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EORs > Peds > Flashcards

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
Q

MC pathogens for OM

A
  • strep pneumoniae
  • Haemophilus *****
  • Moraxella catarrhallis
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26
Q

What is the first-line antibiotic treatment for uncomplicated acute otitis media? according to ROSH`

A

High-dose amoxicillin at 80–90 mg/kg/day.

according to rosh**

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27
Q

tx for recurrent or persistent OM

A

augmentin

PCN allergy: Clinda + Cefixime or Cedinifir

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28
Q

stage 1 acne

A

small, inflammatory bumps from clogged pores

  • Open comedones (blackheads): incomplete blockage
  • Closed comedones (whiteheads): complete blockage
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29
Q

stage 2 acne

A

Stage II: Inflammatory: papules or pustules surrounded by inflammation

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30
Q

stage 3

A

: Nodular or cystic acne: heals with scarring

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31
Q

how to differentiate between acne and rosacea

A

rosacea does not have comodomes

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32
Q

Treatment for acne

  • mild
  • mod
  • severe
A

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

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33
Q

4 main pathophys for acne

A

4 main factors – follicular hyperkeratinization with plugging of sebaceous ducts, increased sebum production,
Propionibacterium acnes overgrowth within follicles, & inflammatory response

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34
Q

mcc of bronchiolitis

A

RSV

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35
Q

acute bronchiolitis

  • age range
  • s/s
  • dx how and findings
A

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
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36
Q

Children develop clinical signs of dehydration during progression to ___-____% loss of body weight.

A

3-9%

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37
Q

other name for croup

A

Laryngotracheitis

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38
Q

SE isotretinoin

A

causes dry lips, liver damage, increased triglycerides/cholesterol, pregnancy category X

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39
Q

treatable causes of alopecia

A

thyroid–TSH
anemia —CBC
autoimmune—ANA

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40
Q

TX alopecia

A

Topical: Minoxidil/Rogaine 2%, %5; *hair loss first before regrowth
Finasteride 1mg ⇒ inhibits T and DHT
Spironolactone ⇒ blocks DHT

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41
Q

flexor surfaces

A

atopic dermatitis

  • AC and popliteal folds
  • wrist
  • hands
  • feet
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42
Q

extensor surfaces

A

Psoriasis

-elbow

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43
Q

what type of hypersensitivity is atopic dermaitits

A

1
IGE mediated
**atopic individuals— asthma

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44
Q

burns caused by acid s/s

A

coagulation, necrosis, eschar; irrigate

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45
Q

burns caused by alkaline s/s

A

liquefaction necrosis, deep damage

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46
Q

first degree burns

A

Erythema of involved tissue, skin blanches with pressure, the skin may be tender

**sunburn

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47
Q

2nd degree burns

-

A

partial thicknes

Skin is red and blistered, the skin is very tender

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48
Q

3rd degree

A

full thickness

Burned skin is tough and leathery, skin non-tender

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49
Q

4th deg burn

A

Into the bone and muscle

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50
Q

allergic contact dermatitis type of hypersensitivity

-exs

A

4

  • *poison ivy
  • *nickle
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51
Q

tx for diaper rash

A

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

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52
Q 
Young women. Papulopustular, plaques, and scales around the mouth
Lip margin (vermillion border) is spared
A

perioral dermatitis

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53
Q

tx for perioral dermatitis

  • mild
  • moderate
A

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

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54
Q

what drug is not effective for dermatophyte infections aka any tinea

A

nystatin

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55
Q

RF for devleop hip dysplasia

A
  • female
  • breech **
  • fam hx *****
  • firstborn
  • oligohydraminos
  • race—-less common in black **
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56
Q

clinical dx of AOM

A
  1. bulging TM
    or
  2. other s/s of inflammation—-erythema, fever, ear pain, middle ear infussion
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57
Q

MC bugs for AOM

A

Strep pneumoniae 25%
H influenzae 20%
M catarrhalis 10%

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58
Q

define recurrent AOM

A

3 episodes in 6 MO or 4 in 12 with clearings in b/w

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59
Q

tx for AOM and age groups and duration

  • kids
  • adults
A
  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

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60
Q

tx for recurrent AOM

A

tympanostomy, tympanocentesis, myringotomy

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61
Q

complications from AOM

A

mastoiditis, bullous myringitis

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62
Q

Acute Pharyngotonsilliits

  • s/s
  • Mc bugs
A

**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
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63
Q

Centor Criteria

A
  1. no cough
  2. exudates
  3. fever > 100.4 F
  4. cervical lymphadenopathy

3 out of 4—->get rapid strep test
sensitivity >90%

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64
Q

TX for pharyngitis

*all bugs

A

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
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65
Q

comps of strep pharyngitis

A

rheumatic fever

glomerulonephritis

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66
Q

how long to use intranasal decongestants and for why

A

no more than 3-5 days

can cause rhinitis medicamentosa

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67
Q

mcc of viral conjunctivitis
mcc for bacterial
Newborns? do what test for it

A

adenovirus

bacterial

  • s. pneumonia
  • s aureus (common)

NEWBORN
*chlamydia—– do a Giemsa stain–>inclusion body, scant mucopurualt discharge

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68
Q

cobbelstone mucosa on inner/upper lid

A

allergic conjuncivitis

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69
Q

Bacterial conjuncivitis tx

  • non contact users
  • contact users
A

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
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70
Q

when do you give HIB vaccine

A

2
4
6
12-15 MO

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71
Q

3 D’s of eppiglottitis

A

drooling
dysphagia
resp Distress

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72
Q

what is this

A

thumbprint sign

epiglottitis

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73
Q

if outpatient tx is option for stable epiglottits what is tx

A

ceftriaxone

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74
Q

anterior causes of nosebleed and four aspects of the area

posterior causes of bleeds

A

kesselbach’s plexus/Littles area —- MC Site

  1. anterior ethmoid
  2. superior labial
  3. sephnopalatine
  4. greater palatine

Woodruff’s plexus
-sphenopalatine

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75
Q

OM with effusion

-define

A

***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

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76
Q

effusion + fever + ear pain with bulging + erythema of TM

A

ACUTE om

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77
Q

perforated TM + persistent or recurrent purulent ottorrhea, otalgia, ear fullness, varyig degrees of conductive hearing loss

A

chronic OM

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78
Q

asymptomatic effusion + no s/s of inflammation (fever, ear pain, red or bulging TM)

A

serous OM or OM with effusion

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79
Q

describe eustation tube of kids vs aadults

A

shorter, narrower and horizontal

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80
Q

when do we do tympanocentesis

A

recurrent OM

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81
Q

describe recurrent for OM

A

3 episodes in 6 MO
OR
4 episodes in 12 MO
with clearing in b/w episodes

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82
Q

nasal packing to tx epistaxis must also get ____ and why

A

abx– to avoid TSS

-cephalopsorin

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83
Q

weber test

rene test

A

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
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84
Q

mcc for conductive hearing loss

-describe weber and rene findings

A

OM mcc
Other: cerumen impaction, OE, exostoses, TM perf, neoplasms

WEBER–>hear in BAD ear
RINNE–> B > A

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85
Q

sensorineural loss describe rinne and weber findingd

mcc

A

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

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86
Q

describe otoscopy findings for OM with effusion

A

effusion with TM that is RETRACTED or FLAT

Hypomobility with insufflation

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87
Q

PE shows edema of external auditory canal producing an anterior and inferior displacement of auricle with percussion tenderness posteriosly

A

mastoiditis

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88
Q

mastoiditis

  • bugs
  • s/s and PE
  • dx ****and the findings for the test
A

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

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89
Q

does candidia plaques bleed when scraped?

A

yes

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90
Q

tx for thrush

A

Nystatin

PO fluconazole

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91
Q

swollen and erythematous eyelid, proptosis, pain with movement of the eye, and an inability to adduct or abduct his eye.

A

orbital cellulitis

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92
Q

what is orbital cellulitis

  • how does pt presnt
  • assoc with? or compl of?
  • mc age population
  • mc bug
  • dx
  • tx ****
A

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&raquo_space;> 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
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93
Q

OE
-weber test will show?
-rinne test
tx

A

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
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94
Q

malignant OE is seen in who

-tx

A

diabetics

TX= hosp and IV ABX due to aspergillus fungus

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95
Q

trismus and muffled voice

A

peritonsilar absces

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96
Q

bug involved with peritonsilar abscess

-tx

A

strep pyogenes

TX
-I/D
-ABX: amoxicillin, ampicillin-sulbactam, and clindamycin IV!!!
-

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97
Q

tx for TM perf

A

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

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98
Q

what are vestibular signs

A
  • nystagmus
  • vomiting
  • ataxia
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99
Q

acid-fast bacilli on Ziehl-Neelsen staining

A

mycobacterium

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100
Q

tx for Mycobacterium Avium complex (MAC)
1st
2nd

A

Clarithromycin + Ethambutol + a rifamycin (either rifabutin or rifampin)

second line
*ethambutol + rifamycin + aminoglycoside

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101
Q

Atypical Mycobacterial infections in children are most frequently located in??
mc age group ?
transmission route

A

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

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102
Q

Mycobacterium MArinum

-tranmission

A
  • **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

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103
Q

EBV

  • tranmission
  • triad
  • dx
  • do not give ___ because ____
A
  • *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
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104
Q

erythema infectiosum

  • also called
  • bug
  • tx
A

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

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105
Q

HFM disease

  • s/s
  • rash
A

LGF, loss of appetite,

rash: small tender erythematous papules or vesicles on pharynx, mouth, hands and feet
* palms
* soles

Coxsackievirus type A

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106
Q

Influenza
-s/s
bug
-tx***

A

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
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107
Q

indications for antiviral tx for influenza

A 
hospitalized 
OUTPT: 
-severe progressive illness, 
immunocomp 
>65+ 
Pregnant 
or 2 wks PP
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108
Q

fever, conjunctivitis, runny nose and cough

A

measles

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109
Q

mumps

-bug

A

paramyxovirus

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110
Q

MCC of pancreatitis in kids?

A

mumps

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111
Q

when is MMR given

A

12-15 MO

4-6 YO

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112
Q

severe hacking cough followed by a high-pitched intake of breath

A

whooping cough aka pertussis

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113
Q

bug for pertussis

A

gram negative bordetella pertussis

VERY Contagious

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114
Q

stages of pertussis

tx

A
  1. Catarrhal stage: cold like s/s, anorexia, sleepy
    2, Paroxysmal stage: high pithced inspiratory whoop
  2. Convalescent stage: residual cough (can be up to 100 days)

tx= macrolides… azitrhomycin or clarithromycin, supportive care with steroids/ albuteol

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115
Q

what is the vaccine for pertussis

A

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

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116
Q

tx for pinworms

A

albendazole or mebendazole

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117
Q

Roseola

  • caused by>
  • age group
  • s/s
  • assoc with?
  • tx
A

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

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118
Q

high fever for few days—– then as pt gets better rash appears
*PT only s/s is fever.. they appear genrally well

A

roseola

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119
Q

3 day rash

A

rubella or german measles

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120
Q

rubella

  • s/s
  • when can s/s be bad
A 
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

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121
Q

-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.

A

acute bronchilolitis

caused by RSV

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122
Q

Bronchiolitis

  • s/s
  • mc age group
  • MCC
  • time of year
  • how to dx **
  • tx
A

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
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123
Q

CXR shows hyperinflation and peribronchial cuffing

A

bronchiolitis aka RSV

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124
Q

indications for hospitalization for bronchiolitis

A
  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
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125
Q

MCC of lower resp tract infections in kids

A

RSV

s.s
Rhinorrhea
Wheezing and coughing can persist for several months
Low-grade fever
Nasal flaring and retractions
Nail Bed cyanosis
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126
Q

when do we give Palivizumab prophylaxis

A

speical populations

once per month for 5 months beg in november

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127
Q

what is MC in a hhistory for pt with asthma

A

eczema and seasonal rhinitis

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128
Q

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.

A

cute asthma

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129
Q

lack of wheezing in an acute asthma attack means

A

IMPEDING RESP FAILURE

EMERGNECY

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130
Q

dx for asthma

A

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

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131
Q
A

croup

*steeple sign

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132
Q

croup

  • bug
  • age group
  • tx
A

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

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133
Q

Cystic fibrosis— transmission + patho

  • maintenance tx
  • extra pulm complications
  • bugs invovled
A

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

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134
Q

a 4-year-old boy with unilateral purulent, foul-smelling nasal discharge for three days. The child has no other respiratory symptoms.

A

FB

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135
Q

tx for FB in bronchus

A

bronchoscope

  • rigid bronchoscopy pref in kids
  • flexible bronchoscope in adults
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136
Q

tx for FB In nose

A

before removing— use oxymetazoline drops to shrink mucous membrane

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137
Q

what to do with insect before removal in ear

A

drown it/immobilize it with mineral oil or viscous lidocaine

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138
Q

hyaline membrane disease

  • another name
  • age
  • dx and finding
  • tx
A

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
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139
Q

MCC of respiratory disease in preterm infant

A

hyaline membrane disease

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140
Q

ground glass apperance on cxr

A

hyaline membrane disease

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141
Q

when does surfactant production begin

A

24 weeks

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142
Q

cold hemagglutinin titer is elevated

A

mycoplasma pnemonia

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143
Q

PE findings for typical pneumonia

atypical

A

signs of consolidation: dullness to percussion, bronchial breath sounds, increase tactile fremitus, egophony, crackles/rales,

atypical will have no pulm PE findings

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144
Q

who does mycoplasma pneumonia usually affect

  • s.s
  • comps
  • dx
A

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
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145
Q

viral pnemonia– mcc

and s/s

A

RSV

fever, nonprod cough, otalgia, anorexia, dyspnea. wheeze, rale and rhonchi

OTHER COMMOM CAUSE OF VIRAL = parainfluenxa virus

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146
Q

tx for RSV pnemonia

A

Ribavirin only effective antiviral tx

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147
Q

Causes for CAP
1st MC
2nd MC

A 
1st = strep pneumoniae 
2nd= Haemophilis influenzae --- <6 YO can get very sick --- gram - rod
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148
Q

outpt tx and inpt tx for bacterial pnemoniae

A

OUTPATIENT=doxy, macrolides**

INPT= cefrtri + azitrhomycin/respiratory floruo

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149
Q

s/s of RSV

A

Rhinorrhea, wheezing/coughing that persists for months, low-grade fever, nasal flaring/retractions, nail bed cyanosis

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150
Q

rheumatic fever affects what valve
MC?
2nd?

A

MC= mitral valve—- stenosis
2nd=aortic valvue
3rd= tri

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151
Q

what causes rheumatic fever
peak incidence
dx
tx

A

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
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152
Q

Jones Criteria
major
minor

A

*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
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153
Q

what is commonly seen with coarcttion of aorta

A

bicuspid valve—- increase incidence of cerebral berry anerurysms too

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154
Q

tx for coarcation of aorta

A

prostaglandins E1

surgical repaiar

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155
Q

hypertrophic cardiomyopathy

-transmission

A

autosomal dominant

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156
Q

murmur due to HCM will increase in intensity with ___ and decrease intensity with____

A

anything that decrease blood volume in LV

INCREASES— standing or valsalva
DECREASES—squatting

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157
Q

tx for HCM

A

Beta-Blockers + Disopyramide (Norpace®)
Calcium channel blockers
Diuretics should be avoided

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158
Q

a lasting fever is the first sign of

A

kawasaki

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159
Q

s/s of kawasaki

A

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

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160
Q

cardiac sequelase of kawaski

A

Coronary artery aneurysm– 25%
myocarditis
mi

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161
Q

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

A

kawasaki

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162
Q

DX for kawasaki *****

A

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

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163
Q

machine like murmur

A

PDA

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164
Q

rough and continuous murmur

A

pda

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165
Q

what wil close a PDA

A

prostaglandin E-2 inhibitors— bc the prostaglandings keep the PDA open

so NSAIDs are tx

166
Q

why are NSAIDs contraindicated in pregnancy

A

bc it keeps PDA open

167
Q

tx for PDA

A

indomethacin aka NSAIDs

168
Q

what makes up tetrollogy of fallot

A

PROVe

P— pulmonary stenosis
R—right ventric hypertrophy
O— overriding aorta
V—-ventricular septa defect

169
Q

cxr shows boot shaped heart

A

tetrollagy of fallot

170
Q

Difficult feeding, failure to thrive. “tet spells” ⇒ a baby with cyanosis and loss of consciousness with crying

A

tetrollagy of fallot

171
Q

mc pathologic murmur in childhoood

A

VSD

172
Q

RLQ pain with internal rotation of hip

A

obturator

173
Q

RLQ pain with hip extension

A

psoas

174
Q

rules of 3 for colic

A

3 hrs/day

3 days/wk

for 3 months

175
Q

define constipation

A

<2 BM per week

>1 episode of encopresis per week—- poop in rectum, loose stool leaks

176
Q

diagnosis for constipation

A

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
Q

sunken eyes
dry mucous mems
generalized skin hyperpigmentation

A

dehydration

178
Q

define dehydration
-mild
mod
severe

A

mild= 3-5%
mod=6-9%
severe= >10%

179
Q

the most accurate signs of moderate or severe dehydration are

A

prolong cap refill
poor skin tugor
abnormal breathing

**others– sunken eyes, decr activity, lack of tears, dry mouth

180
Q

AXR shows double bubble apperance with total absence of distal bowel gas

A

duodenal atresia

181
Q

what can duodenal atresia cause in pregnancy

A

polyhydraminos— incrs aminotic fluid

182
Q

increased assoc of duodenal atreis with?

A

down’s syndrome

183
Q

early biliary vomiting in newborn

A

duodenal atresia

184
Q

encopresis define

A

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
Q

encopresis is always assoc with

A

severe constipation

M> F

186
Q

what would be radio-lucent on xray in terms of FB

A

wood
plastic
glass
fish/chicken bones

187
Q

what would be radio-opaqe on xray in terms of FB

A

coins, screws, button batteries, small toy parts

188
Q

what is indicated for all PTs with suspected inhaled FB

A

bronchoscopy– diagnostic and therapeutic—even if CXR is normal

189
Q

what to do if acid or alkali ingested

A

DO NOT induce emesis
ABCs
edoscopy 2-3 weeks later to assess damage

190
Q

MCC gastroenteritis

A

rotavirus

191
Q

_________ occurs in 1% of people following infections with Campylobacter species

A

Reactive arthritis

192
Q

comps from GERD

A

ailure to thrive, aspiration pneumonia, esophagitis, choking or apneic episodes, hematemesis, anemia, and fussiness

193
Q

MCC of GERD

A

overfeeeding—-

194
Q

GERD health maintenanc

A

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
Q

mcc of cholestasis in newborn

A

hepatitis

*idiopathic

196
Q

tx neonatal hepatitis

A

-genreally self limiting
full recovery during infancy up to 70%

  • incr nutritinoal
  • fat sol vitamins a d e k
197
Q

which strains of hepatitis mc in kids

A

a and b

198
Q

precense of ____ confirms diagnosis of HAV

A

anti-HAV IgM

199
Q

HCV Antibody is present in?

A

acute and chronic infection

200
Q

+ HBsAG

A

active HBV

*antigen used in vaccine

201
Q

+ HBV surface antibody

A

vaccinated
or
natural infection

202
Q

+ core antibody HBV

A

only can get from natural infection—- not from vaccination — and persists lifelong

203
Q

+ HBV e antigen

A

rises early in active infection

204
Q

Infants of infected mothers should receive

A

both vaccine AND HBV immunoglobulin at delivery

205
Q

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

A

hirschsprung dz

206
Q

hirschsprung dz

-cause

A
  • 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
Q

inability to pass meconium 48 hrs PP

A

Hirschsprung dz
**this is the first sign

OTHER s/s = constipation, vomiting and abd distention

208
Q

DX for hirschsprung dz

tx

A

Rectal suction biopsy—- shows absence or paucity of ganglion cells

TX= resection of affected segment or colostomy

209
Q

which is mc– indirect or direct

A

INDIRECT

210
Q

indirect

-describe

A

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
Q

direct inguinal

-describe

A

Passage of intestine through the external inguinal ring at Hesselbach triangle, rarely enters the scrotum

212
Q

bloody with mucous stool

A

intussusception

*****currant jelly

213
Q

Sausage shaped abd mass in RUQ

A

intussusception

214
Q

intussucueption

  • peak incidence
  • can happen in kids after?
A

5-9 MO

-can occur in kids after viral infection

215
Q

MCC of bowel obstruction in neonatal period <2 yrs

A

intussusception

216
Q

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

A

intussucpetoin

217
Q

DX and TX for intussusception

A

barium enema

-both diagnosic and therapeutic

218
Q

ab xr shows crescent sign

A

intussuception

219
Q

ab xr shows target sign

A

intussception

220
Q

neonatal jaundice appers when bilirubin is greater than?

A

2

221
Q

explain physiologic jaundice

A

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
Q

define pathologic jaundice

A

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
Q

borborygmi

A

rumbling of stomach

**lactose intol

224
Q

what supplemet might lactose intol pt need

A

calcium

225
Q

def diangnossis for lac intol

A

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
Q

niacin

A

B3

227
Q

niacin deficiency causes

A

pelagra— means raw skin

228
Q

Pelagra s/s

A
  • 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
Q

causes of pelagra

A

diets low in tryptophan or niacin—– corn staple diets

230
Q

how to assess niacin status

A

measure urinary N-methylnicotinamide or erythrocyte NAD: NADP ratio

231
Q

pelagra tx

A

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
Q

projectile vom after feedings

A

pyloric stenosis

233
Q

pyloric stenosis

  • can cause
  • age
  • dx
  • labs
  • tx
A
  • 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
Q

at what age is the umbilical ring completely closed

A

by age 5

235
Q

when to refer for surgery for umbilical hernia

A

if persists >2 yrs of life

236
Q

causes of VIT A def

A 
inadequre intake 
fat malabsoprtion (foul smelling feces) 
liver disorders
237
Q

s/s of vit A def

A

dry skin/ rashes
ocular effects— dry eyes or **NIGHTTIME Blindness
foul smelling feces/diarrhea from fat malabsoprtion

238
Q

retinol

A

vit A

239
Q

dx of VIT a

A

retionl levels under 20 micrograms/ dL

240
Q

vit C deficiency s/s

A 
swollen, bleeding gums 
bruising 
petechiae 
hemarthrosis 
anemia 
poor wound healing 
perifollicular and subperiosteal hemorrhage 
corkscrew hair
241
Q

rickets causes

A

bones to soften–>bowed legs, fxs, costochondral thickening

242
Q

populations that are more prone to rickets

A
  • darker skin

* exclusively BF beyond 3 to 6 MO

243
Q

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.

A

downs

244
Q

chromosme affected in down’s

A

21

245
Q

Most common issues for those affected with Down’s Syndrome

A
  • ***septal defects b/w atria
  • ***sterility in men

duodnel atresia
incr risk for leukemia
alzhemier dz

246
Q

dz for down’s

-prenantal

A

PRENANTAL US= nuchal translucency and hypoplastic nasal bone (wks 11-14) first tri

labs prenatal–>chorionic villus sampling/amniocentesis

247
Q

amniocentesis

-performed when

A

15th week or preg or later

this has less risk than chorionic villus sampling

indicated in moms >35 YO

248
Q

chorionic villus sampling

-done when

A

10-12th week
**placental tissue sample is retrieved via vagina and cervix

-more risk to fetus

inds for mom >35 YO

249
Q

when is the quad prenantal screen done

A

15th adn 22nd week

looks for four specific substances: AFP, hCG, estriol, inhibin-A

250
Q

Hep B vaccine dosing

A

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
Q

Rotavirus dosing

A

First dose at 2 months

Second dose at 4 months

Third dose at 6 months

252
Q

DTAP

A

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
Q

HIB dosing

A

first at 2 MO

second at 4 MO

third at 12-15 MO

254
Q

PCV 13 dosing

A

2 mO
4 MO
6 MO
12-15 MO

255
Q

Polio dosing

A

2 MO
4 MO
6-18 MO
4-6 YO

256
Q

MMR dosing

A

12-15 MO

4-6 YO

257
Q

Varicella dosing

A

12-15 MO

4-6 YO

258
Q

Hep a dosing

A

12-24 MO

2nd dose at least 6 MO after first

259
Q

TDAP

A

11-12 YO

260
Q

HPV

A

two doses at 9-14 YO
**doses are 6-12 MO apart

three doses after 15 YO
0
1-2
6

261
Q

meningococcal

A

11-12 YO

16 YO

262
Q

when does moro reflex go away

A

3 mo

263
Q

HA, fever and stiff neck (nuchal rigidity)

A

meningitis

264
Q

MCC of meninigitis

A

viral

265
Q

knee extension causes pain in neck

A

Kernig

266
Q

Leg raise when bending neck

A

Brudzinski sign

267
Q

Bacterial etiologies for meningitis in
-neonate

viral etiologies

A

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
Q

spinal tap finding for

  • bacterial men
  • viral men
A

bacterial = incr protein, decr glucose

viral=no specific charactersitics

269
Q

tx for bacterial meningitis

*household contacts tx with?

A

dexamethasone + IV ABX — ceftri, vanco*
**vanco + rocepfin + ampicillin

household contacts tx with rifampin

270
Q

tx for focal seizrues

A

phenytoin

carbamazepine

271
Q

list types of generalized seizures

A 
absence 
tonic cloinc 
atonic 
clonic 
tonic 
myocloinc
272
Q

tx for absence or petit mal

A

ethosuximide
or
valpric acid

273
Q

tx for grand mal or partial focal seizures

A

carbamazepine
phenobarb
phenytoin

274
Q

define SE

A

a seizure lasting >5 mins OR two or more seizures in a five min period without person reutnirng to baseline

275
Q

what is the preferred initial treatment for SE

-what is given next

A

lorazepam

next is phenytoin

276
Q

when does teething occur

A

6-24 MO

277
Q

what not to give for teething

A

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
Q

first dental appointment should be when

A

1 yo

279
Q

delayed menses
short stature
wide torso
tanner stage 1 for a teenager

A

tanner syndrome

280
Q

genetics behind tuner syndrome

A

missing X chromosome in famles

45XO

281
Q

MCC of primary amenorrhea

A

turner syndrome

282
Q

low anti-Mullerian hormone

A

turner

283
Q

tx for turner

A

growth hormone tx

sex hormone replacement

284
Q

tx for turner

A

growth hormone tx

sex hormone replacement

285
Q

tx for GAD

A

SSRIs— paroxetine and escitalopram
SNRI—Venlafaxine

Busprione— but takes 2 weeks for effects to work

benzos= short term tx and BB

therapy

286
Q

tx for panic disorder

A

SSRI**** paroxetine, sertraline, fluoxetine
benzos for acute attack
CBT

287
Q

first line tx for phobias

A

exposure therapy

SSRI + CBT

benzos- ex prior to flying

treat agoraphobiga jsut like GAB with SSRI and CBT

288
Q

tx for dystonic rxn

A

diphenhydramine and benztropine

289
Q

tx for ADHD

  • 1st lines
  • 2 lines
A

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
Q

some medication tx for autism

A

second gen antipsychotics (risperidone, aripiprazole) for aggression/hyperactivity, mood lability, can also use haldol and carbamazepine

SSRIs for sterotyped/repetitive behavior

291
Q

tx for major depressive disroder

A

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
Q

depressive symptoms for >2 years is called

A

persistent depressive disorder

293
Q

what is precursor to antisocial personality disorder

A

conduct disorder

294
Q

conduct disorder vs antisocial personality disorder

A

conduct disorder= under 18

antisocial = over 18

295
Q

oppositional defiant disorder

A

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
Q

intense fear of beocming fat— even tho you are underweight

A

anorexia

297
Q

weight is <85% of ideal body weight

A

anorexia

298
Q

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.

A

anorexia

299
Q

differentiate anorexia from bulemia

A

BMI < 17 or body weight <85% of ideal weight= anorexia

300
Q

highest suicide rate of eating disorders

A

anorexia

301
Q

two types of anorexia

A
  1. binging/purging
    - laxative use/diuretic use
    - excessive exercise
  2. restricting
    - eat little
    - exercise to excess
302
Q

when do you hospitalize anorexia

A

if weight is under 75% expected body weight

303
Q

scars on knuckles, swollen parotid glands + dental erosions + normal weight +hypokalemia

A

bulemia

304
Q

tx for bulemia

A

-restore nutritional state

Fluoxetine 60 mg PO—- 60 mg– higher dose than used for depression

seocond line= TCA, MAOIs

therapy

305
Q

what is second leading cause of death in 15-19 YO

A

suicide

306
Q

what is second leading cause of death in 15-19 YO

A

suicide w

306
Q

what is second leading cause of death in 15-19 YO

A

suicide

307
Q 
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
A

avasc necrosis of proximal femur

308
Q

hip XR shows left proximal femoral epiphysis to be misshapen and more horizontal than the unaffected hip

-femoral head can appear collapsed

A

avasc necrosis of proximal femur

309
Q

insidious onset of dull ache or throbbing localized pain to groin, lateral hip or butt
MC affecting one hip

A

asvasc necrosis of proximal femur

310
Q

another name for AVN in kids

A

legg-calve perthes disease

311
Q

persistent pain and a limp

A

AVN / leg calve perthes disease

312
Q

Diagnostic TOC for AVN

A

MRI

313
Q

7-17 YO obese male during a growth spurt
+limp
+knee pain with external rotation of affected leg

A

SCFE

314
Q

main diff b.w AVN and SCFE

A

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
Q

DX for SCFE

A

AP and frog leg lateral XR
**lateral radiograph is best way to identify a subtle slip

xr negative– then do MRI

316
Q

tx for congenital hip dysplasia
< 6 MO
6-15 MO
15-24 MO

A

< 6 MO = pavlik harness (abducting bracing)

6-15 MO hip spica cast

15-24 MO= Open reduction then hip spica cast

317
Q

Juvenille idiopathic athritis starts at or before

A

age 16

318
Q

mc form of JIA

A

oligoarticular JIA – affects young girls– <4 joints

319
Q

tx for JIA

A

NSAIDs, intra-articular corticosteroids, and disease-modifying antirheumatic drugs - methotrexate

320
Q

progrssively worsening pain at night— bone swelling or joint swelling

A

osteosarcoma

xr= hair on end apperance or sun ray/burst

321
Q

mc site of mets for osteosarcoma

-age range

A

lungs

then bone

kids 10-14 YO

322
Q

pain of bone/joint with fever
palpable mass over joint, swelling, local tenderness

5-25 YO

A

ewing’s sarcoma

323
Q

XR shows lytic lesion… onion skin apperance

A

ewing

324
Q

MC benign bone tumor in 10-20 YO

A

osteochondroma

325
Q

xr shows pedunculate or sessile lesions found on the surface of bones

A

osteochondroma

326
Q

nursemaid elbow tx

A

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
Q

tibial tubercle is pronounced and tenderess to palpation over tibial tubercle

A

osgood-schlatter

328
Q

osgood-schlatter age range

A

mc in 9-14 YO doing sports or rapid growth spurt

329
Q

tx for osgood

A

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
Q

tx for radial head subluxation

A

supination-flexion technique

331
Q

adams forward bending asymmetry in scapular height noted

A

scoliosis

332
Q

define scoliosis

A

cobb angle > 10 +

333
Q

MC ednocrine illness in kids

A

insulin dep DM

334
Q

dx of DM

-gs?

A
  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
Q

DM TX
1
2

A

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
Q

High fasting insulin and C-peptide levels suggest

A

dm 2

337
Q

presence of prolonged candidal infection should prompt consideration of diabetes mellitus in a PT <2 Y

A

consider dm

338
Q

target A1C for dm pt

A

<7.5

339
Q

most causes of hyperthyroid in kids is from

A

graves dz

340
Q

tx for graves

tx for neonatal graves

A

propylthiouracil
methimazole *** has less SE
radioiodine

neonatal= propranolol +/- methimazole
-most cases remit within 2-3 mo

341
Q

mcc of juvenile or acquired hypothyroid

A

hashimotos

342
Q

congenital hypothyroid also called

A

cretinism

343
Q

hypotonia, lethargy, macroglossia, large fontanelles and dry skin in infant

A

cretinism— aka congenital hypothyroid

344
Q

when do most children present with s/s of hashimoto

A

5 yrs and older

**unusual to present before 5

345
Q

tx for hashimoto

A

levothyroxine

346
Q

CHILD + Lymphadenopathy + bone pain + bleeding + fever in a CHILD, bone marrow > 20% blasts in bone marrow

A

acute lymphocytic leukemia (ALL)

347
Q

dx for

acute lymphocytic leukemia

A

bone marrow with >20% blasts

ANC <1000

348
Q

painless cervical or supraclavicular lymphadenopathy

A

hodgkin lymphoma

**Upper boddy lymph nodes— neck, axilla, shoulder, chest

349
Q

weight loss >10%, temp > 38C and night sweaths

A

B symptoms of hodgkin lymphoma

350
Q

what is assoc with 40% of pt with hodgin lymhoma

A

EBV

351
Q

tx for lead poisoning

A

Dimercaprol
CaNaEDTA

chelation therapy if levels are over 45

352
Q

cyrptochordism
define
tx

A

failure of testicles to descene– both or one

tx= orchiopexy by age 1 *******

correct ASAP after 4 MO

353
Q

tx for cystitis

A

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
Q

enuresis

  • define
  • dx
A

invol loss of urine in kid >5 YO

DX

  1. first r.o infection with UA and urine culture
  2. full hsitory
355
Q

tx for enuresis

A
  1. nighttime audio alarm

MEDS= desmopressin acetate (DDAVP)

356
Q

glomerulonephritis

-halmark s/s

A

hallmark= hematuria

postinfectious— group A strep infection– skin or throat

357
Q

urethral meatus is found located proximal to the tip of the glans on the ventral aspect of the penile shaft.

A

hypospadias—– urethra opens onto the bottom aka underside of penis
more common than epispadias

358
Q

ntrapment of the foreskin in the retracted position

A

paraphimosis

emergency

359
Q

Lifting of the affected testicle does not relieve pain and there is a loss of a cremasteric reflex.

A

testicular torsion

360
Q

negative phren sign

  • describe it
  • dx
A

testicular torsion

—lifting of testicle does not relieve pain

361
Q

urologic emergencies

A

paraphimosis

torsion

362
Q

young female patient with recurrent cystitis or pyelonephritis trigger eval for what diseae?

A

vesiculoreteral reflux

363
Q

tx for diaper candiasis

A

nystatin, clotrimazole, econazole x2 weeks

364
Q

satellite lesions

A

diaper candiasis

365
Q

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.

A

verrucae

366
Q

first line tx for utricaria

A

allegra claritin carinex zytrec

2nd gen

367
Q

peds epi dose for anaphylaxis

A

0.01 mg/kg SC or IV

368
Q

widespread rash composed of blanchable, edematous, pink, papules, and wheels on the face, trunk, and lower extremities

A

urticaria

369
Q

TEN is over ____% of body

A

30

370
Q

main diff b/w TEN and SJS

A

TEN= older patients and 30% of body affected

SJS= younger pt and <10% affected

371
Q

dx for celiac

A

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
Q

DX KOH

  1. long branching fungal hyphae with septations
  2. budding yeast and pseudohyphae
  3. short hyphae and clusters or spores– “sphagetti and meatballs”
A
  1. dermatophyte
  2. candidia
  3. tinea
373
Q

MC fungal infection in peds

A

tinea capitis

374
Q

tx for tinea capitis

A

PO griseofulvin– DOC
+
topical therapy with selenium sulfide or ketoconazole shampoo

375
Q

Lesions consist of hypo or hyperpigmented macules that do not tan

A

tinea versicolor

376
Q

tx for tinea versicolor

A

Selenium sulfide 2.5% to skin for 10 mins– then wash off

377
Q

what medicaiton is not effective to treat dermatophyte infections

A

Nystatin

AKA ANY TINEA INFECTION DO NOT TREAT WITH NYSTATIN

378
Q

purplish, itchy, flat-topped bumps. On mucous membranes, such as in the mouth, it forms lacy white patches, sometimes with painful sores

A

lichen planus

379
Q 
purple 
papule 
polygonal 
pruritis 
planar
A

lichen planus

380
Q

tx for lichen planus

A

topical steroids

381
Q

impetigo

-tx

A
  1. topical bactroban (mupirocin) x 5 days

warm water soaks 15-20 min before abx

382
Q

bright red rash

A

measles aka rubeola

383
Q

only childhood exanthem that starts on the trunk and spreads to the face

A

roseola aka sixth disease

384
Q

type of hypersensitivity erythema multiforme

A

4

385
Q

MCC erythema multiforme

A

infection
HSV
mycoplasma pneumonia
URI

386
Q

target “iris” lesions

dull “violet red”

A

multiforme

387
Q

Macules, vesicles, central bullae with pale red rim and peripheral red halo

A

multiforme

388
Q

blanching and lack of itchiness

A

multiforme

389
Q

raised, papular, target lesions and dusky center

A

multiforme

390
Q

annular lesion

A

urticaria

391
Q

what bleeding disorder presents with prolonged pTT and normal platelet count
-tx

A

hemophilia A

-Factor VIII concentrate or ccryoprecipitate

392
Q

infant will ____ their birth weight by 1 yr

A

triple

393
Q

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

A

kawasaki

394
Q

The rooting reflex starts to disappear at about ____ of age.

A

2-3 MO

395
Q

moro reflex is gone by what age

A

4-5 MO

396
Q

tx for torus or buckle fracture of disal radius

A

ace wrap or anterior splinting

**very stable fx occuring fter fall on hand

397
Q

____is the definitive test to diagnose spina bifida occulta

A

xray or mri

398
Q

abx of choice for epiglottitis

A

ceftriaxone or cefotaxime

399
Q

Homocystinuria is a disorder of amino acid metabolism and is best treated with

A

high dose vit b6

400
Q

what GI disorder is diagnosed in the frirst day of life

A

duodenal atresia

401
Q

The side effects of the psychostimulants

A

wt loss
anorexia
sleep disturbances

402
Q

he preferred method of prophylaxis for rheumatic fever

A

Benzathine pen G evry 4 wks

403
Q

___ is the treatment of choice for an infant with Chlamydial pneumonia.

A

erythromycin
or
sulfisoxazole

404
Q

which bone CA in kids has pain relived with ASA and pain is worse at night.

A

osteoid osteoma

405
Q

alternative for tx of strep if PCN allergic

A

erythromycin

406
Q

we do not use _____ in kids for epistaxis because ___

A

silver nitrate

-incrs risk of nasal septal perforation

407
Q

reye syndrome is a complication of

A

influenza— also assoc with ASA use in viral infections

408
Q

fetal alcohol syndrome can cause

A

low brith weight

409
Q

extensive bullous impetigo tx

A

penicillinase resistant abx—- dicloaxcillin

410
Q

characterized by an abrupt onset of fever that ceases upon the onset of the maculopapular rash.

A

roseola

411
Q

Patients with sickle cell disease should receive prophylactic

A

penicillin V starting at 2 months of age and folic acid starting at 1 year of age.

EORs (15 decks)

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