Peds Flashcards
1
Q
abdominal wall defect to the right of the cord insertion, not covered by membrane or skin “free floating”
A
Gastroschisis
2
Q
abdominal wall defect at linea alba, covered by skin
A
umbilical hernia
3
Q
midline abdominal wall defect, covered by peritoneum
A
omphalocele
4
Q
How is gastroschisis (free floating, exposed bowel) managed after delivery?
A
- Covered with sterile saline dressings and plastic wrap (minimize heat/fluid loss)
- NG tube
- Antibiotics
- Prompt surgical repair
5
Q
Are malformations such as cardiac disease, neural tube defects, or trisomy syndromes more common with Omphalocele, Gastroschisis, or both?
A
Omphalocele!
Gastroschisis is an isolated defect >90% of time
6
Q
Which abdominal wall defect is correlated with increased maternal AFP?
A
Gastroschisis (note: so NOT Down’s syndrome/neural tube defect)
7
Q
Tx of Lyme disease in kids
A
Doxy, Amoxicillin, Cefuroxime (all oral).
Note: Doxy is CI in pregnant women and kids<8 b/c of effects on bone
8
Q
When is someone considered to have immunity to Varicella?
A
2 doses of vaccine (2nd @ 4 years) or previous infection
9
Q
Post-exposure prophylaxis for varicella (chickenpox)
A
A. Immune (prior infection/2 doses vaccine by age 4): observation
- No immunity and immunocompetent: VACCINE
- No imm., immunocompromised: IVIG
10
Q
Most common complication of Mumps
A
Aseptic Meningitis
Mumps will present with fever + parotitis, “swelling of cheeks
11
Q
findings of all TORCH (congenital) infections
A
- hepatosplenomegaly
- IUGR
- Jaundice
- blueberry muffin spots
12
Q
specific findings of TORCH (congenital) infections
A
Toxo: diffuse intracerebral calcifications, chorioretinitis
Rubella: cataracts, PDA, hearing loss
CMV: periventricular calcifications
Syphilis: rhinorrhea, desquamating/bullous rash, abnormal long bone radiographs
13
Q
Do you need a CT before lumbar puncture in infant?
A
Usually not, since their fontanelles are open and can accommodate some swelling. Go ahead with LP + antibiotics (Ceftriaxone + Vancomycin)
14
Q
Which antibiotic should be avoided in infants with hyperbilirubinemia?
A
Ceftriaxone…it displaces bilirubin from albumin-binding sites = increased risk kernicterus
…use Cefotaxime instead
15
Q
Treatment for neonatal conjunctivitis
A
Prophylaxis (against GC): Topical erythromycin
GC Tx: IV/IM Ceftriaxone or Cefotaxime (i.e. jaundice)
Chlamydia Tx: Oral erythromycin
16
Q
EEG: 3 Hz spike and wave discharges
A
Absence seizure
17
Q
Guillain-Barre involves:
A
demyelination of the peripheral schwann cells
18
Q
most common complications of meningitis
A
HEARING LOSS cerebral palsy intellectual disability or developmental REGRESSION epilepsy SIADH (monitor Na+)
19
Q
difference between Neuroblastoma and Wilm’s tumor
A
Neuroblastoma: from neural crest cells, arises from adrenal gland or sympathetic chain. most common extra-cranial tumor kids. presents age 2
Wilms: from mesonephros. most common renal tumor. may see hematuria.
20
Q
features of absence seizure
A
- less than 20 seconds/episode
- automatisms usually
- provoked by hyperventilation
- postural tone preserved
21
Q
differential for T-wave inversion
A
MI, Myocarditis (i.e. Coxsackie, Friedreich ataxia), old pericarditis, digoxin toxicity, myocardial contusion
22
Q
Niemann Pick vs Tay-Sachs
both have: Auto Rec, Ashkenazi, Age 2-6mo, Loss of motor milestones, Hypotonia, feeding difficulty, Cherry Red Macula
A
Niemann: Hepatosplenomegaly, Areflexia. Sphingomyelinase def
Tay-Sachs: HYPERreflexia. No hepatosplenomegaly. B-hexosaminidase A def
23
Q
failure to thrive, bilateral cataracts, jaundice, hypoglycemia. Increased risk E COLI NEONATAL SEPSIS
A
Galactosemia (Auto Rec)
- def of galactose-1-phosphate-uridyl-transferase def
- cut out LACTOSE (galactose + glucose) and Galactose
24
Q
Ingestion of botulism spores vs toxin
A
Spores: Infant botulism. Environmental spores, honey also increases risk.
Toxin: Food-borne botulism. Paralysis is preceded by n/v, diarrhea, abdominal pain.
25
Classic triad of brain abscess
- fever
- focal neuro deficits
- severe headaches (nocturnal or morning)
so looks like brain tumor, but theres a fever. cyanotic congenital heart defects and recurrent sinusitis increase risk by allowing seeding of bacteria
26
DDx of marfanoid habitus
Marfans: AD; Aortic root dilatation; upward lens dislocation...NORMAL INTELLECT
Homocystinuria: AR; Thrombosis; downward lens dislocation, Megaloblastic Anemia...DISABLED INTELLECT
27
Disadvantages of Pulse ox (taken @ fingertip, earlobe, or foot in infants)
- does NOT give info about Ventilation
| - inaccurate if extremity is cold, calloused, or moving
28
Presentation of carotid artery dissection
Mechanism: Penetrating trauma, fall with object in mouth (tootbrush, pencil), neck manipulation (yoga/sports)
Sx: Gradual-onset HEMIPLEGIA, aphasia, neckpain, thunderclap headache
Dx: CT or MRa
29
Brain tumor that causes bitemporal hemianopsia and endocrinopathies
Craniopharyngioma...compresses optic chiasm (might start running into furniture etc) and pituitary, can get GH def or Diabetes insipidus
30
where are most medulloblastomas found?
cerebellar vermis...truncal ataxia
31
side effect of hydroxyurea
Myelosuppression
32
Acute drop in hemoglobin, low reticulocyte (<1%), and no splenomegaly in sickle cell patient
Aplastic Crisis...usually due to Parvo b19
...get fatigue, pallor, and f(x)nal systolic murmur
33
Pt with cystic fibrosis + epistaxis /easy bruising
VITAMIN K DEFICIENCY
| ...CF = pancreatic insuff = def of fat-soluble vitamins = vit k deficiency
34
why are sickle cell patients predisposed to folate deficiency?
the chronic hemolysis of SCD = bone marrow tries to make new rbcs to compensate for the anemia = lower folate
35
Iron def anemia and alpha and beta thal are all microcytic anemias. What are the RDWs?
Normal in thal.
| Increased rbc distribution width in Iron Def Anemia
36
Which anemia caused by excessive consumption cow's milk (>24 oz /day)?
Iron deficiency anemia
37
Appearance in Fanconi anemia
- short stature
- microcephaly
- abnormal thumbs, low set ears, strabismus
- hypogonadism
- hypopigmentation of skin, cafe au lait, large freckles
38
A congenital condition dx by chromosomal breaks on genetic analysis that causes aplastic anemia in children
Fanconi anemia...mutation of NHEJ chrom repair (also mutated in ataxia-telangiectasia)
39
Most common cancer of childhood, when its going to present and in who, how to dx
ALL
Age: 2-6
Boys, Down syndrome,
Dx: BONE MARROW BIOPSY. presence of >25% lymphoblasts (on biopsy) is diagnostic.
40
**Pt with hereditary spherocytosis is going to undergo splenectomy, how long will they be @ enhanced risk of pneumococcal sepsis?
* *up to 30 years and probably longer!
- >so normal treatment for sphero pts is supportive care w/ oral folic acid and blood transfusions during severe anemia
- ->do splenectomy if its severe or refractory to therapy (abolishes need for transfusions or risk of severe anemia)
- ->give anti-pneumococcal, HIB, and meningococcal vaccines several weeks prior to surgery
- ->daily Penicillin prophylaxis for 3-5 years following
41
Brain tumor that can cause Parinaud (limited upward eye gaze, upper eyelid retraction, pupils dont react to light but to accomodation)
Pinealoma
42
What's the expected triad of HUS?
- microangiopathic hemolytic anemia
- thrombocytopenia
- acute kidney injury
43
Meconium ileus is dx'ic for:
Cystic fibrosis
44
If you suspect lead poisoning in a child, they give you Hgb, hct, and capillary lead level that is high, what is next step?
You can't just initiate tx. HAVE TO MEASURE VENOUS LEAD LEVEL.
If moderate, give DMSA.
If severe, Dimercaprol + EDTA.
45
In whom is rotavirus contraindicated?
Hx of Intussuseception due to increase risk with vaccine. , also uncorrected meckels, or SCID.
46
when do you expect a child to complete potty training?
Age 5...no intervention for bed wetting earlier than this
47
by 12 months, childs weight should _____ and height should _____
weight: triple
height: increased 50%
48
How can you differentiate transient synovitis from Legg-Calve-Perthes?
Transient synovitis resolves in 1-4 weeks.
| Pain >1 mo likley to be LCP (avascular necrosis of the femoral head, usually boys 4-10 yo)
49
Signs of Iron poisoning
- hematemesis
- hypotension + anion-gap metabolic acidosis (poor perfusion and build up of lactic acid)
- tachypnea and resp alkalosis to compensate
- Iron = Radioopaque = visualized on xray. Esp be suspcious if mother is pregnant (pre-natals)
- ->Chelation w/deferoxamine
50
Maneuvers that decrease murmur intensity in HCM
ones that increase preload or afterload (squatting, leg raise, hand grip) = increased LV cavity size = decreased outflow obstruction
51
Manuevers that increase murmur intensity in HCM
ones that decrease preload (Valsalva, abrupt standing, amyl nitrate admin) = worsening LVOT = increase murmur
52
where are most intussusceptions?
Ileo-cecal.
Exception = Henoch Schonlein Purpura --> Ileo-ileal
53
Tx for ileo-cecal intussusceptions
Air or contrast enema
54
What will you hear on cardio exam in Tetrology of Fallot?
- Harsh, systolic ejection murmur at LSB
| - Single S2 (stenotic pulm valve)
55
Most common congenital defect in Down's
Complete AV septal defect
| failure of endocardial cushion merging = both ASD and VSD + common AV valve due to poor mitral/tricuspid development
56
Hypogonadotropic hypogonadism + anosmia (inability to smell)
Kallman Syndrome
57
Failure to GnRH cell migration and defective formation of olfactory bulb. Infertility, amenorrhea, absent breasts in female. Low FSH and LH. Short stature + delayed puberty.
Kallman Syndrome
58
Single S2 heart sound
Transposition of great vessels
tetrology of fallot
tricuspid atresia
truncus arteriosus
59
Most common congenital cyanotic heart condition in the neonatal period:
Transposition of the great vessels
| -->Prostaglandins should be initiated to promote mixing of the blood
60
most common triggers of myocarditis
Viral: Coxsackie and Adenovirus
61
most serious sequalae of Kawasaki
Coronary artery aneurysm
62
Clinical signs of Kawasaki
Fever >5 days plus 4 of following:
- bilat nonexudative conjunctivitis
- Mucositis (strawberry tongue/injected lips or pharynx)
- Cervical lymphadenopathy w/at least 1 LN>1.5cm
- Erythematous rash, includes palms/soles
- Edema/erythema of extremities
Most commonly kids <5 yo
63
Most life-threatening finding in Marfans
Aortic root dilation
64
cardiac anomalies of turners syndrome
Bicuspid aortic valve>coarctation of aorta>aortic root dilation.
Get 4-extremity BPs and Echo in all Turners pts
65
murmur in Edwards syndrome
holosytolic from VSD
66
3 P's of McCune Albright Syndrome
Precocious puberty
Pigmentation (cafe-au-lait spots)
Polyostotic fibrous dysplasia (multiple fractures)
67
Low set ears, micrognathia, cleft palate; cardiomegaly; absence of thymic shadow; cyanotic, hypoxic despite O2, truncus arteriosus
DiGeorge: Abnormal facies + thymic hypoplasia (absence of sailors signs) + congenital heart disease. Look out for hypocalcemia and viral/fungal infections
68
Who gets screened for chlamydia and neisseria gon?
ALL sexually active women under 24 years old by NAAT
69
most common causes of acute and chronic stridor
Acute: Croup, Foreign body (incidence epiglottitis low after vaccine)
Chronic: Laryngomalacia (inspiratory, worse when supine), Vascular Ring (biphasic, improves with neck extension)
70
<1yo, respirtory (stridor, wheezing) + esophageal (dysphagia, vomiting) sxs. Stridor is often biphasic and improves with neck extension.
Vascular Ring...caused by abnormal aortic arch dev, i.e. double aortic arch
-->since its a fixed intrathoracic obstruction, racemic epi and prone position don't improve sxs (vs croup or laryngomalacia)
71
chronic inspiratory stridor due to collapse of the supraglottic structures during inspiration, improves with prone position
Laryngomalacia
72
why are pts with Turners at increased risk for osteoporosis?
No ovaries ("streak ovaries) = Estrogen deficient. Estrogen normally inhibits osteoclast-mediated bone resorption
73
Tx for HUS
DIALYSIS + transfusions. No antibiotics, no platelets, no antitoxin
74
T/F: Henoch-Schonlein purpura presents with thrombocytopenia
False
75
Manifestations of Friedreich Ataxia (3 domains)
Neuro: Ataxia, Dysarthria
Skeletal: Hammer toes, scoliosis
Cardiac: Concentric hypertrophic cardiomyopathy (cardiomyopathy = most common cause of death)
76
Pharmalogical treatment for QT prolongation
```
Beta blockers (class 2 antiarrythmics)! Symptomatic pts may need pacemaker.
Note: the only beta blocker to be avoided is Sotalol!its a class 3 and can increase QT by blocking K channels
```
77
GI Manifestations of Henoch-Schonlein Purpura
Intussusception (ileo-ileal), also GI hem is possible
78
When should gonads be removed in crypotarchidism?
AFTER PUBERTY. Risk of malignancy is relatively low but they need to be removed, but can do this after beneficial gonad-driven puberty
79
Most common cause of congenital hypothyroidism
Thyroid dysgenesis
80
Abdominal swelling discovered incidentally, i.e. while bathing a child
Wilms tumor (vs neuroblastoma usually found due to sxs)
81
Syndromes associated with Wilms tumor
BECKWIDTH-WEIDMAN!
| Also, WAGR = Wilms, Aniridia (absence of iris), GU abnormality, mental Retardation
82
Most common cause of vaginal bleeding in neonatal period
```
hormone withdrawal (estrogen). self limitied/no tx
Note: neonatal chlamydia causes conjunctivitis/pneumonia, but not vaginal discharge
```
83
T/F: UTI is due to poor hygiene; Pyelo is due to ascending infection
False. BOTH are due to Ascending infection....for UTI, this means from bacteria from vagina ascend urethra to bladder
84
____ is associated with osmotic diuresis that depletes total body K+ stores, even though serum K+ may be elevated
DKA
| insulin normally puts K intracellularly; excess glucagon in DKA causes diuresis
85
maternal estrogen effects in newborns
-breast hypertrophy
-swollen labia
-leukorrhea (white discharge)
-uterine withdrawal bleeding
No work up needed
86
______ is a major risk factor for membranous nephropathy in kids
active Hep B Infection
87
T/F: Constitutional short stature, which will ultimately resolve after delayed puberty/growth spurt, will show normal bone age right now
False. Will show reduced bone age
88
what would renal biopsy show in someone with HSP showing renal manifesations?
IgA deposition in mesangium
89
Patient with anovulatory cycles (q4mo) presents with 3 days heavy vaginal bleeding. Management?
Tx with High-dose OCP --> this stabilizes the endometrium and stops the bleeding
90
Tx options for strabismus (which is abnormal after 4mo age)
- Penalization: cycloplegic drops to blur normal eye
- Occlusion: patch over normal eye
- prescription eyeglasses
- surgery
91
How to differentiate hearing impairment and ADHD?
Similar features of having problems at home and school, but ADHD normally doesn't have delayed language skills
92
most common cause hearing impairment
conductive hearing loss due to repeated ear infections
93
Mgmt of nephrotic syndrome in kids
First assume its MCD unless other suspicions, and tx with empiric steroids BEFORE doing any kind of renal biopsy or workup
94
Inspiratory stridor that is worse when supine, improved when sitting up
Laryngomalacia aka floppy supraglottic strucs. Visualize with laryngoscopy. Can reassure in most cases (spontaneous resolution by 18mo)
95
T/F: Posterior urethral valves occur in boys=girls
false, only occurs in males
96
T/F: Cystic fibrosis does not cause pancreatitis>infertility
False. >95% males will have infertility!! (due to congenital bilat absence of vas deferens due to fetal accum of inssipated mucus).
10% have pancreatitis.
97
Tx for tinea capitis (causes alopecia)
ORAL griseofulvin or terbinafine (topical doesn't cut it for scalp)
Its a dermatophyte infection, usually Trichophyton tonsurans
98
how would renal papillary necrosis present?
Black kid (i.e. Sickle cell TRAIT) presents with painless hematuria, UA shows normal/intact rbc's, no protein or signs of hypertension. hematuria resolved spontaneously.
99
Can chronic constipation in young kids cause UTI?
Yes, stool in the vault presses on bladder = urinary stasis. Will say "cries with urination"
100
risk factors for ARDS
- Prematurity
- Maternal DIABETES: delays surfactant maturation...maternal hyperglycemia = fetal hyperglycemia = fetal hyperinsulinemia -->insulin antagonizes cortisol and blocks maturation of sphingomyelin
- C/s
101
hypochloremic hypokalemic metabolic acidosis
pyloric stenosis
102
jaundice, FTT, hepatomegaly few days after birth after breast milk or formula
Galactossemia
103
reccurent pulm/sinus/GI infections, association with atopic triad and autoimmune dz, anaphylaxis during transfusions
Selective IgA deficiency
104
If you cant use Doxycycline for Lyme disease, what would you use?
Amoxicillin or Cefuroxime. IV Ceftriaxone if terrible. Esp in kids (dont wanna use Doxy <8)
105
Bilateral leg pain in kids that occurs for a few hours at night, relieved by massage or nsaids, no abnormalities on physical exam or trauma/systemic sxs
Growing pains! normal
106
tx for pyloric stenosis
CORRECT ELECTROLYTE ABNORMALITIES (K, Cl, H) PRIOR TO SURGERY
107
most common predisposing factor for bacterial sinusitis in kids
Viral URI (mucosal inflam from viral illness prevents mucociliary clearance of bacteria)
108
fever, nasal congestion, rhinorrhea, purulent discharge, cough for >10 days in kids
bacterial sinusitis
109
first line tx of bacterial sinusitis
Augmentin (amox-clavulanic)
110
6 year old boy with hip or knee pain
LCP!!! (ages 4-10, boy, avascular (osteo) necrosis of femoral head). Antalgic gait: shorter time weight bearing on painful side
111
puberty age kiddo with hip or knee pain, obese
SCFE
112
dz results from failure of __ cell development; small/absent lymphoid tissue; recurrent sinopulmonary and GI infxs after 6mo age (maternal antibody protection wanes)
X-linked agammaglobulinmia. Tx with IV immunoglobulins
113
dz results from ____ deficiency; severe, recurrent viral, fungal and bacterial infections and FTT
SCID. Can be from adenosine deaminase deficiency or
114
Failure of oxidative burst results in this dz and predisposition to infections by:
Catalase + organisms (Staph, e coli, Candida, Pseudomonas, nocardia, aspergillus, listeria, serratia)
Chronic Granulomatous Disease
115
Complement deficiency = increased risk of _____ infections
encapsulated bacteria
116
3 bacteria AOM
strep
nontypeable H flu
Moraxella
117
tx for AOM
10 day amoxicillin. 2nd line is amox-clav
118
kid pulling on ear, fussy, bulging erythematous TM with dec mobility on air compression
classic AOM
119
t/f: UGI series findings of ligament of treitz on left side of abdomen and corkscrew pattern indicate malrotation
False. Lig of T is usually on left, so seeing it on the right = malrotation; in contrast, seeing corkscrew pattern = volvulus, a complication from malro
120
baby comes in with bilious emesis. next steps?
cessation of feeds, NG tube for decompression, IV fluids. First due Xray to r/o pneumoperitoneum
121
gold standard for dx of malrotation
UGI series
122
hirschprung, meconium ileusand intussusception are evaluated with
contrast enema
123
bronchiolitis presentation
<2 years old, fall/winter, wheezy cough, uri, fever, tachypnea. can lead to apnea
124
big indicators of precocious puberty
Girl <8, Boy <9 and bone age advanced
125
Precocious puberty based on LH levels
High LH: Central (Gonadotropin-dependant). MRI then tx w/ GnRH agonist therapy
Low LH: Do GnRH stimulation test.
-->low LH = Peripheral (gonadotropin-independant).get pelvic US
-->high LH = Central
High LH: MUST GET AN MRI TO R/O TUMOR, even if no neuro/mass sxs (80% idiopathic but still have to r/o). Tx
126
why is central precocious puberty (gonadotropin dependent/high LH) treated with GnRH agonist?
To prevent premature epiphyseal plate fusion and thus get full adult height potential. must get MRI before tx to r/o tumor
127
angelman and prader-wili genotypes
Angelman: loss of maternal copy 15q11-q13 (so she's daddys angel)
Prader-Wili: loss of paternal copy 15q11-q13 (so mom feeds this fatty). associated with sleep apnea and DM2
128
elfin facies, friendly af, hypercalcemia, heart problems, very friendly with strangers
Williams (chrom 7q deletion)
129
Manuevers that ____ return of blood to heart reduce the intensity of innocent murmurs
decrease. i.e standing, Valsalva. (on the other hand, if it gets worse with standing though, could be HCM so need echo even if its a young kiddo)
130
most worrisome complication of Marfan's
aortic root dilation
131
What else is seen in Henoch-schonlein except for palpable purpura? (
- abdominal pain (won't have fevers or bowel changes)
- arthritis/arthralgia (might think septic joint at this point)
- intussusception
- renal dz similar to IgA Nephropathy (mesangial deposition of IgA
132
IgA mediated vasculitis of the small vessels
Henoch-Schonlein purpura
133
normal genotype, failure of puberty, short stature, can't smell
Kallman Syndrome: Hypogonadotropic hypogonadism
134
insenstivity of FSH and LH receptors on testicles = testicular atrophy, tall man, gynecomastia very high FSH and LH levels but low testosterone. Dz and Tx
Klinefelter's (47 XXY). Tx w/Testosterone
135
Female phenotype, male genotype, no ovaries
AIS or 5alpha reductase deficiency
136
genetic short stature vs constitutional growth delay
Short stature: Bone age is normal and puberty occurs at normal time, niggas just got bad genes
Const. growth delay: delayed bone age (10 in a 13 year old) and puberty occurs later, will reach normal adult heights though (late bloomer)
137
Tx of hip pain in a fat 14 year old
surgical pinning of his SCFE
138
How can you differentiate between gonococcal and trachomatal conjunctivitis in newborn?
Gonococcal: PURULENT. day 2-5 usually. erythromycin ointment prevents 75% but can still get it. Tx w/ Ceftriaxone.
Chlamydial: day 5-14. milder, eyelid swelling, Watery discharge.
Note: chemical (first 24 hours) is also watery discharge. caused by silver nitrate.
139
T/F: Baby with breastfeeding jaundice spread on his face, arms and full chest (~15) needs phototherapy
False. Phototherapy if total bili>20, exchange transfusion if >25. Tx for this dude = increase feeds and optimize lactation, consider formula if doesnt help.
140
How much is consider enough in terms of baby feeds during first month of life?
8-12x/day (ever 2-3 hours) for >10-20 minutes/breast during 1st month
141
who gets transposition of the great vessels?
infant of diabetic mother
142
Why does tetralogy of fallot have harsh crescendo-decrescendo murmur?
Pulmonary stenosis (RV outflow obstruction). murmur at upper LSB. this is most important for prognosis
143
well-appearing neonate age 2-8 weeks has painless bloody stools. Fhx of allergies, eczema, or asthma.
milk or soy protein induced colitis. give formula, or have mom eliminate milk and soy from her diet.
144
joint pain, rash, fever 1 or 2 weeks after antibiotic initiation, usually beta lactams (penicillins, cephalosporins) or bactrim. . Type 3 hypersensitivity.
serum sickness like rxn. hepatitis b and c patients increased risk but can happen to anyone even peds.
145
why are newborns without a thymus and cleft palate at risk for tetany, seizures and arrythmia?
DiGeorge syndrome: parathyroids are fucked = severe hypocalcemia. Also, get an ECHO b/c patients probs have Truncus arteriosus.
146
risk factors for necrotizing enterocolitis
prematurity, very low birth weight, congenital heart disease (i.e. DiGeorge pt, any congenital heart defect), formula feeding
147
whats the leading cause of death in the NICU?
necrotizing enterocolitis. stop feed, decompress, antibiotics.
148
CXR shows pockets/cysts of air throughout bowel in premature infant with bloody stools. "air (gas cysts) within the bowel wall"
pneumatosis intestinalis: classix xray finding for Necrotizing Enterocolitis
149
newborn with heart defect, premature, bloody stools, abdominal distention, feeding intolerance.
necrotizing enterocolitis
150
blue/gray macules on back/butt/thighs/presacral area in black, hispanic, asians, called ______, are benign and disappear by _____
Mongolian spots. within a few years, can last up to 10 years old
151
blue/gray macules on back/butt/thighs/presacral area in black, hispanic, asians, called ______, are benign and disappear by _____
Mongolian spots. within a few years, can last up to 10 years old
152
why is cystic fibrosis patient who stopped taking medications having easy bruising and epistaxis? lab abnormality?
Malabsorption of fat soluble = no vit k = no factor 2, 7, 9, 10, = increased PT
153
Tx for ITP
Kids: Just petechiae/skin - observe; bleeding - IVIg/steroids
Adults: Plt<30k or bleeding - IVIg/steroids.
154
most common predisposing factor for orbital cellulitis
bacterial sinusitis
155
preseptal or orbital cellulitis: opthalmoplegia, pain, vision changes
orbital
156
port wine stain, seizures, tram track calcifications, mental retardation, glaucoma
Sturge Weber. eval for glaucoma and give anti-seizure
157
What diseases would you expect in the hx of a patient with pseudogout?
Hemochromatosis, hyperparathyroidism, acromegaly, or hypothyroidism
(calcium pyrophosphate deposition, involving knee and wrist)
158
genetic cause of retinoblastoma
Inactivation of Rb tumor suppressor gene
159
complications of retinoblastoma
- highly malignant cancer: Liver and brain mets!
| - strabismus, dec vision, eye pain, glaucoma, orbital cellulitis
160
initially well newborn develops acholic stools, dark urine and jaundice in first 2 months of life, with hepatomegaly. Lab shows conjugated bilirubinemia
Biliary Atresia
161
most common indication for pediatric liver transplant
biliary atresia
162
evaluation of kiddo suspected of biliary atresia (initially well appearing develops CB jaundice/hepatomegaly in first 2 months)
First US: may show absent/abnormal gallbladder
Dx goldstandard: Intraoperative Cholangiogram shows biliary obstruction
Liver scintography: highly suggestive of biliary atresia when liver fails to excrete tracer into small bowel
163
Tx of biliary atresia
Kasai procedure = Hepatoportoenterostomy. Ultimately need liver transplant
164
Criggler Najjar and Gilberts results in:
unconjugated bilirubinemia
165
Dubin Johnson and Rotar result in:
conjugated bilirubinemia
166
most common cause of congenital hypothyroidism
thyroid dysgenesis (not defective thyroxine synth)
167
babies with which abnormality are most likely to develop umbilical hernia?
congenital hypothyroidism ("protruding umbilicus")
168
name features of congenital hypothyroidism
big/protuberant tongue, jaundice, dry skin/constipation, poor feeding, umbilical hernia, enlarged fontanelle. can lead to mental retardation, give levothyroxine
169
causes of meningitis in children
<3 mo: GBS, E coli, Listeria
3 mo - 10 years: N mening, Strep pneumo
>10: N mening
170
which of the dermatophyte infections (tineas) are tx with oral antifungal (terbinafine or itraconazole)
Nails (onychomycosis) and Hair (tinea capitus).
Just like girls, these infxs are high maintenance when it comes to hair and nails. I want to look terbinaFINE when i drink, az(h)ole! (terbinafine = hepatotoxic)
171
why isn't ketoconazole first line for onychomycosis (we use oral terbinafine or itraconazole)
causes Gynecomastia, also can be hepatotoxic
172
Infant was normal until 24 hours when he starts to develop cyanosis and pulse ox that doesnt improve with 100% O2. Murmur is present. Whats going on and whats your next step?
R-L Congenital heart defect. His PDA is closing and leading to cyanosis. Need to kEEp it open so give PGE1 (NOT INDOMETHACIN YOULL KILL HIM)
173
Tx for hereditary spherocytosis (obvi AD condition)
- Supportive care with Folic Acid and blood transfusions during periods of extreme anemia
- Splenectomy if severe or refractory to tx
174
most feared complication after patient gets splenectomy (i.e. spherocytosis)
SEPSIS SEPSIS SEPSIS SEPSIS SEPSIS from encapsulated organisms
175
How long is a splenectomy patient @ risk for sepsis and how do you prevent this?
at least 30 years risk of SEPSIS from encapsulated organisms
- need to give anti-pneumococcal, H flu, and meningococcal vaccines weeks before operation
- need DAILY ORAL PENICILLIN prophylaxis for next 3-5 years!
176
T/F: After a splenectomy, penicillin must be taken daily oral for 1 year
False, it must be taken daily orally for the next 3-5 years!
177
most common pathogen in 15 year old with CF vs 30 year old with CF
<20: Staph Aureus (including pnuemonia)
| >20: Pseudomonas
178
hx of skin infections, what antibiotic needed?
Vanco...think MRSA
179
T/F: If strong suspicion for bacterial meningitis in kid, give antibiotics now and then do LP
False. Try to do LP first if possible because antibiotics will sterilize csf (unless very toxic picture obviously)
180
What's your empiric treatment for bacterial meningitis in a kid?
- Ceftriaxone (or cefotaxime) + Vanc.
| - Most common = Cef covers both Strep pneumo and Neiss, resistant s. pneumo respond to vanc.
181
Specific (nonempiric) tx for peds meningitis
S pneumo: Pencillin or 3rd gen cephalo 10-14 days
N men: Penicillin 5-7 days. Give Rifampin to contacts
HiB: Ampicillin + Dexamethasone. rifampin to contacts
182
subcutaneous emphysema secondary to severe coughing fits in kids. next step?
CXR to r/o pneumothorax
183
T/F: don't use tylenol in kids to treat fever, Reye syndrome risk
False, don't use aspirin (unless kawasaki dz). Reye = hepatic encephalopathy, hypoglycemia, hepatomegaly, coma.
184
Down syndrome kid has this congenital heart defect
complete AV septal defect (endocardial cushion defect, ASD and VSD)
185
DiGeorge kid has congenital heart defect
- Truncus Arteriosus, Transposition of the Great Vessels.
| - Both cause cyanosis but truncus arteriosus kid looks like shit, transposition he looks comfortable
186
PDA is associated with this dz
congenital rubella
187
Cyanosis and severe HF due to Tricuspid Regurg. Triple or quadruple gallop (widely split S1 and S2 with loud S3 and/or S4) + holosystolic murmur at LSB
Ebstein anomaly
188
Who gets coarctation of aorta?
Tina Turner's daughters bahenchod
189
Why might i miss the homocystinuria question?
B/c looks exactly like Marfans: lens subluxation, tall and long extremities, join hyperlaxity, skin elasticity, pectus excavitation, scoliosis.
Unique: Marfans = aortic root dilation, upward lens dislocation, normal intellect
Homo: fair skinned/blue eyes; downward lens; MENTAL RETARDATION; THROMBOSIS = STROKE/PE/MI; high homocysteine and methionine levels, tx w/B6, folate, b12, and anticoags
190
Androgen insensitivity syndrome = 46xy with female phenotype. When should gonads be removed?
AFTER PUBERTY...decrease risk of cancer but allow for adult height potential
191
whats the genotypical and phenotyipcal difference between mullerian agenesis and androgen insensitivity syndrome?
AIS: 46 XY, phenotypically female. (x-linked mutation)
- Has breasts (T converted to E).
- No uterus or vagina (sertoli cells of testes secrete MIF). -Has TESTES (Y chrom has SRY gene = TDF = testis) remove after puberty.
- Absent pubic/axillary hair
Mullerian Agenesis: 46 XX, phenotypically female.
- Has breasts (E)
- Absent/rudimentary uterus and upper vagina; normal OVARIES.
- Normal axillary and pubic hair.
192
T/F: Breastfeeding decreases rates of maternal breast and endometrial cancer
False, decreases rates of BREAST and OVARIAN cancer.
193
Maternal benefits of breast feeding
- less postpartum bleeding, rapid uterine involution
- faster return to prepartum weight
- maternal infant bonding
- decreased risk ovarian and breast cancer
194
infant benefits of breast feeding
- improved immunity!
- improved GI f(x)
- PREVENTION OF OTITIS MEDIA, Resp Illness, Gastroenteritis, UTI
- Decreased risk Necrotizing enterocolitis, T1DM, childhood cancer
195
Maternal contraindications to breastfeeding
- Active untx TB (if 2 weeks of tx can feed)
- maternal HIV
- Herpes on breast
- chemotherapy/radiation
- druggie/alcohol
- specific meds
196
Infant contraindications to breastfeeding
Galactossemia
197
Which infant could get Isoimmune-mediated hemolysis (ABO incompatibility): A+ or A-
A- bruh
198
Why does squatting improve tet spell in tet fallot patients?
the problem is cyanosis due to RVOT. Squatting increases systemic afterload, which increases pulmonary blood flow and improves hypoxemia.
199
Parents asks about breastfeeding, need to supplement and when her baby can have cows milk and pureed veggies. how do you response?
- Recommend exclusive breastfeeding first 6 months, which needs supplementation of 400 units vit D started w/in 1st month of life.
- pureed foods at 6 months. first fruits and veggies before meat
- at 12 months, introduce cows whole milk
200
Parents ask if their infant will get iron deficiency anemia. Response?
Increased risk if:
- mom had IDA
- getting cows whole milk before 12 months
- premature
- ->can supplement Iron (on top of the vit d for breastmilk) if develop IDA
201
best initial test CF
sweat chloride. (vs most accurate test is genetic analysis)
202
Tx for Kawasaki
IVIg!!!! and aspirin
203
Features of Kawasaki
<5yo, fever for >5 days plus 4 of the following:
- bilateral conjunctivitis w/o exudate
- oral erythema/strawberry tongue/dry and cracked lips
- erythema/swelling of hands; desquamation of fingertips 1-3 weeks after onset
- nonvesicular rash
- cervical lymphadenitis
204
complications of kawasaki dz
-Coronary artery aneurysm
-myocarditis/pericarditis
-MI
HEART HEART HEART HEART
205
which 3 year old is most at risk of coronary artery aneurysm? and what medications do they usually receive?
Kawasaki dz kids tx with IVIg and Aspirin. NOT. STEROIDS. SON. DONT. WORK.
206
T/F: Kawasaki dz is tx with aspirin and steroids
False, aspirin and IVIg jignesh
207
Criteria for juvenile idiopathic arthritis
```
SYMMETRICAL ARTHRITIS at least 6 weeks
(>5 joints means polyarticular)
-elevated CRP and ESR
-ANEMIA
-High Platelets man (thrombocytosis)
-HYPERgammaglobulinemia
-HYPERferritinemia
```
208
Precocious puberty: LH/FSH in central vs peripheral
Central: High. Get CT/MRI to r/o tumor even if no mass effect sxs
Peripheral: Low. CAH is an example of peripheral.
209
girl that hasnt menstruated has no uterus and normal ovaries. what does she have and what other findings would there be?
Mullerian agenesis. normal breast and pubic hair development. no cervix or upper vagina. labia, clitoris, ovaries (external genitalia and gonads) are normal.
210
T/F: Amoxicillin is used for strep and staph
False, its used for STREP (pneumo) and others
211
top 3 causes of bacterial sinusitis (most cases are viral)
STREP PNEUMO, H FLU, MORAXELLA (not staph! usually does chronic)
212
cause and tx of nocturnal perianal pruritis in kids
Enterobius vermicularis;
| tx with Albendazole, or pyrantel pamoate
213
tx for patient with megacolon/megaesophagus + RBBB/cardiomyopathy
Chagas dz: benznidazole
214
T/F: Meconium ileus and hirschsprungs are both associated with downs
False. Mec ileus = Cystic Fibrosis; Hirschsprungs = downs. BROOOOOOOOOO
215
difference btwn hischsprungs and meconium ileus
H: Downs; Rectosigmoid obstruction; Normal mec consistency; + squirt sign
MI: CF; Ileum obstruction; Insippated mec; - squirt sign look for future Sinopulmonary dz (sinusitis)
216
FTT, bilateral cataracts, jaundice, hypoglycemia, convulsions in an infant
Galactossemia = Galactose-1-P UDT def. Increased risk for E coli neonatal sepsis
217
Why is a baby born at home having easy bruising/bleeding/echhymoses?
Didn't receive vit K injection that everyone gets at birth
218
kid with chronic oligoarthritis, daily fevers, rash that worsens with the fever. Joint pain and stiffness worse in the morning. leukocytosis, thrombocytosis, elevated inflammatory markers.
Juvenile idiopathic arthritis (systemic)
219
HUS triad
- microangiopathic hemolytic anemia
- thrombocytopenia
- AKI
220
When do you start the tx of clubfoot in an infant?
Immediately!
"equinus and varus of the calcaneum and talus, varus of the midfoot, adduction of forefoot"
--> Stretching/manipulation of the foot, followed by serial casting. surgical tx btwn 3-6 months if this doesnt help.
221
Kid comes in with a cat bite. management?
-irrigation
-since deep puncture, need ABx: Pick Augment (amox-clav)
-avoid closure. possible tetanus
(vs human/dog bites...can just observe)
222
most common syndromic cause of gynecomastia
Klinefelters (47XXY)
223
What is hemihyperplasia associated with?
Beckwidth-Wiedemann. Also has macroglossia, omphalocele, and hyperinsulinism
224
Think of this syndrome as "multi-organ enlargement"
Beckwidth Widemann
- macrosomia, macroglossia, large kidneys, pancreatic beta cell hyperplasia (hypoglycemia)
- hemihypertrophy
- risk of abdominal tumors
225
what followup is required in a patient with Beckwidth Wiedamnn?
look for abdominal tumors: WILMS TUMOR and hepatoblastoma. do AFP and US every 6mo until 6 years old
226
how do you make the dx of the most common malignancy in kids?
Acute Lymphoblastic Leukemia (ALL)
| -->have to get a BM bx and >25% lymphoblasts confirms the dx
227
laryngomalacia is due to ____ and causes ___
increased laxity of the supraglottic structures; inspiratory stridor worse in the supine position, usually babies 4-8mo
228
Most cases of rhinosinusitis are viral. What makes you think its bacterial?
Any of the following:
- persistent sxs >10 days w/o improvement
- severe sxs, fever>102, purulent nasal discharge
- face pain>3 days
- worsening sxs >5 days after initially improving after viral URI
229
who is the most likely to get cerebral palsy?
Premature infants baba
230
T/F: Only kids are affected by rubella
FALSE; ADULTS GET JOINT PAIN JOINT PAIN JOINT PAIN JOINT PAIN JOINT PAIN JOINT PAIN. + fever and cephalocaudal rash
231
why does kiddo with a loud machine like murmur have leukocoria (white pupillary reflex)
congenital rubella --> CATARACTS
232
most common complication of Sickle Cell trait, which is generally asx
Painless hematuria (sickling in the renal medulla)
233
kid comes in with episodes of inconsolable crying but its totally fine in between. Has some emesis and abnormal stools. He is lethargic. What's your next step in mgmt? Vitals look ok.
Thinking INTUSSUSCEPTION.
- ->may be associated with recent viral/GI infx, or reason to have a lead point
- ->need AIR ENEMA (US guided) or saline enema; can get an xray to r/o obstruction
its a surgical emergency
234
signs of platelet disorders vs coag factor disorders
Platelet: Easy mucosal bleeding, petechiae, echhymoses
Coag: Hemarthroses, hematomas (so Hemophilia has the H's)
235
risk factors for developing celiac (duodenal bx shows increased intraepithelial lymphocytes and flattened villi)
- DM1
- Downs
- selective IgA def
- autoimmune thyroiditis
- 1st degree relative
236
mesonephros and paramesonephros
mesonephros gives rise to male parts (seminal vesicles, epididymitis, vas deferens)
paramesonephros fills out the pussy (uterus, vagina, fallopian tubes)
237
____ tumor arises from metanephros
Wilms. (precursor for renal parenchyma)
238
Where does neuroblastoma arise from?
Neural crest cells.
| +VMA, HVA in urine. Calcifications/hemorrhage seen on xray
239
3 most common cancers in kids
1. Leukemia
2. CNS tumors
3. Neuroblastomsa (adrenal medulla. most common extracranial solid tumor in kids)
240
How do you evaluate a patient with primary amenorrhea?
1. Pelvic Exam/US
a. No uterus: Get karyotype.
46XX = mullerian agenesis, 46XY = AIS
b. Uterus present: Get FSH level.
Increased: get karyotype. Decreased: Cranial MRI.
241
Duodenal atresia and ____ _____ will both present the same: ____ _____ on xray, but theres no ____ _____. Duodenal associated with Downs, whereas the other is not. Both will have Polyhydramnios and bilious vomiting and need surgery.
Annular pancreas. Double Bubble on xray but No Distal Air
242
Duodenal Atresia = double bubble + no distal gas vs
______ = double bubble + normal gas
(both = bilious vomiting)
Malrotation --> normal gas b/c it happens very late in development. i.e. will have a normal pregnancy/all screening and prenatal work was good.
243
DDx of double bubble sign on baby gram (xray)
- Duodenal atresia and annular pancreas (no distal gas)
| - Malrotation (normal gas) and volvulus
244
How does intestinal i.e. jejunal atresia present?
Triple (or double) bubble sign + multiple air-fluid levels.
| -->Mom doing COCAINE...vascular accident in utero. needs surgery.
245
T/F: Pyloric stenosis typically presents within first 24 hours
false, usually starts around weeks 2-8
| -->Make sure you CORRECT ELECTROLYTES before surgery (hypochloremic hypokalemic metab alk)
246
Non-bilious emesis on day 0-1 with gurgling and bubbling. Imaging shows NG tube that coils.
```
Tracheoesophageal fistula (may have atresia or fistula present)
Tx: Parenteral nutrition + surg
```
247
Which Histamine blockers are good for allergy vs GERD
Allergy (H1 blockers: Cetirizine, Fexofenadine, Loratadine; Diphenhdramine (drowsy)
H2 (GERD): Ranitidine, famotidine, cimetidine. (don't confuse loratadine/fexofenadine as h2).
"Cim-ran's fam has GERD"
248
If baby has imperforate anus (no hole), whats next?
This is why you don't take temp rectally at first.
-Look for VACTERL (esp heart and esophageal defects)
-do upside down baby gram to see how far gas goes
either reanastomose or colostomy.
249
chronic constipation or failure to pass meconium, + squirt sign. Dx?
<1 mo old: Barium Enema
>1 mo old: Anorectal manometry
Confirm with Full thickness bx
250
baby with constipation, no prenatal screen, xray shows dilated loops of bowel, barium swallow shoes micro-colon distal to obstruction. Dx/Tx: Gastrogafin enema
Meconium ileus
| vs hirschsprung shows dilated colon with distal normal looking colon
251
Tx for AOM
Amoxicillin
| if allergic, Azithromycin
252
Tx for strep pharyngitis (if rapid strep test is + or CENTOR >4)
Amoxicillin-Clavulanate
| vs most URIs are just Amoxicillin, with Azithro if pen all
253
CENTOR criteria
```
+1: Fever
+1: Exudates
+1: absence of cough
+1<15
-1>44
<1 = no tx (viral, 2-3 culture/rapid strep, >4 tx Augmentin
```
254
Tx, things to look for in necrotizing enterocolitis
NPO now! TPN and IV antibiotics
| -->look out for other complications of prematurity: Retinopathy of prematurity, ARDS, Intraventricular hemorrhage
255
T/F: Both septic hip and transient synovitis will have fever
False, Transient synovitis occurs 1 week AFTER URI so no longer has fever
256
teenager who develops colicky flank pain after drinking alcohol or getting diuresis
Ureteropelvic J(x) obstruction: narrowing of lumen, only problematic w/high flow state. Dx with IV Pyelogram.
257
contant leak of urine in girls as well as normal bladder f(x). US shows no hydronephrosis. VCUG shows no VUR. Boys are mainly asx.
Low Implantation of Ureter (the other one is normal).
258
T/F: Low APGAR scores indicate future pulmonary and neurological risk
False, does not predict outcomes
259
Hypsarrythmia is associated with:
- West syndrome (juvenile epilepsy): Treat with ACTH
| - Neuroblastoma: Look for "dancing eyes, dancing feet" opsoclonus myoclonus
260
cyanosis with feeds (newborn). coughing/frothing. dz and f/u
```
Esophageal Atresia (IE with TEF)
-->commonly develop aspiration pneumonia
```
261
painless rectal bleeding/hematochezia in a male <2 years old
Meckels
262
premie with vomiting/abdominal distention/fever +/- blood in stool. CXR finding and Tx?
Nec enterocolitis: air in the bowel wall (pneumatosis intestinalis)
Tx: STOP FEEDS, need IV fluids now and NG tube for decompression/feeds
