Peds 2 Flashcards
1
Q
most common reservoir for human rabies in the US
developing world?
paralysis?
what kind of phobia?
A
bats in US
dogs
ascending flaccid paralysis
hydrophobia and aerophobia
2
Q
Herpangina
Etiology Age Season Cx features Tx
A
Coxsackie A
3-10 yrs
Summer and early fall
Fever, pharyngitis, gray vesicles/ulcers on posterior oropharynx
Supportive
3
Q
what is hyper IgM due to
what kind of infections
A
defect in CD40 ligand which is on T cells and binds CD40 on B cells for class switching
sinopulmonary infections with encapsulated bacteria
viral infections
pcp too
4
Q
pt with otitis and mastoiditis has serious risk factor for what and managment
A
direct spread of infection into a temporal brain abscess
next step is CT scan with contrast and MRI
CT better at depicting bone, and mastoid process damage
MRI better for soft tissue
5
Q
Age for imaginary friends
A
Age 3-6
6
Q
Pts with infection and resp distress that hyperextend the neck and maintain tripod position
A
Epiglottitis
7
Q
Risk factors for IDA in children over 1 nutrition wise
A
Over 24 oz cows milk a day, don’t start till 1 yrs old
Under 3 servings a day of iron rich foods
8
Q
CH50 assay is used to determine what
A
complement concentration
infections with encapsulated bcateria
9
Q
in both infants and chidlren, ___ is the most common organism responsible for osteomyelitis
A
staph aureus
10
Q
Language
12 months 18 months 2 yrs 3 yrs 4 yrs 5 yrs
A
12 months: first words besides mama and dada
18 months: 10-25 words and more than 1 body part IDd
2 yrs: 50+ vocab, 2 word phrase
3 yrs: 3 word sentence speech 75% recognized
4 yrs: id color and 100% speech intelligible
5 yrs: counts to 10, 5 word sentence
11
Q
Laryngotracheitis is what
A
Croup
12
Q
What term infants get NEC
A
Ones with reduced mesenteric perfusion from congenital heart disease and/or hypotension
Mainly terminal ileum, and colon
13
Q
Vaccines for medically stable preterm infants should be administered based off what
A
Chronologic age
14
Q
respiratory tract features in CF
A
sinopulm infx
nasal polyps
bronchiectasis
digital clubbing
15
Q
Risk factors for vitamin K deficiency
A
Inadequate dieatary intake
Disorders of fat malabsorption: CF and biliary atresia
Disorders of intestinal inflammation: celiac and IBD
Decreaed production by bacterial flora from freq abx use
16
Q
When do you use palivizumab in infants with RSV
A
Preterm birth under 29 weeks
Chronic lung disease of prematurity
Hemodynamically significant CHD
17
Q
Koh prep showing hyphae and yeast cells in spaghetti and meatball pattern?
Cx feautres
Tx?
A
Tinea versicolor (pityriasis versicolor) malessezia globosa exposed to hot and humid weather
Hypopig, hyperpig, or mild erythemaout lesions
Topical ketoconazole, terbinafine, selenium sulfide
18
Q
What age does malroation with midgut volvulus usually present
A
Under 1 month
19
Q
INTRAOSSEOUS CANNULATION
A
When IV access cannot be ontained in emergency cases uses a IO access immediately.
Proximal tibia is most common spot
20
Q
what is the single second heart sound from in TOF
A
normal aortic and inaudible pulmonary component of the S2
21
Q
After 6 months of life what becomes the most important cause of IDA
A
Inadequate dietary intake
22
Q
Gradual onset of hemiplegia
Neck pain
Aphasia (or other stroke sx)
Thunderclap headache
What is this and how diagnose and treat
A
GNAT: carotid artery injury or dissection which can lead to thrombus formation which can extend into the middle and anterior cerebral arteries
Dx: CT or MR angiography
23
Q
primary ciliary dyskinesia extrapulmonary features
how about CF extrapulm
A
situs inversus
infertile
normal growth
CF: pancreatic insufficiency, infert, FTT
24
Q
older children, unilateral LAD with history of periodontal disease
A
poptostreptococcus
25
Most common congenital cyanotic heart disease in the neonatal period
Exam and x ray finding
Transposition of great vessels
Single S2
+/- VSD murmur
Egg on a string heart (narrowed mediastinum)
26
____ causes hereditary fructose intolderance
Sx
Aldolasae B def
Fruits and veggies into diet accuulates fructose 1 phosphate
Vomit, poor feed, lethargy
Seizuress and encephalopathy
27
If you see nocturnal perianal pruritits think what
Helminth infection, enterobius vermicularis
28
___ anemia is often caused by excessive consumption of cow's milk
IDA
29
the most common cause of a pediatric stroke is what
pts with SCD
mri if concern for stroke
30
RBCs in IDA, a thalassemia and b thalassemia
Increase, decrease or same?
Decreased, normal, normal
31
developmental dysplasia of hip, what is managment
treatment?
B/L US
after 4 months x rays are preferred
pavlik harness treats
32
clinical findings of congenital syphillis
rhinorrhea
abnormal long bone radiographs
desquamation or bullous rash (starts maculopapular)
syphillis is RAD
33
Non neurological manifestations in freidrichs ataxia
Death?
Hypertrophic cardiomyopathy, dm and skeletal deformities like scoliosis and hammer toes
cardiomyopathy in 90% of pts
Leading casues death is cardiomyop also resp failure can cause death
34
What are arterial lines used for
Continuous bp monitoring and to draw lab studies
35
What immunodef gives anaphylaxis during transfusion
Selective IgA def
36
Oral laxatives for kids
Polyethylene glycol and mineral oil
37
Do pituitary adenomas have calcifications within the mass
No
38
Intraventricular hemorrhage occurs predominatly in what infants
Premature and low birth weight
Also exposure to vascular perfusion injuries
Hypoxic episodes, hypotension, reperfusion of damaged vessels, increased venous pressure, abrupt change in cerebral flow
39
Electron microscopy findings in alport
Alternating areas of thinned and thick cap loops with split of GBM
40
Dx retropharyngeal abscesses
Lateral neck radiographs demonstrate prevertebral space thickening
CT scan of neck too
41
managment when vaginal foreign body suspected
external exam of genitalia with child in knee to chest
small bodies can usually be removed with calcium alginate swab or irrigation with warmed fluids after topical anesthetic applied
exam under anesthesia if that doesn't work
42
Developmental dysplasia of the hip is assocaited with what
Breech presentation
43
Gastric outlet obstruction is also what
Pyloric stenosis
44
B thalassemia minor
```
MCV
RDW
RBCs
periph smear
serum iron studies
response to iron supplements
hemoglobin electrophoresis
```
MCV: decreased
RDW normal
RBCs normal
PS: target cells
serum fe study: normal or increased iron and ferritin
response to FE sup: no improvment
hemoglbin electrophoresis: increased hemoglobin A2
45
The diagnosis of autism is clinical but should what
Involve comprehensive eval with assessment of language, social, and intellectual development and hearing, vision and genetic stuff
46
retinal hemangioblastomas are associated with what
Von hippel lindau syndrome
47
breath holding spells common for what age and what are they
is this normal?
6 months to 2 years
episode of apnea precipitated by frustration, anger, or pain
benign
cyanotic: from crying and breath holding in forced expiration, then apnea, limpness, and LOC
pallid: from minor trauma
normal yes
48
When is a VCUG indicated
Hydronephrosis on renal US
Also in newborns under 1 month and kids under 2 with recurrent UTIs or first UTI from organism other than E coli
49
a thalassemia minor
```
MCV
RDW
RBCs
periph smear
serum iron studies
response to iron supplements
hemoglobin electrophoresis
```
```
MCV: decreased
RDW normal
RBCs normal
PS: targer cells
serum iron studies: normal/ increased iron and ferritin
```
no response to iron supp
hemoglobin electrophoresis normal
50
Howell jolly bodies seen in what pts
Asplenic pts bc spleen usually removes normal nuclear remnants of RBCs which are the HJ bodies
51
Helmet cells or schistocytes seen in what
Microangiopathic hemolytic conditions like DIC, HUS, and TTP
52
crqadle cap in infants
greasy scales with mildy erythemaotous base on scalp
seborrheic dermaitits
53
RDW in iron deficiency anemia and how much
elevated over 20%
54
mono presents as what when treated with aminopenicillin
morbilliform rash on the trunk that spares extremities and arthralgia does not occur
55
Todd paralysis
Self limited focal weakness that occurs after a focal or generalized seizure
Postictal partial or complete hemiplegia involgin an ipsilateral upper and LE
56
most common type of tinea capitis is what
trichohyton tonsurans
microsporum can cause it too
57
EBV LAD
bilateral subacute-chronic LAD with systemic symptoms
58
If suspected lead poisoning then what is next step in management
Dra venous lead level
If 5-44 then no meds, repeat in 1 month
If 45-69 then DMSA, succimer
If over 70 then EDTA
59
Focal or gen seizures, mental retard, and port wine stain or nevus flameus along the teritory of the trigeminal nerve
Gongetical unilateral cavernous hemangioma
Other findings in this disease
Sturge weber syndrome
Hemiparesis, hemisensory distrub, ipsilateral gluacoma
60
Separation anxiety manifests at what age
9-18 months
61
Retropharyngeal abscess results from what and what infections
Pre existing URI and direct spread of bacterial inx from pharyngitis, tonsillitis, OM or sinusitis
Polymicrobial
S pyogens, a aureus, anaerobes
62
if contrast enema shows a transition zone btwn a narrow rectosigmoid and dilated megacolon workup for what and how
hirschrpungs
rectal biopsy performed
63
GERD in infants
physiologic
pathologic
and tx for both
physiologic
- asx, happy spitter,
- reassurance and position therapy and freq small feeds
- usually resolves by 1
pathologic
- FTT, really irritable, sandifer syndrome
- thickened feeds, antacids, esohageal ph probe monitor and upper endoscopy if really severe
64
Posterior urethral valves can present with what
Urosepsis, FTT and RENAL failure
65
what would CHF show on cxr
increased pulmonary vascular congestion and intersitial edema
66
features of LAD
recurrent skin and mucosal bacterial infections (omphalitis and periodontitis)
-no pus, poor wound healing
delayed umbilical cord sepration
marked peipheral leukocytosis with neutrophilia
67
What occurs in orbital cellulitis that isn’t in preseptal cellulitis
Ophthalmoplegia, pain with exye movement, proptosis, vision impairment
68
Neuroblastoma occurs when
Anatomy and sx
Within first year of life
Adrenal glands, abdominal mass that crosses midline with systemic sx
69
Complications of NEC
Short bowel syndrome
Septic shock
Intestinal strictures
Deat
70
acute bacterial rhinosinusitis most common orgnaisms and treatment
s pneumo
h flu
morax cat
amox-clav
71
Fever in measles or rubella has a fever of 104 or higher? And which has cervical adenopathy?
Which has posterior auricular or suboccipatal LAD?
Measles for fever and cervical
Rubella for post auric and subocc
72
Diagnosing wilms tumor
Abdominal US then contrast enhanced CT of the abdomen and of chest to ID pulmonary metastases
73
Pts who present with migraine sx that need neuorimaging
History of coordination difficulty, numbness, tingling, focal neuro signs, history of HA that awakens from sleep
74
Most common sites of thromboembolism in antithrombin III def
Femoral and messenteric veins
Cerebral thromboses is less common
75
Paroxysmal nocturnal hemoglobiunira is diagnosed by what
Erythrocyte CD55 and CD59 protein testing
76
small palpebral fissures
smooth philtrum
thin vermilion border
what in utero exposure
what other features
alcohol
decreased growth, microcephaly
adhd, dumb, social withdraw, motor and language delay
77
Clinical features of Digeorge
Conotruncal cardiac defects (truncus arteriosus)
Abnormal facies
Thymic aplasia (t cell lymphopenia and increased viral and fungal infx)
Cleft palate
Hypocalcemia: tetany, seizures and arrhythmias
78
Mentzer index in thalassemia is what
How bout IDA?
MCV/RBC and under 13
IDA: over 13 bc RBCs decreased
79
Criteria for cyclic vomiting syndrome
```
3 or more episodes in 6 month period
1-10 days
Vomiting 4times or more and hour at peak
No sx in btwn vomiting
No underlying condition
```
Predictable pattern of vomiting
80
Opalescent teeth is found in what disease
Osteogenesis imperfecta
Calld dentinogenesis imperfecta discolered teeth
81
The incidence of cyclic vomiting syndrome is highest in which children
How treat
Age
Those whose parents have a hx of migraine headaches
Treat with antiemetics and sumatriptin
2/3 resolves on own by 5-10
82
Measles or rubella has maculopapular rash that erupts on face and spreads caudal WITHIN 24 hours
Rubella
Measles takes multiple days
83
Maternal withdrawal of estrogen key features
Treatment?
Presents in neonatal period and lasts under a week
Can cause vaginal bleeding and discharge
-neonatal endometrium may slough off after estrogen gone from birth = mucoid vaginal bleeding
-can lead to breast bud and external genitalia eongorgement
Reassurance
84
clindodactyly and large space btwn first 2 toes
DS
85
All children under the age of ___ with a first febrile UTI should undergo a renal and bladder US
2
86
What food should be introduced after 6 months of breastfeeding then what
Pureed fruits and vegetables then pureed proteins like meats.
87
Which is the only vaccines that pt needs to weigh 2 or more kgs (4 lbs 6 oz) before administering it
Hepatitis B
88
Scaly erythematous pruritic patch with centrifugal spread, subsequent central clearing with raised annular border is what and what is treatment
Topical clotrimazole and terbinafine
Second line is oral terbinafine and griseofulvin
Tinea corporis (ringworm)
89
Benign or pahtologic murmur?
Murmur that intensity decreases on standing and valsalva maneuver?
Benign
90
Clubfoot aka ____ presents with equinus of the ____ and varus of the ___ and varus of the ___ and adduction of the ___
Talipes equinevarus
```
Equinous calcaneum (EC if you know this dumb ass language)
Varus of talus (Va tech)
```
Varus of midfoot
Adduction of forefoot
91
In pts with type I DM infection can precipitate DKA due to systemic release of what
Insulin counterreg hormones like catecholamines and cortisol
Resultant excess of glucagon
92
TOF and what make TOF better and how
knee to chest and squatting
if the resistance of the systemic circulation exceeds the resistance of the pulmonary circulation, the blood will shunt from the ventricles to the pulmonary artery
otherwise PVR exceeds that of systemic and shunt from ventricles into aorta = cyanosis
93
progression to cardiac tamponade is characterized by becks triad which is what
cxr shows what
distant heart sounds, distended jugular veins, and hypotension
chest x ray shows cardiomegaly
94
Lower abdominal cramping with meses in absence of other pathology, cramping during first few days is what
And caused how
Tx
Primary dysmenorrhea
Prostaglandin release from sloughing endometrium
NSAIDs
95
hyper IgM syndrome quant Igs
tx
decreased IgG and IgA
increased IgM
antibiotic prophylaxis and interval admin IVIG
96
anstranger anxiety is normal finding that starts when and subsides when
6-9 months then ends by 3
97
Intestinal malrotation can present with what and dx
Recurrent bilious vomiting, lead to volvulus which causes severe bilious emesis and hypovolemic shock
Upper GI series is dx
98
Contraindications to rotavirus vaccine
Anaphylaxis to vaccine
History of intussusception
History of uncorrected congenital malformation of GI tract like meckel
SCID
99
Maculopapular rash followed by successive crops of vesicles
Varicella
100
Turners syndrome
```
Estrogen
Fsh
Inhibin A
Testosterone
GH
LH
```
```
Estrogen decreased
FSH increased
Inhibin A decresaed
Testosterone decreased bc lack production ovaries
GH normal
LH increased
```
101
Thickening of the tunica media in the aortic arch is what
Coarctation of the aorta
102
Jaundice, hepatomegaly and FTT after breast milk or regular formula is what
Galactosemia from no galactose 1 phosphate uridyl transferase activity
103
congenital ___ is characterized by periventricular calcifications
CMV
104
gaucher disease
enzyme def
sx
glucocerebrosidase
bone pain and cytopenias
HSM
105
Tongue laceration in what
Seizure
106
What age say dada and mama and what age first words
Mama and dada 9 montsh
| 12 months is first words
107
how do you diagnose SCD
dx with hemoglobin electrophoresis
-if concern for stroke then do MRI
108
Name for hair pulling disease and people with family or personal history of what have increased risk
Tx?
Trichotillomania
OCD
Tx: abit reversal training
109
Hereditary spherocytosis
Lab findings
Increased MCHC
Neg coombs
Increased osmotic fragiltiy on acidified glycerol lysiss test
Abnormal eosin-5-malemide binding test
110
What age is MMR recommended?
1 and 4
Mmmmrrr tyrel reid
111
hereditary angioedema
edema without what
deficiency
elevated what
presents when
edema without eveidence of urticaria
C1 esterase inhibitor deficiency
-c1q levels normal in this and depressed in acquired form
elevated bradykinin and C2b
presets late childhood after infeciton, dentalprocedure or trauma
112
Features of hemiplegic migraine
Tx
Onset in adolescence and often positive family history
History of HA and visual aura
Sx self resolve
113
Systolic ejection murmur at the left interscapular area
Coarctation of the aorta
114
Treatment of clubfoot aka ____
Talipes equinovarus
Stretch and manipulate foot, then seriel plaster casts, malleable splints or tabing
115
If Digeorge suspected what must be ordered immediatelya
Serum calcium and echo
Hypo
116
Moderate to Severe dehydration should be treated how
What % water loss cap refil
IV fluids, with isotonic crystalloid
10-15% cap refil over 3 seconds
117
what is used to diagnose CGD
dihydrorhodamine test or the nitroblue tetrazolium test
118
episodic inconsoluble crying with normalness in between episodes
lethargy ams, bloody stool, emesis
intussusception
119
normal distribution of eczema in infants and another name for it
face, scalp, extensor surfaces and flexural creases in older children
atopic dermatitis
120
Septic joint
Appearance, wbcs, pmns
Micro nd tx
Appearance: opaque
WBCs 50 k to 150k
Pmns >80-90%
Most common is staph aureus and streptococci
Empiric iv abx with vanco, also synovial fluid aspiration and surgical drainage
121
Diagnosis of fanconi anemia is made by what
What is definitive treatment?
Chromosmal breaks on genetic analysis and clinical findings
SC transplant is tx
122
If have tranposition of great vessels what must be done
Use prostaglandins to keep PDA open if there is one until surgery
123
scaly erythematous patch with hair loss on scalp
can have black dots or tender LAD
most common in af american children
how to confirm
tinea capitis which is a dermatophyte infection
also common in ICPts
confirm with KOH exam
124
causes of RTA type 1
urine pH?
genetic disorders and nephrolithiasis
meds
autoimmune disorders like sjogren and RA
>5.5
125
Peak age of wilms tumor and another name
sx
Neprhoblastoma and age 2-5
wagr, beckwith wiedemann and dnys drash
Asx
126
Pains that occur at night and resolve by morning affect LE and normal physical exam and activity?
Tx?
Growing pains
Just massage, stretch, heat analgesics
127
Degeneration of the spinal tracts
Freidrichs ataxia
128
Lab findings in HUS
Heamolytic anemia, schistocytes, incerased billy
Thromboyctopenia
AKI
TRIAD
129
Social/cognitive
```
12 months
18 months
2 yrs
3 yrs
4 yrs
5 yrs
```
```
12 months: sep anxiety, follows 1 step commands
18 months: understands mine
2 yrs: 2 step commands, toilet train
3 yrs: knows age/gender
4 yrs: cooperative play
5: has friends and potty trained
```
130
By age 12 months of life a childs weight should ___ and height should increase by __
Tirple
50%
131
Which bacteria is by far the most common cause of sepsis in pts with SCD
S pneumoniae from non vaccine serotypes
132
patients refusal to speak in a specific social situation but engage in normal communication in situations in which she feels comfortable is consistent with what
selective mutism
has to happen for 1 month or more
133
Posterior urethral valves and amnio
Oligohydramnios
134
Etiology of pediatric viral myocarditis
Clinical presentation
Coxsackie B virus
Adenovirus
HF, dyspnea, tachy, nausea, vomit
135
Clinical manifestations of fanconi anemia
Bone marrow
Appearance
Skin
Eyes and ears
Bone marrow: aplastic anemia
Appearance: short, microcephaly, abnormal thumbs, hypogonads
Skin: hypopigmented/hyperpigmented, cafe au lait, large freckles
Eyes and ears: strabismus, low ears, mid ear abnormalities
136
causes of RTA 2
urine pH
fanconi syndorme
(glucosuria, phosaturia, aminoaciduria)
<5.5
137
Complications of bronchioloitis
Apnea and resp failure
138
What is the most common predisposing factor for orbital cellulitis
And dangerous complications
Bacterial sinusitis
Blindness, subperiosteal abscesses, cavernous sinus thrombosis, intrcranial infection and death
139
What can increase pulmonary vascualar resistance in TOF
Exertion, feeding and agitiation resulting in complete RVOT obstruction
140
what is technetium-99m scan used to diagnose
meckels diverticulum, which presents with painless rectal bleedinng in chidlren
141
RDW in IDA
How about in:
A thal?
B thal?
Increased
Normal in thals
142
Treatment for lyme disease in kids under 8 or pregnant women or just anyoone
Everyone: doxy, amoxicillin, cefuroxime
Kids and preggos: amox and cefuroxime
143
Oral succimer can be used for whqat
Lead posioning
144
3 things in HUS
HAT
Hemolytic anemia (schistocytes and increased bilirubin)
Acute kidney injury
Thrombocytopenia
145
hypoketotic hypoglycemia during fasting states is in what metabolic disease
medium chain acyl coa dehydrogenase deficiency MCAD
146
Severe aortic narrowing in coarctation makes systemic blood flow dependent on what and then what happens when it closes
ductus arteriosus
When closes around day 3 of life, infants may develop heart failure and shock
147
Microcolon in what disease
CF and meconium ileus
148
chronic hemolysis of SCD can lead to what deficiency
folate as BM tries to make more red blood cells to compensate for anemia
macrocytic anemia, hyperseg m=neutrophils and low reitc count
149
morning vomiting and nocturnal HAs are red flags for what
intracranial pathology
150
crescendo decresecedo systolic ejection murmur reps what in TOF
RVOT obstruction
151
Most common CHD in turners syndrome
VSD
152
Low pitched, muscial pure or squeaky tone at LLSB (still’s murmu) or high pitched at LUSB (pulmonary flow murmur)
Benign or pathologic?
Benign
153
Second and third trimester maternal hyperglycemia can lead to what
Fetal hyperglycemia and hyperinsulinemia
-increased metabolic demand—>hypoxemia—>Increased EPO—>polycythemia
- organomegaly neonatal hypoglycemia
- macrosomia
154
cutaneous ___ causes an erythematous vesiculopapular rash in warm, moist areas
candidiasis
155
DD of hematochezia in early toddlerhood is what
Hemorrhoids, infectious colitis, intusssception, meckels diverticulum and IBD
156
hypointense center and ring enhancement with surrounding edema
brain abscess
157
Complications of bacterial meningitis
Hearing loss (most common)
Intellectual disability (ADHD, absence seizures, etc)
Cerebral palsy
Epilepsy
158
Moonface with large ears and neurobehavioral problems and big ass balls
Fragile x syndrome
| CGG repeat
159
Treatment of cephalohematoma
Most cases don’t need any and resorb spontaneously within 2 weeks to 3 months
160
Breast feeding reduces the risk of what cancer
Ovarian and breast
161
slanted palpebral fissures
DS
162
Diagnosing meckels diverticulum and tx
Technetium 99m pertechnetate scan
Surgical resection is necessary to prevent further bleeding
163
iron deficiency anemia
```
MCV
RDW
RBCs
periph smear
serum iron studies
response to iron supplements
hemoglobin electrophoresis
```
MCV decreased
RDW increased
RBCs decreased
periph smear: microcytosis, hypochromia
iron study: increased TIBC decreased iron and ferritin
response to Fe supp: increased hemoglobin
hemoglobin electrophoresis: normal
164
Inspiratory strigoder that worsens when supine and better when prone
- peak age is when
- management
Laryngomalacia
Peak age is 4-8 months
Confirm with flexible laryngoscopy
Reassurance for most cases
Supraglottoplasty if severe
165
how long do absence seizures last
10-20 seconds
166
_____ rehydration should be initial tx in children with mild to moderate dehydration which is what % volume loss? Cap refill?
Oral
Mild: 3-5%,
Moderate: 6-9% 2-3 cap refil delay
167
Prodrome of nausea, warmth, lighthead and or diaphoresis then pass out
Vasovagal syncope
168
Reye syndrome cx features and after what infection
Encephalopathy and acute liver failure
Varicella and influenza giving aspirin
169
Renal complications of sickle cell trait
painless hematuria from
Hematuria, renal medullary carincoma and UTIs
Painless hematuria from papillary ischemia or necrosis
170
What is the antibiotic prophylaxis for RF
Continuous intramuscular benzathine penicillin G every 4 weeks
171
focal seizure may be what kind
originate in how many hemispheres then what
what kind of weird things
motor, sensroy, or autonomic (sweating)
one hemi, may generalize and cause impairment of consciousness
repetitive semi puproseful movements like cheiwing sucking and swallowing called automatisms
172
```
Social and cognitive for
2 months
4 months
6 months
9 monhts
12 months
```
2: smiles
4: looks around a lot
6: stranger anxiety
9: waves by and patty cake
12: separatoin anxiety, comes when called
173
Etiology of exudative effusions
```
Empyema
Chylothorax (lymphatic flow through thoracic duct disrupted = direct leakage of chyle
```
Malignancy
TB
174
renal angiomyolipoma in what disesae
TS
175
Most common cause of aplastic anemia in children is what
Congenital: fanconi anemia
-AR or x linked
176
What kind of feeding in neonate increases risk of NEC
Formula feeding
177
Inflammatory joint WBCs and PMNs
Non inflammatory
Inflammatory is 2-10k and over 50%
Non inflamm is 200-2000 wbcs and 25%
178
Constitutional growth delay is characterized by what
-normal birth weight and height but btwn 6 months and 3 yrs age, hieght growth velocity slows and child drops % on the growth curve. At 3 child regains normal growth velocity and follows the growth curve at 5-10%, growth spurt happens later
Delayed growth spurt puberty and bone age
179
The presence of microvesicular steatosis on liver bx in context of acute hepatic encephalopathy is consistent with what
Reye syndrome
180
Fever sore throat and HA preceding a rash which spreads across the trunk, groin, and axillae, and has a finely papular sandpaper texture most pronounced in the skin folds.
What disease?
As the illness resolves, ____ of the rash results in what
scarlet fever after strep pyogenes
Desquamation results in peeling of hands and feet
181
Fine motor
```
12 months
18 months
2 yrs
3 yrs
4 yrs
5 yrs
```
12 months: two finger princer grasp
18 month: 2-4 cubes, remove clothes (kobe 24 cubes & 18 nude)
2 years: 6 cubes and line
3 years: cipy circle
4 years copies cross
5 years: copies square, tie shoes, dress/bath on own, print letters
182
Infants who are SGA are at risk for what complications
| Calcium and sugar is 2
Hypoxia, perinatal asphyxia, meconium aspiration, hypothermia, hypoglycemia, hypocalcemia, and polycythemia
183
Fetal factors for SGA
Genetics, chroms, congential ifx, inborn errors of metabolism
184
Treatment for pyloric stenosis
Laboratory derangements should be normalized first with IV rehydration then pyloromyotomy
185
What vaccines should infants get at 2 months
```
dTAP
Rotavirus
H influenza
Pneumococcal
Inactivated polio
```
186
milk protein allergy cx features
regurge/vomit
eczema
bloody stools
187
Pneumococcal sepsis is present up to ____ years after splenectomy
30
188
Iron poisoning can lead to what
Free raidcal production and lipid peroxidation
Abdominal pain and hematemesis, hypovolemic shock and metabolic acidosis
189
neurofibromatosis type 1 inheritance and manifestaions
AD
cafe au lait,
freckles lisch nodules
neurofibromas which is a nerve sheath tumor
optic gliomas
190
nucleated RBCs are seen in what
severe hemolysis or myelofibrosis
191
When is a vaccine contraindicated to give agin
Anaphylaxis to vaccine
Neuro disorder in person
Encephallopathy within week of previous vaccine
Personal history nor family history of febrile seizures is contraindication
192
Exudative effusions
Pleural fluid analysis:
Pleural protein/serum protein ration
Pleural ldh/serum ldh
Pleural ldh
>0.5
>0.6
>2/3 UL of normal for serum LDH
193
Pt with gross hematuria nad UA with normal appearing red blood cells suggests what etiology
Extra glomerular
194
Atlantoaxial instability is a malformation seen in 10-15% of what pts and from what
sx
DS pts
Laxity of posterior transverse ligament which causes increased mobility btwn C1 and C2
Sx: behavioral change, torticollis urinary incontinence, vertebrobasilar sx like dizzy, vertigo and diplopia
UMN signs too
195
clinical presentation of possible child abuse
unexplained injury
injury in diff stages of healing
malnutrition
sudden behavioral or scholastic changes
196
Most common cause of osteomyelitis in healthy children and SCD
And treatment
Healthy: s aureus
SCD: salmonella
-healthy: naf/oxacilllin or cefazolin with low MRSA chance
If high MRSA then clinda or vanco
SCD: healthy coverage + 3 gen cepahlosporin
197
s aurues is common in what type of sinusitis
chronic
198
what infections with CGD
catalase positive
199
ostsclerotic cortical lesion on image with central nidus lucency
pain at night
quickly releived by NSAIDs
osteoid osteoma
200
Maternal factors for small for gestation age
Preeclampsia, malnutrition, placental insufficiency, multiparity, drugs
201
friedreichs ataxia
sx
MRI
inheratince
neurologic findings like loss of reflexes and vibratory position sense, weakness
-CV manifestations, loss cardiac muscle fibers and arrhythmias
feet deformed with high plantar arches
MRI or brain and SC show marked atrophy of cervical spinal cord and minimal cerebellar atorphy
AR GAA repeat
202
Incopmleete obliteration of the fetal vitelline duct (omphalomesenteric)
What tissue
Sx
Meckel’s diverticulum
Heterotopic gastric tissue
Painless hematochezia most comomon
Ectopic gastric tissue secretes acid causing mucosal ulceration of surrounding small bowel
203
46 xy male internal genitalia, and female or undermasculinized external genitialia at birth
at puberty experience maculinization due to testosterone but lack breast development
5-a reductase deficiency
204
Osteod osteoma presents in what decade of life and side of pain
Unilateral and second decade
| 10-20
205
Biliary atrewsia presents with what type of hyper billy
Direct
206
A peripheral smear of thalassemias shows what cells
Target cells and teardro cells
207
Gold standard for diagnosis of viral myocarditis is what
Tx?
Myocardial biopsy
Diuretics and inotropes bc of the HF
208
Murmur that increases with standing and valsalva maneuver is benign or pathologic
Benign
209
Lab findings in reye syndrome
Tx?
Increased:
AST, ALT, PT, INR, PTT, NH3
Supportiveq
210
DKA and free fatty acids
Increased circulating bc of increased glucagon and lipolysis
211
Hypopigmentation involving skin hair eyes and brain nuclei metabolic thing that is not albinism
Dx in newborn
Dx later in life
Pku
Dx: positive newborn tandem mass spectrometry
If suspected later in life then quantitative aa analysis
212
Most common congenital foot deformity characterized by medial deviation of forefoot with neut position of hindfoot is what
Tx?
Metatarsus adductus
Corrects spontaneously
213
AUB is often from what in kids and requires what
anovulatory dysfunction from immature HPO axis = heavy irreg bleeds
first do CBC, preg test, and coag study
if hemodynamically stable then IV estrogen or high dose oral estrogen/progestin contraceptive pills
hemodynamically unstable pt: dilation and curettage
214
billious emesis in neonate workup when stable and pt also has not passes meconium so suspect what and workup
suspect distal intestinal obstruction
abdominal x ray first to ID pneumoperitoneum from perforated bowel
then after that is excluded do water soluble contrast enema (gastrografin) can dissolve and break up poop
surgery if this does not work
-microcolon = meconium ileus
215
Applying sunscreen correctly
50 SPF 30 mintues before sun exposure
216
Antibiotic prophylaxis for RF
RF without carditis
RF with cardidtis but no residual heart or valve disease
RF with carditis and persistent heart or valve disesae
1) 5 yrs or until 21
2) 10 yrs or until 21
3) 10 yrs or until 40 yrs old
217
tx of tinea capitis
oral griseofulvin or terbinafine
218
acute unilateral LAD in children usually from what
bacteria
| s aureus most common then strep
219
Treatment of strabismus to prevent amblyopia (vision loss from disuse)
Eyeglasses
Patch normal eye (occlusion therapy)
Blurring the vision of the normal eye with cycloplegic drops (penalization therapy)
Surgery if persistent or severe cases
220
Lateral neck radiograph shows widened prevertebral space but no other abnormalities
Other findings
Dx
Retropharyngeal abscess
Inability to extend neck and widened preverterbal space
Lateral x ray
CT contrast for pts with no respiratory compromise for size of abscess
221
Treatment for enterobius vermicularis pinworm
Albendazole or pyrantel pamoate
222
Treatment for clubfoot and managment
Serial manipulation and casting sx, for refractory cases
Karyotyping shouold be considered
223
Fever and maculopapular rash a week after receiving the MMR vaccine
Tx?
Most likely due to infx with vaccine strain
Can cause mild version of infx
No treatment needed
224
infant with a normal anion gap and FTT most likely has what
what do all types of the thing present with and why
renal or GI etiology of acidosis
all types of RTA can present as growth failure bc of acidic conditions
225
Maternal hyperglycemia in the first trimester can lead to
Congenital heart disesae
Neural tube defects
Small left colon syndrome
Spontaneous abortion
226
von gierke disease
what def
sx
glucose 6 phosphatase def so no glycogen to glucose and leads to glycogen accumulation in liver, kidney, intestinal mucosa
3-4 months pt gets hypoglycemia-->seizure, and lactic acidosis
hyperuricemia and hyperlipidemia
Doll like face and hepatomegaly
227
Dactylitis (hand foot syndrome) can be the earliest manifestation of what
Vaso occlusion in a SCD
Age 6 months to 4 years
Symmetric swelling of hands and feet
228
When does pyloric stenosis usually start being symptomatic
Week 3-5 KD
229
Keoptic chiasm compression
Pituitary stalk compression and endocrinopathies like GH def and DI
Suprasellar, calcified mass on imaging
Craniopharyngioma
230
Is prematurity a risk factor for IDA in young children
Yes
231
bacteria in otitis media
h infl, morax, strep pneumo
232
subacute chronic LAD from what
uni or bilateral?
age group and description
mycobacterium avium intracellulare (non tb mycobacteria)
unilateral
under 5 years old, firm, nontender LAD less that 4 cm in size
skin over LN often violaceous color
233
vaginal foreign bodies is a common cause of what
what is most common foreign body
presents with what
can cause vulvovaginitis (foul smelling discharge, bleeeding an spotting or urinary complaints in prepubertal children
toild paper most common,
234
Intermittent strabismus can be expected in infants under what
Under 4 months bc immature extraocular muscles
235
Solitary hyperpigmented lesion in first few months of life that has increased density of overlying dark, coarse hairs and tx
Congenital melanocytic nevus
Large lesions removed
236
mullerian agesnisis aka what
reproductive organs?
mayer rokitansky
kuster hauser
absent or rudimentary uterus and upper vagina, normal ovaries
breast and body hair growth normal too
237
abuse in children must be ruled out in any child with what
abrupt onset mood change, bedwetting and or academic difficulty
238
Other classical findings of scarlet fever besides rash
Tx?
Strawberry tongue, palatal petechiae, tonsillar exudates
Mouth pale with red cheeks = circumoral pallor
treat with PCN
239
PaCO2 and HCO3 in pyloric stenosis
PaCO2 increased, HCO3 increased
Loss of volume increases angiotensin II which increases HCO3 reabsorption and aldosterone
240
Biphasic stridor due to tracheal compression
What is
Diagnose and confirm
Vascular rings
Barium swallow and confirm with MRI with angiography
241
Clinical features of pineal gland masses
Limited upward gaze
Upper eyelid retraction
Pupils non reactive to light but are to accomodation
Obstructive hydrocephalus: papilledema, HA, Vomit, ataxia
242
DKA and potassium
Diuresis accompanied by net renal loss of K+ with depletion of total body K+ stores
Serum concentration of K+ may be elevated due to acidemia and decreased insulin activity causeing redistribtion of K+ to EC comparment
243
laboratory findings in anemia of prematurity
Low hemoglobin and hematocrit
Low reticulocyte count
Normocytic, normochromic RBCs
244
Pt with guillen barre syndrome, what is the most life threatening complication and how do you manage this pt
Other dysfunction
Neuromuscular respiratory failure
Assess pts pulmonary fnct with seriel spirometry and measure FVC
-decline in 20mL/kg req intubation
Autonomic dysfunction like hr and bp instability, flaccid quads and bulbar palsy
245
fever urticaria and joint pain 1 week after penicillin therapy is concerning for what?
-no mucosal involvement too
what type rx
etiology
serum sickness like reaction
type III HS
etiology: antibiotics (beta lactam and sulfa) and acute hep B
246
Treatment of NEC
Broad spectrum abx bc of risk of septic shock
247
Gross motor
```
12 months
18 months
2 yrs
3 yrs
4 yrs
5 yrs
```
12 months: walk first steps independently, throw ball,
18: kick ball and run
2 yrs: walk up/down stairs with both feet on each step, jump
3 years: walk up/down staris with alt feet, ride trike
4 yrs: hops on 1 foot
5 yrs: skips and catch ball with 2 hands
248
Varicella post exposure prophylaxis
History of immunity (prior infection or 2 doses of vaccine)
Yes and no
Yes: observe
No: varicella vaccine in normal person
-VZIG in ICP
249
dermatophyte infection of scalp (tinea capitis) always requires what
oral antifungal
250
Lab values in reye
Ast and alt up
Pt and ptt and inr up
Increased NH3
Bilirubin is normal
251
causes of RTA 4
urine pH
obstructive uropathy
CAH (aldosterone def)
<5.5
252
infant pt that developed tachycardia, tachypnea, and ddistant muffled heart sounds 1 week after cardiac surgery is suggestive of what
can progress to what
large ones can lead to what
life threatening pericardial effusion
eventual progression to cardiac tamponade
larger effusions can lead to abdominal pain, vomiting, and decreased appetite
253
Classical features of NEC
Feed intol
Increase abdom girth
Blood stools
Vomiting
254
DKA and renin
Increases it bc of diuresis
255
Endometriosis pain is when
A few days before menses
256
osteosarcoma age group highest risk
location
constitutional sx
13-16
metaphyses of long bones
distal femur, prox tibia, prox humerus
no fever, weight loss or malaise
257
if have presence of exudates, edema, petechiae on palate and no viral sx then what test do you get?
if negative then what
rapid strep test
if negative then throat culture (bc rapid strep only 70-90% sensitive), if that is negative then it is viral pharyngitis
258
Ages to give varicella vaccine
1 and 4 yrs old
259
Basophilic stippling seen in what
Thalassemias and lead or heavy metal poisioning
260
Rotavirus vaccine is usually administered when
2-6 months
261
treatment for ringworm and what infection
tinea corporis from trichophytopn rubrum
first line is topical like clotrimazole and terbinafine
oral griseofulvin and terbinafine if that fails
