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Quarter 3 Finals > Peds > Flashcards

Peds Flashcards

1
Q

Cerebral Palsy

A

Non-progressive
d/t brain injury
4 types: Spastic*, ataxia, dyskinetic, mixed

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2
Q

Hydrocephalus

A

Increased volume of CSF –> ventricular dilation and increased ICP

2 types: obstructive vs non-obstructive

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3
Q

Hydrocephalus sx

A

Bradycardia
HTN
HA, behavior change, papilledema, spasticity

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4
Q

Hydrocephalus dx

A

Newborn: Ultrasound
Children: MRI/ CT

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5
Q

Hydrocephalus tx

A

Neurosurgeon –> Shunt

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6
Q

Microcephaly

A

> 2SD below mean OR
<5th%

If sx: delay milestone, seizure, Early fontanelle closure, Prominent suture

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7
Q

Macrocephaly

A

> 2SD above mean OR

>97th%

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8
Q

Rate of growth of Macrocephaly hints at Etiology

A

Rapid: increased ICP
Catch up: Premie, neuro intact
Normal: Familial

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9
Q

Chari malformation Type 1

A

Type 1: cerebellum disp caudally, Syringomyelia- fluid filled cyst in spinal cord “cape like sensory loss”

sx onset teen or adult

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10
Q

Chair malformation type 2

NEED SURGERY

A

all sx of type 1 + Myelomeningocele

Sx earlier (Prenatal or AT BIRTH)

dysphagia, apneic spells

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11
Q

Spina Bifida
Closed: occulta
Open: Meningocele, myelomeningocele

A

Risk factors:

Low folate, fever, genetics, poor managed DM, obesity

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12
Q

Spina bifida Occulta

A

Hairy patch
Dimple
Dark spot

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13
Q

Spina bifida meningocele

A

Outpoutching of spinal FLUID and MENINGES

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14
Q

Spina bifida myelomeningocele

A

Outpouching of SPINAL CORD and MENINGES

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15
Q

Spina bifida myelomeningocele (THE WORST)

A

Sensory loss, paralysis, Incontinence (urinary and bowel)

Often also has: Chairi II and Hydrocephalus

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16
Q

NF1

A 
Autosomal Dominant
Macrocephalus, seizures, cognitive delay
"Cafe-au-lait" spot
Axillary/inguinal freckles
Lisch nodules
Optic pathway glioma
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17
Q

Migraine

A

Focal
2-72 hrs
Pulse/throbbing
Associated sx: N/V, photophobia, maybe aura

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18
Q

Tension HA

A

Diffuse, can last up to 7 days
Constant pressure
Not worse w activity
maybe photophobia

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19
Q

Pseudomotor Cerebri

A

Idiopathic intracranial HTN (increased ICP but no mass or hydrocephalus)

OBESE TEEN GIRL

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20
Q

Pseudomotor Cerebri classic sx

OBESE TEEN GIRL

A

HA and Papilledema

Also: pulsatile tinnitus, neck stiff

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21
Q

Pseudomotor Cerebri Dx

A

LP would show increased opening pressure

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22
Q

Tx for Pseudomotor Cerebri

intracranial HTN

A

Acetazolamide

Topiramate, weight loss

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23
Q

Absence seizure

A 
Considered generalized (both hemispheres)
Sudden impaired consciousness w/o loss of tone

Provoked by hyperventilation

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24
Q

Abscense seizure

A

often gone by age 10
Dx: EEG

lasting 10 sec, may have up to 10/day

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25
Absecne seizure tx
Ethosuximide
26
Febrile Seizure dx
EEG not indicated!! not necessary
27
Febrile Seizure dx, IF lasting LONGER than 5 min
IV Benzos
28
Guillian Barre C. Jejuni
Acute flaccid paralysis | Ascending symmetric weakness
29
Dx of Guillian Barre
EMG/NCV CSF has increased protein, normal WBC Spinal MRI (with AND without contrast): enhanced nerve roots and cauda equina
30
Tx of Guillian Barre
IVIG or plasma exchange
31
Botulism
``` Honey Ach <6 mo usually Descending weakness Constipation, hypotonia ```
32
Dx of Botulism
Stool sample, EMG/NCV
33
Tx of Botulism
Immunoglobulin- BIG-IV or BabyBIG
34
Duchenne MD
X. link recessive MORE SEVERE FORM earlier onset, death by 18YO "Gower sign"
35
Dx of Duchenne MD
Increased muscle enzymes | genetic testing
36
Tx of Duchenne MD
Glucocorticoids
37
Becker MD
sx onset later less severe, BUT Cardiomyopathy may be more severe
38
Chiari Malformation Type 1
Neck pain If syingomyelia: cape like sensory loss, loss of abd reflex
39
Dx of Chiari
MRI
40
Tx of Pseudomotor cerebri
Acetazolamide
41
Epilepsy
>2 unprovoked, more than 24 hrs apart
42
Most common generalized seizure
Tonic and Clonic
43
Absence
provoked by Hyperventilation
44
tx for Abscence seizure
Ethosuximide
45
Croup (viral)
Parainfluenza: most common Barking cough "Seal" Hoarse, Stridor
46
Steeple sign on CXR
Croup
47
Croup
Mild: no stridor Mod: stridor, some retractions Severe: stridor, retractions, AND agitation
48
Stridor
inspiratory squeaking
49
Tx of Croup
Mild: Supportive, maybe steroid Moderate: Steroid, Epi Severe: ED
50
Epiglottitis
EMERGENCY Usually bacterial: Hib Vaccine available
51
Triad: | Dysphagia, drooling, distress
Epiglottitis and "Hot potato voice"
52
Thumb sign on CXR
Epiglotitties
53
Epiglottitis tx
3rd gen Cephalosporin (Ceftriaxone)
54
If you suspect Aspiration from foreign body,
PROMPT Bronchoscopy should be performed
55
Tracheomalacia
Floppy trachea- abn collapse d/t inadequate supporting cartilage
56
Cause of floppy trachea "tracheomalaica"
Craniofacial abn Genetic Conn tissue disorder
57
Tracheomalacia
Harsh, barking cough EXPIRATION worse Most improve 6-12 mo CPAP if severe
58
Triad: Paroxysmal cough INSPIRATORY whoop Post-tussive emesis
Pertussis
59
Gold standard Pertussis dx
Nasal culture OR PCR from nasopharyngeal swab
60
Tx of Pertussis
Macrolides (Azithro, Clarithro) Bactrim is backup
61
Bronchiolitis (viral)
Lower respiratory infection
62
Bronchiolitis (viral)
RSV most common Leading cause of hospitalization in infants and young children
63
Bronchiolitis non severe vs moder-severe
non severe: f/u in 2 days | mod-severe: hospitalize and supportive (bronchodilator)
64
RSV Broncholitis
Pariticularly severe Worse with RF: <6 mo, premie, 2nd hand smoke, immunocompromised, severe asthma Can have PNA or Apnea with it
65
RSV Broncholitis tx or prevention
RSV Prophylaxis- Palivizumab FOR HIGH RISK CHILDREN <2YO
66
Round PNA on CXR are usually caused by:
Staph or Strep
67
Atypical PNA are usually ____ on CXR
Diffuse
68
Tx for bacterial PNA
Amoxicillin
69
Tx for Atypical PNA
Macrolide (Azithro) or Doxy
70
Cystic Fibrosis
CFTR gene Cl transport faulty --> thick mucus newborn screen
71
Diagnostic test for Cystic Fibrosis
Sweat chloride >60
72
Bronchiectasis
Abn dilation and distortion of bronchial tree --> COPD
73
Cause of Bronchiectasis
Cystic Fibrosis is most common cause in children chronic cough w purulent sputum crackles, rhonch, digital CLUBBING, increased AP diameter
74
CF causes
Bronchiectasis Obstructive pattern on PFT CXR: "Tram track" "ring shadows"
75
Infant Resp Distress Synd
"Hyaline membrane dz" Deficient surfactant Alveolar collapse Cause: Prematurity, genetic disorders
76
Infant Respiratory Distress Synd
Sx start almost immediately after birth Tachypnea, retractions, flaring, EXPIRATORY grunting, cyanosis
77
Tx for Infant Respiratory Distress Synd
PRENATAL steroids Exogenous surfactant CPAP w O2
78
CXR shows "Ground glass appearance" and Air bronchograms
Infant Respiratory Distress Syndrome
79
Bronchodilator test for Asthma Reversible IF:
>12% or | >200 mL after use
80
Ratio in asthma is
DECREASED
81
Stepwise approach for Asthma
SABA ICS LABA (with a steroid) LTRA
82
Risk factors for Obstructive sleep apnea
Adenotonsilar hypertrophy | Obesity
83
Dx and Tx of Obs sleep apnea
Polysomnography PE Focused sleep hx Tx: Adenotonsillectomy, CPAP
84
Highest risk for Type 1 DM
White (non hispanic)
85
Two peaks of Type 1 DM in childhood
4-6 and | 10-14 YO
86
Gene that increases risk of DM Type I in peds
HLA-DR3 HLA-DR4 (in whites)
87
Environmental risk factors for type 1 DM
Viral infection Further from equator Diet (cows milk early, not breastfeeding, solid foods too early) Higher socioeconomic status
88
Type 1 DM clinical presentation
3Ds + weight loss and fatigue
89
Type 1 DM diagnosis
Classic DKA Silent (incidental) discovery
90
Glucose control as you age
Can be more strict as you get older <5 YO: 80-200 6-11: 70-180 >12: 70-150
91
Syringe insulin method
Good: cheaper, less training Risk: higher risk for Hypoglycemia
92
Overweight
85-95th percentile
93
Obese
>95th percentile
94
Exercise recommendation for kiddos
30-60 min per day
95
Screen time for kiddos
<2 hours of non-academic per day
96
Sx of Type 2 DM
Thirsty, Polyuria Visual disturbance Frequent infections Peds: No sx, fatigue, irritable, difficulty concentrating
97
Signs of Type 2 DM
Acanthosis Nigricans (posterior neck, axilla, abdomen, thigh, elbow space)
98
Who to screen for Type 2 DM
>10 YO, overweight/obese, AND 2 of the following risk factors
99
The 4 risk factors for Type 2 DM for screening
Type 2 in first or second deg relative High risk ethnic Insulin resistance signs Maternal hx of DM/gestational Dm
100
How often to repeat type 2 DM screening
every 3 years
101
When to use Insulin
Ketosis Severe hyperglycemia Mixed Type 1 and 2 Recommended when plasma glucose >250 or A1C > 9%
102
After starting new DM med, how often do we monitor A1C?
3 months
103
How often to measure blood glucose if on insulin?
3x/day
104
Comorbidities to monitor if Type 2 DM
HTN | Hyperlipidemia
105
Med to treat HTN if pt (over 13 YO) has Type 2 DM
ACE-I or ARB (first line) Thiazide, CCB (2nd line)
106
Lipid goals for teens w Type 2 DM
LDL <100 Trig <150 HDL >35
107
When to use Statin to tx Type 2 DM teen with Hyperlipidemia?
LDL >130 pt is >10YO Obesity/other CVD risk factors are present AND if you have already tried non-pharm therapy for 6 mo with no luck
108
Short stature
2 or more SD below mean OR <2.3 %
109
Skeletal age: most widely used system to test
Greulich-Pyle Atlas method | left hand wrist X ray compared use age and gender
110
"Normal" causes of short stature
Familial | Constitutional delay of growth
111
Pathologic causes of short stature
``` GH deficient Turner Prader willi Noonan Achondroplasia ```
112
How would I check my parental mean height?
Subtract 5" from my dad, and average w my mom
113
How would Jared check his parental mean height?
Add 5" to mothers, then mean with dad
114
Tx for GH deficiency
Recombinant Human GH is 1st line tx
115
Tx for GH deficiency
rhGH 1st line Must tx prior to epiph plate closure Daily SubQ injections
116
Side effects of Recomb Human GH replacement
Pseudotumor cerebri Hyperglycemia Gynecomastia
117
Turner Syndrome
45 X0 Loss of all or part of X chromo SHORT STATURE Shield shaped thorax, low hairline, underdeveloped gonads, amenorrhea
118
Noonan syndrome
SHORT stature Auto-Dominant CHD (heart) Variable gene mutations Triangle head, curly wooly hair, neck webbing
119
Prader Willi
Chromosome 15 Obesity SHORT stature
120
Achondroplasia
Auto-DOMINANT FGFR3 gene *Most common bone dysplasia in humans
121
Achondroplasia
Disproportionate with Rhizomelic short- long bones are short
122
Autosomal Dominant causes of short stature
Noonan | Achondroplasia
123
What are IGF-1 levels in Turner, Noonan, Prader willi, Achondroplasia?
Normal, even though they are short
124
Complications assoc with Achondroplasia
Rhizomelic shortening Macrocephaly Brachydactylyl Obestiy
125
Tall stature
Gigantism, GH excess b4 epiphyseal closing
126
GH excess Gigantism dx
Serum IGF-1 GH suppression test MRI
127
GH suppression test
(give glucose, if GH does not fall in response= abnormal)
128
Tx for GH excess
Octreotide* Bromocriptine Surgery/radiation
129
Precocious puberty
Girls: before 8 Boys: before 9
130
Central precocious puberty
Gonadotropin dependent Elevated LH and FSH
131
Peripheral precocious puberty
Testes are the problem | Elevated gonadal steroids, but low LH and FSH
132
Central/ gonadotropin dependent Precociosu
Girls > boys MRI brain/ Pit Tx: GnRH agonist
133
Peripheral precocious puberty | gonadotropin-indep
``` Rare 50% cases in boys Cause: steroids Congenital Mccune Albright ``` Tx: underlying
134
21 a hydroxylase deficiency
Too much Androgens (virulizing) Not enough Aldosterone or Cortisol
135
Klinefelters
most common cause of primary testicular failure Gynecomastia
136
Tx for 21 a hydroxylase deficiency High Androgen Low Cortisol and Aldosterone
GnRH analog Hydrocortisone Fludrocortisone

Quarter 3 Finals (10 decks)

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