Peds Uworld review 2 Flashcards
What is the weber and Rinne test?
Weber = tuning fork on top of head, detects bone conduction
Rinne = on mastoid process, then air
What determines an abnormal Rinne test?
-If bone conduction is heard longer than air conduction in affected ear (normal is reversed)
What sort of study design would be used to determine incidence of a disease?
Cohort study
What sort of study would be used to determine a disease prevalence?
Cross-section study
What is involved with a cross-sectional study?
Sample of individuals from a population at a given point in time to determine prevalence
What is the cause of physiologic jaundice of the newborn, and when does it typically appear/resolve?
- Increased RBC breakdown and Decreased hepatic UDP glucuronosyltransferase activity.
- Appears day 2-3, and resolves by 1-2 weeks.
At what level of bili is exchange transfusion indicated for physiologic jaundice of the newborn?
25 mg/dL
For how long is nocturnal enuresis normal?
Until age 5
Which gender typically requires more time to be fully toilet trained?
Boys
How can you differentiate between CVID and SCID?
CVID is due to abnormal maturation of B cells, but B and T cell counts are normal
SCID is due to T cell defects causing a low T cell count, and thus a low B cell count
Which gets better with ice pack application: myasthenia gravis or Lambert-Eaton syndrome?
MG, since this decreases breakdown of ACh in the synapse
What heart sound can classically be heard at onset of a new MI?
S4
What immunologic process is impaired with a splenectomy?
Antibody-facilitated phagocytosis, due to a loss of splenic macrophages
Which is associated with CF and which with down syndrome: meconium ileus vs Hirschsprung
CF = meconium ileus Hirschsprung's = DS
What is the level of obstruction seen with meconium ileus vs Hirschsprung’s disease?
Hirschsprung’s = Rectosigmoid
Meconium ileus = Ileum
What is the “squirt sign” associated with Hirschsprung’s disease?
Rectal exam produces an explosive discharge of stool and flatus
What associated conditions develop with Tourette syndrome? (2)
OCD and ADHD
What is the most common cause of lymphadenitis in children?
Staph Aureus
What gyn cancer is associated with Lynch syndrome?
Endometrial cancer
What is the general physiologic process that is impaired with Lynch syndrome?
DNA mismatch repair
What is the cause of a Meckel’s diverticulum?
Failure to obliterate the vitelline (omphalomesenteric) duct
What is the diagnostic test for a Meckel’s diverticulum?
Tch-99 pertechnetate scan
What are three conditions that can lead to pellagra (1 medication, 1 inherited disease, 1 acquired disease)?
- Isoniazid (interference of Y metabolism)
- Hartnup disease (Lack of Y uptake)
- Carcinoid syndrome (consumption of Y)
What is the pharmacotherapy for Tourette’s disorder? (2)
- Alpha-2-agonists if mild
- antipsychotics
What is the classic x-ray appearance of an osteosarcoma? What 2 labs are elevated?
- Sunburst appearance on xray
- Elevated alk phos and LDH
What are the classic findings of fetal hydantoin syndrome?
- Hypoplastic fingers/nails
- Cleft lip/palate
- MR
What is the role of x-rays in diagnosing osteonecrosis of the femoral head?
Will detect later findings, but not sensitive enough for early disease–need MRI
How long should pts with mono avoid contact sports?
Minimum of 3-4 weeks
What CT findings highly suggest a hydatid cyst 2/2 echinococcus granulosus?
Eggshell calcifications
What are simple hepatic cysts? S/sx? Imaging findings/?
- Congenital cyst related to fluid secretion by epithelial lining
- Dull RUQ pain, early satiety
- No calcifications
What are the upper endoscopy findings of ZES?
Prominent gastric folds, multiple duodenal/jejunal ulcers
What is the treatment for persistent enuresis?
- Bedwetting alarms/rewards
- Desmopressin if refractory
What are the adverse effects of desmopressin?
Since it is an ADH analogue, isovolemic hyponatremia
What is the appropriate diagnostic test for a Zenker’s diverticulum?
Contrast esophagram
What are the five components of metabolic syndrome?
- Abdominal obesity
- Impaired fasting BG
- HTN
- High triglycerides
- Low HDL
What is the pathogenesis of polycythemia in an infant?
- In utero hypoxia causing increased RBC production
- Delayed cord clamping causing excessive placental blood transfer
What are the s/sx of polycythemia in a neonate?
RUddy complexion
-Respiratory distress and hypoxia d/t increased viscosity of the blood
What level of hematocrit is diagnostic of polycythemia in the neonate?
Over 65%
What are the s/sx of contact lens associated keratitis?
- Conjunctival injection
- Pain
- Purulent d/c
- Hazy cornea
What is the treatment for keratitis?
Emergent abx and removal of contact lens d/t risk of corneal perforation and loss of vision
What is disruptive mood dysregulation disorder?
-Adolescent mental disorder, characterized by persistently irritable or angry mood and frequent temper outbursts that are disproportionate to the situation
What is the pathophysiology for Osgood-Schlatter disease? What is the other term for this?
- Traction apophysitis
- Periods of rapid growth cause tension on the quadriceps tendon and thus the apophysis of the tibial tubercle.
What is the common presentation of patellofemoral stress syndrome?
Overuse injury in runners characterized by anterior knee pain that worsens upon descending steps of hills.
What is the common presentation of patellar tendonitis?
- Overuse syndrome resulting from repetitive jumping or kicking.
- Anterior knee pain after exercise.
- Point tenderness at the inferior pole of the patella
What are the five s/sx or lab results that indicate septic arthritis over transient tenosynoviits?
- Fever over 101
- Inability to bear weight
- WBC over 12
- ESR over 40
- CRP over 2 mg/dL
What are the specific s/sx of congenital syphilis?
- Snuffles
- maculopapular rash that desquamates
- Abnormal long bone radiographs
What are the cranial manifestations of CMV?
Ventricular calcifications
What lung manifestations may occur with exertional heat stroke?
ARDS
What is the difference in treatment in exertional vs nonexertional heat stroke?
- Exertional = ice water bath immersion
- Non-exertional = evaporative cooling
What are the pupils like with anticholinergic toxicity?
nonreactive mydriasis
how long do abscence seizures typically last? What sort of movements may be seen?
- Less than 20 seconds
- Simple automatisms (but no more complex motor movements)
What is the treatment for mil, moderate, and severe hypothermia?
- Mild = Passive external warming (90 F+)
- Moderate = active external warming (warm baths, heating pads) (82-90 F)
- Severe = Peritoneal irrigation with warm fluids (less than 82 F)
What vitamin has been shown to decrease mortality in Measles?
Vitamin A
How does the rash progress with Measles?
Cephalocaudal
What is the emergent treatment for uterine bleeding in a hemodynamically stable pt?
High dose oral estrogen/progestin contraceptive pills
What is the emergent treatment for uterine bleeding in a hemodynamically unstable patient?
D and C and/or pRBC infusion
What happens to the following with Bruton’s agammaglobulinemia:
- T cell count
- B cell count
- IgA levels
- IgG levels
- IgE levels
- IgM levels
- T cell count elevated
- B cell count markedly reduced
- All Ig levels markedly reduced
What happens to the following with CIVD:
- T cell levels
- B cell levels
- IgA levels
- IgG levels
- IgE levels
- IgM levels
- T cell counts normal
- B cell counts normal
- All Ig levels markedly reduced
What is the cause of SCID, and what happens to T cells, B cells, and Ig levels because of this?
-Impaired T cell development and thus subsequent B cell dysfunction
Both B and T cell counts reduced, and thus Ig levels down
What is transient hypogammaglobulinemia of infancy?
- transient decrease in IgG levels (variable IgM levels)
- Normal B and T cell concentrations
- Basically worse infections until 9 ish months, but not life threatening
What happens to H and K with high aldosterone levels?
Increased renal secretion (contraction alkalosis)
What is “contraction alkalosis”?
Loss of fluids cause aldosterone release, which promotes H and K excretion.
What are the s/sx of CN poisoning?
- Almond breath
- AMS
- Lactic acidosis
- Seizures
- Coma
When does EtOH withdrawal set in?
12-48 hours
In whom is CN poisoning 2/2 Nitroprusside use more common in?
Renal insufficiency
What are the s/sx of HTN encephalopathy?
Encephalopathy without focal symptoms (diffuse brain edema)
What are the urinary metabolites seen with a neuroblastoma?
Homovanillic acid
vanillylmandelic acid
What is the standard test for lactose intolerance?
Hydrogen breath test
What is the medical term for strawberry hemangiomas? What is the treatment for these lesions if they’re in a life threatening place?
- Infantile hemangiomas.
- Beta blockers
What is the highest predisposing factor associated with aortic dissection?
Systemic HTN
What is the relationship between atherosclerosis and aortic dissection?
Associated, but not causative.
what are the common symptoms of cataracts?
Halos around lights
Decreased visual acuity
Glare
What is the underlying pathophysiology of cataracts?
Oxidative damage from things like DM, smoking, aging, or glucocorticoid use
What are the s/sx of Chikungunya fever? (5)
- High fevers
- Polyarthralgias
- HA
- Conjunctivitis
- Maculopapular rash
What are three lab manifestations of Chikungunya?
- elevated LFTs
- Lymphopenia
- Thrombocytopenia
How is Chikungunya spread?
Mosquito bites
What is pyoderma gangrenosum?
Neutrophilic ulcerative skin disease usually associated with an underlying systemic disorder (e.g. IBD) that starts as an inflammatory papule, pustule, or nodule, and progresses to an expanding ulcer with a purulent base and ragged violaceous borders
What is the treatment for pyoderma gangrenosum?
Corticosteroids
How is pyoderma gangrenosum diagnosed?
Skin Bx
What is ecthyma gangrenosum?
Hemorrhagic pustules with surrounding erythema that evolve into necrotic ulcers
usually due to pseudomonas infection