Peds uworld Flashcards
1
Q
Most common cause of viral meningitis
A
non-polio enterovirus’s (echovirus, coxsackievirus)
2
Q
Which precaustions are needed if you suspect a Measles kid is in your ER?
A
Airborne precautions
3
Q
Cough
Coryza
Conunctivitis
Maculopapular rash that starts ate the head and spreads to the rest of the body
A
Measles (rubeola)
Everyone needs a N95 mask
Dx - titers and PCR
Tx - vit A in severe cases
4
Q
At what age do kids get their first MMR?
A
1 year
Ideally get two doses between 1 and 4
If international travel is planned, an additional dose can be given b/w 6 and 11 months
5
Q
Herpangina is caused by?
A
Coxsackie A virus
typically kids age 3-10
Gray vesicles on the tonsillar pillars and posterior oropharynx
Can occur w/ or w/o the hand and foot rash
Tx - supportive
6
Q
Herpetic gingivostomatitis is caused by?
A
HSV1
kiddos 6mo - 5yrs
Tx - po acyclovir
Presents on lips, anterior oropharynx
7
Q
Group A strep
A
Strep pharyngitis
can be complicated by acute rheumatic fever
8
Q
Tx for enterobius
A
Albendazole
Or pyrantel pamoate
9
Q
If you suspect meningitis
A
Do a LP and give abx
10
Q
Most common cause of bacterial meningitis in kids >1 months?
A
strep pneumo
Neisseria meningitidis
11
Q
mild infection of the eyelid anterior to the orbital septum
A
Preseptal cellulitis
Tx - po abx
12
Q
Infection posterior to the orbital septum presenting w/ pain w/ EOM, diplopia, ophthalmoplegia
A
Orbital cellulitis Emergency Complications -> blindness, intracranial infection Red flags - vision changes If unclear - get a CT Need to be admitted
13
Q
work up for a baby w/ suspected sepsis
A
CBC Blood cultures LP UA Urine culture
14
Q
Low grade fever
Maculopapular rash starting at head and spreading to body
Posterior auricular and suboccipital lymphadenopathy
Arthralgias
A
Rubella (German measles)
Fever is lower grade than seen in measles and arthralgia is unique to rubella
15
Q
congenital rubella causes
A
sensorineural hearing loss
cataracts
PDA
16
Q
Inspiratory stridor
Barky cough
Hoarseness
A
Croup (parainfluenza)
kids 3-36 months
Xray - subglottic edema “steeple sign”
Tx - attempts to reduce subglottic edema; corticosteroids (dexamethasone), nebulized racemic epinephrine if severe (stridor at rest)
17
Q
Kiddo w/ painful swelling in groin
PE - nontender papule on ant thigh, inguinal lymph node w/ overlying erythema
A
Bartonella henslae
Dx - clinical or serology
Tx - usually self limiting, Azithromycin if disseminated dz or immunocompromised host
18
Q
Healthy kid w/ soft mobile cervical lymph nodes
A
Observe unless
- Systemic syx
- LN is >2cm, firm, immobile
19
Q
nonvax kid w/ facial swelling and fever
A
Mumps
Fever and parotitis
Complications - aseptic meningitis, orchitis
20
Q
Most common cause of sepsis in sickle cell dz pt
A
Strep pneumo (but also H. flu, Neisseria meningitidis)
Asplenia makes pt more susceptible to encapsulated organisms
Should receive vax and penicillin prophylaxis
21
Q
Fever, pharyngitis, tonsillar exudate
Strawbery tongue
Tender ant cervical LN
Rash worse in axillae and groing
A
Scarlet fever (S. pyogenens, GAS)
“sandpaper” rash is prominent along skin folds and often results in desquamation
Dx - rapid strep Ag test, throat culture
Tx - Penicillin
22
Q
Best way to prevent congenital rubella?
A
Vax prior to conecption (live attenuated)
Syx - Cataracts/glaucoma, sensorineural hearing loss, congenital heart dz (PDA)
23
Q
If you suspect Strep pharyngitis
A
Rapid strep ag test +/- throat culture
Tx -amoxicillin
24
Q
Most likely cause of osteomyelitis in Sicle cell pt
A
Salmonella and staph aureus
Tx - w/ abx that cover GP and GN (cephalosporing + vanc)
25
What supplements should be considered in exclusively breastfed infants?
```
Vit D (400 IU in first month of life)
If premie of introduc ed to cows milk before 1 yr of life - also needs Fe
```
26
Kiddo swallowed a coin, seen in the esophagus on CXR. Now what?
Flexible endoscopy\
| IF object was sharp or impacted - rigid endoscopy
27
Management of a kiddo that injested a coin that is now in his trachea?
Rigid bronchoscopy
28
Kiddo has rash, weight loss, and microcytic anemia
Celiac
Get a anti-tissue transglutaminase ab assay (IgA), if + confirm w/ endoscopic duodenal bx
Intestinal malabsorption -> weight loss, Fe deficient anemia
associated with T1DM and dermatitis herpetiformis (vesicles filled w/ clear fluid that crust over)
29
What is the advantage of breastfeeding
Ideal nutrition for infants
Human milk protein (70% whey) absorbs better than caesin
Improves gastric emptying
Passive immunity w/ IgA
Recommend exclusively BF until 6 months and slowly introduce pureed foods
30
Kid swallowed a button battery. Now what?
Immediate endoscopic removal to prevent esophageal ulceration
If battery is distal to the esophagus - let it pass through and confirm excretion through stool exam
31
2 day old exclusively BF w/ jaundice
High total bili
NL conjugated
Physiologic Jaundice
Pathophys - decreased hepatic uridine diphosphoguconurate glucuronosyltransferase activity
Usually benign, elevated indirect bili (increased bili production, decreased clearance, increased enterohepatic recycling)
Tx - phototherapy
Risk of kernicterus
32
When is exchange transfusion considered for a jaundice baby?
Total bili >20
33
Excessive crying for >3hrs/day, >3days/wk x 3 weeks in an otherwise healthy kid
Colic
Review soothing and feeding techniques
Reassure
34
Boy 3-5 wks old w/ projectile nonbilious vomiting after feedings
```
Infantile hypertrophic pyloric stenosis
Confirm w/ abd U/S
Can have an olive shaped mass on exam
Can cause hypochloremic metabolic alkalosis
Tx - pyloromyotomy
```
35
Initial management of a kiddo presenting w/ constipation?
po laxatives
| At risk of constipation during transitional events (dietary, toilet training, school)
36
Best way to fluid resuscitate a kid
NS bolus (20mL/kg)
37
2 y/o male, painless hematochezia
Meckels diverticulum
Outpouching of gastric mucosa d/t incomplete obliteration of the fetal vitelline (omphalomesenteric) duct
Dx - technetium-99m pertechnetate scanning
38
Where is upper and lower GI bleeding divided?
At the ligament of Treitz
39
Abd pain, elevated direct and indirect bili, RUQ mass
| Y/S extrahepatic cystic mass
```
Biliary cyst
Congenital or acquired cyst of the CBD
single or multiple
extrahepatic or intrahepatic
Tx - surgical excision
```
40
Premmie with increased gastric residual volume, vomiting, abd distension is highly suspicious for?
necrotizing enterocolitis
41
Kiddo has tx resistant GERD and eczematous patches
Eosinophilic esophagitis
Suspect if a GERD kid does not improve after 2 months of tx w/ PPI
EGD - circular rings and thickened linear furrowing of the esophagus
bx - >15 eos/hpf
Tx - dietary modification +/- topical (po) glucocorticoids
42
Next step for a suspected intussusception?
U/S guided air contrast enema
43
Kiddo has green vomit. Now what?
Neonatal bilious emesis = bowel obstruction
| Get an immediate Xray to determine need for surgery, if stable do a contrast study to eval the level of obstruction
44
2-6 m/o w/ areflexia, hepatosplenomegaly, "cherry-red" macula, developmental regression
Niemann-Pick dz type A (A most severe, C least)
Sphinomyelinase deficiency
Fatal by 3 y/o
Tx - supportive
45
Pathophys of Guillain-Barre
demyelination of Peripheral motor n.
| LMN signs
46
Grip myotonia (delayed muscle relaxation), facial weakness, foot drop, dysphagia, cardiac conduction anomalies
Myotonic muscular dystrophy (type 1, steinert dz)
AD expansion of trinucleatides
Other problems - cataracts, testicular atrophy/infertility, baldness
47
New onset seizures + a birthmark that is non blanching, erythematous and macular
Sturge-Weber syndrome
a neurocutaneous disorder
Port wine stain
Pathophys - mutation in GNAQ gene
Can also have - capillary-venous malformation, IDD, visual field defects, glaucoma
Dx - MRI w/ contrast
Tx - laser therapy, antiepileptic drugs, intraocular pressure reduction
48
Greatest RF for CP?
Although the etiology is multifactorial, the primary RF is prematurity
49
kiddo has staring spells where he turns his head and "chews" and won't respond
Focal seizure
Originates in 1 cerebral hemisphere +/- LOC
Cannot envoke focal seizures w/ hyperventilation
Absence would just be a staring spell w/o moving
50
kiddo has a fall, then hours later presents with unilateral hemiparesis
Suspect a internal carotid a. dissection or thrombus, especially if there is a oropharyngeal injury
Hemiparesis, facial droop, aphasia
Dx - Ct or MR angio
51
kiddo w/ limb ataxia, wide based gait, decreased vibratory and position sense, absent ankle DTR. Feet have high plantar arches. MRI of brain and spinal cord show atrophy of the cervical spinal cord and minimal cerebellar atrophy. NCS are NL T wave inversion on EKG.
Friedreich ataxia
ar, excessive GAA repeats leading to abn of the frataxin protein
Offer prenatal counseling for future pregnancies
52
Most common form of inherited IDD
Fragile X syndrome
X linked, w/ trinucleotide repeat expansion
Speech, motor delys, prominent jaw, large ears, macroorchidism
53
DDx for flaccid paralysis
Inant botulism - ingestion of botulinum sporse from environment, descending, Tx w/ human botulinum IVIG
Foodborne botulism - ingestion of botulinum toxin, descending, Tx w/ equine botulism antitoxin
Guillain-Barre syndrome - autoimmune peripheral n. demyelination, ascending, Tx w/ pooled human IVIG
54
Minor trauma followed by breath-holding, pallor, diaphoresis, LOC
Pallid
55
Neonate w/ FTT, b/l cataracts, jaundice, hypoglycemia
Galactosemia
Galactose-1-phosphate uridyl transferase deficiency
elevated blood galactose
Tx - eleminate galactose from diet
56
RF's for brain abscess
```
Congenital Heart Dz
Recurrent sinusitis
Otitis media/mastoiditis
Dental infection
Presents with fever, HA (nocturnal or morning), FND, seizure
Dx w/ CT
```
57
kiddo has an increasing head circumfrence and bulging fontanelles, fussy x 1 month. now what?
Suspicious for hydrocephaus
Get a CT
Might need a VP shunt
58
Characteristics of absence seizures
Impairment of conciousness w/o loss of postural tone
occur w/o warning
<20s
Accompanied by simple automatisms (ie eyelid fluttering, lip smacking)
59
```
Marfanoid body habitus
IDD
Downward lens dislocation
hypercoagulability
Fair complexion
```
Homocystinuria
ar, error in methionine metabolism d/t cystathionine synthase deficiency
Tx - vitamin supplementation (B6, folate, B12) to lower homocysteine levels, antiplatelet or anticoag
60
How do you eval respiratory fxn in Guillain-Barre?
Spriometery
Gold standard in eval for respiratory fxn (FVC)
Peak flow meter only measures the airflow out of the lungs
61
Neonate with scalp swelling that does NOT cross suture lines
Cephalohematoma
Subperiosteal hemorrage
Reabsorb in weeks to months
NO skin discoloration
62
Neonate w/ scalp swwlling that does cross suture lines
Caput succedaneum
| Swelling is in the skin layers
63
Kiddo has sudden onset unilateral hemiparesis
Pediatric stroke
| Most common cause is sickle cell dz, get a Hgb electrophoresis
64
Sickle cell pt with high ret count and thrombocytopenia
Splenic sequestration, pooling of red blood cells w/in the spleen
Occurs in younger pts with sickle cell dz whose spleens have not yet become fibrotic from recurrent vasooclusion
Anemia + splenomegaly
normocytic anemia, high ret count, thrombocytopenia
65
Pt is pancyotopenic weeks after a URI
Acquired aplastic anemia
| dx w/ BM bx
66
Pt has half Hgb A and half Hgb S on Hgb electrophoresis
Sickle cell trait
| Have normal lives, but increased risk for painless hematuria
67
tumor in the posterior fossa causing truncal and gait ataxia
Medulloblastoma
second most common posterior fossa in kids and arises from the cerebellar vermis
Can also have signs of increased intracranial pressure due to poximity to the 4th ventricle -> obstruction
68
How does hydroxyurea protect SCD pts from occlusive crisis
Increases fetal Hgb levels
| Can cause myelosuppression (neutropenia, anemia, thrombocytosis), dose dependent
69
Xray with "sunburst" periosteal reaction and Codman triangle
Osteosarcoma
Most common primary bone tumor in kids
Involves the metaphyses
Large tender mass on PE
70
kiddo presents with limitation of upward gaze, bilateral eyelid retraction, and light-near dissociation
Parinaud syndrome d/t pineal glad tumor
| Can also include HA and vomiting d/t obstructive hydrocephalus
71
CF kid is presenting with easy bruising. Why?
Vit K defeciency
| CF are at risk of ADEK vit dfeciencies d/t lack of pancreatic enzymes and malabsorption.
72
Vit K is a cofactor for?
II, VII, Ix, X
1972 (X, IX, VII, II)
Prolonged PT
73
ar cause of congenital marrow failure, poor growth, morphologic abnormalities, macrocytic anemia
Fanconi anemia
Dx made by chromosomal breaks on genetic analysis, genes are believed to be involved in DNA repair
Tx - hematopoietic stem cell transplant
Most are diagnosed by 16, predisoposed to cancer
74
Family gets bloody diarrhea after cook out, 2 weeks later kiddo develops scleral icterus, abdominal pain
Hemolytic uremic syndrome
Initial infection with Shiga toxin producing E. coli (o157:H7)
Microangiopathic hemolytic anemia, thrombocytopenia, AKI
75
Types and inheritance of hemophilia
Hemophilia
A - Factor VIII def
B - Factor IX def
X-linked, only males are affected
76
Hemophilia kid presents with a big swollen knee
Hemophilic arthropathy
Occurs in both types of hemophilia and represents significant morbidity
Caused by deposition of iron/hemosiderin deposition leading to synovitis and fibrosis of the joint
Dx w/ MRI to get a good assessment of the extent of the damage
Tx early with the deficient factor
77
kiddo w/ brain mass has bitemporal hemianopsia and DI
Craniopharyngiomas
Calcified tumor in the suprsellar region
Comes with pituitary hormone deficiencies (DI, growth hormone deficiency)
78
Acute severe anemia in SCD. Sudden drop in Hgb, very low ret count, no hepatosplenomegaly
Aplastic crisis
Parvo is the most common trigger
splenic sequestration would have a higher ret count and a large spleen
79
Healthy kid has URI and 3 weeks later presents with scattered petechiae, thrombocytopenia, and peripheral smear showing large platelets
Immune thrombocytopenia
Observe, resolve spontaneously in 6 months
If kiddo has bleeding - give IVIG, glucocorticoids
80
Jaundice kid has anisocytosis, spherocytes, and polychromatophilia on smear
Hereditary spherocytosis
Triad of: Coombs-negative hemoltic anemia, jaundice, splenomgaly
Dx is confirmed with eosin-5-maleimide binding and acidified glycerol lysis tests
81
infant has acute onset of b/l hand and foot swelling, tenderness
Dactylitis
Earliest manifestation of vaso-occlusion in SCD
Presents 6m-4y
82
If a kid has a big swollen knee after a minor fall, do what?
Get a CBC and coag studies. Suspicious for hemarthrosis, hemophilia
83
Pts with functional asplenia will have what finding on peripheral smear
Howell-Jolly Bodies
Seen in SCD pts with functional asplenia
Small purple dot w/in the RBC
84
RF for retropharyngeal abscess
Pre-existing URI (rhinorrhea, nasal congestion
Polymycrobiol
ages 6m-6y
Decreased after 6y d/t regression of retropharyngeal LN and fewer viral URI
85
Newborn with hydrocephaly w/ diffuse intracerebral calcifications and vetriculomegaly
Congenital toxo
| Mom had contact with cat poop or undercooked meat
86
Coughing fits followed by vomiting
Pertusis
Get a PCR from the nasopharynx
Tx - Macrolides (Azithromycin clarithromycin)
Start tx before getting results back
87
Food poisoning that causes vomiting
```
Staph aurea
ingestion of preformed toxin
occurs w/in 1-6 hours after exposure
+/- diarrhea
Usually transmitted via contaminated food handlers
```
88
What can cause decreased morbidity from malaria
Sickle cell trait protects from severe complications
Syx of febrile paroxysms
Dx with thick and thin blood smears
89
Most common RF for bacterial sinusitis?
Viral URI, mucociliary clearance is inhibited and pt is less able to clear bacteria
bacterial sinusitis - nasal drainage, congestion, cough, appear ill, high fevers (102.2), purulent nasal drainage x 3 days
90
infant with meningitis becomes hypotensive, develops petechia, and dies. Why?
Waterhouse-friderichsen syndrome
| Sudden vasomotor collapse and skin rash due to adrenal hemorrhage
91
2 weeks s/p strep pharyngitis kid presents with a big swollen knee and new onset of fever, leukocytosis, + CRP, + ESR
Suspicious for septic joint
| Get a artrocentesis, cultures and empiric abx
92
Kiddo has insidious onset of limp, hip pain and an antalgic gait. Internal rotation and abduction of the hip is limited
Legg-Calve-Perthes dz
Idiopathic avascular necrosis of the femur
Boy 3-12
Xray - sclerosis of the femoral head w/ flattening and fragmentation
Tx - non weight bearing, splint, potential surgery
93
Kiddo has unilateral knee swelling. Aspiration reveals translucent fluid with a WBC coung of 20k, no organisms on gram stain
Lyme dz (Borrelia burgdorferi)
Presents as an inflammatory monoarticular or oligoarticular arthritis
Synovial fluid = inflammator w/ negative Gram stain
Look for travel hx to the east coast
spirochete, deer tick (ixodes scapularis)
Dx with ELIDA and estern blot
Tx - doxycycline or amoxicilin
94
Trendelenberg sign (drooping of contralateral pelvis) is caused by?
Weakness of paralysis of the gluteus medius and minimus m., inn by superior gluteus n.
95
kid w/ fever > 5 days and 4 of the 5: nonexudative conjunctivitis, extremity changes, cervical lymphadenopathy, oral mucosal changes, polymorphous rash
```
Kawasaki dz
Vasculitis of small and medium arteries
children <5, asian
Elevated inflammatory markers (CRP, ESR), thrombocytosis, sterile pyuria
typically self-resolves in 2 weeks
```
96
What is a complication of Kawasaki dz
Coronary a. aneurysm and thrombosis
Early tx with IVIG and ASA decrease MandM (start w/in 10days of fever onset)
Get an EKG at diagnosis and repeat every 6-8 wks
97
10 days after starting tx for strep pharyngisits kiddo has fever, uticarial rash, arthralgi, lymphadenopathy
Serum Sickness like rxn
Caused by B-lactams and sulfa drugs (PCN, Bactrim) w/ syx 1-2 after exposure
Resolves spontaneously after removal of abx
type III hypersensitivity
98
Hip pain in kiddo 2wks after URI and NL xray
Transient synovitis
NL lab results, able to bear weight, lack of fever r/o septic arthritis
tx - NSAIDs and rest
typically boys 3-8
99
knee pain, tenderness over proximal tibia at the site of the patellar tendon
Osgood-Schlatter
Traction apophysitis of the tibial tubercle
Xray - ant soft tissue swelling, lifting of the tubercle from the shaft, irregularity or fragmentation of tubercle
worse w/ activity, improves w/ rest
100
RF for vitamin D deficiency rickets
Exclusive BF
Increased skin pigmentation
Lack of sun exposure
Exam - craniotabes, rachitic rosary, genu varum
Xray - cupping and fraying of the metaphyses of the long bones
101
What is recommended for postexposure prophylaxis after exposure to an animal risky for rabies?
Rabies IG
Rabies vaccine
Prognosis - coma, Resp Failure, death w/in weeks
102
Newborn w/
copious rhinorrhea
ABN long-bone radiographs
Desquamating or bullous rash
Syphilis
103
Newborn w/ periventricular calcificaitons
CMV
104
Kiddo gets successive patches of intensely pruritic vesicles
Varicella
Self-limiting
Transmitted in aerosols w/ 2wk incubation
Varicella vax at age 1 and 4
105
Acute, unilateral cervical lymphadenitis is caused by
Staph aureus
106
Tx for Lyme dz in kids <8y/o
po amoxicillin
rash = erythema chronicum migrans
Doxycycline is contra in kids <8y/o and preggos
107
```
Shortly before delivery preggo has Hep panel:
HBsAg +
Anti-HBsAg -
IgM Anti-HBcAg +
HBeAg +
Anti-HBeAg -
```
Mom has active Hep B
| Kiddo needs hepB IG followed (passive) by Hep B vax (active)
108
1 wk after MMR vax kiddo has fever and rash
Reassure
| Some kiddos get fever and rash 1-3 weeks after vax, doesn't need tx
109
Tx for cat bite
po Amoxicillin w/ clavulanate
| Tx against Pasturella multocida and po anaerobes
110
1 wk s/p heart surgery kiddo presents with tachycardia, tachypnea, and distant "muffled" heart sounds
Pericardial effusion
w/in days or months after surgery
Postpericardiotomy syndrome
LIfe threatening, needs drainage
111
Cardiovascular abn in Turners
Bicuspid aortic valve
Coarctation of aorta
aortic root dilation
45, X
112
Harsh holosystolic murmur at LLSB
VSD
Get an echo
75% close spontaneously by 2 y/o
Large defect -> PHTN, growth failure, CHF, Eisenmenger syndrome
113
Blue spells, murmur gets louder and cyanosis improves w/ squatting
Tetralogy of Fallot
RV outflow tract obstruction and R to L shunting during exercise or agitation
Squatting increases afterload, increasing flow across RVOT
114
Kawasaki tx
ASA + IVIG w/in 10 days of fever onset to prevent coronary a. aneurysms
115
Which med can cause Reye syndrome
ASA
| Kawasaki is an exception
116
Pt has a hx of rheumatic fever. How do you manage?
Continuous abx prophylaxis w/ PCN to prevent recurrent GAS and limit progression to rheumatic heart dz
IM benzathine PCN G q4wks
117
```
Low set ears
Micrognathia
cleft palate
Truncus arteriosis
At risk for?
```
DiGeorge baby
Need immediate eval for hypocalcemia
Suspect in craniofacial abn, thymic hypoplasia, congenital HD
22q11 poor development of pharyngeal pouch
118
baby gets blud during feedings, different BPs in different limbs, crescendo decrescendo at LUSB
Tetralogy
LUSB murmur d/t turbulence at stenotic pulmonary a.
Give Oxygen and put knees to chest
119
Kiddo has grade II murmur that disappears w/ standing
Benign murmur
| reassure
120
Febrile kid gets ASA then presents with vomiting, encephalopathy, hepatic dysfunction, abn behavior -> seizures, lethargy
Reye syndrome
121
vomiting, abd distension, Tripple bubble sign on Xray w/ gasless colon
Jejunal atresia
| RF - prenatal exposure to cocaine/vasoconstricive drugs
122
ASA during flu or varicella infection causes?
```
Reye syndrome
Encephalopathy/cerebral edema
Acute fatty liver failure
Elevated LFTs, coagulopathy, hyperammonemia
Bx - microvesicular steatosis
```
123
newborn chokes and coughs during first feedings
esophageal atresia w/ tracheoesophageal fistula
ng tube insertion ill fail w/ tube in the esophageal pouch
Polyhydramnios, aspiration PNA
Workup for VACTREL
124
What is VACTREL?
```
vertebral, anal atresia
cardiac
tracheoesophageal fistula
renal
limb
```
125
Ulcerative Colitis kid has diarrhea, rash, and irritability
Niacin deficiency
Pellagra
Death in severe cases
126
First week of life, kiddo has suboptimal breastfeeding, dehydration. Decreased bili elimination
```
Breastfeeding failure jaundice
unconj hyperbioi
inadequate stooling
Caused by lactation failure,
Tx - optimize lactation, BF 15 min easch side q 2-3 hr
```
127
Newborn w/ feeding intolerance, abd distension, bloody stool
Nec enterocolitis
RF - prematurity, hypoension, congenital heart dz
Xray pneumatosis intestinalis
128
Small palpebral fissures
smooth philtrum
Thin vermillion border
Fetal alcohol syndrome
129
Kid has head trauma and vomiting. Order a?
CT w/o contrast
130
```
Cafe au lait spots
macrocephaly
feeding problems
short stature
learning diabilities
```
Nuerofibromati=osis `
| May later develop fibromas, neurofibromas, or different tumors
131
>50 words, 2 word phrases
2 y/o
132
Loc, hemiparesis resolving in hours
Seizures
| Todd paralysis, self-limited focal weakness after a seizure
133
unilateral HA, photophobia
Migraine
| Kids - NSAIDs supportive, try tirptans if this isn't effective
134
Most common tumor in kids?
Pilocytic astrocytoma
135
IDD, fair complexion, musty odor
Phenylketonuria
Deficiency of phenylalanine hydroxylase
Build up of phenylalanine and its neurotoxic metabolites
Tx - low Phe diests
If missed on newborn screen - get quantitative amino acid analysis for elevated Phe
136
Most common cancers in kids
Leukemia
CNS tumors
Neuroblastoma
137
KIddo has increased urine catecholamines and other metabolites (Homovenillic acid, vaillylmandelic acid)
Neuroblastoma
Arises from neural crest cells
median age 2 yrs
138
Kiddo < 3y w/ fever >102.2 w/o obvious syx
Get a cath and urine culture
139
FHx of RF
Hematuria
Sensorineural deafness
Alport's syndrome
| EM - alternating thin and thick capillary loops w/ splitting of the GBM
140
FTT
Metabolic acidosis
NL anion gap
Renal tubular acidosis
defect in either H+ excretion or bicarb reasorptoin in the kidney
FTT - cells don't grow well in acidic environments
141
Kids that have recurrent or chronic pyelo
severe vesicoureteral reflux
Complications - parenchymal scarring, HTN, renal insufficiency
Dx on voiding cystourethrogram
142
Kiddo has abd pain, vomiting, erythematous macular rash on her legs and back, hematuria, proteinuria
Henoch-Schonlein purpura
IgA mediated small vessel vasculitis (nephritic syndrome + rash)
renal Bx - IgA deposition in the mesangium
143
Fluid resuscitation in vomiting kid with Na 165
NS, intial fluid of choice in severe hypovolemic hypernatremia
144
How do UTI's happen?
When bacteria ascend into the bladder from the vaginal introitus
Sex is a big RF for UTI d/t introduction of uropathogens into the urethra
145
Renal dz in Active Hep B infection
Membranous nephropathy
| Nephrotic syndrome in adolescents/adults, Hep B is a huge RF
146
Causes of nephrotic syndrome
Minimal change dz (kids)
Focal Segmental glomerulosclerosis (FSGS)
Membranous nephropathy
Membranoproliferative glomerulonephritis
147
Causes of nephritic syndrome
```
Poststrep GN (peds)
Hemolytic uremic syndrome (peds)
IgA nephropathy
Membranoproliferative glomerulonephritis (nephrotic, nephritic)
Crescentic glomerulonephritis
```
148
Why does constipation increase risk for cystitis?
Urinary stasis
| Impacted stool -> rectal distension -> compresses the bladder -> incomplete voiding -> stasis
149
What is normal weight loss after birth?
Newborns lose up to 7% of birth weight in first 5 days of life
No tx is required
Birthweight should be regained by age 10-14 days
150
Pink stains, or brick dust in a kids diapers are?
Uric acid crystals
| Uric acid excretion is especially high at birth and tapers until adolescence
151
New born has dry flaky hands and feet after birth
totally normal. Skin is adjusting to the dry extrauterine environment
152
Most common cause of anemia in preterm infants
Anemia of prematurity
D/t diminished erythropoietin levels, shortened RBC life span, blood loss
Low Hgb, HCT, low ret count
epo diminishes after delivery because theres more oxygen in the tissues, further exacerbated by HgbF turnover every 40-50 days, frequent phlebotomy
153
Kiddo has fever, irritability and skin tenderness that progresses to generalized erythema, superficial flaccid blisters, epidermal shedding w/ light pressure
Staphylococcal scalded skin syndrome (SSSS)
Exfoliative toxin-producing strains of Staph aureus
Typically in kids and young children
154
Kiddo has a hoarse cry, increased TSH and low T4
Congenital hypothyroidism
Thyroid dysgenesis is the most common cause of congenital hypothyroidism
Associated wth neurodevelopmental injury if not treated early
Syx develop as maternal T4 wanes (lethargy, englarged fontanelle, protruding tongue, umbilical hernia, poor feeding, constipaiton, dry skin, jaundice)
Tx - levothyroxine
155
3-4 m/o w/ hypoglycemia, lactic acidosis, hepatomegaly, elevated triglycerides
Glucose-6-P deficiency (type 1 glycogen storage dz, von Gierke dz)
Often presents w/ seizures
Pts have doll-like face, thin extremities, short stature, protuberant abdome (d/t hepatomegaly)
156
Low IgG
Low IgA
High IgM
NL WBC
Hyper IgM syndrome
| Defect in CD40 ligand
157
Low or absent B cells, low Immunoglobulins
Xlinked agammaglobulinemia
158
NL B cells
| Low Immunoglobulins
Common Variable immunodeficiency
159
NL B cells
| Low IgA
IgA deficiency
160
NL B cells
| low IgG
IgG subclass deficiency
161
Most common complication of babies born to diabetic moms
Hypoglycemia
| GDM is significant enough
162
Kiddo flexes hips when neck is flexed and there is a erythematous nonblanching pinpoint ras on the lower limbs and trunks
Neisseria meningitidis
Common cause of meningitis in kids > 3m
Meningeal signs + petechial or purpuric rash
Tx 3rd gen cephalosporin (ceftriaxone) and vanco
163
Dad picked kid up by the arm and now she holds her hand pronated and won't use it. Hyperpronation reduces the injury
Radial head subluxation (nursemaids)
Caused by ligament displacement d/t axial traction on the arm
tx - forearm hyperpronation or supination w/ flexion
164
knee Xray w/ central lytic lesions, ornion skinning, and moth-eaten appearance w/ extension into soft tissue
Ewings sarcoma
Presents similar to osteomyolitis
Highly malignant, usually in lower extremity
Metaphysis and diaphysis of the femur
Mets to lung and LN
White males 10-20yo
Tx - surgery, w/ pre op radiation, multi-drug chemo
165
II/VI holosystolic murmur over LLSB, diastolic rumbler over cardiac apex
VSD (L to R)
Eisenmenger when shifts to R to L
FTT, fatigability, HF
Diastolic rumble d/t flow across mitral valve
166
RF's for Respiratory distress syndrome
```
Prematurity (#1)
Maternal DM
Male
Perinatal asphyxia
C-section w/o labor
RDS is caused by surfactant deficiency
Tx - antenatal corticosteroids and postnatal tx with exogenous surfactant w/ respiratory support
```
167
Precocious puberty d/t an ovarian mass
Granulosa cell tumor
Malignant, estrogen secreting tumor
U/S Ovarian mass, thickened endometrium
168
local rash with a thick golden yellow crust
```
Impetigo
(GAS or staph)
Bullous is always staph
Tx with topical mupirocin
If skin involvement is extensive give po abx (cephalexin, dicloxacillin, clindamycin)
```
169
Kid has viral URI that improves and a week later develops new cough and nasal discharge
Acute bacterial rhinosinusitis
Tx - po abx (amox-clavulancin acid)
Persistant or worsening syx should raise concern for bacterial sinusitis
170
Really tall waves on lead I on EKG
Lshift deviation
Suggestive of tricuspid atresia
Cyanotic congenital heart defect, L axis deviation on EKG, decreased pulmonary markings on CXR (hypoplasia of the RV and pulmonary outflow tract)
171
```
Microcephaly
Prominent occiput
IUGR
Micrognathia
Closed fists w/ overlapping digits
```
Edwards syndrome (trisomy 18)
Also rocker bottom feet
95% mortality in the first year of life
172
RF for polycythemia in a newborn
```
Delayed cord clamping
Maternal HTN
Maternal DM
HCT>65%
Syx - RDS, hypoglycemia, neurologic syx
Tx - hydration is asyx, syx need partial exchange transfusion (blood removed and replaced with NS)
```
173
episodes of vomiting lasting up to 10 days; >3 episodes in a 6 month period
Cyclic vomiting syndrome
Tx- anti-emetics, anti-migaine agents
Typically have a Fhx of migraines
174
Most common causes of PNA in CF kids?
Kids/teens - Staph aureus
Adults - Pseudomonas aeruginosa
The change in flora occurs around 20 y/o
175
Kid with Tourette syndrome is at increased risk for?
ADHD and/or OCD
176
Lesch-Nyhan syndrome is caused by?
Hypoxanthine-guanine phophoribosyl transferase (HPRT)
self-mutulation, neuro, gouty arthritis, tophus formation
kid w/ gout - suspect Lesch-nyhan
177
Copious purulent eye drainage and eyelid swelling in the first week of life
Gonococcal conjunctivitis
| prevented w/ top erythromycin rigth after birth
178
Watery eye discharge w/in 5-14 days after birth
Chlamydial conjunctivitis
179
Kiddo is verbal at home but silent at school
Selective mutism
syx for > 1 month
Considered to be an anxiety disorder and should be treated early to prevent long term educational and social impairment
180
kiddo has recurrent skin/mucosal bacterial infections and severe periodontal dz, high WBC with PMN predominance
Leukocyte adhesion deficiency
Also see delayed umbilical cord seperation (>21 days)
Pathophys - defective integrins on the leukocyte surface, which normally let PMN's adhere to the vascular endothelium
Infection will have a lack of purulence
181
How do you define sm all for gestational age and what are they at risk for?
```
<10th percintile for weight at birth
Hypoxia
Polycythemia
hypoglycemia
hypothermia
hypocalcemia
```
182
Precocious development of pubic and axillary hair, acne, and body odor in a kid with a normal bone age
Premature adrenarche
Caused by early activation of adrenal androgens and is more common in obese kids
estrogen and test are WNL so no premature puberty or virilization
Mild elevation of DHEA presents with adrenarche but does not affect skeletal growth so bone age is NL
183
Tx for septic arthritis
Emergency surgical drainage and IV abx to prevent permanent joint destruction
Staph is most common
184
Neurofibromatosis kid has left eye squinting, proptosis, esoropia, and optic disk pallor
Optic pathway glioma
associated with NF 1
Unilateral vision loss, proptosis, esotropia, optic disc pallor
Mutation in NF1 which codes for neurofibromin
185
Teen with abn uterine bleeding shortly after undergoing menarche
Hypothalamic-pituitary-ovarian axis prematurity
| anovulatory cycles w/o sluffing cause increased bleeding
186
Tx for chlamydial conjunctivitis
po macrolide (erythro)
top is ineffective
watch fpr pyloric stenosis - side effect of azithro and erythro
187
Tx for gonococcal conjunctivitis
IM ceftriaxone
188
Superficial infantile hemangiomas AKA
Strawberry hemangiomas
Benign, grow rapidly but regress spontaneously
If complications do arise - BBlockers
189
Pediatric HTN, Higher pulse ox in upper extremities than lower
Coarctation of the aorta
Important cause of pediatric HTN
Caused by thickening of the tunica media of the aortic arch
190
Etiology of marfan
Mutation in fibrillin 1
AD
Tall, thin extremities, arachnodactylyl, joint hypermobility, upward lens dislocation, aortic root dilation (most dangerous)
191
Third world
cc eye redness, watery discharge
pe pale follicles and inflammatory changes in the tarsal conjunctivae bilaterally. Conjunctivae are mildly thickened
Visual acuity is 20/20
Trachoma
Caused by chlamydia trachomatis A,B,C
Leading cause of blindness in the world
Presents with follicular conjunctivitis and inflammation
Repeat or chronic infection causes inversion of the eyelashes and scarring of the cornea
tx - po azithromycin, need surgery to preserve vision
192
when should vaccines be given to premmies?
According to chronologic age, not gestational
| Weight must be >2kg (4lb6oz) prior to first HBV
193
If a SCD pt is taking hydroxyurea, their HbF level will likely be?
>15%
| Hydroxyurea can cause myelosuppression -> neutropenia
194
```
Infant w/
Macrocytic anemia
Short
webbed neck
cleft lip
shield chest
triphalangeal thumbs
```
Diamond-Blackfan syndrome
AKA congenital hypoplastic anemia
Macrocytic anemia, low ret count, congenital anomalies
elevated HgbF on electrophoresis
Normal chromosomes
Tx - corticosteroids, transfuse if unresponsive
195
Painful lytic bone lesion w/ overlying swelling and hypercalcemia
Langerhans histiocytosis
196
Thrombocytopenia
Eczema
Recurrent infections
Wiskott-Aldrich syndrome
X-linked defect in WAS
Impairment in cytoskeleton changes in leukocytes, platelets
Low platelet count and small platelets is the most pronouced finding
Tx - stem cell transplant
197
Hematochezia
Shock
Metabolic acidosis
Radiopaque tablets on Xray
Iron poisoning
Occurs in kids whose mom has pre-natal vitamins because kids think it's candy
Tx - deferoxamine binds ferric iron and allows for urinary excretion
198
```
Persistant jaundice
Hemolytic anemia
Splenomegaly
+ FHx
Spherocytes on peripheral blood smear
```
Hereditary spherocytosis
Defect in RBC membrane
AD defect in ankyrin gene leads to spectrin deficiency
Dx - RBC fragility on acidified glycerol lysis and eosin-5-malemide binding tests
Negative coombs test
199
Tx for QT syndrome
Beta blockers w/ pacemaker
| Avoid all meds that block K+
200
Management of asthma that is unresponsive to nebulized steroids (AMS, minimal aeration, hypercarbia, worsening hypoxemia)
Intubate
201
Teen notices a breast lump days before her next period. Now what?
Reschedule for a few days after her period
Most likely a fibroadenoma
Reexamine after her period to assess if the mass decreases in size/tenderness
202
Kiddo has wight patches w/ scaling and itching
Tinea versicolor
Usually trunk and upper extremities
Most noticeable after sun exposure
Dx - KOH w/ yeast cells and hyphae (spaghetti and meatballs)
Tx - TOP selenium sulfide, antifungals
Vitilgo - looks similar but not itchy or scaly
203
Contras to rota vax
Hx of intussesception
Hx of uncorrected GI malformatin (ie meckels)
SCID
204
kids can say mama dada by?
9 months
205
kids can respond to name and babble by?
6 months
206
Say words other than mama dada?
1 year
207
seperation anxiety is normal at?
9-18 months
208
young girl w/
pubic/axillary hair
advanced bone age
elevated LH
Central Precocious puberty
Needs an MRI to evaluate for tumor
If no tumor -GnRH agonist
Note that they'll be shorter despite bone age because estrogen closes the plate
209
Tx for immature HPO axis presenting with heavy bleeding?
high dose OCP's
| Stabilizes the endometrium and stop the acute bleeding
210
Neonate w/ blanchin erythematous papules and pustules
Erythema toxicum neonatorum
Benign
Resolves spontaneously w/in 2 wks
211
Frequent infections
| Small tonsils
X-linked agommaglobulinemia (Bruton)
Abn B cell development d/t defect in tyrosine kinase
Typicaly presents around 6mo when maternal immunity wanes
Tx - IVIG, prophylactic abx
212
What do you tell parents that are concerned for imaginary friends?
Totally normal for 3-6 y/o and can be seen throughout school age
May help with social relationships as this is a form of rehearsal and lets them express creativity
213
Kids that get frequent
GI (Giardia, salmonella, campy)
Respiratory (PNA, sinisitis, OM)
also has FTT, autoimmune dz, chronic lung dz, GI disorders
Common variable immunodeficiency
B cell differentiation is abn, decreased production of multiple IG classes
Risk of encapsulated bacteria, Giardia, and enterovirus
FTT and chronic pulmonary dz
Tx - IVIG to prevent severe infection
No response to vax, severely low IgG
214
IF CF kids is hospitalized for flu, also prophylax for?
Staph aureus
| Start IV vanc (MRSA) in addition to cefepime (MSSA, pseudomonas) and oseltamivir
215
Comorbidity of absence seizures?
ADHD, anxiety
ADHD tends to be inattentive subtype
absence = 3Hz spike wave changes on EEG
ADHD is a common comorbidity in any child with epilepsy
216
Croup kid being treated with steroids is entering respiratory failure
Give nebulized racemic epinephrine
| subglottic edema causes barky cough and inspiratory stridor
217
SCD pt presents with nagging groin/thigh/butt pain w/o erythema or elevated inflammatory markers
Osteonecrosis
| Xray appears normal, MRI more revealing
218
Teen has excessive urination despite no UTI syx and restricting fluid intake. Serum and urinary Sodium is essentially normal but SG low
Hyposthenuria
Inability of the kidneys to concentrate urine
Occurs in pts with SCD or trait
Polyuria, low SG, NL serum sodium
219
Kid has been exposed to varicella but asymptomatic. Now what?
Give varicella vax if <4y/o
Kids <4 have only had 1 vax and are considered non immune. They will need postexposure prophylaxis.
If kiddo cannot receive vax give varicella IG instead
220
Puberty is considered precocious in kids
<8, girls
| <9, boys
221
Bedwetting is normal until
5 y/o
222
HSP increases the risk for which GI dz?
intussusception
d/t intestinal edema and bleeding
IgA mediated vasculitis
Kiddo has palp purpura, abd pain, arthralgi, +/- hematuria
223
Cardiac anomaly in Edwards syndrome
VSD
| holosystolic murmur at LLSB
224
Most common cause of acute bacterial rhinosinusitis?
strep pneumo (30%)
H. flu (30%)
Moraxella catarrhalis (10%)
Tx - amoxicillin-clavulanic acid
225
solitary herald patch followed by clusters of smaller oval lesions in a "christmas tree" pattern
Pityriasis rosea
| Tx - reassurance, symptomatic relief (antihistamines, top corticosteroids)
226
Which maneuvers decrease the intensity of the murmur in hypertrophic cardiomyopathy?
maneuvers that increase preload or afterload
Squatting, leg raise, hand grip
Increase in LV cavity size decreases the obstruction
227
Teen w/ back pain
urinary incontinence
NL straight leg test
step off on PE
Spondylolistesis
Forward slip of vertebrae (L5,S1), manifests in preadolescent kids
back pain, neuro dysfunction, step-off are usually less severe
228
If kiddo has pertusis, what do you do for the rest of the family?
Give a macrolide abx to all household contacts
229
After repair of cryptorchidism, pt is at greatest risk for?
subfertility
Testicles that haven't descended by 6 months need an orchipexy, ideally before 1 yr
Almost all also have a patent processus vaginalis so this repair also prevents future inguinal hernias
No risk of torsion
230
Kiddo has coughing paroxysms and subQ emphysemsa
Get a CXR to r/o PTX
231
Kiddo has decreased hip ROM and foot points outward. Flexion of the hip causes external rotation
Slipped capital femoral epiphysis
Needs surgical pinning to lessen risk of avascular necrosis
Obese boys in early adolescence
232
Kiddo has proteinuria on dipstick. now what?
Repeat dipstick on two subsequent occasions
| This may be transiet proteinuria, but if elevated at 3 visits its considered persistant and needs further workup
233
After using a topical anesthetic, kiddo turns blue
Methemoglobinemia
Cyanosis after exposure to an oxidizing agent (dapsone, nitrities, local/topical anesthetic)
Pulse ox will be low, but PaO2 is NL
1 out of 4 of the Hgb becomes oxidized to ferric (Fe3+) vs the normal ferrous (Fe2+). Ferric has weaker O2 affinity, causing the other 3 ferrous to have increased O2 affinity -> makes off loading in the tissues harder
O2 does not improve sats, blood will be dark chocolate colored
If oxygen delivery is impaired enough -> AMS, seizures, death
234
Tx for methemoglobinemia
Methylene blue
| Acts as a e- receptor for NADPH and reduces methemoglobin back to hemoglobin
235
Daily fever x 2 months
Arthritis of at least 1 joint
Pink macular rash
Leukocytosis, thrombocytosis, elevated ESR, and anemia
```
Juvenile idiopathic arthritis
Arthritis worse in the morning
Anemia of chronic dz
Dx of exclusion
Tx - NSAIDs, glucocorticoids, biologics
```
236
PDA is what type of shunt?
Extracardiac L to R
237
AFter repair of truncus arteriosus defect kiddo is gittery. Micrgnathia, hypertelorism, low calcium, no thymus. Why gittery?
Hypoparathyroidism
| DiGeorge syndrome
238
15 y/o boy hasn't started shaving,
Reassure
239
Collection of fluid in the middle ear, but tympanic membrane is mobile
Serous otitis media
| Can accumulate d/t UTI
240
dark urine 10 days s/p URI
PSGN
| Antigen-antibody immune complexes
241
7 d/o Bilious vomit, one bloody stool. Poor barium movement through GI on swallow study
Failure of normal bowel rotation
242
Kiddo presents with bloody mucous diarrhea after completing a 10 day course of amoxicillin-clavulanate
C. diff
243
Trisomy 18 pt is also exposused to alcohol in utero. Which will cause the baby to have a low birth weight?
Trisomy 18 (Edwards)
244
Newborn is having coughing during feeds and polyhydramnios. Next you?
Insert a NG tube
245
Newborn has a lobulated and compressible lesion overlying the buttocks. Petechiae and bruises. Why?
Thrombocytopenia from platelet sequestration
246
Humeral fx, now can't extend wrist or fingers
Radial n.
247
Stidor is caused by pathology at the?
Larynx
248
kid has itching and hair loss on the scalp. Alopecia, numerous broken hairs. Occipital LN
Trichophyton tonsurans
249
Nonproductive cough worse during day. Does not worsen w/ exercise. Does not respond to INH steroids. Xray - linear consolidation in the R middle lobe. Dx?
Bronchiectasis
| Middle lobe syndrome?
250
Teen has seizure after deciding to d/c his CCB which controls his HTN. Current BP 250/154. Now what?
Give sodium nitroprusside
251
Severe intermittent abdominal cramping, reddish discoloration of stool
Intussusception
252
New born w/ jaundice, BF. HCT was 54%, now 5@. High total bili, direct is NL. Dx?
Physiologic jaundice
253
Teen girl w/ mass on one side of neck, progressive axillary and inguinal lymphadenopathy, pruritis, weight loss.
CXR - mediastinal mass
Icreased ESR, ferritin. Dx?
Hodgkin dz
254
Kiddo has low BP and Urine output.
Give IV dopamine
255
Teen female w/ short stature and delayed puberty. Never had a period. Multiple nevi over face and trunk. b/l pedal edema. Tanner 1
Gonadal dysgensis (Turners)
256
Kid was unattended now has bomiting and drooling. Two small superfical ulcers on lips and tongue. What did she ingest?
Drain cleaner
| basic
257
kiddo has a hard time clearing chickenpox. Why?
Defect in T cells
258
Toddler with aniridia and mass in the flank. You order a?
U/S of the abdomen
259
Kiddo w/ SOB, JVD, swelling of the face and Upper extremities
CXR - mass in the superior mediastinum and large pleural effusion in the right hemithorax
Thoracentesis - 400mL of reddish brown serosanguineous fluid w/ numerous erythrocytes. Why?
Malignant pleural effusion
| Classic presentation of non-Hodgkin lymphoma
260
URI kid has BP 60/palp and an S3
Cardiogenic shock s/t myocarditis
261
16 y/o female comes to the office and hasn't had vax's since she was 10. What is she due for?
HPV
Meningococcal
TdaP
262
Tx for UTI in a 3 m/o
Cefotaxime
263
Premmie infant gets frequent PNA s/t grade 4 intraventicular hemorrage. Barium swallow shows grade 4 GERD. What will help decrease the frequency of his PNA?
Fundoplication
264
Retinal hemorrhages and subdural tears are caused by what type of injury?
Acceleration-decelaration head injury
265
Excess of which vitamin can cause pseudotumor cerebri?
Vitamin A
266
kiddo has non billious projectile vomiting in first days of life
Get a abd U/S to r/o pyloric stenosis
267
Toddler w/ abd pain, firm nodular midline mass. 120/80
| Xray and U/S - 12 cm midline mass w/ calcifications
Neuroblastoma
| also look for HTN
268
Sexually active teen should be screened for ?
Chlamydia, gonorrhea
269
Teen has intermittent swelling of lips, arms, face, chest that seems random. also gets abd and diarrhea w/ these episodes
Get measurement of serum C1 esterase inhibitor concentration
270
electrolyte abnormalaties in pyloric stenosis?
Low Cl-, K+
pH high
hypochloremic alkalosis
271
Teen w/ increasing facial hair, 12lb weight gain, striae
Cushings
| Get a morning fasting cortisol
272
2 greatest RF's for interventricular hemorrhage in a newborn?
Prematurity
| Low birth weight
273
1st line therapy for unexplained enuresis
Desmopressin
274
Endometriosis vs primary dysmenorrhea
PD - pain starts w/in 24 hours of menstruation, no pain w/ sex
Endo - pain days prior, pain with sex
275
Primary amenorrhea is defined as
absence of menarche by age 15
276
1st step in management of a pyloric stenosis pt?
IV hydration and K replacement
| Followed by pyloromyotomy
277
Precocious puberty (secondary characteristics; pubic hair, acne)
Accelerated borne growth/age
Low-NL LH
LH levels do not respond to GnRH stimulation
Nonclassic congenital adrenal hyperplasia
21 hydroxylase deficiency
low-NL LH level d/t inhibition of the hypothalamus by high androgen levels from the adrenals or testes
NO salt wasting
278
Turners newborn has peripheral edema
congenital lymphedema d/t abd development of the lymphatic network
Accumulation of protein rich interstitial fluid in the hands, feet, and neck (webbed neck). Can cause cystic hygroma if severe enough
Tuerners - webbed neck, corshoe kidney, carpal/pedal edema, nail dysplasia
279
Blue sclerae
| Recurrent fx's
Osteogenesis imerfecta
Also associated w/ hearing loss and opalescent teeth (dentinogenesis imperfecta; caused by discoloration of dentin)
AD mutation in COL1A1
280
Osteogenesis imperfecta is a defect in?
Type 1 collagen
281
Toddlers behaviors toward sex
Normal - exporing own or others genitals, mastubatory movements, undressing self/others
NL for school kids - Interest in sex words/play, asking about sex, masturbatory movements
ABN - Repeated object insertion into V or A, sex play involving g-g, o-g, or a-g contact, use of force/threats/bribes in play, sexual knowledge not appropriate for age (ie oral sex)
282
Newborn
| Dehydration, salt wasting (hypotensive), virilization
Congenital adrenal hyperplasia
| 21-hydroxylase deficiency causes 17-hydroxyprogesterone to be elevated
283
Meconium ileus is diagnostic for?
Cystic fibrosis
| Inspissated (viscous) meconium can cause life-threatening obstruction of the ileum
284
Newborn has b/l medial deviation of the foot, but ROM and DTR's are NL
Metatarsus adductus
Tx - reassurance
Feet are flexible tat over corrected in utero
285
Newborn has rigid medial/upward deviation of the forefoot and hindfoot. Hyper-planta flexion of the foot
Clubfoot
| Tx - serial manipulation and casting, surgery for refractory cases
286
Inspiratory and expiratory stridor that improves with extension of the neck, but not when prone
Vascular ring
Rings of vessels encircle the trachea and or esophagus and present with respiratory syx that improve with neck extension
abn development of aortic arch
can also have dysphagia
287
Stridor that is worse when supine, improves when prone
Laryngomalacia
288
Kiddo w/
sudden behavioral problem
Unstable home environment OR
Parents with active drug/alcohol abuse
Be suspicious for physical or sexual abuse
289
sharply defined rash extending circumferentially around the anus
Strep perianal dermatitis
look for recent contact with strep pharyngitis pt
Tx - po abx (penicillin, amox)
290
Causitive organism in impetigo?
Staph
Strep pyogenes
Tx - TOP abx
291
kid walks on toes
b/l calf enlargement
Gower sign
Duchenne muscular dystrophy
presents ages 2-5 y/o
X-linked recessive, deletion of dystrophin gene
Dx - genetic testing
292
How do you manage a vaginal foreign body?
Toilet paper is most common
Remove w/ calcium alginate swab or irrigation w/ warmed fluid after top anesthetic is applied
If this fails - general anesthesia
293
When should burn injuries concern you?
Sparing of the flexor surfaces ("zebra pattern", doughnut pattern)
Sharp lines of demarcation (no splash marks)
Uniform burn depth
294
What happens to the CBC in splenic sequestration?
Normocytic anemia
Rets increase
Thrombocytopenia
Caused by splenic vaso-occlusion -> rapid splenomegaly
295
Kid with limp, Xray looks normal in early dz
Legg Calve Perthes
| Avascular osteonecrosis of the femoral head
296
Kiddo w/ purulent eye discharge in first week of life
Gonococcal conjunctivitis
| needs IM cefotaxime/ceftriaxone
297
Kiddo w/ purulent eye discharge in second week of life
Chlamydial conjunctivis
| needs po erythro
298
How do you tell the difference b/w X-linked agammaglobulinemia (Bruton's) and Common variable immunodeficiency
Brutons - low B cell count and low Ig's (all types)
| Common variable immunodeficiency - NL B cell count, low Ig's (all types)
299
Clear vesicles over erythematous skin, just over the cheeks
HSV
"punched out" lesions w/ hemorrhagic crusting
if kiddo has atopy w/ superimposed HSV = eczema herpeticum
300
Best way to prevent SIDS?
Avoidance of second had smoke
Avoid pacifiers in bed
sleep supine w/ firm bedding
don't share the same bed
301
```
Macrosomia
Macroglossia
Umbilical hernia/omphacele
hemihyperplasis (ie R extremity larger than L)
Hypoglycemia
```
Beckwith-Wiedemann syndrome
Overgrowth disorder, prediosposed to neoplasms
11p15, alter insulin-like growth factor 2
Monitor closely for hypoglycemia
Get abd U/S and serum alpha fetoprotein q 3m from birth - 4y/o to asses for Wilms tumor or hepatoblastoma
302
Most common risk factor for orbital cellulitis
Bacterial sinusitis
303
Male teen has gynecomastia
Reassure
Pubertal gyneo is seen in 2/3 of boys during mid to late puberty
d/t transient increased estrogen from the testicles
unilateral or b/l or painful
Usually resolves in months - 2yrs
304
Which beta blocker should be avoided in kids with long QT syndrome?
Sotalol
305
New heart murmur after strep pharyngitis needs?
PCN prophylaxis
306
Tx of lead poisoning must be based on?
The venous level of lead
307
Systolic murmur best heard when lying down. Improves with standing
Innocent murmur, reassure
308
Kid under 2 y/o tx for UTI also needs a?
Renal U/S to evaluate for anatomic abnormalities
309
TX for OCD
SSRI + CBT
310
Obese kid with limp
SCFE
311
When should a drain clearner kid get an EGD?
Within 24 hours
312
Anaphylaxis during blood transfusion
Selective IgA deficiency
| Most common immune deficiency
313
Why does putting knees to chest help in tetrology?
Increases systemic vascular resistance
Increases pulmonary blood flow
Help pt overcome RV obstruction
314
Obese girl w/ pubic hair, no other signs of puberty
Premature adrenarche
| Early activation of adrenal glands, related to obestiy
315
Anterior R sided cervical mass x 1 day
Staph aureus, strep pyogenes
| Most common causes of acute unilaterlal lymphadenitis
316
Rare, but potentially serious complication of infectious mono?
Acute airway obstruction
Suspect in pts with throat tightness of difficulty swallowing
tx - corticosteroids
317
Raised macular lesion w/ hair
Congenital melanocytic nevus
| Presents in first few months of life
318
Neonates (<2m) are at greatest risk of which complication of bronchiolitis
Apnea
319
Why does viral illness increase risk of intussusception?
Hypertrophy of Peyer patches in terminal ileum serves as nidus for telescoping
320
```
Male 2-5
Diffuse bone pain
pallor petechiae
Rubbery LN
Elevated WBC
CXR with wide mediastinum
```
Acute lymphoblastic anemia
Most common cancer in kids
BM bx confirms dx if >25% lymphoblasts
321
Newborn w/ bilious vomiting, no meconium
SBO
Either meconium ileus or Hirschprung's
Get contrast enema to find the level of the blockage
322
Tx for homocysttinuria
Vitamin B6, B12, Folate to lower homocysteine levels
323
Inheritance patter of muscular dystrophies
myotonic - AD
Duchenne, Becker Xlinked
Duchene - more severe dz, Gower sign, younger kids
Becker - milder dz, older kids
324
Describe duchenne muscular dystrophy
X linked deletion of dystrophin on p21
Onset 2-3
Progressive weakness, Gower sign, calf pseudohypertrophy
Comorbids: scoliosis, cardiomyopathy
Prognosis: wheelchair by adolescence, death 2-30 d/t heart failure
325
Describe becker MD
```
X linked deletion of dystrophin on p21
onset 5-15 y/o
Milder dz
Comorbid: Cardiomyopathy
Death by age 40-50 from HF
```
326
Describe myotonic muscular dystrophy
AD, expansion of CTE trinucleotide repeat in DMPK gene on 19q13
Onset 12-30
Facial weakness, hand grip, myotonia, dysphagia
Comorbid: arrhythmia, cataract, balding, testicular atrophy/infertility
Death from repirator or heart failure, depends on age of onset
327
Complications of mumps
Aseptic meningitis
| Orchitis
328
Breast development
Absent uterus and upper vagina
Minimal to absent pubic hair
Complete androgen insensitivity
X linked mutation of adrogen receptor
Cryptorchid testes
329
Breast development
Absent or rudimentary uterus and upper vagina
NL ovaries
NL pubic hair
Mullerian agenesis
Hypoplastic or absent mullerian ductal system
Female, just don't menstruate
330
Hypotonia
Hyperpahgia
Obesity
Prader-Willi
Loss of paternal 15q11
Increased risk of OSA, DM, gastric rupture
331
Anosmia
| Delayed puberty
Kallman syndrome
Low FSH/LH, low GNRH
X-linked
hypogonadotropic hypogonadism
Absence of GnRH -> short w/ delayed puberty
Females - no boobs
Boys - eunich appearance, small external genitalia and absent pubic hair, voice deepening, libido
332
Tx for tourette's
Habit reversal training
Alpha-2 agonist (clonidine, guanfacine)
Antipsychotics (risperidone, second gens preferred)
333
Infant w/
asymmetric gluteal/thigh/inguinal creases
Apparent leg length discrepancy
Developmental dysplasia of the hip
Get a U/S, after 4m/o bones are radioopaque and Xrays are preferred
RF: breech, female, FHx
Clunk on hip exam maneurvers (Barlow, Ortolani)
Tx - Pavlik harness
334
Back pain w/ step off
| New bed wetting
Spondylolisthesis
| Forward slip of vertebrae in preadolescents
335
Microangiopathic hemolytic anemia
Thrombocytopenia
AKI
Hemolytic uremic syndrome (HUS)
| Also schistocytes
336
Macroglossia
Umbilical hernia/omphalocele
Hypoglycemia
Beckwith-Wiedemann syndrome
Needs to be monitored for Wilms tumor or hepatoblastoma
Get an abd U/S
337
Pubic hair
Breast development
Irregular cafe-au-lait macules
Recurrent long bone fx
McCune-Albright syndrome
Premature secretion of sex hormones w/o GnRH
Recurrent fx d/t polyostotic fibrous dysplasia
Mutation in GNAS gene -> overproduction of pituitaty hormones (LH/FSH)
can also have thyrotoxicosis (TSH), acromegaly (GH) and Cushing syndrome (ACTH)
338
Situs inversus
Recurrent sinusitis
Bronchiectasis
Kartagener syndrome
Type of primary ciliary dyskinesia
Mutation in dynein
Dx - low nasal NO, Bronchoscopy, Genetic testing
339
Healthy exclusively BF kiddo has painless bloody stool, eczema
Milk or soy protein induced colitis
| Confirm dx if syx resolve after mom eliminates dairy and soy from her diet
340
Postural neck deformity
Congenital torticollis
| SCM m. mass, ipsilateral head tilt, and contralateral chin deviation
341
Newborn is cyanotic but pinks up with crying. Cyanosis worse with feeding
Choanal atresia
Dx - failure to pass catheter from the nose to oropharynx
CT shows narrowing of pterygoid plate in posterior nasal cavity
342
CHARGE syndrome
```
Coloboma
Heart Defects
Atresia choanae
Retardation of growth/development
GU anomalies
Ear abn/deafness
```
343
Dx and management of laryngomalacia
Dx - direct laryngoscopy showing collapse of the supraglottic structures during inspiration
Typically spontaneously resolves by 18 months
344
Newborn with painless scrotal swelling that transilluminates on exam
Newborn hydrocele
Observe, most resolve by 1 y/o
Hydrocele = fluid collection w/in the tunica vaginalis (sac surrounding the testis)
A hernia containing bowel would not transilluminate
345
Swimmers ear
Otitis externa
Pseudomonas
Loss of cerumen d/t swimming increases risk
Tx - fluoroquinolone drops
346
Feeding intolerance
Abdominal distension
Bloody
Necrotizing enterocolitis
| RF's prematurity, hypotension, congenital heart disease
347
Most common cause of sepsis in SCD
Strep pneumo
| This is why SCD kids should receive PCN until at least 5 y/o
348
Life threatening complication of hereditary angioedema
Laryngeal edema
Caused by C1 inhibitory defiency/destruction -> elevated levels of edema producing C2b, bradykinin
episodes typically follow infection, dental proceudre, trauma
349
Healthy kid with severely microcytic anemai
| RDW, Red blood cell count NL
Thalassemia trait
Caused by reduced production of globin chains
Target cells
NL serum iron studies
350
Recurrent skin infections and pulmonary infections w/ Staph, serratia
Chronic granulomatous dz
defect in NADPH oxidase
Dx - abn dihyrohodamine testing
351
If parents refuse to consent to a life saving treatment for their child you?
Can get a court order to mandate tx
352
Exudative effusion into the chest
Chylothorax
Disruption of lymphatic flow w/in the throacic duct
Milky white fluid w/ triglycerides
353
Atopic dermatitis kid should be tx w/ what for rash?
Triamcinolone
354
Scrotal pain x hours
| Unilateral absence of cremastic reflex
Testicular torsion
355
Newborn has a growing dark macule on her leg. No hair
Congenital melanocytic nevus
| Present at birth and can darken during following months
356
Teen with dysmenorrhea, Tender normal sized uterus and no masses. LMP 7 days ago. What next?
NSAIDs
357
CF pt 6 month hx of SOB. Hepatosplenomegaly and edema
Hyponatremia
Low albumin
Urine prot 1+
FVC 30%
CXR hyperinflamation, coarse nodular infiltrates b/l
Why does she have edema?
Cor pulmonale
358
1 wk hx of fever, lethargy, joint pain
Today, petechiae
adenopathy in cervical chain, splenomegaly
Anemia, high high high WBC, thrombocytopenia
ALL
359
Teen has reddish brown urine when he gets a cold
U/A shows nephritis
NL serum C3
IgA nephropathy
360
Anaphylaxis tx w/ epineprhine, methylprednisone. Hemodynamically stable. Waht do you give next?
Fluids
361
Kid with adrenal insufficiency s/t neisseria meningitis has b/l patchy infiltrates. Why?
Increased vascular permeability
362
s/p tonsilectomy kid has seizures in PACU. He got 5% dextrose in water intraoperative. What is wrong?
Hyponatremia
363
Cephaohematoma is caused by
blood under to the periostium of the skull bone (ie parietal)
364
Kid swallows a foreign body and there is obstruction in the lung. Where is most likely
Partial obstruction of the R main stem bronchus
365
Teen is hallucinating, sweating, and belligerent. Give him?
IM lorazepam
| Beware of naloxone as that would be a rapid w/d
366
Abdominal cramps and knee pain, intermittent x weeks
Cramps improved with BM
Multiple bloody stool daily
elevated leukocytes in the Knee
Ulcerative colitis
367
Head trauma with lens chaped extracerebral density
epidural hematoma
368
Head trauma w/ crescent shape
Subdural hematoma
369
Kiddo with pulse > 200, QRS 0.05, no P wave. Does not improve w/ ice bags over the eyes
Give adenosine
370
New born w/ afebrile vomtiting, jaundice, hepatomegaly
Tot bili 14
Direct bili 8
Urine + for reducing substances
Galactosemia (Galactose 1 phosphate uridyltransferase deficiency)
371
4 w/o increasing jaundice x 1 week
exclusively BF
No anemia
Total bili 12, direct 8
Decreased biliary excretion
| NOT decreased hepatic glucuronosyltransferase activity
372
DKA kid w/ orthostatic hypotension
Give insuline and NS
373
Frequent OM, sinusitis, small anterior LN
Antibody deficiency (d/t lack of B cells)
374
2/6 crescendo-decrescendo systolic murmur with musical quality at LLSB w/ no radiation
Still's murmur/innocent murmur
375
```
3 day hx of fever, cough, sputum
afebrile
PMH - respiratory problems since infancy
c/c on exam w/ hyperexpanded ches
Diffuse rhonchi/weezin
CXR - hyperinflation, atelectasis, chronic interstitial changes
```
Cystic fibrosis
376
Healthy teen acute onset fever, malaise, pain in LLE, can't walk
Febrile
No skin break, but swelling and point tenderness
Technetium 99m bone scan w/ uptake at metaphysis of tibia
Acute osteomyelitis
377
Best way to prevent spreading rotavirus?
Good handwashing technique
378
Worsening HA x 6 wks, b/l papilledema, R abducens palsy, gait ataxia
Medulloblastoma
379
Hot day, sudden onset of HA, nausea, vomiting. Exam - aox3, diaphoretic febrile, tachy
Heat exhaustion
380
```
Fever, lymphadenopathy x 3 weeks
Weight loss, steatorrhea, hepatosplenomegaly
Febrile
Low WBC w/ high PMN
High IgG, IgM, NL IgA
```
HIV?
381
Kid on maintnence chemo has patch beneath the scapula w/ 6-8 superimposed small clear fluid filled vesicles
Herpes zoster
382
How do you tx a androgen insensitivity kiddo?
B/l gonadectomy after completion of puberty (after adult height is attained) to decrease chance of malignancy
383
hematureia in SC trait is caused by?
Renal papillary necrosis
| Mild episodes, resolve spontaneously
384
Kiddo has febrile sezure after receiving dTap. Should he get that vax again?
Yes
| Contras to dTap are Immediate anaphylaxis, unstable neuro disorders, encephalopathy w/in 1 week of administration
385
1 yr milestones
```
Weight should triple
Height increase by 50%
Learning to walk independently, but should be able to stand and walk w/ support
2-finger pincer grasp
mama dada + 1
1 step commands
```
386
Anorexia kiddo in tx has arrhythmias and cardiopulmonary failure. Why?
Refeeding syndrome
Taking in carbs -> increased insulin -> promotes cellular uptake of Phos, K+, and Mag causing intervascular deficiencies of the electrolytes -> arrhythmias
387
Kiddo is short despite having tall parents
Little behind to start puberty
Bone age is less than chronologic age
Constitutional growth delay
| See again in 6 months
388
Dihydrorhodamine or nitroblue tetrazolium testing
Chronic granulomatous dz
| Impaired phagocytic killing
389
Hx of PNA, sinus stuff, vit d deficiency
B/l nasal polyps
Multiple bruises
Cystic fibrosis
| Primary ciliary dyskinesia looks very similar but they have situs inversus and do not have pancreatic insufficiency
390
new onset hearing loss
| Chronic ear drainage despite abx
Cholesteatomas
| Granulation tissue, skin debris may be seen on otoscopy
391
Tx for ring worm
```
tinea corporis
Top antifungal (clotrimazole, terbinafine)
```
392
Biolious vomiting
Double bubble on Xray
Associated w/ Down's
Duodenal atresia
393
cytoplasmic aggregates of periodic acid Schiff + material
ALL
| NO auer rods (AML)
394
Dx for malrotation/volvulous
Upper GI series
395
Flat facies and limb deformieies d/t IUGR s/t oligohydramnios
Potter sequence
396
New born w/ barrel shaped chest, concave abdomen
Congenital diaphragmatic hernia
| Needs intubation
397
How do you keep a PDA open?
Protaglandin E1
398
```
Malnourished pt
Angular cheilitis
Stomatitis
Glossitis
Anemia
Seborrheic dermatitis
```
```
Vitamin B2 (riboflaving) deficiency
meat, eggs, dairy, veggies
```
399
Tx for hair loss d/t tinea capitis?
po griseofulvin or terbinafine
400
Fail to pass meconium in first 48 hours
| Down's baby
Hirschprung dz
| Failure of migration of neural crest cells
401
Neonate w/ irritability, high pitched cry, sneezing, poor feeding
Neonatal abstinance syndrome
| w/d from opiates
402
Workup for primary amenorrhea, uterus present
Get a FSH if there is no boobs
If low - pituitary MRI
If hi - Karyotype
403
```
Nurologic syx (ataxia)
skeletal deformities (scoliosis, feet deformities)
Cardiac dz ( hypertrophic cardiomyopathy)
```
Friedreich ataxia
ar
COD - cardio or respiratory
404
Microcytic anema w/ elevated RCDW
Iron deficiency
405
Microcyt anemia w/ NL RCDW
Thalassemia
