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Clinical Medicine LAB - Professor Sample > Peds > Flashcards

Peds Flashcards

1
Q

Metabolic Disorders ?

A

Proprionic acidemia

Methylmalonic acidemia

Isovaleric acidemia

3-Methylcrotonyl- CoA-
carboxylase deficiency

3-Hydroxy-3-methyglutaric aciduria

Holocarboxylase synthase deficiency

Beta-ketothiolase deficiency

Glutaric acidemia type I

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2
Q

Fatty Acid Oxidation Disorders ?

A

Carnitine uptake defect/carnitine transport defect

Medium- chain acyl-CoA dehydrogenase deficiency

Very long-chain acyl-CoA dehydrogenase deficiency

Long-chain L-3 hydroxylacyl-CoA dehydrogenase deficinecy

Trifunctional protein deficiency

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3
Q

Amino Acid Disorders ?

A

Argininosuccinic aciduria

Citrullinemia, type I

Maple syrup urine disease

Homocystinuria

Classic phenylketonuria

Tyrosinemia, type I

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4
Q

Endocrine Disorders ?

A

Congenital adrenal hyperplasia

Primary congenital hypothyroidism

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5
Q

Hemoglobinopathies ?

A

Sickle cell anemia

Beta-thalassemia

S,C disease

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6
Q

Other tests ?

A

Biotinidase deficiency

Critical congenital heart disease

Cystic fibrosis

Classic galactosemia

Glycogen storage disease, type II

Hearing loss

Severe combined immunodeficiencies

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7
Q

Recommended in infants ?

A

Born to mothers with gestational diabetes or DM

Large infants (>3969 g)

Small infants (<2608 g)

Premature (<37 weeks)

Smaller twin (sizes are discordant)

Polycythemia (>70% Hct)

Hypothermia

Low apgar scores (<5 at one min, <6 at five minutes)

Stress (sepsis, RDS)

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8
Q

Lead: CDC recommends universal lead screening despite risk factors for children ages _______ and targeted screening for older children at risk.

A

1 and 2

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9
Q

High levels of lead can cause ?

A

seizures or coma

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10
Q

Lead: Even blood levels less than __ have been correlated with lower intelligence quotients

A

10

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11
Q

Lead: < 10 ?

A

stunt bone growth as a consequence of decreased vit. D metabolsim

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12
Q

Lead: >10 ?

A

slow cognitive and behavioral development

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13
Q

Lead: >20 ?

A

delayed nerve conduction

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14
Q

Lead: > 40 ?

A

decrease hemoglobin synthesis

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15
Q

Lead: > 70 ?

A

anemia with acute poisoning

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16
Q

Lead: 100-150 ?

A

encephalopathy

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17
Q

Lead: >380 ?

A

convulsions, coma, death

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18
Q

Lead Poisoning: ____ mcg/dL is elevated and should be prompt for repeat screening

A

> 5

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19
Q

Lead Poisoning: >45 mcg/dL = ?

A

chelation therapy indicated

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20
Q

Lead Poisoning: > 70 mcg/dL = ?

A

immediate emergent treatment

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21
Q

Most common nutritional deficiency in the US ?

A

Iron Deficiency Anemia

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22
Q

Iron Deficiency Anemia severe causes ?

A

Anemia

Behavioral problems

Cognitive effects

Abnormal sleep cycles

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23
Q

Risk factors for IDA ?

A

Low birth weight
Pregnancy with multiples

IDA in the mother

Use of cow’s milk before 12 months of age

Low iron diet

Chronic illness
Restricted diets

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24
Q

IDA: Universal Screening at __ months by Hgb or Hct

A

12

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25
Q

If child is anemic, further tests may be needed like what ?

A

CBC

Iron studies

Hgb electrophoresis

Etc…..

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26
Q

TB: Screening with TST for high-risk patients include ?

A

Born outside of US? (TST for Africa, Asia, Latin America, or Eastern Europe)

Traveled outside the US greater than one week and staying with friends and family.

Exposed to active TB?

Close contact with a person with postive TST?

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27
Q

HepB: Vaccine - composition ?

A

Inactive subunit of Hep B virus

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28
Q

HepB: Vaccine - immunity life ?

A

Usually for life

Occasionally needs a booster

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29
Q

HepB: Vaccine - contraindications ?

A

none

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30
Q

HepB: Vaccine - Major adverse reactions ?

A

erythema multiforme

erythema nodosum

Stevens-Johnson syndrome

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31
Q

HepB: Vaccine - Common reactions ?

A

Irritability
fever
diarrhea

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32
Q

HepB: Vaccine - Dosing ?

A

Begins at birth

3-4 shots over 6 months (Recombivax, Engerix)

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33
Q

Central elements to reducing Hep B burden in the US ?

A

Immunizations of all infants beginning at birth

Routine screening of pregnant women

HBIG to all infants born of infected mothers

Vaccination

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34
Q

Rotavirus - vaccine: composition ?

A

live, oral, attenuated rotavirus

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35
Q

Rotavirus - vaccine: immunity life ?

A

No clear data on immunity life

For first year after vaccination

85%-98% protective against severe rotavirus disease

74%-87% protective against rotavirus disease of any severity

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36
Q

Rotavirus - vaccine: contrindications ?

A

Acute diarrhea

Severe immunodeficiency

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37
Q

Rotavirus - vaccine: major adverse reactions ?

A

intussusception

Kawasaki dz

ITP

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38
Q

Rotavirus - vaccine: common reactions ?

A

vomiting
irritability
diarrhea
flatulence

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39
Q

Rotavirus - vaccine: dosing ?

A

(Rotateq, Rotarix)

2 months AND
4 months

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40
Q

Rotavirus - vaccine: considerations ?

A

Viral antigens can be detected in stool

CBC usually shows normal WBC count

Patients may be hypernatremic

May develop a metabolic acidosis

Urine can show ketones

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41
Q

DTaP, Tdap - vaccine: composition ?

A

Diphtheria toxoid

Tetanus toxoid

Acellular pertussis

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42
Q

DTaP, Tdap - vaccine: immunity life ?

A

10 years

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43
Q

DTaP, Tdap - vaccine: contraindications ?

A

neurologic disorder, progressive

infantile spasms

uncontrolled epilepsy

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44
Q

DTaP, Tdap - vaccine: major adverse reactions ?

A

Seizures

hypotonic-hyporesponsive episode

Guillain-Barre syndrome

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45
Q

DTaP, Tdap - vaccine: common reactions ?

A

irritability

drowsiness

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46
Q

DTaP - vaccine: dosing ?

A

(higher dose diphtheria and pertussis) [Pediarix, TriHIBit)

5 shots

2 months
4 months
6 months
15-18 months
4-6 years
47
Q

Tdap - vaccine: dosing ?

A

Tdap (Boostrix)

Booster every 10 years

Tetanus needs booster every 5 with dirty wounds

48
Q

Diptheria acute infections with ?

A

Corynebacterium diptheriae: gram + club shaped rods

49
Q

Diptheria facts ?

A

Hemolytic anemia can occur

Thrombocytopenia is frequently associated.

Diagnosis is clinical

Cultures are difficult to grow and require specialized media

50
Q

Tetanus caused by ?

A

Clostridium tetani

51
Q

Clostridium tetani

shape ?

A

Drumstick-shaped gram + bacilli

52
Q

Tetanus dx. ?

A

clinical

Anaerobic culture and microscopic examination can be helpful but are often difficult

53
Q

Pertussis considerations ?

A

Elevated WBC count ~20-30,000 with 70-80% lymphocytes

Identification by culture or PCR from nasal swab is the definitive diagnosis

Culture requires specific media

PCR is more commonly used

ELISA for detection of antibodies (may be unreliable in previously immunized patients)

54
Q

Hib - vaccine: composition ?

A

Hib polysaccharide protein

55
Q

Hib - vaccine: immunity life ?

A

usually for life

56
Q

Hib - vaccine: contraindications ?

A

Children under six weeks

Hypersensitivity to tetanus toxoid

57
Q

Hib - vaccine: major adverse reactions ?

A

angioedema

seizures

hypotonic-hyporesponsive episode

58
Q

Hib - vaccine: common reactions ?

A

fever

fussiness

59
Q

Hib - vaccine: dosing ?

A

(PedVaxHib)

3-4 doses

2 months
4 months
(6 months depending on formulation)
12-15 months

60
Q

Haemophilus influenza B lab findings ?

A

WBC count = elevated with +/- left shift

Blood culture is frequently positive

Culture of aspirated pus or fluid from involved site (ie; septic arthritis)

CSF smear may show pleomorphic gram (-) rods

61
Q

PCV13 (Pneumococcal) - vaccine: composition ?

A

conjugaated pneumococcal polysaccharides

13 strains of polysaccharides (was 7)

62
Q

PCV13 (Pneumococcal) - vaccine: immunity life ?

A

Until 18 years old

Also given to adults:

Over 19 and immunocompromised OR

Over 65 and have not had PCV13

63
Q

PCV13 (Pneumococcal) - vaccine: contraindications ?

A

none

64
Q

PCV13 (Pneumococcal) - vaccine: major adverse reactions ?

A

anaphylaxis/anaphylactoid rxn

angioedema

erythema multiforme

65
Q

PCV13 (Pneumococcal) - vaccine: common reactions ?

A

irritability
altered sleep patterns
fatigue

66
Q

A 23 strain version (PPSV23) is not used in ________.

A

children

67
Q

PCV13 (Pneumococcal) - vaccine: also given to adults if ?

A

Over 19 and immunocompromised OR

Over 65 and have not had PCV13

68
Q

PCV13 (Pneumococcal) - vaccine: dosing ?

A

At least 4 doses

2 months
4 months
6 months
12-15 months

(>24 months depends on previous formulation administered and risk factors)

69
Q

Inactivated poliovirus (IPV) - vaccine: composition ?

A

Polio antigens

70
Q

Inactivated poliovirus (IPV) - vaccine: immunity life ?

A

Usually life

71
Q

Inactivated poliovirus (IPV) - vaccine: contraindications ?

A

Febrile illness

72
Q

Inactivated poliovirus (IPV) - vaccine: major adverse reactions ?

A

seizures

73
Q

Inactivated poliovirus (IPV) - vaccine: common reactions ?

A

irritability

fatigue

74
Q

Inactivated poliovirus (IPV) - vaccine: dosing ?

A

4 doses

2m
4m
6-18m
4-6y

75
Q

Influenza - vaccine: composition ?

A

Usually trivalent grown in eggs, purified surface antigens

Usually contains A and B

76
Q

Influenza - vaccine: immunity life ?

A

1 year

77
Q

Influenza - vaccine: contraindications ?

A

Egg allergy

Guillan Barre (caution)

78
Q

Influenza - vaccine: major adverse reactions ?

A

anaphylaxis

bronchospasm

Stevens-Johnson syndrome

neurologic disorders

Guillain-Barre syndrome

79
Q

Influenza - vaccine: common reactions ?

A

myalgia
fatigue
irritability

80
Q

Influenza - vaccine: dosing ?

A

Once yearly

81
Q

Influenza CXR ?

A

Nonspecific findings

Peribronchial thickening

Diffuse interstitial infiltrates

hyperaeration

82
Q

Influenza Lab tests ?

A

Rapid flu antigen from nasal swab

83
Q

Influenza virus can be found by ?

A

DFA antibody staining of NP epithelial cells

ELISA

PCR

Culture

84
Q

MMR - vaccine: composition ?

A

lyophilized virus grown in chicken embryos

85
Q

MMR - vaccine: immunity life ?

A

life

86
Q

MMR - vaccine: contraindications ?

A

hypersens. to gelatin
anaphylactic

anaphylactoid rxn to neomycin

immunocompromised pts

tuberculosis, active untreated

87
Q

MMR - vaccine: major adverse reactions ?

A

erythema multiforme

Stevens-Johnson syndrome

atypical measles

88
Q

MMR - vaccine: common reactions ?

A

arthralgia/arthritis

fever

urticaria

rash, measles-like

89
Q

MMR - vaccine: dosing ?

A

2 doses

12-15m
4-6 yrs

90
Q

Measles hx. ?

A

Lymphopenia/Leukopenia

high fever 104

runny nose, cough,

red watery eyes

91
Q

Measles DS ?

A

Measles IgM drawn 3 days after the onset of rash

Fluorescent antibody staining of NP cells for direct detection of antigen

PCR of oropharyngeal secretions or urine can show positive results up to 5 days before symptoms begin.

92
Q

Mumps DS ?

A

Viral culture or PCR of saliva, throat, urine, or CSF may be positive for one week after onset of symptoms

Single positive IgM is definitive diagnosis

93
Q

Rubella DS ?

A

Leukopenia common

Thrombocytopenia common

4 fold rise in antibody titer in serum drawn 1-2 weeks apart

Positive IgM titers indicate acute infection

94
Q

Rubella congenital infection is associated with ?

A

Low platelets

Abnl LFTs

CSF pleocytosis

Hemolytic anemia

95
Q

Varicella - vaccine: composition ?

A

live attenuated varicella virus

96
Q

Varicella - vaccine: immunity life ?

A

life

97
Q

Varicella - vaccine: contraindication ?

A

hypersens. to gelatin

anaphylactic or anaphylactoid rxn to neomycin

immunocompromised pts tuberculosis,

active untreated pregnancy or planned pregnancy w/in 4wk

98
Q

Varicella - vaccine: major adverse reactions ?

A

Stevens-Johnson syndrome

erythema multiforme

Henoch-Schonlein purpura

herpes zoster (shingles)

99
Q

Varicella - vaccine: common reactions ?

A

fever rash,
varicella-like
URI sx

100
Q

Varicella - vaccine: dosing ?

A

2 doses

12-15 months
4-6 years

101
Q

Varicella lab tests ?

A

Leukocyte decrease

Fluorescent antibody tests of a lesion smear

PCR is definitive

102
Q

HepA - vaccine: composition ?

A

Hep A antigens

103
Q

HepA - vaccine: immunity life ?

A

life

104
Q

HepA - vaccine: contraindications ?

A

Neomycin hypersensitivity

105
Q

HepA - vaccine: major adverse reactions ?

A

angioedema

erythema multiforme

hepatotoxicity

thrombocytopenia

neurotoxicity

106
Q

HepA - vaccine: common reactions ?

A

irritability

anorexia

fatigue

107
Q

HepA - vaccine: dosing ?

A

2 doses

12-24 months

108
Q

Hepatitis A lab findings ?

A

Bilirubin is elevated

LFTs are elevated

+/- prolongation of the PT

Definitive diagnosis made by positive anti-HAV IgM (anti-HAV IgG persists after infection resolves)

109
Q

Meningococcal - vaccine: composition ?

A

4 conjugated polysaccharides

110
Q

Meningococcal - vaccine: dosing ?

A

2 doses

11-12 years
16-18

111
Q

Meningococcal lab findings ?

A

WBC count low or elevated

Thrombocytopenia +/- DIC

CSF cloudy with >1,000 WBC with many PMNs

Gram (-) intracellular diplococci

112
Q

HPV - vaccine: composition ?

A

quadrivalent polysaccharides

6, 11
16, 18

113
Q

HPV - vaccine: dosing ?

A

3 dose series

11-12 years

114
Q

Newborn Screening ?

A

Blood samples collected by heelstick before hospital discharge

State-to-state variations in testing have diminished since 2010

Secretary Advisory Committee on Heritable Disorders in Newborns and Children set 30 core recommendations.

Clinical Medicine LAB - Professor Sample (36 decks)

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