Qbank copy Flashcards
Next step in pt exposed w/ chickenpox w/ no prior hx?
If immunocompetent, varicella vaccine (not VZV immunoglobulin)
If immunodef, VZV immunoglobulin w/in 10 days
Treatment for mumps?
Supportive, cold compresses to parotid or testes
Risk factors for constipation (3)
Initiation of solid food, toilet training, school entry
Urinary side effect of constipation
Impacted stool –> rectal distension –> compress bladder, urinary stasis, recurrent UTI
Classic triad of congenital toxoplasmosis?
- Chorioretinitis (form of posterior uveitis) 2. hydrocephalus 3. intracranial calcifications
Classic triad of congenital rubella?
- Deafness
- cataracts
- cardiac defects
FYI additional clinical sx of LAD
Poor wound healing, periodontitis (oft necrotizing, oral pain, bleeding & irritation of gums)
Reye’s syndrome classic features (3)
Rash, vomiting, liver damage
Other sx of osteogenesis imperfecta apart from fractures, blue sclera
Dentinogenesis imperfecta: blue-gray to yellow-brown discoloration of teeth (due to discolored dentin shining through translucent, weak enamel)
Contraindications to diphtheria/tetanus?
Anaphylaxis to vacine ingredients
Contra to pertussis?
- Anaphylaxis to vaccine ingredients
- Progressive unstable neuro disorders (uncontrolled epilepsy, infantile spasms)
- Encephalopathy w/in week of previous vaccine dose
- *All others are precautions but not contra!
Why continuous murmur in pda?
Aortic pressure > pulm artery pressure in both systole, diastole
What are the contraindications to breastfeeding?
- Active, untreated TB
- HIV
- Active illicit drug and EtOH abuse
- Skin: herpetic breast lesions, varicella, chemo/radiation
- Only infant condition that is a contra: galactosemia
When is surgery for cyrptorchidism indicated?
6 mo
What is the greatest risk of the above, even w/ orchiopexy?
Subfertility
What is most common cause of chronic stridor in infants?
Laryngomalacia: omega shaped epiglottis, collapse of supraglottic structures
Spontaneous resolution, but increased risk of GERD
FYI Ewing’s sarcoma sx
Really similar to osteomyelitis sx
Differentiate w/ xray: central lytic lesion, onion skinning, moth-eaten appearance
What are 3 associated syndromes of Wilms tumor (= nephroblastoma)
WAGR (Wilms, Aniridia, GU anomalies, mental Retardation)
Beckwith-Wiedemann syndrome
Denys-Drash syndrome
Site of Wilms tumor met?
Lungs
Top causes of bacteremia in sickle cell
- Strep pneumo 2. H. influenza B
Get vaccine and penicillin ppx until 5 yo
Top cause of pneumonia in sickle cell pt
Strep pneumo
Hereditary spherocytosis confirmed by
Eosin-5-maleimide binding (flow cytometry) and acidified glycerol lysis tests
Traditional NaCl fragility test has poor sensitivity
In hereditary spherocytosis, mean corpuscular hemoglobin concentration is low or high?
High, due to cellular dehydration and membrane loss.
Ddx for lytic bone lesion in child
Infectious: brodie abscess from osteomyelitis
Endocrine (hypercalcemia): hyperparathyroid osteitis fibrosa cystica
Neoplastic (hypercalcemia): Ewing sarcoma, Langerhans cell histiocytosis, mets
Idiopathic: benign bone cyst, aneurysmal bone cyst
Healthy infants lose up to 7% birth weight in how many days of life?
First 5 days
Birth weight regained by
10-14 d.o.
In the first week of life, what is healthy number of wet diapers?
diapers = age
Pink stains or brick dust in neonatal diapers represent
Uric acid cristals. Commonly seen in first week as mom’s milk is coming in
Clinical presentation of leukemia?
Fever, weight loss, pallor, other systemic sx
Osteoid osteoma
Limb pain (oft unilateral) that’s worse at night, repsonds to NSAIDS, common in 2nd decade. +/- limp and point tenderness
Next step in management of breath holding spells?
CBC and serum ferritin
Because Fe-def anemia is oft associated w/ breath-holding spells.IF prolonged or recurrent, consider ECG (presence of arrhythmias like prolonged QT) or if pt has murmur, poor growth, or dyspnea with feeds/activity, consider echo.
Ages of onset of Duchenne, Becker, and Myotonic dystrophy
3-5. 5-15. 12-30.
Lab findings on Duchenne muscular dystrophy?
Elevated serum creatin phosphokinase nad elevated aldolase
Nikolsky sign used for dx of
Scalded skin syndome (S. aureus)
1 yo boy with lead level 12 ug/dL (norm <5 ug/dL). Next step?
Fingerstick level can have false +. Measure venous lead level:
- Mild (5-44) –> no med, repeat test in DMSA (Meso-2,3-Dimercaptosuccinic acid)
- Severe (>= 70) –> Dimercaprol (British Anti-Lewisite) + EDTA
12 yo f w/ persistent left ear discharge for 3 weeks, even after 2 courses of abx, hearing loss on left. Intact TM w/ peripheral granulation and skin debris. Pt should be evaluated for
Acquired cholesteatoma (abn skin growth in middle ear behind eardrum) 2ndary to chronic middle ear disease –> retraction pocket in TM –> fill w/ granulation tissue and skin debris
Next step after exposure to tick-infested environment?
Bathe immediately
21 hydroxylase deficiency causes increases in
17-hydroxyprogesterone (NOT 17-hydroxyprogenolone)
Neonate presents w/ bilious vomiting. Best next step for diagnosis after NG tube and IV?
Abd x-ray
Baby w/ bilious vomiting doesn’t have pneumoperitoneum. Best next step?
Contrast study (upper GI vs. enema)
Best dx test for malrotation?
Upper GI (contrast)
CF pt w/ dilated loops of bowel w/ no rectal air and no free air
Most likely meconium ileus –> see microcolon on contrast enema
When is surgery indicated for an umbilical hernia?
- Persists to age 3-4 yo
- Exceeds 2 cm diameter
- Causes sx, strangulated, or enlarges progressively after 1 yo
What is a cyanotic <3 defect w/ left axis deviation and decr pulm markings on cxr?
Tricuspid atresia (hypoplasia of RV and pulm outflow tract)
Duodenal atresia associated w/
Chromosomal abnormalities. Due to failure of recanalization
Jejunal and ileal atresia associated w/
Vascular accident in utero –> necrosis and resorption of distal fetal intestine
EMG is used to eval
Neuromuscular system to differentiate btw peripheral nerve disorders and primary neuropathies
What is the ddx for T-wave inversion?
MI Myocarditis Old pericarditis Myocardial contusion Digoxin toxicity
Peritonsillar abscess vs. epiglottitis
Both have fever, sore throat, muffled voice, drooling but peritonsillar abscess have less acute presentation
Progressive pancytopenia, macrocytosis, caf̩-au-lait spots, microcephaly, microphthalmia, short stature, horseshoe kidneys, absent thumbs suggest
Fanconi’s anemia
Macrocytosis (NO hypersegmentation), short stature, webbed neck, cleft lip, shielded chest, and triphalangeal thumbs suggest
Diamond-Blackfan
Rx for the above?
Corticosteroids. If unresponsive, transfusion therapy
Best way to prevent congenital rubella?
Vaccination prior to conception
Down syndrom pt w/ UMN signs, behavioral changes has
Atlantoaxial instability. Most commonly due to excessive laxity in posterior transverse ligament –> incr mobility btw atlas (C1) and C2 –> compression of spinal cord
Hemolytic anema, thrombocytopenia, and acute renal failure most likely indicates
Hemolytic-uremic syndrome
90% due to diarrheal pathogen (E.Coli, Shigella), 10% S. pneumo (pts have pneumonia or meningitis instead of diarrhea)
Henoch Schonlein sx
Purpura on legs and buttocks, normal platelet count
Preadolescent child w/ back pain, neuro dysfn (ie. urinary incontinence), palpable “step-off” at lumbrosacral area most indicative of
Spondylolisthesis: a developmental disorder characterized by a forward slip of vertebrae (usu L5 over S1)
What is alexia?
Acquired disorder of reading subsequent to brain injury in person previously literate
When is renal biopsy indicated in kids?
Children >10 yo w/ nephrotic syndrome
Any child w/ nephritic syndrome or MCD unresponsive to predisone
FYI: leukocoria
Every case is considered retinoblastoma unless proven otherwise.
Other sx:
Cause of death for retinoblastoma?
Liver and brain mets
What is used for absence seizures (2)
Ethosuximide or valproate.
What is the most common cause of urinary tract obstruction in newborn boys?
Posterior urethral valves (obstructing membrane)
Copious purulent ocular drainage, eyelid swelling in 2- to 5-d.o.
Gonococcal conjuctivitis
Rx: topical erythromycin w/in 1 hr of birth
Milder conjunctivitis 5-14 days after birth
Chlamydia conjunctivitis
Rx for Erb-Duchenne palsy?
Gentle massage and PT to prevent contractures. 80% pts have recovery w/in 3 mo, surgery if no improvement by 6 mo
Characteristics for constitutional growth delay
- Delayed growth spurt, 2. Delayed puberty, 3. Delayed bone age
What is the most common cause of pneumonia in CF child?
NOT pseudomonas, but staph aureus.
Empiric rx: IV vanc (assume MRSA)
What is the empiric drug of choice for CAP?
High-dose oral amoxicillin for s. pneumo, doesn’t cover S. aur
Normal ECG on newborn shows
# Right axis deviation # R waves in V1-V3 due to larger RV since blood is shunted from lungs (PDA) and circulation relies on right heart
Ddx of neonatal jaundice?
# breastfeeding jaundice # breast milk jaundice # heme conditions # sepsis: see sx of poor feed, lethargy, vomiting, hypothermia
Sx of neonatal meningitis?
Not h/a or neck stiffness, but
- temp instability (fever >38 or hypothermia <36)
- poor feed
- irritable, lethargy
Triple bubble sign indicates
Jejunal atresia
Pt w/ fever, drooling, neck stiffness, muffled voice, also w/ inability to extend neck and widened prevertebral space
Retropharyngeal abscess
Pathogenesis of retropharyngeal abscess?
Pre-excisting URI, pharyngitis, tonsilits, AOM, sinusitis –> direct spread. Usu polymicrobial (S. pyogenes, S. aureus, anaerobes)
Language level of a 2 yo?
Speak in 2 word phrases, follow 2 step commands
Most common pathogen of septic arthritis in kids?
S. aureus (Empiric rx: IV vanc)
When does the ductus arteriosus close?
3 days old
What is the <18 form of antisocial personality disorder?
Conduct disorder
What is the most common cause of proteinuria in children/
Transient proteinuria (caused by fever, exercise, seizures, stress, volume depletion)
5 yo w/ 3 days of fever, sore throat. Multiple 1mm vesicles on anterior tonsillar pillars. Grayish ulcerated lesions in posterior oropharynx. Bilateral palpable cervical l.n.
Herpangina
6 mo male w/ low B and T lymphocytes, absent thymic shadow
SCID
What are risk factors for AOM?
# 6 - 36 mo # formula intake # exposure to cigarette smoke # allergic rhinitis or viral URI # craniofacial anomalies # chronic middle ear effusion
If AOM returns w/in a month of initial abx, us
Amoxicillin-clavulanic acid
3 associations of celiac disease
- Fe def anemia 2. Type 1 diabetes 3. Dermatitis herpetiformis (itchy vesicles on extensor surfaces of elbows/knees)
If celiac disease is suspected, what is a highly sensitive test?
IgA anti-tissue transglutaminase antibody. Confirm w/ upper GI endoscopy w/ SI biopsy
Disorder in which pts display severe, pervasive irritability and poor frustration tolerance –> frequent temper outburst
Disruptive mood dysregulation disorder
Disorder in which pts have patterns of angry/irritable mood and argumentative/defiant behavior towards authority.
Oppositional defiant disorder
Pt has 1. Rapid onset of edma (of face, limbs, genitalia, laryges, intestines causing colicky abd pain), 2. no evidence of urticaria
Hereditary angioedema. Episodes usu follow infx, dental work, or trauma. Dysfn C1 inhibitor –> elevated C2b, bradykinin
1 mo w/ harsh III/VI holosystolic murmur of left lower sternal border most likely
VSD (Next step: echo to determine size of defect)
6 yo boy w/ insidious-onset hip or knee pain, antalgic gait (sx >1 mo)
Legg-Calve-Perthes disease: osteonecrosis of femoral head typically in boys 4-10 yo. Idiopathic, but underlying thrombophilia may be predisposing
13 yo boy w/ insidious-onset hip pain and limp
Slipped capital femoral epiphysis. Assoc w/ obesity
Limping when a toddler is learning to walk suggests
Developmental dysplasia of hip
Rate of normal saline IV for dehydration?
20 mL/kg
What is the gold standard for confirmation of Duchenne MD?
Genetic studies
What drug is used for congenital long QT, and why?
Beta blockers to blunt exertional heart rate (pts should avoid vigorous exercise) and shorten QT interval
ECG of hypertrophic cardiomyopathy?
aVL: tall R wave (due to LV hypertrophy)
V3: deep S wave (due to LV hypertrophy)
I, aVL, V4, V5, V6: repolarization changes
How does a newborn present with hypothyroidism?
Initially appear normal at birth, but gradually develop apathy, weakness, hypotonia, large tongue, sluggish movement, abd bloating, umbilical hernia
Newborn screening is performed in all states
5 yo w/ fever, hip pain unable to bear weight, WBC >12,000, ESD >40, CRP >2
Septic arthritis
Get arthrocentesis and IV abx
5 yo w/ hip pain usu after viral infx or mild trauma, decreased range of motion, limping. W/ hip flexed, slightly abducted, externally rotated
Transient synovitis
Rest and get NSAIDs
Congenital sx of syphilis
# Hepatosplenomegaly # Cutaneous lesions # Jaundice # Anemia # Rhinorrhea
By when has the spleen autoinfarcted due to SCD?
First 18-36 mo of life
Acute renal failure, thrombocytopenia, microangiopathic hemolytic anemia, fever w/ schistocytes
HUS after diarrheal illness
First line for bedwetting?
Desmopressin (before Imipramine)
Infant with weight in 5th percentile, height in 5th percentile, head circumference in 10th percentile labeled
Small for gestational age (birth weight < 10th percentile for gestational age)
Follicular conjunctivitis and cornea pannus (neovascularization)
Trachoma (caused by Chlamydia trachomatis A-C). May also see concurrent infx in nasopharynx –> nasal discharge
How to diagnose trachoma?
Giemsa of conjunctival scrapings
What distinguishes Henoch Schonlein purpural kids’ labs?
Normal platelet count, unlike other causes of purpura
Classic tetrad of Henoch Schonlein purpura?
Lower extremity palpable purpura, arthralgia, abd pain (usu colicky), renal disease
Measles vs. rubella?
Measles are more severe (fevers up to 104), coryza, malaise, and rash spreads more gradually (rubella rash spreads in <3 days) and are darker
Common cause of knee pain in adolescent male athletes
Osgood-Schlatter disease = traction apophysitis of tibial tubercle
What are 2 common complications of sickle cell trait?
- Microscopic or gross hematuria 2. Isosthenuria (impairment in concentration)
What is the best empiric therapy (apart from incision and drainage) of unilateral cervical lymphadenitis?
Clindamycin b/c it covers both strep and staph (including MRSA), has good l.n. penetration. **Staph produces beta lactamase
Short palpebral fissures, indistinct philtrum, thin upper lip
Fetal alcohol syndrome
Rx for non-TB mycobacterial infx?
Azithromycin + rifampin
Ddx for aquired torticollis?
# URI# Minor trauma # Cervical lymphadenitis # Retropharyngeal abscess # Atlantoaxial subluxation
Sx of vitamin B3 deficiency?
Diarrhea, dermatitis, dementia (Pellagra)
First 3 steps in caustic ingestions?
- ABCs 2. Remove clothing 3. Upper GI endoscopy w/in 24 hrs to assess injury
What is eczema herpeticum?
A form of primary herpes simplex associated w/ atopic dermatitis. Usu superimposed on healing atopic dermatitis (eczema) after exposure to herpes simplex. Can be life threatening in infants!
What are the sx of eczema herpeticum?
Fever, adenopathy, umbilicated vesicles
What are sx of UTI during infants?
Nonspecific and vague: # fever # fussiness # decr UOP** Clean-catch is hard for kids in diapers --> straight cath instead
What are risk factors for pyloric stenosis?
# First-born boy # Erythromycin # Formula feeding
Sx of orbital cellulitis?
# Pain w/ mvmt # Proptosis # Ophthalmoplegia # Diplopia
6 mo w/ poor feeding, fussiness, bulging anterior fontanelle, widely spaced sutures, prominent scalp veins?
Suspicious for hydrocephalus –> get CT scan
Mitral stenosis in kids is almost always due to
Rheumatic fever.
Rx for pts w/ hx of rheumatic fever?
Continuous penicillin ppx every month to prevent strep pyogenes pharyngitis and limit progression of rheumatic heart disease
What are common pathoens in CF pneumonia?
# Pseudomonas # Burkholderia cepacia (gram neg rod) # Stenotrophomonas maltophilia (gram neg rod) # H. influenza (gram neg coccobacilli) # S. pneumo # S. aureus (**Most common in infants, young kids**)
What is the most common org for CF pneumo in babies?
S. aureus
Why is C. diff colitis rare in infants?
Lack of intestinal receptors to toxin until ~2 yo
What are the clinical features of milk-/soy-induced colitis?
Regurgitation or vomiting +/- painless bloody stools +/- eczema (oft family hx of allergies, eczema, asthma)
What are 2 red flags for intracranial pathology?
ie. for temporal brain abscess, since ICP increases in supine # morning vomiting # nocturnal h/a
What is Beckwith-Wiedemann syndrome?
Overgrowth disorder characterized by predisposition to neoplasms (Wilms tumor, hepatoblastoma).
What is cause and pathogenesis of Beckwith-Wiedemann syndrome?
Alteration of chrom 11p15 that includes genes that encode ILGF2. So at birth, babies have macrosomia, macroglossia, hemihyperplasia, medial abdominal wall defects.
What are the rx for TCA o/d?
# First step: ABCs # Sodium bicarb for cardiac toxicity (prolonged QRS, ventricular arrhythmia) and metabolic acidosis # Benzos for seizures # Nothing for anticholinergic sx
Widened QRS due to a drug puts pt at risk for
Fatal ventricular arrhythmias
Presentation of intraventricular hemorrhage in newborn (increased risk with premies)?
# Lethargy # Hypotonia # High-pitched cry # Rapidly increasing head circumference # Bulging fontanels
What is next step in management of Guillain Barre?
Spirometry to measure FVC (gold standard) to check for respiratory failure
What are the 3 reasons for cow’s milk causing Fe anemia?
- Low Fe content of milk
- Poor bioavailability of Fe from milk
- Increased intestinal blood loss from cow milk protein colitis
One lab way to diff btw Fe def anemia and thalassemia?
RDW >20% most likely Fe def.
FYI viral meningitis
Can present with a viral prodrome of constitutional/URI sx w/ low-gr fever.
Top 2 orgs for bacterial lymphadenitis?
- Staph aureus
- Group A strep
What is suspicious for nephrotic disease in pt from China?
Membranous nephropathy - can be seen in adolescents w/ hep B
What should precede intubation in pts with croup?
Racemic epi
Ddx of maroon-colored stool in 2 yo (5)?
# hemorrhoids # infectious colitis # intussuception # Meckel's # IBD
Workup of intussusception with
Abd ultrasound
Pt with reactive airway disease w/ altered mental status, “silent chest” (absent air entry on exam), hypoxemia, CO2 retention are signs of
Impending respiratory failure from unremitting asthma –> intubation and vent
What is adequate stooling in a newborn?
# First 2 days: dark, sticky meconium # Afterwards: yellowish (yellow-seedy) or green stool
What is adequate urination in first week of life?
Number of wet diapers >= Infant’s age in days
What are the 3 cardiac anomalities of Turner syndrome?
- Coarctation of aorta 2. Bicuspid aortic valve 3. Aortic root dilation
What is the most common population for serum sickness?
Young children following rx of viral infections with abx.
Fever, rash, joint pain, lymphadenopathy 1-2 weeks after penicillin suggests
Serum sickness
In a neonate: poor oral intake, irritability, hyper/hypothermia, respiratory distress, vomiting, jaundice suggests
Neonatal sepsis. Empiric rx: ampicillin + gentamicin
Full/bulging fontanelles suggests
Neonatal meningitis
Which organism causes sepsis in premies?
Enterococcus
Two diff btw Niemann-Pick and Tay-Sachs?
Niemann-Pick pts can show hepatosplenomegaly and areflexia, vs. Tay-Sachs no hepatosplenomegaly and hyperreflexia
Dx of ADHD by
Clinical eval of sx and associated impairment in 2 diff settings (teacher evals are important)
What is the ddx of rash in the neonate?
# Erythema toxicum neonatorum - asymptomatic. Macules/papules/pustules throughout body w/o palms + soles # Neonatal HSV # Neonatal varicella # Staph scalded skin syndrome
What are the 3 patterns of neonatal HSV?
- Vesicular clusters on skin, eyes, mucous membranes 2. CNS infx 3. Fulminant, diseeminated multi-organ disease
What is the rx for staph scalded skin syndrome (3)?
Oxacillin, nafcillin, or vancomycin
Which vitamin can reduce morbidity and mortality of measles?
Vit A
What CBC findings can be seen with measles (2)?
Leukopenia, thrombocytopenia
Cause of intusseption in CF pt
Inspissated stool
Cause of intusseption in pt <2 yo
Viral illness –> hypertrophy of Peyer patches
Cause of intusseption in kids >2 yo
Meckel’s diverticulum
What factors decrease risk of RDS?
# IUGR # Maternal htn # Prolonged rupture of membranes (chronic IU stress)
What factors increase risk of RDS?
# male # perinatal asphyxia # maternal diabetes
52 hr pt w/ narrow colon, dilated loops of small bowel, air in large intestine, rectum. Can’t pass meconium. Ddx (2)
- Hirschsprung disease (assoc w/ Down) - obst in rectosigmoid
- Meconium ileus (pathogn. for CF!!!!) - obst in ileum
Infants <2 mo at great risk of dvlpg what with RSV infx?
Apnea and resp failure b/c can have upper AND lower resp tract involvement
Two additional manifestations of Henoch-Schonlein purpura
- Scrotal pain + swelling 2. Intussusception (ileo-ileal)
Housing before which year increases risk for lead exposure?
1978
When should visual acuity test be performed?
At every well-child visit starting at age 3
What are indications for renal and bladder u/s for UTI (4)?
- t respond to abx
What are indications for voiding cystourethrogram for UTI?
If hydronephrosis or scarring seen in renal ultrasound.
What is guanfacine MOA and what is it used for?
Alpha2 agonist in CNS –> used in
1. htn (decr both systolic and diastolic)
2. ADHD
What is Kasabach-Merritt syndrome?
A platelet consumption disorder associated w/ large or multiple hemangiomas
What are the 3 Ps of McCune-Albright?
Precocious puberty
Pigmentation
Polyostotic fibrous dysplasia
Rx for H influenza type b meningitis?
Dexamethasone
Empiric therapy for meningitis?
IV Ceftriaxone (S. pneumo, N. menin) + Vanc (resistant S. pneumo) OR cefotaxime
10 yo boy w/ abd pain, bloody diarrhea, jaundice, pedal edema. Labs show anemia, thrombocytopenia, renal insufficiency. What is most likely organism?
HUS caused by E. Coli (EHEC). Or Shigella
Rx for HUS?
Generally supportive, w/ plasmapheresis, dialysis if needed, steroids. No abx indicated.
Bedwetting is normal before age
5
What is the pathogenesis of physiologic jaundice of newborn?
Slow bili clearance from decreased uridine diphosphogluconurate glucuronosyltransferase (UGT) activity
In which disease do pts have normal CD3+ but very low CD19+ cells?
X-linked (Bruton’s) agammaglobulinemia
Which org associated with cat bites, and ppx rx is?
Pasturella multocida. Amoxicillin+clavulanate
2 yo w/ initial viral prodrome (ie. URI) –> worsening respiratory disress (from acute LH failure, pulm edema), holosystolic murmur, hepatomegaly suggests
Viral myocarditis (latter signs are signs of heart failure)
2 most common viral myocarditis etiologies?
- Coxsackie B, 2. Adenovirus
What is the difference between pericardial effusion and cardiac tamponade?
Pericardial effusion with enough pressure to affect cardiac function = cardiac tamponade # pericardial effusion may be transudative, exudative, hemorrhagic, malignant
What is the triad characterizing progression to tamponade?
Beck’s triad: 1. distant heart sounds 2. distended jugular veins (or scalp veins in infants) 3. hypotension
What is the first step in management of gonadotropin-dep (central) precocious puberty?
Brain MRI (must be ruled out, even though GDPP is idiopathic in 80% of pts), even with no neuro deficits
What is danazol, and what is it used to treat?
Testosterone derivative, endometriosis
What is a tet spell (pathogenesis)?
Complete obstruction of RV outflow tract from sudden spasm dur exertion or agitation --> Sudden hypoxemia, cyanosis. # obstruction also causes harsh systolic ejection murmur and single s2 (no pulm blood flow)
14 d.o. m infant presents w/ spasms, had no antenatal care
Neonatal tetanus (4 types: generalized, localized, cephalic, noenatal), oft following umbilical stump infx
What is infant botulism caused by?
Ingestion of C. botulinum spores in honey but also soil esp in Cali, Penn, Utah
What is the most common symptom and PE finding for osteosarcoma?
Joint pain and swelling (not constitutional sx), tender soft-tissue mass
What are 4 sx of acute iron poisoning?
- abd pain, 2. hematemesis (Fe is corrosive to GI mucosa), 3. anion gap met acidosis (Fe is vasodilator and causes accumulation of lactic acid) 4. shock (overall Fe disrupts basic cell processes)
What is used to prevent gonococcal ophthalmia?
Silver nitrate in eyes
What is the most common complication of a male CF pt?
> 95% have obstructive azoospermia (good sperm production, but they have congenital bilateral absence of vas)
FYI CF pts with early pancreatic insufficiency
Rarely have pancreatitis
Hip creases that extend beyond normal in a baby may indicate
Developmental dysplasia of the hips
If a baby has asymmetric hip creases with negative Barlow & Ortolani signs, what imaging should he get?
# If 2 wk: wait as hip laxity at birth usu resolves # If 2 wk - 6 mo: hip ultrasound # If >= 4-6 mo: hip x-ray (after femoral head/acetabulum have ossified)
Leg-length discrepancy in a baby may indicate
Developmental dysplasia of hips
What is the rx of for dvlpmtl dysplasia of hip in baby <6 mo?
Pavlik hip harness
Recurrent sinopulm infx, chronic cough, nasal polyps, clubbing
CF
What are 3 EKG characteristics of Wolff-Parkinson-White?
- shortened PR interval, 2. delta waves, 3. wide QRS
What is kidney manifestation of HSP?
IgA nephropathy (Berger) - mesangial deposition
Mongolian spots vs. bruises from coagulopathy or child abuse?
The latter are painful.
Newborn in respiratory distress after pre-term vaginal delivery, prenatal had polyhydramnios, O2 sat 82%, w/ nasal flare, grunt, barrel-shaped chest, scaphoid abdomen. Absent breath sounds on left, right sided heart sounds. Most likely
Diaphragmatic hernia. Herniation --> Pulm hypoplasia and pulm hypertn. # Don't bag-mask ventilate as it may increase air into GI!
What is the rx for strep throat and its benefits?
Penicillin or amoxicillin. Hastens recover, reduces risk of rheumatic fever, and prevents transmission to close contacts.
What is the squirt sign of Hirschsprung?
Rectal exam can provide temp relief –> explosive expulsion of gas and stool. Not seen in meconium ileus as the meconium is inspissated.
Recurent sinopulmonary infx are concerning for
humoral deficiency
What is the pathogenesis of lymphadenopathy and hepatosplenomegaly in ALL?
Extramedullary leukemic spread (may even see widened mediastinum from hilar lymphadenopathy)
What’s an option for bee sting allergies to decr repeat anaphylaxis risk from 30 to <5%?
Venom immunotherapy
Do apgar scores correlate with prognosis?
No. Many babies who initially need pos press ventilation respond well.
What are the characteristics of ALL blasts?
# Lack peroxidase positive granules # Oft contain cytoplasmic aggregates of periodic acid Schiff (PAS)
What are the presenting sx for Conn’s syndrome?
Excess aldosterone (aldosterone-secreting adenoma, bilat adrenal hyperplasia) –> hypokalemia, htn
What is the most common cause of secondary htn in kids?
Fibromuscular dysplasia, a non-inflammatory, non-atherosclerotic vascular disease (intimal form is most common in kids) # presents as new onset htn, may hear bruit at costovertebral
Neonate exposed to a drug has irritability, high-pitched cry, poor sleeping, tremors, seizures, sweating, sneezing, tachypnea, poor feeding, vomiting, diarrhea. Due to
Neonatal abstinence syndrome (infant w/drawal opiates)
Rx for neonatal opiate w/drawal?
Supportive care, morphine
Difference btw presentation of neuroblastoma vs. pheo
Even though elevated catecholamines, HVA, VMA, pts don’t have fainting spells, sweating, palpitations, htn.
What is seen on imaging of neuroblastoma?
Renal calcifications and hemorrhages
Why does standing increase the murmur for hypertrophic cardiomyopathy?
It decrease preload –> decrease ventricular cavity size –> increase LV outflow obstruction
Stridor in infant <1 yo ddx (2)?
- Laryngomalacia - worsens in supine
- Vascular ring - worsens in prone, improves w/ neck extension, 50% associated w/ cardiac abnorm
Describe the rash of measles.
Blanching, reddish-brown, maculopapular, cephalocaudal and centrifugal spread
Pt after elbow fracture with increasing pain concerning for
Compartment syndrome
What is the pathogenesis of scarlet fever?
Erythrogenic exotoxins, following strep pharyngitis, wound infx, burns, strep skin infx.
Rash, erythematous pharynx with gray-white exudates, circumoral pallor. Later in week, desquamation
Scarlet fever (may also see strawberry tongue)
What is the pathogenesis of anemia of prematurity?
- Transition in erythropoiesis sites of neonate
- Shorter life span of RBCs in neonates
- Diminished fetoplacental transfusion (when baby held above level of placenta after delivery)
What is rx for anemia of prematurity?
Fe supplementation, periodic Hb check, blood transfusion. Epo not used
What is the diff btw AOM and OM w/ effusion?
The latter has middle ear effusion WITHOUT acute inflamm
What are serous liquid-filled blisters on the TM called?
Bullous myringitis
Definitition of conjugated hyperbilirubinemia (2)?
> 2 mg/dL of direct bili or direct bili >20% of total
What is the next step for eval of biliary atresia?
Abd u/s (may show absent/abn gallbladder)
What is the gold standard for eval of biliary atresia?
Cholangiogram
What is the rx for biliary atreisa?
Kasai procedure, eventual liver transplant
Most common cause of congenital hypothyroid in US?
Thyroid dysgenesis (85%)
What is the primary murmur in tetralogy of Fallot?
Harsh, systolic ejection murmur over left upper sternal border from pulm stenosis
What is the cause of apical diastolic rumble in VSD?
Relatively incr flow across mitral valve
Caf_-au-lait, macrocephaly, feeding problems, short stature, learning disabilities suggest
NF1
Vocabulary of several hundred words found in a child aged
2 yo
What is the rx for scarlet fever?
Penicillin V (for allergies: erythromycin, clinda, 1st gen ceph)
