peds Flashcards
cyanotic infant with L. axis deviation
decreased pulmonary markings on CXR
ASD or VSD
tricuspid valve atresia
down syndrome heart
complete AV canal defect
maternal lithium use
defect?
ebstein’s anomaly (malformed TC valve into the R ventricle)
tetralogy of fallot on CXR
boot shaped heart (right v hypertrophy)
normal heart deviation newborn
r
total anomalous pulmonary venous return
all 4 pulmonary veins dump into r. atrium (R enlargement) or otherwise the systemic circulation (brachiocephalic veins, SVC, portal/renal veins))
digeorge syndrome heart defect
truncus arteriosus
Gray visicles in posterior oropharynx. Dz and virus
Herpangina
Coxsackie
abx for unilateral cervical adenitis in kids
clinda (strep/staph)
must do I & D too
odynophagia
pain with eating
2 characteristics of niemann-pick dz but not tay sachs
hepatomegaly
arreflexia
enzymes in niemann-pick vs tay sachs
NP: sphingomyelinase
TS: B-hexosaminidase
1 year old
thrombocytopenia
recurrent bacterial infections
eczema
Wiskott-Aldrich Syndrome (X-linked)
Maculopapular rash
started head spread to body
low fever
arthritis
rubella
class of meds to use for tourette’s disorder
antipsychotics
child less than 1
macrocytic anemia w/ low retic count
congenital anomalies
diamond-blackfan anemia
general tx for OCD
high dose SSRI therapy
infection associated (rare) with OCD onset
group A strep infection
1st test in torticollis
c-spine radiographs
erb-duchenne’s palsy noted. 1st step?
reassurance
preterm neonate with:
+gastric volume, vomiting, abdominal distention
w/pneumatosis intestinalis and portal venous air
necrotizing enterocolitis
neonate w/ air in stomach, duodenum. but nothing distal
(double bubble) = duodenal atresia
neonate w/failure to pass mec w/in 48 hours (2)
Hirschsprung dz or CF
infant with virilization
hyponatremia
21-hydroxyase deficiency
2 tests for 21-hydroxylase deficiency
consyntropin stim test
+17 hydroxyprogesterone levels
Kid with recurrent infections - pneumonias, and suppurative adenitis
chronic granulomatous disease
newborn with bilious vomiting and triple bubble sign
jejunal atresia
timeline difference of gonococcal vs chlamydial conjunctivitis
reverse alphabetical order:
less than 5 days = gonococcal
greater then 5 days = chlamydial
differences in bruton’s agammaglobulinemia VS CVID in
a) gender
b) # B cells
c) age of onset
a) Bruton’s is just boys
b) B cells reduced in Bruton’s
c) CVID later onset (15-35)
biggest risk of rotavirus vacc
small risk intussusception
timing or weight for sweat test
greater than 2 weeks
or
greater than 2 kg
laboratory abnormalities of seminoma vs germ cell tumor (2)
seminoma can give +BHCG
germ cell tumors have +BHCG and +AFP
rate over which is tachypnea in a neonate
60
AFP level in aneuplodies
reduced
AFP w/ neural tube defects, ventral wall defects, or multip
increased
infant w/no stool in 24 hours, small colon
meconium ileus (CF)
apgar requiring intervention
less than 7
missense vs nonsense mutations
both point mutations - missense = one different aa. Nonsense makes a stop codon
when to consider adding inhaled steroid to asthmatic tx?
if 3 or more exacerbations/week
pallid spell
minor trauma followed by apnea
association (even with parents) of kids w/cyclic vomiting syndrome
migraines
tx for abnormal uterine bleeding, esp. adolescents
high dose estrogen therapy
4 classes of hypersensitivities
ACID Anaphylactic Cytotoxic (Ab-mediated) Immune complex Delayed (cell-mediated)
normal HR range of newborn
120-160 BPM
conjunctivitis on newborn at day 1
chemical irritation
baby with aniridia. what association?
Wilms tumor
timeline for orchipexy in case of crypotchidism with infant
after 1 yrs old
hyperbilirubinia velocity that is concerning
5 mh/dL per day
cherry vs strawberry angiomas
strawberry is on newborns (superficial angiomas), cherry angiomas are the red dots on adults
nevus simplex
macular stain
breast milk jaundice vs breastfeeding failure jaundice
breastfeeding failure has signs of dehydration (1st week) - brick red crystals in diaper
the 2 genetic conjugated hyperbilirubinemias
dubin-johnson (black liver)
rotor (milder)
timeline of physiologic jaundice vs pathologic
phys 3 day+
path less than 1 day
phys hyperbilirubinemia with +coombs
isoimmunization (Rho or ABO)
phys jaundice with +Hg (2)
Twin-twin transfusion
or maternal-baby trx (delayed clamping)
baby with bili >20. tx?
exchange transfusion
kid less than 2 w/upper limb, head jerking
west syndrome
infantile spasm
tx for west syndrome (infantile spasm)
ACTH
kid 3 mos to 6 yrs with colicky abdominal pain relieved by knee-chest position
intususseception
test if suspect blood in GI from ingested maternal blood vs vasa previa
apt test(alkali-denaturation test)
- if maternal blood ingestion
+ if fetal origin (could be vasa previa, etc)
2 warning signs of anaphylaxis
urticaria
hypotension
empiric tx for meningitis in peds (3)
ceftriaxone, vanco, ampicillin +/- steroids
rosela fever/rash sequence and path
fever 1st
HHV-6
maintenance fluid for kids (3)
per day:
0-10 kg: 100 cc/kg
10-20 kg: 50 cc/kg
20+ kg: 20 cc/kg
parkland formula for IVF (day) w/50 % in 1st 8 hours, 50% in next 16 hours
%BSA X kg X 4
dx of asthma (post-dilater improvement) cutoff
FEV1 greater than 12%
tx of diptheria
IVIG
hip problem in 5-7 yo M
ideopathic osteonecrosis
Legg -Calve-Perthes Dz
1st line tx for mild acne
topical retinoids
association of transposition of great arteries
DM mother (not gestational - true DM)
kid with croup who doesn’t get better.
dz?
bacterial tracheitis
test for digeorge
mitogen stimulation assay
tx of wiskott-aldrich
bone marrow trx
test to dx developmental dysplasia of hip
US
type of XR for SCFE
frogleg XR
tx of retinoblstoma in eye
surgery
sequelae to retinoblastoma of eye
osteosarcoma of bone later in life
test for imperforate anus
upside down babygram
double bubble sign (2 dx possibilities)
duodenal atresia
annular pancreas
baby w/intestinal atresia (fluid levels)
association of mom
mom did cocaine
babygram showing upper obstruction but normal air below
malrotation
girl with normal voiding but constant leak
low implantation of ureters
mandatory step w/cryptorchidism, even if pulled down
removal after puberty
workup of pediatric hematuria (2)
US
IVP
if sickle cell dz and getting regular transfusions, what to do about Fe
deferoxamine
if sickle cell dx, and not get regular trx, what 2 supplements
Fe and folate
tx for acute sickle crisis
danger - priapism or AMS, etc (2)
OR with joint pain (3)
exchange transfusion, now (if in danger)
otherwise ivf, O2, pain control
tx to sickle pt who is a kid for osteo prophylaxis
abx-penicillin
tx, including method for chlamydial conjunctivitis
oral erythromycin
bilious vomiting
upper GI series
ligament of treitz on R, corscrew appearance
volvulus (malrotation)
infant w/FTT
hepatomegaly
cataracts
disorder, enzyme
classic galactosemia
galactose-1-p uridyltransferase deficiency
galactokinase def vs classic galactosemia
galactokinase def is cataracts only
no hepatomegaly, FTT-galactokinase is kind
normal vs not normal cutoff for weight loss in first 5 days
7%
nerves (2 each) affected in
Erb-Duchenne palsy
Klumpke palsy
C5-6
C8-T1
Birth weight should double by:
Triple by:
5 months
12 months
Intoeing should resolve by
4 years
Tx of Von willebrand dz
Desmopressin
1st sign of puberty in boys
Testicular enlargement
Adolescent
Pain on left sternal border exacerbated by deep inspiration
Precordial catch syndrome
Cutoff for physiologic jaundice
Needs to be less than 15
Time course for breastfeeding jaundice vs breast milk jaundice
Breastfeeding is 1st week
Breast milk jaundice is 2nd week
What day should mec stools transition to yello?
3
Swelling of head crossing sutures in a neonate
Caput succedaneum
FTT (2)
not gaining weight by 10 days
failure to regain birthweight by 2 weeks
lethargy (2)
absent eye movements
or
not interacting with others.
lab to check to screen for inborn error of metabolism
NH4
2 abnormal labs in ornithine transcarbomylase deficiency (OTC)
NH4
urine orotic acid
fever without source
vs
fever unknown origin
FUO requires 1 wk investigation
kernig’s sign
resistance to knee extension
brudzinksi sign
flexion of hip w/ passive neck flexion
cutoff for pyuria
5
F/U after
- first UTI
- 2nd UTI
1 US
2. VCUG
Tx of Kawasaki dz (2)
Ivig
Aspirin
Fever
Rash hands feet
Oral lesions
Pathogen?
Coxsackie A
Hand foot mouth dz
Besides lateral and PA, best 2 radiographic tests to get on a kids you suspect foreign body aspiration.
decubitus
inspiratory/expiratory chest films
staccato cough between 4 and 12 weeks of age.
chlamydia pneumonia
Dennie-Morgan lines
lines under the eyes caused by chronic allergies/facial edema
transverse nasal crease
horizontal line on nose caused by chronic allergies
age where kids can start using OTC antihistamines and cold syrups
2 years old
1st line abx for acute otitis media for kids
amoxicillin
cutoff temp to give abx for AOM
> 39 (102.2)
(always tx if bilateral and
otitis media w/effusion (OME) can persist for how long after AOM?
3 months
2nd line tx for AOM or first episode w/high fever
augmentin
GCS (2)
EVM 456
cutoff for dx DM using A1C
6.5%
what to calculate if a hyponatremic dehydration
free salt deficit
what to calculate if a hypernatremic dehydration
free water deficit
risk to watch out for in managing DKA
cerebral edema
OTC topical anesthetic cream that can be applied 30 min prior to needle stick
ELA-max
pediatric dose ibu profen
10 mg/kg
joint pain that sets in a few weeks after infectious diarrhea
reactive arthritis
murmur that is musical or vibratory, and is heard best at the left lower sternal border in the supine position.
Still’s murmur
Why are VSDs not heard in the nursery?
Newborns have elevated pulmonary vascular resistance
path of fetal blood (4)
RA > RV > ductus arteriosus > systemic circulation
main finding in CSF of viral meningitis
pleocytosis (most commonly lymphocytosis)
protein, glucose are normal
type of seizure: simple vs complex
simple: generalized
complex: focal
a “slapped cheek” appearance and a reticular, lacy rash on the extremities
fifth dz (erythema infectiosum)
high fever w/bulging fontanelle, the diffuse blanching rash
Roseola
Roseola pathogen
HHV-6
most common pediatric brain tumor
Medulloblastoma
cutoff size for concerning lymph nodes in kids
2 cm
7 chars. pain
P=Position (be exact)
Q=Quality (dull, sharp, burning)
R=Radiation (be exact)
S=Severity (scale from 1 to 10, if the patient can do this)
T=Timing (when it happens)
A=Alleviating factors
A=Aggravating factors
A=Associated symptoms
HEEADSSS
home eating education activities drugs suicide safety sex
4 categories that cause AMS
(1) Hypoxemia (2) Shock (septic, hypovolemic, cardiac) (3) Hypoglycemia (4) Poisoning
prophylaxis for meningicocemia in adults vs children
adults cipro
children rifampin
IV tx for hypoglycemia
D25 bolus
effects of anticholinergics on pupils
dilate them
FTT (3)
below 3rd percentile in weight, weigh for length
OR
weight loss crossing 2 or more major percentiles on growth curve
kcal/ day needed to grow in normal baby
100-110 Cal/kg/24 hours
nadir of Hg in infant at 2 months
11 g/dL
Screening tool for autism. 16, 30 mos.
M-chat
Most common reason for cp
Prematurity
2 most common surgeries sickle cell pts
cholecystectomy
tonsillectomy
prophylactic med for sickle cell, and age to admin to
penicillin
age 5-6
2 vaccinations sickle cell pts should have at 2 (in addition to standards)
23-valent PNM
meningococcal
anasarca
generalized edema
most common nephrotic dz in peds
minimal change dz
90% of cases
pathophys of edema in nephrotic syndrome
lowering of plasma colloid osmotic pressure.
tx (2) of nephrotic syndrome
steroids
salt restriction
lesions that are flat vs raised, less than 1 cm
flat = macule raised = papule
lesions that are flat vs raised more than 1 cm
flat = patch raised = plaque
pustular lesions in axilla, groin, perianal regions
hidradenitis suppurativa
tx rosaciea
topical metronidazole
lifespan of lice w/o host
26 hours
tx for tinea versicolor
selenium sulfide
tx tinea capitis
griseofulvin
