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
MCC of pharyngitis is ? two microbes Define the criteria used for Dx How do the criteria score direct Tx
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
26
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
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
27
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
``` 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
28
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
Segmental atelectasis w/ perihilar infiltrates Bordatella prapertussis <3mon: admit All other age group/post-exposure: Azithromycin Alternative if >2mon old: TMP-SMX
29
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
Inc association w/ Infantile hypertrophic pyloric stenosis <7y/o: DTaP booster 7-10y/o: Tdap booster Pneumonia
30
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
Encapsulated: HIB Nmeningitidis Streppnemoa (same w/ Sickle Pts) A B C X Y W-135- MCV4 A: Africa; B: USA
31
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
Mycoplasma/Strep/Chlamydophyla pneumoniae 10d after respiratory/GI infection of M pneumoniae or Campybacter jejuni Strep pneumoniae
32
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
Functional asplenia from Sickle Cell HIV Subdural effusion- drained only if ICP/focal neuro signs Highest Peds mortality rate from bacterial meningitis
33
HIB vaccine reduces Pts risk for ? two Dxs ? medical emergency can occur w/out this vaccine What other microbes can cause this emergency
Meningitis, Epiglottitis Epiglottitis- risk of airway obstruction Vacc: GAS, Staph A, Unvacc: HIB, Diphtheria
34
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/ ?
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
35
# Define Conduct D/o What type of behaviors may be seen Opposition/Conduct D/os are screened for using ? tool
Frequent and persistent behavior that violates basic right/society norms Destruction of property Aggression to people/animals Deceit/theft Serious rule violations Vanderbilt
36
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 ?
Stimulants/Atypical antipsychotics B: hyper/impulsive or combo G: inattentive Impulsivity, Inattention
37
? 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
Core: behavior management First: Methyphenidate, Amphetamine SNRI: Atomoxetine AAgonist: Clonidine, Guanfacine Lanugo, Knuckle calluses
38
# 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
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
39
? stats does Lymphoma have Although an unknown etiology, ? association may be present What are the two types
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
40
Stats of NHL This form almost always appears as ? What are the subtypes
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
41
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
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
42
Collectively, ? is the MC malignancy in childhood and adolescence Leukemia holds ? MC stat What 5 inherrited syndromes are at increased risk for CNS tumors
CNS tumors MC childhood Ca ``` NF Li-Fraumeni Syndrome TB Turcot syndrome Von Hippel Lindau Syndrome ```
43
? genetic conditions are more susceptible to leukemia Ages 0-3 are more susceptible to ? type What are the sub-types of leukemia
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
44
Common Sxs for leukemia Common PE findings What lab findings will be seen and aid w/ Dx
Lethargy Anorexia Malaise Pallor Fever Ortho pain Hepatosplenomegaly Ecchymoses Adenopathy Petechie WBC >50K Peripheral smear/marrow aspirate w/ immature blast cells Anemia Thrombocytopenia
45
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
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
46
# Define Henoch-Schonlein Purpura This is usually seen in ? time and characterized by ?
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 ```
47
? is the MC childhood bleeding d/o How does this MC present What is the suspected etiology
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
48
What lab results will be seen w/ ITP What results would be seen after marrow biopsy How is this Tx
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
49
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
6mon or more; SLE, HIV Splenectomy X-linked; A- factor 8 deficient B- factor 9 deficient
50
If severe, how does hemophilia present What coagulation study is used for Dx How is the Dx confirmed
1st year of life w/ bleeding, hemarthrosis Prolonged PTT that corrects when mixed w/ serum Factor assay
51
How is Hemophilia Tx ? is the MC congenital bleeding d/o This MC is lacking and element, ? is it's normal function
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
52
What are the 3 sub-types of Von Willebrand Dz What lab work is ordered How are they Tx
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
53
Sickle Cell and Thalassemias are ? category of hemolytic anemias Define Thalassemia What is the make up of a normal Hgb molecule
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
54
Sickle Cell Dz is d/t an abnormality located ? Define Sickle Cell Anemia Define Sickle Cell Dz
B-chain (HbS) HbSS homozygous- HbS is 90% of total Hgb HbS is >50% of Hgb
55
# Define Aplastic Anemia What drugs can cause this What toxin can cause this What infections can cause this
Macrocytic anemia most often d/t idiopathic cause Felbamate, Chloramphenicol Benzene Mono, hepatitis
56
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
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
57
? 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
TSH Non-compliance Free T4 and TSH d/t high incidence of secondary hypothyroid
58
? 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
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
59
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
Levothyroxine in first month of life Hashimotos; AKA Chronic Lymphocytic Thyroiditis Slow linear/height growth
60
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
Thyroid Ab Consult Endo: Hypo: Levothyroxine Euthyroid w/ +Abs: f/u labs q6mon, Levo Hyper- Propranolol, Methimazole; Reassess TSH q6-8wks Liver Ca risk
61
? is the MCC of Pediatric Hyperthyroidism This is caught d/t many Pts being referred for ? issue What will lab results show
Graves ADHD Low TSH, Inc FT4, T3
62
What causes CAH How does this present in M/F
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
63
# Define Cushing Syndrome and Dz What does this lead to How is Syndrome Dx
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
64
How is Cushing Syndrome Tx based on cause Define Addison's Dz How will Pts present
Endogenous- remove ACTH secreting tumor Primary Adrenal Insufficiency d/t absence of gluco/mineral-corticoids Hyperpigmentation Salt craving Postural hypotnsion Fasting hypoglycemia
65
What lab results may be seen w/ Addisons Dz How are these Pts Tx Define Primary Amenorrhea
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
66
What is the MCC of Primary Amenorrhea Diabetes is characterized by ? and ? What are the two types
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
67
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
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
68
What are the 4 phases of DMT1 How are these Pts Tx What FamHx/genetics makes Pts more susceptible
Preclinical Clinical onset Transient remission/honeymoon Established diabetes Life long insulin Father > Mother; Twins
69
? infections may cause DMT1 What are the 3 Ps of DMT1 presentation How is Type 1/2 differed by Dx
Congenital rubella Enterovirus Mumps Polydipsia Polyuria Plyphagia Autoantibody screens
70
# Define DKA How are Pts Tx
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
71
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
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
72
Peds HgA1c goal ranges What glucose ranges are optimal What are Dawn/Somogyi Phenomenon
<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
73
What are the Sick Day Rules for DMT1 How is sliding scale established What kinds of insulin can be used and how often
``` 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
74
What are the 3 phases of Kawasakis What increases the risk for coronary artery aneurysm development during Kawasakis How is this Tx
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
75
# Define Talipes Equinovarus ? structure is MC affected ? needs to be assessed for and how are Pts managed
Clubfoot, involves entire leg w/ hypoplastic tarsals and limb muscles Talus- shortened foot Hip dysplasia; Refer to Ortho
76
# Define Legg-Calve-Perthes Dz What is a believed association/cause What is the classic presentation
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
77
? 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
Acne Vulgaris- Obstructed follicle (hyperkeratosis) Inc sebum production P acnes proliferation Blackhead- open comedome Whitehead- closed comedome Stage 1- comedomal
78
How is acne classified What are the 4 stages
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
79
How is acne Tx What OCPs can be used Define Erythema Multiforme
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)
80
Erythema Multiforme is usually precipitated by ? are triggered by ? infection What is through to be the cause of autism What screening method is used
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)
81
? is the MC foot d/o in infants and how does it present How is this MC Dx How is it Tx
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
82
MC sites for physeal Fxs What classification is used If SCFE occurs in Pts <10 or >16, ? is an appropriate referral
1: distal radius 2: distal tibia 3: distal fibula SALTR: Seperated Above Lower Through Rammed Endo
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How are SCFE imaged What is the earliest sign seen on images How is this Tx and what are the possible complications
AP, if strong suspicion/Hx- no frog leg view Physis widening w/out slippage Immediate non-weight bearing and Ortho referral; Chondrolysis, Avascular necrosis
84
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
B Henselae 6mon - 5y/o, especially if w/ epilepsy MMR + Varicella
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? infectious fever can have a febrile seizure What category are febrile seizures placed in These are the MC type of seizure in ? population
Roseola Generalized d/t them beginning diffusely 6mon-5yrs
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What are the two categories of febrile seizures How long is Febrile Status Epilepticus
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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# 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
Recurrent, unprovoked seizures Focal- arise from one region in cortex Generalized- arise from both hemispheres simultaneously Febrile seizures
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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
Glial scarring 7d after concussion Tuberous Sclerosis w/ facial angiofibromas, intellectual delay Fragile X
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What are S/Sxs of Secondary HAs What are the indications to obtain imaging What image is ordered
``` 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
90
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
Focal neuro deficit w/ migraine Basilar migraine Sxs (syncope) >1 disabling HA/wk BB TCA Anticonvulsant CCBs Antihistamines
91
# Define Second Impact Syndrome What are the 6 steps for returning to sports after a concussion
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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Historically, Cerebral Palsy is ? Dx as ? What two PE findings may be present How is an Incarcerated Inguinal hernia seen on PE
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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What side of the diaphragm is usually involved in diaphragmatic hernia Herniation MC occurs through ? foramen How is this condition Tx
L > R w/ opening in posterolateral section Bochdalek Intubation Decompression Tertiary transfer for surgery
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What causes umbilical herniation to occur What is the common type that forms These will usually self resolve unless larger than ? size
Intestines fail to completely return to abdomen at week 10 gestation Ventral: contents covered by SQ tissue/skin >2cm
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What are the two RFs for an umbilical hernia When is surgical repair indicated Umbilical hernias present similarly to ? other Dx
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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MCC of Vesicoureteral Reflux Half of males w/ a Dx of VReflux will have ? malformation VUR associated UTI/obstructions have increased risk for developing ?
Congenital Ureteovesical Junction incompetence Posterior urethral valves Reflux nephropathy
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What types of VUR rarely resolve on their own What is the average age most will self-resolve What is the goal for Tx
Bilateral 3 or 4-5 6y/o Prevent pyelonephritis or renal injury
98
What are the two categories of UTIs Most infections are caused by ? What are the RFs for these to occur
Cystitis Pyelonephritis Colinic bacteria- Ecoli Klebsiella Proteus Enterococcus Pseudomonas <1yr: uncircumcised male >1yr: healthy girl
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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
Infancy Toilet training Onset of sexual activity Adenovirus Pyelonephritis
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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
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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How are Peds w/ UTIs Tx When is re-evaluation warranted What ABX may be used
>6mon old: PO ABX Toxic/dehydrated/NPO: IV Ceftriax/Cefotax/Cefepime No response x 2d Cefdinir Amoxicillin Nitro- only in afebrile Pts TMP-SMX
102
When is imaging warranted for UTIs Define Hydrocele What are the two types
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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How do hydroceles present on PE How are these Tx ? is the MCC of intestinal obstructions prior to 3mon of age
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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What are the two RFs for Pyloric Stenosis What is the 'classic' presentation What would be seen on lab results for this MC
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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Ho are Pts w/ Pyloric Stenosis managed Defining criteria for constipation What are 3 common times this occurs
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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How is GI reflux Dx After lifestyle mod, what meds may be attempted Define Intussusception
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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What are two RFs for Intussusception ? infection can cause this issue How does this present to clinic
``` Lymphoid hyperplasia (peyer patches) Meckels ``` Rotavirus (old Rota imm) Paroxysmal pain w/ currant jelly stool and sausage mass in RUQ
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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
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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How is C Diff Tx Where are Campylobacter infections acquired from Campylobacter infection can also induce ? Neuro complication
D/c offender, PO Metronidazole Poultry, Raw milk/cheese Post-infectious Autoimmune Peripheral Neuropathy
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Celiac Dz is associated w/ ? other Dx How is this condition Dx How is the Dx confirmed
DM1 Thyroiditis Turners Trisomy 21 IgA Antiendomysial Ab IgA tissue transglutaminase Ab Endoscopic biopsy of small intestine
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What alternatives are offered during Tx of Celiac Dz Define Galactosemia How does this present
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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Pts w/ Galactosemia are at risk for ? How are these Pts Tx What issues may persist despite Tx
EColi sepsis Eliminate galactose Learning d/o Premature ovarian failure
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# Define SIDS What epidemiology stat does it own Define Pneumonia
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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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
GBS Ecoli Strep pneumo RSV** Strep pneumo HFlu Mycoplasma/Strep/Chlamydophyla pneumo
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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
Fever or Hypoxia only Apnea V: Cough Wheeze Stridor Congestion URI B: F/C/Dyspnea, auscultation findings
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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
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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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
Amoxicillin or, Cefuroxime w/ Augmentin 3rd generation cephalosporin or Augmentin Azith, Clarith, Doxy- >7y/o
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How are neonates w/ CAP Tx inpatient Infants born w/ intestinal atresia need ? DDx r/o ? enzyme difficiency can also indicate the above Dx
Ampicillin/Gentamycin PO PCN Cystic fibrosis Lipase
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When is Cystic Fibrosis tested for in routine care This condition can also cause ? issue seen prior to d/c Define Cystic Fibrosis
Newborn Screening Pathologic jaundice, direct form Autosomal recessive d/o- MC life limiting Dz in Caucasians; median 40y/o
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What mutation causes Cystic Fibrosis What tissues are affected by this Dz These Pts can suffer from chronic respiratory infections d/t ? two microbes
Transmembrane regulator gene on Chromosome#7 (508) ``` Lung Exocrine pancrease GI tract Sinus Testes ``` Staph A, Pseudomonas
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When do Cystic Fibrosis evals need to be done ? newborn screening result suggests CF What is the Dx test of choice
``` 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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How are Pts w/ CF managed Define Bronchiolitis What will be seen/heard on PE
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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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
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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How are these Pts classified How are these classification criteria changed if Pt is 0-4y/o
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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What medications are used as acute asthma meds What s/e can the rescue inhaler cause What medications offer the greatest benefit
Albuterol- Bagonist Ipatropium- anticholinergic A: anxious, tremor, tachy, hypoK Corticosteroids: Fluticasone (first line for persistent asthma)
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? 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
Montelukast Salmeterol Omalizumab- Anti-IgE monoclonal Ab IM Epi
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What is a red flag in Pts w/ Status Asthmaticus Define Still's Murmur MC etiology for pericarditis
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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When is the prognosis for pericarditis poor Stats of PDA What will be felt/heard on PE
<6mon old or recurrent Sxs 2nd MC defect Bounding pulses w/ wide pulse pressure w/ continuous machinery murmur
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How are PDAs Tx but w/ ? s/e Where does coarctation tend to occur Wheat will be seen on exam
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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? is the MC cyanotic heart defect What will be seen on lab results, CXR and EKG How are they Tx
Tetralogy of Fallot- PROV Lab: polycythemia CXR: RVH and boot shaped heart EKG: RAD Prostaglandin E1, Surgical repair
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? 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
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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How do ASDs present on PE When is intervention closure indicated Criteria for Peds White Coat Syndrome
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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? 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
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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What two findings/criteria should make a secondary cause of HTN evident What are indications for meds What meds are used
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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How is Croup Tx What are the criteria for admission When conducting new born exams, how do neck bulge locations hint at Dx
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
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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
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
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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
2nd/3rd line agent, best in concomitant asthma Immunotherapy Topical ipratropium
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How is sinusitis Tx MCC of acquired hearing loss in kids ? complication can arise from this MC and how does it present
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
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? 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
AOM Myringotomy and adenoidectomy HFlu Catarrhalis GAS Step pneumoa
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A Dx of AOM required ? criteria What is the most frequent sequelae of AOM How are Otitis Media Effusions Tx
3 of: Acute onset Effusion Inflammation OME/COM- effusion w/out any other S/Sxs NSAIDs, f/u in 4wks Should clear in 3mon
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How are recurrent cases of Otitis Media managed What vaccines should these Pts get When are children considered candidates for tube insertions
<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
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What are the MCC of Otitis Externa How does this present to clinic ? Neuro Dx commonly develops cataracts
Swimmers Ear d/t Pseudomonas or Staph A Pain, d/c w/ pinna tender to manipulation Oflox/Ciproflox, Polymyxin B, Dexamethasone NF-2
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Cataracts in kids can cause ? type of vision loss ? congenital infection can induce cataracts ? malnutrition d/o can induce cataracts
Amblyopia d/t deprivation/obstruction Rubella Galactosemia
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Direction of strabismus names Timing of strabismus names How is a pseudostrabismus r/o Any/All strabismus need ? next step
Nasal: Eso Temporal: Exo Superiro: Hyper- rare Constant: manifest strabismus/tropia Interrupted fixation: latent strabismus/phoria Normal corneal light reflex Ophth referral
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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
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
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Orbital cellulitis is a complication arising from ? Dx What microbes cause this How does Orbital Cellulitis present differently from Pre-Septal
Sinusitis Staph Strep HFlu Vision loss Pain w/ EOM Chemosis/Proptosis
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How is orbital cellulitis Tx What complication can occur
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
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How does the timing of conjunctivitis help w/ Dx the cause How is this Dx Most critical stages of embryonic development occur during ?
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
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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
Erythromycin Ceftriax Opth consult w/ Acyclovir Erythromycin or Polysporin Gentamycin ointment w/ saline irrigation
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How does post-neonatal viral conjunctivitis present This is MCC by ? microbe How is this Tx
Pre-auricular node Adenovirus Erythromycin, Polymyxin B
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Charcoal can be used for ingsted poisons w/in ? time frame This is ineffective against ? ingestion When are multiple-doses of activated charcoal given
<1hr Hydrocarbon Glycols Metal: Mercury Arsenic Iron Lead Lithium Caustic/Corrosive ``` Carbamazepine Dapsone Theophylline Phenobarbital Quinine ```
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Anion gap metabolic acidosis mnemonic
``` MUDPILES Methanol, Metformin Uremia DKA Paraldehyde Phenoformin Isoniazid, Iron Lacitc acidosis Ethanol, Ethylene glycol Salicylates, Starvation, Seizure ```
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APGAR scoring system
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
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Normal respiratory rate How does respiratory rate change w/ prematurity Normal HR and interventions done if low
30-60bpm More premature= more tachy 120-160 >100: routine 60-99: ventilation support <60: ventilation w/ compressions
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NRP compression:breath ratio How do neonates respond to hypoxia BVM is done at ? rate and in ? position
3:1 w/ two thumbs > two fingers Apnea 40-60bpm in sniffing position
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Congenital heart dz screening is done at 24hrs of life/before d/c and is interpreted how
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
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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
Laying down until 2y/o First week d/t position Prematurity; Low: <2500gm; Very: <1500gm
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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
``` Previous LBW baby Age <16, >35 Socioeconomic status Tobacco/ETOH/Drugs Poor weight gain during pregnancy Education Antenatal care ``` Hypothyroid- umbilical hernia Craniosynostosis
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# Define Caput Seccedaneum Define Cephalohematoma ? head malformation is associated w/ vacuum deliveries and how is it Tx
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
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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
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
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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
Flat acetabulum Muscle contraction limiting ROM Capsule tightening Female First FamHx Breech Oligohydramnios Postnatal swaddling position Barlow Ortolani- hip relocating anteriorly
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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
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
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How is Metatarsus Adductus Dx How are these Tx Define Talipes Equinovarus
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
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? testi/female genitalia abnormalities can be seen on newborn exam Define Spina Bifida When/How is this normally identified during pregnancy
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
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# Define Rachischisis and ? risk needs to be r/o What are the categories of Spina Bifida How is this Tx and avoided
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
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What are the primitive reflexes tested for on newborn exam What do these reflexes evaluate When do these normally disappear
Suck Moro Grasp Brain stem, Basal ganglia 4-6mon d/t increased cerebral inhibition of cerebral influences
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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/ ?
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
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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
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
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# Define Milia Define Milia Rubra Define Cutis Marmorata
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
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# Define Slate Gray Nevi Define Cafe Au Lait macules and when are further work ups indicated Nevus Simplexes are AKA ?
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
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Neonatal sepsis etiologies w/ early onsets Neonatal sepsis etiologies w/ late onsets
``` Mycoplasma GBS- MC/#1 E coli Klebsiella Listeria Salmonella ``` ``` Hflu Neisseria meningitidis CMV HSV Enterovirus Strep pneumo Staph ```
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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
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 ```
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How is Neonatal Sepsis Tx Why would Vanc be added to Tx regiment ? PE finding is a sign of neonatal respiratory distress
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 ```
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Three steps for Tx infant born to a GBS pos mother
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
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
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
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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
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
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How is RDS induced PTX Tx What causes the Bronchopulmonary Dysplasia after RDS What are the 3 RFs for this dysplasia
Sxs= chest tube O2 toxicity/barotrauma O2 dependence at 36wks old RDS persists >14days Prolong mechanical ventilation
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How does RDS cause Retinopathy of Prematurity Criteria for Apnea of Prematurity What are the two types and causes
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
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How is Apnea of Prematurity Tx When does this usually correct itself by? ? is the MC congenital tracheal abnormality
O2, Stimulants: caffeine/theophylline 36-40wks post-conceptual age Tracheomalacia- weak/floppy tracheal wall worse during expiration (harsh, monophonic wheeze/normal voice/inspiration)
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Four possible outcomes from Meconium Aspiration Syndrome How are non-vigorous babies w/ aspiration managed How does aspiration appear on CXRs
Respiratory distress Pneumo-nia/nitis/thorax Suction mouth/trachia Unsuccessful: BVM w/ PPV Coarse, irregular infiltrates
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What causes Transient Tachypnea of the Newborn How would this appear on CXR When is this type of issue more commonly seen
Retained amniotic fluid causes hypoxia that resolves <24hrs Fluid in fissures C-section, LGA d/t no 'squeeze' during birth
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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
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
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Neontal hyperbilirubinemia is ? levels ? is the MCC of neonatal jaundice Define Kernicterus
Total Bili >5mg/dL Hemolytic Dz of the newborn- ABO incompatability is MCC Bilirubin Encephalopathy- indirect bili deposits in brain, disrupts neuron metabolism/function
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Early signs of Kernicterus Late signs of Kernicterus
``` 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 ```
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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
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
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Characteristic clues of Physiological Jaundice Characteristic clues of Pathological Jaundice When evaluating jaundice, ? is the first location that needs to be assessed
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
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? 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
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
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What is included in a standard well visit Define Neonate Define Infant
Growth Development Imms Guidance Screenings 0-28d old 29d-1y/o
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# Define Toddler Define Pre-Schooler Define Child
1-3y/o 2-5y/o 1-12y/o
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# Define Adolescent Define Growth Define Development
13-18y/o Increase in body size Increase in function/process
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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
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
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Pediatric weight percentiles/categories How are heights predicted for fe/males MC factor affecting growth
<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
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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
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
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It is recommended breast milk as sole nutrition source for premature infants d/t ? benefits What are the three categories of formula
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, $$
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Avoid cows milk until ? age Avoid whole milk until ? age Do not substitute formula w/ soy milk for infants under ? age d/t ? risks
12mon d/t risk for GI bleed/anemia 24mon <12mon; Scurvy Anemia Malnutrition
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What are the red flags for Gross Motor What are the red flags for Language
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 ```
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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
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
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When are anemia screenings conducted When does cholesterol screening begin What are the accepted cholesterol limits in kids
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
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# Define Active Immunity Define Passive Immunity Define Primary Prophylaxis Define Secondary Prophylaxis
Immunity from vaccine/toxoid Maternal Ab transfer/administration of Abs Prevent infection before first occurrence Prevent recurrence after first infective episode
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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
First dose before 15wks of age 2nd dose NLT 8mon Influenza Yellow Fever 2y/o; Back seat until 13y/o
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Risks of tobacco smoke Sequence of teeth eruptions at ? ages What labs are ordered if delayed tooth eruption is present
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
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# Define SIDS What stats belong to this Dx of exclusion What therapy may be beneficial in prevention during the first year
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
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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
4-6mon 5-10ug/dL; screen at 12mon MC: occipital, above ears Rare: beard, pubic hair
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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
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
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What are the three types of FTT How is FTT Tx
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
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What is the adverse outcome from Tx FTT Autosomal dominant congenital malformations Autosomal recessive congenital malformations
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
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What are the X-linked congenital malformations RFs for Downs Syndrome What do all Pts w/ Downs need to have ordered
``` Fragile X- excessive gene base repeats Muscular dystrophy Hemophilia A G6PD deficiency Color blindness ``` Inc maternal age, Parental genetics Chromsomal analysis, + translocation= parental analysis
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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
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
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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
All- developmental delay 2/3: polycythemia Half- cardiac anomalies SNHL ``` Cataracts Refractive error Ectopic lens Brushfield spots Strabismus ```
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? 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
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
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What are the classic facial features of FAS What hand feature is seen in FAS What developmental abnormalities are seen in FASD
Short palpebral fissures Smooth philtrum Thin upper lip Clinodactyly- hockey stick crease Fine motor delay ADHD Retardation
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How much ingestion puts fetus at risk for developing FAS Developmental/Neuro problems seen win Fragile X Syndrome What physical attributes will be seen
>7/wk or >3 drinks per period Hyperarousal Anxiety Mood lability Epilepsy Sterotypy- hand flap Joint laxity Oblong face Hypotonia Macro-orchidism
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How is Fragile X Syndrome definitively Dx Define 45XO Majority of defects arise from ? side of parents w/ ? presenting PE finding after birth
DNA amplification w/ direct analysis Turner Syndrome d/t no/abnormal X 2/3 of X are maternal; Extremity edema
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What type of mental development is seen w/ Turner Syndrome What CV issues are usually seen What endocrine d/os are seen
Poor visual-spacial skills Superior verbal skills Coarctation Early onset HTN Bicuspid aorta Hypothyroidism Osteoporosis DMT1
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How is Turner's Dx and what Dx method is not recommended Define Klinefelter Syndrome What issue can present
Direct karytotyping; Barr body analysis 47XXY: phenotypically normal prior to puberty Result of testosterone deficiency: Irregular features Violent tendencies Severe MR
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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
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
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What is the correlation to crying if infant is preterm When is the diurnal variation more common How loud can these reach
Little before 40wks old More than term infant at corrected 6wks Late afternoon/evening 80dB
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? is the MC reported behavior problem in kid 2-3y/o When does this MC become an abnormal How can these be prevented
Temper tantrums ``` Lasting >15min Injury to self/others Negative mood swings w/ tantrum Continue past 4y/o >5/day ``` Parental education at 12-18mon
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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
Fe deficiency Lead toxicity Max potential for adult functioning Kubler-Ross stages of grief
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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
``` Short pregnancy interval Prenatal infection Advanced parental age Maternal obesity Premature ``` Twins, Siblings Sleep- d/t baseline melatonin abnormals
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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 ?
Intrauterine infection Start on Adolescent 11y/o; 6y/o in AfAm; 7 y/o in Caucasian
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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
Thelarche: Tanner 2 Ad/Pub: Tanner 2 Peak: one year after thelarche, tanner 3-4 Female: 4-5yrs Male: 2.5-5yrs 2-5cm
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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
9-11y/o Pubic then axillary <12mon later inc ALP d/t rapid bone turnover; Scoliosis worsens
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Normal male puberty growth sequence Breast mass in adolescent females are usually ? type and evaluated by ? Define Physiologic Leukorrhea
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
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# Define Premature Thelarche What needs to be looked for in history Define premature adrenarche
Isolated breast development in Pt 6-7y/o Estrogen exposure Odor/Hair/Acne in female <8/male <9y/o
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Premature adrenarche causes are associated w/ ? two things What needs to be searched for in their Hx Define premature testelarche
Obesity, CNS injury Androgen exposure Testes >3cc or 2.5cm <9y/o is abnormal and an endocrine emergency; 50% have brain tumor
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# Define Secondary Amenorrhea PCOS can be Dx with two of ? criteria ? is the MCC of abnormal uterine bleeding
Cessation of menses x3mon any time after menarche Hyperandrogenism Infrequent menses/secondary amenorrhea Polycystic ovaries on US Anovulation
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? 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
Combo E/P contraception Pelvic pain during menstruation d/t prostaglandins/leukotrienes from degenerating epithelium Pressure/ichemia heighten sensitivity to bradykinin
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# Define Secondary Dysmenorrhea What are the two MCCs How is dysmenorrhea Tx
Menstrual pain w/ pelvic pathology Endometriosis, PID NSAIDs then hormones w/ f/u and re-eval in 4mon
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Most important part of sports physical What MedHx prevents any sports activity How long are Pts removed from sports after mono
Hx Seizure, even if controlled Stage 2/poorly controlled HTN x28days
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? 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
Anxiety 1st: neglect 2nd: physical/non-accidental trauma Rib Scapular Vertebral Spiral Metaphyseal corner/bucket handle
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# Define Moxabustion Stages of bruising colors Stages of bruising by days
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
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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
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
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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
Retinal hemorrhage Brain swelling Subdural hematoma DMT1 Immature CNS is more susceptible to glycopenia
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# Define DMT1 honeymoon period How is this period measured Inborn errors of amino acid metabolism Inborn errors of carbs metabolism
Residual B-cell function C-peptide PKU Tyrosinemia Homocystinuria Maple syrup Galactosemia, Hereditary Fructose intolerance
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Pts >2mon old may benefit from fever Tx if temp is higher than ? Criteria for FOUO Teething process rarely develops fever higher than ?
>102.2 Temp >100.4 x 8d or more >100.4
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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
Virus EColi then GBS Child <28days old
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# Define Neonatal Sepsis Work Up <1mon old Define Neonatal Sepsis Work Up 1-36mon
``` 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 ```
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What is the MC reason Pts >3y/o seek medical care Three categories of fever Temp defines a fever Timeline for FUO
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
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How are meningitis infections established What two organ systems will have dysfunction ? vaccine has reduced the most cases
Respiratory secretion/droplets Splenic/Complement C5-8 PCV-13
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# 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
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
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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
ABX- Vanc + 3rd gen Ceftriax Meropenum if allergic to either Seizures SIADH Hearing loss Subdural effusion from Strep Pneumo/HIB
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3 MCC of encephalitis ? complication post-measles has no Tx ? Sx can help differentiate 5th Dz from other fever rashes
Enteroviruses Arboviruses- MC is west nile Herpes virus Subacute sclerosing panencephalitis Pruritus
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Transplacental Ab protection time frames Varicella has a higher mortality rate in ImmComp and ? populations Potential complication from Varicella Zoster
Measles x 12mon Rubella x 6mon Roseola x 6mon >20y/o Ramsay Hunt syndrome w/ facial paralysis and ear canal vesicles
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Two presentations of HSV ? is the MC chronic, relapsing skin dz of childhood ? genetic component plays a factor in this condition
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
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What are the cardinal features of Atopic Dermatitis What parts of the body are commonly involved in Peds Cornerstone of Tx is ?
Pruritus w/ cutaneous reaction- ithc that raches Face Scalp Extensor surfaces sparing diaper Hydrocortisone ointment > cream
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? 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
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 ```
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? systemic medication may be used for severe atopic dermatitis What are two possible complications from this Dx How does candida diaper dermatitis present
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
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How is candida diaper dermatitis Tx What type of reaction is allergic contact dermatitis What causes Seborrheic Dermatitis
First line: petroleum/zinc oxide barrier applied last if using multiple topicals Low potency steroid Nystatin/Clotrimazole Type 4 or Delayed Malassezia yeast
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How does Seborrheic Dermatitis present differently from atopic dermatitis How is Infantile Seborrhea Tx How is this Tx in children/adolescents
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
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? is the MC skin d/o in adolescents What is the mildest form of this MC How doe males w/ this present
Acne Vulgaris Comedones on central face Trunk
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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 ?
GAS- well demarcated, tender skin 2cm around anus PO PCN or Amoxicililn 20/400; 20/200
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Persistent eye deviation lasting ? long needs referral Tears are not present until ? time When are basic eye exams started
>6mon old 1-3mon 6mon; 3-5y/o: shapes >5y/o: snellen
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What is the Rule of 8s for vision How can Pts w/ hyperopia/myopia present Define Amblyopia
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
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What test ID's which eye is having tropia 3 MCC of bacterial conjunctivitis How is this form Tx
Cover test- covering unaffected eye makes affected eye move in opposite direction of deviation HFlu Strep pneumo M catarrhalis Topical erythromycin/polymyxin B
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# Define Bleb What DDx is considered for conjunctivitis and how is it differentiated How do blepharitis' present and how are they Tx
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
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What microbes can cause Dacryocystitis How is this Tx Define Hordeolum/Stye
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
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# Define Chalazion How are they Tx Common cold is MCC by ? and less commonly by ?
Meibomiam gland obstruction causing NON-tender/erythematous swelling Warm compress Resistant- refer for steroid injection/surgery Rhinovirus > Coronavirus
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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
Otitis media Early: mast cell degranulation Late: chemical mediator release Decongestants Prevent rheumatic fever, spread, and ENT complications Shorten illness x 24hrs
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# Define Stridor Define Wheeze Define Rhonchi Define Rales/Crackles
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
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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
Cricoid ring Glottis Laryngomalacia- floppy larynx worse w/ swallowing/GERD
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What are the 3 DDxs for Croup and how are they r/o MCC of airway obstructions in infants When are CXRs always needed
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
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What rule is used to determine if Peds need daily anti-inflammatory meds for asthma management What is the goal of Tx
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)
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Step 1 Asthma Tx Step 2 Asthma Tx Step 3 Asthma Tx Step 4 Asthma Tx Step 5 Asthma Tx Step 6 Asthma Tx
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
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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
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
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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
Esohpageal strictures Asthma Barrett's esophagus 1 Tbsp of rice cereal / oz of fluid Nonmyelinated fibers w/ slow onset of poorly localized pain
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? sensation is a bases for functional abdominal pain and IBS How is somatic pain perceived ? criteria is used for Functional GI D/os
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 ```
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# Define Allergic Collitis How is this Tx Define Acute Gastroenteritis
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
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How is non-typhoid salmonella acquired How is Campylobacter infection acquired How is E Coli 0157 infection acquired How is Yersinia infection acquired
Chicken, Reptiles Poultry, Raw dairy Unpasteurized dairy, under cooked beef Chitterlings
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How are Pts w/ Acute Gastroenteritis PO rehydrated How are these Pts re-hydrated w/ IV fluids
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
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Chronic diarrhea can be d/t ? two enzyme deficiencies Chronic diarrhea can be d/t ? two allergies ? chronic GI infection can cause chronic diarrhea
Disaccharide- lactase Lipase- cystic fibrosis Celiac dz Milk protein allergy Giardia lamblia
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What is the function of the Foramen Ovale What is the function of the Ductus Arteriosus What is the function of the Ductus Venosus
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
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Infants w/ congenital heart defects may present w/ ? two PE finding What are the S1-S4 sounds ? will be heard on Pts w/ ASDs
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
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Clicks heard on cardiac exam indicate ? two things What is the most important/valuable part of developing DDxs for murmurs How are murmurs graded
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
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? 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
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
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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
Afib/Flutter Post-surgical repair Myocarditis Drug toxicity Syncope FamHx sudden death
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How is V-tach Tx in Peds Complete heart blocks are associated w/ ? How are acquired complete blocks made
Sxs/Unstable: synch'd cardioversion Concious/ASx: lidocaine or amiodarone Maternal SLE/Sjogrens Secondary to cardiac surgery
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MC congenital heart defect PS is heard at ? location and radiates ? AS is heard at ? location and radiates ?
VSD LUSB to back RUSB to neck
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Acronym for cyanotic lesions
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
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How does transposition of great vessels appear on PE What would be seen on CXR How is it Tx
Failure to pink up Egg on a string PGE to keep ateriosus patent
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Ebsteins anomaly may develop w/ ? maternal MedHx What will be seen on CXR What causes Infective Endocarditis
Lithium exposure Box shaped heart Strep Viridians trapped in fibrin mesh of leaflets Post-Op: d/t Staph A, Coag-neg Staph
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Endocarditis is Dx by ? criteria What are the major criteria What are the minor criteria
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 ```
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How is infective carditis d/t Strep Viridians Tx ? Pts have the poorest outcome How are high risk Pts prophylactically managed
PCN G x 4wks Fungal endocarditis PO Amoxicillin of Clina/Azith if: Dental, Respiratory, Skin, Muscle procedures
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? 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
Normocytic Pallor, Jaundice Petechiae, Purpura
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DDx for microcytic anemia DDx for macrocytic anemia
``` 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 ```
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MCC of Aplastic Anemia How is it Dx How are they Tx
Idiopathic Marrow biopsy Hematopoietic stem cell transplant
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Intrinsic causes of hemolytic anemia RBC membrane defect causes of hemolytic anemia Extrinsic causes of hemolytic anemia Systemic d/os causing hemolytic anemia
Thalassemia, Sickle Spherocytosis Immune mediated DIC, Malignancy
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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
Inc bili, free hgb Dec haptoglobin Keeps glutathione reduced to absorb free radicals Heinz bodies, Bite cells
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Exposure to ? can cause G6PD crisis Dec G6PD and ? levels are Dx Define Hemostatic Dz
Naphthalene Fava Nitro ASA Primaquine Sulfa NADPH production Thrombocytopenia <150K Bleeding/Trauma risk >80K Spontaneous bleed risk <20K
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# Define Adjuvant Chemo Define Neoadjuvant Chemo What benefits does Neo Chemo offer
Chemo after tumor removal Chemo while tumor present Shrinks tumor size More time for surgical planning Earlier attack on metastatic dz
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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
P jiroveci pneumonia Aspergillosis Crypto meningitis HSV infection Fever Fever + Neutropenia
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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
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
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# Define Paraneoplastic Syndrome What two catecholamines are tests for in neuoblastoma Dx work ups What are the cancer presentation warning signs
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 ```
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What are the 3 types of generalized seizures What are the 2 types of focal seizure
Febrile Absensce (petite) Tonic-clonic (grand) Simple- no altered LOC Complex- altered LOC
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What is seen during the Tonic/Clonic phase of generalized motor seizure What occurs during the postictal phase How are these Tx
Tonic: cry, eyes up, apnea, cyanosis Clonic: spastic/rhythmic shaking Gradual return of consciousness Oxcarbazepine, Levetiracetem
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What differs focal seizures from others What are absence seizures precipitated by How are they Tx
Consciousness is preserved Hyperventilation Ethouximide
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# Define Status Epilepticus ? is the MC recurrent pattern of primary HAs Define Pseudotumor Cerebri
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
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What will be seen on PE in Pts w/ Pseudotumor Cerebri What is a potential adverse outcome How are they Tx
Abducens palsy Permanent vision loss Acetazolamide Topiramate CCS
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3 RFs for concussion Define Arnold Chiari Malformation types
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
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# Define Dandy Walker malformation Almost all Pt will have ? Dx How does botulism poisoning initially present
Cystic expansion of 4th ventricle into posterior fossa and cerebellar hypoplasia Hydrocephalus Constipation, Poor feeding
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# Define Duchenne Muscular Dystrophy What will be seen on PE ? will be seen by 6y/o and ? will be seen by 12y/o
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
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? 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
CK Inc CT in muscle Brain ,Skin
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Congenital brain d/os are associated w/ ? abnormalities What are the two neurocutaneous d/os and what PE findings suggest their Dx
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
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NF-1 is AKA ? What types of cells make up the neurofibromas 90% of adults w/ NF-1 have ? cardinal feature
Von Recklinghausen dz- auto-dom mutation of chrom #17 Schwann Iris hamartomas- Lisch nodules
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Criteria for Dx NF-1
``` 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 ```
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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
``` #22, merlin NF-1: #17 that coded for neurofibromin ``` ``` #9: hamartin #21: tuberin ``` Spasms
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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
Adenoma sebaceum/ash leaf spots/Shagreen patch Intellectual delay Epilepsy Renal angiomyolipomas Seizure d/t ischemic brain injury
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What is the MC inherited kidney Dz What opposite form usually presents w/ kidney failure early in childhood ? kidney malformation is associated w/ Turners
Autosomal dominant PKDz d/t polycystin 1 or 2 defects and w/ cerebral aneurysms Autosomal recessive PKDz w/ portal HTN ASx horse shoe kidney
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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
+ prehn's sign w/ EO Premature; 6mon- refer Failure of ventral urethral folds to fuse
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What are the two etiologies of hypospadias When is the ideal age for surgical correction Fetus born w/ polyhydramnios may have ? issue
Congenital Adrenal Hyperplasia w/ female masculinization Androgen insensitivity 6-12mon Esophageal/Intestinal atresia
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What PE findings suggest tracheoesophageal fistula
``` Drooling Single umbilical artery VACTERL: Vertebral anomalies Anal atresia Cardiac anomaly TEF Renal anomaly Limb anomaly ```
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How are tracheoesophageal fistulas Dx What type of contrast agent is used ? structure is defected during diaphragmatic hernia
OG catheter fails to pass, coiled on CXR Gastrografin Pleuroperitoneal
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Intestinal atresia is associated w/ ? other issues Define Gastroschisis Developmental failures during gastrulation are usually accompanies by ? defects
Trisomy 21, CF Open intestine d/t linear abdominal wall defect, R>L w/out umbilical involvement CV, GU
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Necrotizing Enterocolitis is MC in ? population ? reduces incidences How is this Tx
Premature <34wks and fed enterally Human milk feeding TNP, Broad ABX, Laparotomy
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? is the MC childhood surgery and ? causes this MC How is this MC graded by criteria
Appendicitis d/t fecalith Alvarado/Mantrels Rule: 1pt: Migrating pain Anorexia N/V Rebound pain Fever WBC >75% neutrophils 2pts: RLQ tenderness, Leukocytosis >10K
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2mon milestones 4mon milestones
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
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6mon milestones 9mon milestones
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
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12mon milestones 15mon milestones 24mon milestones
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'
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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
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
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What is the primary cause of cardiopulmonary arrest in children MC type of shock in kids MCC of distributive shock
Respiratory arrest Hypovolemic Sepsis
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What causes dissociative shock ? are the MC types of trauma injuries in Peds ? is the 2nd and 3rd leading cause of traumatic death
Carbon monoxide poisoning Head/limb injury 2nd: Thoracic trauma: MC being rib Fxs 3rd: abdominal trauma
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? 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
Spleen Kehr Pneumococcal and HFlu w/ PCN prophylaxis
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# Define ALTE What are the two MCCs ? prognostic factor is favorable after near drowning
Acute Life Threatening Event GERD, Laryngospasm Regains consciousness enroute to hospital
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Rule of 9s in infant When is a transfer to peds burn center indicated What ABX are used
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
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Activated charcoal is ineffective against ? ingestions ? ingestions should received multiple doses ? two ingestions cause alkalinization of the urine
Caustic/Corrosive Hydrocarbons Metals: Mercury Arsenic Iron Lithium Lead Glycols Carbamazepine Dapsone Theophylline Phenobarbital Quinine Salicylate, Methotrexate; bugger w/ IV BiCarb and D5
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Classic triad of narcotic poisoning ? much Narcan can be used What is the antidote for Fe ingestion poisoning
Miosis Decreased mental status Respiratory depression <1y/o: 1 ampule >1y/o: 2 ampules Deferoxamine
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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
Renal failure, Yersinia N-Acetylcysteine E: respiratory alkalosis L: metabolic acidosis w/ severe anion gap
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How is lead poisoning Tx Methanol ingestion is converted into ? Ethylene glycol ingestion is converted into ?
Edetate Ca disodium Dimercaprol- British antilewisite; peanut allergy Formic acid Oxalic acid
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Methanol/Ethylene Glycol ingestions will both present w/ ? How are they Tx What two supplements are used during Tx
Metabolic acidosis 10% ethanol w/ D5 Fomepizole- alcohol dehydrogenase inhibitor Thiamine/B6- ethylene Folic acid- methanol
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Organophosphate poisoning causes ? syndrome How is this Tx Aspiration of ? compound causes lipoid pneumonitis
SLUDGE: Salivation Lacrimation Urination Defecation Gastroenteritis Emesis Atropine then Pralidoxime Petroleum hydrocarbons
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Only time gastric lavage is used MC foreign body ingestions How are these ingestions Tx
Nicotine ingestion OD w/ charcoal and atropine Coins Endoscopy
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What causes anaphylactoid reactions MC type of non-pyseal Fxs Buckle/Torus Fxs typically occur ?
Non-IgE reaction to anaphylatoxins- C3/5a Complete Fx: Comminuted Oblique Transverse Spiral Metaphysis w/out cortex breaking d/t FOOSH
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# Define Gymnast Wrist How is this Tx
Distal radial physis injury from repetitive impact Absolute rest from impact/weight bearing
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Female Tanner Stages
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
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Male Tanner Stages
``` 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