Peds Flashcards
most common bugs in Retropharyngeal abscess
Strep pyogenes
Staph aureus
oral aneaerobes
retropharyngeal abscess is an infection of what space
space between pharynx and vertebral fascia
widening of prevertebral space on neck XR
suggests retropharyngeal abscess
confirmed by CT with contrast
thumb sign on lateral neck XR
epiglottitis
swollen epiglottis
what pts get Pvalizumab for RSV ppx?
children <2 years and have
- preterm <29 wks
- chronic lung disease of prematurity
- HD signific congenital heart disease
complications of bronchiolitis
apnea, respiratory failure
most middle ear infections are caused by what bugs
strep pneumo
moraxella
H flu
treatment for history of acute rheumatic fever now with MR but otherwise healthy?
IM penicillin every 3-4wks for secondary prevention of ARF
pts with h/o ARF at high risk for recurrence and progression of rheumatic heart disease with subsequent group A strep infection
total iron binding capacity is a measure of
transferrin
stranger anxiety timing
starts 6 months
peaks 8-9 months
resolves 2 years
separation anxiety resolves when
18-24 months
Kawasaki diagnosis
fever >= 5 days and at least four of:
- conjunctivitis
- mucositis (erythematous fissured lips, strawberry tongue)
- rash
- extremity changes
- cervical LAD >1.5cm
lab findings supportive of kawasaki
high CRP hypoalbuminemia sterile pyrua anemia thrombocytosis
describe the three types of renal tubular acidosis
1 (distal)
- poor hydrogen secretion
- high urine pH
2 (proximal)
-poor bicarb resorption
4
-aldosterone resistance
hexagonal crystals on UA
cystinuria
maneuvers to fix radial head subluxation
apply pressure to radial head and
forearm hyperpronation
or supination plus flexion
kid with radial subluxation keeps hand in __ position
pronated
Crigler Najjar
absent uridine diphosphate glucuronosyl transferase
Gilbert
mild deficiency uridine diphosphate glucuronosyl transferase
rash on trunk –> groin, axilla –> peeling hands and feet
with headache, fever, sore throat
scarlet fever - strep pyogenes
bilirubin threshold for phototherapy
20
tx minimal change disease
corticosteroids
WAGR
wilms tumor
aniridia
GU abnormalities
retardation
screening u/s for wilms q3mo
signs/sxs HUS
thrombocytopenia
microangtiopathy hemolytic anemia
AKI
Atomoxetine moa
selective NE reuptake inhibitor
most common heart defect in Down’s syndrome
complete atrioventricular septal defect
failure of endocardial cushions to merge –> both ASD and VSD
Tetralogy of Fallot
- pulmonic stenosis
- overriding aorta
- VSD
- RV hypertrophy
clinical findings of complete atrioventricular septal defect
- heart failure (blood mixing between chambers and severe AV valve regurg leading to vol overload)
- fixed split S2 (delayed pulm valve closure from flow across ASD)
- systolic ejection murmur due to increase pulmonic flow from the atrial septal defect
what happens to most innocent murmurs upon valsalva or standing?
decreased intensity with maneuvers that decr blood flow to the heart
lymphocyte predominant leukocytosis
bordatella pertussis
firstline therapy for immediate effects on night time enuresis
desmospressin; decreases urine production
enuresis alarm is best but takes 3-4 months
what should you counsel pts on desmopressin?
minimize water intake to prevent hyponatremia
how to differentiate peripheral from central precocious puberty?
central has high LH
path and symptoms of intussception
ileum telescopes into cecum -> pain, obstruction edema -> compression of blood vessels -> bowel ischemia -> rectal bleeding (currant jelly stools)
well appearing infant with painless, bloody stools
suspect food-protein induced allergic proctocolitis
manage by eliminating maternal consumption of diary and soy
or switch to hydrolyzed formula
risk factors for baby intraventricular hemorrhage
prematurity (highest risk <32 wks; germinal matrix involutes at 32wks)
very low birth weight
imaginary friends are most common at what ages?
3-6 years
overlapping fingers
retrognathia
edwards syndrome
kid with recurrent staph abscesses
CGD
impaired NADPH oxidase complex
can’t form hydrogen peroxide
risk factors for acute OM
young age (6-18mo)
smoke exposure
daycare
no breastfeeding
common bugs bacterial rhinosinusitis
H flu
Strep pneumo
treatment bact rhinosinusitis
amox + clavulanate
diagnostic criteria bact rhinosinusitis
1 of any:
- persistent sxs >=10 days without improvementt
- severe onset (fever >102.5 and drainage) for 3 or more days
- worsening sympttoms after initial improvemen
osteoid osteoma
- worse at night, unrelated to activity
- classic: responds to NSAIDs
- single small round lucency
Ewing sarcoma
- onion skinning
- worse with activity
- doesn’t improve with NSAIDs
osteosarcoma
- chronic localized pain
- soft tissue mass
- XR bony destruction with sunburst pattern of periosteal reaction
high fever, cramping, diarrhea that becomes bloody
shigella
key lab finding of hereditary spherocytosis
elevated MCHC
microcytic anemia, elevated retics
thalassemia
list the 4 types of hypersensitivity reactions, underlying immunology, and example causes
Type I (immediate): IgE, anaphylaxis, urticaria
Type II (cytotoxic): IgG, IgM autoantibody; autoimmune hemolytic anemia, Goodpasture
Type III (immune complex): antibody-antigen complex deposition; serum sickness, post strep glomerulonephritis, lupus nephritis
Type IV: T cell and macrophage; contact dermatitis, tb skin test
fever, weight loss, Horner’s syndrome; MRI with cervical paravertebral mass
Neuroblastoma
most common extracranial solid tumor of childhood!
tumor of neural crest cells, which give rise to adrenal medulla and sympathetic ganglia
swimming pool, large macules - name of condition and causative organism?
tinea versicolor - Malessezia
cause of hand and foot swelling in turner syndrome
lymphatic dysgenesis (occurs in half of Turner pts)
ppx options for close contacts of meningitis
ceftriaxone, ciprofloxacin, rifampin
pathophys hereditary angioedema
C1 inhibitor deficiency -> elevated bradykinin -> edema
autosomal dominant
joint effusion after minor trauma, suspect _
hemophilia
get coags = prolonged PTT, normal PT and platelets
Hemolytic Uremic Syndrome triad
- hemolytic anemia
- acute kidney injury
- thrombocytopenia
stable pt can be observed with repeat imaging in 12-24hr if a sharp FB is distal to the __
proximal duodenum (at this point, usu will be excreted uneventfully)
bedwetting is normal until age _
5
what screening tests should be done at time of Duchenne muscular dystrophy diagnosis?
Echo and EKG
absent dystrophin in cardiac muscle can lead to dilated CM and conduction abnormalities
when should you consider tympanocentesis with culture
> =3 AOM in 6 months
persistent >3 mo middle ear effusion with hearing loss
why can refeeding syndrome be fatal?
feeding stimulates insulin release
insulin promotes cellular uptake of electrolytes (eg phosphorus, Mg) resulting in electrolyte deficiency which can cause cardiac arrythmia
definition primary amenorrhea
14yo with no secondary sexual char
15yo with secondary sexual char
when do electrolyte abnormalities manifest in infants w/ CAH?
1-2 weeks
earlier than that, normal levels bc of maternal adrenal hormones
bruising, petechiae, bleeding, hepatosplenomegaly, nontender lymphadenopathy
bone pain
nonspecific sxs- fever, fatigue, weight loss
ALL
nonspecific systemic symptoms
post concussive syndrome definition, cause, time to resolution
> 4 weeks concussion sxs (HA, sleep disturbance)
due to not following gradual return to play protocol
most pts improve within 3 months
symptomatic management of conscussion
- headache (eg amitriptyline)
- CBT (for insom, anxiety)
reassurance if mild sxs
liver biopsy Reye syndrome would show
microvesicular fatty infiltration
triple bubble
jejunal atresia
not a/w chromosomal abnormalities
due to vascular insult eg maternal cocaine use
long limbs, scoliosis, joint hypermobility
lens dislocation
aortic root dilation
condition? biochemical cause?
Marfan’s
mutation in fibrillin 1 gene
cause of methemoglobinemia
Hemoglobin gets oxidized to Methemoglobin (which can’t transport O2) by an oxidizing agent (eg lidocaine prilocaine)
low SpO2 that doesn’t improve with oxygen (will stay same bc the way methemoglobin is measured on pulse ox)
falsely normal PaO2 (bc only measures unbound arterial oxygen)
saturation gap - more than 5% diff between pulse ox and ABG
treatment of methemoglobinemia, how does it work
IV methylene blue, helps reduce the methemoglobin
high dose vitamin C is reducing, can be used when don’t have methylene blue or contraindicated (eg G6PD deficiency)
anemic child with history of ileum resection from nec enterocolitis most likely deficient in __. why?
B12
IF-B12 complex absorbed when it binds receptors in distal ileum
juvenile pernicious anemia cause
can’t secrete intrinsic factor
maternal B12 from placenta lasts __
1-2 years
pts w/ Beckwith-Weidemann should get what tests routinely and why?
from birth to age 4:
abdominal u/s - wilm’s tumor
AFP- hepatoadenoma
from age 4-8:
renal ultrasound
what are howell jolly bodies
RBC nuclear remnants
what is in basophilic stippling
precipitated ribosomal ribonucleic acid
most effective med for Tourette (after failure of habit reversal therapy)
antidopaminergic (Tetrabenazine, antipsychotics w antidopa)
palpable purpura
abdominal pain
arthritis
nephropathy, hematuria
Henoch Schonlein Purpura
path of Henoch Schonlein Purpura
IgA immune complex deposition
type of stridor in laryngeomalacia vs tracheomalacia and why
laryngeomalacia - inspiratory stridor (decr pressure beyond larynx leads to airway narrowing)
tracheomalacia- expiratory stridor (increased intrathoracic P during expiration)
most common pneumonia isolate in children and infants with CF
staph aureus!
paroxysmal phase of pertussis can last ___
4-6 weeks
vit K important in hepatic activation of what factors?
2, 7, 9, 10, proteins C and S
children age __ should get renal and bladder u/s after first febrile UTI
<2
myelomeningocele is a/w with what abnormality
chiari II malformation
loss of CSF thru the neural tube defect –> collapse of cranial structures –> small posterior fossa –> medulla and cerebullum get displaced downward
pathogenesis post strep glomerulonephritis
deposition of antibody-antigen complexes in mesangium and BM
tanner stage when breast forms secondary mound
IV
treatment von willebrand and mechanism
desmopression (IV or intranasal) - causes release of vWF from endothelial cells
first sign of puberty in a boy
testicular enlargement
DKA lab findings
- low Na (dilutional and renal losses)
- high Cr (hypovolemia)
how do you calculate anion gap
Na - (HCO3 + Cl)
what is considered elevated AG
> 12
Diagnostic criteria for DKA
3 criteria:
- random BG >200
- venous pH <7.3 or bicarb <15
- mod/large ketonuria or ketonemia
Diagnostic criteria for DM
-A1C >=6.5%
-fasting gluc >=126
-2 hour gluc >= 200
(all above need repeat testing)
OR
classic sxs hyperglycemia and random gluc >=200
oily nonbloody foul smelling diarrhea
giardiasis
mechanism giardiasis
disrupts tight junctions between small intestine enterocytes –> malabsorption lasting up to a month
diagnostic test for PKU for a baby that didn’t get screened
quantitative amino acid analysis (elevated Phenylalanine levels)
most Duchenne’s patients die from what
cardiac/respiratory failure
painless rectal bleeding
Meckel diverticulum
diagnosis of Meckel
technetium 99 scan
brain tumor: ataxia, truncal instability
medulloblastoma
preteen irritable
doesn’t want to hang out with friends
leave me alone
grades going down
Major depressive disorder
microcephaly
cleft lip
distal phalange hypoplasia
wide anterior fontanelle
fetal hydantoin syndrome, from exposure to antiepileptics in utero
in dehydrated child, what is the ratio of acute weight loss to fluid loss?
1kg = 1L
disruptive mood dysregulation disorder
PERSISTENTLY irritable, not episodic
easily set off, out of proportion responses
