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Step 2 UWORLD > Peds > Flashcards

Peds Flashcards

1
Q

abdominal wall defect to the right of the cord insertion, not covered by membrane or skin “free floating”

A

Gastroschisis

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2
Q

abdominal wall defect at linea alba, covered by skin

A

umbilical hernia

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3
Q

midline abdominal wall defect, covered by peritoneum

A

omphalocele

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4
Q

How is gastroschisis (free floating, exposed bowel) managed after delivery?

A
  1. Covered with sterile saline dressings and plastic wrap (minimize heat/fluid loss)
  2. NG tube
  3. Antibiotics
  4. Prompt surgical repair
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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

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6
Q

Which abdominal wall defect is correlated with increased maternal AFP?

A

Gastroschisis (note: so NOT Down’s syndrome/neural tube defect)

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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

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8
Q

When is someone considered to have immunity to Varicella?

A

2 doses of vaccine (2nd @ 4 years) or previous infection

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9
Q

Post-exposure prophylaxis for varicella (chickenpox)

A

A. Immune (prior infection/2 doses vaccine by age 4): observation

  1. No immunity and immunocompetent: VACCINE
  2. No imm., immunocompromised: IVIG
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10
Q

Most common complication of Mumps

A

Aseptic Meningitis

Mumps will present with fever + parotitis, “swelling of cheeks

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11
Q

findings of all TORCH (congenital) infections

A
  • hepatosplenomegaly
  • IUGR
  • Jaundice
  • blueberry muffin spots
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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

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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)

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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

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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

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16
Q

EEG: 3 Hz spike and wave discharges

A

Absence seizure

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17
Q

Guillain-Barre involves:

A

demyelination of the peripheral schwann cells

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18
Q

most common complications of meningitis

A 
HEARING LOSS
cerebral palsy
intellectual disability or developmental REGRESSION
epilepsy 
SIADH (monitor Na+)
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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.

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20
Q

features of absence seizure

A
  • less than 20 seconds/episode
  • automatisms usually
  • provoked by hyperventilation
  • postural tone preserved
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21
Q

differential for T-wave inversion

A

MI, Myocarditis (i.e. Coxsackie, Friedreich ataxia), old pericarditis, digoxin toxicity, myocardial contusion

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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

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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
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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.

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25
Q

Classic triad of brain abscess

A
  • 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

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26
Q

DDx of marfanoid habitus

A

Marfans: AD; Aortic root dilatation; upward lens dislocation…NORMAL INTELLECT

Homocystinuria: AR; Thrombosis; downward lens dislocation, Megaloblastic Anemia…DISABLED INTELLECT

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27
Q

Disadvantages of Pulse ox (taken @ fingertip, earlobe, or foot in infants)

A
  • does NOT give info about Ventilation

- inaccurate if extremity is cold, calloused, or moving

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28
Q

Presentation of carotid artery dissection

A

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

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29
Q

Brain tumor that causes bitemporal hemianopsia and endocrinopathies

A

Craniopharyngioma…compresses optic chiasm (might start running into furniture etc) and pituitary, can get GH def or Diabetes insipidus

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30
Q

where are most medulloblastomas found?

A

cerebellar vermis…truncal ataxia

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31
Q

side effect of hydroxyurea

A

Myelosuppression

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32
Q

Acute drop in hemoglobin, low reticulocyte (<1%), and no splenomegaly in sickle cell patient

A

Aplastic Crisis…usually due to Parvo b19

…get fatigue, pallor, and f(x)nal systolic murmur

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33
Q

Pt with cystic fibrosis + epistaxis /easy bruising

A

VITAMIN K DEFICIENCY

…CF = pancreatic insuff = def of fat-soluble vitamins = vit k deficiency

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34
Q

why are sickle cell patients predisposed to folate deficiency?

A

the chronic hemolysis of SCD = bone marrow tries to make new rbcs to compensate for the anemia = lower folate

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35
Q

Iron def anemia and alpha and beta thal are all microcytic anemias. What are the RDWs?

A

Normal in thal.

Increased rbc distribution width in Iron Def Anemia

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36
Q

Which anemia caused by excessive consumption cow’s milk (>24 oz /day)?

A

Iron deficiency anemia

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37
Q

Appearance in Fanconi anemia

A
  • short stature
  • microcephaly
  • abnormal thumbs, low set ears, strabismus
  • hypogonadism
  • hypopigmentation of skin, cafe au lait, large freckles
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38
Q

A congenital condition dx by chromosomal breaks on genetic analysis that causes aplastic anemia in children

A

Fanconi anemia…mutation of NHEJ chrom repair (also mutated in ataxia-telangiectasia)

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39
Q

Most common cancer of childhood, when its going to present and in who, how to dx

A

ALL
Age: 2-6
Boys, Down syndrome,
Dx: BONE MARROW BIOPSY. presence of >25% lymphoblasts (on biopsy) is diagnostic.

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40
Q

**Pt with hereditary spherocytosis is going to undergo splenectomy, how long will they be @ enhanced risk of pneumococcal sepsis?

A
  • *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
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41
Q

Brain tumor that can cause Parinaud (limited upward eye gaze, upper eyelid retraction, pupils dont react to light but to accomodation)

A

Pinealoma

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42
Q

What’s the expected triad of HUS?

A
  • microangiopathic hemolytic anemia
  • thrombocytopenia
  • acute kidney injury
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43
Q

Meconium ileus is dx’ic for:

A

Cystic fibrosis

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44
Q

If you suspect lead poisoning in a child, they give you Hgb, hct, and capillary lead level that is high, what is next step?

A

You can’t just initiate tx. HAVE TO MEASURE VENOUS LEAD LEVEL.
If moderate, give DMSA.
If severe, Dimercaprol + EDTA.

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45
Q

In whom is rotavirus contraindicated?

A

Hx of Intussuseception due to increase risk with vaccine. , also uncorrected meckels, or SCID.

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46
Q

when do you expect a child to complete potty training?

A

Age 5…no intervention for bed wetting earlier than this

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47
Q

by 12 months, childs weight should _____ and height should _____

A

weight: triple
height: increased 50%

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48
Q

How can you differentiate transient synovitis from Legg-Calve-Perthes?

A

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)

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49
Q

Signs of Iron poisoning

A
  • 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
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50
Q

Maneuvers that decrease murmur intensity in HCM

A

ones that increase preload or afterload (squatting, leg raise, hand grip) = increased LV cavity size = decreased outflow obstruction

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51
Q

Manuevers that increase murmur intensity in HCM

A

ones that decrease preload (Valsalva, abrupt standing, amyl nitrate admin) = worsening LVOT = increase murmur

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52
Q

where are most intussusceptions?

A

Ileo-cecal.

Exception = Henoch Schonlein Purpura –> Ileo-ileal

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53
Q

Tx for ileo-cecal intussusceptions

A

Air or contrast enema

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54
Q

What will you hear on cardio exam in Tetrology of Fallot?

A
  • Harsh, systolic ejection murmur at LSB

- Single S2 (stenotic pulm valve)

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55
Q

Most common congenital defect in Down’s

A

Complete AV septal defect

failure of endocardial cushion merging = both ASD and VSD + common AV valve due to poor mitral/tricuspid development

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56
Q

Hypogonadotropic hypogonadism + anosmia (inability to smell)

A

Kallman Syndrome

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57
Q

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.

A

Kallman Syndrome

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58
Q

Single S2 heart sound

A

Transposition of great vessels
tetrology of fallot
tricuspid atresia
truncus arteriosus

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59
Q

Most common congenital cyanotic heart condition in the neonatal period:

A

Transposition of the great vessels

–>Prostaglandins should be initiated to promote mixing of the blood

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60
Q

most common triggers of myocarditis

A

Viral: Coxsackie and Adenovirus

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61
Q

most serious sequalae of Kawasaki

A

Coronary artery aneurysm

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62
Q

Clinical signs of Kawasaki

A

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

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63
Q

Most life-threatening finding in Marfans

A

Aortic root dilation

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64
Q

cardiac anomalies of turners syndrome

A

Bicuspid aortic valve>coarctation of aorta>aortic root dilation.

Get 4-extremity BPs and Echo in all Turners pts

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65
Q

murmur in Edwards syndrome

A

holosytolic from VSD

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66
Q

3 P’s of McCune Albright Syndrome

A

Precocious puberty
Pigmentation (cafe-au-lait spots)
Polyostotic fibrous dysplasia (multiple fractures)

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67
Q

Low set ears, micrognathia, cleft palate; cardiomegaly; absence of thymic shadow; cyanotic, hypoxic despite O2, truncus arteriosus

A

DiGeorge: Abnormal facies + thymic hypoplasia (absence of sailors signs) + congenital heart disease. Look out for hypocalcemia and viral/fungal infections

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68
Q

Who gets screened for chlamydia and neisseria gon?

A

ALL sexually active women under 24 years old by NAAT

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69
Q

most common causes of acute and chronic stridor

A

Acute: Croup, Foreign body (incidence epiglottitis low after vaccine)
Chronic: Laryngomalacia (inspiratory, worse when supine), Vascular Ring (biphasic, improves with neck extension)

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70
Q

<1yo, respirtory (stridor, wheezing) + esophageal (dysphagia, vomiting) sxs. Stridor is often biphasic and improves with neck extension.

A

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)

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71
Q

chronic inspiratory stridor due to collapse of the supraglottic structures during inspiration, improves with prone position

A

Laryngomalacia

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72
Q

why are pts with Turners at increased risk for osteoporosis?

A

No ovaries (“streak ovaries) = Estrogen deficient. Estrogen normally inhibits osteoclast-mediated bone resorption

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73
Q

Tx for HUS

A

DIALYSIS + transfusions. No antibiotics, no platelets, no antitoxin

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74
Q

T/F: Henoch-Schonlein purpura presents with thrombocytopenia

A

False

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75
Q

Manifestations of Friedreich Ataxia (3 domains)

A

Neuro: Ataxia, Dysarthria
Skeletal: Hammer toes, scoliosis
Cardiac: Concentric hypertrophic cardiomyopathy (cardiomyopathy = most common cause of death)

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76
Q

Pharmalogical treatment for QT prolongation

A 
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
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77
Q

GI Manifestations of Henoch-Schonlein Purpura

A

Intussusception (ileo-ileal), also GI hem is possible

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78
Q

When should gonads be removed in crypotarchidism?

A

AFTER PUBERTY. Risk of malignancy is relatively low but they need to be removed, but can do this after beneficial gonad-driven puberty

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79
Q

Most common cause of congenital hypothyroidism

A

Thyroid dysgenesis

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80
Q

Abdominal swelling discovered incidentally, i.e. while bathing a child

A

Wilms tumor (vs neuroblastoma usually found due to sxs)

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81
Q

Syndromes associated with Wilms tumor

A

BECKWIDTH-WEIDMAN!

Also, WAGR = Wilms, Aniridia (absence of iris), GU abnormality, mental Retardation

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82
Q

Most common cause of vaginal bleeding in neonatal period

A 
hormone withdrawal (estrogen). self limitied/no tx
Note: neonatal chlamydia causes conjunctivitis/pneumonia, but not vaginal discharge
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83
Q

T/F: UTI is due to poor hygiene; Pyelo is due to ascending infection

A

False. BOTH are due to Ascending infection….for UTI, this means from bacteria from vagina ascend urethra to bladder

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84
Q

____ is associated with osmotic diuresis that depletes total body K+ stores, even though serum K+ may be elevated

A

DKA

insulin normally puts K intracellularly; excess glucagon in DKA causes diuresis

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85
Q

maternal estrogen effects in newborns

A

-breast hypertrophy
-swollen labia
-leukorrhea (white discharge)
-uterine withdrawal bleeding
No work up needed

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86
Q

______ is a major risk factor for membranous nephropathy in kids

A

active Hep B Infection

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87
Q

T/F: Constitutional short stature, which will ultimately resolve after delayed puberty/growth spurt, will show normal bone age right now

A

False. Will show reduced bone age

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88
Q

what would renal biopsy show in someone with HSP showing renal manifesations?

A

IgA deposition in mesangium

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89
Q

Patient with anovulatory cycles (q4mo) presents with 3 days heavy vaginal bleeding. Management?

A

Tx with High-dose OCP –> this stabilizes the endometrium and stops the bleeding

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90
Q

Tx options for strabismus (which is abnormal after 4mo age)

A
  • Penalization: cycloplegic drops to blur normal eye
  • Occlusion: patch over normal eye
  • prescription eyeglasses
  • surgery
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91
Q

How to differentiate hearing impairment and ADHD?

A

Similar features of having problems at home and school, but ADHD normally doesn’t have delayed language skills

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92
Q

most common cause hearing impairment

A

conductive hearing loss due to repeated ear infections

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93
Q

Mgmt of nephrotic syndrome in kids

A

First assume its MCD unless other suspicions, and tx with empiric steroids BEFORE doing any kind of renal biopsy or workup

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94
Q

Inspiratory stridor that is worse when supine, improved when sitting up

A

Laryngomalacia aka floppy supraglottic strucs. Visualize with laryngoscopy. Can reassure in most cases (spontaneous resolution by 18mo)

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95
Q

T/F: Posterior urethral valves occur in boys=girls

A

false, only occurs in males

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96
Q

T/F: Cystic fibrosis does not cause pancreatitis>infertility

A

False. >95% males will have infertility!! (due to congenital bilat absence of vas deferens due to fetal accum of inssipated mucus).
10% have pancreatitis.

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97
Q

Tx for tinea capitis (causes alopecia)

A

ORAL griseofulvin or terbinafine (topical doesn’t cut it for scalp)

Its a dermatophyte infection, usually Trichophyton tonsurans

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98
Q

how would renal papillary necrosis present?

A

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.

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99
Q

Can chronic constipation in young kids cause UTI?

A

Yes, stool in the vault presses on bladder = urinary stasis. Will say “cries with urination”

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100
Q

risk factors for ARDS

A
  • Prematurity
  • Maternal DIABETES: delays surfactant maturation…maternal hyperglycemia = fetal hyperglycemia = fetal hyperinsulinemia –>insulin antagonizes cortisol and blocks maturation of sphingomyelin
  • C/s
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101
Q

hypochloremic hypokalemic metabolic acidosis

A

pyloric stenosis

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102
Q

jaundice, FTT, hepatomegaly few days after birth after breast milk or formula

A

Galactossemia

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103
Q

reccurent pulm/sinus/GI infections, association with atopic triad and autoimmune dz, anaphylaxis during transfusions

A

Selective IgA deficiency

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104
Q

If you cant use Doxycycline for Lyme disease, what would you use?

A

Amoxicillin or Cefuroxime. IV Ceftriaxone if terrible. Esp in kids (dont wanna use Doxy <8)

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105
Q

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

A

Growing pains! normal

106
Q

tx for pyloric stenosis

A

CORRECT ELECTROLYTE ABNORMALITIES (K, Cl, H) PRIOR TO SURGERY

107
Q

most common predisposing factor for bacterial sinusitis in kids

A

Viral URI (mucosal inflam from viral illness prevents mucociliary clearance of bacteria)

108
Q

fever, nasal congestion, rhinorrhea, purulent discharge, cough for >10 days in kids

A

bacterial sinusitis

109
Q

first line tx of bacterial sinusitis

A

Augmentin (amox-clavulanic)

110
Q

6 year old boy with hip or knee pain

A

LCP!!! (ages 4-10, boy, avascular (osteo) necrosis of femoral head). Antalgic gait: shorter time weight bearing on painful side

111
Q

puberty age kiddo with hip or knee pain, obese

A

SCFE

112
Q

dz results from failure of __ cell development; small/absent lymphoid tissue; recurrent sinopulmonary and GI infxs after 6mo age (maternal antibody protection wanes)

A

X-linked agammaglobulinmia. Tx with IV immunoglobulins

113
Q

dz results from ____ deficiency; severe, recurrent viral, fungal and bacterial infections and FTT

A

SCID. Can be from adenosine deaminase deficiency or

114
Q

Failure of oxidative burst results in this dz and predisposition to infections by:

A

Catalase + organisms (Staph, e coli, Candida, Pseudomonas, nocardia, aspergillus, listeria, serratia)

Chronic Granulomatous Disease

115
Q

Complement deficiency = increased risk of _____ infections

A

encapsulated bacteria

116
Q

3 bacteria AOM

A

strep
nontypeable H flu
Moraxella

117
Q

tx for AOM

A

10 day amoxicillin. 2nd line is amox-clav

118
Q

kid pulling on ear, fussy, bulging erythematous TM with dec mobility on air compression

A

classic AOM

119
Q

t/f: UGI series findings of ligament of treitz on left side of abdomen and corkscrew pattern indicate malrotation

A

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
Q

baby comes in with bilious emesis. next steps?

A

cessation of feeds, NG tube for decompression, IV fluids. First due Xray to r/o pneumoperitoneum

121
Q

gold standard for dx of malrotation

A

UGI series

122
Q

hirschprung, meconium ileusand intussusception are evaluated with

A

contrast enema

123
Q

bronchiolitis presentation

A

<2 years old, fall/winter, wheezy cough, uri, fever, tachypnea. can lead to apnea

124
Q

big indicators of precocious puberty

A

Girl <8, Boy <9 and bone age advanced

125
Q

Precocious puberty based on LH levels

A

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
Q

why is central precocious puberty (gonadotropin dependent/high LH) treated with GnRH agonist?

A

To prevent premature epiphyseal plate fusion and thus get full adult height potential. must get MRI before tx to r/o tumor

127
Q

angelman and prader-wili genotypes

A

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
Q

elfin facies, friendly af, hypercalcemia, heart problems, very friendly with strangers

A

Williams (chrom 7q deletion)

129
Q

Manuevers that ____ return of blood to heart reduce the intensity of innocent murmurs

A

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
Q

most worrisome complication of Marfan’s

A

aortic root dilation

131
Q

What else is seen in Henoch-schonlein except for palpable purpura? (

A
  • 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
Q

IgA mediated vasculitis of the small vessels

A

Henoch-Schonlein purpura

133
Q

normal genotype, failure of puberty, short stature, can’t smell

A

Kallman Syndrome: Hypogonadotropic hypogonadism

134
Q

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

A

Klinefelter’s (47 XXY). Tx w/Testosterone

135
Q

Female phenotype, male genotype, no ovaries

A

AIS or 5alpha reductase deficiency

136
Q

genetic short stature vs constitutional growth delay

A

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
Q

Tx of hip pain in a fat 14 year old

A

surgical pinning of his SCFE

138
Q

How can you differentiate between gonococcal and trachomatal conjunctivitis in newborn?

A

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
Q

T/F: Baby with breastfeeding jaundice spread on his face, arms and full chest (~15) needs phototherapy

A

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
Q

How much is consider enough in terms of baby feeds during first month of life?

A

8-12x/day (ever 2-3 hours) for >10-20 minutes/breast during 1st month

141
Q

who gets transposition of the great vessels?

A

infant of diabetic mother

142
Q

Why does tetralogy of fallot have harsh crescendo-decrescendo murmur?

A

Pulmonary stenosis (RV outflow obstruction). murmur at upper LSB. this is most important for prognosis

143
Q

well-appearing neonate age 2-8 weeks has painless bloody stools. Fhx of allergies, eczema, or asthma.

A

milk or soy protein induced colitis. give formula, or have mom eliminate milk and soy from her diet.

144
Q

joint pain, rash, fever 1 or 2 weeks after antibiotic initiation, usually beta lactams (penicillins, cephalosporins) or bactrim. . Type 3 hypersensitivity.

A

serum sickness like rxn. hepatitis b and c patients increased risk but can happen to anyone even peds.

145
Q

why are newborns without a thymus and cleft palate at risk for tetany, seizures and arrythmia?

A

DiGeorge syndrome: parathyroids are fucked = severe hypocalcemia. Also, get an ECHO b/c patients probs have Truncus arteriosus.

146
Q

risk factors for necrotizing enterocolitis

A

prematurity, very low birth weight, congenital heart disease (i.e. DiGeorge pt, any congenital heart defect), formula feeding

147
Q

whats the leading cause of death in the NICU?

A

necrotizing enterocolitis. stop feed, decompress, antibiotics.

148
Q

CXR shows pockets/cysts of air throughout bowel in premature infant with bloody stools. “air (gas cysts) within the bowel wall”

A

pneumatosis intestinalis: classix xray finding for Necrotizing Enterocolitis

149
Q

newborn with heart defect, premature, bloody stools, abdominal distention, feeding intolerance.

A

necrotizing enterocolitis

150
Q

blue/gray macules on back/butt/thighs/presacral area in black, hispanic, asians, called ______, are benign and disappear by _____

A

Mongolian spots. within a few years, can last up to 10 years old

151
Q

blue/gray macules on back/butt/thighs/presacral area in black, hispanic, asians, called ______, are benign and disappear by _____

A

Mongolian spots. within a few years, can last up to 10 years old

152
Q

why is cystic fibrosis patient who stopped taking medications having easy bruising and epistaxis? lab abnormality?

A

Malabsorption of fat soluble = no vit k = no factor 2, 7, 9, 10, = increased PT

153
Q

Tx for ITP

A

Kids: Just petechiae/skin - observe; bleeding - IVIg/steroids

Adults: Plt<30k or bleeding - IVIg/steroids.

154
Q

most common predisposing factor for orbital cellulitis

A

bacterial sinusitis

155
Q

preseptal or orbital cellulitis: opthalmoplegia, pain, vision changes

A

orbital

156
Q

port wine stain, seizures, tram track calcifications, mental retardation, glaucoma

A

Sturge Weber. eval for glaucoma and give anti-seizure

157
Q

What diseases would you expect in the hx of a patient with pseudogout?

A

Hemochromatosis, hyperparathyroidism, acromegaly, or hypothyroidism
(calcium pyrophosphate deposition, involving knee and wrist)

158
Q

genetic cause of retinoblastoma

A

Inactivation of Rb tumor suppressor gene

159
Q

complications of retinoblastoma

A
  • highly malignant cancer: Liver and brain mets!

- strabismus, dec vision, eye pain, glaucoma, orbital cellulitis

160
Q

initially well newborn develops acholic stools, dark urine and jaundice in first 2 months of life, with hepatomegaly. Lab shows conjugated bilirubinemia

A

Biliary Atresia

161
Q

most common indication for pediatric liver transplant

A

biliary atresia

162
Q

evaluation of kiddo suspected of biliary atresia (initially well appearing develops CB jaundice/hepatomegaly in first 2 months)

A

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
Q

Tx of biliary atresia

A

Kasai procedure = Hepatoportoenterostomy. Ultimately need liver transplant

164
Q

Criggler Najjar and Gilberts results in:

A

unconjugated bilirubinemia

165
Q

Dubin Johnson and Rotar result in:

A

conjugated bilirubinemia

166
Q

most common cause of congenital hypothyroidism

A

thyroid dysgenesis (not defective thyroxine synth)

167
Q

babies with which abnormality are most likely to develop umbilical hernia?

A

congenital hypothyroidism (“protruding umbilicus”)

168
Q

name features of congenital hypothyroidism

A

big/protuberant tongue, jaundice, dry skin/constipation, poor feeding, umbilical hernia, enlarged fontanelle. can lead to mental retardation, give levothyroxine

169
Q

causes of meningitis in children

A

<3 mo: GBS, E coli, Listeria
3 mo - 10 years: N mening, Strep pneumo
>10: N mening

170
Q

which of the dermatophyte infections (tineas) are tx with oral antifungal (terbinafine or itraconazole)

A

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
Q

why isn’t ketoconazole first line for onychomycosis (we use oral terbinafine or itraconazole)

A

causes Gynecomastia, also can be hepatotoxic

172
Q

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?

A

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
Q

Tx for hereditary spherocytosis (obvi AD condition)

A
  • Supportive care with Folic Acid and blood transfusions during periods of extreme anemia
  • Splenectomy if severe or refractory to tx
174
Q

most feared complication after patient gets splenectomy (i.e. spherocytosis)

A

SEPSIS SEPSIS SEPSIS SEPSIS SEPSIS from encapsulated organisms

175
Q

How long is a splenectomy patient @ risk for sepsis and how do you prevent this?

A

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
Q

T/F: After a splenectomy, penicillin must be taken daily oral for 1 year

A

False, it must be taken daily orally for the next 3-5 years!

177
Q

most common pathogen in 15 year old with CF vs 30 year old with CF

A

<20: Staph Aureus (including pnuemonia)

>20: Pseudomonas

178
Q

hx of skin infections, what antibiotic needed?

A

Vanco…think MRSA

179
Q

T/F: If strong suspicion for bacterial meningitis in kid, give antibiotics now and then do LP

A

False. Try to do LP first if possible because antibiotics will sterilize csf (unless very toxic picture obviously)

180
Q

What’s your empiric treatment for bacterial meningitis in a kid?

A
  • Ceftriaxone (or cefotaxime) + Vanc.

- Most common = Cef covers both Strep pneumo and Neiss, resistant s. pneumo respond to vanc.

181
Q

Specific (nonempiric) tx for peds meningitis

A

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
Q

subcutaneous emphysema secondary to severe coughing fits in kids. next step?

A

CXR to r/o pneumothorax

183
Q

T/F: don’t use tylenol in kids to treat fever, Reye syndrome risk

A

False, don’t use aspirin (unless kawasaki dz). Reye = hepatic encephalopathy, hypoglycemia, hepatomegaly, coma.

184
Q

Down syndrome kid has this congenital heart defect

A

complete AV septal defect (endocardial cushion defect, ASD and VSD)

185
Q

DiGeorge kid has congenital heart defect

A
  • Truncus Arteriosus, Transposition of the Great Vessels.

- Both cause cyanosis but truncus arteriosus kid looks like shit, transposition he looks comfortable

186
Q

PDA is associated with this dz

A

congenital rubella

187
Q

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

A

Ebstein anomaly

188
Q

Who gets coarctation of aorta?

A

Tina Turner’s daughters bahenchod

189
Q

Why might i miss the homocystinuria question?

A

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
Q

Androgen insensitivity syndrome = 46xy with female phenotype. When should gonads be removed?

A

AFTER PUBERTY…decrease risk of cancer but allow for adult height potential

191
Q

whats the genotypical and phenotyipcal difference between mullerian agenesis and androgen insensitivity syndrome?

A

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
Q

T/F: Breastfeeding decreases rates of maternal breast and endometrial cancer

A

False, decreases rates of BREAST and OVARIAN cancer.

193
Q

Maternal benefits of breast feeding

A
  • less postpartum bleeding, rapid uterine involution
  • faster return to prepartum weight
  • maternal infant bonding
  • decreased risk ovarian and breast cancer
194
Q

infant benefits of breast feeding

A
  • improved immunity!
  • improved GI f(x)
  • PREVENTION OF OTITIS MEDIA, Resp Illness, Gastroenteritis, UTI
  • Decreased risk Necrotizing enterocolitis, T1DM, childhood cancer
195
Q

Maternal contraindications to breastfeeding

A
  • Active untx TB (if 2 weeks of tx can feed)
  • maternal HIV
  • Herpes on breast
  • chemotherapy/radiation
  • druggie/alcohol
  • specific meds
196
Q

Infant contraindications to breastfeeding

A

Galactossemia

197
Q

Which infant could get Isoimmune-mediated hemolysis (ABO incompatibility): A+ or A-

A

A- bruh

198
Q

Why does squatting improve tet spell in tet fallot patients?

A

the problem is cyanosis due to RVOT. Squatting increases systemic afterload, which increases pulmonary blood flow and improves hypoxemia.

199
Q

Parents asks about breastfeeding, need to supplement and when her baby can have cows milk and pureed veggies. how do you response?

A
  • 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
Q

Parents ask if their infant will get iron deficiency anemia. Response?

A

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
Q

best initial test CF

A

sweat chloride. (vs most accurate test is genetic analysis)

202
Q

Tx for Kawasaki

A

IVIg!!!! and aspirin

203
Q

Features of Kawasaki

A

<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
Q

complications of kawasaki dz

A

-Coronary artery aneurysm
-myocarditis/pericarditis
-MI
HEART HEART HEART HEART

205
Q

which 3 year old is most at risk of coronary artery aneurysm? and what medications do they usually receive?

A

Kawasaki dz kids tx with IVIg and Aspirin. NOT. STEROIDS. SON. DONT. WORK.

206
Q

T/F: Kawasaki dz is tx with aspirin and steroids

A

False, aspirin and IVIg jignesh

207
Q

Criteria for juvenile idiopathic arthritis

A 
SYMMETRICAL ARTHRITIS at least 6 weeks
(>5 joints means polyarticular)
-elevated CRP and ESR
-ANEMIA
-High Platelets man (thrombocytosis)
-HYPERgammaglobulinemia
-HYPERferritinemia
208
Q

Precocious puberty: LH/FSH in central vs peripheral

A

Central: High. Get CT/MRI to r/o tumor even if no mass effect sxs
Peripheral: Low. CAH is an example of peripheral.

209
Q

girl that hasnt menstruated has no uterus and normal ovaries. what does she have and what other findings would there be?

A

Mullerian agenesis. normal breast and pubic hair development. no cervix or upper vagina. labia, clitoris, ovaries (external genitalia and gonads) are normal.

210
Q

T/F: Amoxicillin is used for strep and staph

A

False, its used for STREP (pneumo) and others

211
Q

top 3 causes of bacterial sinusitis (most cases are viral)

A

STREP PNEUMO, H FLU, MORAXELLA (not staph! usually does chronic)

212
Q

cause and tx of nocturnal perianal pruritis in kids

A

Enterobius vermicularis;

tx with Albendazole, or pyrantel pamoate

213
Q

tx for patient with megacolon/megaesophagus + RBBB/cardiomyopathy

A

Chagas dz: benznidazole

214
Q

T/F: Meconium ileus and hirschsprungs are both associated with downs

A

False. Mec ileus = Cystic Fibrosis; Hirschsprungs = downs. BROOOOOOOOOO

215
Q

difference btwn hischsprungs and meconium ileus

A

H: Downs; Rectosigmoid obstruction; Normal mec consistency; + squirt sign

MI: CF; Ileum obstruction; Insippated mec; - squirt sign look for future Sinopulmonary dz (sinusitis)

216
Q

FTT, bilateral cataracts, jaundice, hypoglycemia, convulsions in an infant

A

Galactossemia = Galactose-1-P UDT def. Increased risk for E coli neonatal sepsis

217
Q

Why is a baby born at home having easy bruising/bleeding/echhymoses?

A

Didn’t receive vit K injection that everyone gets at birth

218
Q

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.

A

Juvenile idiopathic arthritis (systemic)

219
Q

HUS triad

A
  • microangiopathic hemolytic anemia
  • thrombocytopenia
  • AKI
220
Q

When do you start the tx of clubfoot in an infant?

A

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
Q

Kid comes in with a cat bite. management?

A

-irrigation
-since deep puncture, need ABx: Pick Augment (amox-clav)
-avoid closure. possible tetanus
(vs human/dog bites…can just observe)

222
Q

most common syndromic cause of gynecomastia

A

Klinefelters (47XXY)

223
Q

What is hemihyperplasia associated with?

A

Beckwidth-Wiedemann. Also has macroglossia, omphalocele, and hyperinsulinism

224
Q

Think of this syndrome as “multi-organ enlargement”

A

Beckwidth Widemann

  • macrosomia, macroglossia, large kidneys, pancreatic beta cell hyperplasia (hypoglycemia)
  • hemihypertrophy
  • risk of abdominal tumors
225
Q

what followup is required in a patient with Beckwidth Wiedamnn?

A

look for abdominal tumors: WILMS TUMOR and hepatoblastoma. do AFP and US every 6mo until 6 years old

226
Q

how do you make the dx of the most common malignancy in kids?

A

Acute Lymphoblastic Leukemia (ALL)

–>have to get a BM bx and >25% lymphoblasts confirms the dx

227
Q

laryngomalacia is due to ____ and causes ___

A

increased laxity of the supraglottic structures; inspiratory stridor worse in the supine position, usually babies 4-8mo

228
Q

Most cases of rhinosinusitis are viral. What makes you think its bacterial?

A

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
Q

who is the most likely to get cerebral palsy?

A

Premature infants baba

230
Q

T/F: Only kids are affected by rubella

A

FALSE; ADULTS GET JOINT PAIN JOINT PAIN JOINT PAIN JOINT PAIN JOINT PAIN JOINT PAIN. + fever and cephalocaudal rash

231
Q

why does kiddo with a loud machine like murmur have leukocoria (white pupillary reflex)

A

congenital rubella –> CATARACTS

232
Q

most common complication of Sickle Cell trait, which is generally asx

A

Painless hematuria (sickling in the renal medulla)

233
Q

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.

A

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
Q

signs of platelet disorders vs coag factor disorders

A

Platelet: Easy mucosal bleeding, petechiae, echhymoses

Coag: Hemarthroses, hematomas (so Hemophilia has the H’s)

235
Q

risk factors for developing celiac (duodenal bx shows increased intraepithelial lymphocytes and flattened villi)

A
  • DM1
  • Downs
  • selective IgA def
  • autoimmune thyroiditis
  • 1st degree relative
236
Q

mesonephros and paramesonephros

A

mesonephros gives rise to male parts (seminal vesicles, epididymitis, vas deferens)

paramesonephros fills out the pussy (uterus, vagina, fallopian tubes)

237
Q

____ tumor arises from metanephros

A

Wilms. (precursor for renal parenchyma)

238
Q

Where does neuroblastoma arise from?

A

Neural crest cells.

+VMA, HVA in urine. Calcifications/hemorrhage seen on xray

239
Q

3 most common cancers in kids

A
  1. Leukemia
  2. CNS tumors
  3. Neuroblastomsa (adrenal medulla. most common extracranial solid tumor in kids)
240
Q

How do you evaluate a patient with primary amenorrhea?

A
  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
Q

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.

A

Annular pancreas. Double Bubble on xray but No Distal Air

242
Q

Duodenal Atresia = double bubble + no distal gas vs
______ = double bubble + normal gas
(both = bilious vomiting)

A

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
Q

DDx of double bubble sign on baby gram (xray)

A
  • Duodenal atresia and annular pancreas (no distal gas)

- Malrotation (normal gas) and volvulus

244
Q

How does intestinal i.e. jejunal atresia present?

A

Triple (or double) bubble sign + multiple air-fluid levels.

–>Mom doing COCAINE…vascular accident in utero. needs surgery.

245
Q

T/F: Pyloric stenosis typically presents within first 24 hours

A

false, usually starts around weeks 2-8

–>Make sure you CORRECT ELECTROLYTES before surgery (hypochloremic hypokalemic metab alk)

246
Q

Non-bilious emesis on day 0-1 with gurgling and bubbling. Imaging shows NG tube that coils.

A 
Tracheoesophageal fistula (may have atresia or fistula present)
Tx: Parenteral nutrition + surg
247
Q

Which Histamine blockers are good for allergy vs GERD

A

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
Q

If baby has imperforate anus (no hole), whats next?

A

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
Q

chronic constipation or failure to pass meconium, + squirt sign. Dx?

A

<1 mo old: Barium Enema
>1 mo old: Anorectal manometry
Confirm with Full thickness bx

250
Q

baby with constipation, no prenatal screen, xray shows dilated loops of bowel, barium swallow shoes micro-colon distal to obstruction. Dx/Tx: Gastrogafin enema

A

Meconium ileus

vs hirschsprung shows dilated colon with distal normal looking colon

251
Q

Tx for AOM

A

Amoxicillin

if allergic, Azithromycin

252
Q

Tx for strep pharyngitis (if rapid strep test is + or CENTOR >4)

A

Amoxicillin-Clavulanate

vs most URIs are just Amoxicillin, with Azithro if pen all

253
Q

CENTOR criteria

A 
\+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
Q

Tx, things to look for in necrotizing enterocolitis

A

NPO now! TPN and IV antibiotics

–>look out for other complications of prematurity: Retinopathy of prematurity, ARDS, Intraventricular hemorrhage

255
Q

T/F: Both septic hip and transient synovitis will have fever

A

False, Transient synovitis occurs 1 week AFTER URI so no longer has fever

256
Q

teenager who develops colicky flank pain after drinking alcohol or getting diuresis

A

Ureteropelvic J(x) obstruction: narrowing of lumen, only problematic w/high flow state. Dx with IV Pyelogram.

257
Q

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.

A

Low Implantation of Ureter (the other one is normal).

258
Q

T/F: Low APGAR scores indicate future pulmonary and neurological risk

A

False, does not predict outcomes

259
Q

Hypsarrythmia is associated with:

A
  • West syndrome (juvenile epilepsy): Treat with ACTH

- Neuroblastoma: Look for “dancing eyes, dancing feet” opsoclonus myoclonus

260
Q

cyanosis with feeds (newborn). coughing/frothing. dz and f/u

A 
Esophageal Atresia (IE with TEF)
-->commonly develop aspiration pneumonia
261
Q

painless rectal bleeding/hematochezia in a male <2 years old

A

Meckels

262
Q

premie with vomiting/abdominal distention/fever +/- blood in stool. CXR finding and Tx?

A

Nec enterocolitis: air in the bowel wall (pneumatosis intestinalis)
Tx: STOP FEEDS, need IV fluids now and NG tube for decompression/feeds

Step 2 UWORLD (17 decks)

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