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clinicals > PHM > Flashcards

PHM Flashcards

1
Q

name for asthma in child younger than 2 yrs

A

Reactive airway disease

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2
Q

Does bronchiolitis respond with albuterol

A

no

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3
Q

phenobarbital can cause

A

developmental delays

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4
Q

HLH triggered by EBV Give what med?

A

Rituximab - knocks out b cells

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5
Q

Mertazepine withdrawal symptoms

A

Anxiety, insomnia, depression

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6
Q

Seroquel withdrawal symptoms

A

insomnia
nausea
sweating

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7
Q

key lab findings on CBC

A

hyponatremia
increased transaminases

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8
Q

inflammation causes hyponatremia or hypernatremia

A

hyponatremia

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9
Q

treatment for typhus

A

Doxycycline

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10
Q

2nd line for atypical pneumonia

A

Azithromcin

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11
Q

2nd line for atypical pneumonia

A

Azithromycin

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12
Q

what are you looking for on a lateral cxr

A

black space retrosternal
black triangle retrocardiac
as you go down spine should become more radiotranslucent

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13
Q

which direction does the spleen grow

A

towards RLQ

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14
Q

spleen grading

A

non palpable is 1
umbilicus is 4
post umbilicus is 5

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15
Q

tall teen with c/o blurred vision,
eye exam shows a subluxated lens

What is on your differential

A

Marfans
Ehlers Danlos

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16
Q

toddler has glaucoma and seizures with a port wine stain

what on differential

A

Sturge-Weber

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17
Q

S shaped deformity to eyelid
neurofibroma
optic glioma on MRI
lisch nodules (almost 100% of cases have these present by 10 yrs old. - goes up by 10% as they get older to 10)

A

Neurofibromatosis type 1

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18
Q

What is the symptom difference in NF type 1 and 2

A

Type 2 does not have lisch nodules

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19
Q

Abnormal ears
Colobomas in eyes
whats on differential

A

CHARGE syndrome

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20
Q

Male
Weird shape eye lens
hemorrhage
renal failure
anterior lenticonus on eye exam

A

Alport syndrome

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21
Q

child with glaucoma in bilat eyes
Abnormal teeth (conical)
redundant periumbilical skin
eye exam shows posterior embryotoxon (displacement of Schwalbe’s line anterior to the limbus in the cornea)

A

Axenfeld Rieger syndrome

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22
Q

facial asymmetry
eye exam reveals inferotemporal limbal dermoid

A

Goldenhar-kGorlin syndrome

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23
Q

facial asymmetry
inferotemporal limbal dermoid

A

Goldenhar-Gorlin syndrome

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24
Q

young adult with renal cell carcinoma
cerebellar tumor
eye finding: retinal capillary hemangioma

A

VHL (Von Hippel-Lindau syndrome)

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25
Q

10 yo AA male
acute chest
eye finding: sickle cell retinopathy

A

Sickle Cell

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26
Q

what is a possible eye finding in sickle cell pt

A

Sickle cell retinopathy

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27
Q

child development delay
ash leaf spots
eye finding: astrocytic hematoma

A

tubular sclerosis

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28
Q

absence of red reflex test helps screen for

A

need to rule out
retinal blastoma

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29
Q

helpful during testing for red reflex test

A

have them look at something in distance

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30
Q

male UTI risk

A

0-6 mos - same risk as female

6-12 months at increased risk only if uncircumsized

> 1 - think about sexual abuse

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31
Q

if you have a male with UTI thats older than 1, what needs to be on the differential

A

sexual abuse

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32
Q

does renal etiology effect growth

A

yes

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33
Q

4ts for Anterior mediastinal masses

A

Thymoma
teratoma
terrible lymphoma
thyroid

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34
Q

middle mediastinal masses

A

Bronchogenic cyst
Mediastinal lymphadenopathy
Pericardial cyst
tracheal tumors
esophageal tumors
Esophageal conditions: achalasia, diverticulum, hiatal hernia
Aortic aneurysm
aortic dissection

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35
Q

posterior mediastinal masses

A

Neurogenic tumors
Mediastinal lymphadenopathy
Extramedullary hematopoiesis
Neuroenteric cyst
aortic aneurysm
conditions affecting paravertebral spine

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36
Q

dyspnea
face/neck swelling
distended neck veins
cough
dyspnea
orthopnea
upper extremity swelling
distended chest vein collaterals
conjunctival suffusion
headache
chest pain

A

Superior vena cava syndrome - medical emergency

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37
Q

which is better at compensating for the loss of the other between: Illeum and Jejunum

A

Illeum is better at compensating for Jejunum then the opposite

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38
Q

stool alpha 1 antitrypsin is marker of

A

bowel distension

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39
Q

assess for possible carbohydrate malabsorption

A

Stool reducing substances, pH
H2/CH4 breath tests

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40
Q

humans response to lactose

A

majority of humans downregulate lactase expression with age…..

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41
Q

Glucose increases or decreases absorption of fructose

A

increases

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42
Q

FODMAP

A

avoid
fermentable
oligosaccharides
disaccharides
monosaccharides
Polyols (short chain carbohydrates (sugars) that the small intestine absorbs poorly

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43
Q

What are some foods to avoid on FODMAP

A

Dairy based milk
yogurt
ice cream
wheat based products such as cereal, bread, crackers
beans and lentils
some vegetables such as artichokes, asparagus, onions and garlic
some fruits such as apples, cherries, pears, peaches

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44
Q

examples of low FODMAP foods

A

eggs
meat
certain cheeses (brie, camembert, cheddar, feta)
almond milk
rice
quinoa
oats
eggplant
potatoes
tomatoes
cucumbers
zucchini
grapes
oranges
strawberries
blueberries
pineapples

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45
Q

non celiac patient who notices they do better on a gluten free diet. What do they have problems digesting

A

Fructans - oligo or polysaccharides that include short chains of fructose units with a terminal glucose molecule

most common structural forms of fructan are inulin, levanare and geraminan

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46
Q

foods high in fructans

A

wheat products such as pasta and bread

onions
shallots
garlic
barley
cabbage
broccoli
pistachio
artichoke
chicory root
asparagus
ripe bananas
beans/legumes
grapefruit
nectarine
persimmon
plum
pomegranate
watermelon
cabbage
snow peas
rye
pumpernickel bread

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47
Q

fecal calprotectin is a marker of

A

GI inflammation

48
Q

Test for SIBO

A

H2/CH4 breath test

49
Q

some GI dx celiac if TTIGA is >

A

100 or 10xs upper limit of normal.

50
Q

on endoscopy in a celiac pt you will see

A

villous atrophy

51
Q

what rash
plaques with central clearing

not itchy

A

Erythema marginatum

52
Q

What criteria is used for Acute rheumatic fever

A

Jones
either 2 major or 1 major and 2 minor

major
carditis
polyarthritis
EM rash
subcutaneous nodules

Minor
fever
ESR>60
CRP >30
Prolonged PR

53
Q

high prolonged fevers
salmon colored rash that is evervescent with fevers

A

systemic JIA

54
Q

what joints are most commonly affected in JIA

A

C1, C2 - not turning head
TMJ

55
Q

Headache
Non billious vomiting
lymphadenopathy
arthritis/arthralgias

A

rat bite fever

56
Q

bacteria for rat bite fever

A

streptobacillus moniliformis

57
Q

how to dx rat bite fever

A

blood cultures

58
Q

how to treat rat bite fever

A

PCN G x 7 days

59
Q

macular rash first on ankles and wrists, spreads

becomes petechial and pururic

ill appearing
hyponatremic

A

Rocky mountain spotted fever

60
Q

treatment for rocky mountain spotted fever

A

doxy 7-10 days

61
Q

where does the rash start in Murine typhus

A

starts on trunk and spreads
spares palms and soles

62
Q

rash distribution in Meningococcemia

A

early lesions macular that become petechial and purpuric

starts on extremities and tends to spare trunk, palms and soles

63
Q

what is a variant of HSP in kids < 1 yr

A

Acute hemorrhagic edema of infancy

64
Q

symptoms in acute hemorrhagic edema of infancy

A

fever
edema and round shaped purpura primaily over face and extremities.

generally well appearing infant

not associated with HSP symptoms of msk, renal and GI

65
Q

fancy name for measles like maculopapular exanthem

A

morbilliform

66
Q

what exam findings in a rash pt would make you think this is not viral exanthem

A

facial edema
hepatosplenomegaly

67
Q

what score for DRESS

A

RegiSCAR
-Latent period between onset of drug intake and appearance of symptoms (more than 3 weeks)

-Prolonged clinical symptoms after withdrawal of the offending drug

-Fever

-1. Maculopapular rash

-two of the four features among facial edema, rash resolving with psoriasiform desquamation, infiltrated skin lesions, and purpuric lesions on areas other than legs.

-organ involvement

->5% atypical lymphocytes in peripheral smear

-Absolute eosinophil count >1500 cells/mm3

-Generalized lymphadenopathy

68
Q

DRESS symptoms

A

Fever >38.5
lymphadenopathy
eosinophilia
maculopapular rash

69
Q

measles symptoms

A

prodromal illness
cough
congestion
coryza
exanthem 1-2 days after koplik spots
It usually begins as flat red spots that appear on the face at the hairline and spread downward to the neck, trunk, arms, legs, and feet.

70
Q

distribution of measles rash

A

It usually begins as flat red spots that appear on the face at the hairline and spread downward to the neck, trunk, arms, legs, and feet.

71
Q

sandpaper rash

A

scarlet fever

72
Q

this rash is seen on toddlers
central clearing
trunk
not on palms or soles
swelling
itches

A

Giant Urticaria (Urticaria multiforme)

73
Q

How do you treat Giant Urticaria (Urticaria multiforme)

A

benadryl
Atarax

74
Q

when do you usually see Giant Urticaria (Urticaria multiforme)

A

when a virus is treated with antibiotics (frequently amox)

75
Q

target lesion (3 layers)

A

Erythema Multiforme (EM)

76
Q

In older kids that have KD, what needs to be on radar

A

Toxic shock syndrome

77
Q

2 common culprits of toxic shock syndrome

A

Staph and strep

78
Q

Treat for toxic shock syndrome

A

vanc
ceftriaxone
+/- doxy to cover for maurine typhus

79
Q

pronounced facial edema and rash …potential clues for what

A

SSS and DRESS

80
Q

Lymphadenopathy differences in KD vs DRESS

A

KD unilateral >1.5
DRESS Bilataral >1cm

81
Q

rash + posterior pharyngitis clues you into

A

Scarlet Fever & TSS

82
Q

Rash + strawberry tongue clues you into

A

Scarlet fever
KD
TSS

83
Q

Rash + hypotension and shock

A

TSS
KD

84
Q

Rash progresses to vesicles with bulla with desquamation in acute phase…whats on differential

A

SSS
SJS
TEN

85
Q

Progress to desquamation in convalescent phase

A

KD
TSS
Scarlet fever

86
Q

when you have abdominal pain, decreased PO with tachycardia….what needs to be on your differential

A

Cardiogenic shock

87
Q

what happens in joints in septic arthritis

A

joint destruction

88
Q

what joints are more dangerous with a septic arthritis or joint inflammation/effusions

A

closed joints such as hips and shoulders

89
Q

Bactrim can suppress _____

A

WBC

90
Q

Right sided heart lesions
Intellectual disability
pulmonary vein stenosis
Autosomal dominant
affects males and females

A

Noonan syndrome

91
Q

Red eye
preauricular or axillary node
granuloma
fever > 3 days
vomiting

A

Bartonella henselae or Cat schratch disease

92
Q

an infection of the cornea is called ____ from ____

A

keratitis
HSV

93
Q

tender lesions
shin or pretibial
associated with: Crohns, UC, sarcoidosis

A

Erythema nodosum

94
Q

bugs that cause erythema nodosum

A

GAS
TB
Mycopneumoniae

95
Q

rocky mountain spotted fever is caused by what?

A

Tick bite
Ricketsia

96
Q

what season do you see Rocky mountain spotted fever?

A

summer

97
Q

describe rash for Rocky mountain spotted fever

A

maculopapular rash around wrists and on hands and spreads centrally

98
Q

Treatment for Rocky mountain spotted fever

A

Doxy

99
Q

Doxy risks

A

dental staining <8 yo
risk is increased for more then 14 days of treatment

100
Q

okay MCV for baby vs adolescent

A

70 in a baby is fine
adolescent 80-100

101
Q

what does red cell distribution tell us about anemia

A

chronic vs acute

102
Q

RDW is larger if the anemia is

A

newer

103
Q

retic looks at

A

marrow response to anemia

104
Q

in a less than 3 yr old with microcytic or normocytic anemia treat with

A

iron 1 x every other day (not with milk)

105
Q

In thalasemias, sideroblastic anemia or anemia of chronic disease, the mcv is

A

decreased

106
Q

what does Hgb do in 6-8 wk old

A

it plummets then recovers (the plummet stimulates bone marrow to being making own hgb)

107
Q

Normocytic MCV with anemia….retic is low so this is

A

acute
-infection
-drug rx
-blood loss
-renal disease

108
Q

poor production of red cells that is benign and occurs in early childhood characterized by sudden onset of pallor

A

transient erythroblastopenia of childhood

109
Q

what happens with MCV and retic in a normal bone marrow response to anemia

A

Normal MCV
increased retic

110
Q

spherocytes are seen in

A

Hereditary spherocytosis

111
Q

Helmet cells and schistocytes seen in

A

MAHA

112
Q

Heinz bodies seen in

A

G6PD

113
Q

In Macrocytic anemia the MCV is

A

increased

114
Q

Vitamin deficiencies that can cause anemia

A

B12 and Folate

115
Q

What drugs can cause anemia

A

Methotrexate

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