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A1 > Peds 2 > Flashcards

Peds 2 Flashcards

1
Q

What is the most common of all childhood malignancies?

A

ALL

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2
Q

What are the typical s/sx of childhood leukemias?

A
  • B symptoms
  • Bone pain or limp/refusal to bear weight
  • Anemia
  • Ecchymoses/petechiae
  • HSM
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3
Q

What is a chloroma, and what does it signify?

A

Greenish soft tissue tumor on the skin or spinal cord

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4
Q

What are the relative WBC levels in leukemia?

A

Can be high, low or normal

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5
Q

What is the definitive diagnostic test for acute leukemia?

A

Bone marrow bx

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6
Q

What is the role of a CXR in diagnosing ALL?

A

r/o a mediastinal mass

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7
Q

What is the major complication associated with chemotherapy induction in leukemias?

A

Tumor lysis syndrome

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8
Q

What are the electrolyte changes that occur with tumor lysis syndrome?

A

Hyperkalemia
Hyperphosphatemia
Hypocalcemia
Hyperuricemia

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9
Q

What is the treatment for tumor lysis syndrome? (3)

A

IVFs
Diuretics
Allopurinol

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10
Q

What medications, besides chemotherapy, classically precipitates tumor lysis syndrome?

A

Corticosteroids

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11
Q

What diseases are associated with neuroblastomas?

A

Neurofibromatosis

Hirschsprung’s disease

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12
Q

What are the symptoms of neuroblastomas?

A

Nontender abdominal mass
Horner syndrome
HTN
Cord compression

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13
Q

What are the classic PE findings of a neuroblastoma, besides an abdominal mass?

A

Opsoclonus/myoclonus

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14
Q

What is opsoclonus?

A

Random, multi vectorial eye movement, commonly seen with neuroblastomas

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15
Q

How are neuroblastomas diagnosed? (2)

A
  • FNA of tumor revealing small round blue cells

- Elevated 24 hours urinary catecholamines

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16
Q

How are neuroblastomas staged?

A

CT scan

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17
Q

What is the treatment for a neuroblastoma?

A

Surgical resection and/or XRT

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18
Q

What are the skin manifestations of neuroblastomas?

A

Multiple SQ nodules

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19
Q

What ages do Wilms tumors commonly occur in?

A

2-5 years

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20
Q

What syndromes are Wilm tumors commonly associated with?

A
  • Beckwith-Wiedemann syndrome
  • Neurofibromatosis
  • WAGR syndrome
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21
Q

What are the components of WAGR syndrome?

A
  • Wilms tumor
  • Aniridia
  • GU abnormalities
  • Retardation
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22
Q

What are the s/sx of Wilms tumor, besides unilateral abdominal mass?

A
  • Abdominal pain
  • Fever
  • HTN
  • microscopic/gross hematuria
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23
Q

How are Wilms tumors diagnosed?

A
  • FNA
  • Abdominal US
  • CT scan
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24
Q

What is the treatment for a Wilms tumor?

A

Local resection and nephrectomy with postsurgical chem and XRT if there are mets

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25
Q

What germ cell layer do Ewing sarcomas arise from?

A

Neuroectoderm

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26
Q

What germ cell layer do osteosarcomas arise from?

A

Osteoblasts (mesenchymal)

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27
Q

Who classically gets Ewing’s sarcoma? Osteosarcomas?

A 
Ewing's = white male adolescents
Osteosarcomas = Male adolescents
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28
Q

What are the s/sx of Ewing’s sarcoma?

A
  • Local pain and swelling

- Systemic symptoms, e.g. fever, anorexia, fatigue

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29
Q

What are the s/sx of osteosarcomas?

A

Local pain and swelling

systemic symptoms are rare

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30
Q

Where anatomically are Ewing sarcomas commonly located?

A

Midshaft of long bones

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31
Q

Where anatomically are osteosarcomas commonly located?

A

Metaphyses of long bones

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32
Q

What lab abnormalities are common to Ewing’s sarcoma?

A

Leukocytosis

Increased ESR

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33
Q

What lab abnormalities are common to osteosarcoma?

A

Increased alkphos

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34
Q

What is the classic x-ray findings for Ewing’s sarcoma?

A

Onion skinning lytic bone lesion

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35
Q

What is the classic x-ray findings for osteosarcoma?

A

Sunburst lytic bone lesions

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36
Q

Sunburst lytic bone lesions on x-ray = ?

A

Osteosarcoma

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37
Q

Onion skinning lytic bone lesion on x-ray = ?

A

Ewing’s sarcoma

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38
Q

What is the treatment for Ewing sarcoma?

A

Local excision, chemo, and XRT

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39
Q

What is the treatment for osteosarcoma?

A

Local excision, chemo

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40
Q

What is the treatment for a clavicular fracture?

A

Sling

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41
Q

What is a Greenstick fracture, and what is the treatment?

A
  • Incomplete fracture involving the cortex of only 1 side (tension/trauma) side of the bone
  • Reduction with casting.
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42
Q

What is a torus fracture? Treatment?

A
  • Buckling of the compression side of the cortex 2/2 trauma

- Cast immobilization for 3-5 weeks

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43
Q

What is a supracondylar humeral fracture, and what is the treatment?

A
  • Humeral fracture just above the condyle

- Cast immobilization

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44
Q

What are the complications associated with a supracondylar humeral fracture?

A
  • Volkmann contraction (results from compartment syndrome of the forearm)
  • Brachial artery entrapment
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45
Q

What is the treatment for Osgood-Schlatter disease?

A

Decreased activity for 2-3 months or until asymptomatic

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46
Q

What are the components of the SALTER mnemonic for salter-harris classifications?

A 
Straight across
Above
Lower
Through
Erasure of the physis
cRushed
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47
Q

What is the treatment for a salter-harris fracture?

A

Closed or open reduction, followed by immobilization

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48
Q

What is the inheritance pattern of Duchenne’s muscular dystrophy? What protein is deficient?

A

XLR

Dystrophin

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49
Q

Which muscles are more prominently affected with Duchenne muscular dystrophy: proximal or distal? Axial or peripheral?

A

axial and Proximal

50
Q

What are the presenting symptoms of Duchenne muscular dystrophy?

A

Clumsiness, fatigability

51
Q

What is the diagnostic test for Duchennes? What will this show?

A
  • Muscle bx

- Necrotic muscle fibers, and negative dystrophin stain

52
Q

What lab is elevated with Duchennes muscular dystrophy?

A

CK

53
Q

What will EMG show with Duchennes?

A

Polyphasic potential and increased recruitment

54
Q

What is the treatment for Duchenne muscular dystrophy?

A

Physical therapy to maintain ambulation and to prevent contractures

55
Q

What causes the high-output cardiac failure in Duchenne muscular dystrophy?

A

Cardiac fibrosis

56
Q

What is developmental dysplasia of the hip?

A

a congenital or developmental deformation or misalignment of the hip joint. It does not typically produce symptoms in children less than a year old

57
Q

Who usually develops congenital hip dysplasia?

A

Firstborn girls in breech position

58
Q

What are the maneuvers that are used to screen/diagnose developmental hip dysplasia?

A

Ortolani and barlow maneuver

59
Q

What is the Allis (Galeazzi) sign?

A

Test for developmental dysplasia of the hip–The knees are at unequal heights when the hips and knees are flexed (the dislocated side is lower).

60
Q

What is characteristic about the inguinal area in kids with hip dysplasia?

A

Asymmetric skin folds that extend beyond the anus and limited abduction of the affected hip

61
Q

When does DMD and becker’s begin?

A 
DMD = 3-5 years
Becker's = 5-15 years
62
Q

What is the life expectancy for DMD and beckers?

A 
DMD = teens
Becker's = 30s-40s
63
Q

Which more commonly has MR: DMD or beckers?

A

DMD

64
Q

What is the difference in dystrophin in DMD vs beckers?

A

DMD is absent

BEckers has normal levels, but the protein is abnormal

65
Q

How is developmental hip dysplasia diagnosed?

A
  • US prior to 6 months given lack of ossification

- Radiographs after 6 months

66
Q

What is the treatment for developmental dysplasia of the hip (before 6 months, 6-15 months, and 15-24 months)?

A
  • Less than 6 months: Splint with a Pavlik harness (maintains hip flexed and abducted)
  • 6-15 months: spica cast
  • 15-24 months = Open reduction followed by spica cast
67
Q

What are the major complications associated with developmental dysplasia of the hip?

A

AVN of the femoral head

68
Q

What is Legg-calve-perthes disease?

A

Idiopathic AVN and osteonecrosis of the femoral head

69
Q

In whom is Legg-calve-perthes disease most common in?

A

Boys 4-10 years

70
Q

What are the s/sx of Legg-calve-perthes disease?

A

painless limp, antalgic gait, and thigh muscle atrophy

71
Q

If pain is present with Legg-calve-perthes disease where is it usually found?

A

Groin, anterior thigh, or may be referred to the knee

72
Q

What PE finding is classic for Legg-calve-perthes disease?

A

Limited abduction and internal rotation

73
Q

How is Legg-calve-perthes disease diagnosed?

A

Radiography

74
Q

What is the treatment for Legg-calve-perthes disease?

A

■ Observation sufficient if limited femoral head involvement or if full ROM is present.
■ If extensive or ↓ ROM, consider bracing, hip abduction with a Petrie cast, or an osteotomy.

75
Q

What is the prognosis for Legg-calve-perthes disease?

A

The prognosis is good if the patient is < 6 years of age and has full ROM, ↓ femoral head involvement, and a stable joint.

76
Q

What are the components of the STARTSS HOTT mnemonic for the ddx for pediatric limp?

A 
Septic joint
Tumor
AVN
RA/ JRA
TB
Sickle cell
SCFE
HSP
Osteomyelitis
Trauma
Toxic synovitis
77
Q

What is slipped capital femoral epiphysis?

A

Displacement of the femoral head from the femoral neck through the growth place.

78
Q

In whom are SCFEs common in?

A

Obese children

79
Q

What are the presenting s/sx of a SCFE?

A
  • Insidious onset of hip pain, or referred knee pain

- painful limp

80
Q

How do you diagnose a SCFE? What will these show?

A
  • Radiographs of both hips in AP and frog-leg lateral views

- Reveals posterior and inferior displacement of the femoral head

81
Q

What is the treatment for a SCFE?

A

■ Immediate surgical screw fixation to reduce risk of AVN.

■ No weight bearing should be allowed until the defect is surgically stabilized.

82
Q

What is the technical definition of scoliosis?

A

Lateral curvature of the spine more than 10 degrees.

83
Q

What is the treatment for scoliosis (less than 20 degrees, 20-50 degrees, 50+ degrees)?

A

■ Close observation for < 20 degrees of curvature.
■ Spinal bracing for 20–49 degrees of curvature in patients with remaining growth. Curvature may progress even with bracing.
■ Surgical correction for > 50 degrees of curvature.

84
Q

How should babies sleep to reduce the risk of SIDS?

A

On their backs

85
Q

How hot should the water heated be allowed to get with children in the house?

A

Less than 120 F

86
Q

How long should children be rear facing in the car?

A

Until 2 years, and/or weighs over 40 pounds

87
Q

When can solid foods be introduced to an infant diet?

A

After 6 months

88
Q

When should cow’s milk be introduced into an infant diet?

A

No sooner than 12 months

89
Q

When is objective hearing screens indicated for children if not done routinely at discharge?

A

h/o TORCHES infections

90
Q

How long is strabismus considered normal?

A

Until 3 months of age

91
Q

What is strabismus?

A

Misalignment of eyes

92
Q

What is amblyopia?

A

Suppression of retinal imaged in a misaligned eye

93
Q

What two pathologies are indicated with leukocoria?

A
  • Retinoblastoma

- Retinopathy of prematurity

94
Q

Patients who have a severe allergy to eggs should not receive which vaccine?

A

MMR

95
Q

True or false; HIV patients should not be given any live attenuated vaccines

A

False-can get MMR and varicella

96
Q

What are NOT contraindications to vaccinations?

A
  • Mild illness and/or low grade fever
  • Current abx use
  • Prematurity
97
Q

When is screening for Pb poisoning indicated?

A

at 12 and 24 months in high risk areas only (not universal)

98
Q

What are the s/sx of Pb poisoning? (3)

A
  • Intermittent abdominal pain
  • Peripheral neuropathy (wrist or foot drop)
  • Acute encephalopathy if severe
99
Q

What will a PBS show with Pb poisoning?

A

Microcytic, hypochromic anemia with basophilic stippling.

Sideroblasts may also be present

100
Q

What is the treatment for Pb poisoning (less than 45 micrograms, 45-70, 70+)?

A

■ < 45 μg/dL and asymptomatic: Retest at 1–3 months; remove sources of lead exposure.
■ 45–69 μg/dL: Chelation therapy (inpatient EDTA or outpatient oral succimer [DMSA]).
■ ≥ 70 μg/dL: Chelation therapy (inpatient EDTA + BAL [IM dimercaprol]).

101
Q

What is the most common cause of urethral obstruction?

A

Posterior urethral valves

102
Q

What is vesicoureteral reflux?

A

Retrograde projection of urine from the bladder to the ureters and kidneys

103
Q

What is mild (grade I) vesicoureteral reflux?

A

No ureteral or renal pelvic dilation. Often resolves spontaneously

104
Q

What is moderate (grade II) vesicoureteral reflux?

A

Ureteral dilation with associated caliceal blunting in severe cases

105
Q

What is the typical presentation of vesicoureteral reflux?

A

Recurrent UTIs, typically in childhood

106
Q

How is vesicoureteral reflux diagnosed?

A

Voiding cystourethrogram

107
Q

What is the treatment of vesicoureteral reflux?

A
  • treat infx aggressively
  • mild with daily prophylaxis
  • surgery for grade III+
108
Q

What is the common complication to untreated vesicoureteral reflux?

A

Renal scarring

109
Q

What is the major risk factor for cryptorchidism?

A

Low birth weight

110
Q

What is a major complication of untreated cryptorchidism?

A

Infertility and increased risk of testicular malignancy

111
Q

What is the treatment for cryptorchidism?

A

Orchiopexy

112
Q

What organs are affected by maternal hyperglycemia?

A
  • Heart
  • Liver
  • muscle
113
Q

What organs are not affected by maternal hyperglycemia?

A

Brain

Kidneys

114
Q

What causes breastfeeding jaundice?

A

Insufficient breast milk in the first week increases enterohepatic circulation of bili. Beta-glucuronidase present in meconium conjugates bili, and causes it to be reabsorbed

115
Q

What is/causes breast milk jaundice? When does it present, and how long does it last?

A
  • Jaundice on day 4-7, and can persist for up to 12 weeks

- beta-glucuronidase in milk causes deconjugation of bili and increased enterohepatic circulation

116
Q

What are the s/sx of biliary atresia?

A
  • Acholic stools
  • Dark urine
  • Jaundice
117
Q

What is the normal color for infant stools? Are they usually odorous?

A

Yellow

Breast fed infant stools are usually odorless

118
Q

What is the treatment for breast discomfort 2/2 engorgement?

A
  • Increased feedings
  • Warm compresses
  • Manual/mechanical expression of milk
119
Q

What vitamin supplements should a baby receive if exclusively breast fed?

A

Vit D (through mother)

120
Q

What visual problem can arise with NF1?

A

Optic pathway glioma

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