PREP Flashcards
Hep B PEP in neonates varies based on birth weight >2000 g or <2000 g. What do you do for baby who is >2000 g if mom’s status is negative?
HBV vaccine within 24 hrs
ARPKD vs ADPKD: Which has complications including hepatic cysts, colonic diverticula, and cerebral aneurysms?
ADPKD
____-order kinetics: constant proportion of drug is eliminated per unit time. Elimination half life is only applicable in this scenario
first
Physiologic nadir in term babies
8-12 weeks of life; Hgb is 9-11 g/dL
What syndrome has this triad:
Thrombocytopenia
Eczema
Infections
Wiskott Aldrich
When do you test baby with perinatal HCV exposure?
Antibody testing at 18 months (don’t do PCR right away because risk of vertical transmission is low)
ARPKD vs ADPKD: Which has complications including portal fibrosis and portal HTN?
ARPKD
Compare/contrast return to daycare for measles vs. rubella
measles - return 4 days after onset of rash
rubella - return 7 days after onset of rash
The empiric treatment for pre-term late-onset sepsis (7+ days old) includes vancomycin + gentamicin. Why vancomycin?
Covers coagulase-negative Staph, which ampicillin does not
[coag neg staph includes Staph epi, haemolyticus, saprophyticus, etc]
Pediatric CHF is graded A, B, C, D. Stage A is considered high risk for HF, no tx indicated. At what stage do you start ACE-I, beta blockers, ARBs?
Stage B (asymptomatic structural heart disease)
Normal Hgb in term infant
19.3 +/- 2.2
Shockable rhythms
V.fib
Pulseless Vtach
Patient has a low forced vital capacity (FVC) on PFTs – what type of lung pathology?
restrictive
[FVC can be used as estimate of total lung capacity, nl is 80+%]
Pediatric CHF is graded A, B, C, D. Stage A is considered high risk for HF, no tx indicated. At what stage do you add diuretics +/- digoxin?
Stage C (structural heart disease with symptoms of heart failure)
MEN-2
Medullary thyroid cancer
Pheochromocytoma
Hyperparathyroidism
Unexpected event that results in patient harm
sentinel event
Abdominal mass w/ calcifications in child less than 5 years old
neuroblastoma
Most common cardiac complication of JIA
pericarditis
Type of intrarenal injury that presents with fever, rash, eosinophilia, may see urine eosinophils, RBCs, and/or low grade proteinuria. Usually an allergic reaction to a drug
Acute interstitial nephritis
Hep B PEP in neonates varies based on birth weight >2000 g or <2000 g. What do you do for baby who is <2000 g if mom’s status is positive?
Test mom, but give HBV vaccine and HBIG within 12 hours regardless
UTI prophylaxis is typically _______ in babies <2 mo old. Use _______ in kids with VUR (even if they have a history of UTIs resistant to this agent)
amoxicillin; bactrim
First line for PJP prophylaxis
Bactrim
You can also use atovaquone (expensive), dapsone (avoid if hx SJS or sulfa allergy), pentamidine (use if other agents not tolerated)
Which IBD has patchy transmural inflammation w/ granulomas, affects anywhere in GI tract?
Crohns
Birth trauma that can extend to orbits and neck, and carries risk of massive blood loss, anemia, and hypovolemic shock
Subgaleal hemorrhage
Stool microscopy shows round, double-walled eggs
Taenia solium
Tx duration of AOM by age
<24 mo and no severe signs, can observe x 48-72 hrs, or 10 days
2-5 years = 7 days
6+ years = 5-7 days
What are the only 2 approved medications for major depression in adolescents?
Fluoxetine
Escitalopram
46, XY undervirilized infant, increased ratio of T:DHT
5-alpha reductase
What mechanical ventilation variables affect ventilation?
RR
TV
[ventilation is a function of minute ventilation (MV). MV = RR x TV. You can increase MV (aka decrease CO2) by increasing RR or increasing TV]
Newborn presents with direct hyperbilirubinemia and microcephaly, what is top diagnosis on your list?
Congenital CMV
treat with oral ganciclovir for 6 months to decrease risk of hearing loss
All adolescents should be offered HIV screening by age ___
16-18
Prenatal test done between 15-20 weeks gestation
Amniocentesis
Which of the following has periodic pain crises, angiokeratoma, corneal and lenticular opacities, sweating abnormalities, and ESRD?
A. Hurler (MPS I)
B. Hunter (MPS II)
C. Fabry
D. Pompe
C. Fabry
________ = does your test measure what it intends to ACCURATELY
Validity
(external validity = generalizability, internal is ability of a tool to accurately measure the intended condition)
Physiologic nadir in pre-term babies
3-8 weeks of life; Hgb can be lower than term nadir
STI prophylaxis for gonorrhea and chlamydia
Gonorrhea: Ceftriaxone IM x 1
Chlamydia: Doxycycline BID x 7 days
ARPKD vs ADPKD: Which is more likely to see macro cysts?
ADPKD
Prenatal test you can do from 9-10 weeks until term, works well as a screening test that is great for aneuploidies but must be confirmed with additional prenatal testing?
Cell free DNA (must be confirmed with either chorionic villus sampling or amniocentesis)
Which of the following has coarse facial features, hearing loss, corneal clouding, HSM, kyphosis, joint contractures, cardiac stuff, recurrent infections?
A. Hurler (MPS I)
B. Hunter (MPS II)
C. Fabry
D. Pompe
A. Hurler (MPS I)
T/F: A patient with stage I hypertension can be cleared for sports participation
True
Note that a patient with stage II CANNOT be cleared for sports with high static component
Pediatric CHF is graded A, B, C, D. Stage A is considered high risk for HF, no tx indicated. At what stage do you see refractory HF requiring special intervention?
Stage D. utilize all medications in stages B and C + inotropes, IV vasodilators, etc.
Calculating TBSA in infants/young kids:
Head = ____
Chest+Back= _____
Each arm = _____
Each leg = ______
Head = 18
Chest+Back = 18/18
Each arm = 9
Each leg = 14
Most common cause of mastoiditis
Strep pneumo
Antibiotics that inhibit 50s subunit
Macrolides
Clindamycin
Linezolid
Baby presents for routine vaccines and is due for rotavirus vaccine. They have an immunosuppressed parent at home. Do you give the rota vaccine?
YES!
What syndrome has this triad:
Port wine stain
Leptomeningeal angiomatosis
Abnormal intraocular vasculature
Sturge Weber
Almond eyes, down-turned mouth, strabismus, thin upper lip, central hypotonia, small hands and feet
Prader willi
First line treatment for sensorineural hearing loss
Behind-the-ear hearing aids – as young as 2 months! You can do cochlear implant starting at age 1 if BTE hearing aids not effective
Hep B PEP in neonates varies based on birth weight >2000 g or <2000 g. What do you do for baby who is >2000 g if mom’s status is unknown?
Test mom after delivery, give HBV vaccine within 12 hours, give HBIG within 7 days if mom comes back positive or if still unknown
group A strep infection but patient is allergic to amoxicillin
5 days azithromycin OR 10 days clindamycin
_______ = ability of your test to replicate findings
Reliability
Little league shoulder = proximal humeral epiphysitis – stress fracture through growth plate. What do you do for it?
3 months rest
What mechanical ventilation variables affect oxygenation?
PIP
PEEP
iTime
[oxygenation is a function of mean airway pressure (MAP) – you can increase MAP by increasing PIP, PEEP, or iTime. Just watch out for volutrauma]
Most common glycogen storage disease
Type V - McArdle (think muscle, elevated CK)
hemophilia vs thalassemia
hemophilia = lack of clotting factors
thalassemia = lack of Hgb chains
HLH:
2-3 cytopenias
Elevated ferritin
Elevated CD____
Fever
Hemophagocytosis
Increased triglycerides or fibrinogen
Splenomegaly
Decreased ___ cell activity
CD25
NK cell
X-linked recessive song
the OTC bitsy HUNTER’S name was LESCH FABRY. he shot the MEINKE, WASP, and G6P. up came BRUTON, what a DOUCHEY guy. A and B are X-linked, don’t forget DI.
(not pictured: retinitis pigmentosa)
How often should helmets be replaced?
every 5 years
What do you do if pregnant mom develops varicella disease within 5 days before delivery and 2 days after?
Baby gets VZIG
(only give acyclovir if baby develops symptoms)
Williams syndrome and DiGeorge syndrome have what inheritance pattern?
Autosomal Dominant
Calculation for number needed to treat (NNT)
NNT = 100/(difference between two groups)
Excessive diuresis with Lasix can result in contraction alkalosis, which shows ______ chloride and increased HCO3
decreased
What type of IEM is treated with protein restriction?
Urea cycle disorders (i.e., OTC deficiency) – all calories should come from carbs and fats
Pinworm (enterobius vermicularis) infection – tx with 2 doses pyrantal pamoate, albendazole, or mebendazole 2 weeks apart. What do you do if infection recurs?
Treat all household members, even if they’ve never had sxs
Antibiotics that inhibit 30s subunit
Aminoglycosides
Tetracyclines
A young girl who is involved in running sports presents with gradual onset of anterior hip and medial thigh pain that has been progressing, has positive log-roll test, pain with passive flexion and internal rotation. What is your can’t-miss diagnosis?
femoral neck fracture
[make patient NWB, get an MRI! XR cannot rule this out. Caused by accumulation of bony micro trauma and is high risk for progression to femoral neck fracture]
PFTs, nighttime symptoms, and albuterol use in intermittent asthma
PFTs normal
<2 nighttime symptoms/month
Albuterol <2 days/week
Which IBD has contiguous superficial inflammation beginning in rectum and extending proximally as far as the cecum (is limited to colon), see crypt abscesses and pANCA+
UC
ROP screening: all infants with birth weight less than ____ or gestational age less than ____
1500 g; 30 weeks
The most common bone tumors are osteosarcoma and Ewing sarcoma. Which one is more likely to have fever and pathologic fracture?
Ewing
HHV-6 is _____
Roseola
Elimination half-life is only applicable with first-order drug kinetics. It takes ____ half lives to reach steady state.
5
most common malformation accompanying myelomeningocele (occurs in most of these kids); can be asymptomatic or s/s caused by brainstem and proximal cord compression – dysphagia, stridor, hoarse voice, disordered breathing, choking, sudden death
Chiari II malformation
[decreased 4th ventricle pressure –> displacement of medulla + cerebellum –> development of smaller posterior fossa unable to allow growth of these structures]
What diagnosis do you suspect if CCHD screen detects post-ductal sats > pre-ductal sats?
dextro-transposition of great arteries
What type of shock do patients with anaphylaxis present with?
distributive
Which of the following has hypotonia, failure to thrive, and HoCM?
A. Hurler (MPS I)
B. Hunter (MPS II)
C. Fabry
D. Pompe (early infantile)
D. Pompe (early infantile)
[note that late onset pompe has proximal muscle weakness, respiratory insufficiency, and no cardiac involvement]
What type of worms are transmitted through soil – barefoot activities in endemic regions?
Hookworms (Necator americanus, Ancyclostoma duodenale)
Routine screening for hypertension begins at age ____ for low risk pts
age 3
How do you distinguish ethylene glycol poisoning from methanol poisoning?
ethylene glycol –> calcium oxalate crystals in urine
Most common type of tracheo-esophageal fistula
type C (esophageal atresia with distal TEF)
Most common cause of intrarenal AKI in hospitalized kids
Acute tubular necrosis
Can see epithelial OR muddy brown casts, mild pyuria, low grade proteinuria. Caused by damage to renal tubular cells by ischemia (shock, trauma, sepsis), exogenous toxins (contrast, nephrotoxic meds), endogenous toxins (myoglobinuria, hemoglobinuria).
Hep B PEP in neonates varies based on birth weight >2000 g or <2000 g. What do you do for baby who is <2000 g if mom’s status is negative?
HBV vaccine at 1 month, or at nursery discharge
Dance-like movements with hypotonia and emotional lability
Sydenham chorea (1-8 mo after GAS infection)
Prenatal test done between 10-13 weeks, genetic testing done on sample
Chorionic villus sampling
PFTs, nighttime symptoms, and albuterol use in severe persistent asthma
FEV1 <60% of predicted
Nightly symptoms
Albuterol multiple times per day
Severe limitation!
What syndrome has this triad:
Chronic candidiasis
Hypoparathyroidism
Primary adrenal insufficiency
Autoimmune polyglandular syndrome type I
Hypertension
Flushing
Tachycardia
Palpitation
Pheochromocytoma
T/F: Hepatitis B screening is required for all international adoptees, refugees, and immigrants, unless they are vaccinated
False! All of the above should be screened regardless of vaccination status
Which trisomy?
Holoprosencephaly, bilateral postaxial polydactyly of hands, shortened long bones, cleft lip, VSD
Trisomy 13
(Trisomy 18 has less severe cardiac defects, OVERLAPPING fingers, and rocker bottom feet)
Parkland burn formula
(3-4 mL/kg) x (weight in kg) x (%TBSA)
Baby presents with findings concerning for tuberous sclerosis (ash leaf spots, shagreen patch, seizures, family history, etc). What screening test do you do next?
Echo – look for rhabdomyoma which may be present at birth
Which of the following is similar to it’s partner, but without corneal clouding and has better cognitive outcomes?
A. Hurler (MPS I)
B. Hunter (MPS II)
C. Fabry
D. Pompe
B. Hunter (MPS II)
Adolescent men who have sex with men must be offered annual screening for what 4 things?
HIV
Gonorrhea
Chlamydia
Syphilis
PFTs, nighttime symptoms, and albuterol use in mild persistent asthma
PFTs normal
3-4 nighttime symptoms/month
Albuterol >2 days/week (not daily)
Birth trauma that does NOT cross suture lines, resolves within weeks, is not always present at birth, and carries risk of intracranial bleed and/or jaundice
Cephalohematoma
Non-shockable rhythms
Asystole
PEA
Hepatosplenomegaly, pancytopenia, skeletal disease (bone pain, Erlenmeyer flask deformity)
Gaucher disease
Stool microscopy shows oval or ellipsoid thin-shell eggs
Hookworms (Necator americanus, Ancyclostoma duodenale)
What do you have to monitor in patient on valgancyclovir?
CBC for cytopenias
Birth trauma that crosses suture lines, is monitored with serial exams, and usually resolves in 48-72 hours
Caput succedaneum
Severe macrocytic anemia without reticulocytosis, elevated HbF, and elevated erythrocyte adenosine deaminase level (eADA)
DBA
PFTs, nighttime symptoms, and albuterol use in moderate persistent asthma
FEV1 60-80% of predicted
>1 nighttime symptom/week
Daily albuterol
[bonus: 2+ systemic steroid courses/year]
Pre-axial vs post-axial polydactyly
pre-axial = radial
post-axial= ulnar
Most common cause of bacteremia in babies age 29-60 days
E.coli
Baby 29-60 days presents with a fever - what 3 things do you start with?
UA
Blood culture
Inflammatory markers
[IM’s guide whether LP is obtained]
which would be the most significant risk factor for language delay?
a. chronic middle ear effusion
b. bilingual family
c. family hx speech delay
d. late birth order
c. family hx speech delay
[chronic middle ear effusion can cause mild conductive loss but is not historically associated with speech delay]
first line tx for ADHD in preschool years (age 4-6)
parent-behavioral modification training
16 day old presents with signs of meningitis. Mom was GBS positive but got 2 doses abx 2 hrs before delivery. What is empiric treatment of neonates with suspected meningitis born to women who received prepartum antibiotic prophylaxis for group B Streptococcus infection?
Ampicillin + 3rd gen cephalosporin (like cefotaxime).
Not gentamicin!
A pt with hx of ToF s/p repair who has been lost to cardiac follow up presents and has a well-healed median sternotomy scar. There is a harsh III/VI systolic murmur and a II/IV diastolic murmur along the left sternal border. Is this concerning?
No, these findings would be expected after repair of ToF
