Peds Flashcards
Coombs neg hemolytic anemia, jaundice, splenomegaly
Labs showing spherocytosis, hyperbilirubinemai, reticulocytosis, family hx anemia - DIAGNX?
Confirmed by?
Hereditary spherocytosis
Acidified glycerol lysis test
Calcified suprasellar tumor with bitemproal hamianopsia and pituitary hormonal defic (eg DIABETES INSIPIDUS, GROWTH HORMONE DEFIC)?
Craniopharyngioma
DiGeorge chromosome?
22q11.2 del (defective dev of phayngeal pounches)
DiGeorge clinical pres C.A.T.C.H.?
Conotruncal cardiac defects Abnormal facies Thymic aplasia/hypoplasia Cleft palate Hypocalcemia
Ataxia and dysarthria onset in teen years, with scoliosis and feet deformities, with concentric hypertrophic cardiomyopathy - diagnx?
Most common causes of death?
Friedrich’s ataxia
Cardiomyopathy and resp complications
Fluid to correct hypovolemic hypernatremia?
NS (or LR)
Recurrent sinopulmonary and GI infections, plus often atopic or autoimmune dz. If severe, anaphylaxis during blood transfusion (most common primary immune defic) - what is it?
Why anaphylaxis?
Selective IgA defic
Anaphylaxis due to anti-IgA Ab
Most common cause of hip pain in kids 3-10?
Treat with?
Transient synovitis
Ibuprofen and rest
Exudative chest/pleural effusion due to disruption of thoracic duct (milky white fluid with elveated triglycerides) - diagnx?
Chylothorax
Pediatric hypertension in UE and hypoperfusion in LE (low O2 sat) - think?
Pathology?
Coarctation of aorta
Due to thickening of tunica media of aortic arch near ductus arteriosus
Contraindications (3) for DTaP vaxx?
immediate analphylaxis, unstable neurologic disorders, encephalopathy within a week of vaccine
Tumor in precocious puberty, increasing estrogen?
Granulosa cell
hematuria, famhx renal failure and sensoneurinal deafness - think?
alport’s syndrome
Cyanotic spells with a harsh crescendo-decrescendo murmur LUSB- Likely diagnx? Spells due to?
Murmur due to?
Tetralogy of Fallot
Obstruction of RVOT during exertion
Murmur due to turbulence at stenotic pulmonary artery
Primary amennorrhea workup:
First measure FSH if no breast development
- If FSH decreased then pituitary MRI
- If FSH increased then karyotype
Waterhouse Friedrich from meningococcal meningitis - telltale sign? Due to?
Sudden vasomotor collapse with skin rash
Due to adrenal hemorrhage
PNA, cutaneous abscesses and suppurative adenitis form catalase positive organisms - think?
What are the catalase positive organisms?
Dianostic test for this?
CGD
Staph aureus, serratia, burkholderia, aspergillus
Neutrophil testing with dihydrohodamine 123, or Nitroblue tetrazolium
PNA, cutaneous abscesses and suppurative adenitis from catalase positive organisms - think?
What are the catalase positive organisms?
Diagnostic test for this?
CGD
Staph aureus, serratia, burkholderia, aspergillus
Neutrophil testing with dihydrohodamine 123, or Nitroblue tetrazolium
Adolescent male with bone pain not related to physical activity, often proximal femur, responds to NSAIDs - diagnx and treat?
Osteoid osteoma (bone forming tumor) Benign, treat with NSAIDs
What differentiates Fe defic anemia from thalassemia?
RDW (increased in Fe defic)
Cyanotic tet spells helped by what position?
Why?
Knee-chest
Increases systemic vac resistance thus increases pulmonary blood flow and improves hypoxemia
Hip pain after viral infx that goes on 1-4 weeks?
Longer than that?
Transient synovitis
Legg Calve perthes DZ (osteonecrosis of femoral head)
Mild papular/nodular skin lesion with ipsilateral LAD with gradual onset?
Bug responsible?
Treat?
Cat scratch disease (if cat exposure)
Bartonella henselae
Azithromycin
Infant with cyanosis at rest and feeding but relived by crying - think?
First assessment, then?
Choanal atresia
Try to pass a catheter into the nose to oropharynx
Then CT scan to show narrowing at pterygoid plate in posterior nasal cavity
Normocytic anemia, vit defic?
B2 riboflavin
Increased gastric residual volume, vomiting, abd distension in preterm neonate?
Xray findings?
Necrotizing eneterocolitis
Intramural air and portal venous air
Clubfoot treatment?
Stretching and manipulation of foot, serial casts
If that fails then surgery (between 3-6 months old)
HUS triad along with diarrhea?
Organisms?
Treatment?
hemolytic anemia, thrombocytopenia, acute renal failure
Shiga toxin from sigella or E coli O157:H7
supportive treatment
Lyme dz in kids - antibiotic?
Amoxicillin (NOT doxy as contraindicated <8 yo)
Neonatal bilious vomting - managment?
Xray then if stable: contrast enema to determine meconium ileus vs Hirschspring dz
Meconium ileus (pathognomonic for CF) - treat?
Gastografin enema to break up the meconium. If unsuccessful then surgery
fever, lethargy and signs of heart failure with viral prodrome?
treat?
myocarditis
supportive, diuretics, inotropes
most common brain tumor in kids?
2nd most common posterior fossa tumor?
pilocytic astrocytoma
medulloblastoma
sore throat with exudative, fever and all the rest, looks like strep but the polymorphous, maculopapular rash after amoxilllin or ampicillin - diagnx?
EBV (mono)
Make sure with a monospot test
Neonate with macrosomia, macroglossia, umbilical hernia/omphalocele, hypoglycemia - think?
Check for?
Beckwith-Wiedemann
Abd/renal US and serum alpha fetaprotein to check for tumors such as Wilms tumor or hepatoblastoma as kids are very susceptible
Pathogen for PNA in KIDS with CF as opposed to adults?
Kids - staph aureus, Adults - Pseudomonas
Risk factors for surfactant defic?
Prematurity
Maternal DM
Orchiepexy for crytorchidism lowers risk of (3)?
lowers risk of testicular malignancy, improves fertility, removes risk of testicular torsion
Osteomyelitis bug in infants and kids?
Staph aureus
Scaly erythematous lesions on face, chest, extensor surfaces, poss flexural involvement?
Treat?
Atopic dermatitis (eczema) Rx: topical emollients
Setting fires with no motive?
Setting fires with a pattern of violation societal rules? Then >18?
Pyromania
Conduct disorder
Antisocial PD
Hemophilic arthropathy - what deposited in joint causing synovitis?
Prophylactic tx?
hemosiderin Factor concerntrates (VIII, IX)
Edwards syndrome features (6)?
IUGR, microcephaly, prominent occiput, micrognathia, closed fists with overlapping digits, rocker bottom feet
harsh, holosystolic murmur over LLSB - defect?
VSD
Intracranial calcifications and ventriculomegaly, manifesting as macrocephaly as well as nonspecific sign of congenital infx - Bug?
Tx?
Vectors?
toxoplasmosis
Pyrimethamine, sulfadiazine, folate
Raw or undercooked meat, unwashed fruit/veg, cat feces
Threshhold for polycythemia of neonate?
Risk factors?
Present?
HCT >65%
Delayed cord clamping, maternal HTN, maternal DM
resp distress, hypoglycemia, neuro sx
Painless hematochezia in young toddler (2 y/o)?
Diagnose with?
Meckel’s diverticulum
Tech-99 scan
Most common causes of viral meningitis?
echoviruses or coxsackieviruses (non-polio enterovirus)
Severe infx, FTT, chronic dairrhea - think?
TX?
SCID (absence of T-cells and dysfucntional B-cells)
Treat with stem cell transplant
Neonate with catracts, PDA, sensorineural hearing loss?
Congential rubella
Fever, exudative pharyngitis, circumoral pallor, SANDPAPER RASH, strawberry tongue?
Caused by?
Treat?
Scarlet fever
GAS extotoxin
PCN V
Hepetiform rash on top of atopic deramtitis?
HSV causing eczema herpeticum
Hereditary Spherocytosis is a defect of the ….
RBC membrane
1 VUR complication?
Renal scarring
Elevated lead fingerstick - next step?
Check venous lead levels, only chelate if >45
DMSA: 45-69
>70 or acute encephalopathy: EDTA & British anti-Lewsite
Toddler with firm, smooth, unilateral abd mass and HEMATURIA, no pain, suspect?`
Wilms tumor
gray vesicles on the tonsillar pillars (with or without hand and foot involvement?
herpangina due to coxsackie, an enterovirus
Bacterial meningitis in >1 month bugs?
Strep pneum and meningococcus
Maneuver effects on preload/afterload: Valsalva? Sustained hand grip? Passive leg raise? Squatting?
Valsalva: -preload
Hand grip: +afterload
Leg raise: +preload
Squat: +preload and +afterload
HOCM murmur increases with what maneuver?
Why?
Valsalva
decr preload so der LV cavity size so incr LVOT and incr murmur intensity
Major protein source human milk vs formula?
Whey vs casein
whey more easily absorbed
Nephrotic syndrome in adult/adolescent with Hep Infx?
Membranous nephropathy
fever, hives, arthralgia, lymphadenopathy 1-2 weeks after B-lactams or sulfa (bactrim)?
Tx?
Serum sickness like reaction
Resolves with withdrawal of agent
Congenital rubella triad?
Hearing loss, cataracts, PDA
Bronchiolitis complications in neonates?
Apnea, resp failure
Most common cause of sepsis in SCD?
Strep pneumo
Bedwetting pharmacotherapy - 1st and 2nd line?
Try after what?
1st line desmopressin, 2nd line TCAs
Try pharm after behavioral mods and alarm therapy
Most common cause of pediatric stroke?
SCD
Mecomium ileus vs Hirschsprung obstructions?
MI: ileum with narrow colon
HD: aganglionic rectum and proximal dilated colon
2 tourette’s combordities?
ADHD, OCD
Ringworm tx?
Clotrimazole or terbinafine
F/u for UTI in <2 yo girl?
Renal and bladder U/S, if abnormal then voiding cystourethrogram
Precocious puberty with high LH and FSH - central or peripheral?
Treat?
Central (check an MRI too!)
GnRH tx
A. P. G. A. R. stands for?
Cutoff for intervention?
Appearance/color, pulse, grimace/reaction, activity/muscle tone, respiratory effort
<7 (often pulse ox and positive pressure ventilation, HR <60 then chest compressions)
Bugs and tx: Conjunctivitis <24 hours?
2-5 days?
5-14 days?
Chemical, eye lube
Gonococcal, IM 3rd gen cep single dose
Chlamydia, PO macrolide (erythro) (milder swelling than gono)
New onset hearing loss, with chronic ear drainage despite ABX (also granulation tissue and skin debris poss) - diagnx?
Cholesteatoma
How to treat subluxation of radial head (nursemaid’s)?
Hyperpronation (or next best supination with elbow flexion) - no XRay required
Most common risk factor for intussusception?
viral illness (gastro) and resultant hypertrophy of Peyer patches
Sudden drop of HgB with low retic count in SCD and no hepatosplenomegaly?
Most common trigger?
Aplastic crisis
Parvovirus B19
Recurrent sinopulmonary and GI infx - consider?
Bruton’s
Foreign body aspiration - next step?
Bronchoscopy NOT CXR
Tx for adolescents with heavy vaginal bleeding (HD stable)?
high-dose OCPs (stabilizes endometrium and stop acute bleeding)
Sternocleidomastoid muscle mass (in neck), head tilt, chin deviation - diagnx?
Torticollis - postural neck deformity
Situs inversus, recurrent sinusitis, bronchiectasis- diagnx?
Kartagener syndrome (subroup of primary ciliary dyskinesia)
Neonate with rhinorrhea and bullous or desquaming rash? (along with nonspecific congential signs: jaundice, hepatosplenomegaly and blueberry muffin rash)
Congenital syphilis
Diastolic rumble at apex WITH pansystolic murmur at LLSB suggests?
WITHOUT?
VSD
mitral stenosis
Hand and foot swelling with potential for SCD - pathology?
Vaso-occlusion
Vaso-occlusion vs osteomyelitis vs necrosis in SCD?
Acute in >1 site = occlusion
Acute in only 1 site with fever, and positive blood culture = osteomyelitis
Chronic pain with no fever or warmth/erythema = avascular necrosis
Ingestion: abd pain, hematemesis, metabolic acidosis AND you can see the tablets on Xray?
Tx?
Iron poisoning
Chelate with deferoxamine if moderate to severely ill
Acute unilateral lymphadenitis - bugs?
Nodes most affected?
staph aureus and strep pyogenes
sub-mandibular
Tourette’s pharmacotherapy?
a2-agonists (eg guanafacine)
1st gen antipsychotics (haldol, pimozide)
@nd gen antipsychotics eg risperidone
Down syndrome pt with UMN signs?
Atlantoaxial instability
3 associations with celiac?
T1DM, Iron defic anemia and dermatitis herpetiform
How old can you see the thymic silhouette in right middle/upper lung?
<3 years old
Neonate with feeding intolerance, bloody stool, distension - suspect?
Other risk factors?
Xray finding?
Necrotizing enterocolitis
Prematuritiy, hypotension, congenital heart dz
Pneumatosis intestinalis
Absent red reflex - suspect what until proven otherwsie? Next step?
Retinoblastoma
Refer to optho
Infant who is normal at birth but develops apathy, weakness, hypotonia, large tongue, sluggish movement, bloating, umbilical hernia - suspect?
Screened for at birth along with 2 others?
Hypothyroidism
Phenylketonuria and galactosemia
UTIs with normal VCUG and renal US - consider?
Urinary stasis caused by constipation
HUS triad?
microangiopathic hemolytic anemia (so DECR haptoglobin), thrombocytopenia, AKI
Delayed growth spurt, delayed puberty and delayed bone age =
Constitutional growth delay
Measles prodrome?
The rash starts where?
What precuations?
Cough, coryza, conjunctivitis
Maculopapular rash that spreads cepahlocaudal
Airborne (N95 mask)
Orbital cellulits with vision changes and pain on EOM - most common predisposing factor?
Bacterial sinusitis
JA - cutoff for poly or oligoarticular?
Lab findings?
5 or more poly, less than 5 oligo
High ESR, CRP, and ferritin,
High platelets, and high gammglobulins
With Anemia
Double bubble = duodenal atresia, but “triple bubble” is?
Risk factors?
Jejunal atresia
Prenatal exposure to cocaine and other vasoconstrictors
micro-Thrombocytopenia, eczema and recurrent infection - syndrome?
Inheritance pattern?
Gene mutated (WAS) responsible for?
Treat with?
Wiskott-Aldrich
X-linked Recessive
Cytoskeleton regulation
Hematopoetic stem cell transplant
Infant with a hydrocele (it transilluminates) - management?
Watch and wait. Should disappear by 12 months of ago, if not, remove with surgery due to hernia risk
Chronic BIPHASIC stridor as opposed to inspriatory?
Biphasic: vascular ring (improves with neck exptension)
Inspiratory: laryngomalacia (worse when supine, improves when prone)
AOM vs Otitis media with effusion
Both have effusion but only AOM has acute eardrum inflammation
Impetigo treatment?
Topical muciprocin
SGA - weight percentile cutoff?
Possible complications?
<10th
hypoxia, hypoglycemia, hypothermia, hypocalcemia and polycythemia
Scaly erythematous patch on scalp that can progress to alopecia (also inflammation, LAD, scarring) - suspect?
Diagnose with what?
Treat?
Tinea capitis (a dermatophyte infx)
KOH exam of hair shaft
PO terbanifine, griseofulvin (or itra/fluconazole)
Overweight adolescent with a limp?
Treat?
SCFE
Urgent surgical fixation (to prevent avascular necrosis)
Scaly, oily rash on scalp, eyelids, nasolabial folds, postauricular area AND umbilicus - diagnx?
Treat?
Seborrheic dermatitis
Often spontaneous remission, also emollients and nonmedicated shampoo
DKA - serum potassium is normal or elevated. Total body K stores are ??? and why?
LOW due to osmotic diuresis (high blood glucose)
Febrile paroxysms (cyclic fever) - suspect? Diagnose with?
Malaria
Thick and thin blood smears (Giemsa stained parasites)
Single, round, blue inclusions on Wright stain in RBCs - what are they and what do they suggest?
Howell Jolly bodies
suggest physical absence of spleen or functional hyposplenism
might have splenectomy for hereditary spherocytosis
Nonpitting edema in hands and feet in Turner’s?
lymphedema due to dygenesis of lymphatic system leading obstruction
Premies: vaccine by chronological or gestaional age?
Exception?
Chronological
Except Hep B, must be >2kg (4lb6oz) for first dose
Pertussis treatment?
Who gets prophylactic tx?
Macrolides
All close contacts regardless of age, immunization status, symptoms
SCD splenic sequestration crisis - 3 labs?
normocytic anemia, incr reticulocyte count, thrombocytopenia
Low grade fever, maculopapular rash with rapid cepahlocaudal spread, posterior auricular and suboccipital LAD with possible joint pains - think?
Rubella!
Refeeding syndrom presents with?
Electrolytes affected?
Hormone causing it?
arrythmias and cardiopulmonary failure
K, Phos, Mg (cellular uptake so drop in serum)
insulin
Ewing’s sarcoma mets sites?
Common pt demographic?
Lungs and lymph nodes
White males, 1st-2nd decade
RDS presents immediately after birth with increased WOB - xray finding?
Tx?
fine reticular granulairty of lungs
CPAP
Delayed umbilical cord separation, reurrent skin and mucosal bacterial infx (no purulence), severe PERIODONTAL disease. High Leukocytosis with neutrophilia?
Leukocyte adhesion defic
Rapidly progressing, acute liver failure, encephalopathy, vomiting after aspirin? Micro or macrovesicular steatosis?
Reye’s syndrome, MICRO!
Trachoma due to what bug?
Diagnostic sign?
Tx?
Chlamydia trachomatis
Tarsal conjunctivae inflammation
Oral azithro
Limitation of upward gaze, billateral eyelid retraction, pupils react to accomodation but not light - suspected tumor?
Name of above syndorme of sx?
Then addition of headache and vomiting?
Pineal gland tumor
Parinaud syndrome
Obstructive hydrocephalus
Macrocytic anemia with congenital anomalies (eg. short stature, webbed neck, cleft lip, triphalangeal thumbs) - think? (PRESENTS in first 3 MONTHS of LIFE)
DBS (Diamond-Blackfan anemia)
A pure red aplasia
Decreased activity, hoarse cry and jaundice AND hypothyroidism in neonate (although most are asymptomatic)- suspect?
Due to?
Congenital hypothyroidism Thyroid dysgenesis (most common cause)
Marfan’s gene?
Fibrillin 1
Shock emergency when IV access is too hard - do what?
Intraosseus cannulation
Resp distress due to congenital diaphragmatic hernia in newborn - what to do?
Endotracheal intubation (NOT bag and mask) Then place gastric tube to decompress stomach and bowel
Palpable purpura on LE, abd pain, arthrlaigais, renal involvement, hematuria, possible scrotal sweeling (BUT NORMAL PLT COUNT) - suspect?
Pathophys?
GI complication?
Henoch Schonlein purpura
IgA mediated vasculitis
ileo-ileal intussusception
SCID (adenosine deaminase defic) effect on lympocyte count?
SEVERE lymphopenia
Squatting improves cyanosis in tet of fallot - why?
Increases blood flow across RVOT
Most common side effect of sickle cell trait?
Painless hematuria
Pancytopenia with blood counts dropping 4-12 years ld, plus congenital anomialies (hyperpigmentations, eyes, renal, hypogonadism, short staure, limbs)?
Fanconi’s anemia
Pancytopenia followng drugs, toxins (radiation) or viral infection?
MCV?
On bone marrow biopsy (diagnostic)?
Aplastic anemia (acquired)
Normocytic or macrocytic
Hypocellularity with fatty infiltrate
Adolesecent male athlete with knee pain - think?
Which is?
Osgood Schlatters
Traction apophysisits of tibila tubercle
On XR - soft tissue swelling, lifting or fragmentation of tubercle
1 complication of AOM?
mastoiditis
Asymmetric corneal light reflections, deviation on cover test - think?
Treat how to avoid what?
When is reassurnace OK?
Strabismus
Occlusion (patching) or penalization (blurring) of the NORMAL eye to avoid AMBLYOPIA (if doe snot work then surgery)
<4mo old, older needs to treat
New onset stabismus with white eye reflex - suspect?
Retinoblastoma
Cyanotic infant with LEFT AXIS DEVIATION (and decreased pulmonary markings) - suspect?
Triscupid valve atresia
<10 years old, Abdominal pain, jaundice, palpable mass (single, multiple, intra or extrahepatic) - suspect?
Diagnose?
Treat?
Biliary cyst = choledochal cyst
US or ERCP
Surgical excision
ALL age group? Also boys and tri21
Anemia and thrombocytopenia but what about WBCs?
Diagnosis?
2-5 years
Half have WBC <10, 20% have WBC >50
>25% lympoblasts on bone marrow biopsy
Pyloric stenois diagnostic?
Abd US
Trenelenburg sign due to wekaness of which 2 muslcles?
Innervated by what nerve?
gluteus minimus and medius
sup gluteal nerve
Abx for a deep cat bite?
Bug??
Amoxi/clav
Pasteurella multocida
Hereditary spherocytosis is a lack of what in RBC membrane?
How ling PCN prophylaxis post splenectomy?
spectrin
3-5 years
Diarrhea, dementia, dermatitis (and death) is called what?
Caused by deficiency of what?
Which is vitamin Bwhat?
pellagra
Niacin (think corn diets)
B3
Deliberate scald injury signs (4)?
Sharp demarcation
Uniform depth
Spared flexor surfaces
No splash marks
Isolated thrombocytopenia and megakaryocytes with purpura and petechiae post viral infx - suspect?
Age most likley?
Treat?
ITP (immune thrombocytopenia)
2-5
Observe and should get better after 6 mo, unless bleeding then IVIG or steroids (but adults aget these <30 PLT count)
SCID treatment?
Stem cell transplant
Enzyme defic in CGD?
NADPH oxidase
Friedrich’s ataxia 3 systems affected?
neuro, skeletal, cardiac
Most common cyanotic heart porblem in neonates?
Associated murmur?
Transpostiion of great vessels
Single loud S2
Limp: boys 4-10, girl 5-7 with antalgic gait?
Legg Claves (osteonecrosis)
Test for CGD?
Test neutrophils with dihydrohodamine 123 or nitroblue tetrazolium
Hypoglycemia at 3-4 months, hepatomegaly, Doll-like face - associated with?
G6PD defic
Hypothyroid like sx BUT with macrosomia and rapid growth?
Do what?
Beckwith Wiedermann
Abd US to assess for Wilms tumor
What does valsalva do to preload?
reduces!
baby head edema crosses suture line then? does not?
caput if crosses, cephalohematoma if does not
dubin johnson vs rotor difference (direct-conj bilirubinemia)?
dubin black liver
where does indirect bilirubin deposit in brain?
basal ganglia, brainstem nuclei
light isomerizes bilirubin NOT conjugates - T or F?
T
theophylline used for?
central apnea!
most common heart defect in down syndrome?
endocardial cushion defect (between ASD and VSD)
Goat’s milk formula - think?
FOlate defic
Clotting factors still OK with bad liver?
VW and 8
