Peds Uworld review 2 Flashcards
1
Q
What is the weber and Rinne test?
A
Weber = tuning fork on top of head, detects bone conduction
Rinne = on mastoid process, then air
2
Q
What determines an abnormal Rinne test?
A
-If bone conduction is heard longer than air conduction in affected ear (normal is reversed)
3
Q
What sort of study design would be used to determine incidence of a disease?
A
Cohort study
4
Q
What sort of study would be used to determine a disease prevalence?
A
Cross-section study
5
Q
What is involved with a cross-sectional study?
A
Sample of individuals from a population at a given point in time to determine prevalence
6
Q
What is the cause of physiologic jaundice of the newborn, and when does it typically appear/resolve?
A
- Increased RBC breakdown and Decreased hepatic UDP glucuronosyltransferase activity.
- Appears day 2-3, and resolves by 1-2 weeks.
7
Q
At what level of bili is exchange transfusion indicated for physiologic jaundice of the newborn?
A
25 mg/dL
8
Q
For how long is nocturnal enuresis normal?
A
Until age 5
9
Q
Which gender typically requires more time to be fully toilet trained?
A
Boys
10
Q
How can you differentiate between CVID and SCID?
A
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
11
Q
Which gets better with ice pack application: myasthenia gravis or Lambert-Eaton syndrome?
A
MG, since this decreases breakdown of ACh in the synapse
12
Q
What heart sound can classically be heard at onset of a new MI?
A
S4
13
Q
What immunologic process is impaired with a splenectomy?
A
Antibody-facilitated phagocytosis, due to a loss of splenic macrophages
14
Q
Which is associated with CF and which with down syndrome: meconium ileus vs Hirschsprung
A
CF = meconium ileus Hirschsprung's = DS
15
Q
What is the level of obstruction seen with meconium ileus vs Hirschsprung’s disease?
A
Hirschsprung’s = Rectosigmoid
Meconium ileus = Ileum
16
Q
What is the “squirt sign” associated with Hirschsprung’s disease?
A
Rectal exam produces an explosive discharge of stool and flatus
17
Q
What associated conditions develop with Tourette syndrome? (2)
A
OCD and ADHD
18
Q
What is the most common cause of lymphadenitis in children?
A
Staph Aureus
19
Q
What gyn cancer is associated with Lynch syndrome?
A
Endometrial cancer
20
Q
What is the general physiologic process that is impaired with Lynch syndrome?
A
DNA mismatch repair
21
Q
What is the cause of a Meckel’s diverticulum?
A
Failure to obliterate the vitelline (omphalomesenteric) duct
22
Q
What is the diagnostic test for a Meckel’s diverticulum?
A
Tch-99 pertechnetate scan
23
Q
What are three conditions that can lead to pellagra (1 medication, 1 inherited disease, 1 acquired disease)?
A
- Isoniazid (interference of Y metabolism)
- Hartnup disease (Lack of Y uptake)
- Carcinoid syndrome (consumption of Y)
24
Q
What is the pharmacotherapy for Tourette’s disorder? (2)
A
- Alpha-2-agonists if mild
- antipsychotics
25
What is the classic x-ray appearance of an osteosarcoma? What 2 labs are elevated?
- Sunburst appearance on xray
| - Elevated alk phos and LDH
26
What are the classic findings of fetal hydantoin syndrome?
- Hypoplastic fingers/nails
- Cleft lip/palate
- MR
27
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
28
How long should pts with mono avoid contact sports?
Minimum of 3-4 weeks
29
What CT findings highly suggest a hydatid cyst 2/2 echinococcus granulosus?
Eggshell calcifications
30
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
31
What are the upper endoscopy findings of ZES?
Prominent gastric folds, multiple duodenal/jejunal ulcers
32
What is the treatment for persistent enuresis?
- Bedwetting alarms/rewards
| - Desmopressin if refractory
33
What are the adverse effects of desmopressin?
Since it is an ADH analogue, isovolemic hyponatremia
34
What is the appropriate diagnostic test for a Zenker's diverticulum?
Contrast esophagram
35
What are the five components of metabolic syndrome?
1. Abdominal obesity
2. Impaired fasting BG
3. HTN
4. High triglycerides
5. Low HDL
36
What is the pathogenesis of polycythemia in an infant?
- In utero hypoxia causing increased RBC production
| - Delayed cord clamping causing excessive placental blood transfer
37
What are the s/sx of polycythemia in a neonate?
RUddy complexion
| -Respiratory distress and hypoxia d/t increased viscosity of the blood
38
What level of hematocrit is diagnostic of polycythemia in the neonate?
Over 65%
39
What are the s/sx of contact lens associated keratitis?
- Conjunctival injection
- Pain
- Purulent d/c
- Hazy cornea
40
What is the treatment for keratitis?
Emergent abx and removal of contact lens d/t risk of corneal perforation and loss of vision
41
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
42
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.
43
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.
44
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
45
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
46
What are the specific s/sx of congenital syphilis?
- Snuffles
- maculopapular rash that desquamates
- Abnormal long bone radiographs
47
What are the cranial manifestations of CMV?
Ventricular calcifications
48
What lung manifestations may occur with exertional heat stroke?
ARDS
49
What is the difference in treatment in exertional vs nonexertional heat stroke?
- Exertional = ice water bath immersion
| - Non-exertional = evaporative cooling
50
What are the pupils like with anticholinergic toxicity?
*nonreactive* mydriasis
51
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)
52
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)
53
What vitamin has been shown to decrease mortality in Measles?
Vitamin A
54
How does the rash progress with Measles?
Cephalocaudal
55
What is the emergent treatment for uterine bleeding in a hemodynamically stable pt?
High dose oral estrogen/progestin contraceptive pills
56
What is the emergent treatment for uterine bleeding in a hemodynamically *unstable* patient?
D and C and/or pRBC infusion
57
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
58
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
59
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
60
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
61
What happens to H and K with high aldosterone levels?
Increased renal secretion (contraction alkalosis)
62
What is "contraction alkalosis"?
Loss of fluids cause aldosterone release, which promotes H and K excretion.
63
What are the s/sx of CN poisoning?
- Almond breath
- AMS
- Lactic acidosis
- Seizures
- Coma
64
When does EtOH withdrawal set in?
12-48 hours
65
In whom is CN poisoning 2/2 Nitroprusside use more common in?
Renal insufficiency
66
What are the s/sx of HTN encephalopathy?
Encephalopathy without focal symptoms (*diffuse* brain edema)
67
What are the urinary metabolites seen with a neuroblastoma?
Homovanillic acid
| vanillylmandelic acid
68
What is the standard test for lactose intolerance?
Hydrogen breath test
69
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
70
What is the highest predisposing factor associated with aortic dissection?
Systemic HTN
71
What is the relationship between atherosclerosis and aortic dissection?
Associated, but not causative.
72
what are the common symptoms of cataracts?
Halos around lights
Decreased visual acuity
Glare
73
What is the underlying pathophysiology of cataracts?
Oxidative damage from things like DM, smoking, aging, or glucocorticoid use
74
What are the s/sx of Chikungunya fever? (5)
- High fevers
- *Polyarthralgias*
- HA
- Conjunctivitis
- Maculopapular rash
75
What are three lab manifestations of Chikungunya?
- elevated LFTs
- Lymphopenia
- Thrombocytopenia
76
How is Chikungunya spread?
Mosquito bites
77
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
78
What is the treatment for pyoderma gangrenosum?
Corticosteroids
79
How is pyoderma gangrenosum diagnosed?
Skin Bx
80
What is ecthyma gangrenosum?
Hemorrhagic pustules with surrounding erythema that evolve into *necrotic* ulcers
usually due to pseudomonas infection
81
What is the best test to assess for the risk of foot ulceration in pts with diabetic neuropathy?
Monofilament testing
82
What is enthesitis?
Inflammation at tendon/ligament insertion points
83
Diffuse enthesitis is suspicious for what disease?
Ankylosing spondylitis
84
How does hypomagnesemia cause hypocalcemia?
Induces PTH resistance, and decreasing PTH secretion
85
What is the first line medication to reduce the reoccurance of sickle cell crises? What is the side effect of this?
Hydroxyurea
| Myelosuppression
86
Can the CENTOR criteria be used to empirically treat strep in preadolescents?
No--must do a RSAT
87
What type of fluids should be used in the initial resuscitation of a pt with hypernatremia with hypovolemia
NS
88
What are the skin manifestations of Sturge-Weber syndrome?
Port wine stain
89
What are the head XR findings of sturge-weber syndrome?
Gyriform intracranial calcifications that resemble a *tramline*
90
Angiofibromas in a butterfly pattern on a child's face = ?
Tuberous sclerosis
91
What are the UA findings of renal papillary necrosis? Why?
- Normal appearing RBCs in the urine. Nothing else
| - Extraglomerular problem
92
When is myringotomy with tympanostomy tube placement indicated?
If AOM develops 3x/6 months OR
| 4x/12 months
93
What is the underlying cause of dysmenorrhea?
Prostaglandin release
94
When does the pain occur with primary dysmenorrhea vs endometriosis?
```
Primary = at onset of menses
Endo = few days prior
```
95
What happens to thirst mechanism with DI?
```
Central = no thirst
peripheral = thirst intact
```
96
What is the treatment for SIADH? MOA?
Demeclocycline
| Inhibits ADH-mediated aquaporin insertion
97
What is the preferred treatment for nephrogenic DI?
Thiazides
98
What is the screening test for Conn syndrome? What is the f/u test?
Plasma aldosterone / renin concentration
Adrenal suppression testing f/u
99
What are the four major s/sx that distinguish orbital cellulitis vs preseptal cellulitis?
- Ophthalmoplegia
- Pain with EOMs
- Proptosis
- Vision impairment
100
True or false: pts with exertional heat stroke are often volume depleted
False--more often NOT volume depleted. Rather, it's a failure of the thermoregulatory system
101
Which has significant CNS dysfunction: volume depletion 2/2 heat or exertional heat stroke?
Exertional heat stroke
102
What is the inheritance pattern and defect of hereditary spherocytosis? What is the treatment?
AD loss of ankyrin
Splenectomy or folic acid supplementation
103
What happens to Mean corpuscular Hgb concentration with hereditary spherocytosis?
Increases due to a lack of RBC membrane.
104
What is the classic symptom of ABO incompatibility hemolytic transfusion reaction?
Flank pain
| Fever
105
What are the s/sx of IgA deficiency as a cause of transfusion reaction?
Anaphylaxis, with angioedema, hypotension, and dyspnea
106
What disease causes a albuminocytologic dissociation on CSF?
Guillain -barre
107
What is the classic sign of leukocyte adhesion deficiency (outside of the neonatal period)?
Inflammation with a *lack of purulence*
108
What one UA finding distinguishes glomerular causes of hematuria vs nonglomerular?
Proteinuria = glomerular
109
What is the gene defect in osteogenesis imperfecta?What is the mode of inheritance?
AD mutation in the COL1A1
110
What is eczema herpeticum?
Superinfection of eczema with herpes, causing a vesicular eruption on pre existing inflamed skin
111
Type 2 RTA is associated with what disease?
Fanconi syndrome
112
What are the causes of type 1, 2, and 4 RTA?
1 = inability to secrete H+ into urine
2 = inability to reabsorb HCO3
4 Aldosterone deficiency
113
What are the lab findings common to all 3 types of RTA? (2)
Hyperchloremic
| Non-anion gap acidosis
114
What is Juvenile myoclonic epilepsy?
Myoclonic jerks that usually occur in the morning. Not loss of tone, but dropping things common.
115
What are the EEG findings of Lennox-gastaut syndrome?
2.5 Hz Slow spike and wave pattern
116
What are the EEG findings of Infantile spasms?
Hypsarrhythmia
117
What is the classic triad of Hemolytic uremic syndrome?
- Microangiopathic hemolytic anemia
- Thrombocytopenia
- AKI
118
What are the UA findings of multiple myeloma?
Bland UA that may show evidence of granular casts
119
What sort of animal bite always requires abx prophylaxis?
cat bites since they're so deep
120
What areas of the body that, when bitten by an animal, require abx prophylaxis?
Hands
Feet
Genitalia
121
What are the s/sx of atlantoaxial instability that is characteristic of Down syndrome?
-Similar to normal pressure hydrocephalus
122
What are the characteristic AXR findings of jejunal atresia?
Triple bubble sign
123
What is the enzyme that is deficient in lesch-Nyhan syndrome?
HGRPT
124
When is bicarb indicated for the treatment of acidosis? Why not sooner?
If pH less than 7.1
| Risk of impairing cardiac conduction
125
What position is stridor worse with laryngomalacia?
Supine makes it worse
126
What happens to MCV with thalassemias?
Normal
127
What happens to total RBC numbers in thalassemia?
Normal, despite low Hgb
128
What are the classic signs of amyloidosis?
- Macroglossia
- LVH
- Waxy skin
- Anemia
- neuropathy
- Ecchymoses
- Proteinuria
129
What are all the s/sx of anticholinergic toxicity? (5)
```
Blind as a bat
Hot as a hare
Dry as a bone
Red as a beet
Full as a flask
```
130
What are the s/sx of theophylline? (4)
Seizures
Hyperthermia
Cardiac arrhythmias
Hypotension
131
What CNS pathology is a complication of mumps?
Aseptic meningitis
132
True or false: facial nerve palsy is a possible consequence of mumps infx
false
133
what are the classic PBS findings of G6PD deficiency?
Heinz bodies and bite cells
Heinz bodies are oxidized Hgb
134
When are growing pains classically the worst?
At night
135
What happens to the peak of the murmur of aortic stenosis as the disease progresses?
Moves later in systole
136
What happens to S2 with AS and why?
Soft and single S2 due to reduced mobility of the valve
137
A loud S1 is typically heard with what valvular disease?
Mitral stenosis
138
What is the most sensitive indicator for dehydration?
Decrease urine levels
139
Why is a head CT not required prior to performing an LP in infants?
Their open fontanelles relieve intracranial pressure
140
What are the top three modifiable risk factors for pancreatic cancer, in order?
1. Smoking
2. Chronic pancreatitis
3. Obesity
141
What sort of lesions are present in bone with langerhans cell histiocytosis?
Lytic bone lesions, typically in long bones, with systemic hypercalcemia
142
What is the defect an inheritance pattern of Kallmann syndrome?
XLR disorder of migration of fetal gonadotropin-releasing hormone and olfactory neuron
143
What is the diagnostic test of choice for meconium ileus? Treatment?
- Contrast enema after pneumoperitoneum has been excluded by AXR
- This may break up the insuppsated meconim
144
What is the classic appearance of meconium ileus on contrast enema?
Microcolon
145
What is the diagnostic test of choice for malrotation?
Upper GI series
146
What is the test used to differentiate meconium ileus and Hirschsprung's disease? What will this test show with each of these?
Contrast enema
- microcolon = ileus
- Rectosigmoid transition zone = Hirschsprung's
147
What is the treatment for seborrheic dermatitis in children?
Gentle emollients and non-medicated shampoos.
Weak corticosteroids or ketoconazole are second line
148
Peak airway pressure = ? (looking for equation)
Resistive pressure + plateau pressure
149
Plateau pressure = ? (equation)
Elastic pressure + PEEP
150
newborn baby with cyanosis that is better with crying, but worse when feeding = ?
Choanal atresia
151
What are the components of CHARGE syndrome?
```
Coloboma
Heart defects
Atresia, choanae
Retardation
GU anomalies
Ear abnormalities
```
152
When is vaccination against Yellow fever indicated?
Sub-saharan africa or south america trips
153
What are the lab findings of diamond-blackfan anemia?
ONLY RBCs are affected. No pancytopenia
154
What cell lines are decreased with transient erythroblastopenia?
Only RBCs
155
Which test is prolonged with factor 8 deficiency?
aPTT
156
What is the MOA of tetanospasmin?
Prevents release of GABA/glycine from UMN. This causes uninhibited LMN, leading to spasticity/hypertonicity
157
What is needed to make a diagnosis of acute liver *failure*? (3)
- Elevated LFTs
- Features of hepatic encephalopathy
- INR at/over 1.5
158
What are the classic stool findings of a dehydrated infant?
Brick-red urate crystals
159
During the first week of life, how many wet diapers/day should there be?
Same as age in days (e.g. 4 day old should have 4 wet diapers)
160
What is the most common cause of sepsis in the sickle cell population?
Strep pneumoniae
161
What is the major difference between Meniere's disease and labyrinthitis?
Meniere's disease is recurrent and progressive. Labyrinthitis is not
162
What causes the secondary metabolic acidosis with ASA intoxication?
Uncoupling of Mitochondrial ETC, causing lactic acidosis
163
What is the progression of viral bronchitis?
Dry cough, followed by yellowish purulence 2/2 epithelial cell sloughing, and possibly mild hemoptysis
164
When is chronic LAD significant?
If more than 2 cm, firm/hard, and immobile
165
What is the MOA and use of bethanechol?
Cholinergic agent used to treat urinary retention
166
What is the MOA and use of Oxybutynin?
Anticholinergic agent used to treat urinary incontinence
167
What is neuropraxia?
Transient Weakness d/t nerve injury, common with elbow fractures.
168
How does GERD worsen asthma? What is the treatment for this?
Microaspiration of gastric contents, leading to an increase in vagal tone and bronchial reactivity.
Treatment is with PPIs.
169
True or false: pts who are newly diagnosed with rheumatic fever do not need abx unless they have pharyngitis at the time
False--always give PCN to any newly diagnosed rheumatic fever
170
What is the duration of PCN therapy in the following pts:
- Rheumatic fever without carditis
- Rheumatic fever with carditis, but no residual heart or valvular disease
- Rheumatic fever with carditis and persistent valvular disease
- 5 years or until 21 years (whichever is longer) for rheumatic fever without carditis or 10 years carditis w/o valvular disease
- 10 years until 40 years old if have valvular disease
171
What are the two hemoglobins present with sickle cell *trait*? Disease?
- HbA and HbS = trait
| - HbS + HbF = disease
172
What are the classic hand findings associated with Trisomy 18? Feet?
- closed fist with fingers overlapping
| - Rocker bottom feet
173
What are the characteristics of the head with trisomy 18 (2)?
- micrognathia
| - Prominent occiput
174
What are the classic head findings of trisomy 13?
- Microphthalmia
- Cleft lip/palate
- Cutis aplasia
175
What are the characteristic hand findings of trisomy 13? Feet?
Polydactyly
| Rocker bottom feet
176
Isolated thrombocytopenia in a child after recent viral illness = ? What is the treatment?
- ITP
| - Observation if not bleeding. If they are bleeding, then IVIG and corticosteroids
177
What is obesity hypoventilation syndrome, and how does it differ from OSA?
-OSA is only at night, whereas OHS is persistent always. Due to chronic hypercapnia in OHS, there is increased biacarb, and resultant decrease in Chloride
178
Why does squatting relieve Tet spells?
Increases afterload, forcing more blood through stenotic pulmonary artery
179
Does strongyloides produce diarrhea?
Not typically, but if so, not profuse
180
What are the effects of exogenous androgen use in men? (besides obvious, 4)
Gynecomastia
Polycythemia
Hyperlipidemia
Possibly hepatotoxic
181
What animal is histoplasma associated with?
Bird/bat droppings
182
Hilar adenopathy with noncaseating granulomas is suspicious for what infectious process?
Histoplasmosis
183
What normally happens to SBP with inspiration? What changes can occur to this?
Falls by less than 10 mmHg
| -If falls by more than 10 mmHg, then pulsus paradoxus
184
What is the pathophysiology behind pulsus paradoxus?
-If due to tamponade, then L and R ventricles compete for limited space in sac. Increased venous return from inspiration increases RV volume, and thus decreasing space in the LV. This reduces EDV in the LV, and thus reducing SBP
185
What causes pulsus paradoxus with asthma or COPD?
The drop in thoracic pressure is greatly exaggerated with these, causing a much larger volume to be maintained in the lungs, reducing LV EDV, and thus SBP
186
What, generally, is Werdnig-Hoffman syndrome?
AR loss of anterior parts of the spinal cord, and CN motor nuclei, causing a "floppy baby"
187
Large amount of blood on UA, but very few RBC = ?
Rhabdomyolysis (AU detecting myoglobin as blood)
188
Why should plain water never be given to infants under 6 months?
Can dilute out electrolytes since kidneys not yet fully functional
189
What are the s/sx of cavernous sinus thrombosis?
- HA
- binocular palsies
- periorbital edema
- Hypoesthesia
- Hyperesthesia in V1, V2
- CN III, IV, and VI impingement
190
What are the biologic DMARDs for RA?
- Etanercept
- Infliximab
- Adalimumab
- Tocilizumab
- Rituximab
191
When should pts with RA be started on DMARDs? Why?
ASAP to reduce bony erosions and disease progression
192
What is the first line DMARD for RA?
Methotrexate
193
What are the head imaging findings of JC virus?
Patchy white areas c/w demyelination
194
What lab test can differentiate between chloride responsive and unresponsive metabolic alkalosis?
Urinary Cl excretion will be high is unresponsive, and low if responsive
195
What happens to urinary Cl with hyperaldosteronism?
Increased, since there is no stimulus to hold on to Cl
196
What is the most common bodily secretion that transmits CMV?
Saliva (think mono)
197
What is the mechanism of a subdural bleed with shaken baby syndrome?
Shearing of the subdural veins
198
When is rolling over achieved in development?
4-6 months
199
What virus most commonly causes myocarditis, especially in children?
Coxsackie virus
200
What is the acute treatment for myocarditis?
Diuretics and inotropes
