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1
Q

Definition of Colic? When does this stop?

A

3hr for 3 d for 3 wk . Resolves in 4 months. Reassure

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2
Q

Ingestion protocol.

What if sx?

When to give charcoal? aa

A

Upper Gi endoscope w/in 24 hours - If sx after upper GI, Do a water barium in 2-3 days for followup.

Avoid NG lavage in all cases.
Avoid charcoal in all cases

EXCEPT TYLENOL - give charcoal .

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3
Q

Breast Milk

  • For how long
  • When and what to supplement?

Cows milk?
- What to supplement?

A

Breast milk - 6mo minimum, 1+ preferred.
Must supplement with Vit D.

Cows Milk - Causes Iron deficiency

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4
Q

Enuresis - when does it begin? When should it end?

First line in tx?

A

Occurs at 2 -> Goes on normally until ~5y.o.

After 5, consider

  1. Incontinence alarm
  2. DDAVP
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5
Q

Jaundice.

2 major timelines at birth. What are the causes?

A
  1. Dehydration - breast feeding failure.
    - Can start within first days.
    INC enterohepatic circulation and DEC blirubin excretion.
  2. Breast milk jaundice - milk has HIGH lvl of bilirubin
    Can start at 4 days and peaks at 2 wk.
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6
Q

Breath holding? What to do?

A

Check Ferritin and CBC - associated. If normal - reassure

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7
Q

Timeline of normal?
Separation anxiety

Stranger Anxiety

A

Separation - 9-18mo ok

Stranger - Up until 3y.o

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8
Q

H& W change by 1 year?

A

heigh INC by 50 percent,

Weight x3

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9
Q

What vaccines do you give at birth?

When do you give the rest?

A

Birth - Hep B

2 mo - Hep B x 2 , Rota, Tdap, Hflu, Pneumococus, Inactivated polio

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10
Q

When do start vision test?

A

3 y.o - similar timeline as stranger danger!

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11
Q

What is the ppx and t x for conjuncitivitis in neonate
timeline?

GC

CT

A

GC - 2-5 d

  • ppx w topical erythromycin
  • tx - IM/IV cefotaxime (NOT ceftriaxone!)

Chlamydia

  • ppx is tx mom
  • Tx - PO erythromycin
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12
Q

When is rotovirus contraindicated?

A

Intussusception, Meckles, SCID

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13
Q

GENERAL PRINCIPLES

B cell def

vs

T cell - when do they present? Tx?

A

After 6mo - Tx IVIG except IgA

T cell - 1-3 mo - Fungal viral intracelllualr bacteria

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14
Q

list 3 B cell def

A

X linked agamma - Tyrosine kinase
DEC/ABSENT B cells = Low Ig

Common Variable - Acquried - 20-30 y.o . INC risk of autoimmune conditinos and lymphoma. Normalish Cell count, DEC Ig

IgA - after viral/GI infection. Anaphylaxis to IgA/blood. Normal IgG, IgM

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15
Q

4 T cell def

A

Di george - DEC T Cell, PTH, Ca. FISH testing

IL -12 (AR) - DEC Th1 - Disseminated mycobacterial/fungal. DEC IFNgamma (Th1) . May occur after Anti-Tb vaccine

HyperIgE (Jobs - AD) - DEC Th17, DEC N! recruitment - FATED - Coarse facies, Abscess (Cold), Teeth (primary retained), IgE INC, Ezcema (Derm)

Cronic Mucocutaneous Candidiasis - T cell dysfunction - NO SYSTEMIC since B cells are fine.

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16
Q

4 types of Combined immunodef

A

SCID - AR - ADA
SCID XR - IL2,7. Absent thymic shadow, no GC, T cels. MUST IRRADIATE RBC in transfer

Ataxia- Telangiectasia - DNA breaks (ATM gene) - INC AFP, DEC IgA, G, E

Hyper IgM - XR - CD40L - class switch prblem - Pyogenic infections etc. INC IgM, DEC A, E, G

Wiskott Aldrich - XR - WAS gene - T cell actin cytoskeleton - Thrombocytopenia (small), Eczema, Infections. INC autoimmune risk . INC IgE,A, DEC IgG, M

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17
Q

List 3 types of phagocyte disfunction

A

Leuk Adhesion - CD18 - Recurrent skin/mucosal infection. NO PUS- Delayed umbilical separation. INC N! but NOT at the site ofinfcetion.

Chediak Higashi - AR - phagolysosome microtubule problem - Staph/Strep, ALBINISM, NEUROPATHY, PANCYTOPENIA - Giant granules in N!

Chronic Granulomatous D - Xr - NADPH oxidase - o respiratory burst - Catalase negative infections - Nitroblue test is clear. Tx - IFNg

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18
Q

VSD - What to do if heard?

A

75% resolve by 2.yo

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19
Q

Congenital Heart block?

heart failure?

Transposition?

A

Heart block - lupus

HF - thyrotoxicosis

Transposition - DM

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20
Q

PDA - presentation - more than just machine like

A

Continueous - Loud S2, wide pulse pressures. Bounding pulses

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21
Q

Long QT tx?

A

B blocker. _ Pacemaker

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22
Q

Hirshsprungs - Dx/Tx?

A

Barium enema

Biopsy . ACH

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23
Q

Timeline:
Dx?

pyloric stenosis

Malrotation

Biliary atresia?

A

Pylori stenosis - 3k - first bone marle, erythromycin,. US if needed

malrotation w/in 1 month - Upper GI dx -> birds beak,.

w/in 2 months - Cong hyperbili. Light stool. CHOLANGIOGRAM. Tx Kasai -> Liver tx

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24
Q

NEC

workup and tx?

Complications?

A

Serial abd films Q6h. NPO, Abx.

if worsens -> surgery

Complications - stricture, short bowel syndrome

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25
Biliary cyst ? Presentation? Location?
Mass and jaundice Can be extra OR intra
26
Laryngomalacia vs Vascular ring (presentation, timecourse?)
Laryngomalacia - improves w/ prone . Peaks at 4-8 months in presentation. Most resolve by 18mo. Dx - Laryngoscopy. Vascular ring - improves with neck extension. If sx - Surgery
27
COngential Diaphragmatic Hernia? Dx? Tx?
If cliical suspicion and unstable vitals -> intubate BEFORE cxr. NG decompress. DO NOT bag mask! as it may worsen.
28
Diamond BLackfan vs Turners?
Diamond blackfan - Macrocytic Anemia, No hyperseg N! Short, cleft lip, shield chest, webbed neck, abdnormal thumbs. Tx Steroids. Turners - Webbed neck, shield chest etc, Coarctation, Bicuspid A, OSTEOPOROSIS. Lymphadema, HORSEHOE KIDNEY
29
Edwards presentation
T18. Rocker bottom, micrognathia, ABSENT PALMAR CREASE (shaked off hand), VSD
30
Prader Willi - presentations and risk factors
Paternal - DMT2, hyperphagia, gastric rupture!
31
Neuroblastoma - presentation? When? Wilms Tumor
Neuroblastoma - Mass - irregular, corsses midline. \ By 1 year. OPSOCLONUS MYOCLONUS. Wilms Tumor - 2-5 yr. Abd mass w/ HEMATURIA. . Beckwith W, Anaridia.
32
McCune Albright rpesenetation?
Precocisous puberty, cafe au lait spots, bone defects.
33
Beckwith Wiedeman presentation Screening?
Macrosomia, hemihyperplasia. Omphaloceine/umbilical hernia. DONT confuse w/ DM. In these pt screen for Wilms tumor. AFP + Abd US q3mo until they are 4-8 y.o Renal US until adolescent after 8.
34
Hipl dysplasia - screening methods?
Hip dysplasia US 2wk - 6mo 4/6 mo or more, use Hip Xray.
35
IVH- screening? prevention?
Newborns. Screen w/ US. Maternal steroids can prevent.
36
Legg Calve Perthe Vs Slipped Femoral Cap vs Osgood Shattler
Legg Calve Perth - Avasc Necrosis - 4-5 yo bohys Femoral - 12 y.o B Osgood shatller - patellar shatters off by being pulled.
37
Spondylolisthesis presentation?
Boney step off - (palpable) - slipped vertebra - DEVELOPMENTAL DISORDER
38
Metatarsus Adductus
If foot overcorrects - reassure if does not overcorrect - IMMEDIATE CAST
39
Clavicular fracture at birth -What to do?
Analgesics - restri motions. Heals in 7-10 d./
40
Torticollis cause? presentation - what to do?
From trauma, URI, Abscess, AA subluxation MUST get a c spine xray to rule out AAs.
41
Presentation in neonates Syph CMV Rubella
Syph - HSM - ulcers on palms/feet, JAUNDICE, ANEMIA, rhinorrhea CMV - HSM - Chorioretinits, Hearing, Petechiea Rubellma - HSM - Cataracts, Hearing, PDA
42
Bacterial Meningitis Tx algorythm? Tx?
Blood cultures, Tx, LP last Neonate - Amp + Cefotaxime/Gent Adult - Ceftriaxone Vanc+ STEROIDS. If it comes back as NOT strep pneumo, then take off roids.
43
Unilateral cervical adenitisi. What is it? Tx?
staphy/strep Tx - Clinda + I and D
44
Impetigo vs Cellulits Culture?
Impetigo - nonbullous - GAS - Mupirocin (topical) of no Impetigo bullous - Staph - Oral ceph, diclox, clinda Clinical dx - DO NOT NEED TO CULTURE!!! Unless fail initial tx. Cellulitis - poorly demarkated - staph/strep.
45
Herpetic gingivostomatitis? Herpangina? Presentation and age?
Herpetic gigivostomatitis - 6m to 5y.o. - Herpes. Vesciesl. Herparnagina 3-10 y.o Coxsackie - Vescles - aka NOT strep
46
Varicella - post exposure tx? Normal and ICH
Varicella post exposure - give vaccine. In ICH - give Varicella Antibodies
47
Tachoma - wpresentation cause?
Blindness, folliculitis, conjuncitivit.s CHlamydia A-C
48
Minimal Changes disease - Dx?
Clinical diagnosis - Do not need to Bx.
49
UTI in infant- workup??
Culture - CATH - No clean catch in babies! 2mo-2y.o - Bladder and renal US. IF RECURRENT - Voiding cysorethrogram.
50
Acute Hepatitis tx in neonate?
Active and passive Ig.
51
Rheumatic Fever tx?
IM penicilling Q4w for YEARRRS.
52
Lyme Tx? In kids?
Amox, Cefuroxieme, DOxy are all about the same. In kids - amox. Dont give doxy to anyone under 8 y.o
53
Bronchiolitis? VS Croup? Causes and Tx?
Bronchiolitis - Run of the mill RSV> Para Tx - O2, Albuterol, NO STEROIDS - Ribavarin in comorbid - Palivizumab PPX in winter in HIGH RISK COMORBID PT LESS THAN 2 YEARS OLD Croup - Paraflu - Barking, steeple sign. O2, Racemic Epinephrine, STEROIDs,
54
Epiglotitits - presentation/causes tX/
Rapid. Strep, H flu, Viral. High fever, drooling. Better in SNIFF dog position. THUMPRINT SIGN. ET tube in OR, IV cetriaxone/cefuroxime
55
Tracheitis - Causes - presentation
Tracheitis - S aureus > Viral. Prodomal. Sublgottic narrowing.
56
Bordetella - whoooping cough. Presentation - Tx?
Lymphocytosis >70% - Culture is gold standard. Tx - Erythromycin/Azithromycin (MACROLIDE) 14d to kid AND PEERS/CONTACTS. Tx - Erythro - 14 d. Azithro - 5d
57
Acute Bacterial Rhinosinusitis predisposition pathway Tx
Strep > Hflu > Moraxella viral sinusitis -> bacterial sinusitis -> orbital sinusitis Tx - Amox Clavulonic.
58
Acute Otitis Media - Causes tx?
Strep H flu, moraxella HIGH DOSE amox x 10 d
59
Bilious Emesis - Dx pathways -
NPO, NG, X ray (rule out pneumoperitoneum) - Upper GI - malrotation - corkscrew sign Lower - Meconium, Hirshprungs - Water contrast enema
60
Intususseption - Dx? Tx? RISK FACTORS
Dx - US . Tx/dx - air contrast bariun enema Less tahn 2 - peyes patches Greater than 2- meckles.
61
Febrile seizure -At what age what do you do.
Less than 6 mo - sepsis workup. If >18 mo - no workup.
62
Chloroma - dx/workup?
Green/colored tissue in skin/spinal cord. Bone marrow aspirate - CXR to rule out mediastinal mass.
63
Kawasaki tx?
Aspirin and IVIG.
64
CVID inc risk of what?
LYMPHOMA!
65
Cherry red macula WITH HSM, without?
WITH - NP WITHOUT - Tay sacks
66
Cystic hygroma - mech and appearance
– benign klymphangioma in neck – soft, transilluminates. Asosc w/ Turner and Trisomy 21,18,13
67
Club foot
– tx immateied stretching, manipulation w/ serial plasters/splints. Surgery between 3-6mo if not working.
68
Neonatal polycythemia can cause ... how?
respiratory distress by hyperviscocity
69
Downs findings
– Low AFP, estriol. INC bhcg, inbhitinA A and E
70
Breast feeding supplement
– Add VitD within 1st month of life (this is correct!), + - Iron (if preterm until age 1). Introduce pureed food at 6mo, cows milk at 1.
71
Acute otitis media vs otitis media with effusion
OM w E is just effusion. Acute has inflammatory signs.
72
Vaccines by chronological or gestational, meaning?
Chronological. Regardless of preme, give Hep B AT BIRTH and others 2mo after birth. Youre not going not delay giving hep b because they are preterm.
73
Normocytic normochromic RBC with low retic and low Hb in preterm baby?
– Anemia of prematurity, low retic w/ normocytic and normochromic anemia.
74
DTap frequency and contraindication
– 5 doses of DTap from 6wk to 6 years. If pt has a febrile seizure that’s fine – continue to immunize. Only stop if anaphjylaxis or encephalopathy.
75
Rash after birth
erythema toxicum neonatorum – benign evanescent. Common in first 2 wk of life. Spares palms/sole
76
Milk/soy protein induced colitis presentation, etiology, mech prognosis
2-8 wk – painless bloody stools, may have eczema . Eliminate soy/milk from maternal diet. Start formula if needed. NON-IGE MEDIATED!! – Bleeidng usually stops 2 wk after eliminating products and as a whole Usu spontaneously resolves by 1 y.o,
77
Classic Galactosemia
– infantile cataracts, failure to thrive, HSM, E Coli Sepsis – Galactose 1p Uridyltransferase def/
78
Glactokinase def
– infantine cataracts only, nothing else.
79
Homocysteine vs Marfans
– Homocysteine will have fair complexion, devo delay, and CVA
80
Cholesteatoma vs Otosclerosis
chronic middle ear infection – granulation tissue, hearing loss. EAR DRAINAGE PRESENT in cholesteosteatoma.
81
Transiet synovitis
viral disease + joint pain without septic appearance (no fever, able to bear weight), but may still have abducted and externally rotated hip. Ibuprofen, rest and followup.
82
Bacterial and giardia infections in kid think?
B cell – IgA in particular, but Giardia is IgA def, not necessarily T cell.
83
ARDS surfactant deificency risk factors (2
prematurity and maternal DM.
84
Henoch SP raises risk for what GI
– ileo ileo! Intussusception
85
Strep throat vs Viral/EBV
both can have white exudates and LAD. Difference is EBV/viral have clear viral signs aka COUGH, RHINORRHEA AND CONGESTION. Strep throat will not. If many signs of strep (fever, no cough, etc, can rapid strep with empiric penicillin).
86
In first week of life, how many wet diapers?
Every day should have the same number of diapers, 4d -> 4+ wet diaperes.
87
How frequently should bebes be breastfeeding in first month?
Every 2-3 hr for 10-20 minutes.
88
What abx do SS kdis get?
BID ppx penicillin until 5 y.o . Also PCV13 of course.
89
Intestinal atresia etiology
vascular accident in utero
90
Biliary atresia presentation timeline and workup
6-8wk old, sweat test to rule out other problems, PHENObARBITAL with HIDA scan followup in 1 wk. If that fails, surgery.
91
Unilateral Undecended testes
no tx until 1 year of age! Then surgery.
92
Defect in the iris is?
Workup? Coloboma of iris. CHARGE (Coloboma, Heart, Atresia of Choana, Retardation, GU, Ear)
93
Double bubble ddx –
duodenal atresia, annular pancreas, malrotation, volvulus.
94
Failure to pass meconium algorithm
– Rectal exam, then Bariun enema.
95
Which bili causes kernicterus. Tx.
Unconju. Water insoluble, but can cross the BBB. Tx immediate exchange transfusion.
96
Baby in withdrawal from opioids what to do?
Tx opioids and phenobarbital. NEVER naloxone (suden withdrawal -> seizures )
97
Malabsorption workup
Initial screening: Sudan blak stain .Comfirmatory 72 hr stool fecal fat.
98
GERD in baby workup , tx
GERD in baby workup – Usually normal. If severe, interfereing with weigeht gain, dx clinical, but initial test is esophageal pH monitor. Thicken feeds and H2 receptor blockers in kids.
99
Intussusception workup
Ab Xray to rule out obstruction. Air enema. US not ideal but usually occurs due to practicality.
100
When can you begin to give sulfonamides in kids? Example of its use?
Can give sulfa to kids after 1 mo. Giving to kids with vesicoureteral reflux , as they need antibiotic prophylais for the 1st year following diagnosis to revent kidney scarring.
101
PSGN tx in kids
penicillin. Complete recovery in 95% of kids.
102
When do kids get anemia? Nadir? What is acceptable?
? Nadir at 12 wk w/ hg of 9-11. No tx needed. Response in preterms is earlier3-6wk and 7-9 hc. May need transufion.
103
Fever without a focus , age, workup and tx –
Until 3 y.o. Pan culture and give IM ceftriaxone if well appearing. Toxic IV abx.

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