Peds Block 3 Cram Flashcards

1
Q

What is the MC nutritional d/o in the world?

What are the risk factors?

A

Fe deficient anemia

Cows milk intake @ 9-24mon
Under nutrition
Blood loss
Celiac/Giardiasis/H Pylori

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2
Q

Breast fed infants need to have iron supplementation starting @ ?

At what age can Fe foods be introduced to infant diets?

When can they start drinking cows milk?

A

4mon

6mon

12mon; <24oz/day

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3
Q

Microcytic anemia DDx

What is the MC congenital bleeding d/o

A
FLATS
Fe deficiency anemia
Lead poisoning
Anemia of chronic Dz
Thalassemia
Sideroblastic anemia

Von Willebrand Dz

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4
Q

Functions of vWF?

How is it Dx?

How is it Tx?

A

Joins platelets and collagen
Protect Factor 8 from rapid clearance

Measured vWF quantity
Function measured w/ Ristocetin

Desmopressin for Type 1,2
vWF concentrate for Type 3

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5
Q

What Sx combo is a medical emergency for PTs w/ Sickle Cell?

By ? age they are functinoally asplenic leaving them vulnerable to ? microbes

If Sickle PT has osteomyelitis, consider ? microbes?

A

Fever + Sickle Cell anemia

5y/o
Encapsulated: HiB, Strep Pneumo, N Meningitidis

Salmonella
Staph A

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6
Q

What is the most common type of vasooclusive event?

What is the other form of this occlusive crisis?

A

Pain crisis
2-7 days of leg/arm pain w/ possible femoral head necrosis
Tx w/ Fluids, Pain, O2

Acute Chest Syndrome
CXR w/ new infiltrates
1st Sx= chest pain-> respiratory distress
Tx: Fluid Pain Transfusion O2 ABX Dilators

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7
Q

What meds are used for Sickle Cell management?

A

Hydroxyurea @ 9mon old- inc Hgb F and dec occlusive severity/frequency
Daily PO PCN
Vaccines: HIB, HBV Influenza
Folate

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8
Q

What is the most common childhood systemic vasculitis?

What adverse outcome can occur but usually in adults?

A

HSP after URIs

Inflammation of small blood vessels w/ Hemorrhage Ischemia and Leukocyte infiltration

IgA deposition= glomerulonephritis

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9
Q

How does HSP present?

What other outcomes can be seen?

A

Palpable purpura
Arthralgia
Renal involvement
Abdominal pain

Orchitis Pancreatitis
Edema Encephalopathy

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10
Q

What are the 3 phases od Kawasakis

A

Acute:
Fever Conjunctival erythema Cracked lips Strawberry tongue
Cervical lymphadenopathy

Subacute: desquamation, coronary aneurysms (Inc ESR, <1yr, >6yrs)

Convelescent: from Sx resolution until ESR normalizes

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11
Q

When are f/u Echos done for Kawasaki PTs?

How is it Tx?

A

2wks
6-8wks

IVIG- reduces aneurysm risk
High dose ASA

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12
Q

What are the “B-Sxs” of Hodgkins?

What 3 Sxs are less likely to be seen?

What will be seen on PE?

A

Fever x 3 days
Weight loss +10% in 6mon
Drenching night sweats

Fatigue Anorexia Pruritus

Cervical/Supraclavicular lymphadenopathy
Pleural effusion

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13
Q

What is seen on tissue biopsies in Hodgkin results?

Why are CXR and CTs ordered for these PTs?

What info do marrow aspirations provide?

A

Reed-Sternberg cells (owl eyes)

CXR- mediastinal mass eval
CT- Dz staging

Dz staging
+25% blasts= acute leukemia

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14
Q

What is the MC primary malignant tumor of childhood?

This type of tumor is #2 of?

A

Wilms Nephroblastoma tumor

2nd MC malignant abdominal tumor of childhood (#1= neuroblastoma)

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15
Q

What other abnormalities is Wilms tumors associated w?

Why are there so many issues w/ these PTs?

A

WAGR: Wilms tumor Aniridia GU malformation Retardation

Germline deletion Chrom #11p

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16
Q

Wilm tumors make PTs more susceptible for ? syndrome

What are the 3 common sites for these tumors to show?

A

Beckwith-Wiedemann- macroglossia, umbilical hernia, omphalocele

Lungs
Lymph nodes
Liver

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17
Q

What are the 2 MC presenting Sxs of a nephroblastoma?

What labs are drawn and what test is Dx?

What images are ordered?

A

Abdominal mass
Abdominal pain

CBC UA Liver/Renal function
Histology exam= Dx

Abd CT/US: renal or adrenal mass
CXR: pulmonary metastases
CT of chest, abdomen, pelvis

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18
Q

What are oncological emergencies in Peds?

A
Sepsis- chemo causes severe neutropenia
TLS- common in leukemia/lymphoma Txs
Anemia/Thrombocytopenia
Inc ICP
Airway obstruction
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19
Q

What is the MC childhood CA?

What are the 3 subtypes of this kind of CA?

A

Leukemia

ALL: males
AML: neonates, adolescence
CML
JMML

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20
Q

What will be seen on lab results of PTs w/ leukemia?

What type of analysis is done for Dx?

A

Peripheral smear w/ blast cells
Anemia
Thrombocytopenia
WBC >50K

Cytogenetic

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21
Q

Osteosarcomas are assoicated w/ ? hereditary issue

What syndrome is susceptible to this CA?

A

Retinoblastoma

Li-Fraueni Syndrome

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22
Q

What can trigger osteosarcoma and what would be seen on lab results?

What bones are MC affected?

A

Radiation
Osteoid substance

Distal femus
Proximal tibia and humerus

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23
Q

How does Ewing Sarcoma appear under microscopy?

What Sxs does it present w/ that causes it to be mis-Dx as osteomyelitis

A

Small Round Blue cell tumors

Pain and Fever

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24
Q

Although it can occur anywhere, where does Ewings occur MC?

What is the MC childhood solid neoplasm outside of the CNS?

A

Femur and Pelvis

Neuroblastoma

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25
What is the MC infant malignancy What tissues does this grow from?
Neuroblastoma Neural crest cells that form adrenal medulla and SNS Half- adrenal glands Half- paraspinal ganglia
26
What are the MC presenting Sxs of Neuroblastomas? What paraneoplastic syndromes can it present w/?
Abdominal mass and pain Sweating Diarrhea Clonus Horners
27
Where are neuroblastomas likely to metastasis to? How is this Dx?
``` Lymph nodes Long bones Liver Skull Marrow Skin ``` 24hr UA catecholamine
28
What type of infections do CA PTs tend to get? What is the MC if only presenting Sx of a CA PT w/ an infection
``` Catheter/Port infections Crypto meningitis HSV Aspergillus P jiroveci ``` Fever
29
CA PTs w/ what 2 Sxs are immediately admitted? When do parasomnias tend to occur and MC in ? PTs?
Fever + Neutropenia NREM In association w/ REM Preschool kids
30
Parasomnias are linked w/ ? FamHx? What are the different types?
Sleep walking Night terrors Sleep walking Terrors if first 1/3 of night Mares if last 1/3 of night Confused arousal- less dramatic and more gradual than terrors
31
What type of seizure is MC between 6mon and 5yrs What part of the PT Hx has to be present for a Dx of febrile seizure to be given?
Febrile +100.4 before, during or after the seizure
32
What are the two types of febrile seizures Febrile status epilepticus can last for how long?
Simple: <15min and only one in 24hrs Complex/Atypical: >15min, repeats in 24hrs or Hx of neuor issues >30min
33
What meds can be given during a febrile seizure What two meds are not used? What lab result needs to be checked?
Rectal diazepam Antconvulsant Antipyretics Fe deficiency
34
What are the cardinal Sxs of NF Type 1 What imaging is needed during Dx?
Cafe au lait spots Lisch nodules Axilla/Inguinal freckles Neurofribromas, cutaneous Cranial imaging to r/o neoplasms
35
What is the first Sx of botulism poisoning? How are these poisonings Tx?
Constipation Poor feeding IVIG Respiratory/supportive care
36
What type of HA is most recurrent and MC What Sxs are/not seen? What is the etiology of these types of HA?
Tension Squeezing pressure No N/V/phobias Stress/Psych illness
37
How do PTs w/ migraines describe the pain? What Sxs will they complain of? What will be seen in their Hx 90% of the time?
Pounding/throbbing N/V/Phobia 1* or 2* relative w/ recurrent HA
38
What part of the head is measured for circumference? What does accelerated/decelerated patterns mean? What is the criteria for macro/micro cephalus?
Occipitofrontal ``` Accelerated= hydrocephalus Decelerated= brain injury, degenerative d/o ``` ``` Macro= 2 SD above mean Micro= 2 SD below mean ```
39
When does the anterior fontanelle become tense/bulging? Define craniosynostosis
Crying Inc ICP Febrile Premature closure of 1 or more sutures causing unusual/ridge feeling head
40
Who is more likely to have a UTI <1yr and over 1yr What type of microbes are MC cause? What are the 2 forms of UTIs?
Under: uncircumcised male Over: healthy female Colonic: E Coli Klebsiella Proteus Enterococcus Pseudomonas Sapro GBS Pyelonephritis Cystitis
41
How are UTIs Dx How are these samples recommended to be collected?
UA Cath if 2-24mon Clean catch if toilet trained NO perineal bags
42
What lab results are Dx for UTIs What finding is concerning for contaminated samples
Pyuria >10 Pos LE/Nitrite Pos LE/bacteria 3-5 epithelial cells
43
What is the gold standard for Dx UTIs and these are needed for ? What results are Dx or indicative of repeat testing
UA culture: confirmation and appropriate therapy >50K CFU + pyuria >100K if older/adolescent 1-50K= repeat UC
44
When is imaging warranted for UTIs in Peds? When is a VCUG study warranted?
Renal/bladder if 1st UTI in infant or non-toilet trained 1st UTI in 2-24mon w/ abnormal US or recurrent/febrile UTI
45
# Define Enuresis Define Diurnal Define Nocturnal
Incontinence in child who is mature enough to have achieved continence Daytime enuresis Night time enuresis
46
# Define Primary/Secondary Enuresis What are the etiological factors behind enuresis
Primary: incontinence in child who has never achieved dryness Secondary: child who has been dry x 6mon Psych distress Organic illness Developmental difference
47
What type of enuresis often has a FamHx and least likely to have an identifiable cause? What type is more likely to be due to organic etiology? What labs are done for these PTs?
Primary nocturnal Secondary diurnal/nocturnal UA clean catch and culture
48
How are non-organic causes of enuresis Tx? What meds can be used?
Fluid intake restriction Bedtime void Snoring= adenoidectomy Desmopressin, 90% relapse when d/c Rare- Imipramine, TCA
49
What lab results are Dx for Nephrotic Syndromes?
``` Proteinuria: 3-4+ Hematuria Spot urine protein: creatinine ratio >2 Serum albumin <2.5g/dL Serum cholesterol/TG elevation Complement levels normal ```
50
Minimal change nephrotic syndrome How do these PTs present?
No progression to renal failure Inc BUN Normal complement Remission after 8wks of steroids in 90% of PTs Sudden dependent pitting edema/ascites Anorexia Malaise Abdominal pain HTN
51
What finding on PE of a nephrotic syndrome is indicative of tubular necrosis and significant HOTN? What deformity makes PTs are risk for testicular torsion?
Sudden decline of serum albumin and volume depletion Bell-clapper
52
What PE findings are indicative of testicular torsion? Define Hydrocele
High/tender testicle Absent cremaster Negative Prehn's sign Fluid collection in tunic vaginalis
53
What are the two types of hydroceles How are these Tx?
Communicate- w/ peritoneal space Non-communicating- MC; processus vaginalis obliterated Non-Comm: self resolve by 12mon, refer by 18mon Comm: smallest in AM, refer for surgery
54
Communicating hydroceles are associated w/ ? injury/issue What is the MC cause of intestinal obstruction before 3mon old
Inguinal hernias Pyloric stenosis: m>f and more in first born
55
What type of issue is a pyloric stenosis What is the classic presentation of this issue? What will be seen on lab results?
Muscle hypertrophy and spasm= outlet obstruction Non-bilious projectile vomit w/ FTT Hypochloremic, Hypokalemic, Metabolic alkalosis Inc BUN
56
What PE finding is indicative of a pyloric stenosis? What finding is seen on imaging?
Olive sign String sign on barium upper GI seris
57
What is the Rule of 2s for Meckels? How do these PTs present?
``` 2% of population 2 ectopic mucosae: gastric/pancreatic Presents by 2yrs W/in 2ft of cecum 2" long ``` Massive, painless GI bleed
58
What type of scan is ordered for suspected Meckels? What complications can occur even after surgery? Umbilical hernias ? size are less likely to close on their own?
Technetium scan- labels acid producing mucosa Perforation Obstruction Diverticulitis Bleeds >2cm
59
What are the predisposing risk factors for umbilical hernias? What two tissues can be contained w/in the hernia?
Low birth weight African American Omentum Small intestine
60
When are umbilical hernias referred for surgical repair? Define Intussusception and the origin they're associated w/
After 5y/o Sxs / Strangulated Grows after 1-2yrs Telescoping of proximal bowel into downstream bowel Rotavirus infection/vaccine
61
What are the two lead points of intussusception? How do these PTs present?
Lymphoid hyperplasia- Peyers patches Abnormal anatomy- ileocecal valve, Meckels Paroxysmal cramping abdominal pain Currant jelly stools- mucous and blood mixture
62
What is the MC surgical emergency of kids What are the MC causes of the obstruction What emergency occurs after 48hrs of Sx onset?
Appendicitis Fecalith Lymphoid hyperplasia after viral infection Neoplasm Rupture
63
Hirschsprung is AKA ? What is the pathological reason for this issue Where does the dilation occur in the PT
Congenital Aganglionic Megacolon- absent motility and functional obstruction Failure of ganglion cell precursors to migrate to distal bowel Proximal to aganglionic segment
64
How do PTs w/ Hirschsprung's present? What causes polyhydramnios
95% don't pass stool in first 24hrs Distal obstruction w/ distension Bilious vomit Fetus w/ esophageal atresia can't swallow amniotic fluid, prevents transfer for fetus wastes to maternal blood
65
How do PTs w/ tracheoesophageal fistulas present What type of Peds Fx is and is not conerning
Drooling Mucus/saliva bubbling from nose/mouth Single umbilical artery Is: metaphyseal bucket handle Not: spiral
66
What bones in Peds are not likely to be Fx accidentally What type of images are taken when investigating?
``` Scapula Posterior ribs Spinous process/vertebrae Skull Sternum ``` Skeletal surveys if child is <3y/o
67
What type of head traumas are seen in abuse? What is the Shaken Baby triad? Rape kit can be performed it assault occurred within how many hrs?
Shaking Blunt impact/force trauma Retinal hemorrhage Brain swelling Subdural hematoma 72hrs
68
What are the top causes of death in PTs <1yr, 1-4yr, 5-14yr and 15-24yrs old? What are the top 5 unintentional injuries in kids 9-18y/o
<1: development/genetic issues/SIDS 1-4: accidental injuries 5-14: accidental injuries 15-24: accidental injuries MVC Drown Burn Falls Toxins
69
What organ is the MC injured in kids? What type PE finding is indicative of damage to this organ?
Spleen Kehr sign- LUQ pressure causes L shoulder pain
70
If PT has spleen removed due to trauma, what management meds are they put on? Define Nurse Maid elbow
PCN Pneumococcal/H Influenza vaccine Radial head subluxation Annular ligament passing around radial head partiall slips off w/ elbow traction
71
How is Nurse Maid elbow Tx When are images needed for this injury?
Supinate hand w/ pressure on radial head and flex elbow to 90* Unable to reduce Concern for Fx- swelling/bruising
72
PTs that are ? old w/ SCFE need an endocrine work up What is the earliest sign of this issue?
<10yrs >16yrs Preslip condition
73
How are SCFEs classified What complications can develop?
1: 0-33% slip 2: 34-50% slip 3: >50% slip Chondrolysis Avascular necrosis
74
What is the MC foreign body ingestion object When do Peds w/ burns need to be referred?
Coins >10% of body and under 10y/o >20% and older than 10 Face, Hands, Feet, Genital, Perineum burns Electrical Chemical Inhalation burns
75
What is 1st line Tx of anaphylaxis These PTs must be monitored for how long due to likelihood of relapse?
``` Epinephrine, 0.3mg max dose NS for hypovolemia Nebulized B-agonists for bronchospasms Diphenhydramine/steroids 20% relapse w/in 4-6hrs ```
76
What parent is more likely to to be reported as a perpetrator or as the infliction of serious injury? What is the MC types of child abuse and the 3 types?
Mother- perp Father/maternal boyfriend- injury Neglect, hardest to prove
77
What 4 types of Fxs are highly specific for abuse? What type of trauma injury is most common in infant/toddlers?
Rib Metaphyseal/Bucket handle Vertebral Scapular Blunt trauma
78
What medicinal practice is common in Vietnam/SE Asia Define Quat Sha Define Moxabustion
Shaved wind, coining Spoon rubbing Burning of moxa (mugwort) on accupuncture point
79
What color are bruises at specific days of healing? What are the names of visible blood types during the healing phases?
``` Red: 0-2 Blue/purple: 2-5 Green: 5-7 Yellow: 7-10 Brown: 10-14 Gone: 2-4wks ``` Hbg- red/blue Biliverdin- green Bilirubin- yellow
80
How are Fxs healing stages estimated? What is the leading cause of morbidity and mortality in abused minors?
7-14 days: new periosteal bone, callus 14-21: loss of Fx line, trabecular formation 3-6: callus inc w/ density +6wks: sclerotic thickening Shaken baby: retinal hemorrhage, brain swelling, subdural hematoma
81
What 3 STDs in Peds are almost always due to abuse? What can be seen on PE due to the MC form of abuse?
GC/C Syphilis Neglect- Type 1 growth deficiency= normal head/length, low weight
82
What are the legal ramifications for not reporting child abuse in TX? What are neonatal surgical red flags?
Class A midemeanor Delayed meconium passage Abdominal distention Maternal polyhydramnios- can't swallow amniotic fluid Perinatal vomiting
83
Why do tracheoesophageal fistulas occur What is the MC type
Both tissue develop between 4-6wks of gestation Fistula= dysgenesis Esophageal atresia w/ distal TEF
84
What is the VACTERL association w/ T/E fisulations?
``` Vertebral anomalies Anal atresia Cardiac anomalies TEFistula Renal anomaly Limb anomaly ```
85
How are E/T fistulas Dx? How are difficult cases Dx?
OG catheter won't pass CXR showing catheter curled in esophagus Gastrografin swallow Methylene blue challenge
86
How are PTs w/ pyloric stenosis managed? What is the name of the Tx procedure?
NS bolus D5 w/ K+ Surgery won't take them until alkalosis is fixed Pyloromyotomy
87
Congenital diaphragmatic hernia usually occurs on ? side What developmental issue causes this deformity Where is the herniation MC?
Left Defective fusion of pleuroperitoneal membranes Leaves large opening in posterolateral diaphragm Bochdalek foramen: bowel herniation through diaphragm impeding lung development
88
What will be found on PE if child has congenital diaphragmatic hernia How is it Dx
Respiratory distress Scaphoid abdomen w/ bowel sounds in L chest CXR
89
What is a common type of ventral hernia Intestinal malrotation/midgut leaves PT predisposed for ?
Umbilical hernia- protruding contents covered by subcutaneous tissue/skin Midgut volvulus- intestines twist on themselves causing obstruction/artery occlusion
90
How does an intestinal malrotation/volvulus present If there's no rotation, what else can cause the PT to vomit?
Bilious vomit in 1st mon of life Ladd's bands- duodenal constrictors
91
What will be seen on barium imaging of intestinal malrotation/volvulus What sign is seen? How is it Tx?
Cecum in RUQ Corkscrew effect due to volvulus in upper GI Fluid, OG decompression, Laparotomy
92
If Peds PT has atresis, what Dz needs to be screened? What deformities is this associated w/?
CF Trisomy, Malrotation, Annular pancreas, Meconium ilieu w/ CF
93
What is the classic x-ray finding of an intestinal atresia? Define Gastroschisis
Double bubble sign Split/open stomach, usually on R side, w/out involving umbilicus
94
Gastroschisis is thought to be due to the absence of ? artery Define Omphalocele
Omphalomesenteric Impaired mesodermal/ectodermal (muscle/skin) growth of abdominal wall Intestines remain out and covered by peritoneum and amniotic membrane Herniation of bowel contents through umbilical ring
95
PTs w/ omphalocele are more likely to have ? d/o? Meckel's develop due to lack of obliteration of ?
Bechwith-Wiedemann syndrome Omphalomesenteric duct
96
? is a true diverticulum on anti-mesenteric border of ileum All infants/ w/ imperforate anus require ? and commonly have ? dysfunction What causes necrotizing enterocolitis
Meckels MRI of lumbosacral spinal cord Urologic Ischemia secondary to immature GI system MC premature births <34wks
97
What is the Alvarado/MANTRELS rule for appendicitis?
1 Pt: Fever Rebound pain Anorexia Migration to RLQ N/V WBC >75% neutrophils 2Pts: RLQ tenderness, Leukocytosis >10K <4pts: unlikely >7pts: likely
98
What Peds issues cause non-bilious vomit? Which ones cause bilious vomit?
Non: Pyloric stenosis Bilious: Malrotation/Volvulus, Atresia, Hirschsprung, NEC, Intussusception
99
Which Peds issues present w/ pain? Which ones present as painless issues?
Pain: intussusception, Appendicitis Painless: Meckels
100
What GI Tx can be curative for enuresis? Define Hypospadias 10% of these PTs will also have ? issue
Chronic constipation Failure of ventral urethral folds to fuse Undescended testes Inguinal hernias
101
When are hypospadias' Tx If baby is born w/ this, this automatically means no ? procedure
Ideal 6-12mon Before 18mon No circumcision
102
Cryptorchidism usually don't spontaneously descend after ? age Orchidopexy presentation under 2y/o is uncommon presentation for ? issue
4-6mon Testicle CA
103
What are the 3 DDx for testicular torsions?
Epidiymo-orchitis: abnormal UA, no scrotal edema/erythema, + Prehns sign Appendiceal torsion- blue dot on top of scrotum, swelling on upper pole of testicle Incarerated inguinal hernia: hernia felt w/ valsalva, difficult exam due to pain
104
What PT population has renal agenesis presentations the most? Uni/bilateral renal agenesis is often associated w/ ? other issues?
Diabetic mother Black races Unilateral: VUR Vacterl Turner syndrome Lateral: Potter syndrome
105
# Define characteristics of Potter Syndrome Why does this issue cause fetal malformations?
Flat face Club foot Pulmonary hypoplasia Reduced fetal urine excretion= oligohydramnios leading to compression
106
Hemolytic uremic syndrome is characterized by what 3 things What is the MC type?
Microangiopathic hemolytic anemia Thrombocytopenia Renal injury Prodromal diarrheal illness from E Coli O157:H7 in food/water
107
How does HUS present in clinic Since Tx is supportive, what two meds are avoided?
CNS/Seizure involvement Pancreatitis Cardiac dysfuntion Colonic perforation ABX, Anti-diarrheals