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Peds Syllabus Flashcards

1
Q

What are the absolute c/i for breast feeding

What two pediatric metabolic d/os are c/i for breast feeding

? is the MC type of abuse, ? is the down side to this MC, and what are the 3 forms

A 
Antineoplastic/ImmSupp agents
HIV TB Varicella H1N1 HSV on breast
Alcohol: limit <0.5mg/day
Radiopharmaceutical
PCP Amphetamine Cocaine

Galactosemia, Phenylketonuria

Neglect- failure to provide for child’s needs;
Hardest to document/prove;
Physical Medical Emotional

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2
Q

How does Pt w/ neglect abuse present to clinic

What are 6 indicators neglect is occurring

? is the MC form of emotional abuse but this form also includes ? form of abuse

A

Type 1 growth deficiency: normal length/head, low weight

Begging/stealing food
Assuming adult role
Self-destructive behavior
States no adult at home
Inattentive adult
Fatigue

Verbal- witnessing abuse

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3
Q

How is lice Tx first/second line

Launder anything worn/slept on in past ? long and how are items non-washable Tx

How are brush/combs cleaned

A 
1st: Permethrin 1%
2nd, resistant:  
Mathalion 0.5%
Ivermectin 0.5%
Benzoyl 5%
Spinosad 0.9%
Retreat in 9-10 days since eggs can survie

Past 2days;
Air tight bag x 2wks

Detergent/rubbing alcohol soak x 1hr

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4
Q

How does scabies infection start

How can it present in infants

How can it present differently in adolescents

A

Sarcoptes burrows into dermis, lays eggs and dies, eggs hatch 3-4d

Sxs 3-4wks after infestation w/ bullae, pustules, eczematous eruption on neck/higher w/out burrows

Head, neck, palms spared

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5
Q

What causes Molluscum Contagiosum and how does this present

Where is the MC and rarely found on body

How is it Tx

A

Poxvirus in epithelial cells= smooth, dome shaped papule w/ central umbillication

MC: neck, axilla, thigh
Rare: face, periocular

Self-resolves in 6-9mon;
Extensive- cryo, Cantharidin 0.9% not face
Avoid sharing baths/towels

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6
Q

MC complication from measles

Two rare but possible outcomes

When is the MMR vaccine given

A

Otitis media

Encephalomyelitis, Sclerosing panencephalitis

12-15mon, 4-6yrs
Combo w/ MMRV at 4-6y/o only d/t febrile seizure risk

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7
Q

Post-exposure prophylaxis for measles

German Measles is AKA ? and causes ? in kids

IFetus acquires transplacental Abs and is protected x ? long

A

<72hrs: Vaccine
<6d: Immunoglobulin

Rubella; exanthematous dz in Peds; Blueberry muffin babies

First 6mon

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8
Q

Rubella microbe is sensitive to ? but stable in ? environment

How does virus cause infection

How is this passed/how long are Pts infectious

A

Heat, UV, pH; Stable: cold

Invades respiratory epithelium, spreads to nodes

Direct/droplet contact w/ secretions;
2d before and up to 7d after rash onset (virus found in secretions 7d before, 14d after rash)

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9
Q

When is Rubella Congenital infections the highest

How does post-natal infection present

What does this rash look like and present as

A

1st trimester, rare after 16wks

2-3wk incubation, mild prodrome w/ occipital, auricular, anterior cervical adenopathy

Face/neck to torso and fades w/ migration, lasts 3d

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10
Q

What spots may be seen during Rubella infections

What are 3 possible complications that can arise

How is this Dx confirmed

A

Forchheimer- rose colored petechiae in oropharynx

Thrombocytopenia Encephalitis Arthritis

Serological IgM or IgG w/ 4x increase

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11
Q

What are the adverse outcomes for Blueberry Muffin Babies

How long are these Pts infectious

How is post-exposure prophylaxis managed

A

Deaf Cataract Congenital heart dz

Secrete virus in secretions x12mon

Live vaccine <3d of exposure unless;
ImmSupp/Comp, Pregnant, Immunoblobulin <11mon

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12
Q

Roseola Infantum can AKA ? three names

What virus causes this

How is this infection spread

A

Exanthem Subitum; fever that precedes rash; 6th Dz

HHV 6/7

Salivary/Respiratory droplets of ASx adults/infants

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13
Q

How does Roseola present

What type of rash is present

? rare presentation can occur in 12-15mon old Pts

A

Abrupt onset of high fever x 3-5d

Maculopapular, rose colored AFTER fever resolves, move from trunk, to face, to extremities

Febrile seizures

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14
Q

How is Roseola Dx

How is it Tx if Pt is ImmComp

Two rare but possible complications

A

Viral culture- gold standard

Ganciclovir w/ hydration and antipyretics

Encephalitis
Virus associated hemophagocytosis syndrome

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15
Q

What is 5th Disease AKA and what causes this

Although an overall benign viral exanthema for healthy Pts, this microbe has a high affinity for ? part of the body that can cause ?

This microbe has the greatest overall risk to ? Pts and can cause ?

A

Erythema Infectiosum; Parvovirus B19

RBC progenitor cells;
Aplastic crisis/hemolytic anemia

2nd Trimester pregnancy:
HF Anemia Hydrops

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16
Q

How is 5ths Dz transmitted

How long does this incubate for and how does it present

When/How does the rash appear for this infection

A

Respiratory secretions
Blood product transfusions

4-14 days; HA w/ URI Sxs

7-10d later in three stages:

1: slapped cheek w/ circumoral pallor
2: erythematous, maculopapular trunk rash
3: central clearing leaving reticulated, lacy and pruritic rash w/out desquamation and spares palms/soles

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17
Q

How is Varicella transmitted

Where does the virus replicated and for how long

When are Pts infectious and when are they considered non-infectious

A

Airborne
Contact w/ conjunctiva or respiratory tract

Nasopharynx, Upper respiratory tract x 14-16d

2d before through 7d after rash
Once all lesions crusted= non-infectious

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18
Q

MC and 2nd MCC of fever/meningitis in infants

What are the 3 causes of pneumonia is 0-1mon olds

What is the MCC of early onset neonatal sepsis

A

1st: E Coli; 2nd: GBS

GBS, EColi, Strep pneumo

GBS

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19
Q

What causes Rheumatic Fever

This can affect all valves but ?

What lab is drawn for Dx using ? criteria

A

GABHS 2-6wks prior- Abs cross react w/ cardiac Ags causing damage/scars

Tricuspid

Anti-streptolysin O titer; strep Ab test;
Revised Jones w/ 2 major or 1 major and two minor

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20
Q

What are the Major Jones Criteria

What are the Minor Jones Criteria

A 
Carditis
Polyarthritis
Sydenhames chorea
Erythema marginatum
Nodules, subcutaneous
Prolonged PR/heart block
Arthralgia
Fever 
inc ESR/CRP
Leukocytosis
Prior Hx of RF/RHDz
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21
Q

How is Rheumatic Fever Tx

What is added to Tx if severe carditis is present

What is done for long term Tx

A

Cards consult
ABX: Benzathin PCN G or PO Amoxicillin
PCN allergy: Erythromcyin
Salicylates: ASA, NSAID as alternative

PO CCS

PCN prophylaxis w/ PCN-G 1.2M units q28d
If myocardial/valvular defects- lifelong prophylaxis

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22
Q

Impetigo is a possible mild complication from ? Dz process

Secondary Impetigo is MC caused by ? two microbes and is Tx w/ ?

How does Impetigo appear on PE

A

Varicella

MC: Staph A, then GAS
Tx: Topical mupirocin
Wide/Generalized lesions: PO 1st gen cephalosporin (Cephalexin)

Single erythematous papulovesicle w/ honey colored crust MC on face or extremity

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23
Q

Exanthem numbering of Dzs

What causes Scarlet Fever

How does the rash present

A

1st: Measles (Rubeola)
2nd: Scarlet
3rd: German measles (Rubella)
4th: Staphylococcal
5th: Erythema infectiosum
6th: Roseola

GAS pharyngitis

24-48hrs later w/ rash on neck, spreads to extremities;
Finely papular, erythematous eruption feeling like sandpaper, that blanches w/ pressure and leads to desquamation in 3-4days

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24
Q

Scarlet fever can have ? presentation mimicking Kawasaki’s and how are they differentiated

Scarlet fever is a potential systemic complication from ? Dx

Strep pharyngitis is uncommon prior to ? age and most importantly w/out ? Sx

A

Strawberry tongue: GAS isolated from pharynx

Pharyngitis/Tonsillitis

<3y/o; no cough

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25
Q

MCC of pharyngitis is ? two microbes

Define the criteria used for Dx

How do the criteria score direct Tx

A

EBV, CMV

Modified Centor:
Fever >100.4
Adenopathy
Cough, none
Exudate
Age 45/>, subtract one point

0: Tx as viral
1-3: culture or rapid; ABX if pos
4-5: probable, culture and empiric Tx

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26
Q

How is pharyngitis Tx

How is this Tx if Pt is allergic to primary medications

Three possible local complications that can occur from pharyngitis/tonsillitis

A

Amoxicillin 50mg/kg QD x 10days
PO PCN V 10mg/kg BID/TID x 10 days
Benzathing PCN x 1 IM dose

PCN: Cephalexin, Cefadroxil, Clinda x 10days
B-lactam: Azith/Eryth-romycin x 10days

Sinusitis AOM Peritonsilar abscess

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27
Q

What are the possible systemic complications to arise from pharyngitis/tonsillitis

When is Pertussis vaccine given

How is this infection passed and where does it live in the body

A 
TSS
Rheumatic Fever
Scarlet fever
Post-strep glomerulonephritis
PANDAS- basal ganglia infection causing OCD/tics

5 DTaP doses at 2, 4, 6mon and 4-6yrs
1 TDaP dose 11-12y/o

Aersolized droplet to pharynx, larynx, peribronchials

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28
Q

What would be seen on CXR in Pt w/ pertussis

? Pertussis variant may be seen as a milder illness and is not prevented by vaccine

How is Pertussis Tx

A

Segmental atelectasis w/ perihilar infiltrates

Bordatella prapertussis

<3mon: admit
All other age group/post-exposure: Azithromycin
Alternative if >2mon old: TMP-SMX

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29
Q

Why is Clar/Ery-thromycin no preferred when Tx Pertussis in Pts <1mon

Under immunized close contacts are Tx how

MC complication to arise from this Dz

A

Inc association w/ Infantile hypertrophic pyloric stenosis

<7y/o: DTaP booster
7-10y/o: Tdap booster

Pneumonia

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30
Q

Infants w/ fever and bacteremia have higher risk for infection and death if done by ? organisms

How many serogroups of N Meningitidis are covered by ? vaccine

Which serogroups are more common in different locations

A

Encapsulated: HIB Nmeningitidis Streppnemoa (same w/ Sickle Pts)

A B C X Y W-135- MCV4

A: Africa; B: USA

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31
Q

What can cause pneumonia in children >5y/o

Post-infectious autoimmune peripheral neuropathy occurs after ?

? is a common and most frequently ID’d pathogen of meningitis

A

Mycoplasma/Strep/Chlamydophyla pneumoniae

10d after respiratory/GI infection of M pneumoniae or Campybacter jejuni

Strep pneumoniae

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32
Q

What two populations are at higher risk for meningitis from Strep Pneumo

What complication can be seen after meningitis d/t Strep Pneumo

Why is this cause of meningitis feared

A

Functional asplenia from Sickle Cell
HIV

Subdural effusion- drained only if ICP/focal neuro signs

Highest Peds mortality rate from bacterial meningitis

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33
Q

HIB vaccine reduces Pts risk for ? two Dxs

? medical emergency can occur w/out this vaccine

What other microbes can cause this emergency

A

Meningitis, Epiglottitis

Epiglottitis- risk of airway obstruction

Vacc: GAS, Staph A,
Unvacc: HIB, Diphtheria

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34
Q

Secondary infections from Pertussis can occur if infected w/ ? three microbes

? population require the HIB vaccine to reduce sepsis risk

C. Trachomatis can cause ? neonatal eye infection that presents how and Tx w/ ?

A

Strep pneumo
HIB
Staph A

Asplenic w/ PCN prophylaxis along w/ Pneumococcal vaccine
Sickle Cell

Ophthalmia neonatorium on day 4-19; Tx w/ PO Erythromycin x 14days

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35
Q

Define Conduct D/o

What type of behaviors may be seen

Opposition/Conduct D/os are screened for using ? tool

A

Frequent and persistent behavior that violates basic right/society norms

Destruction of property
Aggression to people/animals
Deceit/theft
Serious rule violations

Vanderbilt

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36
Q

Although not FDA approved, ? meds may be used for Opposition/Conduct d/os

What types of Sxs are boys/girls w/ ADHD likely to show

Most Sxs will persist into adulthood, especially ?

A

Stimulants/Atypical antipsychotics

B: hyper/impulsive or combo
G: inattentive

Impulsivity, Inattention

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37
Q

? is at the core of ADHD Tx w/ ? as the first line agent

What meds may be used

What are two PE findings suggestive of an eating d/o

A

Core: behavior management
First: Methyphenidate, Amphetamine

SNRI: Atomoxetine
AAgonist: Clonidine, Guanfacine

Lanugo, Knuckle calluses

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38
Q

Define Nephroblastoma and the two MC stats it holds

This growth originates from ? and is associated w/ ? other abnormalities

? syndrome is at increased risk for developing a nephroblastoma

A

Wilms Tumor; presents as ASx abdominal mass
MC primary malignant renal tumor of childhood
2nd MC malignant abdominal tumor of childhood (1st- neuroblastoma)

Kidney;
WAGR- Wilms, Aniridia, GU malformation, Range of developmental delays

Beckwith-Wiedemann along w/ omphalocele

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39
Q

? stats does Lymphoma have

Although an unknown etiology, ? association may be present

What are the two types

A

MC in 15-19y/o
3rd MC malignancy <14y/o

EBV

NHL- incidence increases w/ age in Caucasian males
HL- MC lymphoma w/ bimodal peaks: 15-35, >50

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40
Q

Stats of NHL

This form almost always appears as ?

What are the subtypes

A

Incidence increases w/ age and more often in Caucasian males

Diffuse, highly malignant and w/ little differentiation

B-cell (Burkitt/Small noncleaved cell)- Sporadic in USA or Endemic in Africa d/t EBV
T-cell- lymphoblastic
Large- either T/B cell

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41
Q

What lab result makes lymphoma Dx reclassified to something else

How is Lymphoma Tx

? population is 10-20x higher risk for developing leukemia and ? population has a higher unvaccinated mortality rate

A

Bone marrow w/ 25% or more blasts= acute leukemia

HL- low dose chemo and field radiation
NHL- aggressive chemo, rarely surgery/radiation

Down Syndrome; Varicella

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42
Q

Collectively, ? is the MC malignancy in childhood and adolescence

Leukemia holds ? MC stat

What 5 inherrited syndromes are at increased risk for CNS tumors

A

CNS tumors

MC childhood Ca

NF 
Li-Fraumeni Syndrome
TB
Turcot syndrome
Von Hippel Lindau Syndrome
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43
Q

? genetic conditions are more susceptible to leukemia

Ages 0-3 are more susceptible to ? type

What are the sub-types of leukemia

A

Downs, Fanconi anemia, NF

Downes Pts AML > ALL

ALL- more common in males 2-3y/o
AML- MC in neonates then late adolescents
CML
JMML

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44
Q

Common Sxs for leukemia

Common PE findings

What lab findings will be seen and aid w/ Dx

A

Lethargy Anorexia Malaise Pallor Fever Ortho pain

Hepatosplenomegaly
Ecchymoses
Adenopathy
Petechie

WBC >50K
Peripheral smear/marrow aspirate w/ immature blast cells
Anemia
Thrombocytopenia

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45
Q

How often Dx w/ Transient Myeloproliferative D/o f/u w/

How is a Dx of leukemia definitively made

What two translocations may be seen in ALL

A

q3mon w/ PE, CBC, blood smear in effort to catch early leukemia

Cytogenetic analysis- evals cell surface markers

t 12;21- MC and favorable prognosis
t 9;22- less common, poor prognosis

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46
Q

Define Henoch-Schonlein Purpura

This is usually seen in ? time and characterized by ?

A

Vasculitis of unknown etiology and is MC systemic vasculitis in childhood, most <6y/o

In winter after URI;
Leukocytic infilatration
Hemorrhage
Ischemia
Glomerulonephritis d/t IgA deposition
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47
Q

? is the MC childhood bleeding d/o

How does this MC present

What is the suspected etiology

A

ITP

1-4wks post-viral infection w/ abrupt onset petechiae, purpura and epistaxis

Anti-platelet IgG/IgM binding to platelet membrane causing spenic destruction of platelets

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48
Q

What lab results will be seen w/ ITP

What results would be seen after marrow biopsy

How is this Tx

A

Severe thrombocytopenia
Normal WBC, RBC, Peripheral smear, PT/PTT

Inc megakaryocytes
Normal erythroid, myeloid elements

Platelets >30K- monitor, most resolve <6mon
Platelets <10K: IVIG, Pred, Splenectomy if life threatening bleeds

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49
Q

Chronic ITP lasting longer than ? time needs ? secondary causes r/o

What is the only definitive Tx for these Pts

Hemophilia is linked to ? part of genetic make up and what are the two types

A

6mon or more; SLE, HIV

Splenectomy

X-linked;
A- factor 8 deficient
B- factor 9 deficient

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50
Q

If severe, how does hemophilia present

What coagulation study is used for Dx

How is the Dx confirmed

A

1st year of life w/ bleeding, hemarthrosis

Prolonged PTT that corrects when mixed w/ serum

Factor assay

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51
Q

How is Hemophilia Tx

? is the MC congenital bleeding d/o

This MC is lacking and element, ? is it’s normal function

A

Desmopressin (DDAVP)- inc Factor 8 and vWF production, no effect on Factor 9

Von Willebrand Dz- deficiency in quantity/function of vWF

Bridges platelets w/ collagen and protects Factor 8 from clearance

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52
Q

What are the 3 sub-types of Von Willebrand Dz

What lab work is ordered

How are they Tx

A

1- dec production of vWF, autosomal dominant and MC
2- normal production, defective vWF (dysproteinemia)
3- no production at all; rare

vWF quantity is measured then,
Function measured w/ Ristocetin

DDAVp for Type 1 and 2
vWF concentrate for Type 3

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53
Q

Sickle Cell and Thalassemias are ? category of hemolytic anemias

Define Thalassemia

What is the make up of a normal Hgb molecule

A

Intrinsic

Insufficient production of normal Hgb d/t dec production of A/B globin components

a2b2;
4a genes encode for 4a proteins
2b genes encode for 2b proteins

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54
Q

Sickle Cell Dz is d/t an abnormality located ?

Define Sickle Cell Anemia

Define Sickle Cell Dz

A

B-chain (HbS)

HbSS homozygous- HbS is 90% of total Hgb

HbS is >50% of Hgb

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55
Q

Define Aplastic Anemia

What drugs can cause this

What toxin can cause this

What infections can cause this

A

Macrocytic anemia most often d/t idiopathic cause

Felbamate, Chloramphenicol

Benzene

Mono, hepatitis

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56
Q

How long are Fe Deficient Anemia Pts Tx prior to f/u

Why is this timeframe needed

How is this prevented

When are screenings started

A

3mon

1-3mon to replete stores and is reflection of true effectiveness

Bottle fed infants= Fe formula
Breastfed infant- Fe supplements at 4mon
6mon= Fe solid foods
12mon= <24oz cow milk/day

12mon

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57
Q

? is the most sensitive test for thyroid function

What is the MCC for this MC to be elevated in Pts under Tx

? thyroid function tests is best for kids

A

TSH

Non-compliance

Free T4 and TSH d/t high incidence of secondary hypothyroid

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58
Q

? thyroid PE finding needs imaging and ? does this finding suggest

What are the two types of Congenital Hypothyroidism

What are the thyroid hormone crucial for

A

Nodular goiter- inborn error of metabolism (iodide use/thyroid hormone synthesis) or transplacental passage of anti-thyroid drugs (methimazole, popylthiouracil)

Primary: MC d/t dysgenesis
Secondary: pituitary/hypothalamic etiology

Tissue maturation/differentiation

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59
Q

How is Congenital Hypothyroidism Tx and if started in ? time frame is best for intellectual development

? is the MCC of Acquired Hypothyroidism

What is often a first but missed first sign

A

Levothyroxine in first month of life

Hashimotos; AKA Chronic Lymphocytic Thyroiditis

Slow linear/height growth

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60
Q

What lab results must be seen in Hashimotos Thyroiditis for a Dx

How are these Pts managed

Why is PTU not recommended for hyperthyroid Tx in PEds

A

Thyroid Ab

Consult Endo:
Hypo: Levothyroxine
Euthyroid w/ +Abs: f/u labs q6mon, Levo
Hyper- Propranolol, Methimazole; Reassess TSH q6-8wks

Liver Ca risk

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61
Q

? is the MCC of Pediatric Hyperthyroidism

This is caught d/t many Pts being referred for ? issue

What will lab results show

A

Graves

ADHD

Low TSH, Inc FT4, T3

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62
Q

What causes CAH

How does this present in M/F

A

21-OH deficiency w/ most being salt wasters

F: ambiguous genitals w/ elevated androgens
M: normal genitals but
a) salt loser- adrenal crisis at 2wks of age
b) non-loser w/ 6mon androgen s/e but no testicular enlargement

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63
Q

Define Cushing Syndrome and Dz

What does this lead to

How is Syndrome Dx

A

Syn: Exogenous glucocorticoids d/t meds
Dz: pituitary adenoma

ACTH secreting microadenoma in pituitary= Cushing Dz

24hr cortisol
Low dexamethasone suppression test
High dexamethasone suppression- differentiates Dx/syndrome
Late evening salivary cortisol

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64
Q

How is Cushing Syndrome Tx based on cause

Define Addison’s Dz

How will Pts present

A

Endogenous- remove ACTH secreting tumor

Primary Adrenal Insufficiency d/t absence of gluco/mineral-corticoids

Hyperpigmentation
Salt craving
Postural hypotnsion
Fasting hypoglycemia

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65
Q

What lab results may be seen w/ Addisons Dz

How are these Pts Tx

Define Primary Amenorrhea

A

HypoNa HyperK Inc renin

Hydrocortisone
Stress dose= 3x/day
Mineralcorticoid deficient= Fludrocortisone

No menses by 16y/o w/ 2* characteristics
No menses by 14y/o w/ NO 2* characteristics

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66
Q

What is the MCC of Primary Amenorrhea

Diabetes is characterized by ? and ?

What are the two types

A

Premature ovarian insufficiency
Mullerian agenesis

Hyperglycemia and glycosuria

T1: MC in childhood d/t autoimmune destruction of B cells
T2: MC in adulthood d/t obesity

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67
Q

Dx criteria for pre-diabetic

Dx criteria for DM

What is first line therapy for DMT2 Tx and what are the indications to start medical therapy

A

A1c 5.7-6.4%

8hr fasting 126 or higher or
2hr OGTT of 200 or higher or
A1c 6.5% or higher or
Sxs w/ random glucose of 200 or higher

Metformin;
Fasting >126, Random >200

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68
Q

What are the 4 phases of DMT1

How are these Pts Tx

What FamHx/genetics makes Pts more susceptible

A

Preclinical
Clinical onset
Transient remission/honeymoon
Established diabetes

Life long insulin

Father > Mother; Twins

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69
Q

? infections may cause DMT1

What are the 3 Ps of DMT1 presentation

How is Type 1/2 differed by Dx

A

Congenital rubella Enterovirus Mumps

Polydipsia Polyuria Plyphagia

Autoantibody screens

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70
Q

Define DKA

How are Pts Tx

A

Glucose >300, pH <7.3, BiCarb <15

Admit
10-20ml/kg bolus:
1/2 in <24hrs, 1/2NS w/ K until glucose <300 then switch to D5 for K component
D10% when glucose <200

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71
Q

What happens if DKA glucose is lowered to fast and is the most serious complication

What issue will correct fastest

What should a DM diet compose of

A

Cerebral edema if >100/hr;
Tx: IV Mannitol, raise HOB, dec IV fluid rate

Hyperglycemia > acidosis

55% carbs, 15% protein, <30% fat
High fiber, <300mg/24hrs cholesterol

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72
Q

Peds HgA1c goal ranges

What glucose ranges are optimal

What are Dawn/Somogyi Phenomenon

A

<6: 7.5-8.5%
6-13: <8%
13-18: <7.5%

<5: 80-180
School age: 80-150
Adolescent: 70-130

D: inc glucose d/t GH release and dec insulin; inc bedtime insulin
S: counter-regulatory low glucose causing hyperglycemia in AM; Tx w/ lower insulin at bedtime

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73
Q

What are the Sick Day Rules for DMT1

How is sliding scale established

What kinds of insulin can be used and how often

A 
Check for ketones if glucose >240
If on pump- change location, give first correction via injection
Check glucose q3hrs
Minimum 8oz sugar free fluid/hr
15g carbs /hr

Rule of 1500:
1500/total= amount 1 unit will decrease glucose

Novolog/Humalog q3
Regular q4-6hrs

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74
Q

What are the 3 phases of Kawasakis

What increases the risk for coronary artery aneurysm development during Kawasakis

How is this Tx

A

Acute: fever, erythema, adenopathy, strawberry tongue
Subacute: desquamation, coronary artery aneurysm
Convalescent: from Sxs resolution until ESR normalizes

Prolonged fever
Inc ESR
<1y/o, >6y.o
Male

IVIG- mainstay and to prevent coronary aneurysms
ASA d/t low risk of Reye syndrome

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75
Q

Define Talipes Equinovarus

? structure is MC affected

? needs to be assessed for and how are Pts managed

A

Clubfoot, involves entire leg w/ hypoplastic tarsals and limb muscles

Talus- shortened foot

Hip dysplasia; Refer to Ortho

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76
Q

Define Legg-Calve-Perthes Dz

What is a believed association/cause

What is the classic presentation

A

Idiopathic avascular necrosis of capital epiphysis of femoral head (osteonecrosis) in 7y/o boys

Hypercoagulation d/t Factor 5 Leiden

7y/o boy w/ atraumatic, painless limp x several weeks preventing them from seeking care

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77
Q

? is the MC skin d/o of adolescence and what are the 3 components of its physiology

What are the two types

What type are women likely to get prior to menses

A

Acne Vulgaris-
Obstructed follicle (hyperkeratosis)
Inc sebum production
P acnes proliferation

Blackhead- open comedome
Whitehead- closed comedome

Stage 1- comedomal

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78
Q

How is acne classified

What are the 4 stages

A

Mild: Non-inflammatory w/ <10 pap/pust
Mod: 10-40 papule/pustule/comedome
Mod Sev: 40-100 pap/pustule w/ 40-100 comedome
Sev: cystic, pustulr and painful

1- comedomal
2- papular
3- acne
4- nodulocystic

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79
Q

How is acne Tx

What OCPs can be used

Define Erythema Multiforme

A

1st: retinoids (Tretinoin Adapalene Tazarotene)
Salicylic/Azelaic acid
B peroxide
Erythromycin, Clinda

Triphasic- first FDA approved but equal efficacy to monophasic

Self limiting hypersensitivity syndrome w/ deep red, demarcated macules w/ gray/bullous center (target lesion)

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80
Q

Erythema Multiforme is usually precipitated by ? are triggered by ? infection

What is through to be the cause of autism

What screening method is used

A

HSV infection; Mycoplasma pneumoniae

Disrupted neural connectivity

M-CHAT-R: Modified Checklist for Autism in Toddlers Revised at 18-24mon;
Two predictive/Three total= refer for eval
(predictive: hearing, finger movement near eye, noise sensitivity)

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81
Q

? is the MC foot d/o in infants and how does it present

How is this MC Dx

How is it Tx

A

Metatarsus adductus w/ medial deviation of mid/forefoot

Mid-heel bisector line between toe 2-3
V-finger test should not gap at base of 5th MT/styloid

No self resolution x 2yrs- refer to Ortho

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82
Q

MC sites for physeal Fxs

What classification is used

If SCFE occurs in Pts <10 or >16, ? is an appropriate referral

A

1: distal radius
2: distal tibia
3: distal fibula

SALTR:
Seperated Above Lower Through Rammed

Endo

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83
Q

How are SCFE imaged

What is the earliest sign seen on images

How is this Tx and what are the possible complications

A

AP, if strong suspicion/Hx- no frog leg view

Physis widening w/out slippage

Immediate non-weight bearing and Ortho referral;
Chondrolysis, Avascular necrosis

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84
Q

What microbe causes Cat Scratch Fever

What Pt populations have increased risk for seizure d/t fever

Febrile seizure is a possible outcome from ? vaccination combo

A

B Henselae

6mon - 5y/o, especially if w/ epilepsy

MMR + Varicella

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85
Q

? infectious fever can have a febrile seizure

What category are febrile seizures placed in

These are the MC type of seizure in ? population

A

Roseola

Generalized d/t them beginning diffusely

6mon-5yrs

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86
Q

What are the two categories of febrile seizures

How long is Febrile Status Epilepticus

A

Simple, tonic-clinic: lasts <15min and only one per 24hrs

Complex/Atypical- lasts >25min, recurs w/in 24hrs or child has pre-existing Neuro issues

> 30min

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87
Q

Define Epilepsy

What are the two types of seizures that can occur w/ this condition

This is not a potential complication that can arise from ? issue

A

Recurrent, unprovoked seizures

Focal- arise from one region in cortex
Generalized- arise from both hemispheres simultaneously

Febrile seizures

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88
Q

Why is epilepsy a potential complication after a concussion

Epilepsy is one of the cardinal features of ? other Neuro Dx

Epilepsy is a potential co-existing condition along w/ ? genetic Dx

A

Glial scarring 7d after concussion

Tuberous Sclerosis w/ facial angiofibromas, intellectual delay

Fragile X

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89
Q

What are S/Sxs of Secondary HAs

What are the indications to obtain imaging

What image is ordered

A 
Worse when laying down/first awakening
Awakens from sleep
Worse w/ cough/valsalva/bending
Papilledema
Focal neuro deficit (CN6)

Abnormal/Focal neuro deficit
Altered LOC
Chronic, progressive pattern
S/Sx inc ICP

CT, if neg then LP

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90
Q

When are triptans c/i in Peds w/ migraines

When do these Pts need to be referred to Neuro

What may be prescribed by Neuro

A

Focal neuro deficit w/ migraine
Basilar migraine Sxs (syncope)

> 1 disabling HA/wk

BB TCA Anticonvulsant CCBs Antihistamines

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91
Q

Define Second Impact Syndrome

What are the 6 steps for returning to sports after a concussion

A

Brain swelling d/t secondary concussion before resolution of first concussion

24hrs per step:
1- physical/mental rest
2- light aerobic exercise w/out resistance
3- sport specific exercise
4- resistance training w/out contact sports
5- full contact practice
6- game

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92
Q

Historically, Cerebral Palsy is ? Dx as ?

What two PE findings may be present

How is an Incarcerated Inguinal hernia seen on PE

A

Non-progressive but changing motor impairment syndromes; Static encephalopathy

Athetosis, Chorea

Felt w/ valsalva
Painful exam w/ bowel sounds over swelling

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93
Q

What side of the diaphragm is usually involved in diaphragmatic hernia

Herniation MC occurs through ? foramen

How is this condition Tx

A

L > R w/ opening in posterolateral section

Bochdalek

Intubation
Decompression
Tertiary transfer for surgery

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94
Q

What causes umbilical herniation to occur

What is the common type that forms

These will usually self resolve unless larger than ? size

A

Intestines fail to completely return to abdomen at week 10 gestation

Ventral: contents covered by SQ tissue/skin

> 2cm

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95
Q

What are the two RFs for an umbilical hernia

When is surgical repair indicated

Umbilical hernias present similarly to ? other Dx

A

Low birth weight, AfAm

Persists >4y/o, Sxs, Larger after 12mon old

Omphalocele- bowel fails to return into abdomen, covered by peritoneum and amniotic membranes

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96
Q

MCC of Vesicoureteral Reflux

Half of males w/ a Dx of VReflux will have ? malformation

VUR associated UTI/obstructions have increased risk for developing ?

A

Congenital Ureteovesical Junction incompetence

Posterior urethral valves

Reflux nephropathy

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97
Q

What types of VUR rarely resolve on their own

What is the average age most will self-resolve

What is the goal for Tx

A

Bilateral 3 or 4-5

6y/o

Prevent pyelonephritis or renal injury

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98
Q

What are the two categories of UTIs

Most infections are caused by ?

What are the RFs for these to occur

A

Cystitis
Pyelonephritis

Colinic bacteria- Ecoli
Klebsiella Proteus Enterococcus Pseudomonas

<1yr: uncircumcised male
>1yr: healthy girl

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99
Q

Three times incidence of UTIs peak

Cystitis UTIs in males is more commonly caused by ? microbe

? is the MC serious bacterial infection in Pts <24mon old w/ fever without a focus

A

Infancy
Toilet training
Onset of sexual activity

Adenovirus

Pyelonephritis

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100
Q

What is a rare complication that can occur from pyelonephritis induced UTIs

How are UTIs in this population Dx

What results are indicative of positive Dx

A

Renal abscess

Catheterization if 2-24mon old or clean catch
UA w/ culture- gold standard, necessary for confirmation and ABX therapy

Bacteria/Pyuria w/ >50K CFU
Leukocyte esterase and nitrite
1K-50K CFUs- repeat culture

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101
Q

How are Peds w/ UTIs Tx

When is re-evaluation warranted

What ABX may be used

A

> 6mon old: PO ABX
Toxic/dehydrated/NPO: IV Ceftriax/Cefotax/Cefepime

No response x 2d

Cefdinir
Amoxicillin
Nitro- only in afebrile Pts
TMP-SMX

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102
Q

When is imaging warranted for UTIs

Define Hydrocele

What are the two types

A

First UTI in infancy or non-toilet trained Pt
VCUG if recurrent, febrile UTIs

Fluid collection in tunic vaginalis

Communicate: w/ peritoneal space
Non-communicating: MC; obliterated processus vaginalis

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103
Q

How do hydroceles present on PE

How are these Tx

? is the MCC of intestinal obstructions prior to 3mon of age

A

Smooth, non-tender and transilluminate

Non-Comm- self resolve by 12mon
Refer if persists past 18mon

Communicating: smallest in AM, associated w/ inguinal hernia
Refer for Uro surgical correction

Pyloric stenosis d/t muscle hypertrophy and spasm induced outlet obstruction

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104
Q

What are the two RFs for Pyloric Stenosis

What is the ‘classic’ presentation

What would be seen on lab results for this MC

A

Male, First born

2-6wks old w/ post-prandial, non-bilious projectile vomit w/ FTT

HypoCl, HypoK, Metabolic alkalosis
Inc BUN

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105
Q

Ho are Pts w/ Pyloric Stenosis managed

Defining criteria for constipation

What are 3 common times this occurs

A

IV fluids/E+
NS bolus then D5 w/ KCl (inelligible for surgery until alkalosis corrected
OG tube for slow feeding

2 or less stools/wk or
Passing hard/pellet stools x 2wks

Introduction of solids/cows milk
Toilet training (functional constipation)
Start of school (social stressors)

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106
Q

How is GI reflux Dx

After lifestyle mod, what meds may be attempted

Define Intussusception

A

24hr pH probe- was Gold Standard
Upper GI/Barium fluoroscopy
EGD- best for GERD progression

H2 blocker Ranitidine
Pro-kinetic- Metoclopromide
PPIs

Telescoping of intestine into downstream intestine

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107
Q

What are two RFs for Intussusception

? infection can cause this issue

How does this present to clinic

A 
Lymphoid hyperplasia (peyer patches)
Meckels

Rotavirus (old Rota imm)

Paroxysmal pain w/ currant jelly stool and sausage mass in RUQ

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108
Q

What are the 4 criteria must be met for a Dx of Toddlers Diarrhea

When does this cross into the realm of Chronic Diarrhea

C Diff work up can only be started in ? Pts

A

Daily passage of 4 unformed BMs w/out pain
Sxs >4wks
Onset 6-60mon
No FTT

> 2wks

> 2y/o w/ recent ABX use

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109
Q

How is C Diff Tx

Where are Campylobacter infections acquired from

Campylobacter infection can also induce ? Neuro complication

A

D/c offender, PO Metronidazole

Poultry, Raw milk/cheese

Post-infectious Autoimmune Peripheral Neuropathy

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110
Q

Celiac Dz is associated w/ ? other Dx

How is this condition Dx

How is the Dx confirmed

A

DM1 Thyroiditis Turners Trisomy 21

IgA Antiendomysial Ab
IgA tissue transglutaminase Ab

Endoscopic biopsy of small intestine

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111
Q

What alternatives are offered during Tx of Celiac Dz

Define Galactosemia

How does this present

A

Avoid gluten;
Ok: oats, rice, tapioca, corn, buckwheat

Autosomal recessive deficiency of galactose 1 phosphate uridyltransferase

Ingestion of milk induces liver failure, renal tubular dysfunction and cataracts

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112
Q

Pts w/ Galactosemia are at risk for ?

How are these Pts Tx

What issues may persist despite Tx

A

EColi sepsis

Eliminate galactose

Learning d/o
Premature ovarian failure

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113
Q

Define SIDS

What epidemiology stat does it own

Define Pneumonia

A

Unexpected death if infant <12mon that remains unexplained after investigation/autopsy

3rd MCC of mortality in US
MCC of death in 1-12mon old

Infection of lower respiratory tract causing consolidation of alveolar spaces

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114
Q

What are the causes of pneumonia for 0-1mon old

What are the causes of pneumonia for 1mon-5y/o

What are the causes of pneumonia in Peds >5y/o

A

GBS Ecoli Strep pneumo

RSV** Strep pneumo HFlu

Mycoplasma/Strep/Chlamydophyla pneumo

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115
Q

How does pneumonia present in neonates

What is the first sign of pneumonia present in young infant

What are the different presentations for viral/bacterial pneumonia

A

Fever or Hypoxia only

Apnea

V: Cough Wheeze Stridor Congestion URI
B: F/C/Dyspnea, auscultation findings

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116
Q

What lab results can help differentiate between viral/bacterial pneumonia

What will each look like on CXR

What ABX is used for out PT Tx

A

V: lyphocyte dominant leukocytosis
B: neutrophil dominant leukocytosis

V: diffuse infiltrates w/ hyperinflation
B: lobar consolidation w/ effusions

Amoxicillin 90mg/kg/day

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117
Q

How is Community Acquired Pneumonia managed in PT <5y/o who has immunizations

How is Tx changed if child is unvaccinated

How are kids 6-18y/o w/ CAP Tx

A

Amoxicillin or,
Cefuroxime w/ Augmentin

3rd generation cephalosporin or
Augmentin

Azith, Clarith, Doxy- >7y/o

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118
Q

How are neonates w/ CAP Tx inpatient

Infants born w/ intestinal atresia need ? DDx r/o

? enzyme difficiency can also indicate the above Dx

A

Ampicillin/Gentamycin
PO PCN

Cystic fibrosis

Lipase

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119
Q

When is Cystic Fibrosis tested for in routine care

This condition can also cause ? issue seen prior to d/c

Define Cystic Fibrosis

A

Newborn Screening

Pathologic jaundice, direct form

Autosomal recessive d/o- MC life limiting Dz in Caucasians; median 40y/o

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120
Q

What mutation causes Cystic Fibrosis

What tissues are affected by this Dz

These Pts can suffer from chronic respiratory infections d/t ? two microbes

A

Transmembrane regulator gene on Chromosome#7 (508)

Lung 
Exocrine pancrease
GI tract
Sinus 
Testes

Staph A, Pseudomonas

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121
Q

When do Cystic Fibrosis evals need to be done

? newborn screening result suggests CF

What is the Dx test of choice

A 
Meconium ileus
FTT
Cholestatic jaundice
E+ abnormals: HypoNa/Cl, Met alkalosis
Chronic GI/respiratory Sxs
Any child w/ nasal polyp
Any sibling of CF+ Pt

Elevated immunoreactive trypsinogen level

Cl sweat test
Cl >60 mEq
Borderline: Cl 30-59 mEq
Neg: Cl <30

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122
Q

How are Pts w/ CF managed

Define Bronchiolitis

What will be seen/heard on PE

A

Enteric pancreatic enzyme capsules w/ lipase/protease- don’t exceed >2500U/kg of lipase= risk of fibrosing colonopathy

Inflammation of bronchioles MC d/t RSV

Retractions, nasal flaring w/ low fever
Wheeze, Crackles, Ronchi

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123
Q

How is a Dx of RSV Bronchilitis confirmed

? is the MC chronic Dz of childhood in industrialized countries

What are the two phases of this MC

How is asthma Dx

A

ELISA, PCR

Asthma- reversible airway obstruction d/t contraction/inflammation

Early- spasms; Late- inflammation

Obstructive PFT pattern reversed w/ B-agonists

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124
Q

How are these Pts classified

How are these classification criteria changed if Pt is 0-4y/o

A

Intermittent: Sxs 2/< days/wk, Awake 2/< x/month
SABA 2/< days/wk, No activity interference

Mild: Sxs >2day/wk, Awake 3-4x/mon, SABA >2 days/wk, Minor limitations

Mod: Daily Sxs, Awake 1/>/wk, SABA daily, Some limitations

Sev: Daily Sxs, Nightly awakenings, SABA several x/day
Extreme limitations

I: 0 awakenings Mi: 1-2/mon Mod: 3-4/mon Sev: >1/wk

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125
Q

What medications are used as acute asthma meds

What s/e can the rescue inhaler cause

What medications offer the greatest benefit

A

Albuterol- Bagonist
Ipatropium- anticholinergic

A: anxious, tremor, tachy, hypoK

Corticosteroids: Fluticasone (first line for persistent asthma)

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126
Q

? med is used for exercise induced asthma

? long acting B2-agonist is used for combo therapy

What other med is used for mod/sev asthma in PTs >12y/o

? medication is used status asthmaticus

A

Montelukast

Salmeterol

Omalizumab- Anti-IgE monoclonal Ab

IM Epi

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127
Q

What is a red flag in Pts w/ Status Asthmaticus

Define Still’s Murmur

MC etiology for pericarditis

A

Tachypnea w/ normal pCO2

Benign/Innocent functional murmur d/t LV outflow

Viral
Rarely Bacterial: MC Staph A/Strep Pneumo
Metabolic- uremia

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128
Q

When is the prognosis for pericarditis poor

Stats of PDA

What will be felt/heard on PE

A

<6mon old or recurrent Sxs

2nd MC defect

Bounding pulses w/ wide pulse pressure w/ continuous machinery murmur

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129
Q

How are PDAs Tx but w/ ? s/e

Where does coarctation tend to occur

Wheat will be seen on exam

A

Indomethacin- most effective in premature infants; may cause transient renal insufficiency

Thoracic region next to ductus arteriosus

Leg BP < Arm BP w/ radiation next to scapula

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130
Q

? is the MC cyanotic heart defect

What will be seen on lab results, CXR and EKG

How are they Tx

A

Tetralogy of Fallot- PROV

Lab: polycythemia
CXR: RVH and boot shaped heart
EKG: RAD

Prostaglandin E1, Surgical repair

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131
Q

? is the MC congenital heart defect

How does the size of this MC determine Sxs

How would a Pt present and how are they Tx

A

VSD- harsh, holosystolic murmur at LLSB

<3mm: ASx
3-5mm: moderate Sxs
>5mm: CHF w/ FTT

P-HTN or FTT;
Diuretic, Digoxin, After load reduction

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132
Q

How do ASDs present on PE

When is intervention closure indicated

Criteria for Peds White Coat Syndrome

A

Systolic murmur in LUSB w/ fixed, split S2

Significant shunt at 3y/o

> 95th percentile HTN w/ normal readings out of office

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133
Q

? is the MC cause of HTN in adolescents and is more likely in ? populations

What is the MC of secondary HTN

Criteria for Pre/Stage 1/2 and when are they f/u

A

Primary/Essential HTN in obese children

Renal Dz

Normal: <90th percentile
Pre: 90-95th; f/u 6mon
1: 95-99 +5mmHg; repeat in 1-2wks
2: >99th +5mmHg; eval/refer for Tx <1wk

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134
Q

What two findings/criteria should make a secondary cause of HTN evident

What are indications for meds

What meds are used

A

BMI <85th percentile
BP >140/100

Stage 2
Stage 1 w/ Sxs
DMT1/2
Failed life style changed

MC first line: CCBs/ACEIs
ARBs, BB, Diuretics

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135
Q

How is Croup Tx

What are the criteria for admission

When conducting new born exams, how do neck bulge locations hint at Dx

A

Dexamethasone- dec Sxs/hospitalizations and gets through worst part of Sxs
Racemic Epi- reduces edema

Suspected bacterial infection
ER bounce back
Age <6mon old
Stridor at rest

Anterior midline: thyroid d/o
Anterior to SCM: brachial cleft cyst
Posterior to SCM: cystic hygroma

136
Q

How are epistaxis Tx

What is the most potent therapy for the Tx of allergic rhinitis

If antihistamines are going to be used, what considerations are considered per generation

A

Sit up, apply pressure x 10min
Afrin/Phenylephrine spray then pack
Site located- cauterize w/ silver nitrate
Persistent despite cautery- anterior packing x/ Augmentin/TMP-SMX
Persistent/Posterior- ENT referral

Intranasal CCS

1st: Diphenhydramine, Hydroxyzine-
Sedation, Paroxysmal hyperactivity, Anticholinergic
2nd: Cetirizine, Loratadine, Fexofenadine-
Less sedation

137
Q

When/why would Montelukast be considered when Tx rhinitis

What last resort Tx is used for medical failures

What medication is reserved for non-allergic rhinitis or rhinitis associated w/ viral URIs

A

2nd/3rd line agent, best in concomitant asthma

Immunotherapy

Topical ipratropium

138
Q

How is sinusitis Tx

MCC of acquired hearing loss in kids

? complication can arise from this MC and how does it present

A

First: Augmentin x 14d
PCN allergy= Levofloxacin for Type 1 hypersensitivity
Clinda + 3rd Gen cephalosporin for non-type 1 sensitivity

AOM

Mastoiditis- otitis media signs w/ tenderness/swelling/erythema and down/out displaced pinna

139
Q

? is the leading cause of clinical visits and ABX

This leading cause also leads to the most surgeries of ? type

What are the MC microbes behind these stats

A

AOM

Myringotomy and adenoidectomy

HFlu
Catarrhalis
GAS
Step pneumoa

140
Q

A Dx of AOM required ? criteria

What is the most frequent sequelae of AOM

How are Otitis Media Effusions Tx

A

3 of:
Acute onset
Effusion
Inflammation

OME/COM- effusion w/out any other S/Sxs

NSAIDs, f/u in 4wks
Should clear in 3mon

141
Q

How are recurrent cases of Otitis Media managed

What vaccines should these Pts get

When are children considered candidates for tube insertions

A

<1mon since Tx- change ABX
>1mon- use same ABX
>3 episodes in 6mon or >4 episodes in 12mon:
refer to ENT for tube evaluation

Conjugate Strep pneumo
Annual influenza

Developmental risks
Recurrent AOM x3mon w/ effusion and bilateral HL

142
Q

What are the MCC of Otitis Externa

How does this present to clinic

? Neuro Dx commonly develops cataracts

A

Swimmers Ear d/t Pseudomonas or Staph A

Pain, d/c w/ pinna tender to manipulation

Oflox/Ciproflox, Polymyxin B, Dexamethasone

NF-2

143
Q

Cataracts in kids can cause ? type of vision loss

? congenital infection can induce cataracts

? malnutrition d/o can induce cataracts

A

Amblyopia d/t deprivation/obstruction

Rubella

Galactosemia

144
Q

Direction of strabismus names

Timing of strabismus names

How is a pseudostrabismus r/o

Any/All strabismus need ? next step

A

Nasal: Eso
Temporal: Exo
Superiro: Hyper- rare

Constant: manifest strabismus/tropia
Interrupted fixation: latent strabismus/phoria

Normal corneal light reflex

Ophth referral

145
Q

What is the MCC of visual impairment in children

How does Preseptal/Periorbital Cellulitis present

if child is non-toxic, no imaging needed and can be Tx w/ ? ABX

A

Retinopathy of prematurity

<5y/o w/ no proptosis/ophthalmoplegia infected w/ Staph A, Pneumococcus or GAS

F/u daily and Rx:
Cephalexin, Clinda, Augmentin
MRSA: Clinda, TMP-SMX

146
Q

Orbital cellulitis is a complication arising from ? Dx

What microbes cause this

How does Orbital Cellulitis present differently from Pre-Septal

A

Sinusitis

Staph Strep HFlu

Vision loss
Pain w/ EOM
Chemosis/Proptosis

147
Q

How is orbital cellulitis Tx

What complication can occur

A

Blood cultures for broad spectrum w/:
Cefazolin or Clinda
Cefuroxime w/ Metronidazole
MRSA: Vanc + Cefotax and Clinda

Cavernous sinus thrombosis- palsy of CN 3, 4, 6 and V1,V2
Subperiosteal abscess
Vision loss

148
Q

How does the timing of conjunctivitis help w/ Dx the cause

How is this Dx

Most critical stages of embryonic development occur during ?

A

Day 2-7: Gonorrhea, Staph/Strep Pseudo EColi
Day 3-21: HSV
Day 4-19: C trachomatis

Gram stain w/ culture
HSV will have dendrite on cornea w/ stain and lamp

First trimester

149
Q

How is Chlamydia conjunctivitis Tx

How is Ophthalmia Neonatorum Tx

How is HSV conjunctivitis Tx

How is Staph A conjunctivitis Tx

How is Pseudomonas conjunctivitis Tx

A

Erythromycin

Ceftriax

Opth consult w/ Acyclovir

Erythromycin or Polysporin

Gentamycin ointment w/ saline irrigation

150
Q

How does post-neonatal viral conjunctivitis present

This is MCC by ? microbe

How is this Tx

A

Pre-auricular node

Adenovirus

Erythromycin, Polymyxin B

151
Q

Charcoal can be used for ingsted poisons w/in ? time frame

This is ineffective against ? ingestion

When are multiple-doses of activated charcoal given

A

<1hr

Hydrocarbon
Glycols
Metal: Mercury Arsenic Iron Lead Lithium
Caustic/Corrosive

Carbamazepine
Dapsone
Theophylline
Phenobarbital
Quinine
152
Q

Anion gap metabolic acidosis mnemonic

A 
MUDPILES
Methanol, Metformin
Uremia
DKA
Paraldehyde Phenoformin
Isoniazid, Iron
Lacitc acidosis
Ethanol, Ethylene glycol
Salicylates, Starvation, Seizure
153
Q

APGAR scoring system

A

Appearance
0: cyanosis 1: acrocyanosis 2: pink

Pulse:
0: none 1: <100 2: >100

Grimace:
0: none 1: grimace, feeble cry 2: sneeze, cough, pulls away

Activity:
0: limp 1: some flexion 2: active

Respiration:
0: none 1: weak 2: strong

154
Q

Normal respiratory rate

How does respiratory rate change w/ prematurity

Normal HR and interventions done if low

A

30-60bpm

More premature= more tachy

120-160
>100: routine
60-99: ventilation support
<60: ventilation w/ compressions

155
Q

NRP compression:breath ratio

How do neonates respond to hypoxia

BVM is done at ? rate and in ? position

A

3:1 w/ two thumbs > two fingers

Apnea

40-60bpm in sniffing position

156
Q

Congenital heart dz screening is done at 24hrs of life/before d/c and is interpreted how

A

Spo2 95% or higher w/ 3% or less difference between right hand/foot= negative screening, plan for d/c

SpO2 90-94% in right hand/foot or 3% difference= repeat in one hour; same results- repeat again in one hour; 3 readings in same range= echo

SpO2 <90% in right hand/foot= +screen- order Echo

157
Q

Infant length is done in ? position until ? time frame

When is the most inaccurate measurements expected

? is the number one cause of LBW and what is the criteria for Low/Very Low birth weights

A

Laying down until 2y/o

First week d/t position

Prematurity;
Low: <2500gm; Very: <1500gm

158
Q

What are the RFs for LBW

Enlarged anterior fonanelle >5cm suggests ? and needs ? other co-existing DDx r/o

Fontanelles that are closed at birth suggest ? Dx

A 
Previous LBW baby
Age <16, >35
Socioeconomic status
Tobacco/ETOH/Drugs
Poor weight gain during pregnancy
Education
Antenatal care

Hypothyroid- umbilical hernia

Craniosynostosis

159
Q

Define Caput Seccedaneum

Define Cephalohematoma

? head malformation is associated w/ vacuum deliveries and how is it Tx

A

Boggy, edematous swelling crossing lines, self resolves

RBC breakdown/jaundice causing swelling w/out crossing suture lines

Subgleal hemorrhage- swelling crosses suture lines pushing ears anteriorly;
Tx: Compression w/ resuscitation PRN

160
Q

What do each of the following suggest for cardiac d/o/dz

Weak pulse

Bounding pulse

Single second sound

Holosystolic, continuous, harsh

Grade 3/>

Diastolic murmur

Hempatomegaly

A

Weak: poor CO/AS

Bounding: high CO, PDA

Second sound: cyanotic dz- truncus/hypoplastic heart

Holosystolic, continuous, harsh- pathologic

Grade 3/>: pathologic

Diastolic: pathologic

Hempatomegaly: left sided HF

161
Q

Since all infants are born w/ limited laxity, what are the three concerns if this persists

RFs for Congenital Hip Dysplasia

What are the two maneuvers done for hip stability during newborn exam

A

Flat acetabulum
Muscle contraction limiting ROM
Capsule tightening

Female First FamHx
Breech
Oligohydramnios
Postnatal swaddling position

Barlow
Ortolani- hip relocating anteriorly

162
Q

When is imaging for hip dysplasia warranted

Congenital Hip Dysplasia referred to Peds Ortho will be placed in ? device for ? age groups

? is the MC foot d/o in infants and what are these Pts at risk for in the future

A

Suspicious PE findings
Clunk or persistent click past 2wks old
RFs- obtain after 4-6wks of age to differ from normal laxity

Pavlik harness- up to 6mon old

Metatarsus adductus- medial deviation of mid and forefoot;
Developmental hip dysplasia

163
Q

How is Metatarsus Adductus Dx

How are these Tx

Define Talipes Equinovarus

A

Mid-heel bisector line- should go between toes 2-3
V-finger- should not gap at base of 5th MT (styloid)

Most self-resolve
If not w/in 2yrs= Ortho referral cast/brace/surgery

Clubfoot- entire leg d/t hypoplastic tarsals and limb muscles
MC affected- talus, causes foot shortening/calf atrophy
Refer all after Dx

164
Q

? testi/female genitalia abnormalities can be seen on newborn exam

Define Spina Bifida

When/How is this normally identified during pregnancy

A

Testi: retractile
Female: hypertrophy d/t maternal estrogen

Cleft Spine; Lumbosacral tube defect d/t incomplete brain/cord/meninge development

2nd-Tri Quad screen- maternal A-fetoprotein/US

165
Q

Define Rachischisis and ? risk needs to be r/o

What are the categories of Spina Bifida

How is this Tx and avoided

A

Spina Bifida Occulta- hair tuft/minor defect w/out neuro S/Sxs; r/o connecting sinus d/t inc risk for meningitis

Meningocele- meninges herniates through neural arch

Meningomyelocele- meninges and cord herniate through neural arch

Myeloschisis- open skin w/ cord exposed
Neurosurgery;
Folate prior to tube closure at 4-6wks EGA

166
Q

What are the primitive reflexes tested for on newborn exam

What do these reflexes evaluate

When do these normally disappear

A

Suck Moro Grasp

Brain stem, Basal ganglia

4-6mon d/t increased cerebral inhibition of cerebral influences

167
Q

Only reflex not present at birth and never disappears

What reflexes disappear at 3, 4, 6 or 12mon

Facial palsy in newborn is associated w/ ?

A

Parachute- appears at 8-10mon; suspended face down, move towards table causes arm extension for protection

3: Asymmetric tonic neck
4: Rooting, Gallant, Placing
6: Moro, Grasp
12: Babinski

Forcep delivery

168
Q

What syndrome is Klumpke’s Palsy associated w/ if a cervical sympathetic nerve root was injured

Define Vernix Caseosa

When is term infant desquamation typically seen

A

Ipsilateral Horner’s Syndrome

Chalky white mixture of shed epithelials cells, sebum, keratin and hair; common in preterms for suspected fetal protection

24-48hrs of life

169
Q

Define Milia

Define Milia Rubra

Define Cutis Marmorata

A

Smooth, white papules on face/scalp d/t trapped keratin; self limited/resolves 1-4wks

Heat rash d/t overheated/febrile infant w/ erythematous papules; Tx/correct overheating

Mottling- cold response; persistent suggests hypothyroidism/vascular malformation

170
Q

Define Slate Gray Nevi

Define Cafe Au Lait macules and when are further work ups indicated

Nevus Simplexes are AKA ?

A

Transient dark macule on lower back/buttocks that fade w/ time

Sharply defined, pigmented macules;
6 or more/ 5cm or bigger to r/o NF-1, TB, McCune Albright Syndrome

Salmon patches
Stork bite- nape of neck
Angel kiss- forehead/eyelids

171
Q

Neonatal sepsis etiologies w/ early onsets

Neonatal sepsis etiologies w/ late onsets

A 
Mycoplasma
GBS- MC/#1
E coli
Klebsiella
Listeria
Salmonella
Hflu
Neisseria meningitidis
CMV
HSV
Enterovirus
Strep pneumo
Staph
172
Q

Early onset neonatal sepsis begins on ? day and presents w/ ?

Late onset neonatal sepsis begins on ? day and is more likely associated w/ ?

What orders are needed

A

0-7d old;
Fast onset, Hypo-thermia/tone/tension

8-28d old;
Insidious onset, Dec feeding/tone, Bulging fontanelle; associated w/ meningitis

CBC 
CXR if + resp Sxs
Blood culture x2
UA w/ culture
Blood glucose
LP
173
Q

How is Neonatal Sepsis Tx

Why would Vanc be added to Tx regiment

? PE finding is a sign of neonatal respiratory distress

A

Draw labs then:
IV Ampicillin+Gentamicin
IV Amp+Cefotaxime if >3wks d/t liver function

Late onset, + meningitis, MRSA coverage

Grunting (can sound like meowing) d/t:
Dec functional residual capacity:
Pneumonia
Pulmonary edema
Peripheral airway obstruction
174
Q

Three steps for Tx infant born to a GBS pos mother

A

1: infant have S/Sxs?
Yes: eval w/ empiric Tx
No: step 2

2: infant <35wks EGS?
yes; limited eval w/ 48hr observation
no: step 3

3: Two maternal ABX doses prior to delivery?
Yes: no eval/therapy, observe x48hrs
No: limited eval w/ 48hr observation

175
Q

Respiratory Distress Syndrome is AKA ? and caused by ?

RDS results in ? and looks like ? on CXR

How is RDS Tx prior to birth

How is RDS Tx after birth

A

Hyaline Membrane Dz: dec surfactant from Type 2 pneumatocytes in <34wks EGA

End expiration atelectasis; Ground glass

Maternal steroids 32-34wks EGA

Intubation w/ surfactant/support via ET tube

176
Q

What complications can arise from RDS

Which one appears on day 2-4 of life and what does this look like

How is this Tx

A

PDA PTX
Bronchopulmonary dysplasia
Retinopathy of prematurity

PDA: L to R shunt (systemic to pulm) as pulmonary edema/hepatomegaly

Fluid restriction w/ diuretic
Indomethacin/Ibuprofen

177
Q

How is RDS induced PTX Tx

What causes the Bronchopulmonary Dysplasia after RDS

What are the 3 RFs for this dysplasia

A

Sxs= chest tube

O2 toxicity/barotrauma

O2 dependence at 36wks old
RDS persists >14days
Prolong mechanical ventilation

178
Q

How does RDS cause Retinopathy of Prematurity

Criteria for Apnea of Prematurity

What are the two types and causes

A

O2 toxicity causes vasoconstriction in developing vessels= obliteration/blindness (term infant eyes fully vascularized- no risk)

10-20sec w/out pulmonary airflow

Central: medulla/pons don’t stimulate phrenic nerve (more common in premature infants)
Obstructive: malformation/positional

179
Q

How is Apnea of Prematurity Tx

When does this usually correct itself by?

? is the MC congenital tracheal abnormality

A

O2, Stimulants: caffeine/theophylline

36-40wks post-conceptual age

Tracheomalacia- weak/floppy tracheal wall worse during expiration (harsh, monophonic wheeze/normal voice/inspiration)

180
Q

Four possible outcomes from Meconium Aspiration Syndrome

How are non-vigorous babies w/ aspiration managed

How does aspiration appear on CXRs

A

Respiratory distress
Pneumo-nia/nitis/thorax

Suction mouth/trachia
Unsuccessful: BVM w/ PPV

Coarse, irregular infiltrates

181
Q

What causes Transient Tachypnea of the Newborn

How would this appear on CXR

When is this type of issue more commonly seen

A

Retained amniotic fluid causes hypoxia that resolves <24hrs

Fluid in fissures

C-section, LGA d/t no ‘squeeze’ during birth

182
Q

How does P-HTN in term infant present

MCC of Hemolytic Dz of newborn

What are the three reasons all newborn have an elevated bili

A

Primary: Hypoxia w/out cardiac/pulm dz and normal CXR
Non-Primary: induced L to R shunt

ABO incompatibility

Inc RBC turnover
Dec hepatic clearance/gut motility

183
Q

Neontal hyperbilirubinemia is ? levels

? is the MCC of neonatal jaundice

Define Kernicterus

A

Total Bili >5mg/dL

Hemolytic Dz of the newborn- ABO incompatability is MCC

Bilirubin Encephalopathy- indirect bili deposits in brain, disrupts neuron metabolism/function

184
Q

Early signs of Kernicterus

Late signs of Kernicterus

A 
Day 4 of life w/:
Lethargy
Emesis
Hypotonia
High pitch cry
Irritable
Poor Moro/feeding
Fever
Hypertone
Bulging fontanelle
Opisthotonic posture
Pulmonary hemorrhage
Paralysis of upward gaze
Seizures
185
Q

What are the two classifications of hyperbilirubinemia

What is a common cause of jaundice in first time mothers

What causes Adequate Intake Breast Milk Jaundice

A

Unconjugated: estimated w/ indirect (MC)
Conjugated: direct; rare but more serious

Breastfeeding jaundice- lack of adequate feeds causes dec gut motility on day 2-3 of life

Defected milk w/ conjugation inhibitor, increased hepatic recirculation d/t glucuronidase; seen on day 7-10 w/ bili rarely above 20mg

186
Q

Characteristic clues of Physiological Jaundice

Characteristic clues of Pathological Jaundice

When evaluating jaundice, ? is the first location that needs to be assessed

A

Evidence starts w/ bili at 5-6 or,
Preterm w/ bili <15 on day 5 of life:
Yellow skin started on face, moves down

Very early, very fast:
Peak bili w/in 24hrs of life in term infant
Bili rises 0.5/hr or 5mg/dl/day
Jaundice w/in 24hrs of life
Hepatosplenomegaly and anemia

Under tongue THEN sclera

187
Q

? is first line test ordered for evaluation of neonatal jaundice

How are these Tx if Mild, Mod or Severe

What are the short and long term adverse effects of neonatal phototherapy

A

Transcutaneous then serum bili

Mild: lifestyle, breast feed, sunlight
Mod: phototherapy
Sev: exchange transfusion if levels >20

Short:
Diarrhea, Dec bonding, GI hypermotility
Temp instability

Long:
Inc risk for asthma and DMT1

188
Q

What is included in a standard well visit

Define Neonate

Define Infant

A

Growth Development Imms Guidance Screenings

0-28d old

29d-1y/o

189
Q

Define Toddler

Define Pre-Schooler

Define Child

A

1-3y/o

2-5y/o

1-12y/o

190
Q

Define Adolescent

Define Growth

Define Development

A

13-18y/o

Increase in body size

Increase in function/process

191
Q

Developmental Scales are AKA ? and use ? as more more detailed screening

Define Developmental Milestones

What growth chart is used from birth to 2y/o and which one is used from 2y/o to 20y/o

A

Ages and Stages;
Denver Developmental Screening Test 2

Observable traits/actions that present/fade at predictable ages

0-2: WHO; more accurate for breast fed
2-20: CDC; accounts for time/place/obesity

192
Q

Pediatric weight percentiles/categories

How are heights predicted for fe/males

MC factor affecting growth

A

<5th: underweight
5-85th: normal
85-95th: over weight
>95th: obese

M: Paternal + Maternal/2 + 2.5
W: Paternal + Maternal/2 - 2.5

Hereditary factors

193
Q

Babies born small/premature can be expected to go through ‘catch up’ growth during ? frame

When is medical interventions indicated for deficient growth patterns

Nutrition/growth during ? pat of life predict adult stature and health outcomes

A

First 6mon

<5% w/out cause
Crosses two percentile lines w/out cause
Discrepancy between Circumference/Weight/Length

First 3yrs w/ biggest risk for stunting between 4-24mon

194
Q

It is recommended breast milk as sole nutrition source for premature infants d/t ? benefits

What are the three categories of formula

A

6mon;
Lower readmission rates
Long term IQ development

Cow milk based:
Fortified w/ Fe, no sterilization needed

Soy based:
Lactose free alternative w/ possible isoflavone effect

Casein hydrolysate:
Used when absorption/digestion problem exists, $$

195
Q

Avoid cows milk until ? age

Avoid whole milk until ? age

Do not substitute formula w/ soy milk for infants under ? age d/t ? risks

A

12mon d/t risk for GI bleed/anemia

24mon

<12mon; Scurvy Anemia Malnutrition

196
Q

What are the red flags for Gross Motor

What are the red flags for Language

A

Rolling <3mon old= inc tone
Poor head control at 5mon= dec tone
Lack of sitting at 7mon= dec tone
Hand dominance <18mon= contralateral motor abnormality

Vary pitch by 4mon
Lack of babble by 6mon
No word/gesture by 15mon
No pointing by 18mon
Less than 50% intelligible speech at 24mon
197
Q

When do Well Child Exams take place

BP is not a standard part of VS until ? age and how is it calculated

All children w/ speech delay need ? tests

A

Day 3-5
Week 2
Mon 2 4 6 9 12 15 18 24 30, then annual

After 3y/o
SBP= 80 + Age x 2
DBP= 2/3 of SBP

Hearing eval w/ tympano/audio-metry
Auditory Brain Stem Response- r/o peripheral loss

198
Q

When are anemia screenings conducted

When does cholesterol screening begin

What are the accepted cholesterol limits in kids

A

12mon if healthy
4mon if high risk

Non fasting 9-11y/o and 17-21y/o
Overweight/Obese- fasting
Parent cholesterol >240= high risk, start at 2y/o

Borderline: <170
High: >200
Acceptable LDL: <110; Border: 110-129; High: >130
HDL should be >40

199
Q

Define Active Immunity

Define Passive Immunity

Define Primary Prophylaxis

Define Secondary Prophylaxis

A

Immunity from vaccine/toxoid

Maternal Ab transfer/administration of Abs

Prevent infection before first occurrence

Prevent recurrence after first infective episode

200
Q

Rotavirus vaccine must be given w/ ? time line

? two vaccines have egg allergy cautions associated w/ them

How long should rear facing car seats be used and how long should kids ride in back seat

A

First dose before 15wks of age
2nd dose NLT 8mon

Influenza
Yellow Fever

2y/o;
Back seat until 13y/o

201
Q

Risks of tobacco smoke

Sequence of teeth eruptions at ? ages

What labs are ordered if delayed tooth eruption is present

A

LBW
SIDS
Respiratory illness- asthma
Otitis media

Deciduous: lower central incisors to upper central incisors to lateral incisors;
Permanent 6-12y/o w/ 3rd molars by 18y/o

TSH, Ca for Hypothyroid/Hypopituitary, Rickets

202
Q

Define SIDS

What stats belong to this Dx of exclusion

What therapy may be beneficial in prevention during the first year

A

Unexpected death <1y/o unexplained by autopsy/CSI and review of clinical history

Third leading cause of US infant mortality
MCC of death 1mon-12mon old

Pacifiers

203
Q

Plagiocephaly is referred if no improvement after ? long

How much lead accumulation can cause irreversible developmental/behavior abnormalities

Where are lice nits MC found and rare found

A

4-6mon

5-10ug/dL; screen at 12mon

MC: occipital, above ears
Rare: beard, pubic hair

204
Q

ABX are not used for diarrhea caused by ?

What are the 4 types of infectious diarrhea that can be Tx by ABX

Defining criteria for FTT

A

E Coli O157:H7- can induce hemolytic uremic syndrome

Shigella- Azith
Salmonella- Azith
Travelers only if bloody/febrile w/ Azith
C Diff- d/c and Tx w/ Metronidazole

Weight <3rd percentile
Crosses two major percentile lines
<80% of median weight for height

205
Q

What are the three types of FTT

How is FTT Tx

A

Wasting: deficient weight gain d/t malnutrition

Stunting: deficient linear growth w/ head circumference spared d/t months of malnutrition

Symmetric: loss of length, weight, circumference d/t malnutrition, genetics, infection or exposures

Inc calories and protein >1.5x

206
Q

What is the adverse outcome from Tx FTT

Autosomal dominant congenital malformations

Autosomal recessive congenital malformations

A

Refeeding Syndrome:
Dec metabolism forces storage for homeostasis
Rapid feeding- loss of fluid/E+; fluid retention, Hypo-Phos/Mg/K/Ca

Marfans
Achondroplasia
Huntingtons
Neurofibromatosis
Polycystic kidney

CF PKU CAH SS

207
Q

What are the X-linked congenital malformations

RFs for Downs Syndrome

What do all Pts w/ Downs need to have ordered

A 
Fragile X- excessive gene base repeats
Muscular dystrophy
Hemophilia A
G6PD deficiency
Color blindness

Inc maternal age, Parental genetics

Chromsomal analysis, + translocation= parental analysis

208
Q

What are the three forms of Trisomy 21

What will be seen on PE of Down Syndrome

What are the face characteristics

What are the extremity characteristics

A

MC- maternal non-disjunction
Translocation- part of #21 is stuck on another chromosome prior to replication
Mosaicism- rarest; pehnotypical normal Pt

General hypotonia- dec Moro reflex
Small head

Flat bridge d/t midface hypoplasia
Up slanting fissures
Macroglossia
Epicanthal folds
Dysplastic pinna

Single palmar crease
Shortened mid-5th phalanx
Wide first toe interspace

209
Q

All Down Syndrome Pts will have ?, two-thirds have ? and half will have ?

What type of hearing loss will majority have

What eye defects will they have

A

All- developmental delay
2/3: polycythemia
Half- cardiac anomalies

SNHL

Cataracts
Refractive error
Ectopic lens
Brushfield spots
Strabismus
210
Q

? x-ray finding in Down Syndrome needs immediate surgical Tx

What is the routine health care check list for all Down Syndrome Pts

? is the most preventable cause of developmental delay/intellectual disability

A

Duodenal atresia; seen as “double-bubble” sign

Hearing screening q3mon until 3y/o, then annual
Cards for Echo
Optho by 6mon then annual
Annual TSH/CBC, Celiac screen

Fetal Alcohol Spectrum D/o

211
Q

What are the classic facial features of FAS

What hand feature is seen in FAS

What developmental abnormalities are seen in FASD

A

Short palpebral fissures
Smooth philtrum
Thin upper lip

Clinodactyly- hockey stick crease

Fine motor delay
ADHD
Retardation

212
Q

How much ingestion puts fetus at risk for developing FAS

Developmental/Neuro problems seen win Fragile X Syndrome

What physical attributes will be seen

A

> 7/wk or >3 drinks per period

Hyperarousal Anxiety Mood lability Epilepsy Sterotypy- hand flap

Joint laxity
Oblong face
Hypotonia
Macro-orchidism

213
Q

How is Fragile X Syndrome definitively Dx

Define 45XO

Majority of defects arise from ? side of parents w/ ? presenting PE finding after birth

A

DNA amplification w/ direct analysis

Turner Syndrome d/t no/abnormal X

2/3 of X are maternal;
Extremity edema

214
Q

What type of mental development is seen w/ Turner Syndrome

What CV issues are usually seen

What endocrine d/os are seen

A

Poor visual-spacial skills
Superior verbal skills

Coarctation
Early onset HTN
Bicuspid aorta

Hypothyroidism
Osteoporosis
DMT1

215
Q

How is Turner’s Dx and what Dx method is not recommended

Define Klinefelter Syndrome

What issue can present

A

Direct karytotyping;
Barr body analysis

47XXY: phenotypically normal prior to puberty

Result of testosterone deficiency:
Irregular features
Violent tendencies
Severe MR

216
Q

How is Klinefelter’s screened, Dx and what would be seen on lab results

How are these Pts Tx and what are they at risk for

What type of genetic defect leads to Marfans

A

Screen: Barr body
Dx: direct karytopying
Inc LH/FSH w/ low T

T replacement
16-30x inc risk for breast Ca

Fibrillin 1 gene on Chrom #15

217
Q

What is the correlation to crying if infant is preterm

When is the diurnal variation more common

How loud can these reach

A

Little before 40wks old
More than term infant at corrected 6wks

Late afternoon/evening

80dB

218
Q

? is the MC reported behavior problem in kid 2-3y/o

When does this MC become an abnormal

How can these be prevented

A

Temper tantrums

Lasting >15min
Injury to self/others
Negative mood swings w/ tantrum
Continue past 4y/o
>5/day

Parental education at 12-18mon

219
Q

What are two labs that would be ordered for temper tantrum work ups

What is the goal of therapy for Peds w/ special needs

What will parents experience/go through after a Dx of special needs

A

Fe deficiency
Lead toxicity

Max potential for adult functioning

Kubler-Ross stages of grief

220
Q

What are possible RFs for autism

What two populations are at increased risk

More than half of Pts w/ autism will also have ? comorbid d/o and why

A 
Short pregnancy interval
Prenatal infection
Advanced parental age
Maternal obesity
Premature

Twins, Siblings

Sleep- d/t baseline melatonin abnormals

221
Q

What perinatal RF put Peds at risk for Cerebral Palsy

Done w/ Deck 4: Neuro/Psych

Average age for female puberty onset is ? age w/ Precocious defined as ?

A

Intrauterine infection

Start on Adolescent

11y/o;
6y/o in AfAm; 7 y/o in Caucasian

222
Q

Tanner stages associated w/ TAPuPMe

Completion of Tanner stages takes ? amount of time for male and female

Once female starts menarche, ? much expected height growth is expected remaining

A

Thelarche: Tanner 2
Ad/Pub: Tanner 2
Peak: one year after thelarche, tanner 3-4

Female: 4-5yrs
Male: 2.5-5yrs

2-5cm

223
Q

Boys going through puberty pass through testicular Tanner 1 to 2 at ? age

When marks onset of adrenarche for boys

Both male and female Pts going through puberty will have ? elevated lab result and ? previous issue may worsen

A

9-11y/o

Pubic then axillary <12mon later

inc ALP d/t rapid bone turnover;
Scoliosis worsens

224
Q

Normal male puberty growth sequence

Breast mass in adolescent females are usually ? type and evaluated by ?

Define Physiologic Leukorrhea

A

Testicular growth SMR 2
Pubarche
Penile growth SMR 3
Peak height velocity SMR 4

Fibroadenoma, cyst; eval w/ US

Tanner stage 3/peripuberty w/ clear, non-odorous vaginal d/c w/out pruritus

225
Q

Define Premature Thelarche

What needs to be looked for in history

Define premature adrenarche

A

Isolated breast development in Pt 6-7y/o

Estrogen exposure

Odor/Hair/Acne in female <8/male <9y/o

226
Q

Premature adrenarche causes are associated w/ ? two things

What needs to be searched for in their Hx

Define premature testelarche

A

Obesity, CNS injury

Androgen exposure

Testes >3cc or 2.5cm
<9y/o is abnormal and an endocrine emergency; 50% have brain tumor

227
Q

Define Secondary Amenorrhea

PCOS can be Dx with two of ? criteria

? is the MCC of abnormal uterine bleeding

A

Cessation of menses x3mon any time after menarche

Hyperandrogenism
Infrequent menses/secondary amenorrhea
Polycystic ovaries on US

Anovulation

228
Q

? is the mainstay of Tx for abnormal uterine bleeding in Pts w/ Von Willebrand dz

Define Primary Dysmenorrhea

Why is there pain associated w/ this condition

A

Combo E/P contraception

Pelvic pain during menstruation d/t prostaglandins/leukotrienes from degenerating epithelium

Pressure/ichemia heighten sensitivity to bradykinin

229
Q

Define Secondary Dysmenorrhea

What are the two MCCs

How is dysmenorrhea Tx

A

Menstrual pain w/ pelvic pathology

Endometriosis, PID

NSAIDs then hormones w/ f/u and re-eval in 4mon

230
Q

Most important part of sports physical

What MedHx prevents any sports activity

How long are Pts removed from sports after mono

A

Hx

Seizure, even if controlled
Stage 2/poorly controlled HTN

x28days

231
Q

? is the MC psych d/o of childhood

What are the two MC types of abuse

What types of Fxs are highly specific for abuse

A

Anxiety

1st: neglect
2nd: physical/non-accidental trauma

Rib Scapular Vertebral Spiral
Metaphyseal corner/bucket handle

232
Q

Define Moxabustion

Stages of bruising colors

Stages of bruising by days

A

Burning of moxa (mugwort) on acupunture sites

Red Blue Green Yellow Brown Gone
0-2 2-5 5-7 7-10 10-14 2-4wks

233
Q

What x-ray series is done for suspected abuse

Deficiency of ? element can mimic osteo abuse

How can the age of a Fx be estimated on x-ray

A

Skeletal survey in Peds <3y/o

Cu

7-14d: new bone/callus
14-21d: loss of Fx line, matured callus
3-6wks: dense callus
>6wks: sclerotic thickening

234
Q

What is the shaken baby triad

Hygiene hpothesis says infectious agents may be protective against ?

Why are the adverse effects of hypoglycemia in Peds more significant

A

Retinal hemorrhage
Brain swelling
Subdural hematoma

DMT1

Immature CNS is more susceptible to glycopenia

235
Q

Define DMT1 honeymoon period

How is this period measured

Inborn errors of amino acid metabolism

Inborn errors of carbs metabolism

A

Residual B-cell function

C-peptide

PKU Tyrosinemia Homocystinuria Maple syrup

Galactosemia, Hereditary Fructose intolerance

236
Q

Pts >2mon old may benefit from fever Tx if temp is higher than ?

Criteria for FOUO

Teething process rarely develops fever higher than ?

A

> 102.2

Temp >100.4 x 8d or more

> 100.4

237
Q

Febrile Pts who appear well probably have ? etiology of sickness

What are the two MCC of fever in 0-3mon old

When is HSV the cause of a fever suspected

A

Virus

EColi then GBS

Child <28days old

238
Q

Define Neonatal Sepsis Work Up <1mon old

Define Neonatal Sepsis Work Up 1-36mon

A 
Admit
CBC w/ culture
LP
US w/ culture
Empiric ABX- Ampicillin/Gentamycin
Admit
CXR if resp signs/>102.1 and WBC >20K
CBC w/ culture
US w/ culture
LP if neuro/meningeal signs
Empiric Ceftriax or Cefotax
Stool WBC and culture if diarrhea
239
Q

What is the MC reason Pts >3y/o seek medical care

Three categories of fever

Temp defines a fever

Timeline for FUO

A

Fever by benign viruses

Fever of short duration- majority, Dx by PE
Fever w/out focus/source- PE fails to Dx
Fever of unknown origin- >8d or 1wk of admission

> 100.4

> 8d w/out etiology or 1wk of admission

240
Q

How are meningitis infections established

What two organ systems will have dysfunction

? vaccine has reduced the most cases

A

Respiratory secretion/droplets

Splenic/Complement C5-8

PCV-13

241
Q

Define Rash of Meningococcemia

Most important step in the Dx process ?

What are 3 c/is for performing this step

What is the one relative c/i

A

Petechial rash evolving into purpuric lesions

LP for gram stain

Evidence of ICP other than bulging fontanelle
Severe CardioPulm compromise
Infected skin over LP site

Thrombocytopenia

242
Q

CT scans prior to LP for meningitis work ups are not recommended, what is needed prior to performing one

Pts are at higher risk for ? during encephalitis compared to during meningitis

3 complications that can remain after Tx of meningitis

A

ABX- Vanc + 3rd gen Ceftriax
Meropenum if allergic to either

Seizures

SIADH
Hearing loss
Subdural effusion from Strep Pneumo/HIB

243
Q

3 MCC of encephalitis

? complication post-measles has no Tx

? Sx can help differentiate 5th Dz from other fever rashes

A

Enteroviruses
Arboviruses- MC is west nile
Herpes virus

Subacute sclerosing panencephalitis

Pruritus

244
Q

Transplacental Ab protection time frames

Varicella has a higher mortality rate in ImmComp and ? populations

Potential complication from Varicella Zoster

A

Measles x 12mon
Rubella x 6mon
Roseola x 6mon

> 20y/o

Ramsay Hunt syndrome w/ facial paralysis and ear canal vesicles

245
Q

Two presentations of HSV

? is the MC chronic, relapsing skin dz of childhood

? genetic component plays a factor in this condition

A

Gingivostomatitis- gingiva and vermillion border

Labialis- cold sore/fever blister on membranes limited to vermillion border; MC manifestation

Atopic dermatitis/eczema

Filaggrin- epidermal structural protein

246
Q

What are the cardinal features of Atopic Dermatitis

What parts of the body are commonly involved in Peds

Cornerstone of Tx is ?

A

Pruritus w/ cutaneous reaction- ithc that raches

Face Scalp Extensor surfaces sparing diaper

Hydrocortisone ointment > cream

247
Q

? class of topical steroids are avoided in Peds

Along w/ short, warm baths, ? else can aid w/ Sx relief

What/When are topical calineurin inhibitors used

A

1-2

1/4 cup bleach bath

Pimecrolimus- mild to mod
Tacrolimus- mod to sev
Unresponsive, Intolerant to other therapies
Steroid phobia
Face/Neck dermatitis
248
Q

? systemic medication may be used for severe atopic dermatitis

What are two possible complications from this Dx

How does candida diaper dermatitis present

A

Cyclosporine 5mg/kg/day

Impetigo- Staph > GAS
Tx w/ topical mupirocin (local) Cephalexin (wide)
Eczema Herpeticum- umbilicated papules w/ crust and punched out erosion

Beefy red tender skin w/ pustules that lasts >4days

249
Q

How is candida diaper dermatitis Tx

What type of reaction is allergic contact dermatitis

What causes Seborrheic Dermatitis

A

First line: petroleum/zinc oxide barrier applied last if using multiple topicals
Low potency steroid
Nystatin/Clotrimazole

Type 4 or Delayed

Malassezia yeast

250
Q

How does Seborrheic Dermatitis present differently from atopic dermatitis

How is Infantile Seborrhea Tx

How is this Tx in children/adolescents

A

ASx circumscribed, well define (AD- ill-defined) w/ thick/greasy, yellow scales

Ketoconazole

Scalp- antifungal shampoo
Inflamed scalp lesion- Fluocinolone
Non-scalp lesion- Ketoconazole
Once controlled- antifungal shampoo qWk

251
Q

? is the MC skin d/o in adolescents

What is the mildest form of this MC

How doe males w/ this present

A

Acne Vulgaris

Comedones on central face

Trunk

252
Q

What causes perianal dermatitis and how does it present

How is it Tx

Visual acuity of new born infants is ? and legally blind defined as ?

A

GAS- well demarcated, tender skin 2cm around anus

PO PCN or Amoxicililn

20/400; 20/200

253
Q

Persistent eye deviation lasting ? long needs referral

Tears are not present until ? time

When are basic eye exams started

A

> 6mon old

1-3mon

6mon;
3-5y/o: shapes
>5y/o: snellen

254
Q

What is the Rule of 8s for vision

How can Pts w/ hyperopia/myopia present

Define Amblyopia

A

Need for vision referral:
2y/o =6=20/60
3y/o +5=20/50
Equals 8 is great, nine or more, vision poor

Hyper: Lack of reading interest
My: squinting

Central vision loss d/t inappropriate visual development

255
Q

What test ID’s which eye is having tropia

3 MCC of bacterial conjunctivitis

How is this form Tx

A

Cover test- covering unaffected eye makes affected eye move in opposite direction of deviation

HFlu Strep pneumo M catarrhalis

Topical erythromycin/polymyxin B

256
Q

Define Bleb

What DDx is considered for conjunctivitis and how is it differentiated

How do blepharitis’ present and how are they Tx

A

Bump/blister on sclera d/t contact w/ allergens

Cilliary flush- injection around limbus

Eye lid inflammation w/ photophobia/foreign body sensation;
Lid scrub w/ meibaby shampoo/topical ABX

257
Q

What microbes can cause Dacryocystitis

How is this Tx

Define Hordeolum/Stye

A

Staph A or Coag negative staph

Massage/warm water compress
Topical ABX if +drainage

Infected glands of Zeis at base of lash follicle w/ Staph A;
Tx: warm compress and NSAIDs

258
Q

Define Chalazion

How are they Tx

Common cold is MCC by ? and less commonly by ?

A

Meibomiam gland obstruction causing NON-tender/erythematous swelling

Warm compress
Resistant- refer for steroid injection/surgery

Rhinovirus > Coronavirus

259
Q

MC complication from common cold

Early and Late phase of allergic rhinitis includes ? events

? class of drug needs to be avoided in the Tx of allergic rhinitis

What are the 4 reasons we Tx Streph pharyngitis

A

Otitis media

Early: mast cell degranulation
Late: chemical mediator release

Decongestants

Prevent rheumatic fever, spread, and ENT complications
Shorten illness x 24hrs

260
Q

Define Stridor

Define Wheeze

Define Rhonchi

Define Rales/Crackles

A

Harsh, INSPIRATORY sound d/t partially obstructed airway

Expiration-
Monophasic, low pitch= lower airway obstruction
High pitch, musical= peripheral airway obstruction

Rattling secretions in airway

Crumpling cellophane d/t fluid/secretions

261
Q

What is the narrowest part of airway in Pts <3y/o

What is the narrowest part in older Peds/Adults

What is the MCC of stridor in infants

A

Cricoid ring

Glottis

Laryngomalacia- floppy larynx worse w/ swallowing/GERD

262
Q

What are the 3 DDxs for Croup and how are they r/o

MCC of airway obstructions in infants

When are CXRs always needed

A

Epiglotitis- no barking cough
Laryngomalacia- infant <6mon w/ worse Sxs w/ GERD
Bacterial tracheitis d/t Staph A: stridor, leukocytosis

Liquids

First time wheezer, especially if unilateral

263
Q

What rule is used to determine if Peds need daily anti-inflammatory meds for asthma management

What is the goal of Tx

A

Rule of Twos:
Day time 2/> per week
Night 2/> per month

Reduce need for SABA 2 or less per week (does not include exercise induced Sxs)

264
Q

Step 1 Asthma Tx

Step 2 Asthma Tx

Step 3 Asthma Tx

Step 4 Asthma Tx

Step 5 Asthma Tx

Step 6 Asthma Tx

A

1- Intermittent
SABA PRN

2- Mild
Low ICS daily

3- Moderate
Low ICS + LABA daily

4- Moderate
Med ICS + LABA daily

5- Persistent
High ICS + LABA daily

6- Persistent
High ICS + LABA + PO CCS daily

265
Q

How are pertussis exposures Tx after close contact

What are the 4 types of functional GI d/os of childhood and how are they characterized

Define GER

A

Azith x 5d
Clarith/Erythromycin x 7-14days

Pain Aerophagia IBS Dyspepsia;
Daily pain, worse in AM, unassociated w/ meals, not relieved w/ BMs and underlying tendency for anxiety/perfectionism

Effortless spitting up that is normal for Pts <12mon old as long as adequate nutrition maintained w/out respiratory/esophagitis complications

266
Q

Older Peds w/ GERD are at increased risk for ?

If formula needs to be thickened for Sx relief, how is this done

How is visceral abdominal pain perceived

A

Esohpageal strictures
Asthma
Barrett’s esophagus

1 Tbsp of rice cereal / oz of fluid

Nonmyelinated fibers w/ slow onset of poorly localized pain

267
Q

? sensation is a bases for functional abdominal pain and IBS

How is somatic pain perceived

? criteria is used for Functional GI D/os

A

Overactive visceral pain

Myelinated w/ rapid transmission of well localized pain

Rome 4: 
Recurrent pain 1d/week for past 3mon w/ two of:
Association w/ defecation
Change in stool frequency
Change in stool form
268
Q

Define Allergic Collitis

How is this Tx

Define Acute Gastroenteritis

A

Milk/Soy induced colitis and common cause of bloody stools in infants w/out N/V/ab pain

Breast fed: maternal diet modificaiton
Hydrolyzed protein formula- casein hydrolysate

Rapid onset F/D/N/V w/ 3 or more loose BMs/24hrs

269
Q

How is non-typhoid salmonella acquired

How is Campylobacter infection acquired

How is E Coli 0157 infection acquired

How is Yersinia infection acquired

A

Chicken, Reptiles

Poultry, Raw dairy

Unpasteurized dairy, under cooked beef

Chitterlings

270
Q

How are Pts w/ Acute Gastroenteritis PO rehydrated

How are these Pts re-hydrated w/ IV fluids

A

MIld: 50ml/kg over 4hrs
Mod: 100mL/kg over 4hrs
Rehydrate 10 mL/kg per each loose stool
Maintain w/ 100ml/kg over 24hrs until diarrhea stops

20mL/kg isotonic NS/LR
10mL/kg for neonates over 20min
Max of 3 boluses then admit

271
Q

Chronic diarrhea can be d/t ? two enzyme deficiencies

Chronic diarrhea can be d/t ? two allergies

? chronic GI infection can cause chronic diarrhea

A

Disaccharide- lactase
Lipase- cystic fibrosis

Celiac dz
Milk protein allergy

Giardia lamblia

272
Q

What is the function of the Foramen Ovale

What is the function of the Ductus Arteriosus

What is the function of the Ductus Venosus

A

Forament connecting atria to bypass lungs

Opening between pulmonary artery and aorta; kept open w/ Prostaglandin E to keep cyanotic lesion open

Opening between unbilical vein and IVC so placental blood can bypass liver and flow to heart

273
Q

Infants w/ congenital heart defects may present w/ ? two PE finding

What are the S1-S4 sounds

? will be heard on Pts w/ ASDs

A

Sweating during feeding
FTT

S1: M/T closure
S2: A/P closure, hidden in holosystolic murmurs
S3: volume- normal variant
S4: ventricular vibration during atrial contraction

Fixed split S2

274
Q

Clicks heard on cardiac exam indicate ? two things

What is the most important/valuable part of developing DDxs for murmurs

How are murmurs graded

A

Valve abnormality
Dilated great vessel

Timing/duration

1: very soft
2: easily heard
3: loud w/out thrill
4: loud w/ thrill
5: loud w/ thrill heard w/ stethoscope at 45*
6: heard w/ stethoscope 1cm off chest

275
Q

? abnormal EKG findings are common in Peds and how can they be confirmed as such

What is the MC symptomatic arrhythmia and how is it Tx

What 4 functional/benign murmurs are there

A

PAC w/ abnormal axis
Sinus arrhythmia d/t cholinergic input;
Inc/dec w/ in/expiration

SVT-
Stable: valsalva, diving reflex
Unstable: adenosine, synchronized cardioversion

Functional peripheral artery pulmonary stenosis
Venous hum- continuous and dec w/ Pt upright
Stills- systolic LV outflow w/ vibratory/musical quality; dec w/ upright position
Pulmonary- RV outflow

276
Q

What EKG finding is not normal for Peds

What can cause this to occur

PVCs are more common in older Pts and only need investigation if / criteria are present

A

Afib/Flutter

Post-surgical repair
Myocarditis
Drug toxicity

Syncope
FamHx sudden death

277
Q

How is V-tach Tx in Peds

Complete heart blocks are associated w/ ?

How are acquired complete blocks made

A

Sxs/Unstable: synch’d cardioversion
Concious/ASx: lidocaine or amiodarone

Maternal SLE/Sjogrens

Secondary to cardiac surgery

278
Q

MC congenital heart defect

PS is heard at ? location and radiates ?

AS is heard at ? location and radiates ?

A

VSD

LUSB to back

RUSB to neck

279
Q

Acronym for cyanotic lesions

A

HE has 5 Ts:

Hypoplastic left heart syndrome- MCC cardiac defect death in 1st month of life
Ebsteins anomaly- TR leading to PFO and cyanosis

Tetrology- MC cyanotic defect
Transposition- 2nd MC cyanotic defect
Tricuspid- no valve, hypoplastic RV
Truncus- no division of pulm artery and aorta
Total anomalous- pulmonary veins don’t connect to LA, instead connect to RA; must keep ASD open for life

280
Q

How does transposition of great vessels appear on PE

What would be seen on CXR

How is it Tx

A

Failure to pink up

Egg on a string

PGE to keep ateriosus patent

281
Q

Ebsteins anomaly may develop w/ ? maternal MedHx

What will be seen on CXR

What causes Infective Endocarditis

A

Lithium exposure

Box shaped heart

Strep Viridians trapped in fibrin mesh of leaflets
Post-Op: d/t Staph A, Coag-neg Staph

282
Q

Endocarditis is Dx by ? criteria

What are the major criteria

What are the minor criteria

A

Duke Criteria:
Two major, One major, two minor:

Blood culture x 2 >12hrs apart
One culture w/ Cox Burnetti
IgG titer >1:800
Endocardial involvement
Positive echo
Predisposing heart condition/IVDA
Fever >100.4
Vascular Sxs
Immune Sxs
Microbe evidence not meeting major critiera
283
Q

How is infective carditis d/t Strep Viridians Tx

? Pts have the poorest outcome

How are high risk Pts prophylactically managed

A

PCN G x 4wks

Fungal endocarditis

PO Amoxicillin of Clina/Azith if:
Dental, Respiratory, Skin, Muscle procedures

284
Q

? form of anemia is associated w/ systemic illnesses that impair marrow synthesis of RBCs

MC signs of anemia d/t hemolysis

Signs of anemia d/t coagulopathy/platelet dysfunction

A

Normocytic

Pallor, Jaundice

Petechiae, Purpura

285
Q

DDx for microcytic anemia

DDx for macrocytic anemia

A 
TAILS:
Thalassemia
Anemia of chornic dz
Iron deficiency
Lead
Sideroblastic
FAT RBC
Folate deficiency/Fanconi
Alcohol/Aplastic anemia
Thyroid, hypo
B12 deficiency
Cirrhosis/Chronic liver dz
286
Q

MCC of Aplastic Anemia

How is it Dx

How are they Tx

A

Idiopathic

Marrow biopsy

Hematopoietic stem cell transplant

287
Q

Intrinsic causes of hemolytic anemia

RBC membrane defect causes of hemolytic anemia

Extrinsic causes of hemolytic anemia

Systemic d/os causing hemolytic anemia

A

Thalassemia, Sickle

Spherocytosis

Immune mediated

DIC, Malignancy

288
Q

What lab results will be seen w/ hemolytic anemia

What is the function of G6PD

What lab finding is created in Pts w/ this deficiency

A

Inc bili, free hgb
Dec haptoglobin

Keeps glutathione reduced to absorb free radicals

Heinz bodies, Bite cells

289
Q

Exposure to ? can cause G6PD crisis

Dec G6PD and ? levels are Dx

Define Hemostatic Dz

A

Naphthalene Fava
Nitro ASA Primaquine Sulfa

NADPH production

Thrombocytopenia <150K
Bleeding/Trauma risk >80K
Spontaneous bleed risk <20K

290
Q

Define Adjuvant Chemo

Define Neoadjuvant Chemo

What benefits does Neo Chemo offer

A

Chemo after tumor removal

Chemo while tumor present

Shrinks tumor size
More time for surgical planning
Earlier attack on metastatic dz

291
Q

Peds w/ Ca can get ? unusual infections

MC and sometimes only presenting Sx of infection in Pts w/ Ca

Pts w/ this MC Sxs and ? need immediate admission

A

P jiroveci pneumonia
Aspergillosis
Crypto meningitis
HSV infection

Fever

Fever + Neutropenia

292
Q

What are 3 unique complications only to brain tumor Tx

? is the MC solid neoplasm outside of the CNS and MC infant malignancy

What type of cells make this MC

A

Cerebellar mutism syndrome: dec speech/behavior
Posterior fossa syndrome: HA and aseptic meningitis
Somnolence syndrome s/p radiation therapy

Neuroblastoma

Neural crease that form adrenal medulla/sympathetic NS

293
Q

Define Paraneoplastic Syndrome

What two catecholamines are tests for in neuoblastoma Dx work ups

What are the cancer presentation warning signs

A

Profuse sweating
Secretory diarrhea
Opsoclonus/Myoclonus- dancing eyes/feet

Vanillylmandelic acid
Homovanilic acid

Limp, especially if atraumatic
Adenopathy >4wks
HA
Morning vomiting
F/NS/WL
294
Q

What are the 3 types of generalized seizures

What are the 2 types of focal seizure

A

Febrile Absensce (petite) Tonic-clonic (grand)

Simple- no altered LOC
Complex- altered LOC

295
Q

What is seen during the Tonic/Clonic phase of generalized motor seizure

What occurs during the postictal phase

How are these Tx

A

Tonic: cry, eyes up, apnea, cyanosis
Clonic: spastic/rhythmic shaking

Gradual return of consciousness

Oxcarbazepine, Levetiracetem

296
Q

What differs focal seizures from others

What are absence seizures precipitated by

How are they Tx

A

Consciousness is preserved

Hyperventilation

Ethouximide

297
Q

Define Status Epilepticus

? is the MC recurrent pattern of primary HAs

Define Pseudotumor Cerebri

A

Ongoing seizure w/out return of consciousness x30min

Tension w/out N/V/phobia (light/noise)

Idiopathic Intracranial HTN- MC idiopathic or rapid onset of weight increasing ICP

298
Q

What will be seen on PE in Pts w/ Pseudotumor Cerebri

What is a potential adverse outcome

How are they Tx

A

Abducens palsy

Permanent vision loss

Acetazolamide Topiramate CCS

299
Q

3 RFs for concussion

Define Arnold Chiari Malformation types

A

Turf , BMI >27, Train <3hrs/wk

Type 1:
Cerebellar tonsils protrude through magnum into canal;
ASx early on, pregress to HA, urine frequency, LE spasticity

Type 2:
Hydrocephalus w/ myelomeningocele anomaly of hind brain d/t elongation of 4th ventricle causing stridor/weak cry/apena

300
Q

Define Dandy Walker malformation

Almost all Pt will have ? Dx

How does botulism poisoning initially present

A

Cystic expansion of 4th ventricle into posterior fossa and cerebellar hypoplasia

Hydrocephalus

Constipation, Poor feeding

301
Q

Define Duchenne Muscular Dystrophy

What will be seen on PE

? will be seen by 6y/o and ? will be seen by 12y/o

A

X-linked dystrophin gene mutation causing delayed milestones and toe walkers

Gower- clumsy/easily fatigued muscles
Pseudohypertrophy of calves d/t thigh atrophy

6: arm weakness
12: wheel chair bound

302
Q

? lab result is elevated in muscular dystrophy

What lab result may be seen after muscle biopsy

? two organs have the same embryonic origin of the ectoderm

A

CK

Inc CT in muscle

Brain ,Skin

303
Q

Congenital brain d/os are associated w/ ? abnormalities

What are the two neurocutaneous d/os and what PE findings suggest their Dx

A

Hair Skin Teeth Nails

NF-1: Cafe au lait macules
Tuberous sclerosis- adenoma sebaceum; fibrovascular lesions that look like acne on nose/malar region or Shagreen patches

304
Q

NF-1 is AKA ?

What types of cells make up the neurofibromas

90% of adults w/ NF-1 have ? cardinal feature

A

Von Recklinghausen dz- auto-dom mutation of chrom #17

Schwann

Iris hamartomas- Lisch nodules

305
Q

Criteria for Dx NF-1

A 
6 or more cafe lait spots
Axilla/Inguinal freckles
2 or more lisch nodules
2 ore more neurofibromas
Optic gliomas
1* relative w/ NF
Osseous lesions on sphenoid/long bones
306
Q

NF-2 is a defect on ? chromosome that codes for ?

Tuberous Sclerosis has ? defected genes and what they code

This is a common cause of ? infantile issue

A 
#22, merlin
NF-1: #17 that coded for neurofibromin
#9: hamartin
#21: tuberin

Spasms

307
Q

What are the 3 cardinal features of Tuberous Sclerosis

What is the MCC of death in adults w/ TS

MC variable presentation of Pts w/ Sturge Weber Syndrome

A

Adenoma sebaceum/ash leaf spots/Shagreen patch
Intellectual delay
Epilepsy

Renal angiomyolipomas

Seizure d/t ischemic brain injury

308
Q

What is the MC inherited kidney Dz

What opposite form usually presents w/ kidney failure early in childhood

? kidney malformation is associated w/ Turners

A

Autosomal dominant PKDz d/t polycystin 1 or 2 defects and w/ cerebral aneurysms

Autosomal recessive PKDz w/ portal HTN

ASx horse shoe kidney

309
Q

How is an Epididymo-Orchitis differed on exam from testicular torsion

Cryptorchidism is more common in ? population and usually don’t self resolve after ? milestone

Define Hypospadias

A

+ prehn’s sign w/ EO

Premature; 6mon- refer

Failure of ventral urethral folds to fuse

310
Q

What are the two etiologies of hypospadias

When is the ideal age for surgical correction

Fetus born w/ polyhydramnios may have ? issue

A

Congenital Adrenal Hyperplasia w/ female masculinization
Androgen insensitivity

6-12mon

Esophageal/Intestinal atresia

311
Q

What PE findings suggest tracheoesophageal fistula

A 
Drooling
Single umbilical artery
VACTERL:
Vertebral anomalies
Anal atresia
Cardiac anomaly
TEF
Renal anomaly
Limb anomaly
312
Q

How are tracheoesophageal fistulas Dx

What type of contrast agent is used

? structure is defected during diaphragmatic hernia

A

OG catheter fails to pass, coiled on CXR

Gastrografin

Pleuroperitoneal

313
Q

Intestinal atresia is associated w/ ? other issues

Define Gastroschisis

Developmental failures during gastrulation are usually accompanies by ? defects

A

Trisomy 21, CF

Open intestine d/t linear abdominal wall defect, R>L w/out umbilical involvement

CV, GU

314
Q

Necrotizing Enterocolitis is MC in ? population

? reduces incidences

How is this Tx

A

Premature <34wks and fed enterally

Human milk feeding

TNP, Broad ABX, Laparotomy

315
Q

? is the MC childhood surgery and ? causes this MC

How is this MC graded by criteria

A

Appendicitis d/t fecalith

Alvarado/Mantrels Rule:

1pt: Migrating pain Anorexia N/V Rebound pain Fever WBC >75% neutrophils
2pts: RLQ tenderness, Leukocytosis >10K

316
Q

2mon milestones

4mon milestones

A

Lifts shoulder when prone
Tracks past mid-line to search for sound
Smiles and coos

Rolls, lifts on hands, no head lag
Reaches w/ raked grasp
Look at hands, moves to toys
Laugh, squeals

317
Q

6mon milestones

9mon milestones

A

Sits
Transfers objects from hand to hand
Feeds/holds bottle
Babbles

Pulls to stand, can get into seated position
Pincer grasp/bangs objects together
Waves bye/patty cake
Non-specific two syllable words

318
Q

12mon milestones

15mon milestones

24mon milestones

A

Walks, stoops, stands
Put block into cup/drinks from cups
Immitates
Specific one/two syllable words

Walks backward
Scribbles/stacks 2 blocks
Spoon/fork
Follows commands for house work w/ 3-6 word response

Walks up and down stairs
Stacks 6 blocks
Washes hands, understands ‘today’

319
Q

What are the top 5 MCC of unintentional injuries in kids 9-18

Glasgow coma scale

What fluid needs to be avoided when giving pRBC transfusions

A

MVC Drown Burn Fall Toxin

Eye: Spontaneous Verbal Pain None
Verbal: Orient Confused Inappropriate Unspecific None
Motor: Follows Localizes Withdraws Flex Extension None

LR- causes hemolysis

320
Q

What is the primary cause of cardiopulmonary arrest in children

MC type of shock in kids

MCC of distributive shock

A

Respiratory arrest

Hypovolemic

Sepsis

321
Q

What causes dissociative shock

? are the MC types of trauma injuries in Peds

? is the 2nd and 3rd leading cause of traumatic death

A

Carbon monoxide poisoning

Head/limb injury

2nd: Thoracic trauma: MC being rib Fxs
3rd: abdominal trauma

322
Q

? is the MC abdominal organ injured in kids

What PE sign helps find this injury

What imms are needed if this MC is taken out

A

Spleen

Kehr

Pneumococcal and HFlu w/ PCN prophylaxis

323
Q

Define ALTE

What are the two MCCs

? prognostic factor is favorable after near drowning

A

Acute Life Threatening Event

GERD, Laryngospasm

Regains consciousness enroute to hospital

324
Q

Rule of 9s in infant

When is a transfer to peds burn center indicated

What ABX are used

A

Head- 18
Chest/Back: 18 each
Legs: 14
Arms: 9

> 10% TBSA in <10y/o
20% in other age groups
Face/Hand/Feet/Genital/Perenium

Silver sulfadiazine
Polymyxin B
Bacitracin
Neomycin

325
Q

Activated charcoal is ineffective against ? ingestions

? ingestions should received multiple doses

? two ingestions cause alkalinization of the urine

A

Caustic/Corrosive
Hydrocarbons
Metals: Mercury Arsenic Iron Lithium Lead
Glycols

Carbamazepine Dapsone Theophylline Phenobarbital Quinine

Salicylate, Methotrexate; bugger w/ IV BiCarb and D5

326
Q

Classic triad of narcotic poisoning

? much Narcan can be used

What is the antidote for Fe ingestion poisoning

A

Miosis
Decreased mental status
Respiratory depression

<1y/o: 1 ampule
>1y/o: 2 ampules

Deferoxamine

327
Q

When using Deferoxamine for Fe poisoning antidote, it’s use is c/i in ? Pts and may predispose them to ? sepsis

Antidote for tylenol poisoning

What lab results will be seen early/late in process

A

Renal failure, Yersinia

N-Acetylcysteine

E: respiratory alkalosis
L: metabolic acidosis w/ severe anion gap

328
Q

How is lead poisoning Tx

Methanol ingestion is converted into ?

Ethylene glycol ingestion is converted into ?

A

Edetate Ca disodium
Dimercaprol- British antilewisite; peanut allergy

Formic acid

Oxalic acid

329
Q

Methanol/Ethylene Glycol ingestions will both present w/ ?

How are they Tx

What two supplements are used during Tx

A

Metabolic acidosis

10% ethanol w/ D5
Fomepizole- alcohol dehydrogenase inhibitor

Thiamine/B6- ethylene
Folic acid- methanol

330
Q

Organophosphate poisoning causes ? syndrome

How is this Tx

Aspiration of ? compound causes lipoid pneumonitis

A

SLUDGE:
Salivation Lacrimation Urination Defecation Gastroenteritis Emesis

Atropine then Pralidoxime

Petroleum hydrocarbons

331
Q

Only time gastric lavage is used

MC foreign body ingestions

How are these ingestions Tx

A

Nicotine ingestion OD w/ charcoal and atropine

Coins

Endoscopy

332
Q

What causes anaphylactoid reactions

MC type of non-pyseal Fxs

Buckle/Torus Fxs typically occur ?

A

Non-IgE reaction to anaphylatoxins- C3/5a

Complete Fx: Comminuted Oblique Transverse Spiral

Metaphysis w/out cortex breaking d/t FOOSH

333
Q

Define Gymnast Wrist

How is this Tx

A

Distal radial physis injury from repetitive impact

Absolute rest from impact/weight bearing

334
Q

Female Tanner Stages

A

No Budy Elevates 2 Mountains in Adulthood:

1: no glandular tissue
2: buds form
3: breast elevated
4: secondary mounds
5: adult size

No Small Cat Sparing Thighs

1: no hair
2: small amount of hair
3: coarse hair
4: adult like sparing thighs
5: adult like encompassing thighs

335
Q

Male Tanner Stages

A 
Genitals:
1- child
2- enlargement, scrotal reddens
3- length
4- girth
5- adult

No Small Cat Sparing Thighs

1: no hair
2: small amount of hair
3: coarse hair
4: adult like sparing thighs
5: adult like encompassing thighs

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