Peds boards (Prep questions + Medstudy) Flashcards
Histopathologic findings of celiac disease?
include villous atrophy with intraepithelial lymphocytosis.
When should we consider Celiac test?
in individuals with gastrointestinal symptoms (including abdominal pain, diarrhea, and bloating) and extraintestinal symptoms (including anemia, poor growth, and dermatitis herpetiformis).
Initial screening for celiac disease?
tissue transglutaminase antibody and total IgA testing.
Infants with CF are at a higher risk of experiencing (eletrolyte abnormality)
Infants with CF are at a higher risk of experiencing hypochloremic hyponatremic dehydration than are older children and adults. Routine supplementation with sodium chloride is recommended in infants, and the dose must be increased with fever, vomiting, diarrhea, or exposure to high temperature. Older children and adults with CF in these high-risk settings should increase their consumption of salty foods to prevent dehydration.
Brucellosis?
Brucellosis is a zoonotic illness transmitted by contact with tissue or fluid of infected animals, including cattle, goats, sheep, and swine.
Consumption of unpasteurized dairy products is the top risk factor for brucellosis in children in the United States.
The symptoms of brucellosis are nonspecific and can include fever, malaise, myalgias, arthralgias, abdominal pain, and headache. Physical examination may reveal lymphadenopathy, hepatosplenomegaly, and arthritis.
Bartonella henselae
- fever of unknown origin.
- This zoonotic infection is typically acquired after contact with cats. However, other animals, including dogs, can be infected. Transmission can also occur via contact with infected fleas. The most common manifestation of B henselae infection is lymphadenopathy/lymphadenitis. Disseminated Bartonella infections present as fever of unknown origin; abdominal ultrasonography may reveal hepatosplenic lesions in children with disseminated infection.
Tularemia?
Francisella tularensis is the organism responsible for tularemia. Disease after a tick bite can manifest as an eschar at the bite site with local adenopathy. If inhaled, pulmonic disease can develop. Typhoidal tularemia manifests as high fever and hepatosplenomegaly.
H. Pylori treatment?
14 days of amoxicillin + PPI + clarithromycin. In case of clarithromycin resistance, add metro.
How to check treatment efficiency for H. Pylori?
Treatment effect should be assessed with a urease breath test or H pylori stool antigen test 4 weeks after completion.
Myringosclerosis
- Myringosclerosis is characterized clinically by asymptomatic calcium and phosphate crystal deposits within the tympanic membrane that appear as whitish plaques on otoscopy.
- Myringosclerosis is typically asymptomatic and rarely requires treatment, because hearing loss that involves the ossicles is uncommon.
Normal IQ?
Results from standardized aptitude (intelligence), achievement, and adaptive tests are typically reported as standard scores with a mean of 100 and standard deviation of 15. The normal range is considered to be within 1 standard deviation (85-115) of the mean.
Define intelectual disability
Intellectual disability is present when both intelligence and adaptive functioning are more than 2 standard deviations below normal (scores <70).
which complement is low on PSGN?
C3. C4 is usually normal
Treatment of PSGN?
supportive care, treating the sequelae of the disease (edema, hypertension, hyperkalemia, acute kidney injury), and preventing complications (encephalopathy, pulmonary edema, congestive heart failure). The initial management should include restriction of fluid and sodium intake. Hypertension and edema, resulting from sodium and fluid retention, are best treated using a potent diuretic such as furosemide, as for the boy in the vignette. If hypertension is persistent, calcium channel blockers are the preferred therapeutic agent. Severe hypertension may require intravenous infusion of nicardipine, sodium nitroprusside, or labetalol. Hyperkalemia and acute kidney injury are managed symptomatically, and they rarely require dialysis.
Milrinone mechanism of action?
Milrinone is a phosphodiesterase 3 inhibitor that increases cardiac contractility and decreases pulmonary and systemic vascular resistance, thus improving overall cardiac output.
Cutaneous mastocytosis
Cutaneous mastocytosis is characterized by macules or papules that have an orange-brown color. Stroking a lesion causes erythema and swelling (ie, Darier sign).
Anomalous coronary artery from the pulmonary artery (ALCAPA)?
Anomalous coronary artery from the pulmonary artery (ALCAPA) can present with heart failure. Prominent Q waves on electrocardiogram are a characteristic feature, given the ischemia from decreased left coronary artery blood flow as the pulmonary vascular resistance drops.
which intoxication let your lips cherry-red?
carbon monoxide poisoning
How to avoid kidney injury from acyclovir?
Intravenous isotonic hydration.
It’s caused due to precipitation of crystals in the renal tubules.
How many words is the kid supposed to say when he is 15 month old?
3-5 words at 15 months.
When the kid is 16, they usually say between 5-10 words
diarrhea agents transmitted by water ingestion?
enteric pathogens associated with untreated recreational water–associated outbreaks include norovirus, Escherichia coli, Shigella, Cryptosporidium, and others.
How many hours after overdose should we check the paracetamol levels in the blood?
4 hours
How does N-acetyl cysteine works during acetaminophen overdose?
N-acetyl cysteine (NAC), which functions by facilitating replenishment of hepatic glutathione, thus decreasing free NAPQI.
NAPQI is the responsible for liver damage.
describe pityriasis rosea
Pityriasis rosea (PR) is a self-limited papulosquamous disorder (ie, lesions are elevated and have scale). It may be infectious (human herpesvirus types 6 and 7 have been implicated) and usually occurs in the spring and fall. In as many as 80% of patients, the eruption begins with a herald patch. This lesion is round or oval, often has central clearing (although in this patient it did not), and exhibits scaling. Within 2 weeks, a more widespread eruption develops that is composed of erythematous papules and plaques. The long axes of plaques are oriented parallel to lines of skin stress. On the back, this alignment of lesions may mimic the boughs of a fir tree (ie, the “Christmas-tree” appearance)
special care for kids with CKD?
Children with CKD are at risk of experiencing abnormalities in the metabolism of calcium, phosphorus, and vitamin D and in parathyroid hormone levels. They also are at risk of developing secondary hyperparathyroidism and mineral and bone disorders, previously termed “renal osteodystrophy.” The goal of prevention of mineral and bone disorders in children with CKD includes normalizing the serum phosphorus values via dietary restriction and phosphate binders (calcium carbonate), controlling hyperparathyroidism with active vitamin D analogs (calcitriol), and supplementing vitamin D to normalize 25-hydroxyvitamin D levels.
Children with CKD may also need a potassium-restricted diet or a formula low in potassium content to prevent hyperkalemia.
Is protein restriction indicated for kids with CKD?
Protein restriction is not recommended in infants and children with CKD, because this has not been shown to improve kidney function and may impair growth.
Difference between IEP and 504?
An IEP is developed for children who qualify for special education. The IEP can provide services and supports such as specialized academic instruction, speech/language therapy, occupational therapy, and adaptive physical education. The services and supports are individualized and based on the specific student’s strengths, weaknesses, and educational needs.
Section 504 of the Rehabilitation Act of 1973 is an important law that protects the civil rights of children with physical or mental disabilities by providing these children with equal access to education in institutions that receive federal funds. This is accomplished through a 504 plan which can provide accommodations, such as changes in 1) the way material is presented (eg, visual, auditory), 2) the manner in which the child completes assignments (eg, handwritten, typed), 3) the setting in which the child is tested (eg, classroom, separate room), and 4) the time allowed for assignments or tests (eg, extended time). Children with conditions such as ADHD can qualify for a 504 plan.
Heritage in Duchenne dystrophy
Duchenne muscular dystrophy is a progressive X-linked recessive neuromuscular disorder caused by a mutation (most commonly a deletion) in the dystrophin gene encoding the dystrophin protein, which is involved in muscle membrane stability. When dystrophin is absent, the muscle membrane is less stable and becomes damaged, resulting in an inflammatory cascade with necrosis and muscle loss
recommendation of discharge from nicu for preterm infants?
The recommendation on discharge from the neonatal intensive care unit is feeding with a preterm transitional formula at 22 calories/oz with a goal of 20 to 30 g/day of weight gain after having reached a weight of 2 kg.
describe PLE (protein losing enteropathy)
Protein-losing enteropathy is defined by excessive protein loss in the intestine, which can result in hypoalbuminemia and edema. Intestinal disorders that can cause a PLE can be divided into inflammatory (resulting in increased gut protein loss), infectious, oncologic, rheumatologic, and lymphatic obstruction.
The test that would diagnose PLE is a fecal α1-antitrypsin (α1AT) level. Because α1AT is not degraded in the stomach and is not actively secreted or absorbed in the intestine, it is a reliable marker of protein loss in the intestine. Elevated fecal α1AT levels should prompt further testing for the causes of PLE.
Beckwith-Wiedemann syndrome (BWS)?
Beckwith-Wiedemann syndrome is an overgrowth disorder manifested by macrosomia, macroglossia, neonatal hypoglycemia, ear creases/pits, hemihypertrophy, and visceromegaly. Patients can also have embryonal tumors (Wilms tumor, hepatoblastoma, neuroblastoma), umbilical hernia/omphalocele, nephrocalcinosis, medullary sponge kidney disease, cardiomegaly, and nephromegaly.
which syndromes increase the risk of leukemia?
down syndrome and li fraumeni syndrome
risk of high exposure to doxorubicin? methotrexate? cisplatin?
doxorubicin - cardiomyopathy
methotrexate - hepatic injury, neurocognitive changes, and bone mineral density loss.
cisplatin - hearing loss
define neutropenia
absolute neutrophil count of less than 1,500 cells/μL.
most common cause of congenital hypothyroidism in the United States?
thyroid dysgenesis
define nephrotic syndrome
Nephrotic syndrome is characterized by proteinuria (urine protein to creatinine ratio > 2 mg/mg or urine protein > 40 mg/m2/h), hypoalbuminemia (< 2.5 gm/dL), edema, and hyperlipidemia.
c. perfrigens?
Clostridium perfringens is an anaerobic, gram-positive bacillus that commonly inhabits the human intestinal tract. The 2 most common manifestations of infection caused by C perfringens include severe soft tissue infections (eg, myonecrosis or gas gangrene) and enterotoxin-mediated food poisoning.
Jugular vein septic thrombophlebitis?
Jugular vein septic thrombophlebitis is the pathognomonic feature of Lemierre syndrome, and Fusobacterium necrophorum is the organism most commonly associated with Lemierre syndrome.
what is the valgus stress test? Lachman test?
Valgus stress test check the MCL
Lachman test check the ACL
Strickler Syndrome?
Stickler syndrome, a connective tissue disorder, is associated with midfacial hypoplasia, cleft palate, Pierre Robin sequence, hearing loss, and eye abnormalities including high-grade myopia, cataracts, and increased risk for retinal detachment.
Pierre-Robin sequence?
Pierre Robin sequence is the clinical constellation of micrognathia, cleft palate, and glossoptosis that can lead to life-threatening obstructive apnea and feeding difficulties in the neonatal period.
Pierre Robin sequence can present as an isolated finding, in association with additional congenital malformations (PRS-Plus), or in association with a defined genetic disorder (syndromic PRS). The most common genetic disorders associated with Pierre Robin sequence are 22q11.2 deletion, Treacher Collins syndrome, and Stickler syndrome.
A urinalysis showing granular or epithelial cell casts is suggestive of…
ATN
A urinalysis showing red blood cell casts…
glomerulonephritis
Just read…
In prerenal AKI, urine specific gravity is greater than 1.020, urine sodium level is less than 10 mEq/L, fractional excretion of sodium (FENa) is less than 1%, and urine to plasma osmolality is greater than 1.5. These urinary indices reflect the renal tubular reabsorption of filtered sodium as well as water in response to decreased renal perfusion. In renal AKI, the urine is dilute with specific gravity below 1.010, urine sodium level is greater than 40 mEq/L, FENa is greater than 2%, and urine to plasma osmolality is less than 1.5. The severity of AKI and renal hypoperfusion is also reflected by serum blood urea nitrogen (BUN) to creatinine ratio. A BUN to creatinine ratio of 20:1 is seen in prerenal AKI, and a ratio of 10:1 to 15:1 is seen in renal AKI.
How to thick the breast milk for babies with GERD?
xanthan gum/carob bean thickeners
How to thick the formula for formula fed babies with GERD?
rice cereal
What do you do if the baby continues to have GERD after formula or breastfeeding thickner?
If GERD continues, a 2- to 4-week trial of hydrolysate formula or elimination of cow milk in the maternal diet is recommended. If unsuccessful, referral to a pediatric gastroenterologist and/or a 4- to 8-week trial of acid suppression may be considered.
Describe Still / Innocent murmur
These murmurs are typically low-pitched, located at the lower left sternal border, and are often described as being musical in character. They may change in character or disappear with position changes, and often are not heard during the Valsalva maneuver.
ecthyma gangrenosum (EG) is caused by…
Pseudomonas aeruginosa
classify neutropenia
Neutropenia is classified as mild (1,000-1,500/µL), moderate (500-1,000/µL), severe (200-500/µL), or very severe (< 200/µL).
Legg Calve Perthes Disease?
Legg-Calvé-Perthes disease is the idiopathic interruption of blood supply to the femoral head epiphysis, with subsequent development of avascular necrosis. The blood supply is generally restored over 2 to 4 years, and the epiphysis undergoes serial fragmentation, collapse, and subsequent regeneration.
Management of Legg Calve Perthes disease
Once LCPD is identified, steps should be taken to prevent collapse of the femoral head. The patient should be provided crutches and instructed on the importance of non–weight bearing while awaiting orthopedic consultation.
When can we start repellents in kids?
The American Academy of Pediatrics states that it is safe to use DEET-containing products on children as young as 2 months of age.
Which repellent should we use in kids and which percentual?
Repellents with DEET (N,N-diethyl-3-methylbenzamide) are commonly used and are the most effective in protecting infants and children from ticks and mosquitos. The duration of protection depends on the concentration of DEET. Products containing 10% DEET typically last about 2 hours, and products with 24% DEET typically last around 5 hours. There is no known benefit in duration of protection with concentrations of DEET greater than 30% to 50%. Of the response choices, an aerosol of 30% DEET is the best option to protect a 6-month-old infant from ticks and mosquitos.
How to classify hypertension?
normal BP (< 90th percentile); elevated BP (≥ 90th percentile to < 95th percentile); stage 1 hypertension (≥ 95th percentile to <95th percentile + 12 mm Hg), and stage 2 hypertension (≥ 95th percentile + 12 mm Hg).
How often do you check the BP for patients who are presenting elevated BP or Hypertension?
Children with elevated BP are recommended to have a BP check at a second visit in 6 months. If the BP is again high, a third measurement is done in 6 months and diagnostic evaluation is initiated. For children with asymptomatic stage 1 hypertension, repeat measurement is recommended in 1 to 2 weeks. A third measurement is done in 3 months and if BP is still high, a diagnostic evaluation is initiated. Children with asymptomatic stage 2 hypertension are recommended to have repeat measurement in 1 week. Once the repeat BP reading is noted to be high, diagnostic evaluation is initiated and a referral to a subspecialist should also be considered.
How to investigate secondary causes for patients with hypertension?
The diagnostic evaluation for children with hypertension includes urinalysis, chemistry panel (including renal function), lipid profile, and renal ultrasonography. According to the current guideline, electrocardiography is not recommended to evaluate for left ventricular hypertrophy. Echocardiography is recommended to assess for left ventricular mass, geometry, function, and cardiac target organ damage.
Major risk factor for iron deficiency anemia in toddlers?
In developed countries, excessive consumption of cow milk is a major contributor to iron deficiency in toddlers, and those who consume over 32 oz daily are at highest risk.
Major complication of JIA?
A complication of systemic JIA is macrophage activation syndrome, a life-threatening illness that presents with persistent fevers, fixed rash, elevated liver enzymes, elevated triglycerides, elevated D-dimers, cytopenias, reduced fibrinogen, and decreasing erythrocyte sedimentation rate. Patients with macrophage activation syndrome can develop bleeding diathesis and cardiac, renal, or liver failure.
Initial treatment for JIA?
The mainstay of treatment for all forms of JIA with low disease activity is NSAIDs, including naproxen, indomethacin, and ibuprofen
Define JIA
Juvenile idiopathic arthritis is defined by 6 weeks’ or longer duration of chronic arthritis with no known cause occurring before age 16 years. Juvenile idiopathic arthritis is diagnosed clinically.
How to treat pathologic phymosis?
Medical treatment usually involves applying a topical steroid cream such as 0.05% betamethasone or 0.1% triamcinolone acetonide 2 or 3 times daily for 1 to 2 months along with gentle retraction. If medical therapy is unsuccessful, a urologist may be consulted. Surgery may be considered in severe cases.
Describe MELAS
MELAS (mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes) is a mitochondrial disorder that presents with childhood onset of myopathy, seizures, recurrent headaches and vomiting, sensorineural hearing loss, early signs of diabetes mellitus, stroke-like episodes associated with periods of regression, and laboratory evidence of lactic acidosis both in serum and cerebrospinal fluid.
Why soy formula is inappropriate for preterm babies?
because of the risk of osteopenia, aluminum toxicity, and prevention of adequate absorption of zinc, phosphorus, and iron
Primaquine should not be used for malaria prophylaxis in…
G6PD deficiency and pregnancy
Adverse effects of doxycycline?
gastrointestinal upset and photosensitivity
Drugs available for malaria prophylaxis?
The drugs available for malaria prophylaxis in the United States include chloroquine, mefloquine, doxycycline, atovaquone-proguanil, and primaquine. While chloroquine and mefloquine are dosed once weekly, resistance to these drugs limits the regions in which they can be used. Chloroquine resistance is widespread except in Central America west of the Panama Canal, Haiti, Dominican Republic, and most of the Middle East. Mefloquine resistance occurs in Southeast Asia.
Adverse effects from chloroquine?
gastrointestinal upset, headache, dizziness, blurred vision, pruritus, and insomnia. Chloroquine can exacerbate psoriasis.
Infants with congenital diaphragmatic hernia repaired in the immediate postnatal period are at risk for…
gastroesophageal reflux disease, growth failure, and pulmonary hypertension
Infants whose congenital diaphragmatic hernia was repaired with a patch are at increased risk for…
recurrent intestinal herniation.
Affected children should be screened with chest radiography annually until age 16 years.
Newborn w Delayed passage of urine and a distended urinary bladder with bilateral hydroureteronephrosis on renal ultrasonography…
posterior urethral valve
Where folate is absorbed?
Folate is absorbed primarily in the proximal small intestine
What is absorbed in the terminal ileum?
The terminal ileum is responsible for cobalamin and bile salt absorption
How to diagnose graves disease?
thyrotropin receptor antibodies.
which labs are associated with hashitoxicosis?
Thyroid peroxidase and antithyroglobulin antibodies are associated with Hashitoxicosis.
what to check if you suspect of ingestion of exogenous thyroid hormone?
Thyroglobulin level measurement can be helpful if ingestion of exogenous thyroid hormone is suspected.
Benign myoclonus of infancy
Benign myoclonus of infancy manifests as myoclonus, spasm with brief tonic contractions, shuddering or atonia, frequently occuring at mealtime between 3 to 8 months of age and experiencing spontaneous remission at 2 to 3 years of age.
Which condition is related to breath holding spells?
Iron deficiency anemia
Acute onset of hyponatremia places you in risk of…
Cerebral edema
Fast correction of hyponatremia its a risk to develop…
Pontine myelinolysis
In which condition we visualize Blue dot sign ?
Torsion of the appendix testis
Findings on US doppler in Torsion of Appendix testis
Findings on Doppler ultrasound, which is often performed to definitively exclude testicular torsion, reveal that testicular blood flow is normal or even increased.
Treatment of torsion of appendix testis?
rest and nonsteroidal antiinflammatory agents
CHARGE syndrome?
coloboma, heart defects, atresia of the choanae, restricted growth and development, genital anomalies, and ear anomalies and/or deafness
Which type of abdomen do we see in infants with diaphragmatic hernia?
A scaphoid abdomen
Persistent pulmonary hypertension of the newborn (PPHN)?
Persistent pulmonary hypertension of the newborn (PPHN) primarily occurs in term infants and is associated with persistent elevation in pulmonary vascular resistance, which leads to right to left shunting through the foramen ovale and ductus arteriosus and hypoxemia. Patients with PPHN present with respiratory distress—hypoxemia, tachypnea, retractions, and grunting—and a harsh systolic murmur at the left lower sternal border in the first 24 hours of life. CXR demonstrates dark, hypoperfused lung fields.
Findings on CXR for TTN (Transient tachypnea of newborn)?
Chest x-ray findings include flattened diaphragms, mild cardiomegaly, fluid in the fissures, and prominent vascular markings.
Corkscrew sign on Upper Gi series?
Malrotation
SMA syndrome?
It occurs after loss of adipose tissue anterior to the duodenum. Normally, adipose tissue separates the SMA from the third portion of the duodenum; however, when the loss of this tissue occurs, the SMA compresses the duodenum, creating a partial or complete small bowel obstruction
How to diagnose SMA syndrome?
Superior mesenteric artery syndrome is diagnosed with upper gastrointestinal series, demonstrating an obstruction in the third portion of the duodenum with contrast “to and fro” flow present.
Which tetanus vaccines should we give to the patient depending of their age?
Children younger than 7 years who require a tetanus vaccine under this management algorithm should receive the DTaP vaccine, children 7 years old and more should receive Tdap. Booster every 10 years of Td
Post Exposure tetanus prophylaxis?
Appropriate postexposure tetanus prophylaxis depends on 2 factors: if the child has received at least 3 doses of tetanus toxoid (typically from a primary series of vaccinations) and if the wound is considered to be clean or dirty. Dirty wounds include burns, bites, crush wounds, and wounds that may be contaminated with soil or dirt. If the child has previously received 3 doses of tetanus toxoid and sustained a clean wound, then no postexposure prophylaxis is indicated if the last dose of tetanus toxoid was within the previous 10 years. If the child previously received 3 doses of tetanus toxoid and sustained a dirty wound, a tetanus vaccine is indicated if the last dose was more than 5 years earlier, as described for the patient in this vignette. A child who did not have 3 previous doses of tetanus toxoid (or if it is uncertain if they did) and who sustained a clean wound requires administration of only a tetanus vaccine, while a dirty wound necessitates administration of both a tetanus vaccine and tetanus immune globulin.
Describe homocystinuria
Homocystinuria characteristically presents with a marfanoid habitus (tall stature, pectus excavatum, long limbs, and scoliosis), eye findings (severe myopia and risk of downward ectopia lentis), intellectual disability/developmental delay, and vascular thromboembolic events. Downward dislocation of the eye lens is typical rather than the upward dislocation seen in Marfan syndrome.
Vascular events are the primary cause of morbidity and mortality in CBS deficiency (also known as cystathionine β-synthase deficiency)
What is ALCAPA?
When the left coronary artery arises from the pulmonary artery and not the aorta, it leads to an ALCAPA. At birth, the condition is typically asymptomatic. The natural history of pulmonary vascular resistance is that it begins to drop in the first few months after birth. As the pulmonary vascular resistance begins to drop, and consequently, the pulmonary artery pressure begins to drop, the perfusion pressure of this coronary artery also drops, resulting in myocardial ischemia and necrosis. In some children who develop collateral vessels from the right coronary artery, this condition will manifest later
When Do you suspect of ALCAPA?
An infant with congestive heart failure and electrocardiogram showing deep Q waves in the inferior leads (II, III, AVF) should be evaluated for an anomalous left coronary artery from the pulmonary artery (ALCAPA).
Transient neonatal pustular melanosis - finding on microscopy?
Microscopic examination of pustule contents would reveal neutrophils but no organisms.
Erythema toxicum - finding on microscopy?
eosinophils
Patients with sickle cell disease are predispose to have infections from which organisms?
Children with sickle cell disease are predisposed to invasive bacterial infections from encapsulated organisms such as S pneumoniae, Haemophilus influenzae type b (Hib), and nontyphoidal Salmonella due to functional asplenia, which results in diminished antibody-mediated phagocytosis. Of these organisms, infection with S pneumoniae occurs most frequently.
Work up for young children with isolated horner syndrome?
Young children with isolated Horner syndrome should undergo careful examination for cervical and abdominal masses, measurement of urinary HVA and VMA levels, and radiologic imaging of the head, neck, and chest.
Why antibiotics are not indicated to treat botulism?
Antibiotic therapy is not indicated in the treatment of infant botulism because bacterial cell lysis and death release the intracellular toxin into the intestinal lumen; aminoglycoside agents in particular potentiate the paralytic effects of the toxin at the neuromuscular junction.
Why should we avoid cow’s milk until 1 year of age?
Due to the low bioavailability of iron in cow’s milk, limit intake to no more than 20 oz per day in children 1–5 years of age. In addition, infants should avoid cowʼs milk until 12 months of age to prevent milk protein–induced colitis resulting in occult gastrointestinal (GI) bleeding.
AAP Recommendation to prevent iron deficiency anemia?
To prevent iron deficiency, the AAP recommends iron-supplemented formula for the 1st year of life in infants who are not breastfed.
Introduce iron-rich complementary foods by 4–6 months of age. Preschoolers should consume at least 3 servings/day of iron-rich foods (e.g., iron-fortified cereals, green vegetables, lean beef, chicken).
Screening for iron deficiency anemia?
The Bright Futures/American Academy of Pediatrics (AAP) guidelines recommend routine hemoglobin testing in children 12 months of age. Anemia is defined as hemoglobin < 11.0 g/dL for both male and female children 12–35 months of age. A second screening at 15–18 months of age is recommended in children at high risk of iron deficiency anemia; those who remain at risk should again be screened at 2–5 years of age.
Laurence-Moon-Biedl/ Bardet-Biedl syndrome?
Laurence-Moon-Biedl/Bardet-Biedl syndrome is associated with retinitis pigmentosa, obesity, developmental disabilities, polydactyly, genital hypoplasia, and hypogonadism (both hyper- and hypogonadotropic hypogonadism).
Prader-Willi syndrome?
Prader-Willi syndrome is associated with hypogonadism, obesity, and intellectual disability
Most prevalent bacterias in AOM?
The most common etiologic agent of acute mastoiditis is Streptococcus pneumoniae. Other bacterial causes include Staphylococcus aureus (including methicillin-resistant S aureus), group A Streptococcus, nontypeable Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus anginosus.
Triad of botulinum toxin?
The classic triad of botulinum toxin includes bulbar palsy, a descending (not ascending) paralysis, and clear sensorium.
DRESS ?
It is a rare, potentially life-threatening condition characterized by rash, hematologic abnormalities (eosinophilia), lymphadenopathy, and internal organ involvement that develops typically 2 to 6 weeks after starting the causative medication. Antiepileptic drugs, in particular carbamazepine, lamotrigine, phenytoin, and phenobarbital, are the most common cause of DRESS.
Treatment of DRESS is supportive with use of systemic corticosteroids or cyclosporine in severe cases with lung and kidney involvement.
Describe Stevens-Johnson syndrome
Stevens-Johnson syndrome is a severe drug reaction that appears up to 3 weeks after starting a medication and is characterized by mucosal lesions at 2 or more sites and widespread targetoid or macular skin lesions preceded by a prodrome of fever, sore throat, and cough
Describe TEN
Toxic epidermal necrolysis presents up to 3 weeks after starting a medication, with mucosal involvement and a morbilliform rash that rapidly blisters and exfoliates involving more than 30% of the cutaneous surface.
A positive Nikolsky sign, where the epidermis detaches with pressure from the finger, is consistent with TEN.
Explain refeeding syndrome
During starvation or malnutrition, fat and proteins are broken down, allowing gluconeogenesis to occur. Insulin levels are low, and already depleted levels of electrolytes shift to maintain homeostasis.
Once refeeding occurs, hyperglycemia results (caused by low insulin levels) and osmolar shifts occur. Intracellular shifts of magnesium and potassium occur, resulting in hypomagnesemia and hypokalemia.
Hypophosphatemia occurs due to increased utilization of phosphate for production of ATP. Increased metabolic thiamine requirements result in thiamine deficiency.
Which bacteria is a lancet-shaped diplococci on Gram stain with α-hemolysis on culture plate?
S. pneumoniae
When infantile hemangiomas are visualized and when do they disappear?
Infantile hemangiomas usually begin growing prior to 1 month of age and continue to grow until approximately 3 to 5 months. By 12 months of age involution begins and is usually complete by 4 years of age but can leave the area distorted. Between 6 and 12 months of age the proliferation and involution often occur at equal rates, leading to little change in the hemangioma during this time.
What is the most common cardiovascular finding in Williams syndrome?
The most common cardiovascular finding in Williams syndrome is supravalvar aortic stenosis
Which are the main characteristics of William syndrome?
Distinctive facies include bitemporal narrowing, periorbital fullness, stellate irides, long philtrum, upper/lower lips with a thickened vermilion, wide mouth, small jaw, large ear lobes, and a broad forehead. Individuals commonly possess a specific neurocognitive profile with overfriendliness, generalized anxiety, attention-deficit/hyperactivity disorder, strengths in verbal short-term memory and language, and weakness in visual-spatial construction. Most have intellectual disability, typically mild. Growth abnormalities are characterized by prenatal growth deficiency and slow weight gain and linear growth in the first 4 years, and a brief pubertal growth spurt resulting in short stature. Endocrine abnormalities can include idiopathic hypercalciuria and hypothyroidism.
Treatment for congenital CMV?
Antiviral treatment with oral valganciclovir for 6 months is the recommended treatment for term neonates with symptomatic congenital CMV infection with and without central nervous system disease. Therapy must be started by 4 weeks of age.
Which signs/symptoms do we see in patients with congenital CMV?
Manifestations include intrauterine growth restriction, microcephaly, intracranial calcifications, chorioretinitis, jaundice, hepatosplenomegaly, petechial/purpuric rash (because of thrombocytopenia), “blueberry muffin” lesions (because of extramedullary hematopoiesis), and elevated transaminase concentrations.
What’s the treatment for labial adhesions?
Nearly all children with labial adhesions will have complete self-resolution within 18 months, therefore asymptomatic individuals should receive reassurance. Symptomatic individuals (those with urinary problems such as urinary tract infections or urinary retention) should first undergo a trial of twice daily topical estrogen cream. Adverse effects of estrogen cream, such as vulvar hyperpigmentation or breast budding, will reverse once the cream is discontinued. If adverse effects become unacceptable or if adhesions are still present after 8 weeks of topical treatment, manual separation in the office may be performed under local anesthetic with postprocedural care involving daily application of a lubricant for several months to prevent reformation of adhesions. Referral to a specialist for surgical lysis may be necessary for patients who are unresponsive to conventional treatments.
Describe the cause for breastmilk jaundice
Breastmilk jaundice occurs most commonly in breastfed infants and is secondary to elevated levels of β-glucuronidase in breast milk. β-glucuronidase unconjugates bilirubin from glucuronic acid and makes it available for reabsorption. Patients develop jaundice that peaks at 2 weeks of life. Usually, it does not require any treatment.
Breastfeeding jaundice?
Patients with breastfeeding jaundice present in the 1st week of life with jaundice, dehydration, and weight loss caused by hypovolemia. These infants develop indirect hyperbilirubinemia secondary to decreased numbers of bowel movements and increased enterohepatic circulation of bilirubin.
At which age the testes descend to the scrotum?
In males at 34 weeks of gestation, the testes are usually palpable only in the inguinal canal, descending into the upper scrotum by 36–39 weeks.
Pentalogy of Cantrell?
Pentalogy of Cantrell includes omphalocele and CDH.
Which class of anti-hypertensive are related to congenital malformations?
ACEIs
Which congenital malformations are expected when the patient take ACEIs during pregnancy?
The most common congenital anomaly associated with use of an ACEI during the 1st trimester is malformation of the cardiovascular and central nervous systems. Exposure to ACEIs during the 2nd and 3rd trimester has also been associated with serious adverse fetal defects, especially in the kidneys. Pregnancy is often complicated by oligohydramnios due to a decrease in the production of urine, which may be associated with intrauterine demise. Surviving infants often have limb and hand anomalies, widely separated eyes, low-set ears, and facial deformities resulting from compression of the fetus within the uterine cavity due to oligohydramnios. ACEIs cross the placenta and inhibit the renin-angiotensin system, causing a decrease in the glomerular filtration rate and urine production.
Genetic syndrome associated with hyperinsulinemia?
Beckwith-Wiedemann
Critical labs for hypoglycemia?
Guidelines recommend obtaining a “critical sample” of blood at the time of hypoglycemia (glucose <50 mg/dL to aid in determining the etiology of persistent neonatal hypoglycemia. In addition to confirming the plasma glucose level, measurements of insulin, β-hydroxybutyrate (a ketone body), free fatty acids, growth hormone, and cortisol levels are useful tests to perform.
Reiter syndrome?
arthritis, conjunctivitis, and urethritis
Whats the treatment for reactive arthritis?
Management is primarily supportive with nonsteroidal anti-inflammatory medications, such as ibuprofen, cold packs to the affected joints, and rest. Prednisone is not used to treat this condition unless it becomes chronic. Antibiotics such as amoxicillin or ceftriaxone are used only if indicated for the underlying infection.
Most appropriate treatment for common warts in kids?
Although a variety of treatments for common warts are available, for most children keratolytic therapy using topical salicylic acid is the preferred initial approach.
Most common analgesia given during circumcision?
A subcutaneous ring block or dorsal penile block should be used during circumcision.
Classify the different types of IVH
Grade 1 IVH: Bleeding within the germinal matrix
Grade 2 IVH: Blood noted in the ventricle
Grade 3 IVH: Blood noted in the ventricle with ventricular dilation
Grade 4 IVH: Blood extends into the brain parenchyma
Describe achondroplasia
Achondroplasia is a skeletal dysplasia caused by mutations in the fibroblast growth factor receptor 3 gene (FGFR3) and is inherited in an autosomal dominant fashion. It is the most common type of skeletal dysplasia, a group of conditions that affect bone development. Children with achondroplasia have disproportionate short stature, long bone shortening that is most prominent in the humerus and femur, brachydactyly (short fingers and toes), kyphoscoliosis, lumbar lordosis, and macrocephaly. Early gross motor delays typically exist because of atypical physical proportions; delays resolve by age 2 to 3 years. Children with achondroplasia are at increased risk of developing otitis media, obstructive sleep apnea, obesity, chronic joint pain, and cervical medullary compression.
Describe Osteogenesis Imperfecta
Osteogenesis imperfecta is a heterogeneous bone matrix disorder characterized by increased bone fragility. Although there are variable phenotypic presentations, all children with osteogenesis imperfecta have bone fragility, osteoporosis, bone deformities, and multiple or atypical fractures. Some also have blue sclera, hearing loss, dental abnormalities, increased ligamentous and skin laxity, and/or easy bruising. Several gene mutations have been identified, but the most common are autosomal dominant mutations in COL1A1 or COL1A2 which encode chains of type 1 collagen.
Describe arthrogryposis
Arthrogryposis (also known as “arthrogryposis multiplex congenita”) is a condition in which multiple joint contractures develop before birth. It can be associated with multiple diagnoses that decrease fetal movement in utero, including central nervous system disorders, neuromuscular diseases, connective tissue or muscular disorders, and trisomies.
How many kcal/day do a preterm baby require ?
premature infants typically require 105 to 130 kcal/kg per day, with a weight gain goal of 15 to 20 g/day.
First diagnostic test on CAH?
A 17-hydroxyprogesterone level is the first-line diagnostic test for congenital adrenal hyperplasia arising from 21-hydroxylase deficiency.
For which of the following conditions would balloon atrial septostomy be helpful?
Transposition of great arteries, tricuspid or pulmonary atresia.
Black widow spider bite symptoms?
Severe cramping, which may occur as soon as 10–15 minutes after the bite of a black widow, is characteristic of envenomation. The neurotoxic venom can also cause diaphoresis, emesis, chest and abdominal pain, agitation, and hypertension. Treatment consists of muscle relaxants and medication to control pain. IV calcium has been shown to not be effective. An antivenin exists but is not often used due to the low mortality of black widow envenomations.
How are the Phosphorus level on vitamin D deficiency?
Vitamin D deficiency may result in hypocalcemia. However, phosphorus levels are typically low in vitamin D deficiency. Parathyroid hormone levels are high in response to low calcium levels, resulting in excess renal phosphorus excretion through the kidney.
Most common cause of tinea capitis and how is it treated?
Trichophyton is the most common cause of tinea capitis, followed by Microsporum species.
Tinea capitis is treated with a systemic oral antifungal agent such as griseofulvin, terbinafine, or fluconazole.
Which are the indications of VCUG after UTI episode?
A voiding cystourethrogram (VCUG) should be performed in children of any age with: ≥ 2 febrile UTIs; an abnormal renal and bladder ultrasound following a first febrile UTI; a UTI associated with a temperature of ≥ 102.2°F (39°C) and a pathogen other than E. coli; failure to thrive; or hypertension.
Which labs are elevated in the setting of streptococcus infection on the skin / pharyngitis?
Elevated DNase B antibody is associated with cutaneous streptococcal infection, while elevated antistreptolysin O levels are present following streptococcal pharyngitis.
