Peds Flashcards
First week of delivery red eyes what diagnosis and best step in management?
Neisseria gonorrhea
Treat with ceftriaxone
After one week of delivery red eyes what is the diagnosis and treatment?
Chlamydia trachomatis
Treat with oral erythromycin
Red eyes After 3 wks of delivery what diagnosis and treatment?
Herpes simplex
Treat with systemic acyclovir and topical vidarabine
The one vaccine every infant gets at birth
If the mother is HBsAg positive infant also gets hepatitis B immunoglobulin (HBIG)
Hepatitis B vaccine
Diagnosis and Txt for TTN
Dx: CXR
Txt: Oxygen PPV if desaturating
First step in management for a Congenital Diaphragmatic Hernia?
Intubation
Asymptomatic flank mass
Hematuria
HTN
Wilm’s tumor
Painful abdominal mass
Opsoclonus/myoclonus
Diarrhea
Neuroblastoma
Three Holosystolic murmurs
MR
TR
VSD
Four components of Tetrology of Fallot
Pulmonary Stenosis
VSD
Overriding aorta
RVH
Most common cyanotic heart defect in neonates
Transposition of the Great Vessels (TGV)
The most common cyanotic heart defect in children
Tetralogy of Fallot
VSD May show this on EKG
RVH
Best initial test in Esophageal atresia
CXR
This is a concern for Esophageal atresia
Aspiration PNA
Best initial step in choanal atresia?
Pass NG tube
Most diagnostic step in choanal atresia
CT scan
First initial step in management of choanal atresia?
Secure airway
Best initial step in Duodenal Atresia?
CXR
Double bubble
First step in management of duodenal atresia
IVF
String sign in a child
Pyloric Stenosis
Best initial test in pyloric Stenosis?
Abdominal US
Most accurate test in Pyloric Stenosis?
Upper GI series
Treatment for Pyloric Stenosis
IVF
NG tube
Pyloromyotomy
Best initial test for Hirschsprung Disease
CXR
Most accurate test for Hirschsprung Disease
Rectal suction biopsy
Abdominal pain
Bilious vomiting
90% occur during 1st year of life
Volvulus
Best initial step in diagnosing volvulus?
Upper GI series
Management of Volvulus
Decompression of gut
IVF
Surgery
What is a pt with a volvulus is decompensating?
Start Abx
Colicky abdominal pain
Bilious vomiting
Currant jelly stool
Sausage like mass
Intussusception
Best initial test for Intussusception?
US
Most accurate test in Intussusception?
Air contrast barium enema
First step in Intussusception?
IVF and correction of electrolytes
US shows Doughnut sign
Intussusception
Treatment of Intussusception
Air enema
Painless rectal bleeding in an infant
Meckel’s Diverticulum
Child born severely premature with low birth weight
Vomiting and abdominal distension
Frank or occult blood in stool
Fever or hypothermia
Necrotizing Enterocolitis
Diagnosis of Necrotizing Enterocolitis
Abdominal XRay
Pneumatosis intestinalis
Treatment for necrotizing Enterocolitis
Abx NG tube NPO IVF Watch lactate Perf or necrosis emergency surgery
Electrolyte abnormalities of infants born to diabetic mothers
Hypocalcemia
Hypomagnesemia
Hyperphosphatemia
Increased aldosterone Decreased cortisol Decreased sex hormones Hypertensive Hypokalemia
Congenital Adrenal Hyperplasia 17a hydroxylase deficiency
Decreased aldosterone Decreased cortisol Increased sex hormones Hypotension Hyperkalemia Hyponatremia Hypochloremia
21-a-hydroxylase def
Decreased aldosterone Decreased cortisol Increased sex hormones Increased 11-DOC HTN
11-b hydroxylase def
Best initial test for Lead poisoning
Finger stick for cap blood lead level
Most accurate test for Lead poisoning
Venous blood lead level
Lead poisoning lifestyle changes and outpatient follow-up
Mild intoxication (<44mcg/dL)
Oral succimer as inpatient
Moderate intoxication (45-69mcg/dL)
IV dimercaprol
Severe intoxication (>70mcg/dL)
Most accurate test in Osteogenesis Imperfecta (OI)
Skin biopsy analyzed for collagen synthesis by culturing dermal fibroblast
Painful limp
Xrays show joint effusions and widening
Ages 2-8
Legg Calve Perthes disease(avascular necrosis of femoral head)
Painful limp externally rotated leg
Xrays show widening of joint space
Adolescence especially in obese pts
Slipped capital femoral epiphysis
PDA Cataracts Deafness Hepatosplenomegaly Thrombocytopenia Blueberry muffin rash Hyperbilirubinemia
Rubella
Periventricular calcifications with microcephaly chorioretinitis hearing loss petechiae
CMV
Chorioretinitis hydrocephalus and multiple ring enhancing lesions on CT
Toxoplasmosis
Treatment for Toxoplasmosis
Pyrimethamine and sulfadiazine
Treatment for CMV
Ganciclovir with signs of end organ damage
Sandpaper rash over trunk and extremities Fever Pharyngitis Strawberry tongue Cervical lymphadenopathy Typically last 3 to 6 days
Scarlet fever
A child with more than 5 days of fever and 4/5 of the following criteria: Rash Mucositis Edema or erythema of hands and feet Cervical lymphadenopathy Limbic sparing bilateral conjunctivitis
Kawasaki Dx
Treatment of Kawasaki Dx
IVIG and aspirin
Elevated WBC and platelet counts
Elevated transaminases
Elevated inflammatory markers
Anemia and pyuria
Kawasaki Dx
Should have echo at diagnosis and repeat echo 2-6 wks later to assess for coronary artery involvement
Kawasaki Dx
Invasive infection of the external auditory canal and skull base
Usually due to Pseudomonas aeruginosa
Malignant Otitis Externa
Best initial test for malignant otitis externa
CT scan of the skull base
Most accurate test for malignant otitis externa
Biopsy
Treatment for malignant otitis externa
Oral/IV ciprofloxacin or ceftazidime
Triad of barking cough, Coryza and stridor
Croup
Inflammation of upper airway including larynx and trachea(subglottic space) usually due to parainfluenza
Croup
CXR shows steeple sign
Croup
Mild: warm/cool mist
Moderate: steroids
Severe: racemic epi and steroids
Treatment for croup
Usually due to H. Influenzae b Fever Hot potato voice Drooling Tripod position Refusal to lie flat
Epiglottis
Intubation
Ceftriaxone for 7 to 10 days
Rifampin to all close contacts
Epiglottis
Thumbprint sign on neck x Ray
Epiglottis
Bordetella pertusis
Pertusis whooping cough
Day 0 to 14 Rhinorrhea Congestion Most contagious period Only time antibiotics are helpful to pt Last 14 days
Catarrhal stage Pertussis
Day 14-45 Last 14-30 days Severe coughing Post-tussive emesis Usually no fever Abx prescribed to reduce transmissibility
Paroxysmal
Pertussis
Day 45 to 60
Prolonged resolution of symptoms
Coughing fits remain less respiratory distress
Last 14 days
Convalescent
Pertussis
Most symptomatic phase of Pertussis
Paroxysmal stage
Treatment for Pertussis
Azithromycin or erythromycin
Productive cough lasting 7-10 days with fever treatment is supportive
Bronchitis
Cervical adenopathy Petechiae Fever above 104 URI symptoms Acute rheumatic fever and glomerulonephritis Txt oral PCN 10 days
Pharyngitis
Gray pseudomembranous plaque on the pharyngeal wall
Diphtheria
Decreased FEV1 and FEV1/FVC ratio
Asthma
Poor night vision
Pseudo tumor cerebri
Vitamin A
Beriberi
Wermickes encephalopathy
Water soluble
Vitamin B1 (Thiamine)
Angular chelitis
Stomatitis
Glossitis
Water soluble
Vitamin B2 (Riboflavin)
Pellagra Diarrhea Dermatitis Dementia Death Water soluble
Vitamin B3 (niacin)
Burning feet syndrome water soluble
Vitamin B5 (panthothenic acid)
Peripheral Neuropathy
Must be given with INH
Vitamin B6 (pyridoxine)
Megaloblastic anemia
Hypersegmented neutrophils
Water soluble
Vitamin B 9 Folate
Megaloblastic anemia
Hypersegmented neutrophil
Peripheral Neuropathy of the dorsal column tracts
Water soluble
Vitamin B 12 cyanocobalamin
Scurvy Ecchymoses Bleeding gums Petechiae Water soluble
Vitamin C
Rickets in children
Hypercalcemia
Polyuria
Polydipsia
Vitamin D
Increased PT/INR
Mild to severe bleeding
Analogous to warfarin
Vitamin K
Teenage girl presents with delayed puberty and incidentally found to have an elevated BP
17-a-hydroxylase def CAH
Treat with Vitamin D and calcium supplements
Rickets
Intermittent abdominal pain
Irritability
Peripheral Neuropathy
Learning disability and behavioral problem
Intervention is needed of the value is >10mcg/dL
Lead poisoning
Inflammation of the patellar ligament at the tibial tuberosity
Osgood Schlatter Dx
Young child with repeated fractures caused by fragile bones, blue sclera, and early deafness
Osteogenesis Imperfecta (OI)
Pavlik harness
Treatment for congenital hip dysphasia
Treatment for neonatal sepsis
Ampicillin and gentamicin
GBS
E. Coli
Listeria
Early causes of neonatal sepsis
Staphylococci
E.coli
GBS
Late causes of neonatal sepsis
Best initial test for toxoplasmosis
Elevated IgM
Most accurate test for Toxoplasmosis
PCR
Best initial test for syphilis
VDRL/RPR
Most accurate test for syphilis
FTA ABS or dark field microscopy
Best initial test for Rubella
Maternal IgM
Best initial test for CMV
Urine or saliva viral titers
Most accurate test for CMV
Urine or saliva PCR for viral DNA
Diagnosis: acute hip pain with limited ROM in obese 12-year-old
SCFE
SCFE has what main complication if not treated properly?
Avascular necrosis of femoral head
How is SCFE diagnosed?
Hip XR
Controversial: frog-leg position
How is SCFE managed?
Non weight-bearing Internal fixation (pinning)
(Even with appropriate treatment patients may develop AVN, osteoarthritis)