Peds 13 Flashcards
Treatment of abnormal uterine bleeding
Iron supplements + OCP (3-6 months then mat attempt to be weaned)
What types (#) of HPV are associated with cancer?
16 and 18
6 and 11 are associated with warts
Diagnostic criteria of Kawasaki
♣ Fever lasting > 5 days with at least 4 out of five of the following:
• Bilateral bulbar conjunctival injection
• Oral mucous membrane changes, including injected or fissured lips, injected pharynx, or strawberry tongue
• Peripheral extremity changes, including erythema or palms or soles, edema of hands or feet, and periungual desquamation
• Polymorphous rash
• Cervical lymphadenopathy
Describe Niacin deficiency
Vitamin B3 deficiency = pellagra = diarrhea, dermatitis, dementia
Describe pathophysiology of breast milk failure jaundice
Decreased intake causes decreased stooling and therefore decreased bilirubin elimination and increased intrahepatic circulation
Tx of battery in the esophagus
Immediate endoscopic removal
Tx of ingested battery distal to the esophagus
Observation - 90% of these are excreted uneventfully
Most common complication of mumps
Aseptic meningitis
What is the problem in Osgood-Schlatter
Traction apophysitis of the tibial tubercle where the patellar tendon inserts
Describe splenic sequestration crisis
♣ Will have increased reticulocytes
♣ Splenic vaso-occlusion leads to rapidly enlarging spleen due to pooling or red blood cells
♣ Occurs in children prior to autosplenectomy
Common complication of JIA
chronic uveitis
Tx for scabies in kids
Permethrin cream (Elimite)
Tx of orbital cellulitis
IV abx
Tx of periorbital cellulitis
oral abx
What is a cholesteatoma
It is a small epithelium-lined sac containing debris in the ear
Describe Kallman syndrome
o Defective migration of GnRH-releasing neuron
o Leads to hypogonadism and anosmia (lack of smell)
Describe cause of respiratory distress in infants of diabetic mother
Polycythemia leads to viscous blood which impairs blood flow to various organs
What are infectious contraindications to breast feeding?
Active pulmonary TB, HIV, malaria, typhoid fever, septicemia
Is mastitis a contraindication for breast feeding?
No - frequent feeding may help by preventing engorgement
What is the first diagnostic test that should be done in a newborn with bloody meconium
Apt-Downey test which can differentiate fetal from adult hemoglobin
Tx of necrotizing enterocolitis
If no evidence of perforation - bowel rest with nasogastric decompression and systemic abx
If evidence of perforation - surgical exploratory laparotomy
Describe laryngomalacia and it’s presentation
- Due to collapse of supraglottic structures during inspiration
- Inspiratory stridor most prominent in infants
- Stridor worse when supine, improves when prone
Describe vascular ring and its presentation
- Results from abnormal development of aortic arch, such that arch encircles and compresses the trachea, bronchus, and/or esophagus
- Presents in infants
- Biphasic stridor that improves with neck extension
- May also present with esophageal (e.g. dysphagia, vomiting, difficulty feeding) symptoms
Next step in acute asthma exacerbation after BiPAP
Intubation (not epi)
What should you do if pt is bitten by a bat
Postexposure prophylaxis - rabies immunoglobulun + rabies vaccine
Describe post-exposure managment of pertussis
Macrolide abx prophylaxis is recommended for all close contacts despite vaccination status (Azithromycin or Erythromycin)
Next step if peripheral IV fails in infant requiring emergency fluid rescuscitation
Interosseous cannulation
What is the cause of “pink stains” or “brick dust” in neonatal diaper
Uric acid crystals - normal
Tx of iron poisoning
Deferoxamine (binds ferric iron, allowing urinary excretion)
Sx of DiGeorge
♣ C – Cleft palate
♣ A – Abnormal facies
♣ T – Thymic aplasia (T-cell deficiency – poor development of lymph node paracortex)
♣ C – Cardiac defects (tetralogy of Fallot, truncus arteriosus)
♣ H – Hypocalcemia (due parathyroid aplasia)
What clinical features help to distinguish Preseptal from orbital (post-septal) cellutits
o Orbital cellulitis
♣ Occurs posterior to orbital septum
♣ Clinical features
• Symptoms of preseptal cellulitis (eyelid swelling, chemosis) PLUS
• Pain with EOM, proptosis, and/or ophthalmalgia with diplopia
Tx of preseptal vs. orbital cellulitis
Preseptal = oral abx
Orbital = IV abx +’/- surgery
Describe nursemaids elbow
♣ Annular ligament is torn at the attachment site to the radius bone when sudden traction is placed on the child’s arm
♣ The radial head slips through the tear, and when the pulling motion has ceased, the radial head recoils with a small portion of the annular ligament trapped between the radius and humerus
Diagnosis of nursemaids elbow
♣ Clinical diagnosis – X-ray not necessary
Tx of nursemaids elbow
♣ Supinate the forearm with the elbow in in flexed position while applying pressure over the radial head – a click may be felt when the annular ligament is freed from the joint
or hyperpronation of forearm
Common empiric tx of meningitis
Ceftriaxone + Vancomycin
What disease presents with herald patch followed by “christmas tree” rash
Pityriasis rosea
Tx of pityriasis rosea
♣ Reassurance (spontaneous resolution)
♣ Treatment of pruritis (e.g. antihistamines)
Desribe McCune Albright syndrome
o Precocious puberty
o Café-au-lait spots
o Polyostotic fibrous dysplasia (leads to recurrent bone fractures)
Describe problem in severe combined immunodeficiency (SCID)
♣ Defect in early stem cell differentiation
• Leads to failure of T-cell development
• B-cell dysfunction due to absent T cells
Presentation of SCID
- Failure to thrive
- Chronic diarrhea
- Recurrent infections
- Absence of thymic shadow and lymphoid tissue
Tx of SCID
• Stem cell transplant
Describe difference between CVID and Brutons
Bruton = defect in B-cell maturation (will have decreased B-cell and immunoglobulin levels)
CVID = less severe; defect in B-cell differentiation (will have normal B-cell and decreased immunoglobulins)
Tx of scabies
Topical Permethrin or Oral Ivermectin
At what age should pts transfer objects hand to hand
6 months
At what age should pts have 2 finger pincer grasp
12 months
Describe Chediak Higashi syndrome
♣ Defect in protein trafficking
♣ Presentation:
• Recurrent infections – impaired phagolysosome formation
• Giant granules in leukocytes – granules have no cytoskeleton to follow to distribute
• Partial albinism – melanocytes cannot pass pigment to keratinocytes
• Peripheral neuropathy
Most common cause of nephrotic syndrome in children
Minimal change disease
Tx of minimal change disease
Steroids
Features specific to congenital syphilis
Rhinorrhea (snuffles), desquamating or bullous rash, abnormal long-bone radiographs
Tx of SCFE
surgical pinning of femoral head
Which HPV strains cause common warts, genital warts, and cancer
1-4 = common
6 and 11 = genital
16 and 18 = cancer
