 20 mins post meals feeds can be thickened with cereal eliminate cows milk protein older kids---small frequent meals, eat slowly, maintain upright position after meals and avoid eating after 7 pm --PPIs if needed
195
mcc of cholestasis in newborn
hepatitis | *idiopathic
196
tx neonatal hepatitis
-genreally self limiting full recovery during infancy up to 70% - incr nutritinoal - fat sol vitamins a d e k
197
which strains of hepatitis mc in kids
a and b
198
precense of ____ confirms diagnosis of HAV
anti-HAV IgM
199
HCV Antibody is present in?
acute and chronic infection
200
+ HBsAG
active HBV | *antigen used in vaccine
201
+ HBV surface antibody
vaccinated or natural infection
202
+ core antibody HBV
only can get from natural infection---- not from vaccination --- and persists lifelong
203
+ HBV e antigen
rises early in active infection
204
Infants of infected mothers should receive
both vaccine AND HBV immunoglobulin at delivery
205
2-week-old boy with constipation. His mother reports that he has not had a bowel movement for over 5 days and is quite concerned. On further examination, you discover that the boy is in the 5th percentile for weight. Physical examination shows a distended abdomen. Rectal examination shows an absence of stool in the rectal vault. A contrast enema reveals dilated loops of bowel and megacolon
hirschsprung dz
206
hirschsprung dz | -cause
* caused by lack of caudual migration of ganglion cells from neural crest - causes obstruction with proximal dilation Absent plexuses (regulate bowel function) → intestine muscles permanently constricted → passing stool difficult, impossible 5x more freq in males 80% have fam hx
207
inability to pass meconium 48 hrs PP
Hirschsprung dz **this is the first sign OTHER s/s = constipation, vomiting and abd distention
208
DX for hirschsprung dz | tx
Rectal suction biopsy---- shows absence or paucity of ganglion cells TX= resection of affected segment or colostomy
209
which is mc-- indirect or direct
INDIRECT
210
indirect | -describe
Passage of intestine through the internal inguinal ring down the inguinal canal, may pass into the scrotum. Often congenital and will present before age one ****** I for an I---> indirect goes THRU inguinal ring
211
direct inguinal | -describe
Passage of intestine through the external inguinal ring at Hesselbach triangle, rarely enters the scrotum
212
bloody with mucous stool
intussusception | *****currant jelly
213
Sausage shaped abd mass in RUQ
intussusception
214
intussucueption - peak incidence - can happen in kids after?
5-9 MO -can occur in kids after viral infection
215
MCC of bowel obstruction in neonatal period <2 yrs
intussusception
216
Previously healthy infants or children may present with sudden onset of crampy or colicky abdominal pain. The pain often occurs in intervals followed by periods of calm. Infants may cry and draw their legs toward the chest
intussucpetoin
217
DX and TX for intussusception
barium enema | -both diagnosic and therapeutic
218
ab xr shows crescent sign
intussuception
219
ab xr shows target sign
intussception
220
neonatal jaundice appers when bilirubin is greater than?
2
221
explain physiologic jaundice
unconjugated hyperbili appearing 24 hrs after birth in infant with NO s/s-- and total bili rises sloewr than 0.2 mg/dL per hour--- or 5 mg/dL per day------ reamins UNDER 18....... resolves within 1 week for FT infant or wihtin 2 weeks for preterm ****PHYSIOLOGIC JAUNDIC
222
define pathologic jaundice
unconjugated hyperbili appers wtihit first 24 hrs after birth or infant shows s/s of illness-- orr if total bili rises faster than 0.2 per hr or 5 per day or becomes > 18 OR lasts more than 1 wk for FT and >2 wks for preterm **prehepatic cause
223
borborygmi
rumbling of stomach | **lactose intol
224
what supplemet might lactose intol pt need
calcium
225
def diangnossis for lac intol
lactose hydrogen test **The hydrogen breath test is positive for lactose malabsorption if the post lactose breath hydrogen value rises greater than 20 ppm over the baseline measurement
226
niacin
B3
227
niacin deficiency causes
pelagra--- means raw skin
228
Pelagra s/s
* photosensitive pigmented dermatitis------ mc in sun exposed skin areas * diarrhea--sometimes vom * dementia--someitmes also anxiety, disorientation * progress to death PE * wide stance gait * unstable on feeet * easily sunburns
229
causes of pelagra
diets low in tryptophan or niacin----- corn staple diets
230
how to assess niacin status
measure urinary N-methylnicotinamide or erythrocyte NAD: NADP ratio
231
pelagra tx
RDA for niacin is 6 to 12 mg daily in children, 16 mg for adult males, and 14 mg daily for nonpregnant adult females
232
projectile vom after feedings
pyloric stenosis
233
pyloric stenosis - can cause - age - dx - labs - tx
- projecticle vom - met alkalosis - dehydration <3 MO DX= US ----- will show double track -can also do barium studies---- string sign LABS--- hypochloremic, hypokalemic, met alkalosis sec to dehydration TX=pyloromyotomy (Ramstedt's procedure)
234
at what age is the umbilical ring completely closed
by age 5
235
when to refer for surgery for umbilical hernia
if persists >2 yrs of life
236
causes of VIT A def
``` inadequre intake fat malabsoprtion (foul smelling feces) liver disorders ```
237
s/s of vit A def
dry skin/ rashes ocular effects--- dry eyes or **NIGHTTIME Blindness foul smelling feces/diarrhea from fat malabsoprtion
238
retinol
vit A
239
dx of VIT a
retionl levels under 20 micrograms/ dL
240
vit C deficiency s/s
``` swollen, bleeding gums bruising petechiae hemarthrosis anemia poor wound healing perifollicular and subperiosteal hemorrhage corkscrew hair ```
241
rickets causes
bones to soften-->bowed legs, fxs, costochondral thickening
242
populations that are more prone to rickets
* darker skin | * exclusively BF beyond 3 to 6 MO
243
epicanthal folds, a broad nasal bridge, a large tongue, small ears, hypertelorism, Brushfield spots, a single palmar crease on each hand, and a harsh holosystolic murmur.
downs
244
chromosme affected in down's
21
245
Most common issues for those affected with Down's Syndrome
* ***septal defects b/w atria * ***sterility in men duodnel atresia incr risk for leukemia alzhemier dz
246
dz for down's | -prenantal
PRENANTAL US= nuchal translucency and hypoplastic nasal bone (wks 11-14) first tri labs prenatal-->chorionic villus sampling/amniocentesis
247
amniocentesis | -performed when
15th week or preg or later this has less risk than chorionic villus sampling indicated in moms >35 YO
248
chorionic villus sampling | -done when
10-12th week **placental tissue sample is retrieved via vagina and cervix -more risk to fetus inds for mom >35 YO
249
when is the quad prenantal screen done
15th adn 22nd week looks for four specific substances: AFP, hCG, estriol, inhibin-A
250
Hep B vaccine dosing
First dose within the first 24 hours of life Second dose at 1-2 months of age Third dose at 6-18 months of age
251
Rotavirus dosing
First dose at 2 months Second dose at 4 months Third dose at 6 months
252
DTAP
First dose at 2 months Second dose at 4 months Third dose at 6 months Fourth dose at 15-18 months Fifth dose at 4-6 years of age Booster doses are given starting at 11 years of age
253
HIB dosing
first at 2 MO second at 4 MO third at 12-15 MO
254
PCV 13 dosing
2 mO 4 MO 6 MO 12-15 MO
255
Polio dosing
2 MO 4 MO 6-18 MO 4-6 YO
256
MMR dosing
12-15 MO | 4-6 YO
257
Varicella dosing
12-15 MO | 4-6 YO
258
Hep a dosing
12-24 MO | 2nd dose at least 6 MO after first
259
TDAP
11-12 YO
260
HPV
two doses at 9-14 YO **doses are 6-12 MO apart three doses after 15 YO 0 1-2 6
261
meningococcal
11-12 YO | 16 YO
262
when does moro reflex go away
3 mo
263
HA, fever and stiff neck (nuchal rigidity)
meningitis
264
MCC of meninigitis
viral
265
knee extension causes pain in neck
Kernig
266
Leg raise when bending neck
Brudzinski sign
267
Bacterial etiologies for meningitis in -neonate viral etiologies
neonate= E coli and S. agalactae (GB strep) viral= enteroviruses--- mc late summer to early fall-- can also be caused by HSV, mumps, west nile
268
spinal tap finding for - bacterial men - viral men
bacterial = incr protein, decr glucose | viral=no specific charactersitics
269
tx for bacterial meningitis | *household contacts tx with?
dexamethasone + IV ABX --- ceftri****, vanco***** **vanco + rocepfin + ampicillin household contacts tx with rifampin
270
tx for focal seizrues
phenytoin | carbamazepine
271
list types of generalized seizures
``` absence tonic cloinc atonic clonic tonic myocloinc ```
272
tx for absence or petit mal
ethosuximide or valpric acid
273
tx for grand mal or partial focal seizures
carbamazepine phenobarb phenytoin
274
define SE
a seizure lasting >5 mins OR two or more seizures in a five min period without person reutnirng to baseline
275
what is the preferred initial treatment for SE | -what is given next
lorazepam next is phenytoin
276
when does teething occur
6-24 MO
277
what not to give for teething
Avoid over-the-counter (including homeopathic remedies) or prescription-strength topical analgesics (eg, lidocaine, benzocaine) for teething pain CAN GIVE tylenol or advil if fussy
278
first dental appointment should be when
1 yo
279
delayed menses short stature wide torso tanner stage 1 for a teenager
tanner syndrome
280
genetics behind tuner syndrome
missing X chromosome in famles | 45XO
281
MCC of primary amenorrhea
turner syndrome
282
low anti-Mullerian hormone
turner
283
tx for turner
growth hormone tx | sex hormone replacement
284
tx for turner
growth hormone tx | sex hormone replacement
285
tx for GAD
SSRIs--- paroxetine and escitalopram SNRI---Venlafaxine Busprione--- but takes 2 weeks for effects to work benzos= short term tx and BB therapy
286
tx for panic disorder
SSRI****** paroxetine, sertraline, fluoxetine benzos for acute attack CBT
287
first line tx for phobias
exposure therapy SSRI + CBT benzos- ex prior to flying treat agoraphobiga jsut like GAB with SSRI and CBT
288
tx for dystonic rxn
diphenhydramine and benztropine
289
tx for ADHD - 1st lines - 2 lines
FIRST LINES = STIMULANTS Methylphenidate---- Ritalin, Concerta, Daytrana Dexmethylphenidate (Focalin) Amphetamine/dextroamphetamine--- Adderal/Dexedrine SECOND LINE/adjuncts Antidepressants (guanfacine, clonidine, imipramine, bupropion, venlafaxine) behavioral mod, fam, edu management
290
some medication tx for autism
second gen antipsychotics (risperidone, aripiprazole) for aggression/hyperactivity, mood lability, can also use haldol and carbamazepine SSRIs for sterotyped/repetitive behavior
291
tx for major depressive disroder
Treatment: SSRIs are the first-line treatment Continue to increase dosage q 3–4 wks until symptoms in remission The full medication effect is complete in 4–6 weeks Augmentation with 2nd medication may be necessary See within 2–4 weeks of starting medication and q2wk until improvement, then monthly to monitor medication changes
292
depressive symptoms for >2 years is called
persistent depressive disorder
293
what is precursor to antisocial personality disorder
conduct disorder
294
conduct disorder vs antisocial personality disorder
conduct disorder= under 18 antisocial = over 18
295
oppositional defiant disorder
less intense form of conduct disorder -children who develop with chronic behavior are at risk for condut disorer MC in boys--- problems worse at school pattern of angry/irritable mood, argumentative/defiant disorder, or vindictiveness lasting at least 6 MO as evidnedced by four of the following ``` Frequent temper tantrums Arguments with adults and authority figures. Does not conform to rules and regulation Intentional exasperation of others Easily annoyed by others. Revenge-seeking & vindictiveness Angry attitude Harsh and unkind. ``` ****conduct disorder you are aggressive to aniamls and humans, destroy property, show pattern of theft or deceit
296
intense fear of beocming fat--- even tho you are underweight
anorexia
297
weight is <85% of ideal body weight
anorexia
298
a 17-year-old female who is in your office for an annual sports physical. She is the star of her high school track team. She has not menstruated for 5 months. Her BMI is 15 kg/m2. On physical exam, you note calluses on the back of her hands and fine hair on her arms. She states that she only eats vegetables but has been trying to cut back as she thinks she is holding excess body fat.
anorexia
299
differentiate anorexia from bulemia
BMI < 17 or body weight <85% of ideal weight= anorexia
300
highest suicide rate of eating disorders
anorexia
301
two types of anorexia
1. binging/purging - laxative use/diuretic use - excessive exercise 2. restricting - eat little - exercise to excess
302
when do you hospitalize anorexia
if weight is under 75% expected body weight
303
scars on knuckles, swollen parotid glands + dental erosions + normal weight +hypokalemia
bulemia
304
tx for bulemia
-restore nutritional state Fluoxetine 60 mg PO---- 60 mg-- higher dose than used for depression seocond line= TCA, MAOIs therapy
305
what is second leading cause of death in 15-19 YO
suicide
306
what is second leading cause of death in 15-19 YO
suicide w
306
what is second leading cause of death in 15-19 YO
suicide
307
``` limp and knee pain shorter kid pain worse after sports exacerbated by internal rotation of hip Pain can be very bad that pt refuses to walk ```
avasc necrosis of proximal femur
308
hip XR shows left proximal femoral epiphysis to be misshapen and more horizontal than the unaffected hip -femoral head can appear collapsed
avasc necrosis of proximal femur
309
insidious onset of dull ache or throbbing localized pain to groin, lateral hip or butt MC affecting one hip
asvasc necrosis of proximal femur
310
another name for AVN in kids
legg-calve perthes disease
311
persistent pain and a limp
AVN / leg calve perthes disease
312
Diagnostic TOC for AVN
MRI
313
7-17 YO obese male during a growth spurt +limp +knee pain with external rotation of affected leg
SCFE
314
main diff b.w AVN and SCFE
AVN = YOUNGER PATIENTS---- 2-11 YO with peak incidnece at 4-8 **pain with internal rotation SCFE-- OLDER--- 7-16 YO and OBESE-----pain with external rotation
315
DX for SCFE
AP and frog leg lateral XR **lateral radiograph is best way to identify a subtle slip xr negative-- then do MRI
316
tx for congenital hip dysplasia < 6 MO 6-15 MO 15-24 MO
< 6 MO = pavlik harness (abducting bracing) 6-15 MO hip spica cast 15-24 MO= Open reduction then hip spica cast
317
Juvenille idiopathic athritis starts at or before
age 16
318
mc form of JIA
oligoarticular JIA -- affects young girls-- <4 joints
319
tx for JIA
NSAIDs, intra-articular corticosteroids, and disease-modifying antirheumatic drugs - methotrexate
320
progrssively worsening pain at night--- bone swelling or joint swelling
osteosarcoma xr= hair on end apperance or sun ray/burst
321
mc site of mets for osteosarcoma -age range
lungs then bone kids 10-14 YO
322
pain of bone/joint with fever palpable mass over joint, swelling, local tenderness 5-25 YO
ewing's sarcoma
323
XR shows lytic lesion... onion skin apperance
ewing
324
MC benign bone tumor in 10-20 YO
osteochondroma
325
xr shows pedunculate or sessile lesions found on the surface of bones
osteochondroma
326
nursemaid elbow tx
The supination-flexion technique is the classic method of reducing a subluxed radial head. It has a success rate of 80-92% Always ensure the child spontaneously uses the arm after reduction before discharging to confirm success
327
tibial tubercle is pronounced and tenderess to palpation over tibial tubercle
osgood-schlatter
328
osgood-schlatter age range
mc in 9-14 YO doing sports or rapid growth spurt
329
tx for osgood
TX: consists of reducing physical activity, applying ice to the tuberosity to reduce swelling, physical therapy, as well as short term NSAIDs surgery if conservative fials for pt with closed growth plates
330
tx for radial head subluxation
supination-flexion technique
331
adams forward bending asymmetry in scapular height noted
scoliosis
332
define scoliosis
cobb angle > 10 +
333
MC ednocrine illness in kids
insulin dep DM
334
dx of DM | -gs?
1. random BGL > 200 + DM s/s 2. two separate fasting (8 hours) gluclose levels of >126 3. GS= two hour plasma glucose of >200 on an oral glucose tolerance test (3 hr GTT) 4. A1C > 6.5
335
DM TX 1 2
1= intensive insulin therapy---- basal level of insulin + premeal boluses of rapid acting insulin *** MDI== multiple daily injfections-- consistes of injections of long acting insulin once or twice daily and a rapid short acting insuin b4 meals/snacks OR ****insulin pump--continuous subcu infusion of rapid or short acting insulin --- supplemented with boluses at meal time/snacks
336
High fasting insulin and C-peptide levels suggest
dm 2
337
presence of prolonged candidal infection should prompt consideration of diabetes mellitus in a PT <2 Y
consider dm
338
target A1C for dm pt
<7.5
339
most causes of hyperthyroid in kids is from
graves dz
340
tx for graves | tx for neonatal graves
propylthiouracil methimazole ******* has less SE radioiodine neonatal= propranolol +/- methimazole -most cases remit within 2-3 mo
341
mcc of juvenile or acquired hypothyroid
hashimotos
342
congenital hypothyroid also called
cretinism
343
hypotonia, lethargy, macroglossia, large fontanelles and dry skin in infant
cretinism--- aka congenital hypothyroid
344
when do most children present with s/s of hashimoto
5 yrs and older | **unusual to present before 5
345
tx for hashimoto
levothyroxine
346
CHILD + Lymphadenopathy + bone pain + bleeding + fever in a CHILD, bone marrow > 20% blasts in bone marrow
acute lymphocytic leukemia (ALL)
347
dx for | acute lymphocytic leukemia
bone marrow with >20% blasts | ANC <1000
348
painless cervical or supraclavicular lymphadenopathy
hodgkin lymphoma | **Upper boddy lymph nodes--- neck, axilla, shoulder, chest
349
weight loss >10%, temp > 38C and night sweaths
B symptoms of hodgkin lymphoma
350
what is assoc with 40% of pt with hodgin lymhoma
EBV
351
tx for lead poisoning
Dimercaprol CaNaEDTA chelation therapy if levels are over 45
352
cyrptochordism define tx
failure of testicles to descene-- both or one tx= orchiopexy by age 1 ********* correct ASAP after 4 MO
353
tx for cystitis
cephalosporin for 14 days first line PO----- Keflex for low risk renal involvement OR cefuroxime, cefdinir etc for those with higher likehood of renal invovleet
354
enuresis - define - dx
invol loss of urine in kid >5 YO DX 1. first r.o infection with UA and urine culture 2. full hsitory
355
tx for enuresis
1. nighttime audio alarm | MEDS= desmopressin acetate (DDAVP)
356
glomerulonephritis | -halmark s/s
hallmark= hematuria postinfectious--- group A strep infection-- skin or throat
357
urethral meatus is found located proximal to the tip of the glans on the ventral aspect of the penile shaft.
hypospadias----- urethra opens onto the bottom aka underside of penis more common than epispadias
358
ntrapment of the foreskin in the retracted position
paraphimosis | emergency
359
Lifting of the affected testicle does not relieve pain and there is a loss of a cremasteric reflex.
testicular torsion
360
negative phren sign - describe it - dx
testicular torsion | ---lifting of testicle does not relieve pain
361
urologic emergencies
paraphimosis | torsion
362
young female patient with recurrent cystitis or pyelonephritis trigger eval for what diseae?
vesiculoreteral reflux
363
tx for diaper candiasis
nystatin, clotrimazole, econazole x2 weeks
364
satellite lesions
diaper candiasis
365
a 9-year-old girl with multiple lesions on her hands and feet. She reports that these are not painful or itchy, but they are very embarrassing. Her best friend will no longer hold her hand and refuses to come to her house for a sleepover. Her past medical history includes atopic dermatitis. On physical exam, she has multiple 4-5 mm flesh-colored, sharply demarcated, rough, round, and firm nodules on her hands and feet.
verrucae
366
first line tx for utricaria
allegra claritin carinex zytrec | 2nd gen
367
peds epi dose for anaphylaxis
0.01 mg/kg SC or IV
368
widespread rash composed of blanchable, edematous, pink, papules, and wheels on the face, trunk, and lower extremities
urticaria
369
TEN is over ____% of body
30
370
main diff b/w TEN and SJS
TEN= older patients and 30% of body affected SJS= younger pt and <10% affected
371
dx for celiac
IgA antiendomysial (EMA) and antitissue transglutaminase (anti-tTG) antibodies. Tissue Transglutaminase Antibodies---- + in 98% patients IgA Endomsysial antibody-- almost 100% specificity but not as sensitive as the one above *Endoscopic intestinal mucosal biopsy of the proximal duodenum (bulb) and distal duodenum is the standard method for confirmation of the diagnosis in patients with a positive serologic test (IgA endomysial antibody) for celiac disease.
372
DX KOH 1. long branching fungal hyphae with septations 2. budding yeast and pseudohyphae 3. short hyphae and clusters or spores-- "sphagetti and meatballs"
1. dermatophyte 2. candidia 3. tinea
373
MC fungal infection in peds
tinea capitis
374
tx for tinea capitis
PO griseofulvin-- DOC + topical therapy with selenium sulfide or ketoconazole shampoo
375
Lesions consist of hypo or hyperpigmented macules that do not tan
tinea versicolor
376
tx for tinea versicolor
Selenium sulfide 2.5% to skin for 10 mins-- then wash off
377
what medicaiton is not effective to treat dermatophyte infections
Nystatin | AKA ANY TINEA INFECTION DO NOT TREAT WITH NYSTATIN
378
purplish, itchy, flat-topped bumps. On mucous membranes, such as in the mouth, it forms lacy white patches, sometimes with painful sores
lichen planus
379
``` purple papule polygonal pruritis planar ```
lichen planus
380
tx for lichen planus
topical steroids
381
impetigo | -tx
1. topical bactroban (mupirocin) x 5 days | warm water soaks 15-20 min before abx
382
bright red rash
measles aka rubeola
383
only childhood exanthem that starts on the trunk and spreads to the face
roseola aka sixth disease
384
type of hypersensitivity erythema multiforme
4
385
MCC erythema multiforme
infection HSV mycoplasma pneumonia URI
386
target "iris" lesions | dull "violet red"
multiforme
387
Macules, vesicles, central bullae with pale red rim and peripheral red halo
multiforme
388
blanching and lack of itchiness
multiforme
389
raised, papular, target lesions and dusky center
multiforme
390
annular lesion
urticaria
391
what bleeding disorder presents with prolonged pTT and normal platelet count -tx
hemophilia A | -Factor VIII concentrate or ccryoprecipitate
392
infant will ____ their birth weight by 1 yr
triple
393
5-day history of fever, erythema, edema of the hands and feet, a generalized rash over the body, bilateral conjunctival injections, fissuring and erythema of the lips, and cervical adenopathy
kawasaki
394
The rooting reflex starts to disappear at about ____ of age.
2-3 MO
395
moro reflex is gone by what age
4-5 MO
396
tx for torus or buckle fracture of disal radius
ace wrap or anterior splinting | **very stable fx occuring fter fall on hand
397
____is the definitive test to diagnose spina bifida occulta
xray or mri
398
abx of choice for epiglottitis
ceftriaxone or cefotaxime
399
Homocystinuria is a disorder of amino acid metabolism and is best treated with
high dose vit b6
400
what GI disorder is diagnosed in the frirst day of life
duodenal atresia
401
The side effects of the psychostimulants
wt loss anorexia sleep disturbances
402
he preferred method of prophylaxis for rheumatic fever
Benzathine pen G evry 4 wks
403
___ is the treatment of choice for an infant with Chlamydial pneumonia.
erythromycin or sulfisoxazole
404
which bone CA in kids has pain relived with ASA and pain is worse at night.
osteoid osteoma
405
alternative for tx of strep if PCN allergic
erythromycin
406
we do not use _____ in kids for epistaxis because ___
silver nitrate | -incrs risk of nasal septal perforation
407
reye syndrome is a complication of
influenza--- also assoc with ASA use in viral infections
408
fetal alcohol syndrome can cause
low brith weight
409
extensive bullous impetigo tx
penicillinase resistant abx---- dicloaxcillin
410
characterized by an abrupt onset of fever that ceases upon the onset of the maculopapular rash.
roseola
411
Patients with sickle cell disease should receive prophylactic
penicillin V starting at 2 months of age and folic acid starting at 1 year of age.

EORs (15 decks)

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