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Peds Flashcards

1
Q

Duodenal atresia

A

Failure to reanalyze; polyhydramnios in utero
Bilious vomiting
Double bubble on XR with no distal air
Down Syndrome

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2
Q

Annular pancreas

A

Double bubble with or without distal air

Bilious vomiting

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3
Q

Malrotation/volvulus

A

Upper GI series: abrupt cutoff of GI tract
Bilious vomiting
Contrast enema: abnormal position of the cecum
Leads to ischemia

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4
Q

Intestinal atresia

A

Double bubble with multiple air-fluid levels
Bilious vomiting
Mom had cocaine or tobacco problem

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5
Q

Pyloric stenosis

A

Sudden onset projectile non-bilious vomiting; olive shaped mass and visible peristaltic waves
CMP: hypochloremic, hypokalemic, metabolic alkalosis
US: donut sign

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6
Q

TE fistula

A

Non-bilious vomiting
NG tube will coil
Bubbling and gurgling with respirations

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7
Q

Bilirubin metabolism

A

Unconjugated from heme breakdown (indirect) -> conjugated in the liver (direct; water soluble) -> unconjugated in the colon

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8
Q

Dangerous hyperbilirubinemia

A

Indirect/unconjugated can cause kernicterus; >20/25

Direct is more concerning: sepsis/obstruction/metabolic dz

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9
Q

Work up for indirect hyperbilirubinemia

A

Coombs: isoimmunization

Hgb, Retic count

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10
Q

Work up for direct hyperbilirubinemia

A

HIDA, Hepatic US, sepsis, metabolic eval

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11
Q

Breast feeding jaundice

A

Quantity problem -> more frequent feeds
Elevated unconjugated
Presents <7 days old; not feeding well, dehydrated, jaundiced

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12
Q

Breast milk jaundice

A

Quality issue (enzyme problem)
Elevated unconjugated
Presents >7 days old; will be feeding normally (just jaundiced)
Temporarily switch to formula

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13
Q

Gastroschisis vs omphalocele

A

Gastro: to the right, no membrane, no chromosome abnormalities
Omphalocele: midline, membrane, chromosome abnormalities

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14
Q

Biliary atresia

A

Persistant/worsening jaundice after 2 weeks; direct hyperbilirubinemia
US + LFTs -> HIDA scan: 5-7 day phenobarbital sim shoes lack of bile reaching duodenum -> intraopertive cholangiogram
Treat w/ Kasai (hepatoportoenterostomy)

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15
Q

NTD

A

Fusion of caudal neural tube

Elevated AFP

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16
Q

Managing dirty wound

A

<3 lifetime doses of Tdap: Clean gets tdap/dirty gets tdap + TIG
>3 doses: clean but >10 years tdap, clean <10 home, dirty >5 years tdap, dirty <5 years home

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17
Q

Contraindications to Tdap

A

Absolute: encephalopathy <7 days after previous dose
Relative: fever, shock, crying, seizures

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18
Q

Epidural hematoma

A

Temple trauma, lucid interval, “lens” on CT

Evacuate

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19
Q

Subdural hematoma

A

Trauma/abuse, LOC w/no lucidity, “crescent”

Evacuation and ICP mgmt

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20
Q

Cerebral contusion

A

Trauma, LOC, punctate hemorrhage

Manage ICP

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21
Q

Car seats

A

Rear-facing: 0-2y

Booster seat: until child is 4’9 (8-12y)

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22
Q

Parkland formula

A

%BSA x kg x 4

1/2 in 8 hours, 1/2 in 16

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23
Q

Sx of shaken baby

A

Subdural hematoma, retinal hemorrhage

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24
Q

Erythema infectiosum

A

Parvovirus B19, slapped cheek, lacy rash

Aplastic crisis, hydrops

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25
Q

Measles

A

4 C’s: cough, coryza, conjunctivitis, coplik spots (white centers on bright red buccal mucosa)
Rash starts on face -> body
Fever starts with rash
SSPE is concerning sequelae

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26
Q

Rubella (german measles)

A

Togavirus
Face -> toes spread; macular (fainter and quicker than measles)
Generalized tender lymphadenopathy
Forchheimer spots (red enanthem)

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27
Q

Roseola

A

HHV-6
Prodrome of high fever that breaks when rash starts
Macular rash on trunk -> face
Febrile seizures

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28
Q

Varicella

A 
Chicken pox
VZV
Rash on trunk/head -> outward spread
Vesicles on an erythematous base in different stages
Contagion ends with final crust
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29
Q

Varicella zoster

A

Shingles
Immunocompromised adults w/varicella hx
Painful prodrome and rash in dermatomal distribution; does not cross the midline
Posteherpetic neuralgia treated with TCA or gabapentin

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30
Q

Mumps

A

B/L parotid swelling

Orchitis

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31
Q

HFMD

A

Coxsackie A
Vague prodrome, often oral pain
Vesicles on erythematous base
Can see herpangina: lesion on soft palate, tonsils, uvula

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32
Q

Bulging fontanelle

A

Meningitis

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33
Q

HSV encephalitis

A

Hippocampus

Bloody LP

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34
Q

West Nile

A

Paralysis + encephalitis

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35
Q

Causes of osteo

A

Most common: staph
Animal bite: pasturella
Sickle cell: salmonella

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36
Q

Pneumonia

A

Strep pneumo, H. flu, Moraxella

Neonatal: E. coli, GBS, chlamydia

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37
Q

Allergic rhinitis

A

IgE
Venous congestion under eyes (allergic shiners), transverse nasal crease (allergic salute), pale and boggy nasal mucosa, polyps, posterior cobblestoning

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38
Q

First line treatment for otitis media

A

Amoxicillin

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39
Q

Causes of otitis externa

A

Pseudomonas, S. aureus

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40
Q

Croup

A

Viral prodrome, barking cough, inspiratory stridor, worse at night
Steeple sign on XR
Recepi and steroids

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41
Q

Epiglottitis

A

High fever, rapid onset
Tripoding, drooling, thumb print sign on XR
Straight to OR

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42
Q

Bacterial tracheitis

A

Ill appearing, subglottic narrowing on XR
Presents similar to croup but in older children
Tracheal culture, abx

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43
Q

Retropharyngeal abscess

A

Drooling and fever; neck in sniffing position, muffled voice, unilateral cervical lymphadenopathy, tonsils with gray exudates
Lateral neck XR: widened paravertebral space
CT scan
Consult surgery

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44
Q

Peritonsillar abscess

A

Hot potato voice, muffled, drooling, tonsillar bulge that displaces uvula
Polymicrobial
Abx and surgical drainage

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45
Q

Breath sounds heard with extra thoracic obstruction (in a FB aspiration)?

A

Inspiratory (stridor)

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46
Q

Breath sounds heard with intrathoracic obstruction (in a FB aspiration)?

A

Expiratory (wheezing)

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47
Q

Most likely place for FB aspiration?

A

Right mainstream bronchus

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48
Q

Treating pneumonia in kids

A

Typical: amoxicillin
Atypical: azithromycin

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49
Q

Bronchiolitis

A

Inflammation of small airways by virus; wheezing caused by sloughed epithelial cells
Treat when: O2 <90%, premature, <3m, cardiopulmonary abnormalities or immunodeficiency

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50
Q

CF

A

Meconium ileus, failure to thrive, frequent respiratory infections, salty
Infertile males, malnourished, pseudomonas
Need pancreatic supplementation and ADEK

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51
Q

Febrile seizures

A

Generalized, <15m, single episode in 24 hours, no neuro deficits
No workup needed

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52
Q

West Syndrome

A 
Infantile spasm
<1yo with symmetric jerking of head, trunk or extremities with NO fever
EEG: hypsarrhythmia
Treat with ACTH
Associated w/ intellectual disability
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53
Q

Tuberous Sclerosis

A

Intellectual disability, seizures

Ash leaf spots on Woods lamp, angiofibromas, cortical tubers

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54
Q

NEC

A

Premature baby and bloody diarrhea
XR: pneumatosis intestinalis
NPO, TPN, IV abx (surgery only if no improvement)

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55
Q

Anal fissure

A

Tear in anal mucosa; hematochezia
Associated w/ constipation
Possible IBD

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56
Q

Intussusception

A

Abrupt, colicky abdominal pain; knee to chest
3m-3yo
Sausage shaped mass, currant jelly diarrhea
Air-contrast barium enema; US to monitor resolution

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57
Q

Meckel’s diverticulum

A

Remnant of omphalomesenteric (vitelline) duct; can contain gastric tissue
FOBT+, anemia, or hematochezia

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58
Q

IBD

A

Blood diarrhea for either; lasts >6w

Seen at 10-20yo

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59
Q

Infectious colitis

A

Bloody diarrhea and fever

Don’t treat unless septic, Shigella or immunosuppressed

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60
Q

Mild-protein allergy

A

Hematochezia and FtT ~6m

Typically outgrown

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61
Q

Apt test

A

Differentiates swallowed maternal blood from fetal blood

Fetal blood resistant to denaturation -> workup

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62
Q

General features of LtoR shunts

A

Increased vascular markings on CXR

Ventricular hypertrophy -> pulmonary HTN (eventual reversal); not cyanotic until reversal

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63
Q

ASD

A

LtoR; fixed wide split S2

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64
Q

VSD

A

LtoR; harsh holosystolic murmur
Most common congenital heart disease
Repair if: right sided hypertrophy, elevated rt pressures, failure to thrive, heart failure

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65
Q

PDA

A

LtoR; continuous machine like murmur
Connection between aorta and pulmonary artery
Indomethacin to close; PGA to keep open

66
Q

General features of RtoL shunts

A

Cyanotic at birth (the T disease)

67
Q

Transposition of the great vessels

A

Most common cyanotic defect of a newborn
Risk factor: pregestational diabetes
Fatal with no PDA

68
Q

Tetralogy of Fallot

A

Most common cyanotic defect of children
Overriding aorta, pulmonary stenosis, RVH, VSD
Tet spells (increases vascular resistance), boot shaped heart
Down and DiGeorge

69
Q

Coarctation of aorta

A

HTN, claudication, temp difference between arm and legs

Rib notching

70
Q

Legg-Calve-Perthe Disease

A

~6y; avascular necrosis of the hip

Insidious onset knee pain, antalgic gait, pain with abduction & internal rotation

71
Q

Slipped Capital Femoral Epiphysis

A

Adolescents: obese or growth spurt
Sudden onset of hip or knee pain
Frog leg XR

72
Q

Septic hip

A 
Any age (typically a toddler)
Febrile illness and joint pain
XR -> joint aspiration
73
Q

Transient Synovitis

A

Synovial inflammation up to 4 weeks after URI or GI viral illness
No fever, no leukocytosis

74
Q

Osgood-Schlatter Disease

A

Teenage athlete; painful knee with swelling over tibial tubercle
Stop exercising or play through it; palpable nodule

75
Q

Osteogenic sarcoma

A

Sunburst onion skin at the distal femur

Retinoblast

76
Q

Ewing’s sarcoma

A

Midshaft; t(11;22) translocation

77
Q

Strabismus

A

“Lazy eye”; reflection of light comes from separate locations on each eye
Patching, glasses, surgery

78
Q

Retinoblastoma

A

Pure white retina instead of red reflex

Look for osteosarcoma

79
Q

Cataracts

A

Milky white

TORCH or galactosemia

80
Q

Posterior urethral valves

A

Male; low/no urine output and +/- palpable bladder
Redundant tissue in urethra
Hx of oligohydramnios
VCUG

81
Q

Ureteropelvic junction obstruction

A

UPJ narrow -> colicky pain

Dx with US; VCUG for reflux

82
Q

Ectopic ureter

A

Females with have constant leak

83
Q

Vesicoureteral reflux

A

Retrograde urine flow; UTIs and scarring

Dx with VCUG

84
Q

Sickle cell substitution

A

Valine for glutamine at 6th

85
Q

Baseline labs in sickle cell

A

Bilirubin, LDH and retic elevated

Haptoglobin low

86
Q

Sickle cell associations

A

Pigmented gallstones/early cholecystecomy
Splenic autoinfarct
Osteomylitis (salmonella)
Avascular necrosis

87
Q

Bruton’s agammaglobulinemia (XLA)

A

X-linked; b-cell deficiency (humoral)
Recurrent “normal” infections: sinus, ears, pneumonia
All Ig are deficient; flow cytometry: no B cells
BTK gene
Treat with scheduled IVIG

88
Q

Hyper-IgM

A

Low IgA and IgG (IgM normal to high); no class-switching

IVIG

89
Q

Selective IgA deficiency

A

Most common primary immunodeficiency
Mucosal barriers
Anaphylactic reaction after blood transfusion (to foreign IgA)

90
Q

Common variable immunodeficiency

A

Looks like XLA but less severe
Deficient in at least 2 of 3 Ig
Scheduled IVIG

91
Q

DiGeorge (22q11)

A

Absent thymus, micrognathia, wide spaced eyes, low set ears
Defect in cellular immunity (thymus); fungal and pneumocystis; watch Ca
TMP/SMX, IVIG and bone marrow transplant

92
Q

Wiskott-Aldrich

A

Combined humoral and cellular defect
X-linked
“Normal” infections, thrombocytopenia, eczema, elevated IgE and IgA
IVIG, splenectomy, bone marrow transplant

93
Q

Ataxia-Telangiectasia

A

Telangiectasia+ataxia, poor DNA repair, lymphoma and leukemia
Sinopulmonary infections and no IgA

94
Q

SCID

A

Causes by absent adenosine deaminase
Essentially AIDS
IVIG and bone marrow transplant

95
Q

Chronic granulomatous disease

A

Cant kill catalase +
Chronic skin or organ abscesses
Elevated IgM and IgG, elevated WBC (just not doing shit)
Negative nitro blue test -> no respiratory burst
TMP/SMX and itraconazole, bone marrow transplant

96
Q

Leukocyte adhesion deficiency

A 
Neutrphils cant get out of blood vessel
No pus but massive leukocytosis and fever
Seen at body/environment junctions
Delayed separation of cord
Bone marrow transplant
97
Q

Chediak-Higashi

A

Indscriminate lysosomal fusion
Albinism, neuropathy and neutropenia
Giant granules in neutrophils
Infections of mucous membranes and skin

98
Q

Hyper-IgE (Job) Syndrome

A

Elevated IgE and peripheral eosinophilia
“Cold” abscesses (staph, h.flu, strep pneumo)
Eczema, retained primary teeth, fractures, post-infection pneumatoceles

99
Q

C1 esterase deficiency

A 
Herediatry angioedema (defect of C1 inhibitor)
Treat with FFP
100
Q

Gonococcal neonatal conjunctivitis

A

Swelling, profuse purulent drainage, corneal edema/ulcer

Single IM cephalosporin

101
Q

Chlamydial neonatal conjunctivitis

A

Mild swelling, water/serosanguinous/purulent drainage

PO macrolide

102
Q

Spondylolisthesis in adolescents

A

Due to growth spurts/ increased lordosis
Pain with extension (athletes with repetitive extension and rotation at higher risk)
Palpable step-off

103
Q

Diamon-Blackfan anemia

A

Congenital erythroid aplasia
Craniofacial abnormalities, triphalangeal thumbs, increased risk of malignancy
Macrocytic anemia and reticylocytopenia
Treat with steroids and RBC transfusions

104
Q

GB

A 
Diagnose clinically: ascending paralysis &amp; decreased reflexes
CSF: increased fluid, nml leukocytes
Abnml electromyogrpahy
Monitor respiratory function
IVIG if needed
105
Q

Treat acute vs chronic ITP

A

Acute: observe/GC, IVIG or anti-D
Chronic: splenectomy

106
Q

Kid with undiagnosed CF

A

Recurrent pulmonary infections
Greasy, loose stools (pancreatic insufficiency)
Bleeding (no ADEK)

107
Q

ALL

A

Most common childhood cancer
Lymphadenopathy/hepatosplenomegaly/ pallor/petechia
Lymphoblasts on biopsy

108
Q

Burkitt lymphoma

A

B cells, EBV
Mass on mandible or abdomen
“starry sky”

109
Q

CLL

A

Lymphadenopathy
Adults
Smudge cells

110
Q

Hodgkin lymphoma

A

Germinal center of B cells

Fever, lymphadenopathy, mediastinal mass

111
Q

Multiple myeloma

A

Plasma cells
Adults
rouleaux RBCs

112
Q

Scarlet fever

A

“strawberry tongue”
Exudative pharyngitis
Sandpaper rash that spares palms and soles

113
Q

Complications of Kawasaki

A

Coronary artery aneurysm, MI

*do an echo on everyone

114
Q

Central precocious puberty

A 
Early 2nd sex (<8 and 9yo)
Advanced bone age
High basal LH OR low basal, high with GnRH stim
Caused by early activation of HPG axis
MRI for hypothalamic or pituitary tumor
Treat with GnRH therapy
115
Q

Peripheral precocious puberty

A

Early 2nd sex (<8 and 9yo)
Advanced bone age
Low basal LH AND low LH with GnRH stim
Caused by gonadal or adrenal release of hormones

116
Q

Cause of cough in croup

A

Inflammation -> edema and narrowing of proximal trachea (tracheolaryngitis)

117
Q

Turner’s associations

A

Coarctation of aorta, bicuspid aortic valve (eventual insufficiency), horseshoe kidney, streak ovaries (not enough estrogen -> osteoporosis)

118
Q

Neonatal polycythemia

A

> 65% hematocrit
Presents: Ruddy skin, hypoglycemia, hyperbilirubinemia, irritable
Hydrate

119
Q

Todd paralysis

A

Self-limited, focal after a seizure

Hemiparesis or hemiplegia

120
Q

Duchenne MD

A

X-r; onset 2-3yo
Weak, grower, calf pseudohypertrophy
Scoliosis and cardiomyopathy

121
Q

Becker MD

A

X-r; onset 5-15yo
Milder than Duchenne
Cardiomyopathy

122
Q

Myotonic MD

A

AD CTG expansion of DMPK gene; onset 12-30yo
Facial weakness, hand grip myotonia, dysphagia
Arrhythmias, cataracts, balding, testicular atrophy

123
Q

Recurrent pulmonary and GI infections; no lymphoid tissue (tonsils/lymph nodes)

A

XLA (abnormal B cell maturation)

Defect in tyrosine kinase

124
Q

Severe, recurrent viral, fungal and bacterial infections with failure to thrive

A

SCID

Adenosine deaminase deficiency (impaired T cells)

125
Q

Recurrent skin and pulmonary infections

A

CGD (oxidative burst)

Organisms will be catalase-positive

126
Q

Eczema, microthrobocytopenia (petechia, purpura, bleeding), recurrent infections

A

WAS (X-r)

Impaired cytoskeleton changes in leukocytes and platelets

127
Q

Transient tachypnea of the newborn

A

Inadequate alveolar clearance, mild pulmonary edema
Starts shortly after birth, resolves by day2
CXR: b/l perihilar linear streaking

128
Q

Respiratory distress syndrome

A

Surfactant deficiency: alveolar collapse/atelectasis
Respiratory distress and cyanosis
CXR: diffuse, reticulogranular appearance, low lung volume, air bronchograms
Grunting, nasal flaring, retractions

129
Q

Persistent pulmonary HTN

A

Pulmonary vascular resistance -> RtL shunt
Cyanosis
Clear lungs and decreased pulmonary vascularity

130
Q

Bronchopulmonary dysplasia

A

Initial RDS with persistent low O2

CXR: hazy with decreased lung volumes

131
Q

Kawasaki

A

Fever >5days plus >4 of:
B/l conjunctivitis, mucositis (strawberry tongue), cervical lymphadenopathy, rash (erythematous and polymorphous), erythema/edema of hands and feet
Treat with ASA and IVIG

132
Q

Congential adrenal hyperplasia

A

21-hydroxylase deficiency
Decreased 11-deoxycorticosterone (aldosterone precursor): salt wasting (hypotension, hyponatremia, hyperkalemia)
Decreased 11-deoxycortisol (cortisol precursor): hypoglycemia
Increased testosterone: Virilization and ambiguous females
Elevated 17-hydroxyprogesterone is diagnostic

133
Q

Acute weight loss in children to fluid loss

A

1 kg acute weight loss = 1L fluid loss

134
Q

Common comorbid disorders with Tourettes?

A

OCD and ADHD

135
Q

NF1

A

AD

Cafe-au-lait, clustered freckles, Lisch nodules (hamartomas of the iris), neurofibromas, optic gliomas

136
Q

Osteoid osteoma

A

Bone forming tumor in adolescent boys
Proximal femur, pain at night, improves with NSAIDs
XR: small, round lucency
Monitor

137
Q

Hirschsprung

A

Failure of NCC migration; chronically contracted
Associated with Down
Positive squirt sign

138
Q

Thiamine deficiency in kids

A

Beriberi

Cardiomegaly, neuropathy

139
Q

Ascorbic acid deficiency in kids

A

Scurvy

Ecchymoses, petechia, bleeding gums, hyperkeratosis, arthralgia, impaired wound healing

140
Q

Hypervitaminosis A

A

Anorexia, pruritus, lack of weight gain, irritability, tender swelling of bones, alopecia, fissuring of mouth, hepatomegaly

141
Q

Neuroblastoma

A

Neural crest cells
Kids <2, abdominal mass, periorbital ecchymoses, spinal cord compression (dumbbell tumor), opsoclonus-myoclonus
Horner’s syndrome
Small, round blue cells

142
Q

Eczema herpeticum

A

HSV1; vesicular rash with “punched-out” erosions and hemorrhagic crusting

143
Q

Murmur of VSD

A

Holosystolic at lower left sternal border

144
Q

Prader-Willi

A

Paternal deletion

Hypotonic, weak suck, obese, hypogonadism, narrow tea/almond eyes/down turned mouth

145
Q

Treatment of impetigo

A

Limited: topical abx (mupirocin)
Extensive: oral (cephalexin, dicloxacillin, clinda)

146
Q

Painless hematochezia in a kid

A

Meckel diverticulum
Viteeline duct
T-99m scan

147
Q

Beckwith-Wiedemann Syndrome

A

Macrosomia, hemihyperplasia, omphalocele, macroglossia

148
Q

Heavy menstral bleeding in otherwise normal teenager

A

vWD

149
Q

Clinical presentation of H-S purpura

A

Purpura, arhtritis/arthralgias, abdominal pain/intussusception, Renal disease

150
Q

Homocystinuria

A

Looks like Marfans but:

Intellectual disability, CVA/thrombosis, fair complexion, megaloblastic anemia

151
Q

Laryngomalacia

A

Inspiratory stridor worse in supine position

Most common cause of stridor in infants

152
Q

Choanal atresia

A 
Blockage of posterior nasal aperture
Cyclic cyanosis (worse during feeding)
153
Q

Gaucher

A

Hepatosplenomegaly, FtT, delayed puberty, anemia, bone pain

154
Q

Congenital VZV

A

cortical atrophy

155
Q

Congenital HSV

A

Temporal lobe hemorrhage

156
Q

Periventricular calcifications

A

CMV; saliva

157
Q

Diffuse parenchymal/intracerebral calcifications

A

Toxo

158
Q

Hereditary spherocytosis

A

Triad: hemolytic anemia, splenomegaly and jaundice

159
Q

Physiologic jaundice of the newborn

A

Day 2-4

Indirect hyperbili

160
Q

Hemolytic disease of the newborn

A

Within 72hrs
Splenomegaly
ABO incompatibility

161
Q

Target cells + MCV <65

A

Thalassemia (decreased globin chains)

Step 2 (8 decks)

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