Peds Review Flashcards
1
Q
At what level of bili is jaundice typically noticed in an infant?
A
4-5 mg/dL
2
Q
How does jaundice appear as bili levels rise?
A
Starts at the head, and as bili increases, progresses down toward the feet
3
Q
When is the optimal time to draw labs for the newborn screen?
A
more than 24 hours after birth
4
Q
Does breastfeeding have to be interrupted when an infant is jaundiced?
A
Most say no
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
6
Q
True or false: PKU is associated with jaundice
A
False
7
Q
By what age is an infant expected to regain their birth weight?
A
2 weeks
8
Q
What are the signs of hunger in an infant?
A
- Increased alertness
- Increased physical activity
- Mouthing
- Rooting
9
Q
How often should an infant be fed?
A
q2-3 hours for 15-30 minutes at a time
10
Q
How often should an infant void and stool?
A
Void 3-6 /day
Stools 3-6 /day
11
Q
When and how much Vit D should infants be supplemented?
A
400 IU /day starting in the first few days of life
12
Q
What are the s/sx of congenital hypothyroidism?
A
- Feeding problems
- Decreased activity
- Constipation
- Prolonged jaundice
- Skin mottling
- Umbilical hernia
13
Q
What are the s/sx of hypoxic-ischemic encephalopathy in a neonate?
A
- Low APGAR scores
- Poor feeding
- Multi-organ dysfunction
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
15
Q
What is the most common cause of congenital hypothyroidism worldwide?
A
Iodine deficiency
16
Q
What are the physical symptoms of congenital hypothyroidism?
A
Glossitis
hoarse cry
myxedematous facies
17
Q
Why might a infant with Congenital hypothyroidism not present for several months after birth?
A
Mother’s T3/T4 maintained infant normally
18
Q
What is myotonic dystrophy?
A
AD disorder characterized by progressive muscle loss and tonic contraction. No cure exists
19
Q
FUO is diagnosed when the fever has been present for how long?
A
2+ weeks
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
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
22
Q
What is Kernig’s sign?
A
Resistance to extension of the knee
23
Q
What is Brudzinski’s sign?
A
Passive Flexion of the hip and knee result in flexion of the neck
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.
25
What is the role of leukocyte esterase in the UA?
SHows WBCs present, but alone is not enough to diagnose a UTI. Nitrites + leukocytes very suggestive
26
What is the concern of using quinolones in children?
Damage to articular cartilage
27
What are the abx of choice for UTIs in children?
Ampicillin and gentamicin
| Ceftriaxone
28
Why is macrobid not used for urosepsis, but is in UTIs?
High concentration in the urine, but not blood
29
What studies should follow for a pediatric episode of pyelonephritis?
Renal and bladder US
30
When is a voiding cystourethrogram indicated in peds?
After 2 or more febrile UTIs, or when US shows hydronephrosis
31
What are grades 1-5 of VUR?
```
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.
```
32
True or false: children under the age of 3 do not develop asthma
False
33
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.
True
34
What is reactive airway disease?
Asthma like symptoms that can and go in a child, but tend to dissipate with aging.
35
What is *the* most concerning sign for respiratory distress in an infant?
Paradoxical breathing
36
A hoarse or muffled cry is associated with an upper or lower airway issue in children?
larynx and pharynx
Lower airways are not affected like this.
37
barky/seal-like cough = ?
Croup
38
Which is more likely to be inspiratory and which expiratory: wheezing vs stridor
```
Inspiratory = stridor
Expiratory = wheezing
```
39
What are polyphonic and monophonic wheezing suggestive of (respectively)?
```
Monophonic = focal airway obstruction
Polyphonic = asthma
```
40
Asymmetric breath sounds in a child is almost pathognomonic for what?
FB aspiration
41
What are the appropriate diagnostic tests for a lower airway FB aspiration in a child? (2)
CXR
| Bilateral decubitus or inspiratory/expiratory films
42
What is the most common cause of wheezing in infants?
Bronchiolitis
43
What is the treatment of bronchiolitis?
Supportive
44
What is the usual cause of bronchiolitis?
RSV
45
Pneumonia due to what pathogen usually presents with a staccato cough between 4 and 12 weeks of age.
Chlamydia pneumoniae
46
True or false: enteritis is not truly present if diarrhea is not present
True
47
What are the s/sx of GERD in an infant?
- Forceful vomiting if overfed.
| - Dehydration
48
What are the s/sx of malrotation?
- Bilious emesis
- hematochezia
- Abdominal pain if presents with volvulus + bowel ischemia
49
What sort of metabolic disturbance is common to peds with pyloric stenosis?
- Hypochloremic, metabolic alkalosis
| - Hypokalemia
50
When should CNS disease be suspected in infants with vomiting?
Absence of fever or diarrhea
51
what is the usual presentation of a milk allergy in infants?
Diarrhea and rash. Not usually dehydration.
52
Why isn't Gatorade recommended for rehydration in children?
high sugar load may cause an osmotic diarrhea effect
53
What test should be obtained prior to beginning treatment for DKA?
Serum osmolality
54
what is the "honeymoon" phase of DM I?
About a month after diagnosis, some pt's insulin production occurs again, but this is transient
55
What are the components of Cushing's triad for increased ICP?
- HTN
- Inappropriate bradycardia
- Cheyne-Stokes breathing
56
What is the classic triad of infantile spasms (west syndrome)?
- Infantile spasms
- Regression of psychomotor development
- Hypsarrhythmia on EEG
57
What is the prognosis for Infantile spasms?
Seizures will likely abate, but psychomotor retardation is permanent
58
What is the treatment for bronchiolitis (RSV)?
Supportive
59
What is the treatment for croup?
Nebulized, Racemic epi
60
What imaging is needed for suspected cases of child abuse?
Skeletal survey
61
What is the treatment for type I and II renal tubular acidosis?
Potassium citrate
62
What is the treatment for the acute onset of Waterhouse friederichsen syndrome?
Replace cortisol
63
What are the usual s/sx of acute onset of Waterhouse-Friederichsen syndrome?
- n/v
- Abdominal pain
- Purpuric lesions (if meningococcus the cause)
- adrenal glands appear large on CT
64
What is the stabilizing treatment for an omphalocele?
Wrap it in sterile gauze with saline to prevent heat loss
65
Which requires emergent surgery: omphalocele or gastroschesis
Gastroschisis
66
When should vaccinations be deferred in the presence of an illness?
Only if significant (AOM, mild diarrhea do not count)
67
How does the endotoxin released by meningococci cause DIC?
Incites release of prothrombin and inflammatory agents
68
Why is leukemia on the ddx for leg/hip pain?
Bone marrow infiltration
69
True or false: osteomyelitis is almost always accompanied by a fever in children?
False- only about half the time
70
What hip movement is impaired with a SCFE?
Internal rotation
71
How will a pt hold their leg if their hip pain is 2/2 an effusion?
Flexed and externally rotated, to "open" the hip joint
72
Is the pain with osteomyelitis of the hip position dependent?
No
73
What is transient synovitis associated with?
Recent URI
74
What are the four major tests (3 labs and image) that should be obtained in the workup of possible septic arthritis?
- WBC
- CRP
- ESR
- plain films
75
What two etiologies of heart murmurs are more commonly found later in childhood?
ASDs and bicuspid aortic valves
76
How can you differentiate between ASD and VSD on auscultation?
ASDs will have fixed split of S2, since there is increased blood going through the pulmonic valve. VSDs will not split
77
Vibratory, soft murmur = ?
Innocent murmur of childhood.
78
What are the four heart defects that can present with CHF in childhood?
- VSD
- Severe AS
- Coarctation of aorta
- Large PDA
79
With a moderate VSD, which ventricle typically hypertrophies? Why?
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
Which type of seizure is more common with brain tumors, partial or generalized?
Partial
81
In the workup of FUO, when is a UA and urine culture indicated (males and females)
- under 6 mo circumcised male
| - Under 12 mo female or uncircumcised male
82
In kids with FUO, or common is meningitis?
Uncommon
83
What is the classic EEG findings of absence seizures?
3 Hz spike and slow wave
84
What is the classic EEG finding of infantile spasms?
Hypsarrhythmia
85
Which is classified as a complex seizure: a generalized or partial seizure?
Partial, since this is more consistent with a neoplastic process
86
Does rotavirus cause dysentery?
No
87
What are the two interpretations of the romberg test?
If swaying occurs with eyes closed only, then proprioceptive defect
If swaying occurs regardless of eye open/closed, then cerebellar problem
88
What is post-infectious cerebellitis?
(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
What is infectious cerebellitis?
- viral/bacterial infx of cerebellum
| - Fever, AMS
90
What is opsoclonus myoclonus syndrome? S/sx?
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
What is a basilar migraine, and what are the s/sx?
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
What area of the brain most commonly is the cause of nystagmus?
Cerebellum
93
Lesions in the cerebellar vermis cause what s/sx?
Truncal ataxia
Dysarthria
Gait abnormalities
94
Lesions in a cerebellar hemisphere cause what sort of s/sx?
- Ipsilateral limb abnormalities
- Nystagmus
- Tremor/dysarthria
- Spare speech
95
Looking towards or away from the side of a cerebellar lesions causes nystagmus?
Toward
96
Lesions of the deep cerebellar nuclei cause what s/sx?
- Resting tremor
- Myoclonus
- opsoclonus
97
Do infra or supratentorial lesions usually present with cerebellar s/sx of raised ICP?
Infratentorial
98
What sort of muscle problems do cerebellar hemispheric lesions cause?
Changes in muscle tone and DTRs, but usually lead to hypotonia and hyporeflexia
99
What are the s/sx of supratentorial lesions? Side?
focal motor and sensory abnormalities on the side *opposite* of the lesion
100
Brain stem tumors are often associated with what sort of neuro sign?
Cranial nerve palsies and gaze palsies
101
How can you tell if there is hepatomegaly?
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
What is the normal liver span?
6-12 cm at midclavicular line
103
What are the labs that are worked up with HSP?
- CBC with differential
- UA
- BUN and creatinine
104
Is ESR elevated with HSP?
No
105
Are platelets decreased with HSP?
No
106
What is the major complication associated with HSP?
Chronic renal failure (5% of children)
107
What is the treatment and f/u for HSP?
Corticosteroids (maybe), but usually self limiting. Serial UAs to check renal function.
108
What bowel disease is associated with HSP?
Intussusception
109
What is the correct airway positioning for the following pts:
- Infants
- 1-3 years
- 1-8 years
- 8+ years
- Infants = sniffing
- 1-3 years = Neutral
- 1-8 years = extended neck
- 8+ years = hyperextended neck
110
What determines the presence of shock in children? Why?
- tachycardia, weak peripheral pulses, AMS
| - NOT BP, since kids can increase SVR markedly
111
True or false: almost all medications that can be given IV can be given IO
True
112
What is the second line access site if IV cannot be established in an emergency?
IO
113
What are the four major complications to using IO for access?
- OI
- Fractured bone
- Overlying cellulitis
- Bone recently used for IO access
114
What major complication can result from IO access?
Compartment syndrome
115
When should dopamine/epi be started in a kid when resuscitating them?
after 60cc/kg
116
What is the drug of choice for PEP of meningococcemia in adult and kids?
```
Adults = cipro
Kids = rifampin
```
117
What are the components of the AEIOU TIPS mnemonic for AMS?
- Alcohol
- Epilepsy
- Infection
- Overdose
- Uremia
- Trauma
- Insulin
- Psychosis
- Stroke/shock/space occupying mass
118
What are the five stages of Fe intoxication?
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
When is activated charcoal indicated and contraindicated?
INdicated = ingestions not d/t small molecules or heavy metals
Contraindicated if loss of airway protection
120
What causes the wide complex tachycardia with TCA overdose?
Na channel blockage in the purkinje fibers
121
What is a BRUE?
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
Which of the following can cause subdural hematomas in an infant:
- seizures
- CPR
- Short falls (less than 4 feet high)
None of these cause subdurals
123
How much weight do infants gain, on average, per day?
25g/day
124
What are the three criteria used to define FTT?
- Weight below 3rd percentile
- Weight for height/length less than 3rd percentile
- Rate growth crosses two major percentiles on growth chart
125
What purpose is served by getting a BUN and creatinine in FTT?
See if renal function is the cause, or is affected.
126
What is the inheritance pattern of CF?
AR
127
What is the role of 5-ASA in Crohn's disease?
No longer recommended due to inadequate evidence of efficacy. Still useful in UC though
128
What are the general drugs used to treat crohn's disease? (3)
Methotrexate
Thiopurines
Corticosteroids
129
What is the MOA of sodium bicarb in TCA intoxication?
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
What EKG finding in TCA overdose is an indication for Na bicarb use?
QRS interval over 100 msec
131
What is the role of Na bicarb use in ASA intoxication?
Alkalinizes the urine, to help excrete salicylic acid
132
What is Panner's disease?
Osteochondrosis of the capitellum of the elbow. IT causes pain and stiffness in the affected elbow, and may limit extension.
133
How can you differentiate between scarlet fever vs EBV with rash after PCN?
Mono will have HSM, and the pt will not get significantly worse after several days like they would with scarlet fever
134
When does handedness develop in children?
around 2 years. Before this may indicate muscular disorder
135
When does imitation start?
18 mo
136
What is the single highest risk factor for cerebral palsy?
Prematurity
137
What are the MRI findings of the head in pts with cerebral palsy?
- Irregularly shaped ventricles and increased FLAIR signal indicating periventricular leukomalacia
- Thinned corpus callosum
138
What sort of cerebral palsy is associated with kernicterus? What are the s/sx of this, and why?
Dyskinetic
| slow, uncontrolled movement throughout, d/t damage to the basal ganglia
139
What is the diagnostic study of choice for Down syndrome?
Lymphocyte karyotype--FISH is for mosaicism
140
What is the most common cardiac defect with Down syndrome?
Endocardial cushion defect
141
What are the components of the atopic triad?
Eczema
Asthma
Allergies
142
What is perioral dermatitis?
Variant of rosacea, commonly seen in adolescents
143
What is pseudofolliculitis?
Papules, but not pustules, usually seen in the beard area
144
What are three major factors that can worsen acne?
- Make-up
- Manipulation
- Overzealous cleaning
145
What is the treatment for mild acne? What about mild, comedonal acne?
- Mild = OTC benzoyl peroxide
| - Topical Retinoids for comedonal
146
What is the treatment for moderate acne?
-Mild treatment strategies + abx
147
What is the treatment for severe acne?
-oral retinoids
148
When should topical retinoids be applied, and why?
-In the PM, since causes photosensitization, and benzoyl peroxide (applied in the AM) inactivates it
149
Besides teratogenicity, what are the side effects of oral retinoids?
- Depression
- Hypertriglyceridemia
- Hepatitis
- Decreased night vision
150
Which abx classically causes dental staining in pts under the age of 9?
Doxycycline (tetracyclines)
151
What is the toxin found in poison ivy? Is this transferred through blisters?
- Urushiol
| - Not transferred through blisters
152
What is the most potent corticosteroid that can be given for skin rashes?
Clobetasol
153
What is the treatment for head lice?
OTC permethrin shampoo
154
What is the treatment for scabies?
Permethrin
| Itch usually persists after scabies killed. treat with topical steroids
155
What are two diseases that have a diaper rash as part of their presentation?
- Zn deficiency
| - Langerhans cell histiocytosis
156
What is the treatment of choice for tinea capitis?
Oral griseofulvin
157
Hypopigmented macules on the face = ?
Pityriasis alba
158
What urine protein/Creatinine ratio is diagnostic of nephrotic syndrome? What amount of protein with a 24 hours urine collection?
- 2.5+
| - 40mg/m^2/hr
159
True or false: interstitial nephritis is associated with significant proteinuria
False
160
What are two possible etiologies of hyponatremia with nephrotic syndrome?
- Fluid overload
| - Pseudohyponatremia from elevated lipids
161
What is the treatment for nephrotic syndrome in children? Why?
- Corticosteroids
| - Na restriction, since they are already fluid overloaded, and this will exacerbate this
162
What life threatening infection can occur with anasarca 2/2 nephrotic syndrome?
Bacterial peritonitis
163
What happens to the tonsillar tissue with sickle cell disease?
Hypertrophy
