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step 2 ck > PEDS > Flashcards

PEDS Flashcards

1
Q

acute otitis media vs otitis media with effusion

A

OME can be distinguished from AOM by the lack of acute inflammatory signs (fever, bulging, TM immobility)

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2
Q

loss of the paternal copy of 15q11

loss of the maternal copy of 15q 11?

A

loss of paternal = prader willi

loss of maternal = angelmans

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3
Q

drooling + tripod
dx?
org?

A

epiglottitis

HiB

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4
Q

kawasaki dz tx?

complication?

A

ivig + aspirin

coronary artery aneurysms

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5
Q

normal RR and HR for babies

A

rr 40-60

hr 120-160

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6
Q

low apgar score does not

A

predict future wellbeing/cerebral palsy

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7
Q

apgar scoring

A

appearance 0 blue, 1 blue extremities, 2 pink
pulse 0 <60, 1 60-100, 2 >100
grimace 0 no response, 1 grimace, 2 sneeze/cough
activity 0 no tone, 1 some flexion, 2 active movement
respiration 0 absent, 1 weak/irregular, 2 strong

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8
Q 
neonate conjunctivitis
day 1
day 2-7
day 7+
3 weeks +
A

1 chemical irritation (due to silver nitrate)
2-7 N gonorrhoeae
7+ chlamydia
3weeks herpes simplex

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9
Q

why do we give neonates IM vitamin K at birth

A

gut is not colonized yet so e coli is not producing enough vitamin K to make clotting factors 2 7 9 and 10 + protein c and s

prevents VKDB (hemorrhagic disease of the newborn)

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10
Q

PKU

A

AR deficiency in phenylalanine hydroxylase
mental retardation

tx: diet low in phenylalanine

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11
Q

cause of cretinism?

A

congenital hypothyroidism

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12
Q

all neonates get what: hep B vaccine or immunoglobulin

A

all get vaccine

those who have HBsAg positive mothers will get immunoglobulin as well

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13
Q

if transient tachypnea of the newborn last longer than 4 hours…

A

consider it sepsis and get blood and urine cultures

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14
Q

caput succedaneum vs cephalohematoma

A

caput does cross suture lines vs cephalohematoma that does NOT cross suture lines

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15
Q

what is risk factor for brachial plexus injury?

A

macrosomic infants of diabetic mothers

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16
Q

differentiate klumpke vs erbs palsy

A

klumpke - c7-T1, claw hand + horners syndrome (ptosis, miosis, anhydrosis)

duchenne erb - C5-C6, waiters tip, unable to abduct or externally rotate or supinate

tx for both immobilization

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17
Q

causes of polyhydramnios

A 
fetus not swallowing
werdnig hoffman (neurological)
intestinal atresias
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18
Q

causes of oligohydramnios

A

fetus cannot urinate
prune belly (lack of abdominal muscles)
renal agenesis (ass with potter syndrome)
flat facies from compression of face with low amniotic fluid

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19
Q

mc cause of an elevated AFP

what two conditions does it otherwise indicate?

A

incorrect dating

neural tube defect or abdominal wall defect

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20
Q

omphalocele vs gastrischisis

what is elevated?

A

omphalocele has a sac covering (failure of the sac to retract)

gastroschisis has NO sac and is due to wall defect lateral to midline

AFP

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21
Q

tx for omphalocele?

what is omphalocele associated with?

A

surgical replacement

w edwards syndrome tri 18

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22
Q

umbilical hernia is associated with what congenital issue?

mech?

A

congenital hypothyroidism

weakeness of the lateral rectus abdominis muscles

must repair after age 4 if it hasnt spontaneously closed

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23
Q

tx for gastroschisis

A

slow return to abdomen (gradual surgical closure)

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24
Q

mc kids abdominal mass?

A

wilms tumor

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25
Q

WAGR syndrome

A

wilms tumor (hemihypertrophy of kidney)
aniridia
genitourinary malformations
retardation

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26
Q

mc cancer in childhood?

A

neuroblastoma

will see jerky eye movements and elevated VMA and metanephrines

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27
Q

hydrocele vs varicocele

A

hydrocele - painless, transilluminates, within scrotum, self resolves

varicocele - swelling of pampiniform plexus, dull ache and heavy scrotum, bag of worms sensation, dx with U/S, often on BOTH sides

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28
Q

cryptorchidism

A

absence of one testicle in the scrotum and is usually in the inguinal canal

tx with orchiopexy after age 1 to avoid sterility

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29
Q

hypospadias vs epispadias

A

hypo - ventral opening of the urethra, ass with inguinal hernias and cryptorchidism, DO NOT CIRCUMCISE until srgical correction

epi - dorsal urethral opening, ass with urinary incontinence, ass with bladder exstrophy, tx w surgery

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30
Q

normal babinski reflex in babies

A

extension of toes

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31
Q

kid with hx of exercise intolerance (cyanosis) and squatting to relieve

A

tet spells = tetralogy of fallot

overriding aorta
pulmonary stenosis
RV hypertrophy
VSD

presents with cyanosis, holosystolic murmur LLSB, squatting to decrease right to left shunting and increased sats, boot shaped heart

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32
Q

in transposition of the great vessels, no oxygenation can occur without…

A

a patent ductus arteriosus, ASD, or VSD

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33
Q

what is given to keep PDA open

A

prostaglandin E1

indomethacin / NSAIDs are A NO GO because they will close it

34
Q

gray cyanosis + absent pulses

A

hypoplastic left heart syndrome

cxr = globular shaped heart

35
Q

what do patient develop in first 4 months in truncus arteriosus?

A

pulmonary htn

36
Q

total anomalous pulmonary venous return

A

no venous return between the pulomonary veins and the left atrium –> oxy blood returns to the SVC

obstruction may or may not be present (angle at which the veins enter)

without obstruction presents later (1-2yo) with right heart failure and tachypnea

37
Q

eisenmenger syndrome

A

left to right shunt due to a vsd reverses into a right to left shunt due to RV hypertrophy

38
Q

all 5 cyanotic heart defects feature what

A

R to L shunt

39
Q

high pitched holosystolic murmur over LLSB

A

VSD

40
Q

FIXED WIDE SPLITTING OF S2?

A

ASD

41
Q

how long into life is a PDA “normal”

A

up to 12 hours

42
Q

machine like murmur + wide pulse pressure + bounding pulses

A

PDA

43
Q

rib notching?

A

coarctation of the aorta

44
Q

coarctation of the aorta is associated with what sex abnormality?

A

turners syndrome (wide neck, shield chest, streak gonads, horseshoe kidney)

45
Q

consider phototherapy for bilirubinemia if it rises to…

A

20-25 mg/dL

46
Q

common complication with a tracheoesophageal fistuladistal esophagus

A

aspiration pneumonia

47
Q

most common type of TEF

A

Esophageal atresia with distal TEF (blind esophagus + trachea that opens up into two bronchi and 1 distal esophagus

48
Q

donut sign?

string sign?

A

donut = intussusseption

string = pyloris stenosis

49
Q

olive sign?

A

pyloric stenosis

50
Q

best initial and most accurate tests for pyloric stenosis?

A

best initial = abd U/S

most accurate = upper GI series

51
Q

choanal atresia

A

born with membrane between nostrils and pharyngeal space that prevents breathing during feeding

blue when feeding and pink when crying

dx with CT scan

52
Q

CHARGE syndrome

A 
coloboma of the eye
heart defect
choanal atresia
retardation of growth or development
genitourinary abnormalities
ear abnormalities or deafness
53
Q

hirschprung disease is associated with

A

down syndrome

54
Q

hirshprungs

A

lack of innervation in distal colon
dont pass meconium in first 48 hours
dstended bowel loops with lack of air in the rectum and high pressure in anal sphincters

dx with full thickness biopsy = lack of ganglionic cells in the submucosa

55
Q

imperforate anus is associated with

A

down syndrome

56
Q

VACTERYL syndrome

A 
vertebral abnormalities
anal atresia
cardiovascular abnormality
TEF
esophageal atresia
renal anomalies
limb abnormalities
57
Q

double bubble sign

A

duodenal atresia

58
Q

duodenal atresia
mech?
dx?

A

lack or absence of apoptosis for canalization of the lumen of the

cxr = double bubble

59
Q

best initial tx for volvulus

A

endoscopic decompression

60
Q

curant jelly…seen in which two settings?

A

currant jelly sputum = klebsiella pneumonia

currant jelly stool = intussusseption

61
Q

intussusception
best dx?
tx?

A

ultrasound is best initial dx = doughnut sign with hypoechoic and echogenic bands (mucosa and submucosa)

barium enema is dx and tx = most accurate test BUT contraindicated in perforation or peritonitis

62
Q

reccurence rate of intussusception

A

10% occur again in 24 hours

63
Q

painless bright red blood per rectum in male kid under age 2

dx?

A

meckels diverticulum ( a true diverticulum)

dx with meckels scan (technetium 99)

64
Q

rules of 2s

A

for meckels diverticulum

affects 2% of population
occurs 2 feet from ileocecal valve
affects 2 types of tissues (gastric and pancreatic)
males are 2x more affected
patient <2 yo
2 inches long
65
Q

when air is seen in the wall of the bowel in a sick patient….

A

nectrotizing enterocolitis!

CT is NOT necessary after xrays,,,,just start antibiotics!! then give IV fluids

66
Q

metabolic findings in infants of diabetic mothers

A

hypoglycemia
hypocalcemia
hypomagnesemia
hyperbilirubinemia

67
Q

CAH three types

A

17alpha hydraxylase def – no cortisol or sex hormones = lots of aldosterone, HTN

21 hydroxylase def – lots of sex hormones NO aldosterone or cortisol + HYPOTENSION, virilized

11beta-hydroxylase def – you get some deoxycorticosterone but not aldosterone, no cortisol, yes sex hormones, virilized, HTN

68
Q

beading of the ribs and genu varum

A

rickets (vit D deficiency)

69
Q

kartagener syndrome is characterized by…

A

infertility and situs inversus

70
Q

tx for neonatal sepsis

A

amp and gent

71
Q

presentation,dx,and tx of toxoplasmosis

A

chorioretinitis, hydrocephalus and multiple ring enhancing lesions onCT

most accurate dx is PCR

pyrimethamine and sulfadiazine

72
Q

presentation,dx,and tx of neonatal syphilis

A

rash on palms and soles, snuffles, frontal bossing, hutchinson eighth nerve palsy, and saddle nose

beat initial is VDRL or RPR; most accurate is FTA abs or darkfield microscopy

penicillin

73
Q

presentation,dx,and tx neonatal rubella

A

PDA, cataracts, deafness, hepatosplenomegaly, thrombocytopenia, blueberry muffin rash, hyperbili

maternal IgM status

supportive

74
Q

presentation,dx,and tx of neonatal CMV

A

periventricular calcifications, microencephaly, chorioretinitis, hearing loss and petechiae

urine or saliva PCR is most accurate

ganciclovir when signs of end organ damage

75
Q

presentation,dx,and tx and herpes

A

week 1 shock and dic, week 2 vesicles on skin, week 3 encephalitis

most accurate PCR, initial tzanck smear

tx acyclovir

76
Q

cough, conjunctivitis, and coryza (stuffy nose) + muscosa koplik spots (gray macule)

A

paramyxovirus (rubeola/measles)

77
Q

croup

A

steeple signs on cxr + barky cough, and inspiratory stridor

due to parainfluenza

give rac epi if severe/respiratory distress

78
Q

epiglottitis

A

h influenza b (Hib)
hot potato voice + fever and tripod drooling + thumbprint sign

INTUBATE!

79
Q

galactosemia

A

neonate with bilateral cataracts, failure to thrive, jaundice, and hypoglycemia

galactose 1 phosphate uridyl transferase deficiency

80
Q

biggest risk factor for intraventricular hemorrhage of newborn

A

prematurity

81
Q

doll face and seizures/hypoglycemia and lactic acidosis

A

glycogen accumulation in von gierke dz ( glucose 6 phosphotase deficiency)

step 2 ck (16 decks)

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