Peds Flashcards
What is encopresis?
Involuntary loss of stool in children who are already toilet trained
What is the initial treatment for retained stool in the rectum in a child with encopresis?
Oral laxative
What are treatment options for functional constipation in children?
Osmotic laxatives: polyethylene glycol, lactulose
Stimulants: senna, bisacodyl
Stool softeners: docusate
Fleet enema contraindicated in infants (due to hypocalcemia)
By what age should kids be having at least 1 BM per day?
3
What type of hypersensitivity reaction is allergic conjunctivitis?
Type I IgE mediated
What bug causes typical community acquired pneumonia?
Strep pneumo
What bug commonly causes ATYPICAL community acquired pneumonia?
Mycoplasma pneumo
What test is used to determine lactose intolerance?
Hydrogen breath test
When would you order an emergent endoscopy for an ingested foreign body?
FB is a battery, is sharp, is two magnets, or has signs of obstruction
How long should you observe most esophageal foreign bodies for?
24 hrs
What are the symptoms of bronchiectasis?
Cough
Large amounts of mucopurulent sputum
Foul smelling sputum
What is shown on chest x-ray in a patient with bronchiectasis?
Tram tracks (dilated & thickened airways)
What are signs/symptoms of scabies?
Severe itching that is worse at night
Small papules, vesicles, and burrows in the webbed spaces of the fingers and toes
What is the treatment for scabies?
Permethrin 5% (infants > 2 months old) or
Oral ivermectin (ivermectin not first-line in pregnancy or children < 15 kg)
What are characteristics of absence seizures?
Brief, sudden impaired consciousness
Appear to be staring into space
EEG shows 3 mHz spike & wave
What is the treatment for absence seizures?
Ethosuximide
What causes indirect inguinal hernias to occur?
Patent processus vaginalis
Does a direct or indirect inguinal hernia appear in the scrotum of a male child?
Indirect
Which type of hernia is most common in children?
Indirect inguinal hernia
What is the most common type of psoriasis in children?
Chronic plaque psoriasis
What is the most common cyanotic congenital heart disease in children?
Tetralogy of Fallot
How is a murmur of tetralogy of fallot described?
Rough, crescendo-decrescendo systolic ejection murmur that is heard best at the left sternal border in the third intercostal space with radiation to the back.
What is seen on chest x-ray of a child with tetralogy of fallot?
Boot shaped heart
If a patient is being treated for strep throat with Amoxicillin and returns to clinic in 7-10 days with a morbilliform rash, what is your suspected diagnosis?
The pt actually has mono and should stop abx
What are the characteristics of Osgood-Schlatter disease?
Young athlete (10-15 yo)
Knee pain while running
Tenderness over tibial tubercle
What is the treatment for Osgood-Schlatter disease?
Ice
NSAIDs
Tylenol
Quad stretches
What is neonatal respiratory distress syndrome?
Respiratory difficulty in a premature infant within the first few hours after birth
What most commonly causes neonatal respiratory distress syndrome?
Deficiency of surfactant
What should be given to women less than 34 weeks gestation at high risk for preterm delivery (e.g., preeclampsia) to reduce fetal morbidity & mortality?
Dexamethasone
What are the characteristics of pyloric stenosis?
Babies between 2-8 weeks
Non-bilious projectile vomiting
Olive-like mass in RUQ
Target sign on abd ultrasound
What is the treatment for pyloric stenosis?
Surgical pyloromyotomy
What test can be done to diagnose vesicoureteral reflux?
Voiding cystourethrography (VCUG)
What is a Russell sign and what disorder is it commonly seen in?
Abrasions on the dorsal aspect of fingers and the hand
Bulimia nervosa
What serum electrolyte is most commonly decreased in patients with bulimia that involves purging via vomiting?
Potassium
What are characteristics of Kawasaki’s disease?
CRASH & burn
Kids < 5 yo
Conjunctivitis
Rash
Adenopathy
Strawberry tongue
Hand or foot edema
High fever x 5 days
What is the treatment for Kawasaki’s?
IVIG and aspirin
What Cobb angle diagnoses scoliosis?
> or = 10*
What is the treatment for scoliosis based on Cobb angle?
20-29: observation
> or = 30: bracing
> or = 50*: surgery
What is the only surgical treatment for sensorineural hearing loss?
Cochlear implant
What is the most common cancer of childhood?
Acute lymphoblastic leukemia (ALL)
What are the signs/symptoms of acute lymphoblastic leukemia (ALL)?
Limping
Bone pain
Fever
Lymphadenopathy
Hepatosplenomegaly
What would you see on blood work in a pt with ALL?
Anemia
Thrombocytopenia
Lymphoblasts on peripheral smear
What is preseptal cellulitis (periorbital cellulitis)?
An infection that affects the anterior portion of eye, and does NOT involve the globe
What is the most common route of infection in preseptal/periorbital cellulitis?
Via the ethmoid sinuses
What are the characteristics of Legg-Calve-Perthes disease?
Boys > girls
4–10 years of age
Unilateral, intermittent limp (worse after activity)
Most commonly caused by osteonecrosis of the proximal femoral head
What are the signs/symptoms of SCFE?
Boy 12–16 yo with obesity
Progressive limp & hip/knee pain
Loss of hip internal rotation
X-ray will show scoop of ice cream slipping off cone
What is the treatment for SCFE?
Non-weight-bearing and urgent ortho consult
What is conduct disorder?
Disruptive behavior disorder characterized by a repetitive and persistent pattern of defiant, dissocial, and aggressive behaviors that violate age-appropriate social norms
How is ODD different than conduct disorder?
They do not violate societal norms or rules and are not violent toward other people or animals
What is the differences between roseola, rubeola, and rubella?
Roseola: caused by herpes virus-6
Rubeola: measles
Rubella: German measels
What are the signs/symptoms of rubeola (measles)?
Unvaccinated
Maculopapular rash that started on head and spread toward feet
High fever
Cough
Conjunctivitis
Red spots with blue or white center on buccal mucosa (Koplik spots)
How does erythema multiforme usually present?
Acute onset of symmetric target lesions on palms and soles, face and trunk may also be involved
What is the treatment for erythema multiforme?
Supportive care
What most commonly causes erythema multiforme?
HSV
What is the most common solid kidney tumor of childhood?
Wilms tumor
What are the signs/symptoms of Wilms tumor?
< 15 years old
Abdominal pain
Anorexia
Abdominal distention
Vomiting
Hematuria
PE will show abdominal mass
When does tooth eruption occur?
Most frequently occurs in children around 7 months of age but may manifest as early as 3 to 4 months of age or as late as 12 to 16 months of age
How is status epilepticus defined?
≥ 5 minutes of continuous seizure or two or more discrete episodes of seizure between which there is incomplete recovery of consciousness
What is 1st line treatment for status epilepticus?
Benzos (lorazepam)
What are signs/symptoms of peritonsillar abscess?
Dysphagia
Drooling
Trismus
Hot potato voice
Uvula displaced away from abscess
What is the treatment for peritonsillar abscess?
I&D or needle aspiration
Abx 7–10 days
What is patent ductus arteriosus (PDA)?
An acyanotic heart disease that is characterized by the failure of normal closure of the ductus arteriosus after birth
How is PDA described on auscultation?
Continuous, rough, machine-like murmur, heard best in the first interspaces of the left sternal border
What is the treatment for a PDA?
Indomethacin
What is pathognomonic for Wilson’s disease?
Kayser-Fleischer rings in the cornea (brown/copper deposit rings around the iris)
Bronchiectasis is commonly seen in what disease process?
Cystic Fibrosis
What are signs/symptoms of pertussis (whooping cough)?
Rapid-fire repetitive coughing followed by an inspiratory whoop and post-tussive emesis
What is the treatment for pertussis?
Azithromycin
What vaccine prevents pertussis?
DTap
Most drug exanthems are caused by what type of hypersensitivity?
Delayed-type T cell-mediated type IV immune reactions
At what age do you administer an M-CHAT to screen for ASD?
18-24 months
What are the most common sources of epistaxsis?
Anterior bleeds: Kiesselbach plexus
Posterior bleeds: sphenopalatine artery
How should infant’s weight change over the course of the first year of life?
Double their birth weight by 4 months and triple their birth weight by 12 months
What is 1st line treatment for cutaneous warts?
Salicylic acid or cyrotherapy
What is the treatment for a neonate (< or = 1 mo) with bacterial meningitis?
Cefotaxime + ampicillin
What is the treatment for bacterial meningitis in children > 1 mo - 18 yo?
Ceftriaxone + vanc
What commonly causes bacterial meningitis in neonates?
E. coli
Group B strep
Listeria monocytogenes
Gram-neg bacilli
What commonly causes bacterial meningitis in children > 1 mo - 18 yo?
Strep pneumo
N. meningitidis
H. influenza
What is the hallmark laboratory finding indicating overly aggressive initial outpatient nutritional therapy?
Refeeding syndrome
Labs show hypophosphotemia
At what age does the rooting reflex disappear?
2-3 months
Acute otitis media with tympanic membrane perforation is initially treated with what?
Amoxicillin
What is the most common pathologic murmur in childhood?
Ventricular septal defect (VSD)
How does ventricular septal defect sound on auscultation?
Loud, harsh, holosystolic murmur at the lower left sternal border
What is immune thrombocytopenia (ITP)?
A condition characterized by isolated thrombocytopenia that occurs in otherwise healthy individuals; often preceded by a recent viral illness
What is 1st line treatment for head lice?
Permethrin
What most commonly causes viral conjunctivitis?
Adenovirus
What are characteristics of rheumatic fever?
History of group A strep infection
Fever, red skin lesions on the trunk and proximal extremities, and small, nontender lumps located over the joints
PE: Jones criteria: joints, oh no—carditis!, nodules, erythema marginatum, Sydenham chorea
What are signs/symptoms of coarctation of the aorta?
Headaches, dyspnea, leg claudication
Higher BP in the arms than in the legs
Delayed femoral pulse
ECG: LVH
CXR: notching of ribs, “3 sign” (indentation of aorta)
What is the treatment for coarctation of the aorta?
Balloon angioplasty with stent placement or surgical correction
What presents with small skin-colored waxy, dome-shaped papules with umbilicated appearance that is highly contagious but self-limited?
Molluscum contagiosum
What is the most common complication of mumps?
Orchitis
What most commonly causes mumps?
Paramyxoviridae
What are signs/symptoms of aortic stenosis?
Dyspnea, chest pain, syncope
Crescendo-decrescendo systolic murmur that radiates to the carotids, paradoxically split S2, S4 gallop
Murmur decreases with Valsalva
What are the characteristics of laryngotracheitis (croup)?
Non-toxic-appearing (6 mo - 3 yo)
Barky seal-like cough
Inspiratory stridor
Low-grade fever
Steeple sign on x-ray
What is croup most commonly caused by?
Parainfluenza
What is the treatment for croup?
Steroids and racemic epi
What is the most common bacterial cause of acute pharyngotonsillitis?
Group A strep
What are the signs/symptoms of congenital hypothyroidism?
Lethargy
Coarse facies
Hoarse cry
Hypotonia
Dry skin
Hypothermia
What is a blueberry muffin rash?
Nickname given to the purpura or petechial rash of cytomegalovirus (CMV) due to its spotted blue or purple appearance on the skin, resembling a blueberry muffin.
What result of a sweat chloride test is indicative of cystic fibrosis?
> 60 mEq/L
What are the characteristics of cystic fibrosis?
Autosomal recessive, CFTR gene
Hx of multiple recurrent respiratory infections or failure to thrive
Pseudomonas most common infecting bacteria in recurrent pulmonary infections
What exanthema is teratogenic in the first trimester and may result in fetal hearing impairment, infantile glaucoma, and cardiac disease?
Rubella (german measles)
What is the most common cause of epiglottitis (esp in unvaccinated children)?
HIB
How is colic defined?
An otherwise healthy infant who is < 3 months of age who cries for ≥ 3 hours per day ≥ 3 days per week without a clear explanation
When should colic resolve by?
9 weeks
What are the signs/symptoms of hypercalcemia?
Bone pain (bones)
Kidney stones (stones)
Abdominal pain (groans)
Constipation (thrones)
Lethargy, psychosis/depression (psychiatric overtones)
What is the difference between croup and bacterial tracheitis?
Pt appears toxic with bacterial tracheitis
What is the most common cause of intestinal obstruction in infants between 6 and 36 months of age?
Intussusception
What is a common complication of influenza in children?
Otitis media
What are the characteristics of osteosarcoma?
Patient will be 10 to 20 yo
Pain, swelling that awakens at night
Codman triangle or sunburst pattern on x-ray
long bone metaphyses (most common)
Most common malignant bone tumor
What presents with a sandpaper rash, strawberry tongue, circumoral pallor, & pastia lines (petechiae in skin folds)?
Scarlet fever
What is the treatment for scarlet fever?
Amoxicillin
What is the causative agent of roseola?
Human herpesvirus 6 (sixth disease)
How does a roseola rash distribute?
Begins at the neck and trunk region and spreads to the face and extremities
What are the signs/symptoms of lead toxicity?
Headache
Joint pain
Abdominal pain and constipation
Lead lines on x-ray
Labs: basophilic stippling
What is the treatment for lead toxicity?
Oral succimer or IV EDTA
What are the characteristics of nephrotic syndrome?
Pitting edema
Proteinuria > 3.5 g/24 hr
Hyperlipidemia
Hypercoagulability (renal vein thrombosis)
Fatty casts
Minimal change disease: children, preceded by URI
What happens on a positive Barlow manuever?
Hip dislocates posteriorly
What is heard on auscultation of ASD?
Wide, fixed split S2
What is the most common inherited disorder of bilirubin glucuronidation, resulting in recurrent episodes of jaundice?
Gilbert syndrome
What presents with hypertension, hematuria, and periorbital edema with recent history of group A strep exposure?
Poststreptococcal glomerulonephritis
What are the signs/symptoms of osteogenesis imperfecta (brittle bone disease)?
Multiple fractures with no history of significant trauma
Hearing loss
Easy bruising
Blue sclera
What is characterized by the lack of peristalsis and involuntary relaxation of the internal anal sphincter, leading to bowel obstruction?
Hirschsprung disease
