peds Flashcards

Question

pertussis ## Footnote 2 tx groups? who else? 2 options each

Answer 1

DX: 1. isolation of bacteria from sample 2. PCR less than 2: **macrolide** azithromycin or clarithromycin infants older than 2: macrolide or TMP-SMX \*\*those in close contacts should recieve prophylaxsis\*\* **_tx no reccomended for those if over 21 days since sxs onset_**

Answer 2

**_parainfluenza virus 1 affecting_ larynx, trachrea aka upper respiratory** ## Footnote also RSV and adenoviruses **6mo-3 years** **rare over 6** 1. **_steeple sign_** 2. **barking seal cough** 3. _inspiratory stridor_ 4. coughing at _night_ esp while laying down 5. respiratory distress (retractions, low O2 stat) DX: clinical TX: 1. mild:oral _dexamethasone/decadron_ 2. mod/sev: - oxygen - _racemic epi_ condsider admission

Answer 3

1. pneumonia ## Footnote major cause of morbidity and mortality can lead to respiratory failure 2. hepatitis can occur in immunocomprimised hosts frequently fatal

Answer 4

causes: 1. generalized hip laxity 2. complete hip dislocation 3. acetabular abnormality MC in left hip, present at birth SXS: **1. initally asymptomatic** **2. then with walking, limp and decreased leg length** **3. asymetry of the skin folds** **4. _loss of adduction_**

Answer 5

RSV-paramyxovirus causes airtrapping, winter months **peaks in 2-6 months, common respiratory illness til age 5** PATHO _virus attacks therminal bronchiolar epithelial calls, cells causing inflammation in small airways_ _can cause **edema, excessive mucous production leading to obstruction**_ RF: 1. prematurity 2. low birth weight 3. less than 12 weeks old

Answer 6

sxs: 1. **starts as URI sxs** 2. **FEVER, WITH EXPIRATORY WHEEZE "JUNKY SOUND"** 3. _gradual onset to RESPIRATORY DISRESS,_ _-tachypnea over 70_ _-nasal flaring_ _-retractions_ _-grunting_ _LOW O2 EXAM!!!!_ DX: 1. RSV NASAL SWAB 2. HYPERINFLAMATION ON XRAY TX: 1. nasal suctioning 2. hydration 3. hospitalization if severe for respiratory support **\*\*\*DONT GIVE STEROIDS or ABX\*\*\***

Answer 7

corynebacterium diphtheriae producing toxin ## Footnote \*\*classifid based on the mucous membrane it is infected\* MC COMPLICATIONS: 1. MYOCARDITIS 2. NEURITITS **_1. laryngeal_** a. upper airway/bronchial obstructions **_2. pharyngeal_** **_a. MOST COMMON FORM!!_** **_b. GRAY MEMBRANE "pseudo membrane" COVERS TONSILS AND PHARYNX_** **_c. BULL NECK_** **_from swelling of cervical nodes_** **_3. myocarditis/neuropathy_** this occurs when the bacterial gets into the blood and settles other places creating that membrane and preventing the organs from working TX: 1. diphtheria horse antitoxin as soo as this is suspected, obtained through CDC 2. **_ISOLATE FOR 3 DAYS UNTIL A NEGATIVE CULTURE CAN BE OBTAINED_**

Answer 8

infectiion of the LOWER respiratory tract 1. **strep pnuemonia MC** 2. haemophilis influenza 3. mycoplasma SXS: 1. **_fever_** **_2. focal crackles/rales on asucultation_** **_3. PRESENT WITH EGOPHONY_** 4. rapid breathing tachypnea DX: 1. consolidation on xray TX: 1. amoxicillin 1st choice 2. 2nd line: macrolide

Answer 9

1. first child 2. girl 3. breech presentation 4. family hx

Answer 10

for 21 days after onset of sxs OR 5 days of abx completed

Answer 11

1st dose: **_12-15 months of age_** 2. 2nd dose: **_4-6 years_**

Answer 12

5 doses **dosing:** 2, 4, 6, 15-18months, and 4-6 years

Answer 13

single dose routine use for: 1. **adolescents 11-18 who have gotten the childhood vaccine** **2. 19-64 year HCW also** \*\*\*can be dosed regardless of interval since last tetnus\*\*

Answer 14

1. Oxygen Sat \< 92% 2. RR \> 70 in infants, or 50 in children 3. Intermittent Apnea or Grunting 4. Dehydration 5. Family unable to provide good observation

Answer 15

opening in the septum that separates the two ventricles 80% involve the _thin membraneous septum_ 20% involve the _muscular septum_ can be isolated or compllex lesions (can be associated with other cardiac issues)

Answer 16

MOST COMMON SIZE ## Footnote large resistance through small hole **normal right ventircular pressure and pulmonary artery pressure** **_small left to right shunt (since left side of hear it high pressure and right is low pressure)_** \*\*aka no enough blood is going left to right that it increases the pressure on the right side of the heart\* SXS: 1. _harsh **holosystolic murmur** along left sternal border, present about 36 hours after birth_ \*\*think about it, there is a bunch of blood trying to fit through a tinny hole, so the whole time it is pumping you get a murmer _2. possible systolic thrill at left lower sternal border_

Answer 17

**increase the pressure in the RV and pulmonary ateries because enough blood is pumping over to increase it** can cause as a result: 1. pulmonary artery Hypertension 2. pulmonary vascaulr obstructive disease 3. if large, LV dilation and failure 4. _HF in 80% of infants with large_ 5. _endocarditis_ SXS: **SIGNS AND SXS OF HF!!!**

Answer 18

1. tx HF as if in adults 2. surgical repair once HF improves \*\*closure in early childhood if pulmonary artery pressure is increased\*\*

Answer 19

1. CXR-possible cardiomegaly, enlarged PA, HF if large defect ## Footnote 2. **_echo doppler is diagnostic!!!_**

Answer 20

TX: 1. 24% CLOSE BY 18 MONTHS 2. 50% BY 5 YEARS 3. REGULAR FOLLOW UP WITH PERIODIC DOPPLER

Answer 21

1. **pulmonary arterial hypertension PAH can lead to irrersible pulmonary vascular obstructive disease PVOD** 2. significant PVOD leads to _pulmoary vascular restistance and pulmonary artery pressure increase_ and can lead to shunt reversal, and right to left shunting \*\*think about it!!!...as more blood going from left to right the damange on the right side fo the heart and pulmonary artert increases,causing back up into the RV this creases the pressure to increase here and then flow from the highp pressure of the right ventricle to the relatively low pressure of left ventricle\*\* **_eisenmenger's physiological complex_** 3. leads to hypoxemia and right sided HF since this gives out and the oxygen then bypasses the lungs **__**

Answer 22

a hole between the two atria in the heart occurs in 25% of people caused by lack of fusion leaving patent foramen ovale physiology: 1. _left to right shunting from_: rt atrium more distensible than left RV more compliant that LV PuVR more than SVR LA pressure higher that RA 2. _hemodynamic burden_: _from right ventricular oolume overload since more is going from the right atrium into right ventricle_ well tolerated for many years

Answer 23

1. **hyperdyanamic RV:** RV vlume increases leading to increase contraction via starling mechanism 2. **accentuated S1 at LLSB** **3. _S2 wildly split_** through inspiration and expiration 4. Grade II-III _cresendo-decresendo murmur_ DX: 1. EKG: afib/aflutter 2. **_echodoppler_**

Answer 24

1. catheter closure at the ASD once sxs present ## Footnote 2. if no sxs closure is reccomend if the _Qp (pulomnary):Qs(systemic) blood flow 1.5:1_ OR PAH present 3. surgical closure-reccomended in pre-school or pre-adolescent years

Answer 25

"domed shaped" stenosis with concentric hypertrophy ## Footnote physiology: a. _must be reduced by 60% to be hemodynamicaly significant_ b. causes _RV pressure overload_ c. can lead to _RT ventricular overload_ mild-mod: well tolerated, monitor severe: leads to RV failure and premature death

Answer 26

dx: echo TX: 1. **_cath balloon vulvoplasty_** gradient less than 25=no intervention gradient over 75 always vulvoplasty

Answer 27

atrial septal defect

Answer 28

1. _ostium secundum: defect in middle septum_ ## Footnote 2. _ostium primum: defect in the lower atrial septum_ _3. sinus venous defect: high in atrial septum_

Answer 29

1. **_MOST CHILDREN ARE ASYMPTOMATIC SO DX OFTEN MISSED IN CHILDREN_** 2. _**systolic ejection murmer** and sxs (fatigue, dyspnea, decreased stamina) present in **20s**_ 3. 3rd-4td decased adults become increasingly symptomatic **_incidence of atrial fib and flutter increase_** 4. **_paradoxicl emboli can result in stroke_** (venous emcbolism) 5. **premature death and heart failure occur in adults who go untreated**

Answer 30

RA RV and pulmonary artery _volume overload_ since there is so much coming from the left atrium over, it effects everything after the RA this can cause _pulmonary HTN to occur late in the disease_

Answer 31

RV to PA: 40 mmHG=mod pulm stenosis ## Footnote RV to PA: 75 mmHg=severe pulm stenosis

Answer 32

1. systolic thrill at supersternal notch 2. _early systolic click upper LSB_ 3. _murmer is harsh, cresendo-decresendo at **upper right SB radiating towards clavicle and louder with inspiration**_

Answer 33

patentcy of the vessel that normally connects the _pulmonary arterial system and the aorta_ in the fetus, between _left pulmonary artery and lower aortic arch_ **normally closes 2-3 days after birth** **BUT** **OFTEN REMAINES OPEN IN PRE-TERM BABIES** **small**: well tolerated **mod**: _elevated PAP, significant shuntin from aorta to PA_ **severe**: AO and PA in free communication _marked left to right shunting and LV dysfunction_ (since the left is the higher pressure system)

Answer 34

1. HF occurs in the first weeks of life!!!!!! 2. **_continous murmer through systole and diastole "machinery murmer"_** heard loudest at LST 3-4th ICS 3.murmer peaks during S2

Answer 35

DX: 1. ECG: LAE, LVH 2. **_echodoppler: LAE, LVE, might see shunt_** tx: 1. **INFANTS: TOC IS INDOMETHACIN (CLOSES IT)** 2. **SURGICAL OR CATHETER CLOSURE IS THE TOC FOR EVERYONE ELSE**

Answer 36

discrete _narrowing of the distal segment of the aortic arch_, just _distal to the origina of the subclavian artery_ causes: 1. **obstruction to outflow to the lower half of the body** 2. **LVH from pressure backload** 3. **arterial HTN** 4. **elevated pressure prior to coarction, lower pressure after** 5. **collateral circulation to lower body dvelops via the internal mammary and subcostal arteries** (notches on the ribs)

Answer 37

SXS: fatigue, dyspnea **_faituge while running_** **_HTN IN CHILDHOOD_** PE findings: 1. difference in BP in arm and legs of over 10 mmHG with high systolic 2. marked HTN of the upper part of the body and high renin from decreased profusion of the kidneys 3. **upper body well developed with thin legs**

Answer 38

1. **_PREMATURE DELIVERY_** 2. **_premature maternal exposure to rubella_**

Answer 39

1. CXR: notching of interior margin of ribs in adolescence 2. echo: show coarct 3. cardiac MRI/MRA and CT mos useful 4: EKG: LVH

Answer 40

50% present with HF

Answer 41

1. direct resection/repair via surgery 2. stenting with cath but less feasible

Answer 42

biventricular origin of the aorta (aka the aorta isn't in the right place) ## Footnote **1. LARGE VENTRICULAR SEPTAL DEFECT** **2. OBSTRUCTION OF THE PULMONARY BLOOD FLOW BECAUSE THERE IS SUBVALVUALAR NARROWING OF PULMONIC OUTFLOW TRACT** this causes: **1. RVH** **2. BLOOD PUMPS FROM THE RV ACROSS THE VSD AND INTO THE AROTA, MEAN IT BYPASSES THE LUNGS AND SO IT LEADS TO CYANOSIS**

Answer 43

2-4 weeks after GAS pharyngitis ## Footnote SXS: 1. migratory athritis 2. pancarditis/valvitis 3. CNS involvement 4. erythema marginatum 5. subcutaneous nodules

Answer 44

group A streptococcus ## Footnote 1. sore throat 2. myalgias 3. abdominal pain 4. exudative tonsilitis DOC: 1. penicillin V 10 days 2. Amoxicillin 10 days

Answer 45

congenital abnormality of the respiratory tract **_incomplete separation of the trachea and esophagus_** the esophagus is attached to the trachea SXS: 1. drooling 2. choking 3. **_unable to feed_** 4. **_respiratory distress_** DX: 1. unable to pass a NG tube into stomache 2. definitive: upper GI studies 3. endscopy Tx: **_SURGERY_**

Answer 46

hypertrophy around pyloric spincter causing gastric outlet obstruction **4-6 weeks of life** SXS: 1. _projectile vomiting_ _2. hungry despite no weight gain_ _3. **OLIVE SHAPED MASS in right upper/epigastric region**_ DX: **_STRING SIGN ON BARIUM SWALLOW_** TX: SURGERY

Answer 47

**malrotation** in utero wih causes incomplete fixation of the small bowel, typically less than 1 y/o ## Footnote _ladds band_ develops between the cecum and peritenum which _obstructs the duodenum and causes obstruction_ SXS: 1. **_sudden onset of BILIOUS VOMITING (green vomit)_** **_2. severe inconsolable abdominal pain_**

Answer 48

DX 1. **_barium study "BIRD BEAK" or "CORKSCREW"_** 2. xray shows **"double bubble" air fluid levels in duodenum and stomach ONLY** TX: **_sugery!!! NOW!!_**

Answer 49

passage of gastric contents into the esophagus causes troublesome symptoms or complications **\*\*\*\*even if a kid is spitting up thats normal, its only when it causes problems or sxs that its a disease\*\*\*** SXS: 1. heartburn 2. respiratory sxs _cough, wheezing asthma_ **_reccurent pneumonia_** 3. vomiting DX: 1. **_trial of acid suppresion with PPI_** **_2. barium swallow-shows abnormalities_** **_3. endoscopy if persists 2 years after tx_**

Answer 50

TX: 1. lifestyle modifications (weight loss, head elevation, no chocolate) 2. PPI's or H2 **_DON'T FORGET THAT ASTHMA AND GERD OFTEN GO TOGETHER_**

Answer 51

motor disorder of the gut congenital _absence of ganglion cells_ and in the _distal rectum and colon_ SXS: 1. **_failure to pass meconinum (first stool) within first 72 hrs of life_** 2. _explosive expulsion of stool and gas after DRE_

Answer 52

DX: 1. rectal bx tx: **_SURGERY!!_** resect the affected bowel and bring normal ganglionic bowel down close to the anus and preserve the spinchter funciton

Answer 53

most common congenital anomaly of the SI **_incomplete obliteration of the vitelline duct_** **_RULES OF 2's:_** 1. **_2% of population_** **_2. male to femal 2:1_** **_3. within 2 ft of the iliocecal valve_** **_4. can be 2 inches long_** **_5. usually present before 2_**

Answer 54

SXS: 1. **_painless GI bleedinging_** **_2. children with intussusception_** 3. presents with signs like appendicitis 4. signs of bowel obstruciton DX: 1. meckel scan (nuclear med) 2. mesenteric angiography 3. resection

Answer 55

invagination of one part of the intesting into itself _telescoping!_!! causes bowel obstruction and ischemia **less than 2 y/o** \*\*\*can be associated with viral influence\*\* also look into: meckles diverticulum, polyp, tumor, vascular malformation

Answer 56

sxs 1. _sudden_ onset of _intermittent sever abdominal pain that is **episodic**_ 2. **_kid drawing legs up to their abdomen repetitively_** EXAM: 1. _**sausage shaped** abdominal mass on right side of colon_ 2. **_CURRANT JELLY STOOL_** **_3. TARGET SIGN/BULLSEYE ON US_** TX: **_barium or air enema_**

Answer 57

reducible-all goes back in incarcerated-can't be reduced strangulated-incarcerated and blood supply cut off **_Umbilical Hernia_** Common surgical condition in children. High incidence in African-Americans. Most will close by 4-5 years of age. **_Diaphragmatic Hernia_** Developmental defect in the diaphragm, allowing abdominal viscera to herniate into the **_chest_**, compromising normal lung development. **_Respiratory distress in the first few hours of life._** Diagnose with a chest x-ray. Treatment is Surgery. **_Inguinal Hernia_** Infants at risk due to anatomic alignment- the inguinal canal is shorter, and more perpendicular **_Indirect-_** Pass through the inguinal canal (most common) **_Direct-_** Do not go through inguinal canal (rare)

Answer 58

most common condition in children requiring emergency abdominal surgery ## Footnote Caused by a nonspecific obstruction of the appendiceal lumen **_Peritonitis from inflammation, perforation occurs within 72 hours_** SXS: 1. anorexia 2. **_periumbical pain that MIGRATES TO RLQ_** 3. VOMITING 4. **_POSITIVE ROVSINGS, OBTURATOR, AND PSOAS SIGN!!!!!!!!!_** **_5. TENDERNESS AT MCBURNEYS POINT_** 1/3 THE DISTANCE BETWEEN SUPERIOR ILIAC SPINE AND UMBILICUS 6. pain with _running, coughing, jumping_

Answer 59

DX: 1. increased WBC 2. pregnancy test ALWAYS to R/o ectopic pregnancy 3. **clinical dx most often** 4. **CT IMAGING** Tx: 1. APPENDECTOMY

Answer 60

genetic correlation immune-mediated inflammation of the **_small intestine_** caused by **_sensitivity to gluten_** **_wheat_** **_barely_** **_rye_** SXS: 1. MALABSOROPTION AKA _DIARREAH, STEATORREAH, WEIGHT LOSS, VITAMIN DEFICIENCY_ _2. HERPETIC DERMATITIS_ DX: 1. **_SERUM CELIAC-ANTIGEN TESTING_** **_2. IF POS-ENDOSCOPY FOR BX_** TX: GLUTEN FREE DIET

Answer 61

Common: caucasions native americans asians lactase deficiency **_developmental:_** low lactase levels due to prematurity **_congenital_**: no lactiacse at all....rare! SXS: 1. adominal pain 2. bloating 3. flatualance 4. diarreah

Answer 62

DX: 1. lactose breath hyrdogen test 2. lactose absorption test TX: 1. reduced dairy intake 2. subsitiute nuitriens like calcium and vitamin D 3. enzyme supplement

Answer 63

starts 2-3 and most kids are dry from age 5

Answer 64

nocturnal enuresis more common in boys **50% cases have family hx** pathogenesis: 1. **delayed maturity level that allows voluntary control of micturation** **2. sleep disorders \*\*so always ask about sleep apnea/snorning\*\*** **3. reduded ADH** **4. genetic factors** **5. UTI** **6. trauma**

Answer 65

DX: 1. UA/UC to r/o infection TX: 1. REASSURANCE 2. LIMIT EVENING FLUID INTAKE 3. REFERR TO ENT FOR SLEEP ISSUES 4. AVOID PHARM TX TILL 7 **DESMOPRESSIN:** synthetic ADH analog **IMPIRAMINE:** tricyclic antidepressant

Answer 66

1. frequent toileting 2. establish routines 3. take break during extended play 4. labial adhesions common in girls and can be txed with topical estrogen

Answer 67

urethral opening located on venral surface of penis ## Footnote from incomplete development of dorsal hood **complications:** **voiding** **sexual dysfunction** **meateal stenosis** **infertility** TX: 1. _surgical repair reccomended from 6-12 months of age!!_ \*\*\*\*\*\*avoid circumcision because the foreskin may be used in surigcal repair\*\*\*\*

Answer 68

**_inability to retract the foreskin_** _90% of uncircumcised men, should retract by age 3_ TX: **1. topical steroid 3 weeks to loosen skin** **2. circumcision definite tx**

Answer 69

**_when foreskin is retracted beyond the glands penis and can't be pulled forward_** THINK OF RUBBER BAND ON WRIST MEDICAL EMERGENCY--LEADS TO STRANGULATION FROM VENOUS CONGESTION TX: 1. _lubrication to push the penis back through the ring to relieve pressure_ _2. SURGICAL INTERVENT OFTEN NEEDED!!!!!!!_

Answer 70

**_herpesvirus 6_** **_90% less than 2 y/o_** sxs: 1. high fever over **_104_** 2. diffuse maculopapular rash _as fever ends_ 3. anorexia 4. erythematous tympanic membrane 5. nagayama spots in the mouth

Answer 71

dx: clinical neutropenia atypical lymphocytosis elevated WBC sterile pyuria TX: supporitve! its a virus!!

Answer 72

parvovirus B19 ## Footnote SXS: 1. "slapped cheek" rash 2. low grade fever 3. rhinnorrhea 4. polarthropathy in adults \*\*\*keep these pts away from pregnant women and immunocomprimised adults\*\*\*

Answer 73

#1: staph aureus MC ## Footnote #2: GAS MC 2-5 y/o TX: 1. topical mupirocin 2. dicloxicillin severe 3. gently clean skin and remove crusts

Answer 74

DOC: doxy if over 8 DOC: TMP/SMX DOX: clindamycin

Answer 75

herpes virus ## Footnote **associated with development of B-cell lymphoma, T cell lymphoma, hodgkins lymphoma, nasopharyngeal cancers** SXS: 1. malaise 2. exudative tonsillitis 3. pharyngitis 4. **posterior cervical lymphadenopathy** 5. petechiae on palate 6. periorbital edema 7. maculopapular rash 8. **splenomegaly/rupture** DX: 1. CBC with elevated lymphocytes 2. Monospot TX: 1. prednisone for swelling

Answer 76

neisseria meningitidis "meningococcal meningitis" **MC cause** SXS: **_1. FEVER CHILLS!!!_** **_2. meningeal signs_** - **_kernig_**-can't extend leg - **_brudzinskis_**- head flexion causees knee raise **_3. nuchal rigidity_** 4. nausea vomiting **_5. altered mental status_** **_6, RASH_** what are the 3 most common bacteria? 5 sxs? including 2 signs? 2 dx? 5 findings? DX: **_1. CT PRIOR TO LP_** **_2. LP!!!!_** 1. increase turbidity 2. increased pressure **_3. INCREASED PMN, neutrophils_** **_4. decreased glucose_** **_5. increase proteins_**

Answer 77

reccomended for all children 11-12 years old with a booster at age 16 \*\*\*if given after age 16 only one dose needed\*\*\*

Answer 78

anyone who has had close contact with the cases respiratroy secreteions within infectious period ## Footnote **most effective if given 24 hours of illness onset of the case**

Answer 79

repeat the lumbar puncture within 24 hours of starting tx because should see improvement in the quality of the CSF

Answer 80

enteroviruses coxsackievirus A or B echoviruses HSV SXS: **_1. meningeal signs_** **_-kernig-can't extend leg_** **_-brudzinskis- head flexion causees knee raise_** **_2. nuchal rigidity_** **_3. nausea vomiting_** **_4. moderate altered mental status_**

Answer 81

1. LP - lymphocytes other stuff normal tx: 1. supportive unless HSV origin, then give acyclovir 2. tx sxs

Answer 82

dx: plain xray tx: 1. glycerin suppository 2. prune juice 3. polyethelene glycol (miralax) 4. disimpaction

Answer 83

causes: 1. introduction of solid foods into infants diet 2. toilet training 3. start of school, new stressful environment 4. functional constipation leads to voluntary stool withholding \*\*\*Kid scared to go to the bathroom so they hold it in and don't get it go\*\*\*\* **FIRST STOOL SHOULD OCCUR WITHOUT 72 horus of life!!!!!!** exam: 1. abdominal distention 2. palpable stool mass 3. soilded underware (small amounts that gets around the stoool blockage) 4. impacted stool on rectal exam

Answer 84

3x or more a day **_acute gastroenteritis MC cause---viral!!!_** rotavirus and norovirus 2nd \*\*\*\*\*\*ALWAYS ASK ABOUT TRAVEL HX\*\*\*\* DX: 1. **_ALWAYS EVALUATE FOR DEHYDRATION_** (URINARY FREQUENCY, SKIN TURGOR, MUCOUS MEMBRANES) 2. **_plain abdominal film_** **_3. stool culture_** **_4. UA to rule out UTI_**

Answer 85

document this in the hospital because it looks like a bruise!!! \*\*this doens't fade like a bruise, and doesn't have as distinct outline as bruise\*\* **most commonly on the back**

Answer 86

common on nose, labial folds fade over 4-6 weeks small white dots

Answer 87

inflammation of small and medium vessels ## Footnote MC in JAPAN, children less than 5 stages **_1. acute_** a. 1-2 weeks b. high fever C. **_bilateral conjunctivitis_** **_d. dry lips and STRAWBERRY TONGUE_** **_e. swelling of hands and feet with cervical lymphadenopathy_** **_f. rash in inguinal area_** **_2. subacute_** sxs get better _platelets start to increase_ **\*\*\*\*\*\*\*\*\*\*\*\*\*\*_HIGHEST RISK HERE FOR CORONARY ARTERY ANEURYSMS AND SUDDEN DEATH\*\*\*\*\*\*\*_** **_3. covalescent_** all clinical sxs disappear, sed rate returns to normal often 6-8 weeks

Answer 88

DX: criteria: FEVER + 4/5 a. conjunctivits b. mucous membrane changes c. extremity swelling d. rash e. lypmhadenopathy **_tx: IV Ig and ASA_**

Answer 89

VARICELLA-ZOSTER virus ## Footnote highly contagious with secondary attack rate over 90% Transmission: aeroisolized droplets or direct contact with vesicle fluid infectious 2 days before rash varicella (chicken pox): **_1st exsposure vesicles on a erythematous base "DEW DROPS ON A ROSE PETAL"_** describe the different stages macules-\>papules-\>vesicles "dew drops on a rose petal"-\>pustules-\>crusts \*\*appeare in crops!\*\* BEGIN ON FACE AND TRUNK AND SPREADS TO EXTREMITIES SXS: 1. rash 2. headache 3. fever 4. sore throat TX: SYMPTOMATIC IN HEALTHY CHILD, acyclovir at risk of severe disease but most supportive

Answer 90

1. pneumonia ## Footnote major cause of morbidity and mortality can lead to respiratory failure 2. hepatitis can occur in immunocomprimised hosts frequently fatal

Answer 91

idiopathic osteonecrosis of femoral head, 4-8 y/o MC, unilateral in 90% ## Footnote causes: 1. coagulation disorders 2. increased intracapsulr pressure 3. second hand smoke **leads to osteonecross from decreased blood supply and then looses structual rigidity and the femor head collapses**

Answer 92

genetic disease defect in Type I collagen causing fragility of the skeleton sxs: 1. short statue 2. lax ligaments 3. many bony deformities 4. **_BLUE SCLERA_** 5. decreased hearing 6. poor teeth

Answer 93

sxs: 1. **_pain and limping worse with activity_** **_2**_. pain radiates to _**groin/proxima thigh_** **_3. DECREASED AROM/PROM_** \*\*\*\*_abduction only 20-30\* and internal rotation!!_\*\*\*\* DX: 1. AP and frog lateral with **_cresent sign!!!_** TX: 1. observation femoral head can revascularize ususally 12-18 months 2. restrict vigrous activity 3. NSAIDs 4. crutches

Answer 94

"intoeing and outtoeing" MC cause is intrauterine contraint of the fetus includes: small uterus twins uterine fibroids causes: 1. femoral anteversion/retroversion 2. tibial torsion/rotation DX: 1. **_ROTATIONAL PROFILE_** **_2. FOOT PROGRESSING ANGLE_** angle the foor is rotated during walking outward is +, inward is negative - normal is 0-30 **_3. MEASUREMENT OF THIGH-FOOT ANGLE_** prone with knee at 90\* rotation of foor compated to femor, 20-30 is normal **_4. MEASUREMENT OF FEMORAL ANTE/RETROVERSION_** patient laying prone, with knees bent 90\* push away from each other 40-50 is normal **_5. FOOT ABDUCTUS_**

Answer 95

most common cause of toeing in, exagerated with weight bearing ## Footnote Tx: none, spontaneous resolution consider braces or orthotic shoes

Answer 96

most common cause of toeing in _after 3_ **patella may be shifted medially!!** tx: corrects by 8 braces and orthotics not helpful

Answer 97

normal in older children or adutls 1. pes planus "flat feet" TX: none, surgery in very extreme

Answer 98

less common than anteversion NO TX

Answer 99

medially rotated forefoot, present at birth and often occurs at _TMT joints_ ## Footnote 25% of pre-term births (esp twins) SXS: 1. hindfoot and midfoot have no defmormity **2. adducted forefoot** **3.** **medial skin crease at TMT joint** **4. forefoot is flexible!** **can be brought back into normal alignment**

Answer 100

DX: 1. serial weight bearing photocopies 2. consider xray - MODERATE BISETS 3rd/4th digit Tx: 1. **_resolves by 6 months spontaneously_** 2. **_serial casting at 6 months for 2 weeek intervals_** \*\*usually 2 monts is enough time\*\*

Answer 101

congenital deformity of foot including "CLUB FOOT": ## Footnote **1. plantar flexion of ankle** **2. adduction of heel** **3. high arch** some hereditary effect, 50% billateral SXS: 1. present at birth 2. noticeable defomormity _not reducible_ 3. can't dorsiflex 4. transverse crease along sole of foot

Answer 102

DX: 1. must access muscle and nerve function TX: 1. immediate casting before leaving hospital 2. serial casting Q1-2 weeks Usuall 2-4 months of treatment 3. surgery after 4 months of tx

Answer 103

**_LATERAL curvature of spine over 10 degrees, ussualy LUMBAR OR THORACIC_** ## Footnote causes: 1. **IDIOPATHIC: MOST COMMON!!!!!! GENETIC BASIS** 2. Congenital: fialure of segmentation or formation 2nd most common 3. Neuromuscular 4. vertebral disease (tumor, infection, MBD) \*\*usually dx preteen\*\*

Answer 104

SXS: USUALLY ASYMPTOMATIC MAY NOTICE POSTURAL CHANGE DX: 1. Adams forward bend most sensitive test!!-one side of back higher than the other 2. if greater than 5-7\* xrays needed **_MEASURE THE COBB ANGLE_**

Answer 105

1. monitor progression while growing 2. 20-40\*-brace!! 80% effective if compliant 3. Over 50%-surgical intervention _fusion or rodding_

Answer 106

SXS: 1. **usually present by age 2 with walking** 2. noticed by parents first 3. rarely pain, but present limp or instability TX: 1. monitoring of rotational measures 2. reassurance 3. referral if no change or improvement

Answer 107

7x greater liklihood of progression in girls

Answer 108

DX" 1. **_bowed long bones_** **_2. osteonpenia_** **_3. many fractures on xray_** _TX:_ symptomatic, tx fractures, and modify fracture risk

Answer 109

transient disturbance of brain function that can present as: 1. involuntary motor 2. sensory 3. autonomic or psychic phenomena 4. LOC/altered conciousness SXS: hold breath spells staring spells Workup: 1. ECG 2. brain MRI (if significant cognitive or motor impairment) Tx: **_benzodiazepines_** **_antieleptic rx_**

Answer 110

metabolic traumatic anoxic infectious genetic mutations spontaneous

Answer 111

misinterpreation of behaviors in child...they are just ruled out as being weird and not an actual sxs of seizure

Answer 112

repeated seizures highest incidence is in newborn!!! **after a single exposure: 50% risk of reccurence** **after 2 seizures: 85% risk of recurrence** 70% who are txed with have remission

Answer 113

most common neurological d/o of infants and children ## Footnote criteria: **1. age 3 months - 6 years** **2. fever over 38 C** **3. non-CNS infxn/inflammation** workup: 1. CBC 2. Blood culture 3. LP to check for meningitis TX: reassurance **prohpylactic NOT reccomended**

Answer 114

90% are generalized and last less than 5 minutes!!

Answer 115

seizure lasting 15 mins or more w/o full recoverying in 30 mins ## Footnote **MEDICAL EMERGENCY** 85% of clases in children less than 5, _most common around age 1_ TX: 1. **benzodiazepam** **2. phenytoin** **3. phenobarbitol**

Answer 116

1. hypoxia and acidosis 2. depletion of energy stores, cerebral edema, and structual damage 3. high fever hypotension respiratory depression death

Answer 117

nonprogressive **motor and postural dysfunction, with sustained or intermittent muscle contraction causing twisting and repetitive movements** SXS: **_1. spasticity of the limbs most common in 75%_** **2. _hyperreflexia_** **_3. involuntary movements_** Often co-exists with speech, vision, hearing, seizures, and mental retardation Tx: multidisplinary

Answer 118

prematurity (most common!) IUGR intrauterine infection antepartum hemorrhage perinatal hypoxia

Answer 119

**from materna exposure from cats, raw meat, or immunosuppresion** sxs: 1. hydrocephalus 2. intracranial calcifications 3. chorioretinitis 4. jaundice 5. fever Tx: pyrimethamine plus sulfadiazine

Answer 120

SUBTYPES: 1. systemic arhritis 2. polyarthritis 3. oligoarthritis 4. enthesitis-related arthritis 5. psoratic arthritis SXS: **_1. red, warm, swelling of joint_** **_2. stiff_** **_3. bony abnormalities_** **_4. decreased ROM_** 5. **_UVEITIS_**-leading cause of blindness in children

Answer 121

1. CBC 2. sed rate 3. CRP 4. rheum factor 5. ANA 6. xray 7. athroscentesis

Answer 122

aka "stills disease" ## Footnote accounts for 10-20% of JIA cases _younger than 16_ sxs: 1. arthalgia of wrists, knees, ankles MC 2. extra-articular fevers with spontaneous oscillations _quotidian fever pattern_ _3. macular salmon rash_ usually waist and axilla that comes and goes with _kobner phenomenon_ gets worse with rubbng skin 4. hepatosplenomegaly

Answer 123

DX: 1. DX of exclusion 2. **leukocytosis common** **3. anemia common** (ANA and rheum usually negative) COMPLICATIONS: 1. joint damage 2. spinal fusions 3. macrophage activating syndrome - bleeding from gums, seizures, coma - WBC, hemoglobin, platelet, and sed rate start dropping

Answer 124

bimodal age distribution **2-5 and 10-14** \*\*\*\*\*SXS IN YOUNGER\*\*\*\* **1.** **_1-2 joints spreads to 5 or more within 6 months_** 2. knees, wrist, and ankles more common 3. dactylitis 4. uvetits possible \*\*\*in older children: starts in small joints of hands and feet\*\*\*

Answer 125

DX; 1. 4 or more joints within 6 months 2. possible + ANA in younger group 3. possible +rheum in older group 4. elevated sed Complications: 1. **_contractures and weaknes, hard time walking_** **_2. if positive rheum factor, more likely for poor outcome_**

Answer 126

**_most common subgroup**_ _**50% of cases_** ## Footnote common in under 5 y/o Persistent: no other joint involvment after the first 6 months than the original joints involved extended: for or less joints over the first 6 months and the increase over time \*\*\*KID STARTS WALKING WITH A LIMP\*\*\* 1. KNEES, ANKLES, ELBOWS 2. warm joints but not red

Answer 127

DX: 1. 2 or more joints in _6 weeks_ 2. ANA+ 3. rheum - 4. sed rate often normal since localized COMPLICATIONS: 1. leg length discrepancies

Answer 128

enthesis: tenderness at the insertion point age 8-12, 10-20% of GIA cases strong relationship to HLA B27 sxs: 1. SI joint tenderness 2. spinal pain 3. HLA-B27 4. anterior uveitis 5. fam hx of spondyloarthropathy or IBS

Answer 129

dx: 1. HLA B27

Answer 130

**MC IN FEMALE CHILDREN IN PRESCHOOL THEN IN MIDDLE-LATE CHILDHOOD** SXS: 1. KNEES ANKLES WRISTS 2. _DIP INVOLVEMENT_ 3. _SKIN RASH PLAQUES_ 4. _NAIL PITTING_ 5. _ONCHOLYSIS_ seperation of nail from nailbeds 6. _uveitis_

Answer 131

1. NSAIDS!! (no ASA=reye) 2. corticosteroids (injection), esp as bridge to DMARD 3. methotrexate hydroxycholoquinolone sulfasalazine etanercept 4. PT/OT

Answer 132

MC IN CHILDREN 7-12 \*\*\*associated with sinusitis\* pathogens: strep pneumoniae staph aureus haemop influenza SXS: PTOSIS eyelid edema exophthalmous purlurent discharge/conjunctivits limited ROM sluggish puppilary response DX: _CT TO DETERMINE THE EXTENT OF DISEASE in soft tissue_ _tx: **MEDICAL EMERGENCY with hospitalization cause it can lead to MENINGITIS BIG DEAL**_ _**\*\*\*broad spectrum abx!! naficillin and metronidzole or clinda\*\*\***_

Answer 133

1. tumor 2. foreign body 3. **paralytic ileus-trauma, surgery, infection, metbaolic disease with DM** **4. volvulus-twisting of intesinte** **5. intusssception-telescoping of intestine** sxs; 1. severe abdominal cramping 2. inability to pass stool 3. **_increased bowel sounds first, then decreased_** 4. **_abdominal swelling, distention_**

Answer 134

1. abdominal xray 2. CT 3. barium enema tx: 1. NG tube (relieve pressure) 2. relieve obstruction 3. surgery often needed

Answer 135

tissue death perforation sepsis death

Answer 136

fatty liver with encephalopathy 30% fatality 2-3 weeks after influenza or varicella infxn if given ASA!!! 5-14 years old, peaks after 18 TX: supportive

Answer 137

red papules or vesicles occur on the touch, oral mucosa hands and feet and butt ## Footnote mild fever and malaise TX: supportive

Answer 138

STREP THROAT WITH DIFFUSE RASH that blanches, **FINE RED PAPULES THAT APRRECIATED BY TOUCH FEEL LIKE _SANDPAPER_** "**_THINK SUNBURN WITH GOOSE PUMPS"_** **_CIRCUMORAL PALLOR STRAWBERRY TOUNGE_** **_\*\*rash fades in 2-5 days, tx strep with amoxicillin\*\*_**

Answer 139

Group B streptococcus

Answer 140

birth-7 days ## Footnote **1. group B streptococcus** **2. E. coli** **3. Klebsiella** **4. listeria** monitor: PROM chorio maternal and baby fever

Answer 141

7-28 days of life ## Footnote 1. **haemophilus influenzae** **2. staphlococcus pneumoniae** **3. neisseria meningitidis _75% of cases!_**

Answer 142

SXS: 1. fever/temp instablitly over 100.4, _abnormal only if less than 2 months old_ 2. Resp difficulty 3. poor feeding DX: bascially everything from CBC to LP tx: Gentamicin and ampicillin

Answer 143

difficulty with transition to breathing on their own, may need a little support oxygen in the begining of life breath faster and work harder to breath if they don't get better work up for sepesis

Answer 144

PRESENTS WITH: **1. JAUNDICE/SCLERAL ICTERUS** **2. KERNICTERUS** TYPES: 1. DIRECT (CONJUGATED)= **ALWAYS PATHOLOGIC** 2. INDIRECT (UNCONGUATED)= **PHYSIOLOGIC VS PATHOLOGIC**

Answer 145

often presents first 24 hours ## Footnote ALWAYS PATHOLOGIC pathologic causes: 1. extrahepatic obstruction 2. persistent intrehepatic cholestatsis 3. acquired intrahepatic cholestasis 4. genetic and metabolic disorders

Answer 146

occurs after 24 hours of life ## Footnote "physiologic jaundice" secondary to decreased amount of UDP-glucouronyl transferase activity causes: **_hemolytic**_ _**process like_** **_1. polycythemia_** **_2. bruising_** **_3. breast milk jaundice_** **_4. sepsis_** **_5. endocrine disorders_** **_6. genetic disoders that affect bili metabolism_**

Answer 147

1. treat cause 2. phototherapy 3. exchange transfusion

Answer 148

1. premature infants 2. maternal DM 3. asian 4. native american

Answer 149

**_human herpes virus 4_** **_"kissing disease" spread by saliva_** \*\*don't participate in contact sports because of potential spleen rupture\*\* SXS: 1. _EXUDATIVE PHARYNGITIS_ _2. SOFT PALATE PETECHIAE_ _3. **POSTERIOR CERVICAL NODE ENLARGEMENT**_ **_4. SPLENOMEGALY IN 50% OF PATIENTS_** **_5. MACROPAPULAR/PETECHIAL RASH_** DX: 1. ATYPICAL LYMPHOCYTES THAT ARE LARGER AND STAIN DARKER AND _VACULOATED_ 2. MONOSPOT tx: supportive

Answer 150

false positive syphilis test

Answer 151

1. splenic rupture ## Footnote pericarditis myocarditis encephalitis aseptic meningitis