Peds Uworld review Flashcards
If a child has incidental proteinuria on dipstick analysis, what is the appropriate next step?
Repeat dipstick testing on two subsequent occasions
What are the common causes of transient proteinuria in children? (5)
Fever Exercise Seizures Stress Volume depletion
What is the treatment for bartonella henselae infex?
Z-pack
What is the defect in Wiskott-Aldrich syndrome?
XLR loss of WAS gene that regulates the cytoskeleton remodeling in response to cell signalling
What is the treatment for Wiskott-Aldrich syndrome?
Bone marrow transplant
What are the physical exam findings of Friedreich’s ataxia?
Ataxia
Loss or proprioception
Absent ankle reflexes
What are the EKG findings with Friedreich’s ataxia?
T wave inversions
What are the nerve conduction velocities with Friedreich’s ataxia?
Normal
How long is having an imaginary friend normal?
3-6 years, maybe a bit longer.
What is the active drug in plan B?
Levonorgestrel
Which bacteria is the most common cause of rhinosinusitis? Second and third?
- Strep pneumoniae
- H flu
- Moraxella
Why are patients with cyanotic congenital heart disease at risk for NEC?
Reduced mesenteric perfusion and/or hypotension
What is the classic AXR findings of NEC?
Pneumatosis intestinalis
What are the AXR findings of malrotation of the intestines with volvulus?
Gasless abdomen due to obstruction involving the duodenum
What is the classic AXR/US description of intussusception?
Target sign
What are the typical s/sx of aplastic crisis?
Severe anemia with low reticulocytes and NO splenomegaly
How do you differentiate aplastic anemia vs aplastic crisis?
Crisis = only RBCs are low Anemia = pancytopenia
What animal is the biggest rabies reservoir in the US?
Bats
What is anemia of prematurity?
- Normally, decreased levels of EPO from a sudden increase in oxygen tension in the blood at birth causes an expected nadir at 2-3 months of age in term infants
- Preterm infants there is low EPO and short RBC lifespan, causing much worse anemia and usually frequent phlebotomy in the NICU
What sort of anemia (micro, normo, macro) is anemia of prematurity? Symptoms?
Normocytic with low reticulocyte counts
asymptomatic usually
Why does sickle cell anemia take several months after birth to manifest?
Change from HgF to HgA
How much HgA is there is sickle cell disease? Sickle cell trait?
Disease = 0% (all HbS) Trait = ~50%
What is the next best step after assessing the ABCs in a child who has swallowed a caustic substance?
Remove clothing and decontaminate
Why should nasogastric lavage or administration of neutralizing substances be avoided in children who ingest a caustic substance?
- May cause vomiting, which will worsen injury
- Also, if neutralize the acid/base, then exothermic rxn can burn
What is the effect of adrenal infarction in meningitis infx caused by N. Meningitidis?
Sudden vasomotor collapse
What is trachoma? S/sx? Treatment?
- Chlamydia serotypes A, B, C inflammation of the eyelid, causing a roughing of the inner surface of the eyelid. THis leads to pain, breakdown of the cornea, neovascularization, and eventual blindness.
- Watery discharge
- Oral azithromycin
True or false: a small amount of vaginal bleeding and/or gynecomastia is a normal variant in newborns
True–maternal estrogen exposure. Routine f/u.
How does recurrent constipation lead to UTIs?
Pressure from stool causes compression of the urethra, leading to urinary stasis
Do UTIs usually result from sexual activity/abuse in women?
In older women, yes
In children, no
How does persistent coughing lead to a pneumothorax?
SQ emphysema from increased alveolar pressure
WIth a SCFE, how is the leg held, and what motions are restricted?
Held in passive external rotation
Decreased internal rotation, abduction, and flexion
What is the treatment for a SCFE?
Surgical screw placement
What is metatarsus adductus? Treatment?
- Medial deviation of the forefoot with a normal, neutral position of the hindfoot
- “Correctable” with passive movement
- Reassurance
Does hypocalcemia cause focal neurologic deficits?
No
What is the classic triad of s/sx of a brain abscess?
- Fever
- Morning HAs
- Focal neurologic changes
What are the histologic characteristics of the liver with Reye’s syndrome?
Microvesicular fatty infiltration
What are the s/sx of diamond blackfan anemia?
- Congenital anomalies
- Macrocytic anemia
- Low reticulocyte count
What cell line(s) are affected with diamond blackfan anemia?
Only RBCs–pure red cell aplasia
What cell line(s) are affected with Fanconi anemia?
Pancytopenia
What are the congenital deformities of Fanconi anemia? (5)
- Cafe-au-lait spots
- microcephaly
- Microphthalmia
- Short statues
- Absent thumbs
What is the classic tetrad of s/sx for HSP?
- Palpable purpura
- Arthralgias
- Abdominal pain
- Renal disease
true or false: HSP is characterized by thrombocytopenia
False–normal platelet levels. Thrombocytopenia is suggestive of ITP
What is the most common nutritional deficiency in infants?
Fe
What are the three major risk factors for Fe deficiency in infants?
- Preterm (lower stores)
- Cow’s milk before 12 months of age
- Maternal Fe deficiency
What is the most common cause of pneumonia in CF pts below 20 years of age? Over?
Under 20 = Staph Aureus
Over = pseudomonas
What are bitot spots, and what do they indicate?
Dry, silver-gray plaques on the bulbar conjunctiva that indicate Vit A deficiency
What is the most common predisposing factor for bacterial sinusitis in kids?
Preceding viral URI d/t impaired ciliary clearance
What organ is responsible for premature adrenarche in children? Thelarche?
Adrenarche = Adrenal androgen secretion Thelarche = pituitary or ovaries
Which cancers can breastfeeding help prevent in the mother?
Breast and ovarian–NOT endometrial
True or false: breastfeeding is associated with a reduced incidence of AOM in children
True
For a cyanotic congenital heart defect, do you want to maintain a PDA, or close it?
Maintain it with PGE2
What may be seen with the carotid upstroke with HOCM?
Seemingly dual upstroke
What findings in the iris is characteristic of Down syndrome?
Brushfield spots (white-gray spots on the periphery)
Retinal hemangioblastomas are associated with what neurocutaneous disorder?
VHL
Onion skinning and Moth eaten appearance of bone on x-ray = ?
Ewing’s sarcoma
What is the classic presentation of midgut volvulus?
Bilious vomiting and abdominal distention
What is the best first diagnostic step in evaluating a suspected midgut volvulus?
AXR to r/o pneumoperitoneum, followed by Upper GI series
What will an upper GI series reveal with a midgut malrotation? Volvulus?
Ligament of Treitz on the right side of the abdomen = malrotation
Volvulus = corkscrew pattern with contrast
What are the contraindications to the rotavirus vaccination?
- h/o intussusception
- immunodeficiency (it’s a live attenuated vaccine
- Uncorrected congenital malformation of the GI tract
What are the three major cardiovascular malformation associated with Turner’s syndrome?
- Bicuspid aortic valve
- Coarctation of the aorta
- Aortic root dilation
47 XXY genotype = ?
Klinefelter
What is hemihyperplasia, and what disease is it associated with?
Overgrowth of one side of the body
Beckwith-Wiedemann syndrome
What are the s/sx and associations with cyclic vomiting syndrome in children?
- Recurrent episodes of emesis that resolve spontaneously in an otherwise normal child
- Associated with a family h/o migraines, since it is thought that this is an “abdominal migraine”
What is the treatment for cyclic vomiting syndrome?
Antiemetics
What is the causative agent of herpangina? S/sx? Age range affected? Treatment?
- Coxsackie virus A
- 3-10 years old
- Fever, pharyngitis, gray vesicles/ulcers on posterior oropharynx
- Supportive treatment
What is the causative agent of Herpetic gingivostomatitis? Age ranged affected? S/sx? Treatment?
- HSV-1
- 6 mo -5 years
- Fever, pharyngitis, clusters of small vesicles on anterior oropharynx
- Acyclovir
What disease are pts with absence seizures predisposed to developing?
ADHD
What is cataplexy, and what disease is it classically seen in?
- Sudden, intermittent muscle weakness triggered by strong emotions
- Narcolepsy
Are SGA infants at risk for hyper or hypocalcemia?
Hypocalcemia
What hemodynamic problem are SGA infant at risk of developing? Why?
Polycythemia
Increased EPO secretion in response to hypoxia
What is the prophylaxis for pertussis exposure?
Macrolide abx + immunization if not already immunized
Erythromycin use in neonates is associated with what disease?
Pyloric stenosis
What is the first and second line treatment for scarlet fever?
- PCN V
- Erythromycin or clindamycin if PCN allergy
What are the memorable symptoms of opiate withdrawl in the neonate?
- Sneezing
- Tachypnea
- Sweating
What are the memorable symptoms of cocaine withdrawl in the neonate?
- Jitteriness
- Excessive sucking
- Hyperactive moro reflex
What are the s/sx of a pineal gland tumor?
- Limited upward gaze
- Upper eyelid retraction
- Pupils are non-reactive to light, but reactive to accommodation
What is the tick that harbors Lyme disease?
Ixodes scapularis
Who should receive a screening test for GC/chlamydia?
All sexually active women less than 25 years old
What causes a UTI with sex?
AScending bacteria that are introduced from sex
What is the most common pathogen with acute unilateral lymphadenitis?
Strep or staph
Which immunodeficiencies have absent lymphoid tissue?
- Bruton’s agammaglobulinemia
- SCID
Which viruses commonly cause aseptic meningitis?
Echovirus
Coxsackie
True or false: focal neurologic signs are not found with meningitis
True
After a diagnosis of Guillain-barre is made, what is the next most important step? Why?
Spirometry to determine impending respiratory failure
What causes the sloughing off of skin with staph scalded skin syndrome?
Exfoliative toxin from staph destroys the desmoglein 1 protein, which is responsible for keratinocyte adhesion in the superficial epidermis
This is a toxin mediated process
Fair hair and skin
MR
CVA or other clotting events = ?
Homocystinuria
How does torticollis present?
Head tilting + palpable, non-transilluminating mass just posterior to the SCM
What is a major consequence of untreated torticollis?
Positional plagiocephaly
Fluctuant mass in the posterior neck of an infant that transilluminates = ?
Cystic hygromas (congenital malformation of the lymphatic system)
What is the usual cause of croup?
Parainfluenza virus
What is the henderson-Hasselbalch equation for the bicarb buffer in blood?
pH = 6.1 + log(HCO3/0.03*PaCO2)
What is the appropriate imaging type to screen for suspected spinal malignancy without nerve s/sx or concern for epidural abscess? What labs should be obtained (2)?
x-ray
ESR and CRP
What are the red flags for back pain 2/2 CA? (6)
- Over 50 years
- H/o CA
- Constitutional s/sx
- Nocturnal pain
- No response to treatment
- Significant or progressive neuro deficits
What are the typical fundoscopic findings of CRAO?
White retina with a cherry red spot
What is the role of thrombolytics in CRAO?
Useful if initiated within 4-6 hours of visual loss. Given intraarterially.
What are the differences on nasal inspection of allergic vs nonallergic rhinitis?
- Allergic = Pale mucosa
- Nonallergic = erythematous mucosa
What is the role of NSAIDs in IBDs?
May worsen s/sx
What is the most common congenital cyanotic heart condition in the neonatal period, and what are the heart sounds and CXR findings associated with this?
- Transposition
- Single, loud S2
- “egg on a string”
What happens to mitral valve motion with HOCM?
Systolic anterior motion
What is thought to be the pathogenesis of necrotizing enterocolitis?
Lack of proper gut motility, along with lack of gut flora causes an overgrowth
What sort of LAD is nearly pathognomonic for secondary syphilis?
Epitrochlear (“sailor’s handshake”)
What is the treatment for stroke 2/2 septic emboli from endocarditis?
Abx (no need for anticoagulation or antiplatelet therapy)
What is the screening test for bladder CA?
There is none. Low benefits.
What is the most common cause for the s/sx of spinal stenosis?
Spinal osteoarthritis
What movement is limited in pts with Avascular necrosis of the femoral head?
Cannot internally rotate, or abduct.
What is the age range for pts with AVN of the femoral head vs SCFE?
AVN = 4-10 years SCFE = 12+ years
What are the classic head CT findings of alzheimer’s disease?
-Diffuse cortical and subcortical atrophy which is disproportionately greater in the temporal and parietal lobes
What are the two major adverse effects of PTU?
- Agranulocytosis
- Hepatic injury
What is the first and second line therapy for restless leg syndrome? MOA?
- Ropinirole (Dopamine agonist)
- Gabapentin (alpha-2-delta Ca channel blocker
What happens to platelets levels with a sickle cell crises? Why?
Decreased d/t splenic trapping
Which abx used in the treatment of acne classically causes photosensitivity? How?
Doxycycline (or other tetracyclines) causes ROS generation
What is the role of corticosteroids in the treatment of spinal cord compression?
Reduces inflammation of the epidural venous plexus, which contributes to cord compression
What serum albumin-to-ascites gradient is indicative of portal HTN?
More than 1.1
How many PMNs in ascitic fluid is diagnostic of peritonitis?
More than 250
What do the following colors of ascitic fluid usually indicate as an etiology:
- Bloody
- Milky
- Turbid
- Straw color
- Bloody = malignancy, trauma, or TB
- Milky = chylous, pancreatic
- Turbid = infx
- Straw = benign causes
What level of ascitic protein is high vs low? What does each indicate?
High = over 2.5. This indicated CHF, pericarditis
Low = less than 25. This indicates cirrhosis, or nephrotic syndrome
What is the 2nd line treatment for PCP prophylaxis if pts cannot tolerate Bactrim?
Pentamidine
What is the treatment for traveler’s diarrhea?
Cipro
What is the diagnostic test of choice for giardia?
Stool antigen assay
What is the biggest risk factor for cerebral palsy?
Prematurity
Besides anaphylaxis, what are the two major contraindications to the pertussis vaccine?
- Progressive neurologic disorder
- Encephalopathy within a week pf previous vaccine dose
Which two abx classically cause serum sickness?
PCNs and Bactrim
What are the s/sx of serum sickness?
Fever
Urticaria
arthralgias
What is the gene that is affected with NF1 and NF2? What chromosome?
NF1 = neurofibromin = 17 NF2 = merlin = 22
What is the classic exposure to Arsenic? S/sx (4)?
- Working with old wood
- Polyneuropathy, pancytopenia, mild increase in LFTs, variety of skin lesions
What are the major differentiating factors between Arsenic poisoning and Pb?
Ar = skin manifestations Pb = GI manifestations
What is the genetic defect in hyper IgM syndrome?
Lack of or defect in CD40 ligand
What is the long term treatment for hyper IgM syndrome?
Prophylactic abx and IVIG
What is the long term therapy for children with acute rheumatic fever?
IM PCN G until adulthood
Which two antiepileptic drugs are used as migraine prophylaxis?
Topiramate
Divalproate
What are the indications for pharmacologic migraine prophylaxis?
- More than 4/month or more than 12 hours
- Disabling
- Refractory to other meds
Children under what age with a first febrile UTI should receive imaging? What is the imaging of choice?
Under 2 years, renal and bladder US
When are children ok to drink cow’s milk? How much are they allowed to drink?
Not until 1 year old
No more than 24 oz.
If not, then Fe deficiency can develop
In a woman with complete androgen insensitivity, when should the testicles be removed, and why?
After puberty, to allow for hormone production (estrogen) to continue normal development
What causes the increased incidence of intussusception after a recent GI illness?
Hypertrophy of Peyer’s patches serve as a latching point
What causes the increased risk of intussusception with HSP?
Bowel wall edema and localized hemorrhage, which can act as lead points
What is an odd but very rare presentation of HSP?
Scrotal pain and swelling
Where are medulloblastomas usually found in the brain? What s/sx can this cause (2)
- Cerebellum
- Cerebellar signs
- Proximity to 4th ventricle means hydrocephalus
Eyelid retraction is caused by a brain tumor where?
In the pretectal region–usually the Pineal gland
Why might total T3 and T4 levels be low in a cirrhosis pt, but with normal TSH
Total down because bindings proteins down. Effective T3/T4 fine however
What is respondent bias?
When outcome is obtained by the patient’s response, and not by objective diagnostic methods
What is recall bias?
Inaccurate recall of past exposures by pts
What is selection bias?
Nonrandom selection of test subjects
Immunofluorescent staining of skin bullae showing Linear IgG and C3 depositions at the dermal-epidermal junction = ?
Bullous pemphigoid
What is the pharmacologic treatment of stress incontinence? Neurogenic bladder?
- Oxybutynin for stress incontinence (anticholinergic)
- Bethanechol for neurogenic (cholinergic)
What drug can cause methemoglobinemia? (3)
Topicals (e.g. benzocaine), dapsone, and nitrates
What is methemoglobinemia?
Fe2+ to Fe3+ causes an increased binding affinity for Oxygen, causing hypoxia
Which oxygen sat is usually artificially elevated with methemoglobinemia: the ABGs or pulse oxy? Why?
ABGs since sat is calculated, whereas pulse ox is wavelength of light dependent, which is different with methemoglobin
With decreasing renal function, and thus decreasing ability to secrete H+, how do the remaining tubules adapt to maintain a physiologic pH?
Increase NH3 production to secrete H+
What are the appropriate precautions for measles outbreak?
Airborne
What three major infections need airborne precautions?
- TB
- Measles
- Varicella
What happens to RDW with Fe deficiency anemia? Why?
Over 20%–this is the first lab abnormality with Fe deficiency*
Since nutrient availability varies throughout the day, the marrow will produce RBCs of varying sizes.
What will prenatal US show with gastroschisis?
Intestines free floating in amniotic fluid, and all edematous and stuff
How often is gastroschisis an isolated defect?
90% of the time
What are the LFTs and alk phos levels with Rotor’s syndrome?
Normal
How can you differentiate Rotors/dubin johnson syndrome from Gilbert’s?
the former two will have elevated conjugated bili, whereas Gilbert’s has unconjugated hyperbilirubinemia
Over what age should pts with nephrotic range proteinuria suspected of having MCD get a bx?
Over 10
What is the classic presentation of spondylolisthesis?
- Back pain
- Enuresis
- Palpable step off
- Decreased perineal sensation
What is the classic RBC morphology with EPO deficiency?
Burr bodies (cytoplasmic projections on RBCs)
What are the foods that should be avoided in gout?
- Alcohol
- Meats
- Seafood
- Fructose containing foods
What lung volume curve is characteristic of an upper airway obstruction?
Flow limited with expiration and inspiration
What are the surgical indications for removal of a swallowed battery?
Hematochezia
Melena
Severe abdominal pain
What sort of mattress can be used to prevent SIDs?
firm mattress
What is the role of pacifiers with SIDS?
Help prevent
Homes built before what year are risk factors for Pb poisoning?
1978
What is the screening test for Pb poisoning? confirmatory?
Capillary finger prick testing is screening, but need venous levels to confirm, since high false positive rate
What is the treatment for Pb poisoning, given various Pb levels?
(0,45) = Recheck in 1 month
[45, 70) = DMSA
70+ = DMSA + EDTA
Beckwith-wiedemann syndrome looks like what condition? What are the signs that can differentiate it?
Looks like congenital hypothyroidism, but has hemihypertrophy hypoglycemia, and macrosomia
What tests should be ordered for kids with Beckwith-Wiedemann syndrome?
Abdominal US and AFP to assess for Wilms tumors and hepatoblastomas
What is the role of formula feeding with pyloric stenosis?
Increases risk
What maneuvers can be used to differentiate between vascular rings vs laryngomalacia?
Laryngomalacia = Stridor is worse when supine, improves when prone
Vascular rings = Biphasic stridor that improves with neck extension
What type of stridor is present with laryngomalacia vs vascular rings?
Laryngomalacia = inspiratory
vascular rings = biphasic stridor
Why does the stridor with vascular rings improve with neck extension?
decreases tracheal compression
True or false: in children whose parents are divorced but have joint custody, both must agree with the child’s treatment
False-only one
What is the pharmacotherapy for neuropathic pain 2/2 DM neuropathy?
- either TCAs (if young)
- or antiepileptics drugs (pregabalin)
Large volume rectal bleeding without abdominal TTP = ?
Most likely diverticulitis
What sort of GI bleeding is characteristic of angiodysplasia?
Slow, painless bleed
What is the treatment for cryptococcal meningitis?
Amp B + flucytosine
What are the classic CSF findings of cryptococcal meningitis?
- elevated opening pressure
- Pleocytosis
- Elevated protein
- Low glucose
What medications classically precipitate acute angle closure glaucoma?
Sympathomimetics
What is the appropriate care for frostbite?
Dunk in warm water, only if there is no chance of secondary refreezing
What is the pathophysiology of TTP?
Deficiency of plasma protease ADAMS13 (due to the formation of an autoantibody), causing long chains of vWF to accumulate on endothelial walls, trapping platelets and generating thrombi
What is the classic pentad of TTP?
- Thrombocytopenia
- Microangiopathic hemolytic anemia
- Renal insufficiency
- Neurologic changes
- Fever
What is the treatment for an acute episode of TTP?
Plasma exchange
What are the PBS findings of TTP? What about D-dimer levels?
Schistocytes and RBC fragments
D-dimer levels are normal
True or false: the ANS is unaffected with GBS
False– it is affected, and can cause autonomic s/sx
What sort of WBCs characterize a leukemoid reaction compared to CML?
Predominance of late PMN precursors:
- Metamyelocytes
- bands
NOT promyelocytes and myelocytes
What sort of WBCs characterize CML?
-Basophilia
-predominance of:
promyelocytes and myelocytes
What is De Quervain’s tenosynovitis (which two tendons are affected), and in whom is it classically seen?
- Inflammation of the abductor pollicis longus and extensor pollicis brevis tendons as the pass through a fibrous sheath at the radial styloid process
- New mother who hold child with outstretched thumb
What is the classic presentation of acute papillary muscle rupture?
inferior wall MI leading to new holosystolic murmur over the apex
New onset edema in the hands and feet of an african child = ?
Dactylitis 2/2 vasoocclusive crisis from sickle cell disease
What is the PEP for varicella in a child under 13 years?
Vaccination if not completely vaccinated. IVIG if they cannot have Live attenuated vaccines
When should a battery be removed endoscopically if ingested?
If still in the esophagus, since it may erode here. If past the esophagus, 90% of the time it will pass without incident.
What is ichthyosis vulgaris?
- Inherited skin disorder caused by a mutation in the filaggrin gene.
- Causes scaly, dry skin that is worse in the winter. Initially mild but with aging looks like severe dryness.
What is the pathophysiology, presentation, treatment, and prognosis for milk-protein-induced enterocolitis?
- non-IgE mediated immune rxn to proteins in milk that causes rectal inflammation
- Presents as painless bloody stools with eczema and vomiting
- Treatment is elimination of milk and soy from mother’s diet if breastfeeding.
- Excellent prognosis, and most children do not develop allergies to milk/soy
What are the two types of breath-holding spells?
Cyanotic = crying followed by breath holding
Pallid = minor trauma followed by breath holding and LOC
What age range typically manifests breath-holding spells?
6 months to 2 years
What is the treatment for pertussis?
Macrolides
What are strawberry angiomas?
Angiomas seen in infants that initially grow in size, but then resolve by age 5-8.
What are biliary cysts, how do they present, and how are they treated?
- Congenital dilatations of the biliary duct/tree
- Present with mild abdominal pain with mass, jaundice, and elevated bilirubin (direct and indirect)
- Surgical resection d/t risk of cholangiocarcinoma development
What is the difference in the rash between Varicella vs HSV-1 (eczema herpeticum)?
HSV-1 have a “Punched out” erythematous base with hemorrhagic crusting, and are localized
Varicella has vesicular, pruritic vesicles/pustules in crops in varying stages.
What is the most common predisposing factor for orbital cellulitis?
Sinusitis
What is the classic tetrad of symptoms of orbital cellulitis?
- Painful eye movements
- Proptosis
- Ophthalmoplegia
- diplopia
What are the indications for abx treatment of sinusitis? (3)
- Over 10 days
- Severe features
- Worsening s/sx for more than 5 days after initial improvement