Peds UWorld Flashcards
Macrocytic anemia, low retic count, and congenital anomalies?
- think: diamond-blackfan syndrome
- AKA: congenital hypo plastic anemia
5 Early Ssx of congenital syphilis?
- Hepatosplenomegaly
- Cutaneous lesions
- Jaundice
- Anemia
- Rhinorrhea
Metatarsus adductus: what is it? Types? Tx?
- 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
What cancers does breast feeding reduce the mothers risks for?
- Breast
2. Ovarian
Patient with Down syndrome who presents with upper motor neuron findings?
-think: alantoaxial instability
Genetics of fragile X?
-mutation in FMR1 gene, caused by an increased number of CGG trinucleotide repeats
What is Reye syndrome AKA?
-fatty liver encephalopathy
What is given to close a PDA?
- indomethacin
- potent prostaglandin inhibitor
What is given to keep PDA open?
-prostaglandin E1
Alantoaxaial instability: what is it? Who is it commonly seen in? Ssx?
- 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)
Asymmetry of inguinal folds in an infant or neonate?
- worry about developmental dysphasia of the hip
- get ultrasound (if < 6 mnths old) or xray ( > 6 mnths)
What should be done with an anyphylacyic rxn, encephalopathy, seizure, or any other CNS complication occurs within 7 days after getting DTaP?
- give DT should be given instead
- adverse rxns are assumed to be from the pertussis portion
What is the most common cause of communicating hydrocephalus?
-subarachnoid hemorrhage
Marfan features + mental retardation + thromboembolic events + downward dislocation of lenses?
-homocystinuria
Bruton’s agammaglobulinemia: what immunoglobulin concentrations are seen?
- igA, igM, igD, and igG are decreased (ALL)
- absence of B cells too!
Homocystinuria: what is it? Cause? Genetics? Tx?
- autosomal recessive
- caused by cystathionine synthase deficiency
- tx: high doses of bit B6
4 Ssx of homocystinuria?
- Marfan’s features
- Mental retardation
- Thromboembolic events
- Downward dislocation of lenses
Tx for tricyclic antidepressant intoxication?
-sodium bicarbonate
How is chlamydial conjunctivitis prevented?
- maternal prenatal testing and tx of mothers chlamydia
- ophthalmic prophylaxis given at birth does not prevent chlamydial conjunctivitis, only gonorrheal
5 Reasons an umbilical hernias should be referred to surgery?
- If they persist to age 3-4yrs
- Larger than 2 cm in diameter
- Causes symptoms
- Becomes strangulated
- Enlarges progressively from ages 1-2
Caput succedaneum?
- diffuse swelling of the scalp
- can be ecchymotic (bruised/discolored)
- can extend across the midline and across suture lines
3 Complications of orbital cellulitis?
- Orbital abscess
- Intracranial infection
- Cavernous sinus venous thrombosis
Metaphysis?
-wide portion of a long bone
Hemarthrosis after minor trauma in a young child?
- suggests bleeding disorder
- ex hemophilia
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
Triad of HUS?
- Thrombocytopenia
- Anemia
- Renal failure
3 Ssx of necrotizing enterocolitis? 2 findings on xray, why?
- Increased gastric residual volume
- Vomiting
- Abdominal distention
* *in a preterm neonate!!!!!
- xray: pneumatosis intestinalis + portal venous air! –> air is from gas produced by bacterial overgrowth
3 Most common causes of acute bacterial rhinosinusitis?
- Strep pneumo
- Nontypeable H. Influenza
- Moraxella catarrhalis
Tx for strawberry hemangiomas?
- none!
- usually regress by ages 5-8 yrs
Most common cause of osteomyelitis in infants and kids?
-staph aureus
What is the most common cause of cerebral palsy?
-cerebral anoxia
“Target sign” on abdominal ultrasound?
-intussusception
Classic triad of congenital toxoplasmosis?
- Chorioretinitis
- Hydrocephalus
- Intracranial calcifications
Tx for impetigo?
- Topical mupirocin
2. Oral erythromycin
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
What is the most common cause of secondary HTN in kids?
-fibromuscular dysplasia
Wiskott-Aldrich syndrome triad? Most common of the 3?
- Thrombocytopenia (most common!) –> due to decreased platelet production
- Eczema
- Recurrent bacterial infections
What are the 3 causes if anemia of prematurity?
- Transitions in erythropoiesis sites of the neonate
- Shorter lifespan of RBCs in neonates
- Low fetoplacental transfusion –> occurs when the baby is held above the level of the placenta after delivery
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
Describe the murmur of VSD?
-pansystolic murmur that is loudest at the left lower sternal border + diastolic flow murmur at apex
Tx for OCD?
- high-dose selective serotonin reuptake inhibitors (ex. Fluoxetine)
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
4 Common ssx of necrotizing enterocolitis? What is seen on xray?
- Feeding intollerance
- Increasing abdominal girth
- Bloody stools
- Vomiting
- see pneumatosis intestinalis on xray
3 Ssx of niacin deficiency?
- Diarrhea
- Dementia
- Dermatitis
* *vitamin B3 deficiency = pellagra
For how long is bed wetting normal?
- until age 5
- boys usually do it longer than girls
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
Absent or hypoplastic thumbs + depression of all cell lines? Pathophysiology?
- think: fanconi anemia
- pathophysiology: spontaneous chromosomal breaks
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
Most common cyanotic congenital heart defect at birth?
-transposition of great vessels
4 Common facial features of fetal alcohol syndrome?
- Smooth philtrum
- Thin vermillion border
- Small palpebral fissures
- Microcephaly
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
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
What is the most common congenital heart disease associated with Edward’s syndrome?
-VSD
What is the most common cause of pulmonary infections in CF pts? Tx?
- pseudomonas aeruginosa
- tx: aminoglycoside (ex tobramycin) + antipseudomonal penicillin (ex piperacillin)
4 Red flags for orbital cellullitis?
- Decreased visual acuity
- Diplopia
- Opthalmoplegia
- Proptosis
Syncopal episode (w/out post-episode confusion) + hearing impairment + family hx of sudden cardiac death?
-think: congenital long QT syndrome
4 Ssx of intussusception?
- Sudden onset of abdominal pain
- Vomiting
- Red currant jelly stools that contain blood and mucus
- Abdominal mass
Tx of intussusception?
-air or water-soluble contrast enema
What are 3 classical signs of posterior urethral valves that can be seen on prenatal ultrasounds?
- Bladder distension
- Bilateral hydroureters
- Bilateral hydronephrosis
What embryonic structure do neuroblastoma masses arise from?
-neural crest cells
4 Ssx of cri-du-chat syndrome? Genetics?
- Microcephaly
- Hypotonia
- Short stature
- Cat-like cry
- genetics = deletion of 5p!
Describe chronic pyelonephritis findings on IV pyelogram?
- Blunting of calices
2. Focal parenchymal scarring
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
Tx for lyme dz in kids < 8 yrs old?
-amoxicillin
Tx of necrotizing enterocolitis?
- Empiric broad-spectrum antibiotics bc of the serious risk of lethal septic shock if perforation occurs
- Surgical intervention
5 Ssx of Beckwith-Wiedermann syndrome? What must they be monitored closely for?
- Macrosomia
- Macroglossia
- Umbilical hernia/omphalocele
- Hemihyperplasia
- Hypoglycemia
- monitor closely for Wilms tumor or hepatoblastoma!!
What os the cause of meningitis that is accompanied by a petechial or purpuric rash?
-Neisseria meningitis!!!
What congenital heart defect is associated with William’s syndrome?
-supravalvular aortic stenosis
Myotonic congenital myopathy?
- muscle weakness and atrophy (esp in the distal muscles of the upper and lower extremities)
- myotonia
- testicular atrophy
- baldness
- autosomal dominant
What is the most common cause of hip pain in children? Tx?
- transient synovitis
- tx: NSAIDs + rest
What is terminal deoxynucleotidyltransferase? What is it expressed in?
- TdT
- only expresses by preB and preT lymphoblasts
- positive in 95% of ALL pts
Failure to thrive, bilateral cataracts, jaundice, and hypoglycemia in newborn?
-think: galactosemia from galactose-1-phosphate uridyl transferase deficiency
5 Ssx of measles?
- Coryza
- Conjunctivitis
- Cough
- Koplik’s spots
- Maculopapular rash that begins on face
* *5 “C” sounds!
3 most common manifestations of polycythemia in newborns?
- Respiratory distress
- Poor feeding
- Neurologic manifestations
3 Most common causes of neonatal jaundice?
- Breast milk jaundice
- Hematologic
- Sepsis –> so work up all jaundice for sepsis if you dont know the underlying cause!!
Drug of choice for congenital long QT syndrome?
-beta-blockers!!!
What occurs in partial seizures with secondary generalizations?
-tonic-clonic manifestations –> diffuse muscle aches & elevated CPKs
Max oz of cows milk that 1-5yr olds should consume a day?
-20oz!
5 Ssx of HSP?
- Palpable purpura
- Hematuria
- Abdominal pain
- Arthralgias
- Scrotal swelling –> occasionally
Triad for congenital rubella syndrome?
- Sensorineurial deafness
- Cardiac malformations
- Cataracts
What is often the earliest manifestation of sickle cell anemia in pts?
- dactylitis
- vaso-occlusion of hands and feet
What to do for a unimmunized pt exposed to varicella zoster?
- normal = give vaccine
- immunocompromised = give varicella Ig within 10 days of exposure
Pertussis prevention of close contacts of an infected pt?
-14 days of erythromycin, no matter how old they are, their immunizations, or sx!
When does VSD usually present? How?
- usually at 6 wks
- presents w/: tachypnea & failure to thrive
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
Which peds patients is orthostatic proteinuria common in?
-adolescent boys
Top 3 bacterial causes of otitis media (in order)?
- Strep pneumo
- H. Influenzae
- Moraxella catarrhalis
3 Common ssx of trachoma? Caused by? Tx?
- Follicular conjunctivitis
- Pannus of the cornea = neovascularization
- Concurrent infection of nasopharynx with nasal discharge
- caused by chlamydia trachomatis
- tx: topical tetracycline or oral azithromycin
Presentation of choledochal cysts in infants?
- Jaundice
2. Acholic stools
2 tx of absence seizures?
- Ethosuximide
2. Valproic acid
Tx of galactosemia?
-galactose-free diet!
What 3 types of seizures have loss of conciousness?
- Generalized seizures
- Partial seizures with generalization
- Complex partial seizures
Orbital cellulitis: what is it? 3 Ssx?
- serious bacterial infection
- Ssx:
1. Pain with extraocular movements
2. Visual impairments
3. Opthamoplegia
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
6 Ssx of compartment syndrome?
- Sever pain
- Pallor
- Poikilothermia
- Paresthesias
- Pulselessness –> late finding
- Paralysis –> late finding
Confirmatory test for SLE?
-anti-smith antibody test
Tx of clubfoot?
- initially: stretching and manipulation of the foot (starting immediately!)
- then: serial plaster casts, malleable splints, or taping
- if unresponsive: surgery
What happens to benign murmurs of kids when they stand up or perform the valsalva manuver?
-decreases in intensity!
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
What is the most common cyanotic congenital disease in kids less than 4 yrs old?
-tetralogy of fallot
Traction apophysitis of the tibial tubercle: AKA?
-Osgood-Schlatters Disease
Osgood-Schlatters Disease: AKA?
-traction apophysitis of the tibial tubercle
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
Neonate with non-bilious, projectile and persistent vomiting? What to do next?
- think pyloric stenosis
- do abdominal ultrasound next
Common presentation for neonatal enterocolitis (3)?
- Abdominal distention
- Vomiting
- Frank blood in stools
What is mitral valve stenosis almost always due to?
-rheumatic fever as the result of a group A strep infection
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
3 Ssx of androgen excess in males with precocious pubarche? Cause?
- Coarse axillary hair
- Coarse pubic hair
- Severe cystic acne that is resistant to tx
- caused by late-onset (AKA: nonclassical) adrenal hyperplasia caused by 21-hydroxylase deficiency
6 Indications for the evaluation of neonatal jaundice?
- Hyperbilirubinemia of > 2 mg/dL
- Jaundice that appears in first 24-36 hrs of life
- Serum bili that is rising faster than 5mg/dL/24 hrs
- Serum bili > 12 mg/dL in full-term (esp in absence of risk factors) or of 10-14 in premeies
- Jaundice persists after 10-14 days of life
- Signs or symptoms
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
What 2 things can be seen on plain xrays and CT scans in neuroblastoma?
- Calcifications
- Hemorrhages
* * most commonly in the abdomen
“Squirt sign”
- rectal examination causes explosive expulsion of gas and stool from temporary relief of an obstruction
- positive in hirschsprung
- negative in meconium ileus
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!
Tx/workup of simple febrile seizures?
- no work up needed
- tx: reassurance
3 Ssx of cholesteatoma?
- New-onset of hearing loss
- Chronic ear drainage despite antibiotic tx
- Granulation and skin debris seen on otoscopy
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
3 Ssx of McCune Albright syndrome?
- Precocious puberty
- Cafe au lait spots (Pigment) = they are lgr than in NF, have irregular borders, and not in axilla or groin
- Multiple bone defects = Polyostotic fibrous dysplasia
* * 3 Ps
5 Possible long term sequelae associated with bacterial meningitis?
- Hearing loss
- Loss of certain cognitive functions
- Seizures
- Mental retardation
- Spasticity or paresis
Pancytopenia following drug intake, exposure to toxins, or viral infection?
-Think: aplastic anemia!
When is chelation tx used in lead posioning?
-when the serum lead levels are 45 or greater
What is the cut off for small for gestational age?
-Birth weight less than the 10th percentile
What is PANDAS?
- Pediatric Autoimmune Neuropsychic Disorders Associated with strep infections
- onset of OCD ssx after a group A strep
3 Common features of IgA deficiency?
- Recurrent sinopulmonary infections (w/ strep & hemophilus)
- Recurrent GI infections (w/ giardia)
- Anaphylactic reactions to transfusions
Honey-colored crusted exudates?
- impetigo!
- ALWAYS when you see those words!!!!
Tx for immune thrombocytopenia?
-corticosteroids are the drug of choice, but only if the platelet count is <30,000
What should be obtained when a hemophilia is suspected?
-factor VIII and IX levels
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!
4 abnormalities in tetrology of fallot?
- VSD
- Overriding aorta
- Pulmonary stenosis
- RVH
What causes measles?
-paramyxovirus
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