Peds/OB Flashcards
Abdominal mass benign in kid
most commonly Neuroblastoma
Sxs of neuroblastoma
abdominal mass in kid, mainly benign. periorbital echhymosis, flushing (catecholamine release), hypertension (presses on renal a), opsoclonus-myoclonus, spinal cord compression
most common renal tumor kids
Wilms tumor; age <5; usually painful, along with hypertension and hematuria; no flushing or sweating
When can you have Rh incompatibility
Rh(D) negative mother + positive father. Prior pregnancy with RhD + fetus = antibodies that can cross placenta and destroy RhD postive fetal rbcs = Hemolytic disease of the newborn
aplastic crisis
from Parvo b19; sudden drop in Hgb and v low reticulocyte count; transient arrest of hematopoeisis
when do you get DTaP vaccine?
5 doses at 2, 4, 6 months; 15-18 months; 4-6 years
contraindications to DTaP vaccine
Encephalopathy after previous dose or anaphylaxis to vaccine component. If they are on steroids, have some minor illness/infection, give it anyways
first line treatment for allergic rhinitis
allergen avoidance intranasal corticosteroids (not decongestant)
contraindications to MMR vaccine
anaphylaxis to MMR, neomycin or gelatin
immunodeficiency
pregnancy
diagnostic criteria for kawasaki dz
fever >5 days with 4 of the following:
- conjunctivitis
- mucous membrane changes
- rash
- lymphadenopathy
- extremity edema/erythema
complications of kawasaki dz
coronary artery aneurysms (by day 10), MI and ischemia
tx of kawasaki dz
Aspirin + IVIg; all kids get an Echo;
Developmental dysplasia of the hip is characterized by abnormal _____ _____. Prognosis is
Acetabular development (=shallow hip socket, poor support femoral head). Prognosis is excellent, 95% pts have reduction of a dislocated hip.
adolescents with leg-length discrepancy, gait abnormalities (toe walking, Trendelenburg gait), activity related pain
DDH. Can result in chronic, activity related hip pain and osteoarthritis in adolescents and young adults
avascular necrosis of femoral head in children 5-7
Legg-Calve-Perthes dz. Caused by idiopathic interruption of blood supply.
sxs of JIA
fever, joint pain and rash
precocious puberty
onset of secondary sex characteristics:
<9 boys, <8 girls
Sxs of Congential Adrenal Hyperplasia (decreased 21-hydroxylase on ACTH stim test)
early pubic/axillary hair growth severe acne hisutism and oligmenorrhea in girls increased growth velocity and bone age increased 17-hydroxyprogesterone
Tx of Congenital Adrenal Hyperplasia
Hydrocortisone
Target glucose levels gestational diabetes
Fasting <95
1 hour postprandial <140
2 hour postprandial < 120
–>can use most anti-hypoglycemic i.e. insulin, metformin or glyburide
when do you screen for gestational diabetes?
usually 24-28 weeks; earlier if there are risk factors (obesity, prior macrosomic infant) at initial prenatal even
Hyperthyroidism tx in pregnancy
1st trimester: PTU preferred (teratogenic effects methimazole)
2nd/3rd trimester: Methimazole preferred (hepatotoxiciy of PTU)
when is post partum thyroditis?
<1 year following pregnancy. associaed with thyroid peroxidase antibody
test to differentiate Graves from postpartum and silent thyroiditis
Radioactive iodine uptake. graves (high) from increased thyroid hormone synthesis; PT and silent (low RAIU) from thyroid peroxidase antibody.
Absent testicular enlargement at age ____ = delayed puberty
14
test if you’re worried about primary hypogonadism
Karyotype: Klinefelter = 47XXY
insulin is recommended in t2dm with ______
a1c>9, esp if + sxs
screening for gestational diabetes
- administer 50g oral glucose test and check glucose after 1 hour: >140 then next step (challenge)
- Admnister 100g oral glucose, check fasting each hour for 3 hr (glucose tolerance test)
when do you screen for gestational diabetes?
usually 24-28 weeks; earlier if there are risk factors (obesity, prior macrosomic infant) at initial prenatal even
how do you prevent neonatal rubella?
admin of MMR vaccine pre-conception (live vaccine so not during pregnancy)
baby born with hearing loss, no red reflex, heart murmur
congenital rubella
sxs include sensorineural hearing loss, cataracts, PDA
vertebral osteomyelities in traveler with cavitary pulm lesion
Pott’s disease: TB betch
How long is patient with active pulm TB infectious with aerosolized droplets prior to onset of sxs?
3 months
Peds oropharyngeal lesions on anterior oral mucosa
apthous stomatitis (canker sores, recurrent) and Herpes gingivostomatitis (vesicles, ulcers, fevers)
peds tonsillar exudates
GAS (anterior cervical ln)
Mono (diffuse cervical ln, +/- hepatosplenomegaly)
peds oropharyngeal lesions on posterior oral mucosa
Herpangina (Coxsackie; vesicles, ulcers, painful pharyngitis, prevent by hand washing)
most common causes viral CNS infections
Enteroviruses (Coxsackie, Echovirus), then herpesvirus and arbovirus
tx for gastroparesis
dietary modification: smaller more frequent meals
common offenders for erosive esophagitis
Tetracyclines (Doxy), Bisphosphonates
best initial test for esophageal perforation
esophagram with water-soluble contrast
how do you dx painless bleeding in 2 year old?
Meckels diverticulum: need a Tech-99m pertechenate scan
failure of vitelline duct to obliterate during 1st 8 weeks of gestation
Meckel’s diverticulum (common cause painless bleeding 2yo)
tx for diffuse esophageal
CCB
solid and liquid dysphagia, can be triggered by hot/cold liquids or gerd
diffuse esophageal spasm
first line tx for toxic megacolon (IBD)
steroids to treat underlying inflammatory bowel disease; if perforation then surgery
management of pt with gallstones and biliary colic
elective lap chole
weight loss + fat, bulky stools
fat malabsorption
labs for pyloric stenosis pt
hypokalemic, hypochloremic metablic alkalosis
who gets pyloric stenosis?
boys 3-6 weeks old, especially if first-born, bottle fed or preterm. azithromycin/erythromycin (macrolides) increase risk also
who gets hepatic adenoma?
young females on OCP, can improve with cessation of OCP if <5cm
breast milk jaundice
beta-glucuronidase in breast milk deconjugates = unconjugated bili,
tx for breast milk jaundice
continue breast feeding exclusively, will self resolve by month 3
isolated gastric varices
hallmark of splenic vein thrombosis (usually hx of pancreatitis)
screening test for Marfans kid
echo: high risk of SCD from aortic root dz
most common congenital heart defect Down’s syndrome
endocardial cushion defect (get an echo)
for acute MR, is it the papillary muscle or chorda tendinae?
chorda tendinae, i.e. connective tissue disorder. CT-CT.
papillary muscle rupture can happen 2-5 days post MI
echo is needed at time of dx and annually afterwards for this connective tissue disease
Marfan’s Syndrome: majority of pts develop aortic root disease (dilation, dissection)
Berry aneurysms occur in this connective tissue dz
Ehlers-Danlos
prevention of preeclampsia in higher risk patients
aspirin at 12 weeks gestation
preventing preterm delivery if hx of preterm delivery
intramuscular hydroxyprogesterone
Rh(D) women with negative anti-D antibody
Anti-D immune globulin at 28 weeks and <72 hours after delivery
neonatal erbs palsy
brachius plexus injury from fetal macrosomia causing shoulder dystocia
breech positioning causes increased risk of
DDh
protracted labor
<1cm/2 hours after 6cm dilation
variable decelerations
abrupt drops in fetal HR <2 minutes; from umbilical cord compression; tx with amnioinfusion
what is misoprostol used for in pregnancy?
PGE1 analog, used for cervical ripening and induction of labor
when does unknown GBS status require tx?
delivery <37 weeks; intrapartum fever; rupture of membranes >18 hours
when do you screen for GBS
36-38 weeks via rectovaginal culture
what do you test at 24-28 week preconception visit?
Hgb/Hct; antibody screen if Rh(D) negative; 50g 1 hour gct
what do you test at 35-37 weeks?
GBS
why do you need intramuscular betamethasone if delivery <37 weeks?
decrease risk of necrotizing enterocolitis, neonatal respiratory distress, and intraventricular hemorrhage of prematurity
what bHCG is pregnancy visible on US
1500
how do you treat ectopic pregnancy
methotrexate or surgery
postexposure prophy after sexual assault
GC (Cef), Chlamydia (Azithro), HIV (HAART), Trichomonas (Metronidazole), Hep B (vaccine +/i immunoglobulin if not immunized)
most common cause of pathologic nipple discharge
papilloma
unilateral breast discharge eval
<30: US +/- mammogram
>30: US + mammogram
