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LMCC > Peds > Flashcards

Peds Flashcards

1
Q

ASA in children should be avoided because risk of…

A

Reye’s syndrome

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2
Q

Tissue that grows primarily in first 2 years

A

CNS

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3
Q

Tissue that grows primarily in mid-childhood

A

Lymphoid tissue

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4
Q

Tissue that grows primarily in puberty

A

Gonads

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5
Q

Premature infants (<37wk) use corrected GA until age…

A

2yo

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6
Q

Birth weight

A

Average is 3.25kg (7lb)
20-30d/g in term neonate
Up to 10% weight loss in first 7d of life is normal
Should regain birth weight by 10-14d of age
2x birth weight by 4-5mo
3x birth weight by 1yr
4x birth weight by 2yr

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7
Q

Length/height

A 
Average is 50cm (20in)
25cm in 1st yr 
12cm in 2nd yr 
8cm in 3rd then 
4-7cm/yr until puberty
1/2 adult height at 2yo 
Measure supine lenght until 2yo then measure standing height
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8
Q

Head circumference

A

Average is 35cm (14in)
2cm/mo for first 3mo
1cm/mo at 3-6mo
0.5cm/mo at 6-12mo

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9
Q

Moro reflex

A

Abduction/extension of arms, opening of hands, followed by flexion/adduction of arms
Disappears by 4-6mo

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10
Q

Galant

A

Pelvis moves in direction of side that back is stroked along paravertebral line
Disappears by 2-3mo

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11
Q

Grasp

A

Disappears by 3-4mo

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12
Q

ATNR (asymmetric tonic neck reflex)

A

Fencing posture when you turn infant’s head to one side

Disappears by 4-6mo

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13
Q

Rooting

A

Disappears by 2-3mo

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14
Q

Parachute reflex

A

Ipsilateral arm extension to side infant is tilted toward while sitting
Present by 6-8mo
Does not disappear

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15
Q

Gross motor: 1mo

A

Turns head side to side when supine

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16
Q

Gross motor: 2mo

A

Briefly raises head when prone

Holds head erect when upright

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17
Q

Gross motor: 4mo

A

Lifts head and chest when prone
Holds head steady when supported sitting
Rolls prone to supine

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18
Q

Gross motor: 6mo

A

Tripod sit

Pivots in prone position

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19
Q

Gross motor: 9mo

A

Sits well without support, crawls, pulls to stand, stands with support

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20
Q

Gross motor: 12mo

A

Gets into sitting position without help
Stands without support
Walks while holding on

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21
Q

Gross motor: 15mo

A

Walks without support, crawls up stairs/steps

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22
Q

Gross motor: 18mo

A

Runs, walks forward pulling toys or carrying objects

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23
Q

Gross motor: 24mo

A

Climbs ups and down steps with 2 feet per step, runs, kicks ball

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24
Q

Gross motor: 3yr

A

Rides tricycle
Climbs up 1 foot per step, down 2 feet per step
Stands on one foot briefly

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25
Q

Gross motor: 4yr

A

Hops on 1 foot

Climbs down 1 foot per step

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26
Q

Gross motor: 5yr

A

Skips

Rides bicycle

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27
Q

Fine motor: 1mo

A

Fist with thumb in fist

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28
Q

Fine motor: 2mo

A

Pulls at clothes

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29
Q

Fine motor: 4mo

A

Briefly holds object when placed in hand

Reached midline objects

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30
Q

Fine motor: 6mo

A

Ulnar or raking grasp
Transfers objects from hand to hand
brings objects to mouth

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31
Q

Fine motor: 9mo

A

Early pincer grasp with straight wrist

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32
Q

Fine motor: 12mo

A

Neat pincer grasp

Releases ball with throw

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33
Q

Fine motor: 15mo

A

Picks up and eats finger foods
Scribbles
Stacks 2 blocks

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34
Q

Fine motor: 18mo

A

Tower of 3 cubes
Scribbling
Eats with spoon

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35
Q

Fine motor: 24mo

A

Tower of 6 cubes

Undresses

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36
Q

Fine motor: 3yr

A

Copies circle
Turns pages one at a time
Puts on shoes
Dress/undress fully except buttons

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37
Q

Fine motor: 4yr

A

Copies cross
Uses scissors
Buttons clothes

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38
Q

Fine motor: 5yr

A

Copies a triangle and square
Prints name
Ties shoelaces

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39
Q

Gross motor red flag

A

Not walking at 18mo

Rolling too early at <3mo

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40
Q

Fine motor red flag

A

Hand preference at <18mo

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41
Q

Speech: 1mo

A

Cries, startles to loud noises

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42
Q

Speech: 2mo

A

Variety of sounds (coos)

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43
Q

Speech: 4mo

A

Turns head towards sounds

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44
Q

Speech: 6mo

A

Babbles

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45
Q

Speech: 9mo

A

Mama, dada
Imitates 1 word
Responds to no regardless of tone

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46
Q

Speech: 12mo

A 
2 words 
Follows 1 step command 
Uses facial expression
Sounds 
Actions to make needs known
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47
Q

Speech: 15mo

A

4-5 words

Points to needs/wants

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48
Q

Speech: 18mo

A

10 words

Follows simple commands

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49
Q

Speech: 24mo

A

2-3 word phrases
50% intelligible
Understands 2 step commands

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50
Q

Speech: 3yr

A

Combines 3 or more words in a sentence
Recognizes colours, preopositions, plurals, counts to 10
75% intelligble

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51
Q

Speech: 4yr

A

Speech 100% intelligble
Uses past tense
Understands 3 part directions

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52
Q

Speech: 5yr

A

Fluent speech, future tense, alphabet

Retells sequence of story

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53
Q

Babinski sign

A

Present up to 2yo

Upgoing plantar reflex

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54
Q

Social: 1mo

A

Calms when comforted

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55
Q

Social: 2mo

A

Smiles responsiveley
Recognizes and calms down to familiar voice
Follows movement with eyes

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56
Q

Social: 4mo

A

Laughs responsively
Follows moving toy or person with eyes
Responds to ppl with excitement

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57
Q

Social: 6mo

A

Stranger anxiety

Beginning of object permanence

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58
Q

Social: 9mo

A

Plays games

preaches to be picked up

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59
Q

Social: 12mo

A

Responds to own name

Separation anxiety begins

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60
Q

Social: 15mo

A

Looks to see how other react (ie. after falling)

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61
Q

Social: 18mo

A

Shows affection towards other

Points to show interest in something

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62
Q

Social: 24mo

A

Parallel play

Helps to dress

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63
Q

Social: 3yo

A

Knows sex and age
Shares some of time
Playes make believe games

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64
Q

Social: 4yo

A

Cooperative play
Fully toilet trained by day
Tries to comfort someone who is upset

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65
Q

Social: 5yo

A

Cooperates with adult request most of the time

Separates easily from caregiver

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66
Q

Speech red flag

A

<10 words at 18mo

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67
Q

Social red flag

A

Not smiling at 3mo

Not pointing at 15-18mo

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68
Q

Breastfed infants require supplements

A

Vitamin D 400IU/d
Fluoride after 6mo if not sufficient in water
Iron at 6-12mo if not receiving fortified cereals/meat/meat alternatives

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69
Q

Foods to avoid in early infancy

A

Honey until past 12mo (botulism)
Added sugar, salt
Excessive milk (no more than 750mL per day after 1y)
Limit juice intake (1/2 cup daily)

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70
Q

Milk

A

Breastfeeding recommended
9-24mo: homo milk
2-6yr: 2% milk

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71
Q

C/I to breastfeeding

A

Medications known to cross into breast milk (chemo)
HIV/AIDS
Active untreated TB
Herpes in breast region
>0.5g/kg/d of EtOH or illicit drugs
OCPs are NOT a C/I to breastfeeding (estrogen may decrease lactation but is safe for baby)

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72
Q

Meds that cross into breast milk

A 
Bromocrimptine 
High dose diazepam
Gold
Metronidazole 
Tetracycline
Lithium
Cyclophosphamide
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73
Q

Wet diaper amount

A

1 wet diaper per day of age for first wk
1-2 black or dark green stools/d on day 1 and 2
3+ brown/green/yellow stools per day on day 3 and 4
3+ yellow, seedy stools per day on day 5

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74
Q

Infantile colic

A

Unexplained paroxysms of irritability and crying for >3h/d, >3d/wk for >3wk in an other wise healthy, well-fed baby (rule of 3s)
Peaks at 6-8wk
Usually resolves by 3mo

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75
Q

When to see dentist

A

6mo after eruption of first tooth and definitely by 1yo

First tooth typically at 5-9mo

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76
Q

Enuresis

A

Involuntary urinary incontinence by day and/or night in child >5yo

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77
Q

Secondary enuresis

A

Involuntary loss of urine at night after child had sustained period of bladder control (>6mo)

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78
Q

Pharmaco treatment for enuresis

A

Don’t do before age 7 because often resolves spontaneously

Consider DDAVP oral tablets (antidiuretic)

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79
Q

Encopresis

A

Fecal incontinence in child >4yo at least once per mo for 3mo

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80
Q

Failure to thrive

A

Weight <3rd percentile

Falls across two major percentile curves or <80% of expected weight for height and age

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81
Q

Decreased weight, normal ht, normal HC

A

Caloric insufficiency
Decreased intake
Hypermetabolic state
Increased losses

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82
Q

Decreased wt, ht and normal HC

A

Structural dystrophies
Endocrine d/o
Constitutitional growth delay (BA < CA)
Familial short stature (Bone age = chronological age)

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83
Q

Decreased wt, ht, hc

A

Intrauterine insult

Genetic abnormality

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84
Q

Overweight BMI

A

> 85th percentile

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85
Q

Obesity BMI

A

> 95th percentile for age and height

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86
Q

Risk factors for SIDS

A 
Prematurity <37wk
Early bed sharing <12wk 
Alcohol use during pregnancy
Soft bedding
Low birthweight 
Bed sharing 
Aboriginals
Male
No prenatal care
Smoking in household
Prone sleeping 
Poverty
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87
Q

Prevwntion of SIDS

A

Back for sleeping
Avoid sharing bed, overheating, overdressing
Appropriate infant bedding
Exclusive BF in first month and no smoking
Pacifiers appear to have a protective effect
Do not reinsert if falls out during sleep
Infant monitors do not reduce incidence

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88
Q

Tests to order to R/O pathologic causes of fractures

A 
Ca2+ 
Mg2+ 
PO4
ALP
PTH
Vit D 
Albumin
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89
Q

Tests to order to R/O pathologic causes of bruising

A 
CBC 
INR 
PTT 
vWF
Factors VIII/IX
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90
Q

Sexual assault examination kit

A

Within 24h if prepubertal

Within 72h if pubertal

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91
Q

Ductus arteriosus

A

Connection btwn pulmonary artery and aorta

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92
Q

Ductus venosus

A

Connection btwn umbilical vein and IVC

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93
Q

Prenatal circulation of oxygenated blood

A

Oxygenated blood from placenta –> umbilical vein –> IVC –> RA –> foramen ovale –> LA –> LV –> aorta –> brain/myocardium/upper extremties

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94
Q

Prenatal circulation of deoxygenated blood

A

Deoxygenated blood returns via SVC to RA –> 1/3 of blood goes to RV –> pulmonary arteries –> ductus arteriosus –> arota –> systemic circulation –> placenta

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95
Q

Ductus venosus closure

A

Separation of low resistance placenta –> systemic circulation becomes high resistance system

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96
Q

Foramen ovale closure

A

Increased pulmonic flow –> increased LA pressures

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97
Q

Ductus arteriosus closure

A

Increased oxygen concentration in first breath –> decreased prostaglandins –> ductus arterosus closure

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98
Q

Acyanotic heart disease

A

L to R shunt

Obstructive

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99
Q

Cyanotic heart disease

A

R to L shunt

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100
Q

L to R shunt

A

ASD
VSD
PDA
Atrioventricular spetal defect

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101
Q

Obstructive causes of acyanotic CHD

A

Coarctation of aorta
Aortic stenosis
Pulmonic stenosis

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102
Q

R to L shunt

A

Tetralogy of Fallot

Ebstein’s anomaly

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103
Q

5Ts of cyanotic CHD

A 
Tetralogy of Fallot
Transposition of the great arteries 
Truncus arteriosus
Total anomalous pulmonary venous drainage 
Tricuspid atresia
Hypoplastic left heart syndrome
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104
Q

Boot shaped heart on CXR

A

Tetralogy of Fallot

Tricuspid atresia

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105
Q

Egg-shaped heart

A

Transposition of great arteries

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106
Q

Left to right shunts

A

ASD
VSD
PDA

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107
Q

3 types of Atrial Septal Defects

A

Ostium primum
Ostium secundum
Sinus venosus (located at entry of SVC into right atrium)

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108
Q

Ostium primum

A

AKA endocardial cushion defect
Defect in atrial septum at level of tricuspid and mitral valves
Common in DS

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109
Q

Ostium secundum

A

Most common type, 50-70%

Foramen in septum primum

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110
Q

Foramen ovale

A

Foramen in septum secundum

Normally closes at birth when pulmonary vascular pressure decreases and the LA > RA

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111
Q

Mgmt of ASDs

A

80-100% spontaneously close if ASD diameter is <8mm

Elective surgical or catheter closure btwn 2-5yo

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112
Q

ASD heart murmur

A

Grade 2-3/6 pulmonic outflow murmur, widely split, and fixed S2

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113
Q

ECG for ASD

A

RAD
Mild RVH
RBBB

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114
Q

Most common congenital heart defect

A

VSD (30-50%)

Majority are small and close spontaneously

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115
Q

ECG for VSD

A

LVH
LAH
RVH

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116
Q

VSD heart murmur

A

The size of the VSD is inversely related to the intensity of the mumur
Holosystolic murmur at LLSB

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117
Q

Treatment of VSD

A

If small –> most close spontaneously

If mod/large –> tx CHF and surgical closure by 1yo

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118
Q

PDA

A

Patent vessel btwn descending aorta and the left pulmonary artery
Normal functional closure is at 15h
Normal anatomical closure within first days of life

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119
Q

Treatment for PDA

A

Premature infants have higher rates of spontaneous closure
Indomethacin (antagonizes prostaglandin E2, only effective in preterm)
Catheter or surgical closure if PDA causes resp compromise, FTT or persists beyond 3mo

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120
Q

PDA heart murmur

A

Machinery murmur continuous through systolic and diastolic at L infraclavicular area

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121
Q

Coarctation of the aorta

A

Narrowing of aorta almost always at level of ductus arteriosus

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122
Q

Syndrome often a/w coarctation of aorta

A

Turner syndrome (15-35%)

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123
Q

Obstructive lesions

A

Coarctation of the aorta
Aortic stenosis
Pulmonary stenosis

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124
Q

Coarctation of the aorta tx

A

Give prostaglandins to kep ductus arteriosus patent
Surgical correction in neonates
Balloon arterioplasty may be considered for older children

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125
Q

Test to differentiate btwn cardiac and other causes of cyanosis

A

Hyperoxic test
Obtain preductal, right radial ABG in room air, then repeat after pt inspires 100% O2
If PaO2 improves to >150mmHg –> less likely cardiac cause

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126
Q

Preductal and post ductal oximetry

A

> 5% difference suggests R to L shunt

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127
Q

Tetrology of fallot

A

VSD
Pulmonary stenosis
Aortic root overriding VSD
RVH

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128
Q

Most common cyanotic heart defect dx beyond infancy

A

Tetrology of fallot

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129
Q

ToF murmur

A

Single loud S2 due to severe pulmonary stenosis, systolic ejection murmur at LSB

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130
Q

ToF ECG

A

RAD, RVH

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131
Q

ToF CXR

A

Boot shaped heart
Decreased pulmonary vasculature
Right aortic arch in 20%

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132
Q

ToF mgmt

A

Surgical repair at 4-6mo of age

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133
Q

Most common cyanotic CHD in neonates

A

TGA

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134
Q

Transposition of the Great Arteries

A

Parallel systemic and pulmonary vasculature
Systemic: Body –> RA –> RV –> aorta –> body
Resp: Lungs –> LA –> LV –> pulmonary artery –> lungs
Survival dependent on mixing through PDA, ASD, VSD

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135
Q

TGA mgmt

A

Prostaglandin E1 infusion to keep ductus open until surgical mgmt

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136
Q

Total anomalous pulmonary venous return

A

All pulmonary veins drain into right sided circulation

ASD must be present to mix oxygenated blood to LA

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137
Q

Total anomalous pulmonary venous return mgmt

A

Surgical repair

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138
Q

Ebstein’s anomaly

A

Septal and posterior leaflets of tricuspid valve are malformed and displaced into RV
–> RV dysfunction, tricuspid dysfunction
Often A/W ASD and/or patent foramen ovale causing R–>L shunt
A/W maternal benzo and lithium use in 1st trimester

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139
Q

Ebstein’s anomaly mgmt

A

Newborn: consider closure of tricuspid valve and aortopulmonary shunt, or transplant
Older: Tricuspid valve repair or replacement

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140
Q

Truncus arteriosus

A

Single great vessel giving rise to aorta, pulmonary and coronary arteries
Requires surgical repair within first 6wk of life

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141
Q

Hypoplastic left heart syndrome

A

Hypoplastic LV
Narrow mitral/aortic valves
Small ascending aorta
Coarctation of aorta

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142
Q

Most common cause of death from CHD in first mo of life

A

Hypoplastic left heart syndrome

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143
Q

Hypoplastic left heart tx

A

Surgical palliation or heart transplant

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144
Q

4 key features of CHF in peds

A 
2 tachys and 2 megalys 
Tachycardia 
Tachypnea
Hepatomegaly 
Cardiomegaly
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145
Q

PVCs

A

Common in teens

Benign if single, uniform, disappear with exercise and no associated structural lesions

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146
Q

Most frequent sustained dysrhythmia in children

A

SVT

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147
Q

Still’s murmur

A

Innocent
3-6yo
High-pitched, vibratory, LLSB or apex, SEM
Flow across pulmonic valve leaflets

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148
Q

Global developmental delay

A

Performance significantly below average in 2 or more domains of development in a child <5yo

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149
Q

Intellectual disability

A

Historically defined as IQ<70

Limitations in both intelligence and adaptive skills

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150
Q

Bilingual exposure and language delay

A

Bilingual exposure generally does NOT explain frank delay in language development

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151
Q

Developmental disorder with high incidence of psychiatric comorbidity

A

Specific learning disorder

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152
Q

Most common preventable cause of intellectual disability

A

Fetal alcohol spectrum disorder

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153
Q

Fetal alcohol spectrum disorder diseases

A

FAS
Partial FAS
ARBD (Alcohol related brain damage)
ARND (Alcohol related neurodevelopmental disorder)

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154
Q

Criteria for dx of FAS

A
  1. Growth deficiency not due to nutrition
  2. Characteristic pattern of facial anomalies (short palpebral fissures, flattened philtrum, thin upper lip)
  3. CNS dysfunction, need >/= 3 (motor skills, neuroanatomy/neurophysiology, cognition, language, academic achievement, memory, attention, executive function, affect regulation, adaptive behaviour, social skills or social communication OR microcephaly in infant/young children)
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155
Q

Criteria for dx of ARBD

A

Congenital anomalies (malformations and dysplasias of cardiac, skeletal, renal, ocular and auditory systems)

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156
Q

Criteria for dx of ARND

A

CNS dysfunction
Complex pattern of behavioural or cognitive abnormalities inconsistent with developmental level that can’t be explained by familial background or environment alone

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157
Q

Dx criteria for DM (Types 1 and 2) in children

A
  1. Symptoms (polyuria, polydipsia, weight loss) and hyperglycemia (random glucose >/= 11.1)
    OR 2. 2 of the following on one occasion: fasting glucose >/= 7, 2h plasma glucose during OGTT >/=11.1, Random glucose >/= 11.1
    OR 3. One of the following on 2 separate occasions: fasting glucose >/= 7, 2h plasma glucose during OGTT >/= 11.1, random glucose >/= 11.1
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158
Q

T1DM

A

Most common form of DM in children
M=F
Bimodal, peaks at 5-7yo and at puberty

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159
Q

Major negative outcome of DKA in children

A

Cerebral edema

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160
Q

Tx for cerebral edema

A

Mannitol
Decrease fluids
Elevate head of bed
Intubate

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161
Q

Kussmaul breathing from DKA

A

Deep laboured breathing for respiratory compensation of metabolic acidosis

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162
Q

DKA management

A

ABCs
100% O2
Correct fluid losses first (NS + 40mEQ/L KCl)
Insulin 0.05-0.1U/kg/h after fluids running for 1-2h
Add glucose once glucose levels drop to keep in 8-12 range
Can replace fluids with D10NS + 40mEq KCl
DON’T GIVE BICARB

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163
Q

Cushing’s Triad of cerebral edema

A

HR low
High BP
Irregular respirations (Cheyne-Stokes)

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164
Q

T2DM

A

F > M
Less common in children but increasing rates due to child obesity
Glycemic taret HbA1c = 7%
Metformin first line
Can start on insulin if A1c > 9% at dx
Screening: Add annual screening for PCOS and NAFLD

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165
Q

Short stature

A

Height <3rd percentile

Poor growth evidenced by growth deceleration (height crosses major percentile lines, growth velocity <25th percentile)

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166
Q

Short stature ddx

A 
ABCDEFS 
Alone (neglect)
Bone dysplasias (rickets, scoliosis, mucopolysaccharidoses) 
Chromosomal (turner, down) 
Delayed growth (constitutional)
Endocrine (low GH, Cushing, hypothyroid) 
Familial
GI malabsorption (Celiac, Crohn's)
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167
Q

Investigations for short stature

A

Calculate mid-parental height Boys: (mother + father’s height in cm + 13)/2
Girls: (mother + father’s height in cm - 13)/2
AP xray of left hand and wrist fot bone age
GH testing
Other tests based on hx/pe

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168
Q

GH therapy for GH deficiency

A

May help reach adult height if given at an early age AND
1. GH shown to be deficient by 2 diff stimulation tests (arginine, glucagon, insulin)
2. Growth velocity <3rd percentile or height <3rd perventile
Bone age xrays show unfused epiphyses/delayed bone age

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169
Q

Measure proportionality

A 
Calculate Upper/lower segment ratio using pubic symphysis as landmark
Normal newborn: 1.7
Normal child: 1.4 
Normal adult: 0.9 
Normal female: 1
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170
Q

Proportionate short stature with slow growth velocity

A 
Endocrine (height more affected than weight) 
Chronic disease (weight affected more than height)
Psychosocial neglect
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171
Q

Tall stature

A

Height greater than 2 SD above the mean for a given age, sex and race

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172
Q

Beckwith-Wiedemann Syndrome

A

Overgrowth syndrome
Growth slows by ~8yo and adults are not unusually tall
May grow asymmetrically (hemihyperplasia)
A/w omphalocele, umbilical hernia, macroglossia, visceromegaly, creases near ears, hypoglycemia, renal abnormalities
Increased risk of cancerous and noncancerous tumours (esp Wilms tumour and hepatoblastoma) - 10%
Normal life expectancy

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173
Q

Tall stature etiology

A

Constitutional/familial
Endocrine: Beckwith-wiedemann syndrome, hyperthyroidism, hypophyseal gigantims, precocious puberty
Genetic: homocystinuria, klinefelter syndrome, Marfan syndrome, sotos syndrome

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174
Q

Homocystinuria

A

Disorder of methionine metabolism causing abnormal accumulation of homocysteine
Characterized by myopia, dislocation of lens, bloot clotting, osteoporosis, developmental delay

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175
Q

Sotos syndrome

A

Genetic disorder
Distinctive facial appearance (long, narrow face, high forehead, flushed cheeks, pointed chin, down-slanting palpebral fissures), overgrowth in childhood, learning delay
Adult height usually normal
A/W ADHD, phobias, OCD, impulsivity
Scoliosis, sz, heart or kidney defects, hearing loss, vision problems

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176
Q

Neonatal grave’s disease/Congenital hyperthyroidism

A

Typically caused by transplacental transfer of TSH receptor antibody
A/w low birthweight, IUGR, microcephaly, prematureity, tachy, frontal bossing, triangular facies, hepatosplenomeg, goiter

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177
Q

Neonatal grave’s investigations

A

TSH receptor antibody levels during 3rd trim or in cord blood
Neonatal TSH, T3, free T4

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178
Q

Neonatal grave’s mgmt

A

Methimazole and beta adrenergic blocker (ie. propranolol)

Should resolve within a few weeks

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179
Q

Congenital hypothyroidism epidemiology

A

F:M = 2:1

One of the most common preventable cause of intellectual disability

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180
Q

Congenital hypothyroidism clinical manifestations

A

Usually asymptomatic in neonatal period b/c maternal T4 crosses placenta
Prolonged jaundice, feeding difficulty, lethargy, constipation, umbilical hernia, macroglossia, large fontanelles, puffy face, swollen eyes

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181
Q

Congenital hypothyroidism investigations

A

Most commonly detected at newborn screen of TSH
Rpt screening at 2wks in high risk infants (preterm, very low birth weight, NICU, specimen collection <24h
Abnormal results confirmed with serum levels from venipuncture

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182
Q

Primary congenital hypothyroidism lab results

A

Increased TSH, low free T4

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183
Q

Secondary congenital hypothyroidism lab results

A

Low TSH, low free T4

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184
Q

CH treatment

A

Thyroxine replacement within 2wk to avoid cognitive imapirment
If tx started after 3-6mo, may result n permanent developmental delay

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185
Q

Congenital adrenal hyperplasia

A

Autosomal recessive disorder characterized by partial or total defect of various synthetic enzymes required for cortisol and aldo production in adrenal cortex

186
Q

Most common cause of ambiguous genitalia in genotypically normal females (46XX)

A

Congenital adrenal hyperplasia

187
Q

Enzyme responsible for CAH 95% of the time and function

A

21-hydroxylase mutation
Leads to decrease in cortisol and aldosterone production –> increased shunting of precursors to androgens
Cortisol deficiency leads to elevated ACTH = adrenal hyperplasia

188
Q

Classic 21-OH deficiency with salt wasting

A

Inadequate aldosterone resulting in FTT, hyper kalemia, hyponatremia, hypoglycemia, acidosis (majority of classic type_

189
Q

Classic 21-OH deficiency without salt wasting

A

Simple virilization with adequate aldosterone
Females: Amenorrhea, precocious puberty, polycystic ovaries, hirsutism
Males: Typically asymptomatic at birth, may have hyperpigmentation, penile enlargement, rapid growth and accelerated skeletal maturation, virilization later in life

190
Q

Non-classic CAH

A

Mild androgen excess, sometimes asymptomatic, virilization present later in life

191
Q

CAH investigation

A

High serum levels of 17-OH progesterone
Newborn screening
Assess plasma ACTH, serum electrolytes, plasma glucose, plasma aldo, plasma renin, blood gas
U/S to look for enlared adrenal gland and presence of uterus

192
Q

CAH treatment

A

Glucocorticoids (ie. hydrocortisone); more in times of stress
Mineralocorticoids (ie. fludrocordisone) as necessary to reduce ACTH levels

193
Q

HPG axis during puberty

A

Pulsatile release of GnRH –> increased release of LH and FSH –> maturation of gonads, release of sex steroids –> secondary sexual characteristics

194
Q

Female puberty

A

Onset: age 8-13 (7 in African descent), earlier common

  1. thelarche (breast budding)
  2. pubarche (axillary hair, body odour, mild acne)
  3. growth spurt
  4. menarche (mean age 12.5)
195
Q

Male puberty

A 
Onset: age 9-14yo, earlier uncommon 
1. Testicular enlargement
2. Penile enlargement 
3. Pubarche (axillary and facial hair, body odour, mild acne) 
4. Growth spurt (occurs later in boys) 
Gynecomastia common and self limited
196
Q

Female breast tanner staging

A

1: papilla elevation
2: breast and papilla elevated as small mound, areola enlarging
3: Enlarging breast and areola, no contour separation
4: areola and papilla form secondary mound
5: mature, nipple projects, no secondary mound

197
Q

Female genital tanner staging

A

1: no hair, prepubertal
2: small amount of long, straight or curled, slighlty pigmented along labia majora
3: Darker, coarser, curlier hair distributed sparsely over pubis
4: adult-type hair; no extension to medial thighs
5: mature distribution with spread to medial thighs

198
Q

Male genital tanner staging

A

1: no hair, prepubertal
2: small amount of long, straight or curled slightly pigmented hair along base of penis. enlargement of testes and scrotum, reddening of scrotal skin
3: darker, coarser, curlier hair distributed sparsely over pubis. lengthening of penis, further enlargement of testes and scrotum
4: adult type hair, no extension to medial thighs. Increasing penile circumference and length, development of glands, further enlargement of testes and scrotum, darkening of scrotal skin
5: mature distribution with spread to medial thighs. Adult size

199
Q

Precocious puberty in females

200
Q

Precocious puberty in male

201
Q

Central cause of precocious puberty

A

GnRH dependent
hypergonadotropic hypergonadism
Hormone levels as in normal puberty
Premature activation of HPG axis
May be normal, CNS disturbance (tumours, hamartomas, post-meningitis, increased ICP, radiotherapy), NF, primary severe hypothyroidism
If proven central cause, get MRI of brain

202
Q

Peripheral cause of precocious puberty

A

GnRH independent
Hypogonadotropic hypergonadism
Adrenal d/o (CAH), testicular/oavarian tumour, gonadotropic/hCG secreting tumour (ie. hepatoblastoma, intracranial teratoma, germinoma), exogenous steroid administration, McCune-Albright syndrome, primary severe hypothyroidism

203
Q

McCune-Albright Syndrome

A

Genetic disorder
Develop fibrous tissue in bones (polyostic fibrous dysplasia) –> asymmetric growth
Cafe au lait spots w/ irregular borders
Precocious puberty (menstrual bleeding at very young age)
Goiter
Hyperthyroidism
Acromegaly

204
Q

Tx of central precocious puberty

A

GnRH agonists (ie. leuprolide)

205
Q

Tx of peripheral precocious puberty

A

Meds that decrease production of specific sex steroid or block its effects (ie. ketoconazole, spironolactone, tamoxifen, anastrozole)
Surgery

206
Q

Delayed puberty in males

A

Lack of testicular enlargement by 14yo

207
Q

Delayed puberty in females

A

Lack of breast development by 13yo or absence of menarche by 16yo or within 5yr of pubertal onset

208
Q

Central causes of delayed puberty

A

Constitutional delay in HPG axis activation (most common)

Hypogonadotropic hypogodanism

209
Q

Peripheral causes of delayed puberty

A

Hypergonadotropic hypogonadism (ie. primary gonadal failure, gonadal damae, Turner’s syndrome, hormone deficiency, androgen insensitivity syndrome)

210
Q

Tx of delayed puberty

A

Hormone replacement
Cyclic estradiol and progesterone for females
Testosterone for males

211
Q

Mild degree of dehydration

A 
5% in <2yo, 3% in >2yo
Normal pulse 
Normal BP 
Decreased UO
Slightly dry oral mucosa 
Normal ant fontanelle 
Normal eyes
Normal skin turgor 
Normal cap refill
212
Q

Moderate degree of dehydration

A 
10% in <2yo, 6% in >2yo
Rapid pulse 
Low to normal BP 
Markedly decreased UO 
Dry oral mucosa 
Sunken anterior fontanelle 
Sunken eyes 
Decreased skin turgor 
Normal to increased cap refill
213
Q

Severe degree of dehydration

A 
15% in <2yo, 9% in >2yo
Rapid, weak pulse 
Decreased in shock (very late  finding in peds and very dangerous) 
Anuria 
Parched oral mucosa 
Markedly sunken anterior fontanelle 
Markedly sunken eyes
Tenting 
Increased cap refill
214
Q

Mild dehydration tx

A

Rehydrate with ORT at 50cc/kg over 4h

215
Q

Moderate dehydration tx

A

Rehydrate with ORT at 100cc/kg over 4h

216
Q

Severe dehydration tx

A

IV resuscitation with NS or RL at 20-40cc/kg over 1h

Begin ORT when pt stable

217
Q

IV fluid for newborn

218
Q

IV fluids for first month of life

A

D5W/0.45 NS + KCL 20mEq/L (only add KCl if voiding well)

219
Q

IV fluids for children

A

D5W/NS + KCl 20mEq/L or D5W/0.45NS + KCl 20 mEq/L

220
Q

Pyloric stenosis - 3Ps

A

Peristalsis
Pyloric mass
Projectile vomiting (2-4wk after birth)

221
Q

Fussiness after feeds, spit ups, arching of back, poor weight gain

222
Q

GERD investigations

A

Empiric trial of acid suppression
pH monitoring study
Upper GI study
Endoscopy

223
Q

Bilious emesis ddx

A

Malrotation with volvulus
Meconium ileus
Duoenal atresia/stenosis
Hirschsprung’s disease

224
Q

Upper GI series sign for duodenal atresia

A

Double bubble sign

225
Q

Triad of intussusception

A
  1. colicky progressive abdo pain
  2. bilious vomiting
  3. red currant jelly stool
226
Q

Gastroesophageal reflux vs GERD

A

Reflux is vomiting typically soon after feeding, non-bilious, very common, rarely progresses to GERD
GERD = reflux when it causes troublesome symptoms (ie. poor weight gain, heart burn, asthma, URTIs, OMs)

227
Q

Sigmoid volvulus AXR sign

A

Coffee bean sign

228
Q

Diarrhea

A

Infants = increase in stool frequency to 2x as often per day
Older children = 3+ loose or watery stools/day
Acute: <2 wk
Chronic: >2wk

229
Q

Most common virus causing gastroenteritis

230
Q

Stool analysis (bacterial vs viral)

A

Leukocytes/erythocytes –> bacterial/parasitic

pH <6 and presnece of reducing substances –> viral

231
Q

Most common cause of chronic diarrhea in thriving child

A

Toddler’s diarrhea

232
Q

Toddler’s diarrhea

A

Onset at 6-36mo
Ceases spontanesouly btwn 2-4yo
4-6 BM/d
Dx of exclusion in thriving child

233
Q

Toddler’s diarrhea tx

A 
4Fs 
Fibre 
Normal fluid intake 
35-40% fat
Discourage excess fruit juice
234
Q

Skin rash a/w celiac disease

A

Dermatitis herpetiformis

235
Q

Diagnosing celiac disease

A

Serum anti-tTG antibody (type of IgA antibody)
IgA deficient pts have false negative anti-tTG
MUST measure IgA concomitantly
Small bowel mucosal biopsy (usually duodenum) is dx with increased intraepithelial lymphocytes (earlist path finding)

236
Q

Milk allergy

A

IgE mediated

Skin, upper and lower respiratory symptoms within hours of milk exposure

237
Q

Cow’s milk protein allergy

A

Non-IgE mediated, more common

238
Q

Most common cause of acute abdo after 5yo

A

Appendicitis

239
Q

Common site for intussusception

A

Ileocecal junction

240
Q

Intussusception tx

A

Air enema or hydrastatic pressure

Sugery rarely needed

241
Q

Physiologic anemia

A

Normal to fall to as low as 100g/L at 8-12wk of age due to shorter fetal RBC lifespan
Usually no tx required

242
Q

Most common cause of childhood anemia

A

Iron deficiency anemia

243
Q

Mentzer index

A

MCV/RBC
Helps distinguish Fe def anemia vs thalassemia
Ratio < 13 = thalassemia
Ratio > 13 = iron deficiency

244
Q

Blood smear indicative of fe-def anemia

A

Hypochromic, microcytic RBCs
Pencil shaped cells
Poikylocytosis

245
Q

Iron studies in iron-def anemia

A 
Low ferritin 
Low Fe 
High TIBC 
High transferrrin
Low TSat
246
Q

Fe def anemia tx

A

Oral iron therapy: 4-6mg/kg/d elemental iron divided BID to TID for 3 mo
Repeat Hb after 1mo of treatment

247
Q

Most common cause of thrombocytopenia in childhood

A

Immune thrombocytopenic purpura

248
Q

Immune thrombocytopenic purpura

A

Binding of antiplatelet antibody to platelet surface, leading to removal and destruction of platelets in spleen and liver

249
Q

ITP presentation

A

50% present 1-3wk after viral illness
No lymphadenopathy
No hepatosplenomegaly
Sudden onset petechiae, prupura, epistaxis in otherwise well child

250
Q

ITP management

A

Spontaneous recovery in >70% of cases within 3mo
IVIg or prednisone if significant bleeding, plt <10 or at risk of significant bleeding
avoid contact sports
avoid ASA/NSAIDs

251
Q

Most common type of pediatric malignancy

252
Q

Leukemia classification

A

ALL (80%)
AML (15%)
CML (<5%)

253
Q

Most common presentation of Hodgkin lymphoma

A

Persistent, painless, firm, cervical or supraclavicular lymphadenopathy

254
Q

Hodgkin lymphoma treatment

A

Combo chemotherapy and radiation

255
Q

Non-Hodgkin lymphoma treatment

A

Combo chemotherapy

No added benefit of radiation in peds protocols

256
Q

Most common primary renal neoplasm of childhood

A

Nephroblastoma (Wilm’s Tumour)

257
Q

Most common cancer occurring in first year of life

A

Neuroblastoma

258
Q

Nephroblastoma prognosis

A

90% long term survival

259
Q

Neuroblastoma prognosis

A

Poor

Often late detection

260
Q

Fever without a source

A

Acute febrile illness (typically <10d) with no cause discerned even after careful hx and physical

261
Q

Fever of unknown origin

A

Daily or intermittent fevers for at least 2 consecutive wk of uncertain cause after careful hx and P/E and initial lab assessment

262
Q

More common bacterial causes of AOM

A

S. pneumoniae
H. influenza
M. catarrhalis
GAS

263
Q

AOM tx

A

Watchful waiting if appropriate

Abx if <6mo or moderately/severely ill (Amoxicillin 75-90mg/kg/d dosed BID x10d for 6mo-2y and 5d if >/2 yr)

264
Q

Most common cause of pediatric hearing loss

A

OM with effusion

265
Q

Erythema infectiosum

A

AKA Fifth disease/slapped cheek
Parvovirus B19
Flu-like illness for 7-10d then rash appears ~10-17d after
Erythematous maculopapular rash, lacy on cheeks, may affect trunk/extremities
Supportive mgmt

266
Q

Giannoti-Crosti Syndrome

A

EBV and Hep B
* Asymptomatic symmetric papules
* On face, cheeks, extensor surfaces of extremities, spares trunk
* Viral prodrome
* May have lymphadenopathy, hepatosplenomegaly
* Asymptomatic symmetric papules
* On face, cheeks, extensor surfaces of extremities, spares trunk
* Viral prodrome
* May have lymphadenopathy, hepatosplenomegaly
Supportive mgmt
Pain control
Resolves in 3-12wk

267
Q

Hand, foot, mouth dz

A

Coxsackie group A
* Vesicles and pustules on erythematous base
* Extremities
* May have vesicles in posterior oral cavity
Supportive mgmt

268
Q

Measles

A

Morbillivirus
* Airborne transmission
* Prodrome of fever, cough, coryza, conjunctivitis
* Maculopapular rash starts on neck, behind ears and along hairline 3d after start of symptoms
* Rash spreads downward, reaching feet in in 2-3d
* Initial rash on buccal mucosa as red lesions with bluish white spots in center (Koplik spots)
Supportive
Unimmunized contacts: measures vaccine within 72h of exposure or IgG within 6d of exposure

269
Q

Roseola

A

HHV6
* Exanthem subitum = blanching, erythematous macules start on neck and trunk —> spread to arms (less commonly face and legs)
* Rash typically preceded by 3-4d of high fevers –> end as rash appears
* Usually in children <2yrs
Supportive tx

270
Q

Rubella

A
  • Droplet transmission
  • Prodrome of low grade fever, sore throat, arthritis
  • Pink, maculopapular rash appears 1-5d after start of symptoms
  • Starts on face and spreads to neck and trunk
    Supportive
    MMR vaccine for prevention (caution with pregnant women)
271
Q

Varicella

A 
Varicella zoster virus 
Mainly airborne transmission 
Groups of polymorphic lesions (macules, papules, vesicles, crusts) 
Generalized distribution
Significant pruritus 
Supportive 
Consider antiviral
272
Q

Mono classic triad

A

Febrile
Generalized non-tender lymphadenopathy
Pharyngitis/tonsillitis

273
Q

Coarctation of the aorta often associated with…

A

Bicuspid aortic valve (75-85%)

274
Q

CXR findings of coarctation of the aorta

A

Upper left mediastinal shadow
Cardiomegaly may be seen in older children
Dilated intercostal collateral arteries may erode 3rd to 8th ribs causing rib notching (years to develop)

275
Q

Coarctation of the aorta murmur

A

Grade 2-3/6 ejection systolic murmur best heard in left interscapular area
Ejection click may be aduible when associated with bicuspid aortic valve

276
Q

Treatment for GAS pharyngitis

A

Penicillin V
Amoxicillin
or Erythromycin x 10d
Tx prevents rheumatic fever but does NOT alter risk of post-strep GN

277
Q

PANDAS

A

Pediatric autoimmune neuropsychiatric disorder associated with group A streptococci

278
Q

Scarlet fever

A

Hypersensitivity rxn to exotoxin produced by GAS
Fever, sore throat, strawberry tongue
Sandpaper rash ~24-48h after pharyngitis (blanchable, perioral sparing, non-pruritic, non-painful)
Tx: Penicillin, amoxicillin, or erythromycin x 10d

279
Q

Rheumatic fever

A

Due to antibody cross-reactivity following GAS

Tx: Penicillin or erythromycin for acute course x 10d, prednisone if severe carditis

280
Q

Post-strep GN

A

Occurs 1-3wk after initial GAS infection
Dx confirmed with elevated serum antibody titres against strep antigens (ASOT, anti-DNAse B), low serum complement (C3)
Tx: fluids, Na+ restriction, loop diuretics for HTN and edema
Tx: Penicillin or erythromycin if evidence of persistent GAS infection
Prognosis: 95% children recover completely within 1-2 wk

281
Q

Bacterial meningitis CSF findings

A 
WBC < 100x10^5
Neutrophils 100-10000 x 10^5 (may be normal) 
Glucose <0.4 (CSF:Blood), may be normal 
Protein > 1 (may be normal)
RBC 0-10
282
Q

Viral meningitis CSF findings

A 
WBC 10-1000 x 10^5 (may be normal) 
Neutrophils usually <100 x 10^5
Glucose level usually normal 
Protein 0.4-1 ( can be normal) 
RBC 0-2
283
Q

Herpest meningitis CSF findings

A 
WBC 50-1000 (can be normal)
Neut <100
Glucose <0.3 
Protein 1-5
RBC 10-50
284
Q

Common culprits of bacterial meningitis in 0-4wks

A 
KLEG 
Klebsiella (-) 
L. monocytogenes (+) 
E. coli (-) 
GBS (+)
285
Q

Common culprits of bacterial meningitis in 1-23mo

A 
H. SN-EG 
GBS 
E. coli 
S. pneumoniae 
N. meningitidis 
H. influenzae
286
Q

Common culprits of bacterial meningitis in >2yo

A

SNL
S. pneumo
N. meningitis
L. monocytogenes

287
Q

Empiric abx for 0-28d suspected meningitis

A

Ampicillin + Cefotaxime

288
Q

Empiric abx for 28-90d suspected meningitis

A

Cefotax + Vancomycin (+ Amp if immunocompromised)

289
Q

Empiric abx for >90d

A

Ceftriaxone +/- vancomycin

290
Q

HSV meningitis tx

291
Q

Pertussis bacteria

A

Bordtella pertussis

Gram negative pleomorphic rod

292
Q

Stages of pertussis

A

Prodromal catarrhal stage: 1-7d, URTI symptoms, no or low-grade fever
Paroxysmal stage: 4-6 wk, whooping cough
Convalescent stage: 1-2wk, decreased frequency of coughing episodes, may last up to 6mo

293
Q

Pertussis treatment

A

Macrolide (azithro, erythromycin, clarithromycin) if B. pertussis isolated or symptoms present <21d
Droplet isolation until 5d of tx
Report to Public Health
Macrolide abx for all household contacts
Vaccine

294
Q

Common bacterial culprit of preseptal cellulitis in children

A

H. influenza

295
Q

Common bacterial culprits of preseptal cellulitis in adults

A

S. aureus

Streptococcus

296
Q

Treatment for preseptal cellulits

297
Q

Treatment for orbital cellulitis

A

Admit
Blood cultures x 2
Orbital CT
Ceftriaxone + Vancomycin IV x 7d

298
Q

Cardinal signs of orbital cellulitis

A
  • Ophthalmoplegia/diplopia
  • Decreased VA
  • Pain with extra ocular eye movement
299
Q

Common bacterial culprits for UTIs

A 
KEEP (Gram neg) 
Klebsiella 
E. Coli 
Enterobacter
Pseudomonas 
and 
S. saprophyticus (+) 
Enterococcus (+)
300
Q

Empiric abx for UTI in neonate

A

IV amp and gent

Abx ourse: 7-10d

301
Q

Empiric abx for infant/older children

A

Oral abx (based on local E. coli sensitivity
If requiring IV: IV amp and gent
Abx course: 7-10d

302
Q

UTI imaging for neonates

A

Kidney/bladder U/S for:

  • Children < 2y.o. with first febrile UTI
  • Children of any age with recurrent febrile UTIs
  • Children of any age with UTI who have fam hxof renal or urologic disease, poor growth, hypertension
  • Children who do not respond as expected to appropriate antimicrobial therapy
303
Q

Voiding cystourethrogram

A

X-rays to take pictures of urinary system

  • Children of any age with ≥ 2 febrile UTIs OR
  • Children of any age with first febrile UTI AND abnormality on renal U/S OR
  • Fever ≥ 39C and pathogen other than E. coli OR
  • Poor growth or hypertension
304
Q

Small for gestational age

A

2 SD < mean weight for GA or <10th percentile

305
Q

Large for gestational age

A

2 SD > mean weight for GA or >90th percentile

306
Q

Low birthweight

307
Q

Very low birthweight

308
Q

Extremely low birthweight

309
Q

APGAR

A 
Appearance (colour) 
Pulse
Grimace (irritability) 
Activity (tone) 
Respirations

If <7 at 5min, then reassess q5min until <7

310
Q

APGAR scores of 1

A 
HR <100/min 
Slow, irregular resps 
Grimace 
Some flexion of extremities 
Body pink, extremities blue
311
Q

APGAR scores of 2

A 
HR > 100/min 
Good, crying resps 
Cough/cry 
Active motion 
Completely pink
312
Q

HR at which to start chest compressions in neonate

313
Q

Treatment for apnea of prematurity (<34wk)

A

Methylxanthines (caffeine) to stimulate CNS and diaphragm

Not for term infants

314
Q

Hemorrhagic disease of the newborn

A

Vitamin K deficiency

Both PT and PTT are abnormal since factors X, IX, VII, II are affected

315
Q

Hypoglcyemia in newborn

A

Glucose <2.6mmol/L

316
Q

Preferred imaging modality to investigate intraventricular hemorrhage

317
Q

Neonatal hyperbilirubinemia

A

Total serum bili >95th percentile (high risk zone) on Butani nomogram in infants >3wks GA

318
Q

Jaundice is pathological if

A
  • It occurs within 24h of birth
  • Conjugated hyperbilirubinemia is present (>35)
  • Unconjugated bilirubin rises rapidly or is excessive for pt’s age and weight (>257 in full term)
  • Persistent jaundice lasts beyond 1-2 wk of age
319
Q

Enzyme used to conjugate bilirubin

A

Glucoronyl transferase (Immature in neonates)

320
Q

Enzyme in meconium used to hydrolyze conjugated bili back to unconjugated bili

A

Beta glucuronidase

Causes increased enterohepatic circulation

321
Q

Physiologic jaundice

A

Total bili = 257umol/L

Peaks at 3-4d of life, resolves by 10d of life

322
Q

Breastfeeding jaundice

A

Lack of milk production –> dehydration –> exaggerated physiologic jaundice
Early in first week of life

323
Q

Breast milk jaundice

A

Onset at 7d of life, peaks at 2-3wk, usually resolved by 6wk

Glucoronyl transferase inhibitor in breast milk

324
Q

Galactosemia

A

Genetic disorder (GALT gene) causing inability to properly process galactose
A/W jaundice, cataracts, lethargy, repro problems in females
Decreased level of erythrocyte galactose-1-phosphate uridyltransferase

325
Q

Criggler Najjar Syndrome

A
  • RARE auto recessive conditions that causes severe unconjugated hyperbilirubinemia starting in first few days of life
    • Results from decreased bili clearance caused by deficient (type 2) or completely absent (type 1) UDPGT = kernicterus
326
Q

Gilbert Syndrome

A
  • UGT1A1 gene (auto recessive): Decreased enzyme function interferes with gluronidation àconjugation of bili is slowed
  • Intermittent, self-resolving epis of unconjugated hyperbilirubinemia
  • Usually STARTS in adolescence
327
Q

Kernicterus

A

Unconjugated bili concentrations exceed albumin binding capacity –> bili deposited in brain = tissue necrosis and permanent damage to basal ganglia or brainstem
Incidence increases as bili > 340umol/L

328
Q

Unconjugated hyperbilirubinemia tx

A
  1. Phototherapy
  2. Exchange transfusion (mostly for hemolytic or G6PD)
  3. IVIg if severe (DAT+)
329
Q

Biliary atresia

A

Atresia of extrahepatic bile ducts which leads to cholestasis and increased conjugated bili after 1st week of life
Tx: Kasai procedure (anastomosis to allow bile to drain directly into intestine); 2/3 require liver transplantation

330
Q

Necrotizing enterocolitis

A

Primarily affects terminal ileum and colon

Internal inflammation a/w focal or diffuse ulceration and necrosis

331
Q

Necrotizing enterocolitis AXR hallmark

A 
Pneumonitis intestinalis 
(intramural air)
332
Q

Persistent Pulmonary Hypertension of the Newborn

A

Persistence of fetal circulation due to persistent elevation of pulmonary vascular resistance (ongoing R–>L shunt through PDA, foramen ovale –> decreased pulmonary blood flow and hypoxemia –> further pulmonary vasoconstriction)

333
Q

Respiratory distress syndrome

A

Deficiency of lung surfactant —> poor lung compliance due to high alveolar surface tension —> atelectasis —> decreased SA for gas exchange —> hypoxia + acidosis —> respiratory distress

  • Resp distress within first few hours of life, worsens over next 24-72h
  • Hypoxia
  • Cyanosis
334
Q

Most common cause of respiratory distress in premature infants

A

Respiratory distress syndrome

335
Q

RDS treatment

A

Resuscitation, oxygen, ventilation

Surfactant (decreases alveolar surface tensions, improves lung compliance and maintains functional residual capacity)

336
Q

RDS CXR findings

A

Ground glass
Air bronchograms
Decreased lung volume

337
Q

Transient tachypnea of the newborn

A

Delayed clearance of fluid from lungs following birth
Usually in late and late preterm babes born via C/S to diabetic moms
Tachypnea with no hypoxia or cyanosis

338
Q

TTN Tx

A

Supportive
O2 if hypoxic
Ventilator support
Recovery expected in 24-72h

339
Q

TTN CXR

A

Perihilar infiltrates

No consolidation/air bronchograms

340
Q

Snowman heart on CXR

A

Total anomalous pulmonary venous return

341
Q

Tricuspid atresia murmur

A

Single S2 with 2-3/6 systolic regurg murmur at LLSB if VSD is present

342
Q

Hirschprung disease

A

Absence of myenteric plexus in distal colon
40% of children with this do not pass mec in first 24h
Dx via full-tickness rectal bx
Tx: remove aganglionic bowel and restore continuity of healthy bowel with distal rectum

343
Q

Most commonly used diuretic for CHF edema in children

A

Lasix

then thiazide diuretic as second line/in combo

344
Q

Mongolian spots

A

Congenital dermal melanocytosis

345
Q

Hemolytic uremic syndrome

A

Simultaneous occurrence of triad of:
Non immune MAHA
Thrombocytopenia
Acute renal injury

346
Q

Most common cause of acute renal failure in children

A

Hemolytic Uremic Syndrome

347
Q

Most common cause of HUS in peds

A

E. coli O157:H7, shiga toxin

348
Q

Tx of HUS

A
  • Mainly supportive (nutrition. hydration, ventilation if needed, blood transfusion for symptomatic anemia
  • Steroids not helpful
  • Abx are C/I as death of bacteria leads to increased toxin release and worse clinical course
349
Q

Nephritic syndrome

A 
PHAROH: 
Proteinuria (>50mg/kg/d) 
Hematuria (>5 RBCs/hpf) 
Azotemia 
RBC casts
Oliguria 
HTN

Most common in 5-15yo

350
Q

Most common cause of acute GN in pediatrics

A

Post-infectious GN

351
Q

Causes of nephritic syndrome

A 
Post-infectious GN 
Membranoproliferative 
IgA nephropathy
Idiopathic rapidly progressive GN 
Anti-GBM disease 
HSP 
Granulomatosis with polyangitis 
Goodpasture's syndrome
Polyarteritis nodosa
SLE 
Bacterial endocarditis
Abscess or shunt nephritis 
Cryoglobuminemia
352
Q

Nephrotic syndrome

A 
PALE 
Proteinuria (>50mg/kg/d) 
HypoAlbumoinemia (<20g/L)
HyperLipidemia 
Edema
Most common in 2-6yo, M>F
353
Q

Most common cause of nephrotic syndrome in peds

A

Primary idiopathic

354
Q

Nephrotic syndrome etiology, glomerular inflammation absent on renal biopsy

A

Minimal change disease (85%)

Focal segmental glomerular sclerosis

355
Q

Nephrotic syndrome etiology, glomerular inflammation present on renal biopsy

A

Membranoproliferative GN

IGA neprhopathy

356
Q

Causes of nephrotic syndrome

A

AI (SLE, DM, rheumatoid arthritis)
Genetic (sickle cell dz, alport)
Infections (hep B/C, post-strep, infective endocarditis, HUS, HIV)
Malignancies
Meds (NSAIDs, antiepileptics)
Vasculitides (HSP, granuloamtosis with polyangiitis)
Congenital

357
Q

Often first sign of nephrotic syndrome

A

Edema (periorbital, pretibial)

358
Q

Urine findings of nephrotic syndrome

A

3-4+ proteinuria, microscopic hematuria
Microscopy (oval fat bodies, hyaline casts)
First morning urine protein/creatinine ratio (>200mg/mmol)

359
Q

Tx for nephrotic syndrome

A

Often corticosteroids
Furosemide + albumin for generalized edema
May need statin therapy
ACEI/ARBs for persistent HTN

360
Q

HTN in childhood

A

sBP and/or dBP >/= 95th percentile for sex, age and height on >/= 3 occasions

361
Q

Treatment of HTN in peds

A

Gradual BP lowering using thiazide diuretics

If HTN emergency, use hydralazine, labetalol, sodium nitroprusside

362
Q

Cerebral palsy

A

Non-progressive central motor impairment syndrome due to insult to or anomaly of immautre CNS

363
Q

Types of cerebral palsy

A

Spastic (70-80%) – UMN of pyramidal tract affected
Athetoid/dyskinetic (10-15%) – Basal ganglia
Ataxic (<5%) – cerebellum
Mixed

364
Q

Simple febrile seizure

A 
ALL of: 
<15min 
Generalized tonic-clonic 
No recurrence in 24h period 
No neuro impairment or developmental delay before or after seizure
365
Q

Complex febrile seizure

A 
At least 1 of:
Duration >15min 
Focal onset or focal features
Recurrent (>1 in 24h period) 
Previous neuro impairment or neuro deficit after sz
366
Q

Neurofibromatosis type I

A

Autosomal dominant
Dx requires 2 or more of:
>/= 6 cafe au lait spots (>5mm if prepuberal, >1.5cm if postpubertal)
>/=2 neurofibromas of any type or one plexiform NF
>/=2 Lisch nodules (hamartomas of iris)
Optic glioma
Freckling in axillary or inguinal region
Distinctive bony lesion
First degree relative with confimed NF-1

367
Q

Neurofibromatosis type II

A

Autosomal dominant
Bilateral vestibular schwannomas or 1st degree relative with NF2 and either unilat vestibular schwannoma OR any 2 of: meningioma, glioma, schwannoma, NF, posterior subcapsular lenticular opacities

368
Q

Infantile spasms

A

Brief repeated symmetric contractions of neck, trunk, extremities lasting 10-30s, often a/w developmental delay

369
Q

Infantile spasm EEG

A

Hypsarrhythmia (high voltage slow waves, spikes and polyspikes, background disorganization)

370
Q

West syndrome

A

Infantile spasms
Psychomotor developmental arrest
Hypsarrhythmia

371
Q

Infantile spasm tx

A

ACTH injections
Vigabatrin (GABA inhibitor)
Benzo

372
Q

Lennox Gastaut

A

Triad of:
Multiple seizure types
Diffuse cognitive dysfunction
Slow generalized spike and slow wave EEG
Seen with underlying encephalopathy and brain malformations

373
Q

Lennox-Gastaut tx

A

Valproic acid
Benzos
Ketogenic diet

374
Q

Juvenile Myoclonic epilepsy (Janz Syndrome)

A

Generalized tonic clonic sz

Autosomal dominant with variable penetrance

375
Q

Juvenile myoclonic epilepsy EEG

A

3.5-6Hz irregular spike and wave, increased with photic stimulation

376
Q

Juvenile myoclonic epilepsy mgmt

A

Lifelong treatment with valproic acid

377
Q

Childhood absence epilepsy

A

Multiple absence sz per day lasting <30s without post-ictal state
May resolve spontaneously or become generalized in adolescence

378
Q

Childhood absence epilepsy EEG

A

3Hz spike and wave

379
Q

Childhood absence epilepsy mgmt

A

Valproic acid or ethosuximide

380
Q

benign focal epilepsy of childhood with rolandic/centrotemporal spikes

A

Focal motor sz involving tongue, mouth, face, upper extremity usually in sleep-wake transition states
Remains conscious but aphasic post-ictally

381
Q

Benign focal epilepsy with rolandic spikes EEG

A

Repetitive spikes in centrotemporal area with normal background

382
Q

Benign focal epilepsy tx

A

If frequent sz: carbamapazemine

If infrequent sz: no tx needed

383
Q

When to initiate tx for sz

A

Often if >2 unprovoked afebrile sz within 6-12mo

384
Q

When to discontinue tx for sz

A

Until pt free of sz for >2yr then wean over 4-6mo

385
Q

Chronic asthma management

A 
Rescue ventolin (SABA)
1st line: low dose ICS 
2nd line <12yo: moderate dose of daily ICS
2nd line >12yo: leukotriene receptor antagonist OR LABA + low dose ICS or Leukotrine antagonist monotherapy
386
Q

Age to start PFTs

A

> 6yo

self-monitor with peak flows to improve self-awareness of status

387
Q

Bronchiolitis

A

LRTI usually in children <2yo

Leads to increased incidence of asthma in later life

388
Q

Most common viral etiology of bronchiolitis

389
Q

Time course of bronchiolitis

A

Peaks at 3-4d, lasts 2-3wk

390
Q

Cystic fibrosis presenting signs

A

CF PANCREAS
Chronic cough and wheeze
FTT
Pancreatic insufficiency (ie. steatorrhea)
Alkalosis and hypotonic dehydration
Neonatal intestinal obstruction (ie. mec ileus), Nasal polyps
Clubbing, CXR findings
Rectal prolapse
Electrolyte elevation in sweat, salty skin
Absence or congenital atresia of vas deferens
Sputum with S. aureus or P. aeruginosa

391
Q

Testing for CF

A

Sweat chloride test x 2

CFTR gene mutation analysis

392
Q

Croup

A

Laryngotracheobronchitis
Subglottic laryngitis
Barking cough, stridor, worse at night
Most commmon in 6mo-3yo

393
Q

Croup etiology

A

Parainfluenza (75%)
Influenza A and B
RSV
Adenovirus

394
Q

Croup CXR

A

Steeple sign from subglottic narrowing

Not needed for dx

395
Q

Croup tx

A 
Stridor at rest is emergency 
No evidence for humidifed O2 
Dexamethasone PO 1 dose 
Racemic epi neb 1-3 doses, q-12h 
Intubation if unresponsive to tx
396
Q

Bacterial tracheitis

A 
Subglottic tracheitis 
Rare 
Caused by S. aureus, H. influenza, pneumococcus, M. catarrhalis 
Rapid deterioration
IV abx and intubation
397
Q

Epiglottitis

A

Supraglottic laryngitis
4Ds: Drooling, dysphagia, dysphonia, distress
Avoid examining throat to prevent further exacerbation

398
Q

Epiglottitis etiology

A

H. influenzae

beta-hemolytic strep

399
Q

Juvenile idiopathic arthritis

A

Arthritis in >/=1 joint(s) for >/= 6wk, onset age <16yo
Exclusion of other causes of arthritis
Classification defined by features/numbers of joints affected in first 6mo of onset

400
Q

Still’s disease/systemic arthritis

A

Onset at any age
1-2x/d fever spikes (>38.5C) >/= 2d/wk with temps returning below baseline
Erythematous salmon-coloured maculopapular rash, lymphadenopathy, hepatosplenomegaly, leuk, thrombocytosis, anemia, serositis

401
Q

Oligoarticular arthritis

A 
1-4 joints
Most common type of JIA 
Typically large joints (knees, elbows, wrists) 
ANA + in 60-80% 
RF neg
402
Q

Polyarticular arthritis

A 
>/=5 joints 
RF neg (usually) - symmetrical, large and small joints of hands and feet, TMJ, cervical spine 
RF pos - severe, rapidly destructive, symmetrical, large and small joints
403
Q

Enthesitis-related arthritis

A

Weight-bearing joints, esp hip and intertarsal joints

Risk of developing ank spond

404
Q

Psoriatic arthritis

A

Arthritis + psoriasis OR
arthritis and at least 2 of dactylytis, nail pitting or other abnormalities, or fam hx of psoriasis in a 1st degree relative
Asymmetric or symmetric small or large joint involvement

405
Q

Juvenile idiopathic arthritis tx

A

1st line: NSAIDs, intra-articular corticosteroids
2nd line: DMARDs (MTX, sulfasalazine), corticosteroids, biologics (IL1, IL6 inhibition for systemic arthritis, TNF antagonist for polyarticular JIA)

406
Q

Lyme arthritis

A

Caused by spirochete Borrelia burgdorferi

Do not treat children <8yo with doxycycline (may cause permanent tooth discolouration)

407
Q

Reactive arthritis

A

Salmonella, Shigella, Yersinia, Campylobacter, Chlamydia, Streptococcus

408
Q

Reiter’s syndrome

A

Conjunctivitis
Urethritis
Arthritis
Occuring after an infection

409
Q

Transient synovitis of the hip

A 
Benign, self-limited inflammatory joint disorder usually after URTI, pharyngitis, AOM 
More common on right side 
Painful limp but full ROM 
Symptomatic and anti-inflammatory meds
Usually resolves in 24-48h
410
Q

Most common vasculitis of childhood

A

Henoch-Schonlein Purpura

411
Q

Henoch-Schonlein Purpura

A

Vasculitis of small vessels, often following 1-3wk of URTI
Clinical triad:
Palpable purpura (non-thrombocytopenic purpura in lower extremities, scrotal swelling)
Abdo pain (GI bleed, intussusception)
Arthritis (large joints)

412
Q

HSP tx

A

Mainly supportive
Anti-inflammatory meds for joint pain, corticosteroids for select pts
Self-limited, resolves within 4wk

413
Q

Most common cause of acquired heart disease in children in developed countries

A

Kawasaki disease

414
Q

Kawasaki disease

A

Medium-sized vasculitis with predilection for coronary arteries
Likely triggered by infection

415
Q

Kawasaki dx criteria

A

HOT CREAM
Fever persisting >/= 5d AND >/=4 of:
Conjunctival injection (bilateral, non exudative)
Rash (polymorphous)
Edema/erythema of hands and feet
Adenopathy (cervical >1.5cm in diameter, usually unilateral)
Mucosal changes (fissured lips, strawberry tongue, injected pharynx)

416
Q

Kawasaki tx

A

IVIG and high dose ASA
Once afebrile >48h, low dose ASA until plts normalize
Baseline echo and follow up periodic echo usually at 2 and 6wk

417
Q

Risk a/w kawasaki

A

Coronary aneurysm

If receive IVIg within 10d onset, reduces risk

418
Q

Most common organisms a/w septic arthritis

A 
Staph aureus 
Streptococcus (neonate --> group B, infant/older child --> group A and strep pneumo) 
H. influenza type B 
N. gonorrhea 
Kingella kingae
419
Q

Slipped capital femoral epiphysis

A

Posterior displacement of capital femoral ephiphysis from femoral neck through cartilage growth plate
Causes limp and impaired internal rotation
Common in adolescents
Tx: Internal reduction of femoral head

420
Q

Legg-Calve Perthes dz

A

Most commonly affects boys btwn 4-10yo
Avascular necrosis of capital femoral ephiphysis
Refer to ortho

421
Q

Developmental dysplasia of hip

A

Most common in females born breech

Femoral head not properly aligned with acetabulum

422
Q

Most common cause of neonatal and antenatal hydronephrosis

A

Ureteropelvic junction obstruction

423
Q

Potter’s syndrome

A

Bilateral renal agenesis

424
Q

Cryptorchidism

A

Most common genital progrem

Presents with empty and hypoplastic or poorly rugated scrotum or hemiscrotum

425
Q

DiGeorge Syndrome

A

CATCH-22
Congenital heart abnormalities
Abnormal facies
Thymic aplasia
Hypocalcemia from hypoparathyroidism Failure of 3rd and 4th branchial pouch development
–> poorly developed thymus and parathyroid
HypoPTH –> HypoCa –> Tetany
Low T-cell maturation –> recurrent infections (esp candida)
Gene deletion in chromosome 22q11

Tx: Ca supplement and thymus tissue transplant

426
Q

Suggestion of impending respiratory failure in asthma attack

A

PaCO2 > 43

427
Q

3 most common bacterial infections in cystic fibrosis patients

A

Staph aureus
H. influenza
Pseudomonas aeruginosa (most common in pts >10)

428
Q

Bacterial infection in CF a/w multiple antibiotic resistance

A

Burkholderia cepacia

429
Q

Most beneficial agent for long-term mucus clearance in cystic fibrosis patient

A

Aerosolized dornase alfa (DNAse to help break down polymerized DNA dervied from degraded neutrophils in viscous mucus)

430
Q

Bilirubin induced neurologic dysfunction

A

Caused by indirect hyperbilirubinemia
Kernicterus, opisthotonus , delayed motor skills, choreoathetosis, sensorineural hearing loss
Tx: Immediate exchange transfusion

431
Q

Epiphora

A

Overflow tearing in neonates

432
Q

Congenital nasolacrimal duct obstruction

A

Occurs in 5% normal newborns
Blockage commonly at valve of Hasner at distal end of duct
Blockage can be unilateral or bilateral
Spontaneous resolution is estimated to be 90% within first year of life
Test with dye disappearance test – should drain into nose within 5 minutes if no obstruction
If obstructed, dye remains in eye and is seen as bright green tear meniscus or dye escapes over eyelid and drains down cheek

433
Q

Car seats (stage 1)

A

Rear-facing seats should be used until children weigh at least 10kg and are at least 1y of age and able to walk
No more than 2.5cm/1in of movement in either direction

434
Q

Car seat (stage 2)

A

Forward- facing infant/child car seat

10-18kg

435
Q

Car seat (stage 3)

A

Child booster seat

18-36kg

436
Q

Car seat (stage 4)

A

Seatbelt

At least 36kg or 145cm or 8yrs ago

437
Q

Fragile X Syndrome

A 
X-linked disorder (expansion of CGG trinucleotide repeat) 
Most common inherited cause of intellectual disability 
Prominent jaw, forehead, nasal bridge
Long thin face with large ears
Macroorgchidism
Hyperextensibility
High arched palate 
May have sz, scoliosis, MV prolapse
438
Q

Botulism symptoms

A 
Poor ability to suck pooled secretions
Poor head control
Hypotonia 
Weak cry
Constipation
Lethargy 
Facial weakness
Extraocular muscle paralysis
Irritability
Hyporeflexia
Sluggish pupils 
Resp difficulty
439
Q

Type of NTD that is not compatible with life

A

Anencephaly

440
Q

AFP trend in maternal serum consistent with NTD

A

Increased at 16-18wks

441
Q

What to test in amniotic fluid to dx NTD

A

AFP

Acetylcholinesterase

442
Q

PECARN >2yo

A 
CT Head if one of:
AMS (altered mental status)
GCS <15
Signs of basal skull fracture
Observe or CT head if:
History of LOC
History of vomiting
Severe headache
Severe mechanism (>5 feet fall) 
If none of the above, no CT head required
443
Q

PECARN <2yo

A 
CT Head if one of:
AMS
GCS <15
Palpable skull fracture
Observe or CT head if:
LOC > 5 seconds
Nonfrontal hematoma
Not acting normally
Severe mechanism (>3 feet fall) 
If none of the above, no CT head required
444
Q

CXR for inspiratory body

A

Deviates away from side of obstruction

445
Q

Most common locations for foreign body obstruction

A

Upper esophageal sphincter
Middle of esophagus where it crosses over aortic arch
Lower esophageal sphincter

446
Q

Tx for developmental dysplasia of the hip

A

<6mo: Pavlik harness

>6mo: Closed reduction with spica cast

447
Q

Most common cause of painless hematochezia

A

Meckel’s diverticulum

448
Q

Juvenile Idiopathic Arthritis

A

<16yo, for at least 6 wks
Morning stiffness at least 1h in the morning, decreased ROM, swelling, fevers, rash, post-exercise pain
ANA+ (a/w uveitis –> most examine with slit lamp for inflammatory cells/increased protein in anterior chamber of eye within 1mo of dx)
Anti-cyclic citrullinated peptide antibody (specific)

449
Q

Abdo pain in DKA can be a/w…

A

Hypokalemia causing skeletal muscle weakness and ileus

Order ECG –> flattening of T- waves and prolonged QRS

450
Q

Klinefelter features

A

Tall
Small testicles
Infertile

451
Q

Osgood Schlatter

A 
Common
Begins at onset of teen growth spurt, resolves in 18-24mo 
Clinical dx 
Pain confined to tibial tubercle of knee
Worse with activity 
Conservative mgmt
452
Q

Most common neuro sequelae after meningitis

A

Sensorineural hearing loss

Test hearing 4-6wk post tx

453
Q

Respiratory distress syndrome long-term complication

A

Bronchopulmonary dysplasia

454
Q

Respiratory distress syndrome acute complication

A

Alveolar rupture

455
Q

Hypothyroidism and bone/height age relative to chronological age

A

Delayed bone age relative to height age and chronological age

456
Q

CF and bone/height age relative to chronological age

A

Bone and height age are equivalent and both lag behind chronological age

457
Q

Chromosomal abnormalities and maternal substance abuse and bone/height age relative to chronological age

A

Height age delayed relative to bone age

458
Q

ITP purpura vs vasculitic purpura (ie. HSP)

A

ITP purpura is non pruritic and non palpable in dependent areas of body

459
Q

Most common congenital abnormality causing primary hypogonadism

A

Klinefelter

460
Q

Physiologic genu varum

A

Resolves by 2 yo

Xrays would show normal mineralization of growth plates

LMCC (22 decks)

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