Peds Flashcards by Justin Tu

TORCHES infections are what?

Toxoplasmosis, Other agents (varicella, parvovirus), Rubella, Cytomegalovirus, Herpes/HIV, Syphilis)

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What chromosomes are associated with Down’s, Edward’s, Patau, Turner’s, and Klinefelter’s?

21;
18;
13;
45X;
47XXY

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When does the greatest change in bone mass occur in boys and girls?

Boys: 14-17;

Girls 12-15

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When can baby keep head midline? When can they sit and transfer objects? When can they cruise with pincer grasp?

4 mos;
7 mos;
10 mos;

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When can a kid pile two cubes and use single words? When does hand dominance emerge? When can they go up and down stairs, use two-word phrases, and build eight-cube towers?

14 mos;
18 mos;
24 mos (2 yrs)

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When can a kid pedal a tricycle, go up stairs with alternating feet, copy a circle? What about going down stairs alternating feet and copying a cross? What about drawing a triangle?

3 yrs;
4 yrs;
5 yrs;

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What specific anomalies are associated with limb deficiencies?

Craniofacial anomalies

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What is the most common congenital limb deficiency? When should prosthetic fitting first occur for kids?

Terminal transradial;

6-7 months

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What is the Krukenberg procedure?

Reconstructs the forearm and creates a sensate prehensile surface for children with absent hands by separating the ulna and radius in the forearm

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The most common congenital lower limb deficiency is

fibular longitudinal deficiency

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70-80% of patients with partial proximal femoral focal deficiency (PFFD) also present with

associated fibular deficiencies

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What is the most common prosthetic foot prescribed for the child amputee?

Solid ankle cushion heel (SACH); energy-storing feet becoming more popular

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Most common cause of pediatric acquired amputation? What about disease-related amputation?

Trauma;

tumor

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Most common complication of amputation in the immature child? Where most likely to occur?

Terminal overgrowth at transected end of long bone; occurs most frequently at humerus, then fibula, then tibia, then femur (HFTF)

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When are motorized wheelchairs classically introduced to kids?

Age 5-6 years old

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Children with congenital limb deficiency do/do not develop phantom sensation or pain

DO NOT;

if ACQUIRED, some kids retain some awareness of the amputated part

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Nmemonic for club foot deformity?

CAVE:
midfoot CAVUS
forefoot ADDUCTUS
hindfoot VARUS
hindfoot EQUINUS

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How to manage clubfoot?

Start with Ponseti method of serial casting and manipulation; try to initiate in first month of life;
Can do PT and bracing, and last line of treatment is surgical correction

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What is Blount’s disease? In whom is it more common? How to treat?

Abnormal fxn of medial portion of prox tibial growth plate with bowing in prox tibia;
AA’s;
osteotomy of prox tibia and fibula

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Most common cause of congenital torticollis? Where is head tilted and rotated?

SCM fibrosis;

Tilted to ipsilateral side, rotated to contralateral side

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Mainstay of treatment of congenital torticollis?

Stretching by tilting head to contralateral side and rotating to the ipsilateral side of fibrosis

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What is nursemaid’s elbow, and how to manage it?

Subluxation of radial head;

Supination, extension of forearm

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What is pathology behind medial epicondylar apophysitis?

Repetitive traction stress on apophysis of medial epicondylar ossification center of humerus

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Most common cause of limping and pain in child’s hips?

Transient (toxic) synovitis of hip

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Treatment for LCP vs. SCFE?

LCP: abduction brace, rest, may need varus osteotomy if need surg; SCFE: surgical pinning preferred

Most common cause of structural scoliosis?

Idiopathic

When is neuromuscular disease most commonly seen?

CP, muscular dystrophy, spinal muscular atrophy, spina bifida

When to brace for scoliosis? When is surg needed?

20-40 degrees; | Over 40 degrees

How is Scheuermann's disease diagnosed radiographically?

Having 3 or more consecutive vertebrae with greater than 5 degrees anterior wedging

Most common type of spondylolisthesis? Most common in adults? In kids, where is the spondylolisthesis most common? When do you need surgery?

Isthmic; degenerative; L5-S1, followed by L4-5; usually over 50% slippage (i.e. grade 3)

Most common connective tissue disease in kids?

Juvenile idiopathic arthritis

Type of JIA most likely to develop chronic iridocyclitis? Acute iridocyclitis?

Oligoarticular; | systemic

Juvenile dermatomyositis is associated with

histologic presence of vasculitis, onset of calcinosis, lack of association with childhood malignancy

Jones Criteria to diagnose rheumatic fever?

``` Major: JONES Joints (polyarthritis) Heart (carditis) Nodules (subcutaneous nodules) Erythema marginatum Chorea; minor include fever, arthralgia, elevated CRP/ESR, prolonged PR interval ```

What is the hallmark of hemophilia?

Hemarthrosis

Most common cause of pediatric burn injury?

Scald burns

Of all the burn-related contractures in kids, which is most commonly involved?

Axilla

Reasons to hospitalize kids with burns?

Over 5% full thickness injury, over 10% total BSA in kids or elderly, or over 20% in general; inhalation injuries, electrical burns, trauma; HEENT, hands, feet, genitalia

Most common type of tumor in kids? Most common type of malignant bone tumors in kids?

ALL; | osteosarcoma, followed by Ewing's sarcoma

Leading cause of TBI in kids?

Transportation-related

Hypopituitarism presents with

growth failure and delayed or arrested puberty; | see GH, LH, and FSH most deficient

Which has better prognosis classically, TBI or anoxic brain injury?

Traumatic

CP is a disorder primarily of ________ and _____, but is also associated with

movement control; posture; | cognitive and sensory associated problems resulting from non-progressive lesion to immature brain

When do majority of CP cases occur? Some risk factors?

Prenatal; | prenatal ICH, placental complications, gestational toxins, gestational teratogenic agents

What is most common antecedent of CP?

Prematurity

Most common type of CP?

Spastic diplegia

Which type of CP has highest incidence of significant disability? Which has high incidence of sensorineural deafness?

Tetraplegic; | dyskinetic

What is common cause of spastic diplegia, and what can be seen on MRI?

History of IVH; | can see peri-ventricular leukomalacia

For ataxic CP, what is this classically associated with?

Sensorineural hearing loss, hyperbilirubinemia, neonatal jaundice

GMFCS descriptors

Level 1: Walking without restrictions 2: Walking without assistive devices; 3: Walks with assistive mobility devices; 4: Self-mobility with limitations; 5: Self-mobility severely limited even with use of assistive devices

Prognosis for ambulation in kid with CP is good if

independent sitting occurs by age 2

Predictors of successful and unsuccessful employment include

IQ level, ambulation level, speech, and degree of hand function

What are positions for asymmetric vs symmetric tonic neck reflex? When are they suppressed?

For asym, turn neck to side and see extension on that side with flexion on occiput side; for symm, neck flexion and neck extension lead to arms flexing and extended, respectively, while legs do the opposite; 6-7 months

Which geographic regions have highest incidence of myelodysplasia? Lowest?

British Isles, Ireland, Wales, Scotland; | Japan

For spina bifida, when does defect of neural tube closure typically occur?

Day 26

What is myelomeningocele classically associated with?

Arnold-Chiari malformation type 2 with hydrocephalus

Most frequent single cause of death in spina bifida?

Central respiratory dysfunction (stridor, central apnea, aspiration)

Proteus UTI's associated with

calcinosis

Presence of ________ or _______ reflex associated with greater chance of bowel continence

bulbocavernosus; | anocavernosus

In spina bifida, what is the relationship of intellectual function with level of spinal cord dysfunction?

Inversely proportion, ie higher the lesion, lower the score

In spina bifida, among verbal, math, written, or visual perceptual skills, what is usually greatest?

Verbal

For spina bifida, when to achieve independent self-cath?

Age 5-6 years; boys learn easier than girls due to anatomic differences

What are kids with spina bifida at increased risk for reaction wise?

Anaphylaxis (latex allergy)

For spina bifida thoracic lesions, what is ambulation ability?

Assistive devices for passive standing: parapodium, swivel walker, HKAFOs with spinal extensions, walker or Lofstrand crutches

For spina bifida lower thoracic and lumbar lesions, how to ambulate?

RGO; | can use AFO if L3 spared

Functional community ambulation in spina bifida by level?

Thoracic: 0 to 33%; High lumbar: 31% can achieve some degree; Low lumbar: 38% get there under age 15, 95% if age 15-31; Sacral: All can achieve

Employment rate among those with spina bifida?

25-50%

Why does Gower's sign happen?

Proximal (pelvic girdle) muscle weakness; can't rise from sitting position on floor

Muscle biopsy findings for Duchenne?

Degenerating fibers often observed in clusters, with necrotic fibers surrounded by macrophages and lymphocytes

In DMD, where is earliest weakness seen? At ankle, knee, and hip, what muscle groups are stronger?

``` Neck flexors; pelvic girdle weakness precedes shoulder weakness; Ankle DF weaker than PF; Ankle evertors weaker than inverters; knee extensors weaker than flexors; hip extensors weaker than flexors; hip abductors weaker than adductors ```

Emery-Dreifuss muscular dystrophy inheritance, protein involved, and contractures of what?

X-linked recessive; emerin; elbow flexors

Central core myopathy with high incidence of

malignant hyperthermia

Another name for SMA type III, and what is characteristic prognosis-wise?

Kukelberg-Welander syndrome; | good long-term survival, depending on respiratory function

Number one cause of mortality in childhood neuromuscular diseases?

Pulm complications