Peds Flashcards
1
Q
When do introduce pureed foods?
A
6 months
2
Q
When to introduce cows milk?
A
1 year
3
Q
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?
A
Vitamin D, Vitamin D and B12, Vitamin D and B12 and iron, Vitamin D and iron
4
Q
Vitamin A deficiency presentation timeline and symptoms?
A
2nd-3rd year. Night blindness or impaired adaptation to darkness. Photophobia, dry scaly skin, dry conjunctiva, dry cornea, cloudy cornea
5
Q
Lab findings vitamin D deficiency. Calcium, phosphorous, alk phos, PTH, 25OH vitamin D
A
Calcium or phosphorous-normal to decrease, alk phos is increase, PTH is increase, 25 oh vitamin D-low
6
Q
Vitamin deficiency with angular cheilosis, stomatitis, glossitis, normocytic anemia, seborrheic dermatitis
A
B2
7
Q
Scurvy triad?
A
Punctate hemorrhage, gingivitis, corkscrew hair
8
Q
Precocious puberty High LH imaging?
A
CT/MRI
9
Q
Precocious puberty treatment?
A
GnRH analog
10
Q
Premature adrenarche labs?
A
> 40 dHEAS
11
Q
Risk factor precocious puberty development and why?
A
Obesity leads to increased adiposity and can stimulate sexual hormone production centrally and peripherally
12
Q
Premature adrenarche increases risk for what?
A
PCOS, DMII, metabolic syndrome
13
Q
3 risk factors lead poisoning?
A
home
14
Q
Best initial and most accurate test for lead poisoning?
A
Best initial-capillary (fingerstick) blood specimens
Most accurate-venous lead required if capillary >5mg/dL
15
Q
Contraindications to IO Placement?
A
1) Overlying cellulitis
2) Previous fracture/IO in same area
3) Bone fragility (OI)
16
Q
MCC death from child abuse and pathagnomonic sign of syndrome?
A
Shaken baby. Retinal hemorrhages.
17
Q
MCC mortality 1 month-1 year age?
A
SIDS
18
Q
Baby acne another name and tx?
A
Erythema toxicum neonatorum. No tx as it resolves spontaneously 2 wks after birth
19
Q
Marfan vs Homocystinuria differences?
A
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
20
Q
Homocystinuria tx?
A
Folate, B6 and B12
21
Q
What differentiate Ewing from osteo?
A
Both present with erythema and warmth of area, intermittent fevers, leukocytosis, anemia, and increased ESR. “Onion skin” periosteal reaction to bone
22
Q
Septic arthritis vs transient synovitis differentiation?
A
Similar presentation with cross over but transient synovitis rarely have FEVER or lab abnormalities
23
Q
Septic arthritis tx in children based on age?
A
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
24
Q
Most common organism osteo for 4 years, and sickle cell?
A
4 years-S aureus
Sickle cell-salmonella and s aureus
25
Infant has regurgitation/vomiting, eczema and bloody stools diagnosis and tx?
Milk protein allergy. Remove dairy and soy protein from diet
26
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
27
Double bubble vs tripple bubble?
Doubble bubble on abdominal xray-duodenal atresia, tripple bubble on abdominal xray-jejunal atresia
28
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
29
Hirschprung vs Meconium ileus associated disorder, level of obstruction, meconium consistency?
Hirsch-down, rectosigmoid, normal consistency
| Meconium ileus-CF, ileum, inspissated
30
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.
31
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
32
NG tube misplaced in duodenum and ligament of treitz on rt side of abdomen diagnosis?
Malrotation
33
Intussusception stool description and location of abnormality?
Ileum telescopes into cecum with rectal bleeding ("currant jelly" stools)
34
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)
35
Risk factors for pyloric stenosis?
First born boys, erythromycin use, formula feeding
36
IV hydration before surgery for pyloric stenosis decreases risk of what postoperatively?
Postoperative apnea
37
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
38
Tx constipation in children?
Increase fiber intake, decrease cow milk
39
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.
40
Gold standard test for biliary atresia?
IOC
41
Diagnosis of PS?
Abdominal ultrasonography shows doughnut sign
42
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.
43
Tx hydrocele?
Observation until 12 months age
| after 12 months age: surgery to prevent inguinal hernia
44
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
45
Cause of congenital hypothyroidism and clinical manifestations?
Thyroid dysgenesis. Pale, pot bellied, puffy face, poor brain development, protruding umbilicus, protruberant tongue
46
Physical exam and a x-ray findings for transposition of great vessels?
Single S2, +/- VSD. "egg on a string heart"
47
Physical exam and x-ray findings for TOF?
Harsh pumonic stenosis and VSD murmur, bood shaped heart
48
Physical exam and x-ray finding of tricuspid atresia?
Single S2, VSD, minimal pulmonary blood flow
49
Physical exam and x-ray for truncus arteriosus?
Single S2, systolic ejection murmur, increased pulm blood flow and edema
50
Physical exam and x-ray for TAPVR?
Severe cyanosis, resp distress, pulm edema, "snowman" sign
51
Tests to order once Digeorge suspected?
ECHO, serum calcium levels
52
Symptoms of Digeorge?
CATCH-conotruncal anomalies, Abnormal facies, T-cell lymphopenia (no thymus), Cleft palate, Hypocalcemia
53
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
54
Management of TOF?
Knee chest positioning for increased afterload. surgery before 6 months
55
Conditions where you need to keep PDA open?
TAPVR, coarctation of aorta, transposition of great arteries, hypoplastic left heart syndrome, tricuspid atresia
56
How to maintain patency for PDA?
Prostaglandin E1 and avoid indomethacin and oxygen
57
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
58
Workup for breath holding spells?
CBC/ferritin
59
Juvenile angiofibroma location, symptom and tx?
Nasopharynx, epistaxis and nasal/airway obstruction, surgical removal
60
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.
61
Bronchiolitis MCC and prevention for who and with what?
RSV. Premature infants can be given natalizumab
62
Complication and confirmation of severe coughing paroxysm?
CXR and pneumothorax
63
MCC pneumonia in CF and tx.
greater than 20: P aeruginosa. tx. amikacin, ceftazidime, and ciprofloxacin
64
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
65
Most accurate test CF?
Pilocarpine iontophoresis measurement of sweat chloride concentration >60 on 2 separate occasions
66
Tx of RDS?
Antenatal with corticosteroids. Postnatal with exogenous surfactant and resp support
67
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
68
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)
69
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
70
4 indications for renal and bladder U/S when looking for VUR as possible cause?
-Infants and children
71
Tx of aplastic crisis?
Transfusion
72
What complication of sickle cell is anemia not seen in?
Vasoocclusive crisis
73
MCC sepsis in sickle cell?
Pneumococcus
74
Diamond blackfan pathophys and tx?
Pure RBC aplasia. Corticosteroids and transfusion if unresponsive
75
Disthinguishing feature of fanconi anemia?
Pancytopenia secondary to aplastic anemia
76
What levels do you need to assess in children at 9-12 months and test?
Iron levels in all children! CBC
77
Characteristic finding on peripheral smear of thalassemia?
target cell
78
Neonatal polycythemia level, causes, and tx?
greater than 65% HCT, IUGR, HTN, DM, smoking, and partial exchange transfusion (replace blood with NS)
79
Diagnosis for B-ALL and tx?
B-all will have greater than 20% lymphoblasts on bone marrow biopsy. Immunostaining for TdT+ expressed only by pre B and pre T lymphoblasts. Can also be PAS+ Multi drug chemo and intrathecal for CSF and testes
80
AML age group, translocation in acute promyelocytic, serious complication, and tx?
50-60. 15;17 translocation, DIC secondary to auer rods, and ATRA (vit A derivative)
81
AML diagnosis?
Cytoplasmic staining showing MPO+, PBC showing auer rods
82
PResentation of type 1 glycogen storage disease and deficiency?
increase glycogen in liver, lactic acidosis, hyperuricemia, and hyperlipidemia. Glucose 6 phosphatase deficiency
83
Cardinal signs of beckwith wiedmann and surveillance tests?
Wilms tumor, organomegaly, macroglossia, hemihyperplasia. AFP and U/S of abdomen/renal
84
3 risk factors with downs Hematologic, GI, MSK?
ALL, Duodenal atresia, Alantoaxial instability
85
PKU diagnosis and tx?
Newborn screen (tandem mass spectrometry), quantitative AA analysis (increase phenylalanine levels)
86
Back pain at L5-S1 w/ neurologic dysfunction (Eg urinary incontinence) and palpable "step off" in lumbosacral area?
Spondylolisthesis
87
Diagnosis and tx of neonatal displaced clavicular fracture
X-ray and reassurance, gentle handling, and analgesics
88
Legg Calves Perthes presentation and tx?
Avascular necrosis of femoral head. Maintaining femoral head within acetabulum with splinting or surgery
89
Diagnosis and tx of slippled capital femoral epiphysis??
ap and frog leg lateral view radiographs. immediate surgical screw at current degree of slippage!!
90
Problem with developmental hip dysplasia?
displacement of femoral head from acetabulum
91
Screening developmental dysplasia and tx?
0-12 month w/ positive barlow or ortalani (palbable clunk) means immediate ortho referral. 2-6 months with - barlow ortalin and asymmetry you have U/S. greater than 6 months with - barlow ortalani and asymmetry you have hip x-ray. Pavlik harness.
92
Pulling kid by arm while in hurry causes what and tx?
Radial head subluxation through parts of annular ligament. Supination of forearm and flexion of elbow or hyperpronation of forearm
93
Soft palate trauma can cause what?
Compress internal carotid or dissect internal carotid
94
Tx clubfoot?
Nonsurgical immediately after birth with stretching and manipulation or serial plaster cast that corrects majority of time. Surgical between 3-6 months if conservative measures fail
95
MCC sepsis in term vs preterm?
Term-GBS, Pre-term-E coli
96
MCC of unilateral cervical lymphadenitis?
1) S. aureus, 2) Group A strep
97
When is exchange transfusion indicated for physiologic jaundice?
greater than 20-25
98
Prophylaxis for pertussis if close contact with child?
Azithromycin for less than one month old for 5 days. If older than one month, Azithromycin for 5 days or clarithromycin for 7 days or erythromycin for 14 days. If not fully immunized, should receive immunization
99
Most common predisposing factor to bacterial sinusitis?
Viral URI
100
Adolescents with abnormal uterine bleeding mcc and tx?
Immature HPO with ovulation issues. High does estrogen therapy 1st line
101
Tx lead poisoning?
mild-(5-44)-nothing and monitor with less than 1 month repeat level
moderate(45-69)-dimercaplosuccinic acid
severe(greater than70)-dimercaprol and EDTa
102
Tx in infant botulism vs foodborne botulism vs GBS
infant-human botulism Ig, foodborne-equine botulism Ig, GBS-pooled human Ig
103
Management of patient with distress, dhsphagia and drooling in tripod position
Epiglottitis. Endotracheal intubation followed by tracheostomy if it doesnt work. Ceftriaxone 7-10 days and rifampin for all close contacts
104
According to what age should immunizations be given. Gestational or chronologic?
Chronologic
105
Cephalohematoma vs Caput succedenum presentation
Cephalohematoma-localized to one cranial bone subperiosteal hemorrhage
Caput succedenum-diffuse ecchymotic swelling of scalp that can cross suture lines
106
Symptoms of supratentorial tumors?
Increase ICP and seizures
107
Symptoms of posterior fossa tumors?
Increase ICP, ataxia, and clumsiness
108
Symptoms of spinal cord tumors?
Back pain, weakness, abnormal gait
109
Symptoms of brainstem tumors?
Ataxia, clumsiness, CN palsies
110
Age at which rotavirus delivered and Contraindication to rotavirus vaccine?
2-8 months b/c highest risk of dehydration here. Anaphylaxis, hx of intussusception, hx of uncorrected congenital malformation of GI tract (ie meckel), SCID
111
Contraindication to diphtheria/tetanus vaccine?
anaphylaxis
112
Contraindication to pertussis vaccine?
anaphylaxis, unstable neuro disorder, encephalopathy within 1 week
113
Measles mortality and morbidity reduced with what vitamin?
Vitamin A
114
Varicella PEP protocol?
Immunized or previous infection: observe
Immunocompetent and no immunization: Vaccine within 3-5 days
Immunocompromised and no immunization: Immunoglobulin within 10 days
115
All states screen for what abnormality at birth?
PKU/hypothyroid
116
How often should height, weight, and head circumference be measured?
Height and weight at every visit. Head circumference every visit until 2 years.
117
How are hearing and vision screened?
Measured objectively at least once by 4 years of age
118
Iron supplements in children timeline for preterm and term?
Term-4 to 6 months
| Preterm-2 months
119
True or false. Screening for sexually active female girls
True
120
When does anterior fontanelle close and what disorder should you suggest if it does not close?
18 months. Hypothyroidism, hydrocephalus, rickets, iugr
121
What possible disease if only one artery in umbilical artery?
congenital renal malformations
122
APGAR normal and diff values?
Appearance (color)-0 is pale blue, 1 is extremities blue, 2 is pink. Pulse-0 is not detectable, 1 is less than 100, 2 is greater than 100, Grimace (reflex)-0 (none), 1 is grimace, 2 is grimace and strong cough, cry or sneeze, Muscle ton-0( limp), 1 (some flexion of extremities), 2 (active motion). Resp- 0 (none) 1 (slow weak cry), 2 (strong good cry)
123
Patient with rapid head growth and poor feeding and irritability best test and tx?
Think hydrocephalus. CT head and shunt from ventricle to peritoneum, pleura, or RA
124
VSD best initial test and tx?
ECHO. Observation if small defect and no other issues because most close spontaneously by 2 years
125
What type of murmur do you not need a workup for in children?
grade 1/2 midsystolic murmur
126
Patient comes in with fever, pharyngitis, and gray vesicles/ulcers on posterior oropharynx cause and tx?
Coxsackievirus A. supportive management
127
Patient is 3 yrs old and comes in with fever, pharyngitis, and clusters of small vesicles on anterior oropharynx (lips)? Cause and tx?
Herpetic gingivostomatitis. Oral acyclovir
128
Fever, urticaria, joint pain 1 week after starting penicillin therapy?
Serum sickness like reaction
129
Thickened BM with subepithelial spikes?
Membranous nephropathy
130
Crescent formation on biopsy?
PSGN
131
Most common predisposing factor for orbital cellulitis?
Bacterial sinusitis
132
Normal HR, RR, SBP, DPB hewborn?
120-160, 40-60, 65/50
133
MCC red eyes at 1 day, 2-7 days, greater than 7 days, and greater than 3 weeks?
Chemical irritation b/c silver nitrate, N gonorrhoeae (day 0 with topical erythromycin), Chlamydia (day 0 with oral erythromycin), herpes if more than 3 weeks
134
What two eye drops are given to all new borns tin the delivery room and what is it aimed towards?
erythromycin eye drop and silver nitrate solution
135
Tx of HSV conjunctivitis after 3 weeks?
Topical vidaribine and oral acyclovir
136
MCC transient polycythemia in newborns?
Delayed cord clamping
137
How do you evaluate if jaundice needs evaluation?
138
cause Presentation of Duchenne-Erb paralysis and level?
Lateral traction on neck during delivery. Waiters tip with inability to abduct and externally rotate and supinate arm. C5/C6
139
PResentation of Klumpke paralysis and level?
Upward force on arm during delivery. C7-C8 +/- T1, claw hand due
140
Best initial step if suspective diaphragmatic hernia?
Intubation. NG to decompress stomach/bowel is important
141
What is omphalocele associated with defect?
Edwards syndrome
142
MCC for elevated AFP and incorrect dating?
Omphalocele
143
Most common clinical clue for wilms tumor presence?
Aniridia
144
Best initial most accurate test wilms tumor?
Best initial-abdominal ultrosonography. Most accurate: contrast enhanced CT
145
Tx for cryptorchidism and risk factor even with surgery?
Orchipexy after 1 and associated with increased risk of malignancy regardless of surgical intervention
146
What is epispadias associated with?
Bladder exstrophy
147
Chromosome deletion in TOF association?
Chromosome 22
148
3 holosystolic murmurs?
MR, TR, VSD
149
Pulsus alternans sign of ?
LV systolic dysfunction
150
Heart sound ASD?
Fixed wide splitting S2
151
Best initial and most accurate heart defects?
Best initial echo, most accurate: cardiac cath
152
Coarctation associated congenital condition?
Turner
153
Best initial/most accurate test pyloric stenosis?
Abdominal US and most accurate is upper GI series.
154
First step management choanal atresia vs duodenal atresia?
choanal-secure airway
| duodenal-iv fluids
155
Diagnosis for imperforate anus?
Complete inability to pass meconium (physical diagnosis)
156
Pyloric stenosis and duodenal atresia and volvulus and intussusception cause obstruction and need what before surgery?
1) best initial step in managment is IV fluids and NG tube to decompress the bowels
157
Best initial treatment volvulus?
Endoscopic decompression and surgical decompression if this fails
158
Best initial and most accurate test volvulus?
Best initial-AXR, most accurate-upper gi series
159
Timing of year for rotavirus vs adenovirus present most common?
Winter rota and year around for adeno
160
3 forms of rickets?
Vitamin D deficient rickets by lack of vitamin D in diet. Vitamin D dependent by inability to convert 25 OH to 1,25 OH and x-linked hypophosphatemic due to inability to retain phosphate
161
Neonatal sepsis tx?
ampicillin and gentamicin
162
Triad of toxo, best initial/most accurate, and tx?
Chorioretinitis, hydrocephalus, ring enhancing CT lesions, IgM toxo and PCR for toxo most accurate, pyrimethazole and sulfadiazine
163
Syphilis presentation, best initial/most accurate, and tx?
Rash on palms of hands and soles of feet, frontal bossing, hutchinson 8th nerve palsy, and saddle nose. VDRL/RPR isinitial and FTA ABS or dark field. Penicillin
164
Rubella presentation, best initial/most accurate, and tx?
Cataracts, sensorineural hearing loss, cardiac issues (PDA), mental retardation, blueberry muffin,IgM rubella, supportive
165
CMV presentation, best initial/most accurate, and tx?
Chorioretinitis, periventricular calcifications, hearing loss, Urine or saliva titers and PCR saliva for viral DNA, ganciclovir
166
Herpes presentation, best initial/most accurate, and tx?
Week 1 is shock and DIC, week 2 is vesicular skin lesions, week 3 is encephalitis. Best initial is Tzanck and most accurate is PCR. Acyclovir and supportive
167
Fifth disease, roseola, and mumps diagnostic tests?
Clinical diagnosis
168
Classic pentad of scarlet fever?
Fever, pharyngitis, sandpaper rash over trunk and extremities, strawberry tongue, and cervical lymphadenopathy
169
MCC croup and tx
1) parainfluenza virus 1 and 2, 2) RSV. Racemic epi
170
Gray highly vascular pseudomembrane plaques on the pharyngeal wall cause, diagnostic test, and tx?
Corynebacterium diphtheriae, culture small portion of superficial membrane, and antitoxin
171
Deficiency and toxicity of vitamin A
Deficiency-hypoparathyroidism and poor night vision
| Toxicity-hyperparathyroidism and pseudotumor cerebri
172
vitamin D excess?
Hypercalcemia, polyuria, polydipsia
173
Bugs causing acute otitis media?
Nontypeable H flu, moraxella catarhalis, s pneumoniae
174
When should myringotomy with tympanic tube placement be considered in children with multiple AOM episodes?
greater than 3 episodes in 6 months or greater than 4 in 12 months
175
Patient presents with asymmetric neck spasm for 2 days. What is the best next test?
Cervical x-rays to ensure no cervical spine fracture or dislocation
176
Best initial management of congenital diaphragmatic hernia?
Endotracheal intubation
177
Concave abdomen and barrel chest in infant in respiratory distress?
Congenital diaphragmatic hernia
178
Desquamating vs sandpaper like rash vs blanching erythematous rash?
Desquamating-SSSS, sandpaper like-scarlet fever, blanching-Kawasaki
