Peds Shelf Flashcards
B. Pertussis tx and post exposure ppx?
Macrolides: azithromycin, clarithromycin, erythromycin
Pt is primarily breast fed, with physical findings of craniotabes, rachitic rosary, and genu varum. Dx?
Ricketts
T or F: all close contacts of a B. pertussis pt should receive macrolide ABX regardless of immunization.
True
??? is the most common cause of isolated proteinuria in children, and should be reevaluated with ???
Transient proteinuria. Repeat urine dipstick on 2 separate occasions
??? is an overgrowth disorder characterized by a predisposition to neoplasms. Physical findings include neonatal hypoglycemia, macrosomia, macroglossia, hemihyperplasia, and abdominal wall defects.
Beckwith-Weidemann Syndrome (BWS)
BWS should receive abdominal US and aFP levels to screen for most common assoc neoplasms: ?? and ??
Wilms tumor and hepatoblastoma
First step in evaluating primary amenorrhea (after neg pregnancy test)?
Pelvic US
Pelvic US of turners syndrome pt may show “??? ovaries”
Streak ovaries
A single S2 and a harsh, holosystolic murmur heard best at the LL sternal border is characteristic of ???
VSD.
Initial evaluation of VSD is ??? to determine size and location of defect.
ECHO
T or F: most small VSDs close spontaneously and require no further tx.
True (if SMALL defect)
Ascending progression of muscle weakness after “cold”: Dx? Test for most life threatening complication?
GBS. Spirometry to evaluate for neuromuscular respiratory failure.
Most common cause of urinary tract obstruction in newborn boys?
Posterior urethral valves
Oligohydramnios/low amniotic fluid restricts fetal movement, leading to physical anomalies such as flat facies and limb deformities. This process is referred to as ???
Potter sequence
Oligohydramnios from low urine production in utero can cause ??? and postnatal ???
Pulmonary hypoplasia; RDS
Encephalopathy and acute liver failure after viral illness and 2/2 ASA?
Reye’s syndrome
Pathophysiology of Reye syndrome?
Microvesicular fatty infiltration and hepatic mitochondrial dysfunction
Genetic transmission of duchenne and Becker muscular dystrophy?
X-linked recessive
Genetic transmission of myotonic muscular dystrophy?
Autosomal dominant (expansion of CTG)
Pt with testicular atrophy, dysphasia, facial weakness, and Delayed muscle relaxation (myotonia) most notable after handshake: Dx?
Myotonic muscular dystrophy
T or F: simple febrile seizures require no further work up
True
Infant with leukocoria (white reflex on Ophthalmoscopic exam) is considered ??? until proven otherwise.
Retinoblastoma (infants with visual problems have high suspicion for Rb)
Postictal paralysis, with restoration of motor function in 24 hrs
Todd’s paralysis
Legg-Calve-Perthes disease is characterized by ??? of the femoral head and an ??? gait
Avascular necrosis (osteonecrosis); antalgic (shorter weight bearing on affected side due to pain)
Pt with palpable “step-off”
Spondylolisthesis
Kawasaki Dz is Dx clinically by fever and 4/5 of following:
Conjunctivitis. Oral mucosa changes. Rash. Extremity changes. Cervical lymphadenopathy.
Kawasaki Dz most feared complication is ???, which is evaluated by ???
CA aneurysm; ECHO
Kawasaki Dz tx?
IV Ig and Aspirin.
??? has been shown to reduce morbidity/mortality of pts with measles.
Vitamin A
Newborn with cyanosis that is aggravated by feeding and relieved by crying. Also failure to pass catheter through nose into pharynx. Likely Dx?
Choanal artesian
Child with nocturnal vulvar itching should receive what Dx test? And likely Tx?
Scotch tape test for pinworms. Mebendazole
Infants are labeled SGA when birth weight is below the ?? percentile for GA
10th
Pt presenting 1-2 wks post-penicillin tx for URI; with fever/urticarial rash/polyarthralgia/lymphadenopathy. Dx?
Serum sickness-like rxn (drug-induced rxn, but not a true allergy)
Pt presents with hypovolemic vs. septic shock requiring emergency fluid resuscitation: when IV access can’t be obtained, ?? access should be attempted
IO
Immune-mediated vasculitis that often occurs after mild illnesses, presenting with abdominal pain, palpable purpura on LE, arthralgias, renal Dz, scrotal pain/swelling. Dx?
Henoch-Schonlein purpura
Pt with “currant jelly” or bloody stools, palpable tube/sausage shaped mass, and target sign on US?
Intussusception
Classic x-Ray findings of “sunburst” periosteal rxn and Codman triangle
Osteosarcoma
Classic x-Ray finding of “onion skin” periosteal rxn?
Ewing Sarcoma
The AAP recommends exclusive breast feeding until ???
6 mos
Puréed foods are introduced at ???, cows milk introduced at ???
6 mos; 1 year
Preterm infants are at increased risk for ???
Iron deficiency anemia
Malformation seen in Down syndrome pts presenting with UMN findings?
Atlantoaxial instability
Pt presenting with follicular conjunctivitis and pannus (neovascularization) formation in cornea. Most likely Dx? Tx?
Trachoma (via chlamydia serotypes A-C). Topical tetracycline of oral azithromycin
??? conjunctivitis presents 5-14 days after birth, and ??? conjunctivitis presents 2-5 days after birth.
Chlamydial; gonococcal
FAS is characterized by 3 pathognomonic facial dysmorphisms:
Small palpebral fissures, smooth philtrum, thin vermilion (upper lip) border.
*microcephaly too
Most common anatomic abnormality in infants with bladder exstrophy?
Epispadias
Preferred initial tx for Partial seizures?
Phenytoin
Symptoms of orbital cellulitis:
Proptosis, ophthalmoplegia, diplopia
Most common predisposing factor for orbital cellulitis?
Bacterial sinusitis
Management of child who ingested a battery: if battery is located in esophagus? Battery located distal to esophagus?
Immediate endoscopic removal.
Observation and stool examination
Racemic epinephrine should always be tried prior to endotracheal intubation in pts with ???, but has no role in management of ???.
Croup; Asthma
Rash described as “Sandpaper like”
Scarletina (from GAS infection)
CSF findings in viral meningitis:
normal glucose, normal to elevated protein, elevated mononuclear WBCs (lymphocytes)
Non-cyanotic congenital heart defect that has a loud/harsh holosystolic murmur at the LLSB
VSDS
Pt presenting with persistent productive cough and steatorrhea, likely Dx?
CF
Most specific test for muscular dystrophy?
Serum creatine phosphate (elevated in MD)
Pts with nephrotic syndrome are at increased risk of infection, particularly by ???
Encapsulated organisms (SHiN SKiS = strep pneumo, H.inf, Neisseria, Salmonella, Klebsi, strep agalactiae/GBS)
Infant rash with microscopic scraping showing prominent eosinophilia, likely Dx?
Erythema toxicum
Psych term for parent inducing illness in child in order to play sick role by proxy
Münchausen syndrome by proxy
??? disorder is seen only in girls and characterized by normal development followed by Regression.
Rett’s disorder
Therapy of choice in Wilsons dz
Penicillamine
Birth trauma injury that presents as swelling that is limited by the suture lines
Cephalohematoma
Child with cognitive impairment, dystonia, and self-mutilating behavior: likely Dx? Pathophysiology of dz?
Leech-Nyhan syndrome. X-linked deficiency in HGPRT, leading to hyperuricemia.
Every pt with osteosarcoma should undergo a ??? to r/o metastatic dz
Chest CT (lungs most common site)
Tx for sickle cell pts with recurrent vasocclusive events?
Hydroxyurea
Preferred tx of intussusception?
Air enema
The classic triad of ??? is situs inversus, recurrent sinusitis, and bronchiectasis
Kartagener’s syndrome
Two important risk factors for RDS?
Prematurity and maternal diabetes mellitus
Henoch-Schonlein purpurA is associated with Ig? deposition in affected organs
IgA
Fetal hydantoin syndrome is characterized by:
Nail and digit hypoplasia, dysmorphic facies, and mental retardation
This is an AR disorder presenting with frequent feedings, rapid breathing, characteristic doll-like face with thin limbs, hypoglycemia, and elevated lactate/uric acid?
Von Gierke’s dz (glycogen storage disorder 1)
In maple syrup urine disorder, what AA’s are elevated?
BCAAs: isoleucine, leucine, valine
Pt with transposition of great arteries must receive ??? to keep the ??? open.
PGE1; ductus arteriosus
Fetal exposure to valproate can cause:
Neural tube defects, cardiac anomalies, cleft lip, mid face hypoplasia, depressed/broad nasal bridge, long philtrum
Classic presentation of infectious mononucleosis:
Fever, exudative tonsillitis/pharyngitis, and posterior or diffuse cervical lymphadenopathy
Doxycycline is CI in kids <8 and pregnant moms, so must use ??? or ??? to tx Lyme dz in this population
Amoxicillin or cefuroxime
Pt with throat pain, fever, and malaise presenting with rash after ampicillin/amoxicillin use. Likely Dx?
IM
Most common anatomic abnormality in infants with bladder exstrophy?
Epispadias
Webbed neck, broad chest/widely spaced nipples, horseshoe kidney, streak ovaries, low set ears, coarctation of aorta, bicuspid aortic valve, and short stature are all sequelae of ???
Turner syndrome
Pt presenting with delayed umbilical cord separation (>30 days), poor wound healing, recurrent skin and mucosal bacterial infections. Likely dx?
Impaired leukocyte adhesion
Test to Dx pyloric stenosis? Test to Dx duodenal atresia?
Abdominal US; Abdominal X-ray
Patient presenting with knee pain and hip/leg is externally rotated. Radiographs show posterior and medial displacement of femoral head. Likely Dx?
Slipped capital femoral epiphysis
CAH pts are deficient in what enzyme?
21-hydroxylase
Undescended testes carry increased risk of ??? and ???
Germ cell tumors(Seminoma) and Infertility
Deficiency in ???, which inhabits the GI tract, predisposes to Giardia infection
IgA
Low serum albumin and elevated urine protein with oval fat bodies point to a ??? syndrome
Nephrotic
Most common form of nephrotic syndrome in children and its treatment?
Minimal change dz, tx with corticosteroids
A ??? hemorrhage crosses suture lines, grows slowly over first day of life, related to birth trauma/vacuum assist, can lead to hemorrhagic shock(tachycardia)
Subgaleal
Henoch-Schonlein purpura symptoms are caused by?
Deposition of IgA and C3 in small vessels
What can develop after a mumps infection?
Pancreatitis
A child with fair skin, growth retardation, MR, mousy body odor and eczema. Likely dx?
PKU (disorder of AA metabolism)
To prevent MR in PKU pts, must restrict ??? and supplement ???
Phenylalanine; Tyrosine
??? manifests as unconjugated hyperbilirubinemia and dehydration in first week of life
Breastfeeding failure jaundice
Fever, dysphagia, trismus, inability to extend neck and widened prevertebral space on lateral X-ray suggest dx of ???
Retropharyngeal abscess
Classic triad of congenital toxoplasmosis:
Chorioretinitis, hydrocephalus, and intracranial calcifications
What is the most common predisposing factor for bacterial sinusitis?
Viral URI
??? is indicated for all premature and LBW newborns to r/o IVH
Transfontanel US
??? occurs due to laxity of supra glottis structures and presents as inspiratory stridor that worsens when supine, crying or feeding; improves in prone position
Laryngomalacia
Pt presenting with thrombocytopenia, h/o eczema and multiple bacterial infections: likely dx? Pathophys?
Wiskott-Aldrich syndrome (WAS); impaired platelet production
ADHD symptoms present before age ??? and occur in at least ??? settings
Age 12; 2
Hallmark X-ray finding in NEC?
Pneumatosis intestinalis (bowel gas in bowel wall)
Dx of Meckels Diverticulum?
Technetium-99m pert scan
Infant appeared normal at birth, but gradually developed weakness, hypotonia, large tongue, abdominal bloating, umbilical hernia, and sluggish movement: Dx?
Congenital hypothyroidism
Tx of gonococcal conjunctivitis? Tx of chlamydial conjunctivitis?
IV or IM ceftriaxone/cefotaxime;
Oral erythromycin
Clinical features of Prader-Willi syndrome? Dx/path?
Hypotonia, hyperphagia/obesity, hypogonadism, almond shaped eyes.
Deletions on paternal 15q11-q13
Most common cause of congenital hypothyroidism?
Thyroid dysgenesis
Screening for developmental dysplasia of the hips: 2 wks-6 mos? >6 mos?
Hip US; Hip X-ray
Complications of bronchiolitis 2/2 RSV? Prophylaxis for children <2 yo at high risk?
Apnea, respiratory failure;
Palivizumab
In an infant with meningococcemia, watch out for ???, which is characterized by sudden vasomotor collapse and skin rash(purpura/Petechia) due to adrenal hemorrhage
Waterhouse-Friderichsen syndrome
??? is a rare condition characterized by precocious puberty, cafe au lait spots, and multiple bone defects
McCune-Albright syndrome
Pt with recurrent catalase positive infections and abnormal nitroblue tetrazolium test: Dx? Tx?
Chronic granulomatous disease; daily bactrim and gamma interferon 3x/wk (BMT is experimental/curative)
Patient with recurrent UTIs should receive???
Voiding cystourethrogram
21-hydroxylase deficiency presents with ambiguous genitalia, ???, and increased ???
Salt wasting(hypotension, decreased Na, increased K); 17-hydroxyprogesterone
11beta-hydroxylase deficiency presents as ambiguous genitalia, ???, and increased ???
Fluid/salt retention(HTN); 11-deoxycorticosterone and 11-deoxycortisol
Most common complication of sickle cell trait ?
Hematuria
Stridor that improves with neck extension, condition is associated with cardiac abnormalities: Dx?
Vascular ring
First step in managent of gastroschisis?
Sterile wrapping of exposed bowel
Pinealomas present with features of ???
Parinaud syndrome(limited upward gaze, ptosis, pupillary abnormalities), HA/V, central precocious puberty
Congenital rubella infection presents with infant symptoms of ???
Hearing loss, cardiac anomalies, cataracts/glaucoma
Early symptoms of congenital Syphilis infection:
Hepatosplenomegaly, jaundice, anemia, rhinorrhea, and cutaneous lesions on palms/soles
Late symptoms of Syphilis infection:
High arched palate, hutchinson teeth, perioral fissures, saddle nose
Pt with recurrent catalase positive infections and abnormal nitroblue tetrazolium test: Dx? Tx?
Chronic granulomatous disease; daily bactrim and gamma interferon 3x/wk (BMT is experimental/curative)
??? vesicles localize to anterior oropharynx/lips; whereas ??? vesicles localize to posterior oropharynx/tonsillar pillars.
HSV gingivostomatitis; Herpangina (coxsackie A)
??? is radiopaque, and infested tablets can be seen on X-ray
Iron
The standard of care for both diagnosis and treatment of foreign body aspiration is???
Bronchoscopy
Tinea capitis tx?
Griseofulvin or oral terbinafine
Minimal Change Disease histopathology? Tx?
Normal histopathology; steroids
Overuse injury in runners, Pt presents with anterior knee pain that’s worse when descending steps/hills: Dx?
Patellofemoral stress syndrome
A traction apophysitis of the tibial tubercle. Pain is reproduced by knee extension against resistance. Mass may be felt: Dx?
Osgood-Schlatter dz
Congenital hypothyroidism has typical findings of:
Poor feeding, constipation, low tone, macroglossia, umbilical hernia, large anterior fontanelle
Low levels of thyroid hormone can lead to:
MR, poor linear growth, failure of bone maturation
??? begins with URI symptoms and progresses to whooping cough. Post-tussive emesis is common.
Pertussis
Common feature of Retts Disorder?
Seizures
HepB infection is a significant risk factor for this less common nephrotic syndrome in kids?
Membranous nephropathy
Lyme Dx tx if 8 ???
Amoxicillin; doxycycline
Impetigo tx?
Muciprocin
Pertussis tx?
Erythromycin
Definitive tx for compartment syndrome? *done within 6 hours to preserve tissue/avoid amputation
Fasciotomy
Why sickle cell pts at high risk of developing gallstones?
Hemolysis, increased bilirubin metabolism
US findings in cholecystitis?
Pericholecystic fluid, thickened GB wall, gas within GB
Malignant hyperthermia 2/2 anesthetic/depolarizing agents, presents clinically as:
Hyperthermia, tachycardia, muscular rigidity, metabolic acidosis, skin mottling
Heparin type given for suspected PE?
Unfractionated or LMW
Hiatal hernia, EGD revealed metaplasia. Tx?
Nissen Fundoplication
Loss of vision described as: bright flashes/floaters with “curtain pulled over eye” loss of vision
Retinal detachment
Pts should ??? daily dose of steroids prior to surgery
Increase (“stress dose”)
Parkland formula for fluid resuscitation in burn victims:
4 mL • %TBSA • weight kg
How much fluids resuscitated during first 8 hours for burn victims?
Half of parkland total fluids. The other half is given over following 16 hours
Gastrin secreting tumor of pancreas that presents as diarrhea, malabsorption, and refractory PUD
Zollinger-Ellison Syndrome
