Peds UWorld Flashcards
0
Q
Macrocytic anemia, low retic count, and congenital anomalies?
A
- think: diamond-blackfan syndrome
- AKA: congenital hypo plastic anemia
1
Q
5 Early Ssx of congenital syphilis?
A
- Hepatosplenomegaly
- Cutaneous lesions
- Jaundice
- Anemia
- Rhinorrhea
2
Q
Metatarsus adductus: what is it? Types? Tx?
A
- congenital foot deformity
- more commonly seen in first born infants
- 3 types & tx:
1. Type I - mild, feet over correct with passive and active mvmnt - tx = reassurance
2. Type II- feet correct to mid line with passive and active mvmnt - tx = orthosis (corrective shoes)
3. Type III - rigid feet that do not correct at all - tx = serial casts
3
Q
What cancers does breast feeding reduce the mothers risks for?
A
- Breast
2. Ovarian
4
Q
Patient with Down syndrome who presents with upper motor neuron findings?
A
-think: alantoaxial instability
5
Q
Genetics of fragile X?
A
-mutation in FMR1 gene, caused by an increased number of CGG trinucleotide repeats
6
Q
What is Reye syndrome AKA?
A
-fatty liver encephalopathy
7
Q
What is given to close a PDA?
A
- indomethacin
- potent prostaglandin inhibitor
8
Q
What is given to keep PDA open?
A
-prostaglandin E1
9
Q
Alantoaxaial instability: what is it? Who is it commonly seen in? Ssx?
A
- presents over a few weeks
- commonly seen in Down syndrome
- due to laxity of transverse ligament that causes spinal cord compression btwn the atlas and axis
- upper motor neuron ax present
- Ssx: behavioral changes, torticollis, urinary incontinence, & vertebrobasilar Ssx (dizziness, vertigo, diploplia)
10
Q
Asymmetry of inguinal folds in an infant or neonate?
A
- worry about developmental dysphasia of the hip
- get ultrasound (if < 6 mnths old) or xray ( > 6 mnths)
11
Q
What should be done with an anyphylacyic rxn, encephalopathy, seizure, or any other CNS complication occurs within 7 days after getting DTaP?
A
- give DT should be given instead
- adverse rxns are assumed to be from the pertussis portion
12
Q
What is the most common cause of communicating hydrocephalus?
A
-subarachnoid hemorrhage
13
Q
Marfan features + mental retardation + thromboembolic events + downward dislocation of lenses?
A
-homocystinuria
14
Q
Bruton’s agammaglobulinemia: what immunoglobulin concentrations are seen?
A
- igA, igM, igD, and igG are decreased (ALL)
- absence of B cells too!
15
Q
Homocystinuria: what is it? Cause? Genetics? Tx?
A
- autosomal recessive
- caused by cystathionine synthase deficiency
- tx: high doses of bit B6
16
Q
4 Ssx of homocystinuria?
A
- Marfan’s features
- Mental retardation
- Thromboembolic events
- Downward dislocation of lenses
17
Q
Tx for tricyclic antidepressant intoxication?
A
-sodium bicarbonate
18
Q
How is chlamydial conjunctivitis prevented?
A
- maternal prenatal testing and tx of mothers chlamydia
- ophthalmic prophylaxis given at birth does not prevent chlamydial conjunctivitis, only gonorrheal
19
Q
5 Reasons an umbilical hernias should be referred to surgery?
A
- If they persist to age 3-4yrs
- Larger than 2 cm in diameter
- Causes symptoms
- Becomes strangulated
- Enlarges progressively from ages 1-2
20
Q
Caput succedaneum?
A
- diffuse swelling of the scalp
- can be ecchymotic (bruised/discolored)
- can extend across the midline and across suture lines
21
Q
3 Complications of orbital cellulitis?
A
- Orbital abscess
- Intracranial infection
- Cavernous sinus venous thrombosis
22
Q
Metaphysis?
A
-wide portion of a long bone
23
Q
Hemarthrosis after minor trauma in a young child?
A
- suggests bleeding disorder
- ex hemophilia
24
Tx for infants when ruling out sepsis: in a < 28 day old? In an infant > 1 mnth?
- < 28 days = ampicillin & gentamicin
| - > 1 mnth = vancomycin & ceftriaxone
25
Triad of HUS?
1. Thrombocytopenia
2. Anemia
3. Renal failure
26
3 Ssx of necrotizing enterocolitis? 2 findings on xray, why?
1. Increased gastric residual volume
2. Vomiting
3. Abdominal distention
* *in a preterm neonate!!!!!
- xray: pneumatosis intestinalis + portal venous air! --> air is from gas produced by bacterial overgrowth
27
3 Most common causes of acute bacterial rhinosinusitis?
1. Strep pneumo
2. Nontypeable H. Influenza
3. Moraxella catarrhalis
28
Tx for strawberry hemangiomas?
- none!
| - usually regress by ages 5-8 yrs
29
Most common cause of osteomyelitis in infants and kids?
-staph aureus
30
What is the most common cause of cerebral palsy?
-cerebral anoxia
31
"Target sign" on abdominal ultrasound?
-intussusception
32
Classic triad of congenital toxoplasmosis?
1. Chorioretinitis
2. Hydrocephalus
3. Intracranial calcifications
33
Tx for impetigo?
1. Topical mupirocin
| 2. Oral erythromycin
34
What is thought to be the best way to decrease the rates of necrotizing enterocolitis in premature infants? Why?
- breast feeding all premies if possible!
| - why: premies intestines may have increased permeability due to immaturity, breast milk may help counteract this
35
What is the most common cause of secondary HTN in kids?
-fibromuscular dysplasia
36
Wiskott-Aldrich syndrome triad? Most common of the 3?
1. Thrombocytopenia (most common!) --> due to decreased platelet production
2. Eczema
3. Recurrent bacterial infections
37
What are the 3 causes if anemia of prematurity?
1. Transitions in erythropoiesis sites of the neonate
2. Shorter lifespan of RBCs in neonates
3. Low fetoplacental transfusion --> occurs when the baby is held above the level of the placenta after delivery
38
Iron deficiency anemia in infants: common? Presentation? 3 things that increase risk?
- most common nutritional deficiency in infants and children
- often asymptomatic
- full term infants are born with enough iron stores to prevent them from developing deficiency until age 4-6 mnths, regardless of dietary intake
- increase risk:
1. Maternal iron deficiency (w/ breast feeding)
2. Prematurity
3. Cow's milk before age 12 mnths
39
Describe the murmur of VSD?
-pansystolic murmur that is loudest at the left lower sternal border + diastolic flow murmur at apex
40
Tx for OCD?
- high-dose selective serotonin reuptake inhibitors (ex. Fluoxetine)
41
Cyclic vomiting syndrome: what is it? Etiology? Possible complications? Tx?
- recurrent, self-limiting episodes of vomiting and nausea in children in the absence of any apparent cause
- etiology: unclear, but more common in pts who have parents with migranes
- complications: dehydration and anemia
- tx: anti-emetics & reassurance
42
4 Common ssx of necrotizing enterocolitis? What is seen on xray?
1. Feeding intollerance
2. Increasing abdominal girth
3. Bloody stools
4. Vomiting
- see pneumatosis intestinalis on xray
43
3 Ssx of niacin deficiency?
1. Diarrhea
2. Dementia
3. Dermatitis
* *vitamin B3 deficiency = pellagra
44
For how long is bed wetting normal?
- until age 5
| - boys usually do it longer than girls
45
Todd's paralysis?
- postictal paralysis that can follow generalized or focal seizures
- motor deficit rapidly improves and is back to normal within 24 hrs
- usually indicates a structural abnormality underlying the seizures
46
Absent or hypoplastic thumbs + depression of all cell lines? Pathophysiology?
- think: fanconi anemia
| - pathophysiology: spontaneous chromosomal breaks
47
Breastfeeding failure jaundice v. Breast milk jaundice: what is it? When does it present? Tx?
failure jaundice:
-feeding insufficiency results in insufficient caloric intake
-occurs in 1st week of life
-tx: promote and support successful breast feeding
Milk jaundice:
-factor of human milk increases bilirubin enterohepatic circulation
-unconjugated hyperbilirubinemia from third week of life on
-tx: stop breast feeding temporarily if the bilirubin level is markedly increased, otherwise no tx
48
Most common cyanotic congenital heart defect at birth?
-transposition of great vessels
49
4 Common facial features of fetal alcohol syndrome?
1. Smooth philtrum
2. Thin vermillion border
3. Small palpebral fissures
4. Microcephaly
50
Legg-Calve-Perthes disease: what is it? When is it commonly seen? How does it usually present? Dx?
- what: idiopathic osteonecrosis (avascular necrosis) of the femoral head
- when: boys 4-10 yrs, most commonly 7 yrs
- how present: pain of insidious onset and antalgic gait
- Dx: may take a while for changes to be shown on xray, clinical suspicion needed, and repeat xray
51
Reye syndrome: what is it? Common presentation? Tx?
- rare syndrome that is seen only in children <15 who are treated with aspirin for a viral illness
- common presentations: vomiting, agitation, and irrational behavior, progresses to lethargy, stupor, and restlessness
52
What is the most common congenital heart disease associated with Edward's syndrome?
-VSD
53
What is the most common cause of pulmonary infections in CF pts? Tx?
- pseudomonas aeruginosa
| - tx: aminoglycoside (ex tobramycin) + antipseudomonal penicillin (ex piperacillin)
54
4 Red flags for orbital cellullitis?
1. Decreased visual acuity
2. Diplopia
3. Opthalmoplegia
4. Proptosis
55
Syncopal episode (w/out post-episode confusion) + hearing impairment + family hx of sudden cardiac death?
-think: congenital long QT syndrome
56
4 Ssx of intussusception?
1. Sudden onset of abdominal pain
2. Vomiting
3. Red currant jelly stools that contain blood and mucus
4. Abdominal mass
57
Tx of intussusception?
-air or water-soluble contrast enema
58
What are 3 classical signs of posterior urethral valves that can be seen on prenatal ultrasounds?
1. Bladder distension
2. Bilateral hydroureters
3. Bilateral hydronephrosis
59
What embryonic structure do neuroblastoma masses arise from?
-neural crest cells
60
4 Ssx of cri-du-chat syndrome? Genetics?
1. Microcephaly
2. Hypotonia
3. Short stature
4. Cat-like cry
- genetics = deletion of 5p!
61
Describe chronic pyelonephritis findings on IV pyelogram?
1. Blunting of calices
| 2. Focal parenchymal scarring
62
What should be done about a swallowed battery?
- if in esophagus = remove
| - if distal to the esophagus = most pass uneventfully, so they only need to be observed
63
Tx for lyme dz in kids < 8 yrs old?
-amoxicillin
64
Tx of necrotizing enterocolitis?
1. Empiric broad-spectrum antibiotics bc of the serious risk of lethal septic shock if perforation occurs
2. Surgical intervention
65
5 Ssx of Beckwith-Wiedermann syndrome? What must they be monitored closely for?
1. Macrosomia
2. Macroglossia
3. Umbilical hernia/omphalocele
4. Hemihyperplasia
5. Hypoglycemia
- monitor closely for Wilms tumor or hepatoblastoma!!
66
What os the cause of meningitis that is accompanied by a petechial or purpuric rash?
-Neisseria meningitis!!!
67
What congenital heart defect is associated with William's syndrome?
-supravalvular aortic stenosis
68
Myotonic congenital myopathy?
- muscle weakness and atrophy (esp in the distal muscles of the upper and lower extremities)
- myotonia
- testicular atrophy
- baldness
- autosomal dominant
69
What is the most common cause of hip pain in children? Tx?
- transient synovitis
| - tx: NSAIDs + rest
70
What is terminal deoxynucleotidyltransferase? What is it expressed in?
- TdT
- only expresses by preB and preT lymphoblasts
- positive in 95% of ALL pts
71
Failure to thrive, bilateral cataracts, jaundice, and hypoglycemia in newborn?
-think: galactosemia from galactose-1-phosphate uridyl transferase deficiency
72
5 Ssx of measles?
1. Coryza
2. Conjunctivitis
3. Cough
4. Koplik's spots
5. Maculopapular rash that begins on face
* *5 "C" sounds!
73
3 most common manifestations of polycythemia in newborns?
1. Respiratory distress
2. Poor feeding
3. Neurologic manifestations
74
3 Most common causes of neonatal jaundice?
1. Breast milk jaundice
2. Hematologic
3. Sepsis --> so work up all jaundice for sepsis if you dont know the underlying cause!!
75
Drug of choice for congenital long QT syndrome?
-beta-blockers!!!
76
What occurs in partial seizures with secondary generalizations?
-tonic-clonic manifestations --> diffuse muscle aches & elevated CPKs
77
Max oz of cows milk that 1-5yr olds should consume a day?
-20oz!
78
5 Ssx of HSP?
1. Palpable purpura
2. Hematuria
3. Abdominal pain
4. Arthralgias
5. Scrotal swelling --> occasionally
79
Triad for congenital rubella syndrome?
1. Sensorineurial deafness
2. Cardiac malformations
3. Cataracts
80
What is often the earliest manifestation of sickle cell anemia in pts?
- dactylitis
| - vaso-occlusion of hands and feet
81
What to do for a unimmunized pt exposed to varicella zoster?
- normal = give vaccine
| - immunocompromised = give varicella Ig within 10 days of exposure
82
Pertussis prevention of close contacts of an infected pt?
-14 days of erythromycin, no matter how old they are, their immunizations, or sx!
83
When does VSD usually present? How?
- usually at 6 wks
| - presents w/: tachypnea & failure to thrive
84
Parinaud's syndrome? Where is the lesion? What is probably the cause?
- syndrome = paralysis of vertical gaze, can be associated with pupillary disturbances and eyelid retraction (Collier's sign)
- means there is a lesion in the rostral midbrain at the lever of the superior colliculus and CN III
- usually caused by germinomas and pinealomas
85
Which peds patients is orthostatic proteinuria common in?
-adolescent boys
86
Top 3 bacterial causes of otitis media (in order)?
1. Strep pneumo
2. H. Influenzae
3. Moraxella catarrhalis
87
3 Common ssx of trachoma? Caused by? Tx?
1. Follicular conjunctivitis
2. Pannus of the cornea = neovascularization
3. Concurrent infection of nasopharynx with nasal discharge
- caused by chlamydia trachomatis
- tx: topical tetracycline or oral azithromycin
88
Presentation of choledochal cysts in infants?
1. Jaundice
| 2. Acholic stools
89
2 tx of absence seizures?
1. Ethosuximide
| 2. Valproic acid
90
Tx of galactosemia?
-galactose-free diet!
91
What 3 types of seizures have loss of conciousness?
1. Generalized seizures
2. Partial seizures with generalization
3. Complex partial seizures
92
Orbital cellulitis: what is it? 3 Ssx?
- serious bacterial infection
- Ssx:
1. Pain with extraocular movements
2. Visual impairments
3. Opthamoplegia
93
Serum sickness-like rxn: what is it? When is it commonly seen?
- hypersensitivity rxn that occurs 1-2 wks after administration of certain drugs
- NOT a true drug allergy!
- common drugs: (if given for a viral illness)
1. Penicillin
2. Amoxicillin
3. Cefaclor
94
6 Ssx of compartment syndrome?
1. Sever pain
2. Pallor
3. Poikilothermia
4. Paresthesias
5. Pulselessness --> late finding
6. Paralysis --> late finding
95
Confirmatory test for SLE?
-anti-smith antibody test
96
Tx of clubfoot?
- initially: stretching and manipulation of the foot (starting immediately!)
- then: serial plaster casts, malleable splints, or taping
- if unresponsive: surgery
97
What happens to benign murmurs of kids when they stand up or perform the valsalva manuver?
-decreases in intensity!
98
What is the most common cause of chronic inspiratory noise in infants? Tx? Prognosis?
- laryngomalacia
- tx: hold child in upright position for half an hour after feeding, and never feed child when he is lying down
- usually resolves by 18mnths
99
What is the most common cyanotic congenital disease in kids less than 4 yrs old?
-tetralogy of fallot
100
Traction apophysitis of the tibial tubercle: AKA?
-Osgood-Schlatters Disease
101
Osgood-Schlatters Disease: AKA?
-traction apophysitis of the tibial tubercle
102
What are the most common fractures in pediatrics? Most common complication of this fracture?
- supracondylar fractures
| - complication: entrapment of the brachial artery = loss of radial a. Pulse
103
Neonate with non-bilious, projectile and persistent vomiting? What to do next?
- think pyloric stenosis
| - do abdominal ultrasound next
104
Common presentation for neonatal enterocolitis (3)?
1. Abdominal distention
2. Vomiting
3. Frank blood in stools
105
What is mitral valve stenosis almost always due to?
-rheumatic fever as the result of a group A strep infection
106
Thymus in CXR?
- thymus can be very lg on CXR of kids < 2 yrs old
- located in the anterior, superior mediastinum, behind the sternum
- thymus can overlap the heart un infants = "sail sign"
- thymus can be lg and can be mistaken for: cardiomegaly, lung infiltrates, atelectasis, or a mediastinal mass
107
3 Ssx of androgen excess in males with precocious pubarche? Cause?
1. Coarse axillary hair
2. Coarse pubic hair
3. Severe cystic acne that is resistant to tx
- caused by late-onset (AKA: nonclassical) adrenal hyperplasia caused by 21-hydroxylase deficiency
108
6 Indications for the evaluation of neonatal jaundice?
1. Hyperbilirubinemia of > 2 mg/dL
2. Jaundice that appears in first 24-36 hrs of life
3. Serum bili that is rising faster than 5mg/dL/24 hrs
4. Serum bili > 12 mg/dL in full-term (esp in absence of risk factors) or of 10-14 in premeies
5. Jaundice persists after 10-14 days of life
6. Signs or symptoms
109
What congenital GI issue can be seen in newborns of moms who took cocaine during pregnancy?
- jejunal or ileal atresia
| - bc cocaine is vasoconstrictor & causes a vascular accident in utero
110
What 2 things can be seen on plain xrays and CT scans in neuroblastoma?
1. Calcifications
2. Hemorrhages
* * most commonly in the abdomen
111
"Squirt sign"
- rectal examination causes explosive expulsion of gas and stool from temporary relief of an obstruction
- positive in hirschsprung
- negative in meconium ileus
112
Scarlet fever v kawaski, whats the big feature that can help separate them?
- scarlet fever: NO mucous membrane involvement = NO conjunctivitis
- Kawasaki dz: mucus membrane involvement = conjunctivitis!
113
Tx/workup of simple febrile seizures?
- no work up needed
| - tx: reassurance
114
3 Ssx of cholesteatoma?
1. New-onset of hearing loss
2. Chronic ear drainage despite antibiotic tx
3. Granulation and skin debris seen on otoscopy
115
Cholesteatoma?
- destructive and expanding cystic growth in the middle ear and/or mastoid proccess
- consists of keratinizing squamous epithelium
- can be acquired (secondary to chronic middle ear infection) or congenital
116
3 Ssx of McCune Albright syndrome?
1. Precocious puberty
2. Cafe au lait spots (Pigment) = they are lgr than in NF, have irregular borders, and not in axilla or groin
3. Multiple bone defects = Polyostotic fibrous dysplasia
* * 3 Ps
117
5 Possible long term sequelae associated with bacterial meningitis?
1. Hearing loss
2. Loss of certain cognitive functions
3. Seizures
4. Mental retardation
5. Spasticity or paresis
118
Pancytopenia following drug intake, exposure to toxins, or viral infection?
-Think: aplastic anemia!
119
When is chelation tx used in lead posioning?
-when the serum lead levels are 45 or greater
120
What is the cut off for small for gestational age?
-Birth weight less than the 10th percentile
121
What is PANDAS?
- Pediatric Autoimmune Neuropsychic Disorders Associated with strep infections
- onset of OCD ssx after a group A strep
122
3 Common features of IgA deficiency?
1. Recurrent sinopulmonary infections (w/ strep & hemophilus)
2. Recurrent GI infections (w/ giardia)
3. Anaphylactic reactions to transfusions
123
Honey-colored crusted exudates?
- impetigo!
| - ALWAYS when you see those words!!!!
124
Tx for immune thrombocytopenia?
-corticosteroids are the drug of choice, but only if the platelet count is <30,000
125
What should be obtained when a hemophilia is suspected?
-factor VIII and IX levels
126
Growing pains?
- bilateral lower extremity pains that occur at night in kids aged 2-12 yrs
- no systemic ssx, normal activity levels, normal physical exam!
127
4 abnormalities in tetrology of fallot?
1. VSD
2. Overriding aorta
3. Pulmonary stenosis
4. RVH
128
What causes measles?
-paramyxovirus
129
Presentation of Late-onset CAH in females?
- presents in adolescence with:
1. Acne
2. Irregular menses
3. Mild hirsuitism
- hard to distinguish from PCOS sometimes
130
Constitutional growth delays?
1. Delayed growth spurt
2. Delayed puberty
3. Delayed bone age w
131
What type of seizure is an aura indictive of?
-partial seizure from a specific focus of the brain
132
What does RSV increase the risk for?
-asthma later in life
133
5 Ssx of henoch-schonlein purpura?
1. Palpable purpura on the lower extremities
2. Arthralgias
3. Abdominal pain
4. Renal dz
5. IgA depsition in the kidney on immunoflorescence
* *vasculitis of small vessels
134
2 Causes of "floppy baby" syndrome?
1. Infant botulism
| 2. Werdnig-hoffman syndrome
135
Tx for tinea corporis?
- antifungal
| - ex terbinafine
136
What is a "Sunburst" on x-ray classical for?
- osteosarcoma
- most common primary bone tumor in children and young adults
- usually seen at the metaphysis of long bones
137
Preterm infant with respiratory distress that is not responding to oxygen tx? Tx?
- think: hyaline membrane dz!
| - tx: mechanical ventilation + surfactant
138
Friedreich ataxia: what is it? What 3 organ systems are involved? 2 Most common causes of death?
- most common type of spinocerebellar ataxia
- 3 systems:
1. Neurologic = ataxia & dysarthria
2. Skeletal = scoliosis & foot deformities
3. Cardiac = concentric hypertrophic cardiomyopathy
- 2 Most common causes of death:
1. Cardiomyopathy
2. Respiratory complications
139
What should be done in a child < 24 mnths with their first febrile UTI?
- tx with 7-14 days of oral antibiotics
| - renal and bladder ultrasound for any anatomical abnormalities
140
Wilms tumor tx and prognosis?
- lungs are the most common site metastatic spread, but children rarely present with pulmonary sx
- tx: surgery + chemo
- survival rates are excellent, esp in earlier stages of dz
141
Tx of migraines in peds?
- acetominophen or other NSAIDs
| - supportive management
142
Toddler with firm, smooth, unilateral mass and hematuria?
-think: Wilms tumor
143
Most common cardio malformation in marfan's syndrome?
-aortic root dilation
144
What is the most common cause of polycythemia in term infants?
- delayed clamping of the umbilical chord --> excess transfer of placental blood to infant
- hematocrit > 65%
145
Decreased pulmonary markings on CXR?
-means there is pulmonary undercirculation
146
Spondylolisthesis?
- developmental disorder with a forward slip of the vertebrae that mainfests in preadolescent kids
- ssx:
1. Back pain
2. Neurologic dysfunction (ex urinary incontinence)
3. Palpable "step-off" at lumbosacral area
147
Failure to pass meconium within first 24 hrs?
-think: hirschsprung disease
148
Premature pubarche: what is it? Clinical significance?
- pubic hair growth < 8 yrs old
| - 50% of the time associated with a CNS disorder
149
Whey v. Casein in breast milk?
- 70% whey
- 30% cassein
- whey is more easily digested & it helps to improve gastric emptying
150
Chronic granulomatous disease?
- defect in NADPH-oxidase system of phagocytic cells
| - prone to abcesses secondary to catalase-producing organisms, like aspergillius and staphylococcus
151
What is the fluid of choice when resuscitating in severe hypovolemic hypernatremia?
-isotonic, normal saline = 0.9% saline
152
What are the most common causes of pediatric myocarditis? How do they typically present (4)?
- viruses: 1. Coxsackie 2. Adenovirus
- presentation:
1. Lethargy
2. Fever
3. Signs of heart failure
4. Viral prodrome
153
Renal tubular acidosis: in general what is it?
- normal anion gap metabolic acidosis
- caused by a defect in the ability of the renal tubules to resorb bicarb or excrete hydrogen
- there are 3 types
154
Werdnig-Hoffman syndrome?
- degeneration of anterior horn cells and cranial nerve motor nuclei
- causes floppy baby syndrome
- autosomal recessive
155
2 Ssx of aplastic crisis in sickle cell anemia? What is it? What can cause it? Tx?
1. Acute severe anemia
2. Low or absent reticulocytes
- arrest of erthropoiesis
- can be caused by infections, ex. Parvovirus B19
- tx: blood transfusion
156
Describe the ventricular septal defect ,urmur?
-holosystolic murmur that is the loudest at the left lower sternal border
157
Tx of pertussis?
- macrolides (ex amoxicillin)
| - tx should be based on clinical suspicion, dont wait for the confirmatory dx
158
Pediatric CNS tumors: what is more common supratentorial or infratentorial? What is the most common type?
- infratentorial is more common
| - astrocytomas are the most common histologic type
159
What is the nursemaid's elbow? Ssx?
- subluxed radial head that results from a pulling injury
| - ssx: child keeps hand in pronated position and cries/refuses attempted forearm supination
160
Serum iron and TIBC in iron deficiency anemia?
- serum iron is decreased
| - TIBC is increased
161
Glucose in CSF for bacterial v viral meningitis?
- bacterial = low glucose
| - viral = normal glucose
162
Olive-sized mass palpable in the abdomen?
-pyloric stenosis!!
163
What does posterior vermis syndrome cause?
-truncal dystaxia
164
Juvenile angiofibroma: tx?
- some dont need tx
- bc can bleed easily, should only be touched by specialists
- tx is required if its:
1. Enlarging
2. Obstructing airway
3. Causing chronic nosebleeds
165
Niemann-Pick's disease?
- sphingolipidosis due to a deficiency in sphingomyelinase
| - sphingomyelin accumulates in the reticuloendothelial cells of the liver, spleen, bone marrow, and brain
166
Most common heart defect in infant of GDM?
-TGA
167
Most common cause of sepsis in a sickle cell anemia pt? Why?
- strep pneumo
| - its encapsulated and they are functionally asplenic
168
What are 2 important predisposing factors of brain abcesses?
1. Congenital heart disease
| 2. Recurrent sinusitis
169
Ssx of Riboflavin deficiency?
- non-specific and usually mild
- rarely seen in industrialized countries!
- B2
- Ssx: sore throat, hyperremic and edematous oropharyngeal membranes, cheilitis, stomatitis, glossitits, normocytic-normochromic anemia, seborrheic dermatitis, and photophobia
170
Precocious puberty, cafe au lait spots, and multiple bone defect?
-McCune-Albright syndrome
171
Cradle cap?
-seborrheic dermatitis
172
Inspiratory "whoop"?
- pertussis
| - AKA: "whooping cough"
173
If an infant is infected with Hep B via vertical transmission, what is the chance that they will progress to chronic hepatitis?
-90% chance
174
What is commonly seen with complex partial seizures?
-automatisms during loss of conciousness
175
Normal anion gap metabolic acidosis in infants that causes a FTT?
-renal tubular acidosis
176
What does it mean if a murmur changes with position?
-its probably an innocent murmur
177
What is the deficiency in Lesch-Nyhan syndrome?
- hypoxanthine-guanine phosphoribosyl transferase (HgPRT)
| - think: "he's got purine recovery trouble"
178
First-line tx of bacterial OM?
-10 day course of amoxicillin
179
Most common cardio congenital defect in down syndrome?
-endocardial cushion defect
180
5 Possible complications of small for gestational age?
1. Hypoxia
2. Polycythemia
3. Hypoglycemia
4. Hypothermia
5. Hypocalcemia
181
Genes coding for what are mutated in osteogenesis imperfecta?
-type I collagen
182
What is the most common presentation for meckle's diverticulum? In what ages?
- painless melena
| - 2-3 yr old kids
183
Tx of preseptal cellulitis v orbital cellulitis?
- preseptal cellulitis = outpatient oral antibiotics
| - orbital cellulitis = inpatient IV antibiotics
184
Most common early symptom of Cavernous sinus thrombosis?
-headache that eventually becomes unbearable
185
Hemophilic arthropathy?
- consequence of recurrent hemarthrosis
- seen in hemophilia A & B
- associated with hemosiderin deposition in the joint space --> synovitis and fibrosis
186
Typical features of glucose-6-phosphatase deficiency?
- 3-4mnth child presenting with:
1. Hypoglycemia
2. Lactic acidosis
3. Hyperuricemia
4. Hyperlipidemia
5. Characteristic doll-like face (fat cheeks)
6. Thin extremities
7. Short stature
8. Protuberant abdomen (from enlarged liver)
187
Left axis deviation on EKG and decreased pulmonary marking on CXR in a neonate?
- think: tricuspid valve atresia
- will see cyanosis in child
- normally infants are born with a large right ventricle, which will be seen as right axis deviations on EKG
188
Ewing sarcoma: what is it? Who is it usually seen in? Common x-ray findings?
- What: second most common primary bone malignancy in kids
- who: most commonly seen in adolescent boys
- xray: osteolytic lesions + periosteal rxn that looks like "onion skin"
189
What portion of the bowel is usually affected in hirschsprung disease?
-rectosigmoid
190
Acute fever, joint pain, turbid synovial fluid, neutrophil-predominant leukocytosis? Tx?
- think: septic arthritis
| - tx: emergency surgical drainage + IV antibiotics
191
Tx for an infant born to a mom with active hep B?
- passive immunization at birth with hep B immune globulin
| - plus recombinant HBV vaccine
192
Most common predisposing factor for orbital cellulitis? 2 Reasons why?
- bacterial sinusitis
- why:
1. Proximity
2. The orbital venous system is valveless!!
193
Tx of cat bites?
-should be tx prophylactically with a five-day course of ammoxicillin/clavulante (augmentin)
194
5 Major criteria for rheumatic fever?
- use Jones criteria (think "J<3 - carditis
3. subcutaneous Nodules
4. Erythema marginatum
5. Sydenham chorea
195
Treatment of TET spell?
- knee-chest position
| - beta-blocker to decrease afterload
196
Strawberry v. Cherry hemangioma?
- strawberry in infants
| - cherry in adults
197
5 Common physical features of Edward's syndrome?
1. Micrognathia
2. Microcephaly
3. Rocker bottom feet
4. Overlapping fingers
5. Absent palmar creases
198
3 Main Ssx of prader-willi syndrome?
1. Hypotonia
2. Hyperphagia
3. Obesity
199
What is the best thing to do with a child who is reluctant to potty training?
-take a break from potty training for a couple months and let him/her get interested in potty training on their own
200
What is the most common cause of intestinal obstruction during the first two years of life?
-intussusception
201
Collier's sign?
- eyelid retraction
| - usually due to a lesion in the rostral midbrain
202
Tx for kawasaki dz?
1. Aspirin
| 2. IV Ig
203
Gastroschisis: what is it? How does it present? Initial tx?
- congenital abdominal wall defect
- bowel protrudes through defect
- bowel is not covered by membrane
- bowel looks "angry" & matted
- usually not associated with any other abnormalities
- tx: cover bowel with sterile dressings ASAP!
204
What leukemia has a strong PAS rxn?
-ALL
205
2 most common organisms that cause orbital cellulitis?
1. Strep pneumo
| 2. Staph aureus
206
What is the most common cause of anemia in sickle cell patients?
-chronic hemolysis
207
Fibromuscular dysplasia: physical exam? Which side is more often effected? What is seen on angiogram?
- PE: hum or bruit in costovertebral angle due to well-developed collaterals
- right renal a. is often more affected than left
- angiography: see "string of beads" sign
208
7 Ssx of congenital hypothyroidism?
Normal at birth & gradually develop:
1. Apathy
2. Weakness
3. Hypotonia
4. Large tongue
5. Sluggish movements
6. Abdominal bloating
7. Umbilical hernia
209
Diagnostic study of choice for an acute alkali ingestion?
-upper gastrointestinal endoscopy
210
Common Wilms tumor presentation?
- age 2-5 yrs old
- asymptomatic abdominal mass found incidentally
- most often unilateral
211
2 Complications of HSP?
1. Intussusception --> bc of bowel wall edema
| 2. Gastrointestinal hemorrhage
212
What type of seizures has automatisms?
-complex partial seizures
213
What is the most common cause of acute and recurrent headaches in kids?
-migraines
214
What should be done when intravenous access cannot be obtained in an emergent peds case?
-intraosseous access should be tried next!
215
Sfx of desmopressin?
- if too much water is consumed it can cause hyponatremia and seizures!
- used for enuresis
216
Inflamed, fluctuant cervical lymph nodes are cause by which 2 bacterial infections usually? Tx?
1. Strep
2. Staph
- tx: dicloxacillin
217
Langerhans histiocytosis: how does it present? Prognosis? Tx?
- solitary, lytic, long bone lesion
- lesions can be painful, have overlying tender swelling, and can cause pathological fractures
- prognosis: can be locally destructive, but typically resolve spontaneously
- tx: conservative
218
Tx of choice for strep pharyngitis?
-penicillin
219
Dx of pertussis?
-Cultures and/or PCR of nasopharyngeal secretions
220
Osteosarcoma: what is it? Who is it typically seen in? Where? How does it typically present? What does it look like on x-ray?
- What: most common primary bone tumor in children and young adults
- who: boys ages 13-16 are most at risk
- where: usually involves the metaphyses of long bones
- presentation: large tender mass on PE, may also have elevated alk phos and lactate dehydrase (from turnover of damaged osteocytes --> worse prognosis)
- xray: classically see "sunburst" pattern
221
4 Most common causes of aquired torticollis? First thing for dx?
1. URIs
2. Minor trauma
3. Cervical lymphadenitis
4. Retropharyngeal abscess
- dx: cervical spine radiograph to make sure there is no fracture or dislocation!
222
What to do with a child who has a serum lead level of less than 20?
- recheck the level in one month
| - council the parents on lead safety
223
Most common CAH?
-21 hydroxylase deficiency
224
What can be a consequence of trauma to the soft palate by a foreign body?
-internal carotid artery dissection that causes a stroke in children
225
Describe the murmur of mitral stenosis?
-loud first heart sound and mid-diastolic rumble
226
What congenital infection is the "blueberry muffin" rash seen in?
-congenital rubella
227
Post-tussive emesis?
- pertussis
| - AKA: whooping cough
228
6 Ssx of cavernous sinus thrombosis (CST)?
1. Headache --> early sign
2. Periorbital edema --> usually starts unilaterally, but then becomes bilateral
3. Exopthalmos
4. Chemosis (= edema of conjunctiva)
5. Papilledema
6. Dilated tortuous retinal veins
229
Abnormal B-lymphocyte maturation?
- present after 6 mnths of age (when the levels of maternal antibodies drop)
- predisposed to recurrent sinopulmonary infections with encapsulated organisms, like H. Influenza & strep. Pneumo
- also have a deficiency in IgA = predisposes to giardia GI infections
230
Chemosis?
-swelling of the conjunctiva
231
Where is Lyme disease most common in the US?
-northeastern or upper midwestern United States
232
What is the expected weight and height of a child at 12 months?
- weight should triple from birth
| - height should increase by 50% from birth
233
2 most common causes of microcytic anemia in children?
1. Iron deficiency anemia
| 2. Thalasemmia minor
234
What PCO2 level is suggestive of impending respiratory failure?
-PCO2 > 40
235
What is a thrill? Grade?
- its a palpable murmur
| - at least grade 4
236
What 2 ssx does Niemann-Pick's disease have that Tay-Sach's doesnt?
1. Hepatosplenomegaly
| 2. Cervical lymphadenopathy
237
When does vascular ring stridor present? What improves it? What else can it be associated with?
- presents before age 1
- persistent stridor that improves with neck extension
- associated with cardiac abnormalities
238
Most common cardiovascular abnormalities in Turner's syndrome?
- coarctation of the aorta
| - aortic valve abnormalities
239
Transient proteinuria: what is it? Dx?
- Proteinuria that is intermittent, common in school-aged kids
- can be caused by fever, exercise, seizures, stress, or volume depletion
- dipstick test shows protein in urine --> check for hematuria --> if negative, repeat dipstick 2 other times
240
What does it mean to have a leukocyte adhesion deficiency?
- the leukocytes are unable to exit the vasculature and migrate to areas of infection or inflammation
241
Blood-stained eye discharge in a newborn?
-highly characteristic of chlamydial comjunctivits!
242
Cyanosis, single loud second heart sound, and no murmur in the first few hours of life? Explain why?
- transposition of the great vessels
- cyanosis: deoxygenated blood comes from the body and goes into the RA and goes back into the aorta = 2 separate, unconnected circuits
- loud single S2: aorta is closer to the anterior chest wall, so its better heard than the soft s2 of the pulmonic valave
- no murmur: foramen ovale and ductus arteriosus have closed
243
Jervell-Lange-Nielson syndrome?
- congenital long QT syndrome
1. Congenital deaftness
2. Syncopal episodes
3. Family Hx = autosomal recessive
- molecular defects in ion channels
244
Seborrheic dermatitis: common locations? Tx? What can severe cases suggest?
- common locations:
1. Eyebrows
2. Nasolabial folds
3. Bases of eyelashes
4. Paranasal skin
- tx: moisturizers, topical antifungals, anti-dandruff shampoos, and topical steroids
- severe cases can = immunodeficiency
245
Presentation of jejunial atresia? What is seen on Xray? What is one main risk factor?
- presentation:
1. Bilious vomiting
2. Abdominal distention
- Xray = triple bubble sign
- risk = maternal use of cocaine and other vasoconstrictive drugs
246
The rash of what disease is described as "sandpaper-like"?
-scarlet fever
247
When is Guillain-Barre syndrome seen? Pathology?
- Ascending polyneuropathy typically seen one week after a viral infection
- pathology: involves mainly the peripheral motor nerves, but sensory and automatic can also be affected
248
X-linked agammaglobinemia: what is it? What is commonly seen in these pts? What is typically seen in the labs? Tx?
- what: inherited immune deficiency
- recurrent bacterial infections early in life
- labs: normal amnt if T lymphocytes, but low or absent amnt of B lymphocytes
- tx: regular infusions of IVIg
249
7 Contraindications to breast feeding?
```
Maternal:
1. Active, untreated TB
2. HIV infection
3. Herpetic breast lesion
4. Varicella infection
5. Specific meds/chemo tx
6. Street or alcohol abuse
Infant:
7. Has galactosemia
```
250
2 Ssx of Waterhouse-Friderichsen syndrome?
1. Sudden vasomotor collapse
2. Large purpuric lesions on flanks p
* *both due to adrenal hemorrhage
251
What has been shown to reduce the morbidity and mortality with measles?
-vitamin A
252
Cause of transient synovitis?
-unknown, but usually follows a viral infection or mild trauma
253
When is croup most common? What are 4 common symptoms?
- most common btwn 6 mnths - 6 yrs
- ssx:
1. "Barky" cough
2. Fever
3. Rhinorrhea
4. Congestion
254
What is not required in neonates before an LP that is required in older kids? Why?
- head CT is not needed to look for ICP
| - bc the fontanelles are still open, it is very rare that a neonate will herniate after an LP!
255
Choledochal cysts? How many types? Most common tupe?
- congenital abnormality of biliary ducts
- dilation of intra or extra-hepatic biliary ducts, or both
- 5 types, most common = type 1--> dilation of entire common hepatic and common bile ducts or segments of each
256
What acid/base abnormality and electrolyte disturbances are usually seen in pyloric stenosis?
-hypochloremic, hypokalemic, metabolic alkalosis
257
Neonatal abstinence syndrome: what is it? When does it usually present? Ssx? Tx?
- NAS = infant withdrawal to opiates
- usually presents in the first few days of life
- ssx:
1. Iritability
2. High-pitched cry
3. Poor sleeping
4. Tremors
5. Seizures
6. Sweating
7. Sneezing
8. Tachypnea
9. Poor feeding
10. Vomiting
11. Diarrhea
258
4 Common ssx of orbital cellulitis?
1. Pain with eye mvmnts
2. Proptosis
3. Opthalmoplegia
4. Diplopia
259
What is the most common cause of anemia in kids with sickle cell dz?
-hemolytic anemia
260
What fluid should be given for moderate to severe dehydration in children?
- iV bolus of isotonic fluid
261
Other than new born screening, how can you test for PKU?
-Guthrie test of urine = coloration test that detects the presence of metabolic products of phenylalanine in urine
262
Diastolic murmurs are always what?
-pathologic!
263
Recurrent sinopulmonary infections, recurrent GI infections, & anaphylactic rxn to transfusion?
-think: IgA deficiency!
264
Postpericardiotomy syndrome?
- pleuropericardial disease that occurs days to months after cardiac surgery or injury
- inflammation from surgical site can lead to reactive pericarditis, pericardial effusion, or even cardiac tamponade
- difficulty feeding can be a sx in infants
265
What are the three phases of pertussis? How long do they last if untreated?
1. Catarrhal phase = nonspecific sx of malaise, mild fever, cough, rhinorrhea, etc --> lasts 1-2 wks
2. Paroxysmal phase = severe paroxysms of coughing spells that can lead to post-tussive emesis + can have "inspiratory whoop"
3. Convalescent phase = gradually decreasing frequency and severity of cough
* *can last for 3 mnths total if untreated!
266
Cystic calcified parasellar lesion on MRI is almost diagnostic of what?
-craniopharyngioma
267
Most common viral cause of myocarditis?
-coasacki
268
Two top viral causes of otitis media?
1. RSV
| 2. Rhinovirus
269
What type of hypersensitivity rxn is allergic contact dermatitis?
- cell-mediated hypersensitivity
- type IV
- delayed
270
Tx for enuresis?
- desmopressin
| - used only after behavior modifications and bed alarms havent worked!
271
When should chronic granulomatous disease be considered?
-with recurrent or unusual lymphadenitis, hepatic abcesses, osteomyelitis at multiple sites, or unusual infections with catalase-positive organisms
272
Abnormality in Marfan's?
-mutation in fibrillin-1 gene
273
2 tx for enterobiasis?
- AKA: pinworm
1. Albendazole
2. Mebendazole
274
What is the next step when meconium ileus is suspected in a newborn?
- barium enema --> can break up the obstruction
| - surgery required if the enema is unsuccessful
275
Most common cause of congenital hypothyroidism in the US?
-thyroid dysgenesis
276
How does infantile corarctation usually present?
- after child goes home the PDA closes and causes a left sided obstructed lesion in the heart
- child presents with heart failure and shock!
277
What does it mean when there is delayed umbilical cord separation?
-leukocyte adhesion deficiency type I
278
Adult botulism v infantile botulism?
- adult = ingestion of preformed toxin
| - infantile = ingestion of the organism via food (ex honey) and produces the toxin in the intestinal tract
279
Presentation of choledochal cysts in children?
1. Abdominal pain
2. Jaundice
3. Attacks of recurrent pancreatitis w/ increased amylase and lipase levels
280
4 Manifestations of osteogenesis imperfecta?
1. Blue sclera
2. Hearing loss
3. Recurrent fractures
4. Opalescent teeth
281
What 3 conditions are early childhood vision screens looking for? What are the recommended ages to do theses screens?
1. Strabismus
2. Amblyopia
3. Refractive errors
- recommended to screen ages 0-5yrs
282
What is the most common pathogen that causes unilateral cervical lymphadenopathy?
-staph aureus
283
Dx of meckle's diverticulum?
-technetium-99m pertechnetate scanning --> taken up by the heterotrophic gastric mucosa
284
Cephalohematoma: what is it? Presentation? Tx?
- subperiosteal hemorrhage
- presents a few hours after birth
- scalp swelling limited to one cranial bone
- tx: none, usually resolves in 2 wks - 3 mnths depending on the size
285
What 2 types of seizures can have an aura?
1. Simple partial seizures
| 2. Complex partial seizures
286
What is the most common nutritional deficiency in infants?
-iron deficiency anemia
287
What should be done if a finger stick blood test for lead level is positive?
-should check the serum lead level, since the capillary test can give false positives
288
What screening test should be done in all children with behavioral concerns?
- hearing test
| - undetected hearing impairment can often get confused with a behavioral disorder
289
5 Ssx of Niemann-Pick's disease?
1. Cherry red macula
2. Protruding abdomen
3. Hepatosplenomegaly
4. Lymphadenopathy
5. Regression of developmental milestones
290
Triple bubble sign and has less colon on abdominal X-ray?
-think: jejunal atresia!
291
Paroxysmal cough?
- pertussis
| - AKA: whooping cough
292
When is laryngomalacia stridor most common? What worsens it? Improves it?
- most severe at ages 4-8 mnths
| - persistent stridor that WORSENS in SUPINE and IMPROVES in PRONE position
293
Osteonecrosis?
-AKA avascular necrosis!
294
Cause of 80% of nephrotic syndrome in kids < 16 yrs old? Tx?
- minimal change dz
| - steroids
295
What is the key feature in myotonic muscular dystrophy?
- Delayed muscle relaxation
| - ex unable to release hand after a handshake
296
Beck's triad?
- for tamponade
1. Distant heart sounds
2. Distended jugular veins (or scalp veins in infants)
3. Hypotension
297
What is the most common complication of HUS?
-renal damage
298
What conditions are pts with sickle cell trait at an increased risk for?
- Increased risk for renal issues --> most common = painless microscopic or gross hematuria --> caused by sickling in the renal medulla
- isosthenuria can also occur = inability to concentrate urine = nocturia or polyuria
299
Who can give consent in a child with divorced parents who have joint custody?
- only one parent is needed
| - this is especially true when the decision is clearly in the child's best interest
300
4 Ssx of serum sickness-like rxn to medications?
1. Fever
2. Urticarial rash
3. Polyarthralgia
4. Lymphadenopathy
301
Adult presentation of choledochal cysts?
1. Vague epigastric or right upper quadrant abdominal pain
| 2. Cholangitis
302
What can be seen on a lateral neck Xray with retropharyngeal abcess?
- widened prevertebral space
| - normally the prevertebral soft-tissue space should be narrower than the vertebral bodies
303
Infantile colic?
- presents by 3 wks of age
- excessive crying for more than 3 hrs a day
- more than 3 days a week
- more than 3 times a month
- usually resolves by 4 mnths
304
Triad of ssx of brain abcess?
1. Fever
2. Severe headaches (nocturnal and morning)
3. Focal neurologic changes
305
Premature adrenarche: what is it? Organ involved? Clinical significance?
- isolated apperance of axillary hair < 6 yrs old
- generally benign, with no clinical significance
- adrenal glands are involved
306
What nutrient suppliment(s) should breast feed infants be given?
-vitamin D!
307
Most common cause of nephrotic syndrome in kids? Tx?
- minimal change dz
| - steroids! Highly responsive!
308
When does infantile colic usually resolve by?
-usually resolves by four months
309
2 first line Tx for pinworm?
1. Albendazole
| 2. Mebendazole
310
What are the 2 most common bacterial causes of osteomyelitis in sickle cell patients?
1. Salmonella
| 2. Staph aureus
311
What age is it recommended to do meningicoccal vaccination?
-btwn ages 11-12 yrs
312
Purulent, foul-smelling vaginal discharge, and bleeding?
-think: vaginal foreign body
313
Juvenille angiofibroma: what is it? 3 Common ssx? Who is it more commonly seen in?
- benign growth that is capable of eroding and locally invading
- ssx:
1. Nasal obstruction
2. Visible nasal mass
3. Frequent nose bleeds
- more common in adolescent males
314
Presentation of a milk protein intolerance in a neonate?
- vomiting and bloody diarrhea
- stools may have RBCs and eosinophils
- can have family hx of atopic disorder
315
What 2 types of newborns is respiratory distress syndrome common in?
1. Premature infants
| 2. Infants of DM mothers
316
Active hep B & subsequent nephrotic syndrome?
- membranous glomerulonephritis
| - usually secondary to deposition of HBeAg in the glomeruli
317
3 Ssx of acute iron poisoning?
1. Abdominal pain
2. Hematemesis
3. Metabolic acidosis
318
2 Most common causes of viral meningitis?
1. Echovirus
2. Coxsackievirus
* *bot non-polio enteroviruses
319
What tx should precede intubation in a pt with croup?
- racemic epi
| - often decreases need for intubation
320
What 2 types of infections are typically seen in pts with complement deficiency?
1. Gonococcal
| 2. Meningococcal
321
Tx for rheumatic fever? Why?
- antibiotics (usually penicillin) regardless of whether or not pharyngitis is present at the time of exam --> prevents recurrent GAS infections
- bc of risk for developing and the progression of rheumatic heart dz
322
How to dx 21-hydroxylase deficiency?
-measure 17-hydroxyprogesterone --> will be increased!!
323
Tx of acute bacterial rhinitis?
-amoxicillin-clavulanic acid
324
When does separation anxiety usually occur?
-btwn 9-18 mnths
