Peds Flashcards
When do introduce pureed foods?
6 months
When to introduce cows milk?
1 year
Vitamin/mineral for breastfed infants. Child normal w/ nonveg mom? Child nomral term w/ veg mom? Child preterm with veg mom? Child preterm with normal mom?
Vitamin D, Vitamin D and B12, Vitamin D and B12 and iron, Vitamin D and iron
Vitamin A deficiency presentation timeline and symptoms?
2nd-3rd year. Night blindness or impaired adaptation to darkness. Photophobia, dry scaly skin, dry conjunctiva, dry cornea, cloudy cornea
Lab findings vitamin D deficiency. Calcium, phosphorous, alk phos, PTH, 25OH vitamin D
Calcium or phosphorous-normal to decrease, alk phos is increase, PTH is increase, 25 oh vitamin D-low
Vitamin deficiency with angular cheilosis, stomatitis, glossitis, normocytic anemia, seborrheic dermatitis
B2
Scurvy triad?
Punctate hemorrhage, gingivitis, corkscrew hair
Precocious puberty High LH imaging?
CT/MRI
Precocious puberty treatment?
GnRH analog
Premature adrenarche labs?
> 40 dHEAS
Risk factor precocious puberty development and why?
Obesity leads to increased adiposity and can stimulate sexual hormone production centrally and peripherally
Premature adrenarche increases risk for what?
PCOS, DMII, metabolic syndrome
3 risk factors lead poisoning?
home
Best initial and most accurate test for lead poisoning?
Best initial-capillary (fingerstick) blood specimens
Most accurate-venous lead required if capillary >5mg/dL
Contraindications to IO Placement?
1) Overlying cellulitis
2) Previous fracture/IO in same area
3) Bone fragility (OI)
MCC death from child abuse and pathagnomonic sign of syndrome?
Shaken baby. Retinal hemorrhages.
MCC mortality 1 month-1 year age?
SIDS
Baby acne another name and tx?
Erythema toxicum neonatorum. No tx as it resolves spontaneously 2 wks after birth
Marfan vs Homocystinuria differences?
Marfan-normal intellect, AR from aortic root dilation, AD inheritance, upward lens dislocation
Homocystinuria-delayed intellect, downward lens dislocation, thrombosis, megaloblastic anemia (b12) deficiency and lower homocysteine
Homocystinuria tx?
Folate, B6 and B12
What differentiate Ewing from osteo?
Both present with erythema and warmth of area, intermittent fevers, leukocytosis, anemia, and increased ESR. “Onion skin” periosteal reaction to bone
Septic arthritis vs transient synovitis differentiation?
Similar presentation with cross over but transient synovitis rarely have FEVER or lab abnormalities
Septic arthritis tx in children based on age?
less than 3 months-staph, group b strep, gram neg bacilli
antisph (nafcillin or vanco) PLUS gentamicin or cefotaxime
older than 3 months-Staph, strep group A, strep pneumoniae. Gram + coverage with vanco, nafcillin, clinda, or cefazolin
Most common organism osteo for 4 years, and sickle cell?
4 years-S aureus
Sickle cell-salmonella and s aureus
Infant has regurgitation/vomiting, eczema and bloody stools diagnosis and tx?
Milk protein allergy. Remove dairy and soy protein from diet
Breastfeeding failure jaundice underlying problem vs breast mild jaundice underlying problem?
Breastfeeding failure-decreased bilirubin elimination leads to unconjugated hyperbilirubinemia and immature UDP glucoronosyltransferase can’t account for it.
Breastfeeting jaundice-increased B-glucuronidase from breast milk deconjugates intestinal bilirubin and increased enterohepatic circulation happens
Double bubble vs tripple bubble?
Doubble bubble on abdominal xray-duodenal atresia, tripple bubble on abdominal xray-jejunal atresia
What workup should you do if patient has esophageal atresia and distal TEF and diagnostic test?
VACTERL (Vertebral, anal atresia, cardiac, TEF, renal anomalies, limb problems). CXR
Hirschprung vs Meconium ileus associated disorder, level of obstruction, meconium consistency?
Hirsch-down, rectosigmoid, normal consistency
Meconium ileus-CF, ileum, inspissated
Reye syndrome pathophys and labs?
Microvesicular fatty infiltration of brain, liver, and kidneys along with hepatic mitochondrial dysfunction. Increase aminotransferases, increase PT, PTT, and increased ammonia.
Bilious emesis best initial step and best initial test and best next step?
Best initial step-stop feeding, IV fluids, NG decompression
Best initial test-Abdominal x-ray, contrast enema if no pneumoperitoneum
NG tube misplaced in duodenum and ligament of treitz on rt side of abdomen diagnosis?
Malrotation
Intussusception stool description and location of abnormality?
Ileum telescopes into cecum with rectal bleeding (“currant jelly” stools)
Tx intussusception best initial and most accurate test?
Ultrasound showing target sign. Enema (air or water sol. contrast) is diagnostic and therapeutic or surgical removal of lead point (if present)
Risk factors for pyloric stenosis?
First born boys, erythromycin use, formula feeding
IV hydration before surgery for pyloric stenosis decreases risk of what postoperatively?
Postoperative apnea
Cyclic vomiting syndrome charactersitics?
Recurrent and freq vomiting. resolve spontaneously between episodes. >3 episodes in 6 months. Fam hx migraine often present. >4 time/hour lasting 1-10 days with episodes
Tx constipation in children?
Increase fiber intake, decrease cow milk
Presentation timeline and Tx of milk or soy protein induced colitis
Timeline-2 to 8 weeks w/ painless bloody stools and regurgitation or vomiting. tx. elimination of soy and milk protein from mom diet OR hydrolyzed formula switch in babies.
Gold standard test for biliary atresia?
IOC
Diagnosis of PS?
Abdominal ultrasonography shows doughnut sign
Presentation, diagnosis, and tx. of biliary cyst?
Pain, jaundice, palpable mass w/ most common as extrahepatic single cystic dilation of bile duct. Ultrasonograpy, ERCP. Surgical resection.
Tx hydrocele?
Observation until 12 months age
after 12 months age: surgery to prevent inguinal hernia
best initial/most accurate and Tx of varicocele?
best initial-physical exam showing bag of worms, and and most accurate is scrotal U/S. Gonadal vein ligation (boys and young men with atropy) and NSAIDs/scrotal support in older men who do not desire additional children
Cause of congenital hypothyroidism and clinical manifestations?
Thyroid dysgenesis. Pale, pot bellied, puffy face, poor brain development, protruding umbilicus, protruberant tongue
Physical exam and a x-ray findings for transposition of great vessels?
Single S2, +/- VSD. “egg on a string heart”
Physical exam and x-ray findings for TOF?
Harsh pumonic stenosis and VSD murmur, bood shaped heart
Physical exam and x-ray finding of tricuspid atresia?
Single S2, VSD, minimal pulmonary blood flow
Physical exam and x-ray for truncus arteriosus?
Single S2, systolic ejection murmur, increased pulm blood flow and edema
Physical exam and x-ray for TAPVR?
Severe cyanosis, resp distress, pulm edema, “snowman” sign
Tests to order once Digeorge suspected?
ECHO, serum calcium levels
Symptoms of Digeorge?
CATCH-conotruncal anomalies, Abnormal facies, T-cell lymphopenia (no thymus), Cleft palate, Hypocalcemia
Symptoms of coarctation in infant?
Around day 3 as ductus closes, CHF (poor feeding, irritability, diaphoresis), cardiogenic shock with prolonged capillary refill, metabolic acidosis, and poor renal perfusion with decreased renal output
Management of TOF?
Knee chest positioning for increased afterload. surgery before 6 months
Conditions where you need to keep PDA open?
TAPVR, coarctation of aorta, transposition of great arteries, hypoplastic left heart syndrome, tricuspid atresia
How to maintain patency for PDA?
Prostaglandin E1 and avoid indomethacin and oxygen
Viral myocarditis cause and tests?
Coxsackievirus or Adenovirus, CXR (cardiomegaly or pulm edema), ECG (sinus tachy), ECHO (decreased EF or diffuse hypokinesis), Endomyocardial biopsy (gold standard) diffuse infiltrate and myocyte necrosis with subsequent impairment of systolic and diastolic function
Workup for breath holding spells?
CBC/ferritin
Juvenile angiofibroma location, symptom and tx?
Nasopharynx, epistaxis and nasal/airway obstruction, surgical removal
Choanal atresia associated syndrome and imaging?
CHARGE (Coloboma, Heart defects, Atresia choanal, Retardation of growth/development, Genitourinary anomalies, Ear abnormaliteis and deafnes). CT shows narrowing at pterygoid plate.
Bronchiolitis MCC and prevention for who and with what?
RSV. Premature infants can be given natalizumab
Complication and confirmation of severe coughing paroxysm?
CXR and pneumothorax
MCC pneumonia in CF and tx.
greater than 20: P aeruginosa. tx. amikacin, ceftazidime, and ciprofloxacin
What acid base finding in CF patients and why?
contraction metabolic alkalosis. increase cl- needs increase na+ secondary to aldosterone release and decrease H+ and K+ leading to alkalosis
Most accurate test CF?
Pilocarpine iontophoresis measurement of sweat chloride concentration >60 on 2 separate occasions
Tx of RDS?
Antenatal with corticosteroids. Postnatal with exogenous surfactant and resp support
Wt. loss neonates timeline and assessment?
Lose up to 7% in first 5 days and should be regained by 10-14 days. 7% assess for oromotor dysfunction, lactation failure, daily weights and consider formula supplementation
Monosymptomatic isolated enuresis management?
1) Behavior modifications (sugary or caffeniated beverages and voiding before bedtime and drink less before bedtime)
2) Enuresis alarm (1st line when behavior fails)
3) Pharmacotherapy (desmopressin, TCA) (short term but high relapse)
Best initial test and most accurate (gold standard) for VUR?
Best initial-renal or bladder U/S
Most accurate-voiding cystourethrogram (VCUG) for patients with recurrent UTI
4 indications for renal and bladder U/S when looking for VUR as possible cause?
-Infants and children
Tx of aplastic crisis?
Transfusion