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A2 > Peds Review > Flashcards

Peds Review Flashcards

1
Q

At what level of bili is jaundice typically noticed in an infant?

A

4-5 mg/dL

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2
Q

How does jaundice appear as bili levels rise?

A

Starts at the head, and as bili increases, progresses down toward the feet

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3
Q

When is the optimal time to draw labs for the newborn screen?

A

more than 24 hours after birth

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4
Q

Does breastfeeding have to be interrupted when an infant is jaundiced?

A

Most say no

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5
Q

When does breast feeding jaundice present, and how long does it last?

A

Several days after birth, and can persist for up to 12 weeks

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6
Q

True or false: PKU is associated with jaundice

A

False

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7
Q

By what age is an infant expected to regain their birth weight?

A

2 weeks

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8
Q

What are the signs of hunger in an infant?

A
  • Increased alertness
  • Increased physical activity
  • Mouthing
  • Rooting
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9
Q

How often should an infant be fed?

A

q2-3 hours for 15-30 minutes at a time

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10
Q

How often should an infant void and stool?

A

Void 3-6 /day

Stools 3-6 /day

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11
Q

When and how much Vit D should infants be supplemented?

A

400 IU /day starting in the first few days of life

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12
Q

What are the s/sx of congenital hypothyroidism?

A
  • Feeding problems
  • Decreased activity
  • Constipation
  • Prolonged jaundice
  • Skin mottling
  • Umbilical hernia
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13
Q

What are the s/sx of hypoxic-ischemic encephalopathy in a neonate?

A
  • Low APGAR scores
  • Poor feeding
  • Multi-organ dysfunction
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14
Q

What are the most common causes of congenital hypothyroidism in the US?

A
  • Aplasia/Hypoplasia
  • Ectopic gland
  • Autoimmune thyroiditis can lead to abs blocking TSH in infant
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15
Q

What is the most common cause of congenital hypothyroidism worldwide?

A

Iodine deficiency

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16
Q

What are the physical symptoms of congenital hypothyroidism?

A

Glossitis
hoarse cry
myxedematous facies

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17
Q

Why might a infant with Congenital hypothyroidism not present for several months after birth?

A

Mother’s T3/T4 maintained infant normally

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18
Q

What is myotonic dystrophy?

A

AD disorder characterized by progressive muscle loss and tonic contraction. No cure exists

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19
Q

FUO is diagnosed when the fever has been present for how long?

A

2+ weeks

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20
Q

What is it called when a child has a fever, but you cannot find a cause, and it has been less than 2 weeks?

A

Fever without source

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21
Q

What is the role of the findings of leukocytosis in FUO?

A

Low PPV, but a normal WBC has a very high NPV

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22
Q

What is Kernig’s sign?

A

Resistance to extension of the knee

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23
Q

What is Brudzinski’s sign?

A

Passive Flexion of the hip and knee result in flexion of the neck

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24
Q

What is the role of nitrites in the urine?

A

IF positive, very likely infection

If negative, moderate possibility that it is false negative.

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25
Q

What is the role of leukocyte esterase in the UA?

A

SHows WBCs present, but alone is not enough to diagnose a UTI. Nitrites + leukocytes very suggestive

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26
Q

What is the concern of using quinolones in children?

A

Damage to articular cartilage

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27
Q

What are the abx of choice for UTIs in children?

A

Ampicillin and gentamicin

Ceftriaxone

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28
Q

Why is macrobid not used for urosepsis, but is in UTIs?

A

High concentration in the urine, but not blood

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29
Q

What studies should follow for a pediatric episode of pyelonephritis?

A

Renal and bladder US

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30
Q

When is a voiding cystourethrogram indicated in peds?

A

After 2 or more febrile UTIs, or when US shows hydronephrosis

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31
Q

What are grades 1-5 of VUR?

A 
1= Urine refluxes part-way up the ureter.
2 = Urine refluxes all the way up the ureter, but there is no dilatation of the calyces or collecting system.
3 = Urine refluxes all the way up the ureter, with some dilatation of the ureter and/or blunting of the calyceal fornices.
4 = Urine refluxes all the way up the ureter, with marked dilatation of the ureter and blunting and dilatation of the calyces.
5 = Massive reflux into a grossly dilated, tortuous ureter, with calyceal dilatation and blunting, and loss of renal cortex.
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32
Q

True or false: children under the age of 3 do not develop asthma

A

False

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33
Q

True or false: A child with symptoms of asthma who responds to therapy for asthma and has no other identifiable cause for wheezing has asthma by definition, regardless of age.

A

True

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34
Q

What is reactive airway disease?

A

Asthma like symptoms that can and go in a child, but tend to dissipate with aging.

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35
Q

What is the most concerning sign for respiratory distress in an infant?

A

Paradoxical breathing

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36
Q

A hoarse or muffled cry is associated with an upper or lower airway issue in children?

A

larynx and pharynx

Lower airways are not affected like this.

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37
Q

barky/seal-like cough = ?

A

Croup

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38
Q

Which is more likely to be inspiratory and which expiratory: wheezing vs stridor

A 
Inspiratory = stridor
Expiratory = wheezing
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39
Q

What are polyphonic and monophonic wheezing suggestive of (respectively)?

A 
Monophonic = focal airway obstruction
Polyphonic = asthma
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40
Q

Asymmetric breath sounds in a child is almost pathognomonic for what?

A

FB aspiration

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41
Q

What are the appropriate diagnostic tests for a lower airway FB aspiration in a child? (2)

A

CXR

Bilateral decubitus or inspiratory/expiratory films

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42
Q

What is the most common cause of wheezing in infants?

A

Bronchiolitis

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43
Q

What is the treatment of bronchiolitis?

A

Supportive

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44
Q

What is the usual cause of bronchiolitis?

A

RSV

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45
Q

Pneumonia due to what pathogen usually presents with a staccato cough between 4 and 12 weeks of age.

A

Chlamydia pneumoniae

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46
Q

True or false: enteritis is not truly present if diarrhea is not present

A

True

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47
Q

What are the s/sx of GERD in an infant?

A
  • Forceful vomiting if overfed.

- Dehydration

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48
Q

What are the s/sx of malrotation?

A
  • Bilious emesis
  • hematochezia
  • Abdominal pain if presents with volvulus + bowel ischemia
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49
Q

What sort of metabolic disturbance is common to peds with pyloric stenosis?

A
  • Hypochloremic, metabolic alkalosis

- Hypokalemia

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50
Q

When should CNS disease be suspected in infants with vomiting?

A

Absence of fever or diarrhea

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51
Q

what is the usual presentation of a milk allergy in infants?

A

Diarrhea and rash. Not usually dehydration.

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52
Q

Why isn’t Gatorade recommended for rehydration in children?

A

high sugar load may cause an osmotic diarrhea effect

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53
Q

What test should be obtained prior to beginning treatment for DKA?

A

Serum osmolality

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54
Q

what is the “honeymoon” phase of DM I?

A

About a month after diagnosis, some pt’s insulin production occurs again, but this is transient

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55
Q

What are the components of Cushing’s triad for increased ICP?

A
  • HTN
  • Inappropriate bradycardia
  • Cheyne-Stokes breathing
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56
Q

What is the classic triad of infantile spasms (west syndrome)?

A
  • Infantile spasms
  • Regression of psychomotor development
  • Hypsarrhythmia on EEG
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57
Q

What is the prognosis for Infantile spasms?

A

Seizures will likely abate, but psychomotor retardation is permanent

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58
Q

What is the treatment for bronchiolitis (RSV)?

A

Supportive

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59
Q

What is the treatment for croup?

A

Nebulized, Racemic epi

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60
Q

What imaging is needed for suspected cases of child abuse?

A

Skeletal survey

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61
Q

What is the treatment for type I and II renal tubular acidosis?

A

Potassium citrate

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62
Q

What is the treatment for the acute onset of Waterhouse friederichsen syndrome?

A

Replace cortisol

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63
Q

What are the usual s/sx of acute onset of Waterhouse-Friederichsen syndrome?

A
  • n/v
  • Abdominal pain
  • Purpuric lesions (if meningococcus the cause)
  • adrenal glands appear large on CT
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64
Q

What is the stabilizing treatment for an omphalocele?

A

Wrap it in sterile gauze with saline to prevent heat loss

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65
Q

Which requires emergent surgery: omphalocele or gastroschesis

A

Gastroschisis

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66
Q

When should vaccinations be deferred in the presence of an illness?

A

Only if significant (AOM, mild diarrhea do not count)

67
Q

How does the endotoxin released by meningococci cause DIC?

A

Incites release of prothrombin and inflammatory agents

68
Q

Why is leukemia on the ddx for leg/hip pain?

A

Bone marrow infiltration

69
Q

True or false: osteomyelitis is almost always accompanied by a fever in children?

A

False- only about half the time

70
Q

What hip movement is impaired with a SCFE?

A

Internal rotation

71
Q

How will a pt hold their leg if their hip pain is 2/2 an effusion?

A

Flexed and externally rotated, to “open” the hip joint

72
Q

Is the pain with osteomyelitis of the hip position dependent?

A

No

73
Q

What is transient synovitis associated with?

A

Recent URI

74
Q

What are the four major tests (3 labs and image) that should be obtained in the workup of possible septic arthritis?

A
  • WBC
  • CRP
  • ESR
  • plain films
75
Q

What two etiologies of heart murmurs are more commonly found later in childhood?

A

ASDs and bicuspid aortic valves

76
Q

How can you differentiate between ASD and VSD on auscultation?

A

ASDs will have fixed split of S2, since there is increased blood going through the pulmonic valve. VSDs will not split

77
Q

Vibratory, soft murmur = ?

A

Innocent murmur of childhood.

78
Q

What are the four heart defects that can present with CHF in childhood?

A
  • VSD
  • Severe AS
  • Coarctation of aorta
  • Large PDA
79
Q

With a moderate VSD, which ventricle typically hypertrophies? Why?

A

Left d/t volume overload

The VSD shunt occurs in systole, when the right ventricle is also contracting, so the right ventricle ultimately does not fill with the extra volume and dilate, as the VSD flow is immediately ejected into the pulmonary arteries

80
Q

Which type of seizure is more common with brain tumors, partial or generalized?

A

Partial

81
Q

In the workup of FUO, when is a UA and urine culture indicated (males and females)

A
  • under 6 mo circumcised male

- Under 12 mo female or uncircumcised male

82
Q

In kids with FUO, or common is meningitis?

A

Uncommon

83
Q

What is the classic EEG findings of absence seizures?

A

3 Hz spike and slow wave

84
Q

What is the classic EEG finding of infantile spasms?

A

Hypsarrhythmia

85
Q

Which is classified as a complex seizure: a generalized or partial seizure?

A

Partial, since this is more consistent with a neoplastic process

86
Q

Does rotavirus cause dysentery?

A

No

87
Q

What are the two interpretations of the romberg test?

A

If swaying occurs with eyes closed only, then proprioceptive defect

If swaying occurs regardless of eye open/closed, then cerebellar problem

88
Q

What is post-infectious cerebellitis?

A

(aka acute cerebellar ataxia) is an autoimmune response that occurs several weeks after a viral infection, causing sudden onset of ataxia, n/v, nystagmus, dysarthria
-Most recover completely in a few months

89
Q

What is infectious cerebellitis?

A
  • viral/bacterial infx of cerebellum

- Fever, AMS

90
Q

What is opsoclonus myoclonus syndrome? S/sx?

A

A paraneoplastic syndrome that occurs most often with neuroblastoma, generally occurs in the younger child (6 months-3 years).

Ataxia is accompanied by intermittent jerking movements (myoclonus) and erratic, jerky conjugate movements of the eyes (opsoclonus).

91
Q

What is a basilar migraine, and what are the s/sx?

A

Basilar migraine is an uncommon migraine variant. Patients, usually young women or children, first develop visual phenomena like those of typical migraine except that they are bilateral; transient cortical blindness may also occur. There may be associated:

  • Vertigo, ataxia
  • Incoordination of the limbs
  • Dysarthria, and
  • Bilateral limb and perioral paresthesias
  • This is sometimes followed by transient loss or impairment of consciousness or by a confusional state. The impairment in consciousness, in turn, is followed by a throbbing headache, which is usually occipital, often with nausea and vomiting.

Since the symptoms resemble those caused by ischemia in the territory of the basilar-posterior cerebral arteries, this entity is referred to as “basilar migraine” or “basilar artery migraine.”

92
Q

What area of the brain most commonly is the cause of nystagmus?

A

Cerebellum

93
Q

Lesions in the cerebellar vermis cause what s/sx?

A

Truncal ataxia
Dysarthria
Gait abnormalities

94
Q

Lesions in a cerebellar hemisphere cause what sort of s/sx?

A
  • Ipsilateral limb abnormalities
  • Nystagmus
  • Tremor/dysarthria
  • Spare speech
95
Q

Looking towards or away from the side of a cerebellar lesions causes nystagmus?

A

Toward

96
Q

Lesions of the deep cerebellar nuclei cause what s/sx?

A
  • Resting tremor
  • Myoclonus
  • opsoclonus
97
Q

Do infra or supratentorial lesions usually present with cerebellar s/sx of raised ICP?

A

Infratentorial

98
Q

What sort of muscle problems do cerebellar hemispheric lesions cause?

A

Changes in muscle tone and DTRs, but usually lead to hypotonia and hyporeflexia

99
Q

What are the s/sx of supratentorial lesions? Side?

A

focal motor and sensory abnormalities on the side opposite of the lesion

100
Q

Brain stem tumors are often associated with what sort of neuro sign?

A

Cranial nerve palsies and gaze palsies

101
Q

How can you tell if there is hepatomegaly?

A

If lower edge of the liver is palpable more than 2 cm beyond the right costal margin in a child, or more than 3.5 cm in an infant

102
Q

What is the normal liver span?

A

6-12 cm at midclavicular line

103
Q

What are the labs that are worked up with HSP?

A
  • CBC with differential
  • UA
  • BUN and creatinine
104
Q

Is ESR elevated with HSP?

A

No

105
Q

Are platelets decreased with HSP?

A

No

106
Q

What is the major complication associated with HSP?

A

Chronic renal failure (5% of children)

107
Q

What is the treatment and f/u for HSP?

A

Corticosteroids (maybe), but usually self limiting. Serial UAs to check renal function.

108
Q

What bowel disease is associated with HSP?

A

Intussusception

109
Q

What is the correct airway positioning for the following pts:

  • Infants
  • 1-3 years
  • 1-8 years
  • 8+ years
A
  • Infants = sniffing
  • 1-3 years = Neutral
  • 1-8 years = extended neck
  • 8+ years = hyperextended neck
110
Q

What determines the presence of shock in children? Why?

A
  • tachycardia, weak peripheral pulses, AMS

- NOT BP, since kids can increase SVR markedly

111
Q

True or false: almost all medications that can be given IV can be given IO

A

True

112
Q

What is the second line access site if IV cannot be established in an emergency?

A

IO

113
Q

What are the four major complications to using IO for access?

A
  • OI
  • Fractured bone
  • Overlying cellulitis
  • Bone recently used for IO access
114
Q

What major complication can result from IO access?

A

Compartment syndrome

115
Q

When should dopamine/epi be started in a kid when resuscitating them?

A

after 60cc/kg

116
Q

What is the drug of choice for PEP of meningococcemia in adult and kids?

A 
Adults = cipro
Kids = rifampin
117
Q

What are the components of the AEIOU TIPS mnemonic for AMS?

A
  • Alcohol
  • Epilepsy
  • Infection
  • Overdose
  • Uremia
  • Trauma
  • Insulin
  • Psychosis
  • Stroke/shock/space occupying mass
118
Q

What are the five stages of Fe intoxication?

A
  1. GI phase
  2. Latent
  3. Shock (12-24 hours)
  4. Hepatic failure (2-3 days)
  5. Gastric outlet obstruction weeks later 2/2 strictures
119
Q

When is activated charcoal indicated and contraindicated?

A

INdicated = ingestions not d/t small molecules or heavy metals

Contraindicated if loss of airway protection

120
Q

What causes the wide complex tachycardia with TCA overdose?

A

Na channel blockage in the purkinje fibers

121
Q

What is a BRUE?

A

Brief resolved unexplained event–

  • Pallor
  • apnea/bradypnea
  • Marked change in tone
  • AMS

In an infant that is not explained by an organic cause, and resolves without intervention

122
Q

Which of the following can cause subdural hematomas in an infant:

  • seizures
  • CPR
  • Short falls (less than 4 feet high)
A

None of these cause subdurals

123
Q

How much weight do infants gain, on average, per day?

A

25g/day

124
Q

What are the three criteria used to define FTT?

A
  • Weight below 3rd percentile
  • Weight for height/length less than 3rd percentile
  • Rate growth crosses two major percentiles on growth chart
125
Q

What purpose is served by getting a BUN and creatinine in FTT?

A

See if renal function is the cause, or is affected.

126
Q

What is the inheritance pattern of CF?

A

AR

127
Q

What is the role of 5-ASA in Crohn’s disease?

A

No longer recommended due to inadequate evidence of efficacy. Still useful in UC though

128
Q

What are the general drugs used to treat crohn’s disease? (3)

A

Methotrexate
Thiopurines
Corticosteroids

129
Q

What is the MOA of sodium bicarb in TCA intoxication?

A

TCAs inhibit Na fast channels in the his-purkinje system, resulting in decreased conduction velocity, and prolongation of refractory period

Na bicarb increases serum pH and extracellular Na. The increased pH decreases TCAs’ avidity for the Na channels

130
Q

What EKG finding in TCA overdose is an indication for Na bicarb use?

A

QRS interval over 100 msec

131
Q

What is the role of Na bicarb use in ASA intoxication?

A

Alkalinizes the urine, to help excrete salicylic acid

132
Q

What is Panner’s disease?

A

Osteochondrosis of the capitellum of the elbow. IT causes pain and stiffness in the affected elbow, and may limit extension.

133
Q

How can you differentiate between scarlet fever vs EBV with rash after PCN?

A

Mono will have HSM, and the pt will not get significantly worse after several days like they would with scarlet fever

134
Q

When does handedness develop in children?

A

around 2 years. Before this may indicate muscular disorder

135
Q

When does imitation start?

A

18 mo

136
Q

What is the single highest risk factor for cerebral palsy?

A

Prematurity

137
Q

What are the MRI findings of the head in pts with cerebral palsy?

A
  • Irregularly shaped ventricles and increased FLAIR signal indicating periventricular leukomalacia
  • Thinned corpus callosum
138
Q

What sort of cerebral palsy is associated with kernicterus? What are the s/sx of this, and why?

A

Dyskinetic

slow, uncontrolled movement throughout, d/t damage to the basal ganglia

139
Q

What is the diagnostic study of choice for Down syndrome?

A

Lymphocyte karyotype–FISH is for mosaicism

140
Q

What is the most common cardiac defect with Down syndrome?

A

Endocardial cushion defect

141
Q

What are the components of the atopic triad?

A

Eczema
Asthma
Allergies

142
Q

What is perioral dermatitis?

A

Variant of rosacea, commonly seen in adolescents

143
Q

What is pseudofolliculitis?

A

Papules, but not pustules, usually seen in the beard area

144
Q

What are three major factors that can worsen acne?

A
  • Make-up
  • Manipulation
  • Overzealous cleaning
145
Q

What is the treatment for mild acne? What about mild, comedonal acne?

A
  • Mild = OTC benzoyl peroxide

- Topical Retinoids for comedonal

146
Q

What is the treatment for moderate acne?

A

-Mild treatment strategies + abx

147
Q

What is the treatment for severe acne?

A

-oral retinoids

148
Q

When should topical retinoids be applied, and why?

A

-In the PM, since causes photosensitization, and benzoyl peroxide (applied in the AM) inactivates it

149
Q

Besides teratogenicity, what are the side effects of oral retinoids?

A
  • Depression
  • Hypertriglyceridemia
  • Hepatitis
  • Decreased night vision
150
Q

Which abx classically causes dental staining in pts under the age of 9?

A

Doxycycline (tetracyclines)

151
Q

What is the toxin found in poison ivy? Is this transferred through blisters?

A
  • Urushiol

- Not transferred through blisters

152
Q

What is the most potent corticosteroid that can be given for skin rashes?

A

Clobetasol

153
Q

What is the treatment for head lice?

A

OTC permethrin shampoo

154
Q

What is the treatment for scabies?

A

Permethrin

Itch usually persists after scabies killed. treat with topical steroids

155
Q

What are two diseases that have a diaper rash as part of their presentation?

A
  • Zn deficiency

- Langerhans cell histiocytosis

156
Q

What is the treatment of choice for tinea capitis?

A

Oral griseofulvin

157
Q

Hypopigmented macules on the face = ?

A

Pityriasis alba

158
Q

What urine protein/Creatinine ratio is diagnostic of nephrotic syndrome? What amount of protein with a 24 hours urine collection?

A
  • 2.5+

- 40mg/m^2/hr

159
Q

True or false: interstitial nephritis is associated with significant proteinuria

A

False

160
Q

What are two possible etiologies of hyponatremia with nephrotic syndrome?

A
  • Fluid overload

- Pseudohyponatremia from elevated lipids

161
Q

What is the treatment for nephrotic syndrome in children? Why?

A
  • Corticosteroids

- Na restriction, since they are already fluid overloaded, and this will exacerbate this

162
Q

What life threatening infection can occur with anasarca 2/2 nephrotic syndrome?

A

Bacterial peritonitis

163
Q

What happens to the tonsillar tissue with sickle cell disease?

A

Hypertrophy

A2 (26 decks)

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