Peds Flashcards
Foreign body ingestion Rx?
- < 24 HR + no resp Sx
Foley Cath
Bougienage - > 24 or resp Sx
Endoscopic removal - > 2wks
Need surgical
Risk of erosion!
Murmurs in:
- PDA
- Tetralogy of Fallot
- Tricuspid atresia
- Aortic coarctation
- Total anomalous
- PDA = continues machinery murmur at left upper sternal
- Tetralogy = SEM at left upper/mid-sternal + loud S2
- Tricuspid atresia = SEM at left lower sternal
- Coarctation = SEM at left upper sternal radiates to inter-scapular space + wide pulse pressure.
- Total anomalous = SEM + diastolic rumble + fixed wide split S2
Gasoline poisoning Rx?
CVS + Resp support
No antidote
Gasoline poorly absorbed by gut = no need for lavage or charcoal.
If Sx present = CXR 2hr post ingestion + observed in ER for 6 hrs.
Abnormal CXR = admit for blood gas + re-CXR + resp support.
Normal CXR + no Sx = discharge.
Organism of erythema infectiosum / 5th Dz?
Parvovirus B19
How to determine if wheeze in child is foreign body?
CXR:
Focal infiltration or atelectasis
+
Radio-opacities
Dx of Hirschsprung?
Rectal Bx
CPR in children Compression-to-Ventilation ratio.
- Single rescuer:
30:2
Compression = 100 bpm - 2 rescuers:
15: 2
What drug can be used in croup but not bronchiolitis
Oral steroid.
NB: neb epi is beneficial in both.
Apnea in infant? Rx
- If self-correcting, ass w/ feeds = no admission.
2. If sever, life-threatening = admit for observation.
Facts about club foot:
- M:F
- Deformity affects walking?
- Rigid type Rx?
- Corrected deformity needs long FU?
- After Rx participate in usual activity?
- 2:1
- Rigid can be Rx w/ cast but may need surgery
- affects walking
- need FU, risk of recurrence
- Go back to normal after Rx
Neonate hours after birth develops tachypnea + cyanosis?
Dx?
TTN
Supplement O2
CXR
What’s herpangina?
Ferbrile disease by Coxasackie virus.
Sx = oropharyngeal vesicles + ulcers
Sx of herpangina
Rx?
Sudden fever
Neck pain
Then 2 days later grey plaques => vesicles
Mostly on tonsillar pillars
Rx: symptomatic
When is the age for bladder and fecal control?
Bladder: 5
Fecal: 4
1ry vs 2ry enuresis
1ry: no dry period
2ry: dry period > 6months
Investigation in 2ry enuresis?
UA
R/o: DM, DI, over active bladder, cystitis, psychological, seizures.
Child safety seat:
- Stage 1 (Rear facing)
- Stage 2 (Forward)
- Stage 3 (Booster)
- Stage 4 (Seatbelt)
- Stage 1:
At birth
In infant seat. - Stage 2:
At least 1 Yr + 10 Kg
Forward in infant/child seat - Stage 3:
At least 18 kg
Child/booster seat
Stage 4:
At 36 Kg and 145 cm
Seatbelt
Henoch-Schonlein purpura triad?
Purpuric rash
Abdominal pain/renal failure
Joint pain
Type of purpura in HSP?
Non-thrombocytopenic purpura
Causes of neonatal jaundice by time? <24 1 - 3 days 3 - 4 days > 1 week
- <24 hr:
ABO/Rh
Sepsis
2. 1-3: Physiological Breast feeding Hemolysis Sepsis
- 3-4:
Physiological
Breast feeding
Sepsis
4. > week: Hypothyroid Hepatitis Gilbert's : Crigler-Nijjar Biliary obstruction Metabolic error
Rx of viral URTI in neonates?
Nasal rubber suction bulbs
NS nasal drops
Cool-mist humidifiers
MCC of anemia in children?
Iron deficiency
Average birth weight? What happens in first few days then 1-2 wks?
3.5 kg
Baby drops 10% (loss of excess fluid)
In 1-2 weeks baby regain weight
What must be supplemented in breast fed infants?
Vit D
Risk of rickets
Diarrhea by Aeromonas enteritis?
Short IP: 1-2 days
Watery diarrhea + fever
In developing countries
MCC of travelers diarrhea?
Enterotoxiigenic E. coli
Short IP: 1-2 days.
IP of giardia lambilia?
1-2 weeks
MCC of CAH?
21-hydroxylase
Signs of premature infant?
Scant ear cartilage
Absent breast buds
Thin skin
Hypotonic posture at rest
Vaccines at 2 mo
DTaP Hib IPV PCV-13 Rot-1
Drugs cause gynecomastia
Antibiotics (isoniazid, ketoconazole, metronidazole)
Cimetidine
Captopril
Digoxin
Hormones
Assess severity of dehydration
1. Mild: HR: N or high BP: N Sunken eyes: no Urine: normal
2. Moderate: HR: high BP: N Eye: sunken Urine: low
3. Sever: HR: High BP: L Eyes: sunken Urine: none
Accetaminophen toxicity
< 2 HR
Activated charcoal
< 8 HR
N-acetylcysteine (Oral > IV)
T/F: Rotavirus is not associated with URTI
T
MC nutritional def in kids
Iron def anemia
Sx of Atlanto-axaial instability in down
Torticollis UMN Sx (gait, DTR, clonus..)
What’s head tilt test?
Tilt patients bed to Dx syncope.
Cardio = HR < 40
Vasodepressor = HR drops <10%
T/F: orchitis is more common in kids than torsion
Testicular torsion is more common
MCC of otitis media
S. pneumonia
New born foot deformity:
Convex lateral border + adduction of forefoot + normal ankle
Metatarsus adductus
Facts about metatarsus adductus
LFT > Rt
F > M
80% spontaneous resolution w/in 1 Yr
If not resolved w/ stretches => serial casting
MC complication of carniopharyngioma
Central DI
Innocent murmur in strept. Infection
SEM
Grade < 3
Not Sx
No thrill or radiation
Central DI labs? Serum Na Urine Na Extra cellular fluid Plasma arginine vasopressin
High serum Na
Low urine Na
Normal ECF
Low plasma arginine
Source of carniopharyngioma
Rathke’s pouch
MCC of septicemia in infants
GBS = strep. Agalactia
Risks of GBS septicemia
Pre-mature rupture > 24 hrs before delivery
Chorioamnionitis
What's syndesmotic sprain? Injury? Dx? Rx? Complications?
High ankle sprain
Affects anterior, posterior, transverse tibiofibular ligaments + interosseous membrane.
Contact sports = dorsiflexion +/- inversion of ankle
Dx: squeeze test (compress fibula against tibia at mid-calf) pain if +ve.
External rotation stress test by stabilizing leg and externally rotate foot > pain if +ve
Crossed leg test: place involved ankle opposite to knee and pressure applied to medial side of ankle > pain if +ve
Rx: semirigid support
Complication: ankle instability > hypertrophic ossification
Fragile X mutation
CGG repeats on Ch X
MCC of inherited mental retardation
FXS
Hallmark of constitutional delay
Being <50th most of childhood
Bone age < real age
Before Dx constitutional delay what must be checked?
Signs of puberty by age 14.
If no Sx = needs work up
Bug in erythema infectiosum (5th)
Parvovirus B19
Labs in failure to thrive
Normal
MCC of UTI in kids
E. coli 75-90%
Risk factors for UTI in kids
Female gender
Vesicouretral reflux
Anatomical abnormalities: (posterior urethral valve, ectopic ureter)
DM
Wiping techniques
Approach to baby w/ UTI
1st time: UA + C/S
Recurrent: UA + C/S + US + VCUG
VCUG indications: F < 2 yrs F > 5 yrs w/ recurrent UTI Male w/ UTI Febrile child w/ UTI
MC organism in
1. human bite
- Cat/dog
- Goat/sheep
- Rabbits
- Prairie dog/rat flea
- Human: Eikenella (G-ve rod)
- Cat/dog: pasturella
- Goat/sheep: brucella melitensis
- Rabbits: Francisella tularensis
- Prairie dog/rat flea: yresinia pestis
Heinz bodies are seen in what anemia?
G6PD
How to Dx accessory nipple?
Remnants on mammary line
Salt wasting variant of congenital adrenal hyperplasia
- Enzyme missing
- Sx
- 3B-hydroxysteroid dehydrogenase
- infancy => vomiting, diarrhea, dehydration, arrhythmia, cyanosis, ambiguous genitalia
( hypospadias, bifid scrotum, cryptorchidism)
Sleep apnea test
Polysomnography
Most helpful labs in assessment of acute asthma in kids?
FEV1
PEF
Pulse oximeter
Prolonged bleeding after circumcision in otherwise healthy
Hemophilia A
Factor 8 doesn’t cross placenta => early Sx
MC Sx in spondylosis
Low back pain radiates to buttocks / posterior thigh.
Otitis media Rx contraindicated in kids
Fluoroquinolones
Cipro, levo, fluxa,
Prophylaxis to HiB
Rifampin
Klinefelter (KLINE)
Turner (TURNER)
Edwards (EDWARDS)
Prader Willi (PRADER)
Fragile X (FRAGILE)
Klinefelter 47 XXY Killer (aggressive + antisocial) Large breast Non disjunction Elevated (tall)
Tuner 45XO Tight aorta (coarctation) Undersized (short) Renal (horseshoe) Nipple spacing Edema Reproductive failure (ovarian)
Edwards trisomy18 Eighteen Digit overlapping flexion Wide head Absent intellect Rocker-bottom feet Diseased heart Small jaw
Praderwilli Imprinted 15q Paternal Runt (short) Almond eye Delay (mental) Eats lots Rt HF
Fragile X FMR1 gene Repetitive behavior Anticipation CGC Gnathism (protruded jaw) Intellectual impairment Large ears Everted ears
Incidence of nasolacrimal duct obstruction?
Path?
Dx?
Sx?
5% infants
Obstruction at valve of Hasner (distal end)
Dye disappearance test (all fluorescein drains in 5 min)
Sx: tearing
Causes of nasolacrimal obstruction
Congenital
Acquired (sarcoidosis + wegners)
Rx of nasolacrimal obstruction
Massage duct area
90% spontaneous resolution
What can babies eat at
4-6 mo
12-18 mo
18 mo - 3yr
4-6 mo
Solid food + juices
12-18 mo
Egg, potatoes, iron-fortified cereal margarine
18 mo - 3yr
Meat, bread, fruit
Baby
Holosystiloc murmur at lower left sternum
Can’t breath
Can’t feed
Infections
VSD
MCC of hearing loss in infants
Genetic
Rx of sinusitis
Amoxicillin
Cefuroxime
Allergic = clarithromycin or azithromycin
Role of fundal exam in seizure
To see if it’s the 1st seizure
Papilledema, retinal hemorrhage = repetitive seizures
If febrile seizures to confirm it’s one time only.
Vaccines at 2 mo
DTaP IPV HiB Pneumococcal C-14 Rotavirus
Vaccines at 4 mo
DTaP IPV HiB Pneumo-C-13 Rotavirus
Same as 2 mo
Vaccines at 6 mo
DTaP-
IPV
HiB
Flu
Vaccines at 12 mo
Meningococcal
Pneumococcal C13
MMR
Vaccines at 15 mo
Varicella; chicken pox
Vaccines at 18 mo
DTaP
IPV
HiB
Vaccines 4-6 yr
MMRV
Tdap
IPV
Cow milk should be avoided until baby reaches?
Why
12 mo
Low Vit E, iron, FFA
High protein, Na, K
What Sx is a must in necrotizing enterocolitis
Bloody diarrhea
MCC of HTN in adolescent
Essential 85-95%
When to do cryptorchidism for undescended testis?
Why
At 1 Yr
To preserve spermatogenesis.
100% chance of infertility if > 1yr
Galactosemia
Path?
Sx?
Galactose-1-phosphate uridyltransferase deficiency
Sx: Jaundice Cataract Failure to thrive Vomiting, diarrhea
What’s Developmental dysphasia of hip?
M:F
Ass
Subluxation + dislocation of hip
F> M
1st born F
Breech
Oligohydramnois
DDH Rx
Close reduction + pavlik harness + US
T/F: DDH Dx by hip X-ray
F
Not shown on X-ray need US
T/F: normal ESR + CRP role out septic arthritis
T
Teratogenicity in DM
- Sacral agenesis + lumbar vertebral anomalies (esp. caudal region)
- Macrosomia
- Congenital heart defects
- Anencephaly + neural tube, myelomenigocele, hydrocephalus, microcehalus
Rectal prolapse in kids
CF
Labs in anorexia
Low LH+ FSH
What sleep disorders occur at 1-2 HR and 2nd half of night
1-2 hr => parasomnia
Sleep walk and sleep terrors
Late => nightmares
Rx of idiopathic thrombocytopenic purpura
Observe
Sx of idiopathic thrombocytopenic purpura
Bruise
Hx of infection
PLT < 100 + large PLT on smear
Normal Hg + WBC
Normal coagulation profile
Pneumonia in infants < 6mo
At winter
Resp syncytial virus
Drug cause acne
Phenytoin Steroids Anabolic steroid DHEAS OCP
Baby with low Hg + no lead
Trial of iron for 1 mo
RSV vs C. Trachomatis
- C. Trachomatis: Conjunctivitis 50% Hyperinflation + diffuse infiltrates. Wheeze + rales Eosinophilia
- RSV:
Rhinorrhea + pharyngitis
Hyperinflation
Wheeze + rales
EEG of absence seizure
Generalise symmetric three per second spike
Risks for deafness in newborn
FHx Gentamicin CMV, toxo or herpes Low apgar score Low birth weight Oxygen deprivation in birth
Risks for sudden infant death
Sleep in prone position or on side.
Sleep on soft bedding
Sleep with stuffed toys
Bed sharing
T/F: sleeping with pacifiers reduce risk of sudden infant death
T
Rx of nursemaid elbow fracture
Subluxed Radial head reduction (hyperprobation > flexion)
Sling is helpful
No wrist splint
No long arm cast
Familial vs constitutional vs growth hormone deficiency (short stature)
Constitutional; Delayed bone age Delayed puberty Normal velocity FHx
Familial:
Normal bone age
Puberty on time
Growth hormone:
Delayed bone age
Growth <3rd percentile
Low growth velocity
MCC of epistaxis in kids
Nose picking > mucosal irritation (allergic rhinitis)
Sx of osteogenesis imperfecta
Blue sclera Multiple fracture Barrel chest Joint laxity Microcephaly Translucent teeth (opalescent) Hearing loss
Defect in osteogenesis imperfecta
De novo mutation in collagen 1
Sometime FHx
MC sequela of congenital CMV
Hearing loss
What’s an innocent murmur
At 2-6 yr
Systolic grade 1-2
Pitched murmur at lower left sternum
Changes with sitting and standing
Complication of stills murmur
None its innocent
Pathology in total anomalous pulmonary venous return
Pulm. veins don’t connect to left atrium
Pulm. venous return enters systemic venous circulation via embryonic connection
Sx of TAPVR
Pulm HTN + edema
Cyanosis
Parastenal loud S2
Bilateral parotid gland enlargement
Bulimia
Russell sign in bulimia
Callosities on knuckles
Rx pediculosis in kids
Permethrin 1%
Bacterial conjunctivitis is infectious until?
Rx started
Viral infection has late neuro complication (baby seizure, ataxia, quadriplegic)
Measles
Sx of perinatal asphyxia
Hypotonia + low movement
Loss of primitive reflexes
Seizures
Abnormal posture
Koplik spots
Measles
Infant suddenly flexes arms + forward lean of trunk + extends legs
5 sec
Infantile spasm
T/F: infantile spasm asso. with other seizure
True
What’s rabies
Viral infection in saliva and peripheral nerve
Sx of rabies
Pain at site of bite
Encephalitis, confusion, hallucination,
Hydrophobia = can’t drink because of laryngeal spasm.
Paralysis.
Dx of rabies
Skin biopsy form neck
Animal brain tested
Rx of rabies
Death in 3-10 day if not Rx
Prevention:
- pre-exposure: vaccine
- post-exposure:
Clean area w/ soap + water
Vaccine + IG
Rabies post-exposure
- Demotic animal + no Sx
Observe animal 10 days:
No Sx = nothing
Sx = vaccine + IG - Domestic + Sx
Vet check animal to Dx
If confirmed => vaccine + IG - Wild animal
Capture + kill animal + test brain for rabies.
If + => vaccine + IG - Wild animal
Can’t capture => give vaccine + IG
Infantile colic criteria
Excessive crying >3 Hr day > or = 3x week for 3 weeks
T/F: premature infants should use safety seats with restraints that don’t have shields, pads, arm rests.
T
Case neck injury during impact
T/F: safety seat is secure if it moves < 5 cm in each direction
F
< 2.5
Pyloric stenosis facts:
- M:F
- MC age
- Rarely affects babies older than
M > F
MC at 3-5 wks
Rare after 12 wks
MCC of unilateral breast mass in males < 12
Breast development
Assure + repeat in 1 yr
Papile Grading system for internevtricular hemorrhage + ventricular dilatation
Grade 1:
Subependymal
Mostly asymptomatic
Grade 2:
Intraventricular w/o ventricular dilatation
Grade 3:
Intraventricular + dilatation
Grade 4:
Intraventricular + parenchyma
Strider when baby lies down
Laryngialacia
Immature cartilage = collapse of airway in inspiration
Dx laryngiomalacia
Scope
Cause of neonatal physiological jaundice
Temporarily impaired hepatic clearance of bilirubin
Congenital hypothyroid Sx
Hypotonic Big tongue Big forehead Umbilical hernia Dry yellow skin Brittle hair
Jones criteria for rheumatic fever
Major: Joint Carditis (MV) Nodules Erythema marginatum Sydenham chorea
Antiviral contraindicated in babies < 7
Zanamivir
Antiviral not for influenza A
Amantadine
Rimantadine
Rx of derm herpitiformis
Dapsone
Gluten free diet
Scaly papular rash after pharyngitis
Guttate psoriasis
Peak age for febrile seizure
6 mo - 5 yrs
Rx of impetigo
Dicloxacillin
Cephalexin
Skin infection and its fluctuant area? Rx
IV vanco for MRSA
Till culture result
Complication of meningitis
Sensorineural deafness 6 wks post Rx
Resp distress in neonate CXR
Ground glass atelectasis
Air bronchogram
How to divert child attention during abd. exam
Place child hand on top of yours give him sense of control
T/F: kids 2-6 Yrs feel responsible for death of loved ones
T
Can 2-6 Yr olds attend funerals
Yes but must be accompanied by adults for support
Minor jones criteria
Arthralgia Fever ESR CRP Prolonged PR
Heart X-ray in tetralogy of fallot
Boot shaped heart
Malformations tetralogy of fallot
Pulm valve stenosis
VSD
Overriding aorta
Rt ventricular hypertrophy
Cause of systolic murmur tetralogy of fallot
Pulm. stenosis
MCC of scoliosis
Idiopathic
Inheritance in hemophilia A + B
XL-recessive
XL-recessive transmission to kids
All girls carries
No boy affected
MC child abuse in Canada
Child neglect
When is scoliosis significant
> 10 degrees
Rx of functional abdominal pain
Spontaneous resolution in 2 wks.
Remain active
Address emotional stress
Cope with Sx and prevent 2dry gain of child.
Rx of primary enuresis
Motivational + positive reinforcement for 6 mo
Nasal polyps in child Dx?
CF
Athlete with proteinuria
Exercise induced
Transient + nonpathological
Approach to exercise induced proteinuria
UA repeated 48-72 HR from exercise
New born in distress
CXR: fluid in fissure
TTN
NSAIDs SE?
N/V Diarrhea / constipation Low appetite Rash Dizziness + headache Tinnitus Edema Kidney failure, liver failure Ulcer
Rx tet spells
Rt-Lt shunt => cyanosis
Rx;
Neosynephrine
Knee-chest
IV morphine (last)
Nitroglycerin in tet spells
Worsen Sx
T/F: pertussis vaccine could cause infantile spasm
F
MCC of poor weight in babies
Inadequate caloric intake
Survival rate in patau
90% die in first year
1st line Rx impetigo
Topical Abx
Head banging in kids
Prevalence?
Age?
Prognosis?
3-15% of 5-11 mo old
Sx resolve spontaneously by age 3
T/F: head banging is higher in developmental delay syndrome
T
More in down , autism , leach-nyhan
IP of varicella (chickenpox)?
10-20 days
T/F: chickenpox patient should be in resp isolation till no new lesions appear
T
When is varicella not infectious
Lesions are crusted
Labs in bone age < real age
TSH
Age of anterior fontanelle closure
13 mo
FU of early anterior fontanelle closure
Head measurements to R/o: craniosynostosis + abnormal brain development.
When to give Abx in sinusitis
- Sx for 2 weeks
- Fever 39
- Facial pain / swelling
MCC of pneumonia in kids?
Rx?
M. Pneumonia
Macrolides
MCC of otitis externa
P. Aruginosa
MC congenital abnormality of small bowel
Meckles
What's spermatocele? Dx? Contents? Rx? Fertility?
Spermatic cyst
Cyst on upper pile of testis next to epididymis
Painless
Benign
Clear fluid
Dead sperms
No Rx
No effect on fertility
MCC of leukocoria in well newborn
Cataract
DDx: retinoblastoma
Rx of neonatal lupus heart block
Pacemaker
Antibodies in neonatal lupus
Anti-SSA/Ro
Chubby 10 YO with hip pain
+ / - referred knee pain
Comfort in external rotation
Slipped capital femoral epiphysis
Which one improves nutrition:
- Play feeding games w/ healthy meals
- healthy food for all meals including snack
Healthy food all day erry day
T/F: stool culture is not part of septic work up
T
Prepubertal with labial adhesions!
Cause?
Sx?
Rx?
Idiopathic
Girl fails pulled, can’t pee, UTI
Rx: topical estrogen
Can bacterial conjunctivitis cause permanent damage
No
What ophthalmological risk premature infants are at high risk of?
Retinopathy of prematurity
Eye problem in cerebral palsy
Strabismus
T/F: 5% permethrin is safe in 2 month baby
T
1st sign of puberty in boys
Testicular enlargement
At what tanner stage boys reach adult height
4
What do you tell a short boy tanner <4?
He’ll grow taller
Rx of vW disease
DDAVP
Cryoprecipitate
Factor 8
Baby with: Nasal polyps Rectal prolapse Malnutrition Infertile
Dx?
CF
How much do babies with CF need to eat?
120-140% of daily recommended calorie intake
T/F: inguinal hernia in kids closes spontaneously
F
When to Rx inguinal hernia in kids?
ASAP
Risk of Ca and necrosis
MCC of unilateral blindness in kids
Amblyopia
When does autospleenoectomy occurs in Sickle cell?
5 Yr
Shaving vs permethrin 1% I. Pediculosis
Permethrin 1% is better
What disease cause disproportionate short stature
Rickets
T/F: teratogens cause disproportionate short stature
F
Proportionate
MCC of proportionate short stature
Constitutional delay
MCC of HTN in < 10 Yrs
Renal disease = UA, US, Culture
Most specific sign of peritonsillar abscess
Can’t open mouth = trismus
Organism of cut. larva migrans
Hookworm from dogs + cats
MCC of chronic otitis media in kids
Environmental i.e daycare + smoking + crowds + cleft palate
Rx of absence seizure
Ethosuximide
Occult bacteremia Sx
Fever only
Palivizumab uses
RSV prevention in high-risk kids
Qmonths for 4mo starting nov - feb
T/F: Norwalk virus sheds even after acute illness
T
Is Norwalk virus resistant to environmental factors?
Yes! Even cont to shed after illness
MCC of viral diarrhea in adults
Norwalk
Best Rx in obese kids
Family-based + behavior-oriented programs
Mom with DM
When to start screening her kids
At 10 Yrs if have other risks the q2yr i.e obese FHx Black Sx of DM
What’s little league elbow
Medial epicondyle
T/F: preschool speech screening is strongly recommended
F
There’s no enough evidence to not do it but not very helpful.
Flank painless mass in < 5 Yr DDx
Willms tumor
What kind of Ca is willms tumor
Embryonal
MCC of wheeze in infants
GERD
T/F: infantile GERD resolves at 1 year
T
Most effective Rx for asthma
Inhaled steroids
In asthma leukotriebne vs LABA
LABA are more effective
In allergic rhinitis:
Intranasal steroids vs leukotriene inhibitors
Intranasal steroids more effective
What vaccine associated with egg allergy
Yellow fever > flu or MMR
Fetal Alcohol syndrome Sx
Smooth philtrum Thin upper lip Flat nose Clinodactyly (bent finger) Wide palmar crease end b/w 2-3 fingers Railroad ears Small eyes
Anemia of lead poisoning
Abdominal pain Neuro Sx (wrist drop) Micocytic anemia
Normal stages of puberty in F
Thelarche (breast)
Pubarche (hair)
Height peak
Menarche
T/F: ovulatory cycles start 2 yrs after menarche
T
What’s Dance Sign in intussusception
Rt hypochondrium sausage-shaped mass + empty RLQ
Risks for sudden infant death
- Prone sleep
- Overheating (clothes, blankets)
- Cold weather
- Soft bedding
- Stuffed toys
- Smoke
Best estimate of volume loss in dehydration
Weight change since disease.
Lab indicates sever iron deficiency
High free erythrocyte protoporphyrin
Roseola Sx
3 days of high fever then rash that fades in 2 days
Rash in roseola
Maculopapular
Starts on trunk
Not itchy
Blanching
HIV screen in babies of HIV+ mom
HIV DNA PCR at 48 HR, 2mo, 6mo
Erb’s palsy effect on normal baby reflexes
Grasp reflex: not affected
Moro, biceps, radial reflexes: absent
Is Philadelphia chromosome a good or bad prognostic sign in ALL
Good
Rx of bullous impetigo
Oral cephalexin
What’s DEET N,N-diethyl-3-methylbenzamide
Insect repellant
Safety of DEET in kids
Not safe in kids < 6mo
How to use DEET
Spray least concentrated 10%
Avoid hands + face
3x/d max
BB antidote?
MOA?
Glucagon
Increase intercellular cAMP independent of blocked beta receptors.
Mastoiditis on CT scan
Clouding to destruction of septa b/w mastoid cells and soft tissue swelling
+/- temporal bone destruction
MCC of neonatal death in babies with DM mom?
Congenital anomalies esp. cardiac + CNS
Vaginal exam in prepubertal girls
> 2 yr
< 2 yr
Adolescent
> 2 yr
Knee-chest on exam table
Without instrument
< 2 yr
Lying supine in mom lap
Adolescent
Knee spread apart
Exam table
Rx of croup
Dexamethasone single dose
Racemic epi
MCC of ambylopia
Strabismus
What’s amblyopia
Lazy eye
T/F: in acute asthma ipratropium + inhaled SABA reduce hospitalization rate
T
MCC of occult bacteremia in kids
Strep. Pneumonia
Boy with itchy anus at night
Enterobiasis
Pinworm helminth
Name of enterobiasis pinworm?
Where does it live in bowel?
How does it cause itchiness?
Enterobious vermicualris
In ileocecal region
Itchiness from egg deposit in anus at nighttime
Egg survives 3 wk before hatching
How’s pinworm Dx + Rx
Tape at anus at early morning = see worms under microscope
Rx: albendazole or mebendazole
What can mom do to cause her baby necrotizing enterocolitis?
Cocaine
Snowman in a storm on CXR
TAPVR
MCC of osteomyelitis in kids
Rx?
Staph aureus
Rx IV Vanco
Sx of retinitis pigmentosa
Night blindness
Role of ABG in dehydration
None
Cause of encephalopathy in Reye’s syndrome (ASA)
High ammonia
Rx of genu varus
Observation
Spontaneous correction in 2 yrs
How a bay holds arm in nursemaid fracture
Adducted + pronated + flexed elbow
MCC of buckle/torus fracture
Fall on outstretched hand
What’s buckle, greenstick fractures
Buckle: compression
Greenstick: incomplete
Whats osgood-schlatter disease? Age? X-ray? Uni or bilateral? Rx?
It’s apophysitis of tibial tubercle
In athletic kids esp. jumping
Almost exclusive to kids
No need for X-ray
If done = irregular tubercle + hazy metaphyseal border
Rx: self-limited
Rest, ice, NSAIDs
Can resume activity in 2-3 wk
Pathophysiology of omphalocele?
Persistence of normal physiological herniation b/c abdomen too small for mid gut formation / liver
Herniation occurs at 6 wks
Return should occur at 10 wks
Pathophysiology of gastrochosis
Failure of lateral abdominal fold to fuse
Cause of umbilical hernia
Herniation through linea alba
T/F: APGAR Score correlates with risk of necrotizing enterocolitis
T
T/F: HTN causes necrotizing enterocolitis
F
MC complication of sinusitis
Orbital cellulitis
MC cause of pneumonia in preschool kids?
Viruses
T/F: pulmonary hemosiderosis associated with milk allergy?
T
CXR in pulmonary hemosiderosis
Fluffy infiltrates
Lung Bx in pulm hemosiderosis
Hemorrhage with hemosiderin laden macrophages
Rx of Lyme in kids
Amoxicillin
Chubby boy with painful hip
Slipped capital femoral epiphysis
Slipped capital femoral
Dx?
Rx?
Dx: X-rays frog-leg
Wide epiphyseal line
Displacement of femoral head
Rx: urgent surgery = screw fixation
What’s in the urine of a baby with galactosemia
Lots of reduced substance
No ketone bodies
Neonate + reduced substance + low glucose
Galactosemia
MCC of diarrhea in kids?
Rotavirus
60% clod weather
50% tropicals
Dx unilateral renal agenesis
Doppler US
When can baby mobilized arm after Rx of nursemaid fracture
20 min
What’s flexible flat foot
Rx?
Arched when not bearing weight
Flat when bares weight
Rx: none corrects in 1 year of walking
What’s tarsal coalition?
Dx?
Rx?
Fusion of tarsal bones
50% bilateral
Dx: Asymptomatic Tenderness on subtalar joint / ankle Rigid flat foot Peroneal tightness
Rx:
Conservative
Associations in nephroblastoma / willms
Willms tumor
Aniridia
GU abnormalities
Mental retardation
Sx of willms
Abdominal mass
Doesn’t cross midline
Asymptomatic
Becker + Duchenne inherence
XL-R
14 + no period + no 2 sexual approach
FSH + LH => high > karyotype
FSH + LH => low > wait till 16 (constitutional delay)
14 + no periods + has 2 sexual
US
MCC of recurrent acute otitis media
Penicillin resistant strep. Pneumonia
Foreign body removal from ear?
Water irrigation
Fast acting glue
If not work or baby not cooperative send to ENT to do it under GA
T/F: congenital umbilical hernia resolve spontaneously
T
Surgery if not at 2-3 years
Rx of PKU?
Phenylalanine free diet
Sapropterin tetrahydrobioterin (BH4) helps in 50%
If mom gives birth to baby with PKU,
Chances of having another baby with PKU?
25%
It’s AR
Risks for CMV in preggo
Poor mom
Hx of STDs
Hx of cervical dysplasia
Baby with Hg < 4?
Transfuse PRBC
Complications of juvenile idiopathic arthritis
Micrognathia (2/2 early closure of mandibular epiphysis)
Iridocyclitis => scarring + glaucoma
Storage of breast milk
Stored to 4 HR at room temperature.
Stored 48 HR in refrigerator
Stored for 3 mo frozen
If frozen must be thawed slowly to preserve nutrients
Tropical disease could present months after travel?
Malaria
Neonate + fever + resp Sx + CXR peribronchiolar edema
RSV
Rx: supportively
MCC of bleeding in Meckel’s
Ulceration of small bowel 2/2 acid of ectopic gastric mucosa
Helpful imaging modality in septic arthritis?
US
Storage of breast milk
Stored to 4 HR at room temperature.
Stored 48 HR in refrigerator
Stored for 3 mo frozen
If frozen must be thawed slowly to preserve nutrients
T/F: lactose intolerance should avoid all dairy products
F
Only lactose containing
Can add probiotic
1st line Rx of head lice / pediculosis
Permethrin 1%
Malathion 0.5%
Pyrethrins 0.33% pipernyl butoxide 4%
Chances of having a 2 baby with cleft lip
Both genders 3%
M sibling 4%
F sibling 2.5%
Rx of internal tibial intoeing
Cause?
No Rx (not even stretches) No prone sleep
Cause = prone sleep + sitting in feet
Fire ant bite
Clean with soap + water only