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Peds Flashcards

1
Q

What specific fractures are suspicious for child abuse?

A
  • Spiral fractures

- Posterior ribs (squeezing)

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2
Q

What is the workup of abusive head trauma in a child?

A
  • Fundoscopy for retinal hemorrhages
  • CT scan for subdural hematomas
  • MRI to look for white-matter changes
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3
Q

What are the 5 cyanotic heart defects?

A
  • Truncus arteriosus
  • transposition
  • tricuspid atresia
  • Tetralogy of fallot
  • TAPVR
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4
Q

Out of the five major cyanotic congenital heart defects, which can present with cyanosis within the first few hours of life?

A

Transposition

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5
Q

What are the four major drugs that can cause congenital heart defects?

A
  • Phenytoin
  • Li
  • Thalidomide
  • EtOH
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6
Q

What type of shunt causes pink vs blue babies?

A
  • Pink = left to right

- Blue = right to left

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7
Q

What congenital heart condition is associated with Down syndrome?

A

Endocardial cushion defect and ASDs

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8
Q

What congenital heart condition is associated with congenital rubella infection?

A

PDA

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9
Q

What congenital heart condition is associated with Turner syndrome?

A
  • Coarctation of the aorta

- bicuspid aortic valve

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10
Q

What heart condition is associated with Kawasaki’s disease?

A

Coronary artery aneurysm

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11
Q

What congenital heart condition is associated with neonatal lupus?

A

Congenital heart block

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12
Q

What congenital heart condition is associated with William’s syndrome?

A

Supravalvular aortic stenosis

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13
Q

What is william’s syndrome?

A
  • Developmental disorder characterized by mild-moderate MR, “elvin” features, and outgoing personality.
  • Hypercalcemia common
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14
Q

What congenital heart condition is associated with DiGeorge syndrome?

A

Conotruncal abnormalities

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15
Q

What congenital heart condition is associated with maternal use of Li?

A

Ebstein’s abnormality (atrialization of the right ventricle)

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16
Q

What congenital heart condition is associated with neonatal thyrotoxicosis?

A

HF

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17
Q

What congenital heart condition is associated with maternal DM?

A

Asymmetric septal hypertrophy and transposition of the great vessels

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18
Q

What is the characteristic heart sound produced by an ASD?

A

Fixed, widely split S2

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19
Q

What are the 3 D’s of non cyanotic heart defects?

A

VSD
ASDs
PDA

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20
Q

What is the most common type of congenital heart disease?

A

VSD

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21
Q

Where in the heart do most VSDs occur?

A

Membranous portion

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22
Q

What is Eisenmenger syndrome?

A

When a right to left shunt reverses, and causes pHTN

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23
Q

What is the treatment for most ASDs/VSDs?

A

Self limited

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24
Q

True or false: abx are recommended prior to treating most ASDs/VSDs

A

False

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25
Q

When is surgical management indicated in the repair of ASDs vs VSDs?

A

-fail medical management
-less than 1 y.o. with pHTN
-Older children with defects that do not close over time
-

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26
Q

What is the treatment for HF in children?

A

ACEIs

Diuretics

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27
Q

What three major syndromes are associated with ASDs?

A
  • Holt-oram syndrome
  • Fetal EtOH syndrome
  • Trisomy 21
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28
Q

What is Holt-oram syndrome?

A

AD disorder that affect bones in the arms and hands, (absent radii) and may also cause heart problems.

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29
Q

What are the five major syndromes associated with VSD?

A
  • Apert syndrome
  • Fetal alcohol
  • TORCHES infc
  • Cri du chat
  • Trisomies (13, 18, 21)
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30
Q

What is Apert syndrome?

A

Form of acrocephalosyndactyly–deformations of skull, face, hands, and feet. Branchial arch problems.

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31
Q

What are the s/sx of large ASDs and VSDs?

A
  • ASDs = fatigability

- VSDs = Recurrent respiratory infx, CHF, dyspnea

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32
Q

What are the CXR findings of ASDs?

A
  • Cardiomegaly

- Increased pulmonary vasculature

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33
Q

RVH and LVH are associated with ASD vs VSD?

A
  • RVH = ASDs

- LVH = VSDs

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34
Q

What are the four major causes of shock in a neonate?

A
  1. Sepsis
  2. IEM
  3. Ductal-dependent heart disease
  4. Congenital adrenal hyperplasia
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35
Q

What hemodynamic findings on PE can be seen with PDA?

A
  • Wide pulse pressure

- Bounding peripheral pulses

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36
Q

What is the treatment for a PDA?

A

indomethacin will close. Surgery if does not by age ~7 months.

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37
Q

how does coarctation of the aorta usually present?

A
  • Asymptomatic HTN
  • Weak femoral pulses
  • Higher sBP in UE than LE
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38
Q

What is the gold standard for diagnosing coarctation of the aorta?

A

Echo

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39
Q

What is the “3” sign that can be seen on CXR?

A

Coarctation of the aorta

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40
Q

What is the treatment for a coarctation of the aorta?

A
  • If PDA needed, PGE1

- Surgical correction with balloon

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41
Q

What are the components of the CATCH-22 mnemonic for DiGeorge syndrome?

A
  • Cardiac abnormalities
  • Abnormal Facies
  • Thymic aplasia
  • Cleft palate
  • Hypocalcemia
  • 22q deletion
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42
Q

What is the most common cyanotic congenital heart lesion in the newborn?

A

Transposition

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43
Q

What makes transposition of the great vessels compatible with early life?

A

Presence of a VSD or ASD

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44
Q

How does transposition of the great vessels usually present?

A
  • Cyanosis in the first few hours of life

- Murmur of VSD or ASD

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45
Q

“egg shaped silhouette” on CXR is diagnostic for what?

A

transposition of the great vessels

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46
Q

What are the components of the tetralogy of Fallot?

A
  • Overriding aorta
  • VSD
  • RVH
  • Pulmonic stenosis
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47
Q

What determines the degree of cyanosis with tetralogy of fallot?

A

Degree of pulmonic stenosis

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48
Q

What is the mechanism through which squatting relieves symptoms of tetralogy of fallot?

A

Increases systemic vascular resistance, thereby increasing blood flow through the stenotic pulmonary artery

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49
Q

What is the murmur associated with tetralogy of fallot?

A

Systolic ejection murmur at left upper sternal border

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50
Q

Boot shaped heart on CXR is classic for what heart condition?

A

Tetralogy of fallot

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51
Q

What are the signs of autism?

A
  • no babbling by 12 months
  • No two word phrases by 24 months
  • Impaired social interaction
  • Restricted interests
  • insistence on routine
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52
Q

What are the gross motor, fine motor, language, and social/cognitive milestones reached by age: 2 months

A
  • Gross motor = lifts head/chest when prone
  • Fine motor = Tracks past midline
  • Language = Alert to sounds and coos
  • Social/cognitive = Social smile, recognizes parents
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53
Q

What are the gross motor, fine motor, language, and social/cognitive milestones reached by age: 5 months

A
  • Gross motor = Rolls from front to back
  • Fine motor = grasps rattle
  • Language = Laughs and squeals, orients to voice
  • Social/cognitive = Enjoys looking around, laughs
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54
Q

What are the gross motor, fine motor, language, and social/cognitive milestones reached by age: 6 months

A
  • Gross motor = sits unassisted
  • Fine motor = Transfers objects, raking grasp
  • Language = babbles
  • Social/cognitive = Stranger anxiety
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55
Q

What are the gross motor, fine motor, language, and social/cognitive milestones reached by age: 9-10 months

A
  • Gross motor = Crawls, pulls to stand
  • Fine motor = 3 finger pincer grasp
  • Language = mama/dada
  • Social/cognitive = waves bye-bye
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56
Q

What are the gross motor, fine motor, language, and social/cognitive milestones reached by age:12 months

A
  • Gross motor = walks alone
  • Fine motor = 2 finger grasp
  • Language = 1-3 words
  • Social/cognitive = separation anxiety, follows 1-step commands
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57
Q

What are the gross motor, fine motor, language, and social/cognitive milestones reached by age: 2 years

A
  • Gross motor = Walks up/down steps
  • Fine motor = builds 6 cube tower
  • Language = 2 word phrases
  • Social/cognitive = follows 2 step commands
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58
Q

What are the gross motor, fine motor, language, and social/cognitive milestones reached by age: 3 years

A
  • Gross motor = rides tricycle
  • Fine motor = copies a circle
  • Language = 3 words
  • Social/cognitive = Brushes teeth, washes hands
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59
Q

What are the gross motor, fine motor, language, and social/cognitive milestones reached by age:4 years

A
  • Gross motor = hops
  • Fine motor = Copies a cross, uses utensils
  • Language = knows colors and some numbers
  • Social/cognitive = Exhibits cooperative play
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60
Q

What are the gross motor, fine motor, language, and social/cognitive milestones reached by age: 5 years

A
  • Gross motor = Skips, walks backwards
  • Fine motor = Copies a triangle, ties shoelaces
  • Language = 5 word sentences
  • Social/cognitive =
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61
Q

At what age should a child be able to: lift head/chest when prone?

A

2 months

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62
Q

At what age should a child be able to: coo?

A

2 months

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63
Q

At what age should a child be able to: exhibit a social smile

A

2 months

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64
Q

At what age should a child be able to: roll from front to back

A

4-5 months

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65
Q

At what age should a child be able to: sit unassisted

A

6 months

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66
Q

At what age should a child be able to: babble

A

6 months

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67
Q

At what age should a child be able to: laugh and squeal

A

4-5 months

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68
Q

At what age should a child be able to: have stranger anxiety

A

6 months

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69
Q

At what age should a child be able to:use a 3 finger grasp

A

9-10 months

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70
Q

At what age should a child be able to: use a 2 finger grasp

A

12 months

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71
Q

At what age should a child be able to: walk alone

A

12 months

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72
Q

At what age should a child be able to: walk up/down steps

A

2 years

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73
Q

At what age should a child be able to:build a tower of 6 cubes

A

2 years

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74
Q

At what age should a child be able to: use 2 word phrases

A

2 years

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75
Q

At what age should a child be able to: use 3 word phrases

A

3 years

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76
Q

At what age should a child be able to: follow 2 step commands

A

2 years

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77
Q

At what age should a child be able to: copy a circle

A

3 years

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78
Q

At what age should a child be able to:ride a tricycle

A

3 years

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79
Q

At what age should a child be able to: brush teeth with help

A

3 years

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80
Q

At what age should a child be able to: hop

A

4 years

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81
Q

At what age should a child be able to: copy a cross

A

4 years

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82
Q

At what age should a child be able to: know colors and some numbers

A

4 years

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83
Q

At what age should a child be able to: exhibit cooperative play

A

4 years

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84
Q

At what age should a child be able to: copy a triangle

A

5 years

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85
Q

At what age should a child be able to: tie showlaces

A

5 years

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86
Q

At what age should a child be able to: use 5 word sentences

A

5 years

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87
Q

At what age should a child be able to: exhibit domestic role playing

A

5 years

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88
Q

At what age should a child be able to: be 50% intelligible? 75%? 100%?

A

50% = 2 years
75% = 3 years
100% 4 years

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89
Q

Until what age is head circumference measured?

A

2 years

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90
Q

Newborns can lose up to what % of their body weight and still be normal? When should they regain their birth weight by?

A
  • 10%

- by 2 weeks

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91
Q

When can infants be expected to double their birth weight? Triple? Quadruple?

A
  • Double by 6 months
  • Triple by 1 year
  • Quadruple by 2 years
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92
Q

What is the definition of FTT?

A

Weight less than the 5th percentile or crossing two major percentile lines on a growth curve

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93
Q

What is “organic” vs “nonorganic” FTT?

A
  • Organic = Due to underlying medical condition

- Nonorganic = Due to psychosocial factors

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94
Q

What is the order of female pubertal development?

A
  • Thelarche
  • Adrenarche
  • Pubarche
  • Menarche
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95
Q

What is the order of male pubertal development?

A
  • Gonadarche
  • Pubarche
  • Adrenarche
  • Growth spurt
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96
Q

How is precocious puberty defined for boys and girls?

A 
Girls = 8 years or soon
Boys = 9 years or sooner
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97
Q

How is delayed puberty defined for boys and girls?

A 
Girls = 13 years
Boys = 14 years
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98
Q

What is the average age of puberty for girls and boys respectively?

A 
Girls = 10.5 year 
Boys = 11.5 years
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99
Q

What is constitutional growth delay?

A

The growth curve lags behind others of the same age but remains consistent.

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100
Q

True or false: children with constitutional growth delay typically reach full height

A

True

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101
Q

What are the names of the three major trisomies

A 
21 Downs (drink)
18 Edwards (elections)
13 Patau (puberty)
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102
Q

What are the characteristic eye findings with Down syndrome?

A

Upslanted palpebral fissures

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103
Q

What GI diseases are common amongst Down syndrome pts?

A
  • Hirschsprung’s disease

- Duodenal atresia

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104
Q

Why thyroid issue are pts with Down syndrome predisposed to?

A

hypothyroidism

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105
Q

Rocker bottom feet is characteristic of which trisomy?

A

18

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106
Q

Micrognathia is characteristic of which trisomy?

A

18

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107
Q

Clenched hands is characteristic of which trisomy?

A

18

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108
Q

Microcephaly is characteristic of which trisomy?

A

13

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109
Q

Microphthalmia is characteristic of which trisomy?

A

13

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110
Q

holoprosencephaly is characteristic of which trisomy?

A

13

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111
Q

Polydactyly is characteristic of which trisomy?

A

13

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112
Q

What is the genotype of Klinefelter syndrome? S/sx?

A
  • XXY
  • Hypogonadism
  • Testicular atrophy
  • Gynecomastia
  • Female hair distribution
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113
Q

What is the treatment for Klinefelter’s syndrome?

A

Testosterone

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114
Q

What is the genotype of Turner’s syndrome? S/sx?

A
  • XO
  • Primary amenorrhea
  • Webbed neck
  • Coarctation of the aorta
  • Bicuspid aortic valve
  • LAD of the hands and feet in neonatal period
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115
Q

What are the s/sx of Double Y males?

A

Look normal, but some are tall with worse acne

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116
Q

What are the physical features of pts with PKU?

A
  • fair hair and skin
  • Eczema
  • Blonde hair
  • Blue eyes
  • Musty urine odor
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117
Q

what are the physical features of fragile X syndrome?

A

Large jaw, testes, and ears

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118
Q

What is the defect and inheritance pattern of Fabry’s disease? S/sx? Increased risks?

A
  • XLR loss of alpha-galactosidase
  • Severe neuropathic limb pain
  • Angiokeratomas and telangiectasias
  • Renal failure and an increased risk of stroke
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119
Q

What is the defect and inheritance pattern of Krabbe disease? S/sx? Increased risks?

A
  • AR loss of galactosylceramide and galactoside
  • Progressive CNS degeneration within the first 3 years of life
  • Optic atrophy and spasticity
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120
Q

What is the defect and inheritance pattern of Gaucher’s disease? S/sx? Increased risks?

A
  • AR Deficiency of Glucocerebroside
  • Anemia and thrombocytopenia
  • Adult form has normal lifespan
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121
Q

Macrophages with crinkled paper = ?

A

Gaucher’s disease

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122
Q

What is the defect and inheritance pattern of Niemann-pick disease? S/sx? Increased risks?

A
  • AR loss of Sphingomyelinase (No man PCIKs his nose with his sphinger)
  • Cherry red spot and HSM
  • Die by age 3
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123
Q

Cherry red spot on macula + HSM = ?

A

Niemann-pick’s disease

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124
Q

What is the defect and inheritance pattern of tay-sachs disease? S/sx? Increased risks?

A
  • AR loss of heXosaminidase for tay-saX
  • Normal until 3-6 months, then weakness and developmental regression
  • Cherry red macula with NO HSM
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125
Q

Cherry red macula with NO HSM = ?

A

Tay-saX loss of heXosaminidase

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126
Q

What is the defect and inheritance pattern of metachromatic leukodystrophy? S/sx? Increased risks?

A
  • AR loss of Arylsulfatase A

- Demyelination leads to progressive ataxia, and dementia

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127
Q

What is the defect and inheritance pattern of Hurler disease? S/sx? Increased risks?

A
  • AR loss of alpha iduronidase

- Corneal clouding, MR, and gargoylism

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128
Q

What is the defect and inheritance pattern of hunter’s disease? S/sx? Increased risks?

A
  • XLR loss of iduronate sulfatase
  • NO corneal clouding, and mild MR

“Hunters need to see (no corneal clouding) to see the X (XLR)”

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129
Q

What is the inheritance pattern and dysfunction of CF? In which ethnicity is it commonly seen in?

A
  • AR loss of CFTR on chromosome 7

- Whites

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130
Q

What sign of CF presents within 24 hours of birth?

A

Meconium ileus

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131
Q

What signs of CF are typically present before 1 year of life?

A

Recurrent sinopulmonary infections

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132
Q

What signs of CF are typically present after 1 year?

A
  • Pancreatic insufficiency

- nasal polyposis

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133
Q

What causes male infertility with CF?

A

Agenesis of the vas deferens

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134
Q

Unexplained hyponatremia in a white person is suspicious for what disease?

A

CF

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135
Q

How do you typically diagnose CF (if not caught on newborn screen)?

A

Sweat chloride test

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136
Q

What is the treatment for CF pulmonary issues?

A
  • Physical therapy
  • Bronchodilators
  • Abx coverage for pseudomonas
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137
Q

What is the treatment for the malabsorption issues 2/2 CF?

A

Supplemental pancreatic enzymes and Vit ADEK

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138
Q

What is the recommended diet for pts with CF?

A

high protein, high calorie

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139
Q

what is the most common cause of a bowel obstruction in children between 6 months and 3 years?

A

Intussusception

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140
Q

How can Henoch-schonlein purpura lead to intussusception?

A

causes mucosal hematomas

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141
Q

What is the classic triad of symptoms for intussusception?

A
  • Sever abdominal pain
  • Vomiting
  • Bloody mucus (currant jelly) stools
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142
Q

What are the classic findings on physical exam of intussusception?

A

Sausage shaped RUQ mass

Empty RLQ

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143
Q

target sign on abdominal x-ray is characteristic of what disease?

A

-Intussusception

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144
Q

When will and US and abdominal x-ray show signs of intussusception?

A
  • US will show during pain attack

- X-ray will show when progressed

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145
Q

What is the treatment for intussusception?

A
  • Correct electrolyte abnormalities
  • NG tube decompression
  • Air insufflation enema (diagnostic and curative)
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146
Q

When is surgery indicated for intussusception?

A

If pt develop peritoneal signs

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147
Q

In whom is pyloric stenosis more common in?

A

First born boys

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148
Q

maternal ingestion of what Abx is associated with pyloric stenosis?

A

Erythromycin

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149
Q

What is the classic presentation of pyloric stenosis?

A

Nonbilious emesis around 3-5 weeks of age, with progression to projectile emesis

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150
Q

What is the classic PE finding for pyloric stenosis?

A

olive shaped mass and visible gastric peristaltic waves

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151
Q

what is the imaging modality of choice for pyloric stenosis?

A

US

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152
Q

What will lab findings be with pyloric stenosis?

A

-Hypochloremic, hypokalemic, metabolic alkalosis (emesis results in loss of HCl and RAAS activation)

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153
Q

What is the classic Ba enema findings with pyloric stenosis?

A

String sign

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154
Q

What is the treatment for pyloric stenosis?

A
  • NPO
  • IVFs
  • Pyloromyotomy
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155
Q

What is the pathogenesis of a Meckel diverticulum?

A

failure of the omphalomesenteric duct to obliterate, resulting in the formation of a true diverticulum

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156
Q

What sort of tissue is contained with a Meckel diverticulum?

A

heterotopic gastric tissue–can cause intestinal ulceration and painless hematochezia

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157
Q

Are Meckel diverticula true or false diverticula?

A

True–have all three layers

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158
Q

Meckel’s diverticula are most frequently symptomatic in children under what age?

A

2 years

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159
Q

What is the usual presentation of a meckel’s diverticulum?

A

Painless rectal bleeding

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160
Q

What are the complications from meckel’s diverticulum? (3)

A
  • Intestinal perforation/obstruction
  • diverticulitis
  • intussusception
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161
Q

How is a meckel’s diverticulum diagnosed?

A

Meckel scintigraphy scan (Tc99 detects ectopic gastric tissue)

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162
Q

What is the treatment for a meckel’s diverticulum?

A

Surgical excision of diverticulum with adjacent ileal tissue

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163
Q

What is the pathophysiology of Hirschsprung’s disease?

A

lack of ganglion cells in the distal colon, leading to decreased motility due to unopposed smooth muscle tone in the absence of enteric relaxing reflexes

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164
Q

What genetic disease is Hirschsprung’s disease associated with?

165
Q

failure to pass meconium 48 hours after birth suggests what disease process?

A

Hirschsprung’s disease

166
Q

What are the classic PE findings of Hirschsprung’s disease?

A
  • Explosive stool after DRE
  • Lack of stool in rectum
  • Abnormal sphincter tone
167
Q

How is Hirschsprung’s disease diagnosed? What does this show?

A

Ba enema will show a narrowed distal colon with proximal dilation.

168
Q

What is the definitive, confirmatory test for Hirschsprung’s disease diagnosis?

A

Rectal bx shows absence of myenteric plexus

169
Q

What is the treatment for Hirschsprung’s disease?

A

Two-stage surgical repair, where a colostomy is used initially, then followed several weeks later by a definitive “pull through” procedure

170
Q

What is the pathogenesis of malrotation with volvulus?

A

leads to cecum in the right hypochondrium, and the formation of fibrous “ladd bands” which predispose bowel obstruction and constriction of blood flow

171
Q

How/when does malrotation with volvulus usually present?

A

First month of life with bilious emesis, crampy abdominal pain, and bloody/mucus stools

172
Q

What are the classic abdominal x-ray findings of malrotation with volvulus?

A

Bird-beak appearance and air-fluid levels

173
Q

What is the diagnostic test of choice for malrotation?

A

Upper GI series. This will show an abnormal location of the ligament of Treitz

174
Q

What is the treatment for a malrotation with volvulus?

A

NG tube decompression, IVFs, emergent surgical repair

175
Q

What is necrotizing enterocolitis?

A

Bowel undergoes necrosis (usually the ileum/proximal colon).

176
Q

What is the most common GI emergency in neonates?

A

Necrotizing enterocolitis

177
Q

In whom is necrotizing enterocolitis most commonly seen in?

A

Premature infants

178
Q

What are the risk factors for necrotizing enterocolitis?

A
  • Low birth weight
  • Hypotension
  • Enteral feedings
179
Q

What are the usual s/sx of necrotizing enterocolitis?

A

In the first few days of life, there is feeding intolerance, delayed gastric emptying, abdominal distention, and hematochezia

180
Q

What are the complications from untreated necrotizing enterocolitis’?

A
  • Intestinal perforation
  • Peritonitis
  • Shock
181
Q

What might lab findings show with necrotizing enterocolitis?

A
  • Hyponatremia
  • Metabolic acidosis
  • Leukopenia/leukocytosis with L shift
  • DIC
182
Q

Plain radiographs of necrotizing enterocolitis classically show what?

A

Pneumatosis intestinalis (intramural air bubbles representing gas produced by bacteria within the bowel wall)

183
Q

What is the treatment for necrotizing enterocolitis?

A
  • NPO
  • orogastric tube for gastric decompression
  • Correct metabolic disturbances
184
Q

What are the indications fur surgery for necrotising enterocolitis?

A
  • Perforation

- Worsening radiographic signs

185
Q

What is the typical surgical treatment for necrotizing enterocolitis?

A

Ileostomy with mucous fistula

186
Q

What are the complications that result from necrotizing enterocolitis?

A

Strictures

Short bowel syndrome

187
Q

What is the role of B cells?

A

-make immunoglobulins, and are responsible for immunity against extracellular bacteria

188
Q

What is the role of T cells?

A

Responsible for immunity against intracellular bacteria, viruses, and fungi

189
Q

Pneumatosis intestinalis on plain films is pathognomonic for what disease in neonates?

190
Q

What is the defect involved with bruton’s agammaglobulinemia? Pathogenesis?

A
  • XLR B cell deficiency of a tyrosine kinase
  • leads to lack of Igs
  • Severe infx begin at 6 months of age, when maternal Igs are gone
191
Q

How do you diagnose bruton’s agammaglobulinemia?

A

Quantitative Ig levels. If low, confirm with

192
Q

What PE findings are classic for bruton’s agammaglobulinemia?

A

Lack of tonsils and other lymphoid tissue

193
Q

What is the treatment for bruton’s agammaglobulinemia?

A

Prophylactic abx and IVIG

194
Q

What infections are pts with bruton’s agammaglobulinemia at risk of developing?

A

encapsulated organisms (pseudomonas, S pneumoniae, haemophilus)

195
Q

What are the SHINe SKIs organisms?

A 
Strep pneumoniae
HiB
N. meningitidis
E.coli
Salmonella
Klebsiella
GBS
196
Q

What is CVID?

A

Combined B and T cell defect, causing low levels of all Igs and plasma cells, but normal amount of B cells.

197
Q

When does CVID usually present?

A

15-35 years

198
Q

What are the infections that are common to CVID?

A
  • Increased pyogenic infx

- increased risk of lymphoma and autoimmune diseases

199
Q

How do you diagnose CIVD?

A

Quantitative levels of Igs.

200
Q

What is the treatment for CVID?

201
Q

True or false: there is a decreased level of B cells with CVID

A

False- decrease in plasma cells, and hence decrease in Ig, but normal B cell numbers

202
Q

How do you diagnose IgA deficiency?

A

Quantitative levels of IgA

203
Q

What is the treatment for IgA deficiency?

A
  • Usually requires no treatment

- IVIG if necessary, but must be careful if there are IgA in it

204
Q

What electrolyte disturbance is common to DiGeorge syndrome?

A

Hypocalcemia

205
Q

What might CXR reveal with DiGeorge syndrome?

A

Absent thymic shadow

206
Q

What immune cell type is mainly deficient in DiGeorge syndrome?

207
Q

What are the immunologic symptoms of DiGeorge syndrome?

A

Increased Viral, fungal, and PCP pneumonia

208
Q

How do you diagnose the immunodeficiency part of DiGeorge syndrome?

A

Absolute T cell counts

Delayed skin rxn

209
Q

What is the treatment for the immunodeficiency part of DiGeorge syndrome?

A

bone marrow transplant and IVIG for antibody deficiency

210
Q

What is the inheritance pattern and defect in ataxia-telangiectasia? S/sx?

A
  • AR mutation in gene responsible for dsDNA break repair

- Cerebellar ataxia with oculocutaneous telangiectasias

211
Q

What is the treatment for ataxia-telangiectasia?

A

No treatment–may require IVIG if severely infected

212
Q

Which malignancies are pts with Ataxia-Telangiectasias at increased risk for? (3)

A
  • Non-hodgkin’s lymphoma
  • Leukemia
  • Gastric carcinoma
213
Q

What is the inheritance pattern and pathophysiology of SCID?

A

-XLR loss of B and T cells due to a defect in stem cell maturation and decreased adenosine deaminase

214
Q

What is the treatment for SCID?

A
  • Bone marrow transplant

- PCP pneumonia prophylaxis

215
Q

What is the inheritance pattern, defect, and pathophysiology of Wiskott-Aldrich syndrome?

A
  • XLR

- Decreased IgM and thrombocytopenia (Increased IgE/IgA)

216
Q

What are the components of the WIPE mnemonic for Wiskott-Aldrich syndrome?

A
  • Wiskott-Aldrich
  • Infections
  • Purpura (thrombocytopenia)
  • Eczema
217
Q

What infections are pts with Wiskott-Aldrich syndrome at increased risk of developing?

A

-Atopic disorders
-Encapsulated bacterial (from lack of IgM
-

218
Q

What is the typical presentation and prognosis for Wiskott-Aldrich syndrome?

A
  • Presents at birth with bleeding, eczema, and recurrent OM.

- Pts rarely survive to adulthood

219
Q

In general, when do hereditary B cell deficiencies present? How? Treatment?

A
  • After 6 months
  • Infx with encapsulated organisms
  • IVIG
220
Q

In general, when do hereditary T cell deficiencies present? How?

A
  • 1-3 months

- Opportunistic bacterial, viral, and fungal infx

221
Q

What are the general presenting symptoms of a phagocyte deficiency?

A

Mucous membrane infections, abscesses and poor wound healing

222
Q

What sort of infections are pts with phagocyte deficiencies at increased risk for?

A

Catalase + organisms

  • Fungi
  • Gram negative enteric organisms
223
Q

What is the common presentations of complement deficiencies? (2)

A
  • Congenital asplenia or splenic dysfunction

- Recurrent bacterial infections with encapsulated organisms

224
Q

What is the inheritance pattern, defect, and s/sx of: chronic granulomatous disease

A
  • XLR (or AD), deficiency in superoxide production by PMNs and macrophages
  • Granulomas, Anemia, LAD, hypergammaglobulinemia common
225
Q

What infections are pts with chronic granulomatous disease at increased risk for?

A

-Catalase + organisms

226
Q

What is the diagnostic modality of choice, and treatment for chronic granulomatous disease?

A
  • Decreased absolute PMN count
  • DHR test or Nitroblue tetrazolium test
  • daily TMP=SMX
227
Q

What is the inheritance pattern, defect, and s/sx of: Leukocyte adhesion deficiency?

A
  • Defect in chemotaxis of leukocytes, and decreased phagocytic activity
  • No pus with minimal inflammation around wounds
  • Omphalitis in the newborn, with delayed separation of the umbilical cord
228
Q

Delayed separation of the umbilical cord is classic for what immunodeficiency?

A

Leukocyte adhesion deficiency

229
Q

No pus and minimal inflammation around wounds is suspicious for what disease?

A

Leukocyte adherence deficiency

230
Q

What is the treatment for leukocyte adherence deficiency?

A

Bone marrow transplant

231
Q

What is the inheritance pattern, defect, and s/sx of: Chediak-Higashi syndrome?

A
  • AR that leads to a defect in PMN chemotaxis/microtubule polymerization
  • Partial oculocutaneous albinism, peripheral neuropathy, and neutropenias
232
Q

How do you diagnose Chediak-Higashi syndrome?

A

Giant granules in PMNs

-BMT is treatment

233
Q

What is the classic triad of symptoms for Chediak-Higashi syndrome?

A
  • Partial oculocutaneous albinism
  • Peripheral neuropathy
  • Neutropenia
234
Q

What is the inheritance pattern, defect, and s/sx of: Job syndrome?

A
  • Defect in PMN chemotaxis

- Recurrent S. aureus infx

235
Q

What are the components of the FATED mnemonic for Job syndrome?

A
  • coarse Facies
  • Abscesses
  • retained primary Teeth
  • hyper IgE (eosinophilia)
  • Dermatologic defects
236
Q

What is the treatment for job syndrome?

A

Treat with penicillinase-resistant antibiotics and IVIG.

237
Q

What is the acute, subacute, and chronic phase of Kawasaki’s disease?

A 
ACute = 1-2 weeks, 
Subacute= 2-8 weeks. Thrombocytopenia, leukocytosis
Chronic = 8+ weeks, all clinical symptoms have gone, but untreated still at risk for MI
238
Q

What will acute Kawasaki’s disease present lab wise?

A

Normochromic anemia, leukocytosis with a L shift. High ESR and CRP

239
Q

What will subacute Kawasaki’s disease present lab wise?

A

Thrombocytosis

ESR and CRP gradually decrease during this phase

240
Q

What test should be performed at diagnosis of Kawasaki’s disease to follow?

241
Q

What is the treatment for Kawasaki’s disease?

A

IVIG and ASA

242
Q

What is the inheritance pattern and features of C1 esterase deficiency?

A

-AD loss of C1 esterase, causing recurrent episodes of angioedema lasting 2-72 hours

243
Q

What is the diagnostic test and treatment for C1 esterase deficiency?

A
  • Total hemolytic complement establishes diagnosis

- Purified C1 esterase and FFP can be used prior to surgery

244
Q

Terminal complement deficiency presents how? Why?

A
  • Recurrent Neisseria infection, meningococcal or gonococcal

- Inability to form MAC complex

245
Q

What is the treatment for terminal complement deficiency?

A

Meningococcal vaccine and appropriate abx

246
Q

How many days of fever are needed to diagnose Kawasaki’s disease?

247
Q

What are the components of the CRASH and BURN mnemonic for Kawasaki’s disease?

A 
Conjunctivitis
Rash
Adenopathy (unilateral)
Strawberry tongue
Hand and feet desquamation

BURN = fever of 104+ for 5 + days

248
Q

Kawasaki disease and scarlet fever may both present with “strawberry tongue,” rash, desquamation of the hands and feet, and erythema of the mucous membranes. How can you differentiate them?

A

children with scarlet fever have normal lips and no conjunctivitis.

249
Q

When are corticosteroids used to treat Kawasaki’s disease?

A

If IVIG does not work

250
Q

What is JRA? (symptoms, ages, duration)

A

Autoimmune disorder manifesting as morning stiffness and gradual loss of motion that is present for at least 6 weeks in a patient less than 16 years of age?

251
Q

What is the treatment for JRA (juvenile idiopathic arthritis)?

A

NSAIDs

Corticosteroids for carditis

252
Q

What is the pauciarticular subtype of JRA?

A

Involves 4 or fewer joints, with no systemic symptoms

-Uveitis is common

253
Q

What is the RF and ANA status of pauciarticular subtype of JRA?

254
Q

What is the RF and ANA status of polyarthritis subtype of JRA?

A

RF- (+if severe)

ANA+

255
Q

What is the RF and ANA status of systemic subtype of JRA?

256
Q

What is the most common subtype of JRA?

A

Pauciarticular

257
Q

What is the polyarthritis form of JRA?

A

5+ joint involvement, with rheumatoid nodules if RF +

258
Q

What is the systemic onset (still disease) subtype of JRA?

A

Recurrent high fevers
HSM
Salmon colored macular rash

259
Q

When does joint inflammation occur with the systemic onset of JRA (Still disease)?

A

May not occur for months to years after systemic symptoms appear

260
Q

What are the three most common bacterial pathogens associated with AOM?

A
  • Strep pneumoniae
  • Nontypable H influenzae
  • Moraxella catarrhalis
261
Q

What is the treatment for acute OM?

A

High dose amoxicillin or augmentin 80 mg/kg/day x 10 days

262
Q

What is the most common infectious agent that causes bronchiolitis?

263
Q

Young infants in particular are at risk of what complication of an RSV bronchiolitis?

264
Q

What is the definition of acute bronchiolitis?

A

Acute inflammation of the small airways of the lower respiratory tract that primarily affects infants and children less than 2 years

265
Q

What is the typical presentation of bronchiolitis?

A

Days 1-3 with low grade fever, rhinorrhea, cough. Small infants may have apnea

Days 4-6 Respiratory distress, tachypnea, hypoxia

266
Q

What are the PE findings of a kiddo with bronchiolitis?

A

Tachypnea
Hypoxia
Crackles or coarse breath sounds (“washing machine sounds”), and possible wheezing

267
Q

What is the earliest and most sensitive symptom of bronchiolitis?

268
Q

How is bronchiolitis typically diagnosed?

A

Clinically, but if severe, CXR to r/o pneumonia

269
Q

What may a CXR show with bronchiolitis?

A

Flattened diaphragm, interstitial infiltrates, atelectasis

270
Q

What is the role of a nasopharyngeal swab for RSV in diagnosing bronchiolitis?

A

Highly sensitive and specific, but does not change management

271
Q

What is the treatment of bronchiolitis?

A

Supportive:

  • Hydration
  • suction
  • O2
  • Albuterol
272
Q

What is the role of corticosteroids in the treatment of bronchiolitis?

A

NOT indicated

273
Q

When is ribavirin indicated for the treatment of bronchiolitis?

A

In high risk infants

274
Q

What is the RSV prophylaxis?

A

Injectable monoclonal antibodies (palivizumab)

275
Q

What is the technical name for croup?

A

Laryngotracheobronchitis

276
Q

What is the causative agent of croup?

A

Parainfluenza type 1, 2, and 3, as well as RSV

277
Q

What is the typical presentation of Croup?

A

Prodromal URI symptoms followed by a lower grade fever, dyspnea, and inspiratory stridor and barking cough

278
Q

What time of day is croup typically at its worst?

279
Q

How is croup diagnosed?

A

Clinically

280
Q

What might a neck x-ray show with croup?

A

Steeple sign

281
Q

What is the treatment for mild, moderate, and severe cases of croup?

A
  • Mild = outpatient cool mist and fluids
  • Moderate = O2, IM corticosteroids, nebulized epi
  • Severe = (respiratory distress) = hospitalize and give nebulized epi, and consider intubation
282
Q

What is the classic common cause of epiglottitis? Now?

A
  • H. influenzae (but now immunized)

- Strep species and nontypable H flu

283
Q

What is the typical presentation of epiglottis?

A
  • ACute onset fever
  • Dysphagia/drooling
  • Tripod position (neck hyperextension and chin protruding, leaning forward)
284
Q

How is epiglottitis diagnosed? What might a neck x-ray show?

A

Clinically

“thumbprint sign”

285
Q

When is the only appropriate time to use a swab to examine the pharynx of a patient with epiglottitis?

A

If anesthesiologist or otolaryngologist is present

286
Q

What is the treatment for epiglottitis?

A
  • Secure the airway!!

- IV abx (Ceftriaxone or cefuroxime)

287
Q

What are the three most common causes of meningitis?

A
  • Strep pneumoniae
  • Neisseria meningitidis
  • E. coli
288
Q

What is Kernig’s sign?

A

reluctance of knee extension when the hip is flexed

289
Q

What is brudzinski’s sign?

A

Hips are flexed in response to forced flexion of the neck

290
Q

What are the abx of choice for neonatal meningitis?

A
  • ampicillin
  • Cefotaxime
  • Gentamicin
291
Q

What are the abx of choice for treating kids with meningitis?

A

Ceftriaxone and vanco

292
Q

Which improves with administration of nebulized, racemic epi: croup, epiglottitis, or tracheitis?

293
Q

True or false: neonates and young children rarely have meningeal signs on exam

294
Q

Why should neonates not be given ceftriaxone?

A

Increased risk of biliary sludging and subsequent kernicterus

295
Q

What is the difference between retropharyngeal abscesses vs peritonsillar abscesses in terms of: age group affect?

A
  • Retropharyngeal abscess = 6 months - 6 years

- Peritonsillar abscess = 10+ years

296
Q

What is the difference between retropharyngeal abscesses vs peritonsillar abscesses in terms of: presentation?

A
  • Retropharyngeal abscess = Acute onset of fever, hot potato voice, trismus, drooling
  • Peritonsillar abscess = hot potato voice, uvula displace to opposite side
297
Q

What is the difference between retropharyngeal abscesses vs peritonsillar abscesses in terms of: pathogen

A
  • Retropharyngeal abscess = Group A strep

- Peritonsillar abscess = Group A strep

298
Q

What is the difference between retropharyngeal abscesses vs peritonsillar abscesses in terms of: preferred position

A
  • Retropharyngeal abscess = neck extended (flexing worsens symptoms)
  • Peritonsillar abscess = none
299
Q

What is the difference between retropharyngeal abscesses vs peritonsillar abscesses in terms of: diagnostic criteria

A
  • Retropharyngeal abscess = Lateral neck x-ray

- Peritonsillar abscess = Clinically

300
Q

What is the difference between retropharyngeal abscesses vs peritonsillar abscesses in terms of: treatment

A
  • Retropharyngeal abscess = ASpiration or I+D

- Peritonsillar abscess = I+D

301
Q

What will be seen in the oropharynx of a kid with a retropharyngeal abscess?

A

Usually unilateral; a mass may be seen in the posterior pharyngeal wall on visual inspection.

302
Q

What will a lateral neck x-ray show with a retropharyngeal abscess?

A

the soft tissue plane should be ≤ 50% of the width of the corresponding vertebral body.

303
Q

What is the most common cause of neonatal conjunctivitis?

A

C trachomatis and HSV

304
Q

What is the gold standard for diagnosing neonatal conjunctivitis?

A
  • Bacterial cultures

- HSV PCR

305
Q

What is the treatment for neonatal conjunctivitis?

A
  • Empiric abx until known

- Topical erythromycin ointment and oral erythromycin

306
Q

Why are topical abx alone for neonatal conjunctivitis insufficient?

A

Systemic infection usually present

307
Q

Why is empiric abx coverage for neonatal conjunctivitis crucial?

A

If caused by gonorrhea, corneal ulceration can occur, with resultant scarring within 24-48 hours

308
Q

What is the treatment for HSV conjunctivitis?

A

14-21 days of systemic acyclovir + topical agent (e.g.vidarabine)

309
Q

What is the treatment for HSV conjunctivitis?

A

14-21 days of systemic acyclovir + topical agent (e.g. vidarabine)

310
Q

What are the s/sx of neonatal chlamydia conjunctivitis?

A

1-2 weeks after birth, eyelid swelling and relatively scant watery d/c

311
Q

What are the s/sx of neonatal Gonorrhoeae conjunctivitis?

A

Appear within 1 week of birth

-Bilateral purulent with edema

312
Q

What are the s/sx of neonatal HSV conjunctivitis?

A
  • Symptoms appear within2 weeks
  • Conjunctival injection + watery/serosanguinous d/c
  • Vesicle around the eyes
313
Q

Who is the primary reservoir for pertussis?

314
Q

What are the three stages of pertussis infx?

A
  1. Catarrhal (mild URI s/sx for 1-2 weeks)
  2. Paroxysmal (cough with stridor. 2-3 months
  3. Convalescent (symptoms wane)
315
Q

What is the classic presentation of pertussis (age +3 symptoms)?

A

6 month (or less) old with coughing, posttussive emesis, and apnea

316
Q

What lab finding is peculiar regarding pertussis infection?

A

Leukocytosis with lymphocytic predominance

317
Q

What is the gold standard for diagnosing pertussis?

A

Nasopharyngeal swab

318
Q

What is the treatment for pertussis?

A
  • Hospitalize if less than 6 months

- azithromycin x10 days

319
Q

What is the abx of choice for pertussis?

A

Azithromycin

320
Q

What is the PEP for pertussis?

A

Z-pack x5 days

321
Q

What viruses causes erythema infectiosum?

A

Parvovirus B19

322
Q

What viruses causes measles?

A

Paramyxovirus

323
Q

What are the characteristics of the prodromal period, and rash for erythema infectiosum?

A
  • No prodrome

- Pruritic, maculopapular erythematous rash that starts on the arms, and spreads to the trunk and legs

324
Q

What classically makes the rash of erythema infectiosum worse?

A

Fever and sun exposure

325
Q

What are the two major complications of erythema infectiosum?

A
  • Arthropathy (if adult)

- Aplasic crises in sickle cell or hereditary sphereocytosis)

326
Q

What is the prodrome of measles?

A

Low grade fever with a cough, coryza, and conjunctivitis

327
Q

What are the characteristics of the rash with measles?

A

Erythematous maculopapular rash the spreads from head, to toes

328
Q

What is the rare but devastating complication of measles?

A

subacute sclerosing panencephalitis

329
Q

What is the prodrome of rubella?

A

Asymptomatic or tender, generalized LAD (particularly the posterior auricular)

330
Q

What are the characteristics of the rash with rubella?

A

Erythematous maculopapular rash the spreads from head to toe.

331
Q

How can you differentiate rubella and measles on clinical symptoms?

A

Measles appear sicker and have a higher fever (rubella has no to low grade fever)

332
Q

What are the complications from rubella infection (not congenital)?

A

Encephalitis

Thrombocytopenia

333
Q

What are the congenital effects of rubella? (4)

A

PDA
Deafness
MR
Cataracts

334
Q

What is the causative agent of roseola infantum?

A

HHV-6 and 7

335
Q

What is the prodrome of roseola infantum? Rash?

A
  • Prodrome = acute fever without other symptoms

- Maculopapular rash that appears as fever breaks

336
Q

Maculopapular rash that appears as the high fever breaks = ?

A

Roseola infantum

337
Q

What is the major complication associated with roseola infantum?

A

Febrile seizures

338
Q

What are the characteristics of the prodrome and rash of VZV?

A
  • Prodrome = mild fever, anorexia, malaise

- Rash = generalized pruritic, teardrop vesicles on red base with lesions at different stages of healing

339
Q

What are the characteristics of the prodrome and rash of hand foot and mouth disease?

A
  • Prodrome = fever, anorexia, oral pain

- Oral ulcers, maculopapular vesicular rash on the hands and feet, sometimes on buttocks

340
Q

What are the components of the TORCHES infections?

A
  • Toxoplasma
  • Rubella
  • CMV
  • HIV
  • Herpes
  • Syphilis
341
Q

What is the classic triad of s/sx for neonatal toxoplasmosis?

A

-Chorioretinitis
-Hydrocephalus
-Intracranial calcifications
(-blueberry muffin rash)

342
Q

What are the neonatal manifestations of congenital CMV?

A
  • Sensorineural hearing loss
  • Petechial rash
  • periventricular calcifications
343
Q

What are the neonatal manifestations of congenital HIV?

A

Recurrent infections and diarrhea

344
Q

What are the neonatal manifestations of congenital HSV-2

A

Encephalitis

345
Q

What apgar scores is good?

346
Q

What apgar score indicated the possible need for resuscitation?

347
Q

What apgar scores indicates the immediate need to resuscitation?

348
Q

What are the components of the APGAR scores?

A
  • Appearance
  • Pulse
  • Grimace
  • Activity
  • Respirations
349
Q

Over what level of bilirubin does neonatal jaundice occur?

A

More than 5 mg/dL

350
Q

What are scores 0-2 on the APGAR score for appearance?

A 
0 = blue/pale diffusely
1= pink body with blue extremities
2 = Completely pink
351
Q

What are scores 0-2 on the APGAR score for activity?

A

0 absent
1 = arms and legs flexed
2 = active movement

352
Q

What are scores 0-2 on the APGAR score for pulse?

A 
0 = absent
1 = less than 100
2 =  more than 100
353
Q

What are scores 0-2 on the APGAR score for respirations?

A 
0 = absent
1 = slow, irregular respirations
2 = vigorous cry
354
Q

What are scores 0-2 on the APGAR score for grimace?

A 
0 = Flaccid
1 = some flexion of extremities
2 = active
355
Q

Which type of hyperbilirubinemia is ALWAYS pathologic?

A

Conjugated

356
Q

At what levels of bili does kernicterus appear?

A

25 or above

357
Q

Which is associated with BWS: omphalocele vs gastroschisis?

A

Omphalocele

358
Q

How does Kernicterus present clinically? (5)

A
  • Lethargy
  • Poor feeding
  • High pitched cry
  • Hypertonicity
  • Seizures
359
Q

What labs should be obtained for indirect hyperbilirubinemia in neonates? (3)

A
  • CBC with PBS
  • Blood typing of mother (for ABO/Rh)
  • Coombs tests
360
Q

What labs should be obtained for direct hyperbilirubinemia in neonates? (4)

A
  • LFTs
  • Bile acids
  • blood cultures
  • sweat test
  • aminoacidopathies
361
Q

A jaundiced neonate who is febrile, hypotensive, and/or tachypneic needs what sort of testing?

A

Sepsis workup

362
Q

What is the treatment for unconjugated hyperbilirubinemia?

A

Phototherapy or exchange transfusions (if over 20 mg/dL)

363
Q

What levels of bili should phototherapy and exchange transfusion be performed (respectively)?

A
  • Photo = 10-15

- Exchange = 25+

364
Q

What is the role of phototherapy in conjugated hyperbilirubinemia?

365
Q

What are the components of the VACTERL sequence?

A
  • Vertebral anomalies
  • Anal
  • cardiac
  • tracheo
  • Esophageal
  • renal
  • Limb
366
Q

How does tracheoesophageal fistula present?

A
  • Polyhydramnios

- Drooling

367
Q

How do you diagnose tracheoesophageal fistula?

A

CXR showing NG tube coiling

368
Q

What is the presentation of a diaphragmatic hernia?

A
  • Respiratory distress
  • BS in the thorax
  • pHTN
369
Q

How do you diagnose a congenital diaphragmatic hernia?

A

US in utero, confirmed by postnatal CT

370
Q

What is the stabilizing and definitive treatment for a congenital diaphragmatic hernia?

A
  • ECMO or high frequency vent

- Surgery

371
Q

How does gastroschisis present in utero?

A

Polyhydramnios

372
Q

What is the stabilizing treatment for gastroschisis?

A

Place sterile, saline soaked gauze over it

373
Q

What is the stabilizing treatment for an omphalocele?

A

C-section can prevent sac rupture; if the sac is intact, postpone surgical correction until the patient is fully resuscitated. Keep the sac covered/stable with petroleum and gauze. Intermittent NG suction to prevent abdominal distention.

374
Q

How does duodenal atresia present?

A

Bilious emesis within hours after the first feeding

375
Q

What disorder is duodenal atresia associated with?

376
Q

How do you diagnose duodenal atresia? What will this show?

A

AXR

Double bubble

377
Q

Jaundice within how many hours after birth is pathologic?

A

If present in the first 24 hours

378
Q

What is the difference in rate of increase of bili in physiologic vs pathologic jaundice?

A

Physiologic = Less than 0.5 mg/dL/day

Path = more

379
Q

What are the peak bili levels in physiologic vs pathologic jaundice?

A

Phys = 14-15 mg

Path = 15+

380
Q

What percent of bili is direct bili in physio vs patho jaundice?

A

Physio = Less than 10%

Path = more than 10%

381
Q

Within what timeframe does physiologic hyperbili resolve (term and preterm)?

A

Resolves by 1 week in term, 2 weeks in preterm.

382
Q

What is the most common cause of respiratory failure in preterm infants?

383
Q

When does NRDS typically present?

A

first 48-72 hours

384
Q

How is the diagnosis of NRDs confirmed?

385
Q

What is the treatment for NRDS?

A
  • CPAP ro intubation

- Artificial surfactant

386
Q

What are the preventative measures for NRDS?

A

Treat mothers with corticosteroids is less than 30 weeks.

387
Q

An L/S ratio of what value is an indication for corticosteroid use in mothers?

A

2:1 or less

388
Q

What are the two major complications that can arise from NRDS and its treatment?

A
  • Bronchopulmonary dysplasia

- Retinopathy of prematurity

389
Q

What is cerebral palsy?

A

A range of nonhereditary, nonprogressive disorders of movement and posture, usually resulting from a prenatal neurologic insult

390
Q

What are the two major forms of cerebral palsy?

A
  • Pyramidal (spastic)

- Extrapyramidal (dyskinetic)

391
Q

What is the pyramidal (spastic) form of cerebral palsy?

A

Spastic paresis of any or all limbs. Accounts for 75% of cases. Intellectual disabilities are present in up to 90% of cases.

392
Q

What is the extrapyramidal (dyskinetic) form of cerebral palsy?

A

A result of damage to extrapyramidal tracts. Subtypes are ataxic (difficulty coordinating purposeful movements), choreoathetoid, and dystonic (uncontrollable jerking, writhing, or posturing). Abnormal movements worsen with stress and disappear during sleep

393
Q

What are the CXR findings in NRDS?

A
  • Air bronchograms

- Ground glass appearance

394
Q

What are the CXR findings in transient tachypnea of the newborn?

A

Perihilar streaking in interlobular fissures

395
Q

What are the CXR findings in meconium aspiration?

A

Coarse, irregular interlobular fissures

396
Q

What are the CXR findings of congenital pneumonia?

A

Nonspecific patchy infiltrates

397
Q

What is the most common presenting symptom of cerebral palsy?

A

Delayed motor development

398
Q

What symptoms may be associated with cerebral palsy?

A
  • Seizure disorders
  • hearing/visual impairment
  • speech deficits
399
Q

What are the PE findings for cerebral palsy?

A
  • hypertonicity/contractures
  • hyperreflexia
  • pathologic reflexes
400
Q

What are the characteristics of the gait with cerebral palsy?

A

Toe walking, scissor gait

401
Q

What is the treatment for cerebral palsy?

A
  • PT

- Diazepam, dantrolene, or baclofen for muscle spasticity

402
Q

What age group is typically affected by febrile seizures?

A

6 months - 5 years

403
Q

What is the definition of a simple febrile seizure?

A

Less than 15 minutes of a generalized, tonic-clonic seizures, with return to baseline after

404
Q

What is the definition of a complex febrile seizures?

A
  • More than 15 minutes
  • multiple in 24 hours
  • not returning to baseline immediately
405
Q

True or false: simple febrile seizures do NOT cause brain damage

406
Q

True or false: simple febrile seizures typically recur

407
Q

True or false: there is an increased risk of epilepsy in pts with febrile seizures

408
Q

What lab studies are needed for the first time episode of a simple febrile seizure?

409
Q

What is the treatment for a febrile seizure?

A

antipyretics (avoid ASA)

A1 (32 decks)

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