Prep 3 Flashcards
How does Necator americanus (hookworm) infect humans? Like how do you get it?
through the soil
so by being barefoot in endemic areas like really it’s all over the world actually
Name two hookworms
Necator amercanus
Ancylostoma duodenale
How do you diagnose hookworm?
will see the eggs on microscopy
of stool O+P
Blank infections (Necator americanus, Ancylostoma duodenale) are transmitted through soil, often during barefoot outdoor activities in endemic regions.
hookworm
Symptoms of hookworm infection
either asymptomatic or
microcytic anemia
and also eosinophilia will be present on CBC
This infection presents with intense anal pruritis
PINworm
aka enterobius vermicularis
How is giardia transmitted
can be waterborne, foodborne or transmtted via fecal-oral route
Giardia exists in 2 forms, which are
cyst and trophozoites
it’s a protozoa
How to diagnose giardia
a few options:
-antigen assay
-nucleic acid amplification test
-or stool microscopy detecting cyst and trophozoites
Name two tapeworms. What are their symtoms?
Taenia saginata (beef tapeworm)
Taenia solium (pork tapeworm)
get infected when eat undercooked meat infected with the tapeworm
symptoms are N/V and epigastric pain
Stage 1 hypertension in adolescents definition
same as adults
130/80 is stage 1 htn
and 140/90 is stage 2 htn
120 SBP is still considered elevated BP
NORMAL is LESS THAN 120
When to start bp meds for adolescents with essential htn:
stage 2 htn (so bp of 140/90 or higher)
stage 1 not responsive to life style modifications
symptomatic
or any evidence of end organ damage (like LVH)
What is “little league shoulder?”
= when a baseball pitcher who is not skeletally mature throws so much that the proximal humeral physis widens and gets a stress fracture. It’s the weak link – where as in adults the weak link is the rotator cuff.
tx: don’t throw for 3 mo. rest
Infants with ischemic perinatal stroke should be evaluated for these two things
thrombotic disorders
congenital heart disease
Which blood vessel is most commonly affected in ischemic perinatal stroke?
left middle cerebral artery
Besides fluoxetine, what is the one other med that is FDA approved for the treatment of depression in adolescents?
Escitalopram (which is also an SSRI)
Decreases in these three hormones/neurotransmitters are associated with increased aggression
decreased serotonin, oxytocin and GABA
Increases in these three hormones/neurotransmitters are associated with increased aggression
vasopressin and dopamine
The most compelling and successful method of engaging clinicians in quality improvement endeavors is to…
regularly provide them with specific data and frequent reminders to promote process change.
Patients with psoriasis are at increased risk of developing this other medical conditoin
metabolic syndrome
huh, interesting
The most strongly associated comorbidity of psoriasis is
obesity
huh, interseting.
For neonates born to Hep C positive moms, what test should you get at 18 mo?
Hep C antibody test
Glycogen storage disease type 5 (V) is also known as
McArdle disease
Classic feature of McArdle disease
second wind phenomenon
Symptoms of McCardle disease, aka glycogen storage disease type 5
AR disease where adolescents present with exercise intolerance, fatigue/pain/cramps in muscles after exercise or during, second wind phenomenon, and can get recurrent episodes of myoglobinuria after exercise
when not exercising tho they are typically totally fine
Glycogen storage type 2 other name
Pompe disease
remember this because there are two types: infant onset nad late onset
How does glycogen storage disease type 1 present?
in the first few months of life with FTT, severe hypoglycemic episodes, seizures and developmental delay
The 2 forms of Pompe disease (aka GSD type 2) are…
infantile onset: hypotonia, FTT and hypertrophic cardiomyopathy before age 1
late onset: proximal muscle weakness and respiratory insufficiency (no cardiac involvement)
Kids who get cochlear implants are at risk for what type of meningitis specifically
strep pneumo
so if over age 2, they should get the PPSV23 vaccines
Kids who get cochlear implants are at risk for what type of meningitis specifically
strep pneumo
so if over age 2, they should get the PPSV23 vaccines
The PPSV23 vaccine is also called….
the pneumococcal polysaccharide vaccine
What are the two types of pneumococcal vaccines and how are they different?
Standard one that all babies/toddlers should get 4 doses of is the pneumococcal conjugate vaccine. It’s also called PCV13 (stands for pneumococcal conjugate vaccine). It is made of polysaccharide antigen CONJUGATED to a protein carrier (which is actually Diptheria toxin) as a way to deliver the antigen to the body
The other type is the pneumococcal POLYSACCHARIDE vaccine. It is also called the PPSV23 and protects against 23 serotypes.
What causes herpangina and what are the symptoms?
Caused by coxsackie viruses.
= affects the oral mucosa and presents with painful vesicles in the mouth, fever, and sore throat
kids ages 3-10 most commonly get it
Coxsackie virus is a type of
enterovirus
(polio and echo virus are other types of enterovirus)
Vesicular rash on hands and feet + oral vesicles =
Hand foot and mouth disease
caused by coxsackie virus
If a preterm infant fails the car seat test, the next step should be
a car bed test
What is strabismus?
= eye misalignment
will cause a lazy eye on exam
What is pseudostrabismus?
= when the eyes are both properly aligned, but one of the properly aligned eyes APPEARS misaligned due to a wide nasal bridge, prominent epicanthal folds, etc.
Do children with pseudostrabismus need to be referred to ophtho?
No!
But children with strabismus do, so they can get treatment to optimize their visual outcome
What is the difference between latent and manifest strabismus?
latent means it’s only revealed when doing certain maneuvers like the cover/uncover test
manifest means it’s manifesting all the time, constantly present
latent–use the word phoria
manifest – use the word tropia
Esophoria vis esotropia
both mean medial misalignment of the eye
but esophoria means only sometimes present
and esotropia means ALWAYS present
(exo refers to lateral misaligment)
What is amblyopia?
= loss of visual acuity caused by a disruption of the cortical visual pathway that exists between the eye and brain in early childhood
has multiple causes, such as manifest strabismus, retinoblastoma, congenital cataracts, high refractive error, etc.
The danger of not treating manifest strabismus is that it can result in
amblyopia
Pathophys of why strabismus can cause permanent vision damage
When children have strabismus, eye misalignment causes incongruent visual input to the brain (ie, “double vision”); the brain learns to “ignore” input from the affected eye. If not corrected before age 7 ish, this will become permanent.
The serotype that babies usually get if they get neisseria meningitidis
serotype b
If you suspect meningococcal infection, start one of these antibiotics ASAP
ceftriaxone or cefotaxime
High risk contacts of someone with meningococcal disease should be prophylaxis with blank within 24 hours
children – with rifampin
adults – with ceftriaxone or ciprofloxacin
Apt-Downey Test
= qualitative test used to detect whether or not fetal hemoglobin aka infant’s blood is present within in a sample
positive means yes, fetal Hb present
can use in neonates up to 8 weeks old to tell if hematemesis is infant or maternal blood
What is palivizumab?
= the monoclonal ab against RSV
aka Synagis
To diagnose DI, serum osm must be > blank and urine osm must be < blank
> 300
<300
<300 means urine very dilute
Urine osm can range from 50 - 1200. Is a urine osm of 80 seen in very dilute urine or very concentrated urine?
DILUTE
Low urine spec grav means the urine is
dilute
Tuberous sclerosis inheritance pattern
AD with phenotypic variablity
cardiac rhabdomyoma on prenatal ultrasound raises concern that the fetus may have this diagnosis
Tuberous sclerosis
Are hepatic tumors something that happens in Tuberous sclerosis?
No, they are actually not!
Tx for cardiac rhabdomyoma in infant with Tuberous sclerosis
The natural course is that this tumor will involute over time, so you actually just do serial echos and watch it. Surgical intervention is needed though if it causes outflow tract obstruction.
angiomyolipomas of the kidneys think
Tuberous Sclerosis
Subependymal nodules think
Tuberous sclerosis
What type of disease is Tuberous sclerosis?
= a hereditary tumor predisposition syndrome
Is bactrim good at treating anerobes?
NOPE
so would not be good at treating a dental infection
Treatment of choice for soft tissue dental infections
Augmentin
Is prematurity a risk factor for dental carries?
yup
because of enamel defects
What is tooth enamel?
= the hard, shiny, thin outer covering of the tooth
it’s the hardest substance in the human body apparently
associated with low bone mineral stores
How to manage an asymptomatic neonate born to a mom with active HSV lesions:
send surface cultures and blood HSV PCR at 24 hours of life
if positive, obtain LP and start treating
Which eating disorder is fluoxetine approved for as an effective treatment?
bulemia
NOT AN
After an avulsed adult tooth is replaced, which prophylactic antibiotic should be given??
DOXY
or amox
for some reason, has to be strictly one of these two
Tx for infant botulism
human derived botulism immune globulin
A patient can jump, kick a ball, throw a ball overhand, and walk down stairs holding a rail. How old are they?
24 months
A child can balance on 1 foot for 3 seconds, catch a ball with stiff arms, and walk up stairs with alternating feet. How old are they?
3 years old
A child walks down the stairs holding the rail, putting both feet on each step (instead of alternating feet). How old is this child?
24 mo
A child can balance on 1 foot for 3 seconds. How old are they?
3
A child can catch a ball with stiff arms. How old are they?
3
Should a 2 yo be able to walk down stairs while holding the railing?
yup
they won’t alternate feet tho
Can a 2 yo child jump?
yes
Can a 24 mo throw a ball overhand and kick a ball?
yup
but catching a ball with stiff arms, apparently that happens at age 3
Why does ethanol cause an anion gap metabolic acidosis?
because it leads to an increase in both lactic acid and ketoacid production
How to calculate the anion gap
(Na + K) - (Cl + bicarb) = anion gap
Ethylene glycol is found in
antifreeze
Methanol is found in
windsheild wiper fluid
Does ingestion of isopropyl alcohol (rubbing alcohol) cause an anion gap metabolic acidosis?
Nope
so sounds like apparently not so bad if a kids eats this
Name two hydrocarbons
kerosene and paint thinner
State what MUDPILES stands for:
Methanol
Uremia
DKA
Paraldephyde
Iron/Isoniazid
Lactic acid
Ethanol/Ethylene glycol
Salicylates
Symptoms of hydrocarbon ingestion
systemic toxicity–CNS depression, seizures, and cardiac arrhythmias
if aspirated, can cause bad pneumonitis and severe hypoxia
Paint thinners and kerosene are what type of toxic material? Do they cause an AG metabolic acidosis?
hydrocarbons
NO! They do bad things but do not typically cause a metabolic acidosis actually
What did paraldehyde used to be used for?
was an old sedative and antiepileptic
no longer available in the US
Simple way to calculate anion gap
Na - Cl - bicarb
Severe post-prandial epigastric pain + nausea think
peptic ulcer disease
Granuloma annulare
= a skin lesion that can mimic tinea corporis or nummular eczema, but is neither of these
does not have scale, is round and will have elevated firm ish borders
nothing to do about it. will go away on its own in 2-4 years
This type of skin lesion is totally benign and goes away on its own, and consists of papules that form a ring that may mimic tinea corporis
Granuloma annulare
If valproate is taken during pregnancy it can cause
neural tube defects
How to treat SJS
according to prep, we don’t have much to offer, it’s just supportive care
prep says no steroids (risk of sepsis and not shown to efficacious) and no IVIG (risk of renal complications and not shown to be efficacious)
okkkkkkk cool
If a child presents with anal pruritis and is found to have reinfection of pinworm, what should you do?
treat them again
and treat the whole family
high rates of transmission
What is distal patellar apophysitis, and what is its other name:
Sinding-Larsen-Johansson syndrome (SLJS)
= an overuse injury from repeated high intensity extension of the knee (aka running or jumping) in a skeletally immature child, where patellar tendon pulls on the growth plate of the inferior patella, causing inflammation and irritation of the growth plate
= pain at the bottom on the knee cap
(NOT the tibial tuberosity. That would be well below the knee cap).
What does the word apophysitis mean
= a stress injury to the growth plate
= inflammation of the growth plate from over use
Blank presents as focal pain over the tibial tuberosity
Osgood-Schlatter disease
Pansystolic slash holosystolic murmur think
VSD
Innocent murmurs generally have a blank or blank quality
vibratory or musical
Innocent murmurs tend to be blank pitched
low
High pitched murmurs are often
pathologic
How to do post exposure prophylaxis against Hep A for a 5 month old and 13 month old patient
12 mo and up–just give the Hep A vaccine asap
under 12 mo– give hep A immune globulin
Blank hemangiomas are fully formed at birth and do not continue to grow
congenital hemaiomas
If an infant has more than 5 infantile hemangiomas present on skin exam, what should you do
order a liver ultrasound to look for associated hepatic involvement
The gold standard finding used to diagnose a burn wound infection is
the presence of 105 bacteria per gram of tissue from a burn wound biopsy
(or a culture showing a fungus. culture showing a bacteria tho is not helpful AT ALL bcuz there are already bacteria just like everywhere on the skin and burn anyway, so does not tell you if there is an infection or not)
fevers are common in burn pts so that does not help determine if there is an infection either.
Children under this age are at especially high risk of TB infection when exposed, and so should undergo prophylaxis if they have a close contact
5
At 4 years of age, a child should be able to draw a blank part person
4
Fine motor skills that a child should have at age 4
should be able to copy a square
should be able to CUT a circle
tie single knots
draw 4 part person
write part of name
If a 4 yo can cut out a line but cannot cut a circle, is that normal
nope should be able to cut a circle
should be concerned for fine motor delay
Downside of using steroids to treat pericarditis
steroids increase the risk of recurrance
Main tx for pericarditis
NSAIDs
What is papular urticaria
= a chronic skin eruption related to hypersensitivity to insect bites
