PREP 1 Flashcards
Early childhood dental carries present as
white discoloration along the gum line of the upper incisors (like the front teeth for ex) in children under 6
can then progress
Super low calcium think
hypoparathyroidism
In hypoparathyroidism, calcium levels are blank and phos levels are blank
calcium levels are LOW
and phos levels are high
The job of PTH is to
keep calcium levels normal
without it, calcium gets super low
What does PTH do to phosphorous levels:
PTH has a phosphorus-lowering effect by causing phos excretion through the kidneys.
(so in hypoparathyroidism, where PTH is low, phos will be HIGH)
Low calcium, high phos =
hypoparathyroidism
high calcium, low phos =
hypERparathyroidism
This hormone releases calcium from bone
PTH
What does vitamin D do for calcium levels
Increases calcium, because vitamin D increases absorption of calcium from the gut
What does PTH do to vitamin D levels
PTH stimulates the kidney to make active vitamin D, so PTH increases vitamin D levels
this is how PTH increases Ca absorption from the gut (through vit D, which does this)
Genetic disorder associated with hypoparathyroidism
22q11.2 deletion syndrome
Long term tx for hypoparathyroidism
Give calcium and vitamin D (must give calcitriol, the active analogue, since without PTH the kidney cannot convert other forms of vit D into the active form)
The activated form of vitamin D is…
calcitriol
(1,25-dihydroxyvitamin D)
Vitamin D deficiency leads to blank calcium levels
Low
What does vitamin D deficiency do to calcium and phos levels
both low
(low calcium means PTH is being very active trying to raise the calcium, and while being active one of the things PTH does is promote renal excretion of phos, so phos gets low)
What is a kerion
= an acute, local inflammatory reaction to a tinea capitus infection
itchy, bad inflammaed looking boil on head for ex
tx is griseofulvin (systemic)
Alopecia, scaling, pruritus and posterior cervical lymphadenopathy is highly suggestive of
Tinea capitus
Tinea capitus is an infection of what exactly
the root of the hair follicle
Are topical antifungals effective when treating tinea capitus
Nope. Because tinea capitus is an infection of the root of the hair follicle, so topical tx does not work. Need systmic oral antifungal tx.
Blank is an inflammatory reaction to a scalp tinea infection that presents as a large, hairless, red and boggy area over the scalp
kerion
Blank is the most common cause of tinea capitus, and blank is the second most common
Trichophyton, microsporum
Tx for tinea capitus
oral antifugnal, like griseofulvin, terbinafine or fluconazole
Define Tourette syndrome
= presence of vocal AND motor tics over a year
Type 1 error
= when an investigator rejects the null hypothesis when it is in fact true
Type 2 error
= when an investigator fails to reject the null hypothesis when it is in fact false
Type 2 error is also known as
beta
(beta = the ´probability of a type 2 error occuring)
As the probability of committing a type 2 error decreases, blank increases
power
Power =
1 - beta
The probability of accepting an alternative hypothesis when it is in fact true =
power
The probability of rejecting the null hypothesis when the null hypothesis is in fact false =
power
Atypical mycobacterium infection typically presents how?
with subacute, unilateral cervical lymphadenopathy
swollen lymph node in well appearing child that just doesn’t go away after typical abx treatment
the treatment is to surgically remove the whole node
Swollen, non tender, indurated cervical lymph node that has been there for weeks in well appearing 4 yo with normal CBC is most likely due to…
nonTB mycobacteria infection of a lymph node
Top 3 bacteria that cause AOM
H flu
Strep pneumo
Moraxella catarrhalis
When treating CHRONIC supporative otitis media, you should always cover for
pseudomonas
Define chronic suppurative otitis media
= more than 6 weeks of ear drainage from a perfed tympanic membrane
so like just ongoing pus drainage basically
The most common bugs to cause CHRONIC suppurative otits media are
staph aureus (MRSA and MSSA)
pseudomonas**
proteus mirabilis
anaerobes
How to initially treat a child presenting with chronic suppurative otitis media:
topical abx with pseudomonal coverage
so for ex ototopical ofloxicin
and also need to clear ear debris daily in the office, ugh
Criteria that need to be met to clear a kid/teen to go back to playing a sport after a concussion:
- Full resolution of symptoms
- And still full resolution of symptoms even when doing high intensity physical activity
- return to baseline neurocognitive function/academic performance
NEUROPSYCH testing NOT NEEDED and should NOT guide return to play
Low TREC on newborn screen indicates
concern for a primary immunodeficiency
(or may just be a false positive in a premature infant)
TREC stands for
low T-cell receptor excision circle
If a baby has a truly low, confirmed TREC (repeat test still low and infant is at least 37 weeks corrected), what should your next move be?
to start prophylactic abx to prevent infection ASAP
(start prophylactic bactrim and fluconazole)
How to further work up a confirmed low TREC
flow cytometry for lymphocyte subsets
Should a baby with a confirmed low TREC continue to breastfeed?
No–not until it is determined WHICH immunodeficiency the baby has
This is because in some immunodeficiencies, like SCID, CMV can be transmitted through breastmilk and lead to viremia
Symptoms of epididymitis
dysuria
scrotal pain that improves with elevation
pyuria
NORMAL cremesteric reflex
Absent cremasteric reflex think
testicular torsion
Which pre-pubertal boys get epididymitis?
structural abnormalities of the urinary tract
What is the epididymis
= a curved structure at the back of the testicle, in which sperm is stored and matures
Sperm passes from the testicles to the vas deferens via the
epididymis
How acute epididymitis presents
Testicular pain, scrotal redness and warmth
In the pediatric population, who is most likely to get epididymitis?
adolescent boys
especially with a hx of being sexually active, any local trauma, or intense exercise
it’s an ascending infection from the urethra through the vas deferens all the way to the epididymis
Most common bugs that cause epididymitis in sexually active adolescent boys:
chlamydia
neisseria
e coli
Symptoms of adolescent boy presenting with acute epididymitis
dysuria
urinary frequency
discharge
scrotal pain
fever
In epididymitis, is a normal cremesteric reflex present?
yes
What will the UA show in epididymitis?
pyuria
What is a varicocele?
dilation of the veins in the pampiniform plexus of the spermatic cord
In the pediatric population, who is most likely to present with varicocele? How do they present?
adolescent boys
painLESS soft scrotal mass, decreases in size when lying down
Treatement for ADEM
steroids
The FDA doesn’t approve of cochlear implants until a baby is at least this age
must be at least 12 mo old
Name 2 groups of drugs that can cause sensorineural hearing loss
aminoglycosides
loop diuretics!
Name an aminoglycoside
gentamicin
Name a loop diuretic
Furosemide
aka lasix
MOA of loop diuretics:
they block the reabsorption of sodium, potassium and chloride in the ascending loops of henle
Electrolyte side effects of loop diuretics (aka lasix aka furosemide)
loss of sodium and water
hypokalemic metabolic alkalosis
increased calcium lossis in the urine (so you get hypocalcemic)
1st line TREATMENT for babies with sensorineural hearing loss is what?
behind the ear hearing aids, can start as early as 2 months
it’s NOT cochlear implants apparently, not until age 1
Definition of delayed puberty in girls:
no breast development by age 13
LH and FSH are this type of hormone
gonadotropins
How to treat short stature associated with Turner Syndrome
with recombinant human growth hormone
Prenatal sign of Turner syndrome
cystic hygroma
Neonatal signs of Turner Syndrome
small size
lymphedema of the hands and feet
broad chest with wide spaced nipples think
Turner Syndrome
Is intelligence in Turner syndrome usually normal?
yes
Another name for primary ovarian failure is
hypergonadotrophic hypogonadism
How to confirm a diagnosis of primary ovarian failure in a girl with Turner syndrome who has not yet showed signs of puberty
Get GONADOTROPIN LEVELS (FSH and LH)
If they are high, then you know the pt has hypergonadotropic hypogonadism, and you should start estrogen treatment to induce puberty
How to induce puberty in a girl with Turner Syndrome who has hypergonadotropic hypogonadism:
Give estrogen
but start in low doses, and then gradually work up to what would be an adult dose (aka like a birth control pill) to try to mimic normal puberty
Conjugated hyperbili + microcephaly thinki
congenital CMV
Define conjugated hyperbili
= when conjugated bili is 20% or more of the total bili
Tx drug and duration for SYMPTOMATIC congenital CMV
oral valgancyclovir x 6 months
tx can decrease risk of sensorineural hearing loss later on
Risk of treatming CMV with valgancyclovir
gancyclovir can cause neutropenia
Should patients admitted to the hospital for a lyme disease complication (for ex lyme carditis with complete heart block) be treated with PO doxy or with IV ceftriaxone?
IV ceftriaxone
bcuz apparently the book says if you are admitted to the hospital for lyme then you must use IV meds
Monophonic wheezing + LACK of stridor localizes tracheomalacia to what physical location?
INTRAthoracic
What does intrathoracic airway obstruction, whether its in the small airways or the trachea, sound like on auscultation?
expiratory wheezing
What does extrathoracic airway obstruction sound like on auscultation?
stridor
The AAP recommends that men who have sex with men should be screened for these STDs annually:
HIV
syphilis
chlamydia
gonorrhea
Adolescent women having sex with men should be screened at least annually for
gonorrhea and chlamydia
Double standard of STD screening in adolescnents:
AAP says women having sex with men should be screened annually for gonorrhea and chlamydia
but men having sex with women shouldn’t
wtf?
The most common type of heart block seen in neonatal Lupus is
complete heart block
Transplacental transfer of these antibodies leads to neonatal Lupus
anti-Ro/SSA or anti-La/SSB
Pathophys of why neonates with neonatal lupus can get complete heart block and other cardiac problems:
due to anti-ro/SSA and anti-la/SS mediated injury
these antibodies injure the fetal cardiac and conductive tissue
Screening for Hep B refers to doing what lab test exactly?
Hep B surface antigen (HBsAg)
When should you test new immigrant children for Schistosoma and Strongyloides species?
when their stool ova and parasites are negative but they have eosinophilia
ALL new immigrant / international adoptee children should receive these screenings when they arrive in the US:
Hep B surface antigen (regardless of Hep B vaccination status)
Syphilis
HIV
CBC
Stool ova and parasites (check for Giardia and cryptosporidium)
Tb skin test or interferon-gamma release assay
The first sign that a young child may go on to be diagnosed with intellectual disability is a delay in this area
receptive language
Adaptive skills refers to
skills involve in self-management and independent living
so things like self care, navigating relationships, work, money management etc.
A diagnosis of ID (intellectual disability) can be made in a child of what age, in what situation?
Age 5 or older
when the child is significantly below age expectations for both cognitive and adaptive development
Planning, reasoning, problem-solving and learning all fall under this umbrella term
Cognition
Blank is an important early indicator of cognition, and a lack of it can indicate increased likelihood of future intellectual disability
Receptive language
The first rotavirus vaccine needs to be give by this age, or else an infant should not get the vaccine series
needs to be given BEFORE 15 weeks, zero days of life
When should the first rotavirus vaccine be administered?
Between 6 weeks and 14 weeks, 6 days of life
The last rotavirus vaccine dose cannot be given after his age
8 months, zero days
MCV over what is macrocytic
Unclear
Varies by age
most common source of vitamin B12 is
animal fats
Neuro findings associated with folate deficiency
loss of developmental milestones
Causes of macrocytic anemia
B12 or folate deficiency
Loss of deep tendon reflexes + macrocytic anemia =
B12 deficiency
Common ish cause of both B12 and folate deficiency
Celiac disease
Neuro findings of B12 deficiency can include
hypotonia
ataxia
seizure
activity
loss of deep tendon reflexes
Symptoms of vitamin B12 deficiency
fatigue
generalized weakness
irritability, poor appetite
FTT
neuro symptoms (ataxia, low tone, loss of deep tendon reflexes… even seizures in extreme cases)
Vitamin B12 is also called
Cobalamin
Define enteropathy
= ongoing damage, irritation and;or swelling of the small intestine
Tx for nasal polyps
Due to allergies. Treat with intranasal steroids, nasal saline rinses, or systemic steroids.
If refractory, can be surgically removed.
Children with these conditions have a higher risk of developing nasal polyps
CF
PCD (primary ciliary dyskinesia)
Polyps are rare in children under this age
rare under age 10
What causes acute tubular necrosis
ischemia or exogenous or endogenous toxins
BLANK results from damage to renal tubular cells, either from ischemia (like from hypotension) or from toxins (endogenous or exogenous)
Acute tubular necrosis
What will urinalysis show in ATN
muddy brown granular casts
mild pyuria
low-grade proteinuria
urine can be dilute in ATN
Urine spec grav in PRE renal AKI
so this is when the kidneys just are not being perfused
so, urine should be very concentrated
spec grave will be > 1.02
Normal urine spec grav
1.005 - 1.030
What is considered a low spec grav, and what is considered a high spec grav
Low is < 1.005
High is >1.03
