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Peds Uworld > Peds Uworld > Flashcards

Peds Uworld Flashcards

1
Q

Metatarsus Adductus vs Clubfoot

A

MA- Medial deviation of the forefoot that moves laterally with passive and active movement
Clubfoot- Medial and upward deviation of the fore and hind foot. Tx- serial manupuliation and casting as soon as born. Consider karyotyping b/c associated with chromosomal abnormalities.

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2
Q

Preseptal (perirbital) vs postseptal (orbital)

A

Periorbital- Eyelid edema, erythema, tenderness, leukocytosis, fever

Orbital- above PLUS opthalmoplegia, pain with movement, proptosis and vision impairment. Tx iwth IV AB b/c risk of blindness, abcess of the brain, venous sinus thrombosis

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3
Q

Pediatric Viral Myocarditis

Presentation, causes, tx

A

Presentation- viral prodrome then heart failure *dyspnea, syncope, tachy, N/V, hepatomegaly

Dx- x-ray, echo, ekg, Gold STANDARD- biopsy to show infiltrate of myocardium with myocyte necrosis

Bugs- adeno and coxsackie

PE- can have large liver and holosytolic murmur from dilated cardiomyopathy

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4
Q

Vesicoureteral reflux

A

Presentation- 2-24 months with UTI
Dx- first get renal US afer 1st UTI. IF they have recurrent UTIs get a voiding cystourethragram

VCUG
Grade 1- into a non dilated ureter
Grade 2- into pelvis and calyxes without dilation
Grade 3- mild to moderate dilation of ureter, pelvis and calyces with minimal blunting
Grade 4- moderate urethral touristy and dilation of pelvis
Grade V- Gross dilation of the ureter, pelvis and calyxes and loss pf papillary impressions and urethral tortousity

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5
Q

Spondylooslisthesis

A

Developmental disorder characterized by a forward slip of the vertebrae (L5/s1). Presents with progressive back pain and neurological symptoms.

Vs primary/metastasis to spine- usually doesn’t have step off

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6
Q

Primary Amenorrhea

A

If no menses by 14 start work up

Pelvis US
Uterus–> FHS
FSH low get MRI, FSH high karotype

No uterus–> karotype
46XX abnormal mullerian
46XY- androgen insensitive

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7
Q

Tension Pneumothorax

A

Triad of Sudden hypoxia, trachea deviation, and unilateral absent breath sounds
Tx- needle thoracostomy

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8
Q

Niacin defeciecny

A

Pellagra- diarrhea, dermatitis (sun exposed areas), and dementia. and glossitis

Patient either in a 3rd world country with corn and starch as main diet or bowel absorption

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9
Q

Prepubertal bleeding

A

Trauma- unintentional fall, sexual abuse
Rhabdomyosarcoma- rare, kids over 3, protruding vaginal nodules
Estrogen withdrawal- neonatal period, <1 week and exam otherwise normal

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10
Q

fanconi

A

Apastic anemia and progressive bone marrow failure. Autosomal recessive

Appearance- kids <16 short stature, microcephaly, abnormal thumbs, hypogonadism, hypo/perpigmented area, cafe au lait spots, eye and ear abnormalites

Cause- chromosomal break

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11
Q

Nec

A

Presentation- premature, small, heart disease (decreases profusion to the gut)

Clinical- vital sign instability, GI signs- vomitting, lood in stool, abdominal tenderness/distension

Xray- pneumotosis intestinalsis, portal venous gas

Tx- NPO, borad spectrum AB, possible sx

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12
Q

Levels of dehydration

A

Mild- 3-5% volume loss no clinical signs
MOderate 6-9%- decreased skin tugor, dry mucus membranes, tachy, irribility, decreased UOP
Severe >10% cool, clammy skin, dry mucous membranes, sunken eyes, sunken fontanelle, tachy, lethargy, NO UOP

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13
Q

Vit K in neonates

A

Give two paraenteral injection of Vitamin K becauase it has poor placental transfer, absent gut flora, and immature liver so they cant produce their own.

Signs may be bruising, bloody stool, IC hemorrhage, and elevated PT with normal or elevated PTT

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14
Q

Presentation, Labs and Diagnostics of Hereditary Spherocytosis

A

Increase indirect bili, splenomegaly, jaundice, hemolytic anemia

Labs- increase bili, Increase RDW, increase MHCH

Dx- esosin 5 maleimide binding test, osmotic fragility test

Tx- splenectomy

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15
Q

Risk factors for RDS in neonates

A 
Premature
Maternal DM
C section with no labor
Male sex
perinatal asphyxia
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16
Q

Presentation of SSTrait

A

HbA 50% and HbS- 35% Hb F<2%

increased risk of renal issures and usually have painless hematuria that results from sickling in the medulla. Isosthernuria (impairment in concentration) is also common and they have nocturia and polyuria.

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17
Q

Lymphadenitits in children

A

Presentation kids under 5 nontoxic appearing and the affected node is warm, tender, erythematous and 3-6cm in size— acute and unilateral is usually bactieral (staph Aureus or strep)

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18
Q

Iron poisoning
Presentation
Diagnostic
Tx

A

Abdominal pain, N/V, hypotensive shock, metabolic acidosis. Within 2 days hepatic necrosis, within 6 days pyloric stenosis

Diagnostic- anion gap metabolic acidosis and radioopaque pills

tx- bowel irrigation, deferoxamine, supportive care

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19
Q

RTA Type 1, 2, 4

Primary defect, urine pH, serum K, and causes

A

RTA 1- distal, poor hydrogen secretion into urine, pH> 5.5, serum K- low-normal, causes- genetic, medicaiton, AI

RTA 2(proximal) - poor bicarb resorption, pH urine<5,5 (urine is acidified by alpha- intercalated cells in the Collecting ducts ), serum K- low/normal, fanconi syndrome

RTA 4- aldosterone resistance, urine ph <5.5, serum K high, Causes obstructive uropathy and congential adrenal hyperplasia

All RTAs present with failure to thrive due to poor cellular growth and divisin in acidici conditions

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20
Q

Clinical features and management of caustic ingestion in kid

A

Features- laryngeal damage- hoarseness and stridor, esophageal damage, hysphagia gastric damage- bleeding, epigastric pain

Management- ABC, decontamination so remove clothing and DO ENDOSCOPY within 24 hours

Avoid anything that could induce vomitting like milk, water, activated charcoal, vinegar, NG lavage as this could icnrease injury. BG should be placed with endoscopy as to not damage or perforate.

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21
Q

Benign vs pathologic murmur in kids

A

Benign- kid otherwise asymptomatic, usually a mid systolic murmur taht DECREASES WHEN STANDING AND WITH VALSALVA. Don’t work up

Pathologic- chest pain, diaphoresiss, syncope, heart defect, fam hx

Harsh, holosytolic increases with standing and valsalve.
Get EKG and Echo and refer to cardio

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22
Q

Most common organisms for osteo in <2months, 2months-4, >4, SSD

A

<2 months- E coli and group B
2months-4yrs- Kingella kingae
>4 yo- Staph Aureus
SSD- salmonella (3/4 of all SSD osteo), S aureus– remember that microinfarcts can impair flow and increase risk of osteo. Tx empiraically with ceftriaxone and anti-staph dxs (oxacillin, vanc)

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23
Q

OSteoid OSteom
CP
TX
DX

A

Benign bone-forming tumor common in adolesecents
CP- focal tenderness, deformities, or swelling but usually no findings in adolescents. Pains worst at night and better with NSAIDS
X-ray- hypodense lesion on x-ray
TX- NSAIDs for pain, serial examination and x-rays for 4-5 months to monitor

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24
Q 
Reyes- 
Etiology
CP
Lab
Dx
Tx
A

Etiology- ASA in kids in the setting of viral infection (Flu or varicella usually)
CP- Acute liver failure and encephalopathy
Lab- elevated liver enzymes, increase PT/PTT, increase NH3
Dx- liver biopsy showing MICROvesicular steatosis
Tx- Supoprtive

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25
Q

HUS- pathogenesis
CP
Labs
Tx

A

Shiga toxin from Ecoli causing vascular damage and microthrombi form

CP- FATRN- fever, prodrome of bloody diarrhea, bruising and petechia, edema/oliguria

Labs- low platelets, anemia, AKI- Increased BUN and Cr

Tx- dialysis, fluids, electrolyte correction

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26
Q

Workup for bilious vomitting in a newborn

A
  1. X-ray to make sure there isn’t pneumoperitoneum requiring immediate sx
  2. Water soluble contrast enema- if there is microcolon we would consider meconium ileum and hope the hyperosmolar enema breaks up the meconium.
  3. If the contrast enema shows a transition zone then consider rectal biopsy for hirschsprung
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27
Q

common resp tract infection in children

Tx for who

Complications

A

Bronchiolities caused RSV <2 years old= most common
Clinical presentation- wheezing, crackles, resp distress… can have nasal congestion and cough

tx- supportive

Palivizumab for premature <29 weeks, chronic lung develop prematurity, hemodynaically significant heart disease

Complications- apnea and resp failure

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28
Q

Presentation of trachoma/bug/tx

A

Child in unsanitary conditions presenting with conjunctival injection, tarsal inflammation and pale follices. Kids can often concomitant nasopharyngeal infection.

Due to Chlamydia serotypes A, B, and C

Complications- repeated infection can lead to scarring and inversion (trichiasis) and blindness.

Dx- can be clinical- TARSAL CONJUNCTIVAE or use giemsa stain.

Tx- azithromycin or eyelid sx.

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29
Q

Risk factors for UTI in kids and when to do a workup

A

Risk factors- girls, uncircumcised penis, underlying renal anomaly

Any kids with a fever >102.2 should have a occult UTI investigation. If they kid is in diapers straight cath, ua, and culture. If they aren’t they UA and culture

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30
Q 
Anemia of Prematurity
Etiology
Clinical P
Labs
Tx
A

Etiology- low EPO, short RBC life span, iatrogenic blood sampling

Clinical manifestations- usually asymptoamtic, tacycardic, apnea,, poor weight gain

Lab findings-low Hb and low hemotocrit, low RC, normocytic, normochromic RBCs

Tx- iron, minimize blood draws, minmize transfusion

31
Q

igA
CP
Dx
Tx

A 
CP- can be 
asymptomatic,
asthma/eczema
AI
Anaphylaxis to igA containing blood 
Recurrent sinopulmonary and GI infections,

Dx- Low or absent igA with normal IgG, IgM

Tx- supportive, medical alert bracalet for transfusions

32
Q

Tx of croup

A

Mild (no stridor at rest)- steroids
Moderate/severe- stridor at rest- steroids and nebulized epinephrine

If they fail this then intubate

33
Q

Biliary Atresia
CP
Dx
Tx

A

CP- pale stool, direct >2 o2 20% of the total bili. Hepatomegaly, mild elevated transaminases

Dx- Liver US (is there a gallbladder)
Hepatobiliary scintigraphy (does the liver excrete the tracer to the small bowel)
LIver biopsy
Intraopertive cholangiogram (Gold standard)

Tx- Hepatoportoenterostomy or liver transplant

34
Q

Osgood-Schlatter

A

Common knee pain in adolescent male. During rapid periods of growth in which the quads tendon puts traction on the apophysis of the tibial tubercle where the patellar tendon inserts. Worst during sports.

PE- tenderness and edema over the tibial tubercle.

35
Q

Retropharyngeal abcess vs. epiglottis

A

BOth- fever, dysphagia, muffled voice, drooling

RPA- inability to extend neck and widened preveretebral space. Get a CT with contraast

36
Q

Work up for precocious puberty

A

Secondary sexual development girls <8 and guys <9

  1. Check bone age
  2. Advance- basal LH
    - Low- GNrh independent precocious puberty
    - High- GnRH (central) dependent
  3. Normal
37
Q

Acute Cervical Adenitis
Bugs for Bi/UNilateral
Bugs
CP

A

CP- kids under 5, enlarged, markedly tender, warm and erythematous. Clinical dx and treat with AB

Unilateral- staph and strep

Bilateral- Adenovirus and EBV/CMV

38
Q

Presentation of Herpangina

Bug

A

Coxsackie A

Early fall/summer

Fever, phayngitis, gray vesicles ulcers on the POSTERIOR oropharynx

Can also have rashes on hands and foot

vs Strep (positive for TENDER adenopathy and exudate)

39
Q

Contraindications to rotavirus

A
  1. Anaphylaxis to vaccine ingredients
  2. Hx of intussuception
  3. Hx of uncorrected congenital malformations of the GI tract
  4. Severe combined immuno disease
40
Q

Neonatal Conjunctivitis

A

Chemical <24 hours- mild conjunctival irritation and tearing after silver nitrate. Tx with lubricational

Gonococcal 2-5 days. Marked eye swelling, profuse prulent discharge and corneal edema/ulceration- Tx. sigle IM dose of 3rd gen cephalosporin

Chlamydial 5-14days. Mild eyelid swelling, watery, seroanguinous or mucoprulent eye discharge- Tx PO macrolide

41
Q

Impetigo

A

Non-bullous- staph or group A strep, painful non-pruitic pustules, honey contrusted

Bullous- staph, rapidly enlarging flaccid bullae with yellow fluid.

Tx- Limited skin involvement topical AB- mupriocin

Extensive skin involvement- oral AB- cephalexin, dicoxacillin, clinda

42
Q

MCune Albirght

A

3 ps Precocious puberty, Pigementation- cafe au lait spots
Poloyostotic firbous dyaplasia - bone defects.

G-protein cAMP kinase functions

43
Q

Eczema/atopic dermatitis

A

Etiology- dysfucntion in synthesis of stratum corneum

Infant- itchy, red, scaly, crusted on extensors

Tx- topical emolients and possible steroids

Complciations- cellulitis, eczema herpeticum and discomfort interrupting sleep

44
Q

Laryngomalacia

A

Pathophys- increased laxity of the supraglottic structures

CP-stridor and “weird breathing” that peaks at 4-8 months. Worst when feeding and supine.

Dx- clinically but confirmed on flexible laryngoscopy

Management- reassurance for most, supraglottoplasty for severe
Usually self resolve by 18 months

45
Q

Vascular rings

A

Biphasic stridor and feeding difficulties 2/2 compression of teh trachea and esophagus.

Dx- Barium swallow and MRI with angio

46
Q

X-linked agammaglobulenemia

A

CP- recurrent sinopulmonary and GI infections (pneumo Giardia) AFTER 6 MONTHS OF AGE , Absence of lymphoid tissue (scant LN, tonsils)

Dx- Low B cells, and normal T cells, no response to vaccines

Tx- Immunoglobulin replacement therapy and prophylactic antibiotcs

47
Q

Iron Poisoning

A

CP- N/V, abdominal pain, hypotensive shock, metabolic acidosis with anion gap, 30mins to 4 days, radio-opaque pills. Iron can be corrosive to the GI tract, gastric scarring and hematemesis

vs acetoaminophen that takes usually like 24 hours

2 days- hepatic necrosis
2-8 weeks- pyloric stenosis

Tx- whole bowel irrigation, deferoxamine, supportive care

48
Q

Aplastic Crisis

A

SSD- chronically low anemia, high retic count

aplastic crisis- acute drop in Hb, without compensatory rise in RC and WITHOUT spelnomegaly

49
Q

Coartaction of the aorita

A

Pathology- thickening of tunica media of aortic arch near ductus arteriosus

CP- HTN in upper extremity, weak femoral pulse, low post ductal oxygen saturation

Heart failure (irritability/poor feeding/diaphoresis)

Tx- surgical repair

50
Q

Leukocyte Adhesion Defeciency

A

LAD
Lots of infections skin and mucosal infections
Absent pus formation
Delayed Umbilical Cord seperation

MARKED PERIPHERAL LEUKOCYTOSIS WITH NEUTROPHILIA- neutrophils can’t go to the site of infection because of defect in LFA-1 (CD-18) gene inhibiting adhesion and migration

51
Q

TET

Murmur type

A

Harsh sytolic Murmur ejection murmur over left upper ejection murmur. Single S2 becuase pulmonic is inaudible

52
Q

Breastfeeding vs Breast Milk Juandice

vs Biliary Atresia

A

Breastfeeding failure jaundice- first week of life. High UNCONJUGATED bili Lactation failure resulting in decreased bilirubin elimination, increase enteroheptic circulatin and suboptimal breastfeeding with signs of dehydration

Breast Milk Jaundice starts at age 3-5 peaks at 2 weeks, high levels of B-glucoronidase in breast milk decojugate inttestinal bilirubin and increase enterohepatic ciruclation

Biliary atresia- high CONJUGATED bili

53
Q

Legg Calve Presentation

A

Progressive Antalgic gait, unilateral subacute hip pain in a male, thigh muscle atrophy, decreased ROM, collpase of ipislateral femoral headon plain pelvic x-ray .

54
Q

Tx of DiGeorge

A

thymic transplant

Should have dysmorphic facial features, paltal defects, cardiac deformatives

55
Q

tx of WAS

A

Hematopoietic stem cell transplant b/c of the x-linked impaired cytoskelton

56
Q

Absence Seizures

A

Occurence during all activities

Length <20 seconds
Lack of response to verbal or tactiles stimulation

Presence of automatism ((eyelid fluttering)

Provoked by hyperventilation and dignosed by 3Hz psike waves on ECG

57
Q

Spondylolisthesis

A

Developmental disorder (usually presents in preadolescents) characterized by a forward slip of vertebrae L5 or S1. Can cause chronic back pain and neurologic problems. Palapble STEP OFF on exam.

58
Q

INsulin in refeeding

A

carbs trigger insulin release and that causes an uptake of K+, phos, and mag. The decrease

59
Q

Mumur in
1, Ebstein
2. PDA

A
  1. triple or quadruple gallp widely slspilt S1 and S2 sounds plus loud S3 and/or S4 and holosytolic murmur at LLSB
  2. Machine like associated with rubella
  3. TOF- cres-decres systolic murmur heard best at and single second heart sign
60
Q

Workup for abnormal uterine bleeding

A

CBC, coag studies, pregnancy test

In peds like immature axis- treat with high dose oral estrogen/progestin contraceptive pills. stabilizes the endometrium and stops menstrual bleeding

61
Q

Indications for renal and bladder US

A

Infants and children <24 months with first febrile UTI

Recurrent febrile UTIs in children of any age

Non response to AB

UTI in child of any age with family hx or renal or urologica disease or personal hx HTN or poor growth

62
Q

Indications of Cystourthrogram

A

Less than <1 month and children <2 yo with recurrent UTI, or first UTI with an organism other than Ecoli. Or abnormalities on US

63
Q

Choanal Atresia

A

Aggravated by feeding, relieved by crying.

dx- failure to pass catheter and confirmed on CT

CHARGE
Coloboma
Heart Defects
Atresia chonae 
Retardation of growth/development 
GU abnormalities
Ear abnormalties
64
Q

Retropharygneal Abcess

A

Dyspagia, drooling, muffled voice, neck stiffness, trismus likely in the setting of pre existing URI in a kid 6 months to 6 years old

PE- inability to extend neck and widened pre-vertebral space (vs epiglottitis which shows thumb sign)

65
Q

CGD

A

X-linked disorder that prevents phagocytic oxidative burst (formation of H2O2) and therefore impairs intracellular killing by phagocytes

Recurrent infections from catalase positive organisms in the lnungs and soft tissue.

Dx is neutrophil function testing- dihydrohodamine 123 test and nitroblue tetrazolium test

66
Q

Test for different immunodef

  1. CGD
  2. X-linked Brutons
  3. Complement defeciecny
  4. DiGeorge
A
  1. Neutrophil levels- dihydrodamine 123/nitroblue tetrazolium test
  2. B cell and immunoglobulin levels
  3. CH50
  4. T cell
67
Q

Seborrheic dermatitis

A

Peaks in infancy
Erythematous plaques and thick/yellow/greasy sclares

Located on scalp and face face

Tx- emolients
2nd line- topical antifungals and low potency steroids.

68
Q

Biliary Atresia

Presentation
Pathophys
Dx
Tx

A

Presentation- normal at first then week 2-8 juandice and elevated conjugated bili. Light colored stool and dark stool, mild elevation in transaminases

Pathophys- progressive obilteration of the extrahepatic biliary ducts so no connection the liver to small bowel. Without tx will cause inflamed liver (hepatomegaly and hepatitis)

Dx-
US- no or abnormal GB
Hepatobiliary scinitigraphy- failure of tracer excretion

Liver biospy- expanded portal tracts with portal tract edema
GS- intraoperative chlangiogram- biliary obstruction

Tx- liver transplant (number one reason for pediatric liver trasnplant)

69
Q

Croup treatment-

A

No stridor then steroids and himidifed air

Moderate/severe stridor- steroids and nebulized epi

Pending resp failure- intubate

70
Q

Murmur in each cardiac problem

A

Transposition of the great vessels- Single S2 could have no murmur (POF) or VSD/PDA murmur- egg on a a string

TOF- left upper border single S2, cres/des systolic murmur + VSD murmur

Tricuspid Ateriosus- single S2

TAPVRWO = severe cyanosis, resp distress- pulm edema and snowman sign

71
Q

Resp failure in asthamatics

A 
Minimal to no wheezing
Cyanosis
Chest wall retrations
Altered mental status
Extreme fatigue

Lab findings low PO2
High PCO2
Low pH- resp acidosis

72
Q

varicella immunity

A

Children are not considered immune unti lthey have two doses (1 and 4) or they’ve been infected. If not immune and exposed >1 yo, exposed int he last 5 daysand immunocompetetn given them a varicelle vaccine

If pregnant or immunoincompetent give then varicella immunogolbulin

Under <1 don’t need anything

73
Q

Pathological Juandice

A
  • Day one elevated- do coombs b/c likely hemolytic
  • Over 12 at any time
  • Direct is >2- always consider sepsis

Bonus- fast rate of rise

74
Q

X-ray findings

  1. TTN
  2. RDS
  3. Peristant Pulm HTN
A
  1. TTN- peri-hilar streaking/air trapping due to retained fluid
  2. White out- diffuse reticulogranular appearance, air bronchograms
  3. Clear lungs with decreased pulmonary vascularity

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