Peds Case Files and UWorld Flashcards
Most common causes of PNA in the first few days of life
GBS and Enterobacteriae
S. pneumonia
Listeria
S. aureus
Common causes of PNA in the first few months
C. trachomatis
Most common cause of PNA in a 5y/o
mycoplasma
Causes of PNA in the intubated patient
P. aeruginosa and Candida
PNA in cystic fibrosis
pseudomonas
Child from farm with drooling, tearing, obtunded, and vomiting.
Cause?
Tx?
Organophosphate poinsoning
Atropine and pralidoxime
Tx for a pt with and anal fissure
Dietary changes and stool softener
Sx associated with intussiception
coliky pain with episodes of lethargy
Blood in sttol
A premature infant with first oral intake and bloody stool is at high risk of…
Necrotizing enterocolitis
Air in bowel wall entering portal circulation on abdominal x-ray
necrotizing enterocolitis
A patient with acute otitis media fails treatment with abx and returns with a large swelling behind the ear. What is the dx and tx?
Mastoiditis
Myringotomy and drainage
Young patient (<1) with otitis media. Management?
Admit to hospital
Patient who becomes cyanotic except when crying
Choanal atresia
Infants are obligate nose breathers through 4mo. of age
Causes of nonphysiologic jaundice
speticemia
biliary atresia
hepatitis
galactosemia
hypothyroidism
cystic fibrosis
congenital hemolytic anemia
A child whose parent had a growth delay has this kind of growth delay
constitutional growth delay
Cuase of growth delay in a child whose growth rate has fallen away from the normal growth curve with normal parents
GH deficiency
Tx: replace GH
Test to run on a child with delayed growth who has a parent that also had delayed growth
bone age measurement
Typical WBC count, and CXR in GBS pneumonia
LOW WBC with Left shift
CXR showing infiltrates
Organisms common implicated in early onset sepsis
GBS
E. coli
H. influenszae
Listeria
Most common cause of neonatal sepsis from birth to 3mo
GBS
Timeline for gonoccal v chlamydial conjuctivitis
Gonococcal 2-5d
Chlamydial 5-14d
A 3mo old child presents with weezing and a new onset heart mumur. Dx?
VSD
Why does a new heart murmur in a 2-5mo old infant represent a possible non-cyanotic heart lesion like VSD?
between 2-5mo the pulmonary vascular resistance greatly reduces causing increased shunting of blood across the VSD
What is the immediate management in a patient with transposition of the great vessels?
PGE1
-maintain the PDA bcause TGA is ductus dependant
When do cyanotic heart diseases usually present?
When the ductus beings to close
classic radiographic finding of TGA
Egg on a string (narrowed mediastinum)
Exercised induced cyanosis and a systolic murmur in a young child. Dx?
Pulmonary stenosis
12 year old patient with no complains and a systolic murmur in the left second intercostal with no radiation, clicks or snaps. Dx?
Innocent murmur
Benign pulmonary flow murmur
3 year old with long standing fever, rash, lyphadenopathy, organomegaly, and PIP and DIP joint swlling as well as elevated blood counts and fever. Dx
Juvinile idiopathic arthritis (previously juvenile rhematoid arthritis)
Most common rheumatologic disorder in children?
juvenile idopathic arthritis
What is an important exam for a patient with juvenile idopathic arthritis?
Eye exams
anterior uveiitis is common and can lead to vision problems if not treated.
Treatment for juvinie idipathic arthritis
NSAIDs
Steroids
Methotrexate
Immunosuppressive drugs
Infants fed on solely goat’s milk are at increased risk for deficiecy of
Vit B12
Folate
Brucellosis infection
Anorexia, hyperirritability, altered sleep, decreased play, abdominal pain (constipation, vomiting, colic), ataxia, AMS, and seizures are all signs and symtoms of what in a child?
Lead poisoning
Tx of lead poisoning
Chelation with:
EDTA
DMSA
Succimer
Signs of methyl mercury poisoning
ataxia, tremor, dysarthria, memory loss, altered sensorium (smell, taste, sight)
Baby with microcephaly, low birth weight, and seizures with parents who are showing CNS probs was exposed in utero to….
Mercury
Boy with hematuria (2+ protien and RBC casts) and hx of fever and sore throat two weeks ago. Dx?
APSGN
APSGN C3 and C4 levels
C3 LOW
C4 usually normal
If a patient has suspected APSGN and the C3 does not reurn to normal and the hematuria continues over weeks, what Dx must be considered??
SLE lupus nephritis
What drug is used to control HTN in a child with APSGN?
Calcium channel blockers
Recurrent painless gross hematuria, frequently associated with a URI.
IgA Nephropathy
Patient with persistent hematuira and biopsy shows a thinned basement membrany in the kidney. Dad has same problem. Cause?
Beningn familial hematuria
autosomal dominant condition
puritic, boggy or vesicular round lesions that erupt on the extremities, buttocks, and shoulders. Can lead to lichenification.
Nummular Dermatitis
Psoriatic lesions on a child with a URI
Guttate psoriasis
Psoriasis in a patient with a streptococcal infection. Abx for the strep will result in marked improvement of the psoriasis.
Common causes of meningitis in neonates.
E. coli
GBS
Common causes of meningitis in an older vaccinated child?
What is added if the child has not been vaccinated?
S. pneumo
N. gonorrhea
Unvaccinated: H. influenszae type B
Most common long term sequlae of meningitis in children?
Hearing loss
Major CBC difference between shigella and salmonella
Shigella: normal WBC count with remarkable left shift
Salmonella: Leukocytosis
Yersernia infection can mimic what in children?
Acute appendicitis
How long after O157:H7 does HUS develop?
1 to 2 weeks.
Child with bloody diarrhea and tubular mass in the RUQ. Dx?
Intussiception
Air contrast enema is test and possible Tx
Precocious puberty, cafe-au-lait spots, bone defects, and moon facies are all common presentations of…
McCune-Albright disease
Newborn with turner syndrome and lymphadema. Cased by?
Lyphatic dysgensis
common cause of intussiception in a young child following a viral/bacterial illness?
Peyer patch hypertrophy
Patient with recurrent intussiception likely has?
Meckel diverticulum
Patient with failure to thrive and musty odor. Dx?
What enzyme is lacking?
What builds up?
PKU
Phenylalanine hydroxylase
Phenylalanine builds up because it is not changed to tyrosine
How does maternal diabetes cause RDS?
High glucose–> high insulin which antagonizes cortisol–> cortisol noramlly increases surfactant
NF1 v. NF2?
NF1= short stature, learning diabilities, cafe-au-lait, neurofibromas
NF2= bilateral acoustic schannoma
6 year old boy with high grade fever and rash starting of face and spreading to trunk is in the ER. (unvaccinated/foreign/whateverfromanotherplanet) What vitamin has been shown to decrease mortality in this patient?
Measles
Vitamin A
Pathophys of breakfeeding failure jaundice
lack of breast feeding leads to an increase unconjugated bilirubin through inadequate stooling=lack of elimination
Hepatitis is a significant risk factor for this kidney disorder
membranous nephropathy
Most common cause of intestinal obstruction ages 6-36 mo.?
Intussiceoption
This ligand is defficient in children with hyper-IgM syndrome
CD40
Patient with lyphadenopathy, pharyngeal exudates, elevated LFT and thrombocytopenia. Dx?
Infectious mononucleosis
EBV
EBV is associated with these cancers
burkitt lymphoma
Hodgkin lymphoma
Super special name for pinworm
Enterobius vermicularis
Tx of pinworm
mebendazole
pyrantel pamoate
albendazole
Which intracranial bleed is more common in children <1yo?
Older?
Subdural if <1
Epidural if >1
In which kind of brain bleed (sub/epi) are seizures more common?
Subdural
Most common congenital heart defect in edwards syndrome
VSD
What is dentogenisis imperfecta?
Discoloration of the teeth in patient with ostegenisis imperfecta
In a patient with suspected meconium ilius, what is the next best step in Dx after abdominal xray showing sitended loops of bowel with no free air?
Barium enema
Cyanotic infant with left axis deviation and small R waves with prro progression. Dx?
Tricuspid atresia
PAS positivity is specific for what form of leukemia?
Lymphoblastic leukemia
12 year old girl with recurrent middle ear infections and drainage from the ear with peripheral granulation on otoscopy
cholesteatoma
Should premature infants be given vaccines according to chonologic or gestational age?
Chronologic
What is the pathology of a patient that has been starving (anorexia) and resumes feedings?
Resumed feeding causes a spike in insulin which leads to cellular uptake of electrolytes (mag, phos, potassium) for energy metabolism. This leads to derangements in these electrolytes and puts the patient at extreme risk for cadiopulmonary failure as well as cardic arrhythmias
Young patient presenting with acidosis and recurrent kidney stones
RTA
Most likely type II (excess loss of bicarb
most common cause of sepsis in a sickle cell patient
S. pneumo
Tripple bubble sign with gases colon in a patient of a cocaine mom
Jejunal atresia
inheritance patternt of myotonic muscular dystrophy
autosomal dominant
next step in management in a patient with leukocytosis, fever, high crp and esr, and inflammed joint with a URI 2 weeks previous
arthocentesis (septic joint) therapeutic and diagnositic
What do we give to children <8yo for lyme
amoxicillin
Patient with fair hair, blue eyes, and mrphanoid body habitus. Dx?
Increased risk for?
Homocysteinuria
CVA
Who gets a bladder and ureter ultrasound after a UTI
Pt who is less than 24mo
What treatment should be attempted before intubating a patient with croup?
Epinepherine
What is the next best way to follow a patient who has guillian barre syndrome?
Serial PFT and spriometry to evaluate for respiratory failure
FVC is the most indicative
Triad of congenital rubella syndrome
Cataracts
Sensory-neural hearing loss
PDA
15 day old with bilious vomiting and blood stools? Dx?
Best first test? Most accurate test?
Malrotation with volvulous
First: Xray abd
Best: Upper GI series
How to tell larygeomalacia from a vascular ring?
Laryngeomalacia worsens in the supine position and gets better prone
Vascular ring improves with extension of the neck
Most common cause of thrombocytopenia in a well child aged 2-10 years?
Immune thrombocytopenic purpura
gpIIb/IIIa
suspect abuse…next best step?
Skeletal survey
Roughy 90% of viral meningitis in kiddies is caused by…
Echovirus and coxsackie
Child with tramatic injury to the palate presenting with stroke like symtoms. Dx?
Internal carotid artery dissection
Patient with malaise and throat pain takes amoxicillin and gets a rash. Dx?
EBV
Mono
