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QBank knowledge Flashcards

1
Q

Polycythemia for infants is what crit

A

> 65%

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2
Q

What causes polycythemia

A

increase erythropoiesis (diabetes, HTN, smoking, IUGR) or Erythrocyte transfusion (delayed clamping time, twin -twin transfusion)

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3
Q

What are kids disposed to after heart surgery?

A

pericardial effusion leading to tamponade

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4
Q

What is beck’s triad for tamponade?

A

distant heart sounds, distended jugular veins, hypotension

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5
Q

What are breathholding spells associated with

A

Iron deficiency anemia

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6
Q

What 2 types of breathholding are there?

A

cyanotic - normal with crying and pallid - triggered by minor trauma.

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7
Q

How does a VSD present?

A

harsh, holosystolic murmur at the lower left sternal border. The louder the better, because big VSD’s have less murmur activity. 75% close by age 2

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8
Q

Ewings’s sarcoma?

A

x-ray shows onion-skinning, usually at the metaphysis or diaphysis of long-bones. pain and swelling for weeks. often confused with osteomyelitis.

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9
Q

Osteosarcoma

A

asdf

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10
Q

What is the most common congenital adrenal hyperplasia and what level will be raised. Presentation?

A

21-hydroxylase deficiency. presents with virilization of females, salt-wasting, and INCREASED 17-hydroxyprogresterone levels.

If complete deficiency, then you see it as a baby with tons of salt-wasting

If partial deficiency, presents in adolescents as hyperandrogenism (hirsutism, virilization), elevated 17-hydroxyprogesterone, and some salt wasting.

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11
Q

How does acquired aplastic anemia present

A

History of drug or toxin exposure/ingestion or infection. Pallor, weakness, fatigue, loss of appetite. labs show normocytic anemia and ALL things are down (retics, leukocytes, thrombocytes). Bone marrow biopsy shows total decrease

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12
Q

What are other types of anemia

A

fanconi’s - pancytopenia + CONGENITAL ANOMALIES (cafe au lait macules, hyperpigmentation of the trunk/neck/intertrig, upper limb abnormalities, renal abnormalities, hypogonadism, ). Presents between 4-12 years. IT IS AUTOSOMAL RECESSIVE and caused by chromosomal breaks.

Diamond-blackfan - congenital PURE RED CELL APLASIA in first 3 months of life. pallor and poor feeding. congenital abnormalties in 50% including short stature, webbed neck, cleft lip, shield chest, and triphalangeal thumbs.

Transient erythroblastemia of childhood - present 6 months to 5 years. pallor and tachycardia.

Leukemia - fever, lethargy, bruising and bleeding. CBC can show mixed results. bone marrow shows crazy cells.

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13
Q

What is only infant factor contraindication to breastfeeding?

A

galactosemia

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14
Q

What is tx and dx for esophageal coin ingestion?

A

flexible endoscopy

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15
Q

Eczema - where does it present in infants

A

face, chest, and extensor surfaces of extremities. flexural involvement in older kids and adults.

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16
Q

What kidney condition does Hep B put at risk of?

A

membranous nephropathy - presents with edema, hypoalbuminemia, and elevated urine protein consistent with nephrotic syndrome.

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17
Q

How does epiglottitis present and what is major cause?

A

abrupt fever, sore throat, dysphagia, drooling. HIB is major pathogen

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18
Q

when does pyloric stenosis present and how? dx? risk factors?

A

4-8 weeks after birth, non-bilious projectile vomiting, can show hypochloremiac metabolic acidosis. “olive shaped” mass

dx: Ultrasound

risk factors: first born boy, erythromycin tx, formula feeding

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19
Q

when and how and dx of hirchsprung and meconium ileus?

A

failure to pass meconium within 48 hours and dilated bowel loops on x-ray. dx by contrast enema

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20
Q

malrotation with midgut volvulus presentation, dx and when?

A

neonates <1 month. bilious vomiting. dx: upper GI study

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21
Q

CF presentation, dx

A

autosomal dominant recessive, chronic sinpulmonary infections + nasal polyps, sweat testing

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22
Q

How do you treat staph pneumonia?

A

Iv vanc

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23
Q

Describe presentation and tx of tinea corporis

A

superficial fungal infection with erythematous, scaly, pruritic rash with central clearing. treated with topical antifungals such as terbinafine.

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24
Q

What is the triad of Wiskott-aldrich? inheritance

A

X-linked disorder. Triad is thrombocytopenia, eczema, recurrent bacterial infections (strep pneumo, N meningitidis, H influenzae). thrombocytopenia is due to decreased production.

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25
Q

After when is bedwetting (enuresis) abnormal? How common?

tx?

A

> 2x per week after age 5. boys train later than girls. 15% of boys 2% of girls

tx: 1st line, enuresis alarm - 3-4 months before it works

Pharmacotherapy: 1st line, desmopression
2nd line, TCA’s

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26
Q

What is todd’s paralysis

A

a postictal condition that rapidly improves over 24 hours. Sudden loss of consciousness (seizure) followed by hemiparesis and slow restoration (todd’s).

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27
Q

What is hemophilia A and B? Who affects? what are side effects?

A

deficiencies of factor VIII and IX. only males, females are carriers. It can cause hemarthrosis leading to hemosiderin deposition and fibrosis.

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28
Q

What is classic presentation of Henoch-schonlein purpura and what are kidney findings? What is it?

A

IgA mediated vasculitis of small vessels.

  1. palpable purpura in lower extremities
  2. NORMAL PLATELETS (if thrombocytopenia, think more down the HUS road)
  3. arthralgias
  4. abdominal pain leading to intussusception and GI bleeding
  5. Renal disease (mesangial deposition of IgA leading to hematuria, RBC casts, and mild proteinuria)
  6. SCROTAL SWELLING

Rash comes first (symmetric and over legs, butt, arms). Arthralgias/arthritis. Majority also have abdo pain. renal comes in up to 50% and then occurs 4-6 weeks later.

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29
Q

When to operate on umbilical hernia?

A

most disappear by 1 year. If persist more than 3-4 years, exceeds 2 cm, causes sx or strangulates, or enlarges, then operate.

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30
Q

What are the clinical manifestations of osteogenesis imperfecta?

A

blue sclerae, hearing loss, recurrent fractures, and “opalescent teeth”.

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31
Q

Describe presentation of scarlet fever? cause? tx?

A

cause by strains of group A strep that produces erythrogenic toxins. starts with strep pharyngitis (or cellulitis) after 1-7 days of incubation. rash starts on neck, axillae, groin and then generalizes withint 48 hours. rash is punctuate, or finely papular texture that is “sandpaper-like” . pharynx has grey-white exudate. mouth has “circumoral pallor”. By end of 1st week, there is desquamation

tx: Penicillin V. THEN erythromycin, clinda, and 1st generation cephalosporins for those with pen allergy

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32
Q

What is erb-duchenne and what is prognosis?

A

C5,6,7 branchial plexus injury due to vaginal delivery. due to macrosomia (male sex, african american, and post-term pregnancy also a problem). 80% have recovery within 3 months. consider surgery if not better within 3-6 months.

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33
Q

How does atlantoaxial instability present and who does it affect?

A

downs children 10-15%. usually laxity in C1 to C2. presents with upper motor sx (spasticity, +babinski, hyperreflexivity, clonus) + other sx (behavioral changes, urinary incont, torticollis, vertebrobasilar sx, vertigo, diplopia). Down’s are normally hypotonic.

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34
Q

presentation of cephalohematoma?

A

subperiosteal hemorrhage. several hours after birth and limited to one cranial bone. resorb within 2 weeks to 3 months.

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35
Q

Fragile X buzzwords? gene?

A

appearance is large head, long face, prominent forehead and chin, protruding ears, joint laxity, macroorchidism. behavior - autism, hyperactivity, short attention span. Gene is FMR1 - CGG repeats

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36
Q

Kawasaki disease presentation and dx criteria? Complications?

A

FEVER LONGER THAN 5 DAYS. 4 of the following

  • cervical lymphadenopathy with at least one node >1.5 cm
  • erythematous polymorphous rash
  • extremity changes (edema/erythema)
  • Bilateral nonexudative conjunctivitis
  • Mucositis (strawberry tongue, injected pharynx, injected or fissured lips)

Complications: coronary artery aneurysm, myocardial infection + ischemia

Tx: high dose aspirin +IVIG

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37
Q

Vit A def presentation?

A

bad adaptation to the dark, photophobia, scaly skin, xerosis conjunctiva, xerosis cornea, keratomalacia. follicular hyperkeratosis +Bitot spots of shoulder buttocks and extensor surfaces.

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38
Q

What to think of with severe coughing + subq ephmysema

A

pneumothorax

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39
Q

Presentation of craniopharyngioma

A

increased intracranial presure (headaches, vomiting), bitemporal hemianopsia, and a CYSTIC CALCIFIED PARASELLAR LESION practically makes this dx. from remnants of rathke’s pouch.

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40
Q

What happens when you swing kids by arms/

A

subluxation of the radial head. go for forearm hyperpronation and full recovery should occur.

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41
Q

How does one dx an iron deficient anemia and how to distinguish from thalassemias?

A

microcytic anemia. RDW is > 20%. In thalassemias (alpha trait and beta minor), it is normal at 12-14%.

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42
Q

How does sickle cell present in babies?

A

vaso-occlusive disease leading to dactylitis. dactylitis is symmetric swelling of hands and feet. present 6 months to 2 years with acute onset of pain. may show osteolytic lesions on x-ray.

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43
Q

What are the catalase positive organisms and who gets infected? what is test? tx?

A

staph aureas, aspergillus, serratius marascens, burkholderia cepacia. Chronic granulomatous disease (recurrent or unusual lymphadenitis, hepatic abscesses, osteomyelotis). dx by nitroblue tetrazolium, cytochrome c reduction, or flow. tx: daily tmp-sx and gamma-interferon 3x per week.

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44
Q

What enzyme and what is typical presentation of Von-gierkes disease

A

G6 phosphatase deficiency. presentation generally is “DOLL-LIKE FACE” (fat cheeks), PROTUBERANT ABDOMEN (due to enlarged liver and kidneys), thin extremities, short stature. Labs show hypoglycemia, lactic acidosis, hyperuricemia, and hyperlipidemia. hypoglycemic seizures are common.

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45
Q

What to do with croup as it worsens?

A

give racemic epi as it decreases need for intubation.

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46
Q

What is the choana and how does choanal atresia present? What syndrome associated with it? dx?

A

choana - back of nasal passage. atresia presents as cyanosis with feeding, relieved by crying. due to bony (90%) or membranous (10%) obstruction. Syndrome is CHARGE:

C - coloboma (hole in the eye)
H - heart defects 
A - atresia of choana
R - renal anomalies
G - growth impairment
E - ear abnormalities/deafness

dx? failure to pass a catheter through the nose. Can also CT the thing.

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47
Q

What is an intraventricular hemorrhage and what are risk factors?

A

IVH is seen in premature and LBW babies. Patients present with pallor, cyanosis, hypotension, seizures, focal neurological signs, bulging or tense fontanels and is seen mostly in PREMATURE BABIES.

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48
Q

What is anemia of prematurity? labs?

A

common anemia in LBW and preemies. labs show normocytic, normochromic RBC’s, retics low and precursors in bone marrow are decreased, Normal bili, WBC, and platelets

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49
Q

How do kids get a carotid dissection?

A

ONLY WAY is trauma to the soft palate compressing the ICA (thrombosis and stroke) or dissection. onset is 24 hours after trauma. Image with MRI.

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50
Q

What is the presentation retinoblastoma? pathophys?

A

retinoblastoma is the most common intraocular tumor in children due to inactivation of the RB tumor suppressor gene - highly malignant. presents with leukocoria.

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51
Q

What labs are abnormal in muscular dystrophy AND what is gold standard

A

gold standard = genetic testing. labs elevated are creatine phosphokinase and aldolase levels. muscle biopsy shows fatty infiltration and fibrosis. gower sign and bilateral calf pseudohypertrophy

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52
Q

Risk for clavicular fracture and management?

A

all risk factors for shoulder dystocia (maternal diabetes, fetal macrosomia). fractures heal spontaneously in 7-10 days without sequelae. pain decrease by pinning the sleeve to shirt.

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53
Q

what is beckwith-wiedemann and what are clinical features? what do you get eventually? monitoring

A

overgrowth disorder alteration of chromosome 11p15 (sporadic or inherited) that predispose to neoplasms. Mnemonic for presentation - HOMO

H - hypoglycemia and HEMI-hyperplasia
O - Omphalocele
M - Macroglossia
O - Organomegaly

eventually you get wilm’s tumor and hepatoblastoma.

Monitor with this with abdo US.

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54
Q

Where does medulloblastoma present and affect?

A

2nd most common posterior fossa tumor. 90% affect the cerebellar VERMIS.

What is the 1st most common: benign astrocytoma.

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55
Q

What is the triad of kartagener’s

A

recurrent sinusitis, bronchiectasis, dextrocardia (heart points towards right)

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56
Q

What is immediate management of gastroschisis and ompahalocele?

A

immediately wrap the exposed bowel in sterile saline dressing and plastic wrap to minimize heat loss and fluid losses.

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57
Q

Where can pinworms present?

A

anal nighttime itching AND in prepubescent girls, vulvovaginitis.

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58
Q

What is a good apgar score

A

> 7 means leave them alone. <60 bpm, intubate, chest compressions, and if not correction, IV epi.

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59
Q

What are clinical manifestations of Coarctation of Aorta? What genetic defect associated?

A

upper body HTN + lower body hypoperfusion, mild continuous murmur all over the chest due to development of collaterals between hypertensive and hypoperfused vessels. CXR shows rib notching.

7% of Turner’s kids have it.

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60
Q

What are clinical sx of congenital hypothyroidism and major cause?

A

typically appear normal at birth, but gradually develop

Jaundice, LARGE TONGUE, NEW UMBILICAL HERNIA, abdominal bloating, apathy, weakness, hoarse cry, and sluggishness. Most common cause: thyroid dysgenesis is 85% (aplasia, hypoplasia, ectopic gland). Is a genetic thing..

One of 3 things always checked in babies: hypothyroidism, phenylketonuria, galactosemia.

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61
Q

What are the confirmatory tests for lupus? what other things are elevated?

A

anti-smith and anti-double stranded DNA are confirmatory. Clinical features include malar rash, joint pains. Labs show anemia, leukopenia, normal platelets. ANA and RPR are positive.

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62
Q

What is probably normal jaundice and what are jaundice to workup?

A

NORMAL, physiologic jaundice is unconjugated 12-14 between 1 days and 10 days after life. more common in preemies, diabetic moms, and asian babies

Always workup conjugated hyperbili.

Workup for the following:

  1. Jaundice before 36 hours of life
  2. serum bili rising > 5 mg/dl/day
  3. serum bili >12 in term and >10 in preemies
  4. Jaundice after 10 days
  5. signs and sx of jaundice
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63
Q

triad of congenital toxo?

A
  1. chorioretinitis
  2. hydrocephalus
  3. intracranial calcifications

ChoHy InCa

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64
Q

Triad +M’s of congenital rubella?

A
  1. deafness
  2. cataracts
  3. cardiac defects

M’s = microcephaly, micropthalmia, meningoencephalitis

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65
Q

What are contraindications to breastfeeding?

A

Maternal

  1. active, untreated TB
  2. HIV
  3. illicit drug and alcohol abuse
  4. chemo
  5. varicella infection OR herpetic breast lesions

Baby
1. galactosemia

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66
Q

What are some common benign skin and diaper findings within 1 week of birth

A
  1. dry, flaky peeling skin of hands and feet
  2. pink stains or “brick dust” in diaper is normal uric acid crystals. uric acid crystal excretion is high at birth and seen in 1st week as mom’s milk comes in.
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67
Q

Normal loss of birthweight?

A

Lose up to 10% and regain by 10-14 days

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68
Q

Name 3 systems involved in Freidrich ataxia? age of onset? inheritance? cause of death?

A
  1. neurologic (ataxia, dysarthria)
  2. skeletal (scoliosis, feet deformities)
  3. cardiac (concentric hypertrophic cardiomyopathy)

Age of onset: before 22. Death by 35

Autosomal recessive

death: cardiomyopathy and respiratory problems

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69
Q

Growing pains. age of presentation? presentation? epi?

A

Occur in 10-30% of children ages 2-12.

bilateral, lower extremity pain (thigh, calf)
occurs at night and resolves by morning
normal physical exam

Tx: massage, stretching, analgesia, reassurance

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70
Q

What are the clinical features of cystic fibrosis?

A

respiratory (bronchiectasis, recurrent pneumonia, chronic rhinosinusitis)

GI (obstruction as a baby of meconium ileus, pancreatic disease)

repro (infertility in 95% of men and 20% of women)

MSK (osteopenia, clubbing)

actually, having oily stools rarely have pancreatitis because stuff is getting out.

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71
Q

What is myotonic muscular dystrophy?

A

and AUTOSOMAL DOMINANT type of muscular dystrophy that presents from age 12 to 30 and causes myotonia. Classic finding: patient is unable to release a hand shake (grip myotonia). Dysphagia leading to aspiration pneumonia. Cardiac conduction problems. Cataracts, and TESTICULAR ATROPHY, frontal baldness, and insulin resistance. Skeletal muscle weakness of FACE, forearms, hands, ankle dorsiflexors (foot drop).

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72
Q

Why do we give erythromycin drops at birth

A

for gonococcal eye infection and NOT for chlamydia.

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73
Q

When does intrapartum chlamydia present and how? How does one treat?

A

chlamydia trachoma conjunctivitis 5-14 days after birth.

pneumonia - 4-12 weeks after birth.

tx: ORAL erythromycin for 14 days.

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74
Q

How long duration must there be antalgia for legg-calve-perthe disease? What are other features? prognosis?

A

LCP is osteonecrosis of the femoral head that affects kids 4-10 years. Must have > 1 MONTH of antalgia. pain is insidious onset and has mild chronic pain. self-limited in 18 months

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75
Q

What are the 3 P’s of McCune-Albright?

A
  1. precocious puberty
  2. pigmentation (cafe au lait)
  3. polyostic fibrous dysplasia (results = bone fractures)
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76
Q

How does Klumpke palsy present? What is the main manifestation?

A

really only due to shoulder dystocia (risk factors: maternal diabetes and obesity + baby >4 kg). Damage to C8 and T1.

CLAW HAND + no grasp reflex (ERB-DUCHENNE HAS INTACT GRASP REFLEX - involved 5th and 6th cervical nerves).

Horner syndrome

Tx: can be permanent, but physical therapy to prevent contractures.

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77
Q

What marks B-cell deficiencies?

A

start at 6 months after mom’s antibodies are gone. lack of IgA leads to giardia. Lack of other stuff leaves encapsulated organisms like sinopulmonary infections like H influenzae and Strep pneumo

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78
Q

What is the mnemonic for DiGeorge

A 
C - conotruncal cardiac defects
A - abnormal facies
T - thymic aplasia/hypoplasia
C - cleft palate
H - hypocalcemia

22.11.2 deletion leading to defective development of pharyngeal pouches.

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79
Q

What are hallmarks of leukocyte adhesion deficiency?

A
  1. delayed separation of the umbilical cord
  2. recurrent bacterial infections of skin and mucosa
  3. necrotic periodontal infection
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80
Q

Prader Willi. What is the genetic defect? What is presentation? What are complications?

A

It is due to maternal uniparental disomy (i.e. LOSS of paternal 15q11-q13). ALMOND SHAPED EYES + downturned mouth. hypotonia, weak sucking, short stature, hypogonadism, intellectual disability,

complications?
sleep apnea
T2D
gastric distension/rupture
death by choking
these kids are SUPER obese
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81
Q

clubfoot description and tx

A

presents with equinus and varus of calcaneum and talus, varus of midfoot, and adduction of the forefoot.

Stretching, manipulation, serial casting IMMEDIATELY

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82
Q

What is clinical manifestation of reye syndrome? What brings it on.

Pathology in the liver?

Lab findings?

A

kids <15 years old treated with aspirin during a varicella or flu infection

Clinical features: acute liver failure and encephalopathy (presentation of vomiting, agitation, irrational behavior progressing to lethargy, stupor, and restlessness)

Pathology: bx of liver, kidney, brains shows microvesicular steatosis.

Labs:

  • increased transaminases
  • increased PT, INR, PTT
  • increased ammonia

treatment: supportive

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83
Q

What is the mutation in osteogenesis imperfecta?

A

mutation in type 1 collagen

84
Q

Lesch-Nyhan. inheritance? enzyme? clinical presentaiton

A

X-linked recessive (only men); deficiency of hypoxanthine-guanine phosphoribosyl transferase (HPRT). increased levels of purines leads to…

@ 6 months. hypotonia and persistent vomiting. progressive mental retardation, dytonia, SELF-INJURY (biting of upper extremities). Gouty arthritis, tophus formation, obstructive nephropathy.

give fluids and allopurinol.

85
Q

vaginal bleeding of infants?

A

at <3 months, maternal estrogens can cross the placenta and enter the fetal blood stream before birth causing withdrawal bleeds.

86
Q

hemolytic-uremic syndrome triad? how to tell from HSP

A

hemolytic anemia, thrombocytopenia, acute renal failure.

other symptoms include: petechiae, purpura, abdom tenderness.

In HSP has NORMAL PLATELET COUNTS

87
Q

What is the ddx or a single, painful, lytic long bone lesion?

A

If with hypercalcemia and overlying swelling, consider langerhans histiocytosis

With fever, consider osteomyelitis and a brodie abscess

endocrine (hyperparathyroid osteitis fibrosa cystica)

Neoplastic (Ewing sarcoma, langerhans histiocytosis, mets)

idiopathic

88
Q

In children <3 what should you include on DDX for finding on CXR if you suspect schmootz in the right lung?

A

THYMUS. It is known by the “sail sign” due to its triangular shape, scalloped border, and uniform density to on the upper right border of the heart. Like a little flag hanging above the heart <3

89
Q

What is a common skeletal complication of sickle cell?

A

ASEPTIC NECROSIS of the femoral head. Classic story, a sickler has gradually progressing hip pain for several weeks and is afebrile.

Why? There are two main arteries in the femur and one an become obliterated later in life which means that older kids only have 1 which, if it sickles, causes AVN.

90
Q

Tetraology of fallot. 4 things? pathophys? presentation

A

Main pathology is Right Ventricular Outflor Obstruction. Caused by overriding aorta, RVOT, Right ventricular hypertrophy, big VSD.

Presentation: toddlers who tire easily and get cyanotic. Gets better with squatting because you increase the peripheral vascular resistance DECREASING the right to left shunt.

Physical: harsh, systolic ejection murmur over mid to leftupper sternal border

91
Q

Where are most brain tumors found in kids and what is the most common type?

A

WAY more infratentorial rather than supratentorial.

benign astrocytomas are definitely the MOST common types.

92
Q

Turner Syndrome presentation in infancy? genetic defect? problems later on?

Presentation later?

A

XO. Only girls.

infant presentation: webbed neck, horseshoe kidney, carpal and pedal edema, nail dysplasia.

later presentation: delayed puberty, short stature, bicuspid aortic valve

why carpal and pedal edema? Due to abnormal development of the lymphatic system.

Later on, because of gonadal dysgenesis, they all have osteoporosis. Always give HRT.

93
Q

Galactosemia. What is the defect? What is presentation? Complications?

Dx

A

Galactose-1-phosphate uridyl transferase (GALT) deficiency

Presentation?

  1. CATARACTS + convulsions
  2. vomiting and poor weight gain + HYPOGLYCEMIA
  3. jaundice and hepatomegaly

dx: newborn elevated galactose levels and decreased GALT activity

Tx: remove milk

Complications: E. coli sepsis

94
Q

developmental dysplasia of the hip. presentation? management?

A

palpable clunk with barlow or ortolani maneuver. Soft-click, leg-length discrepancy, asymmetric inguinal skin folds

if soft-click
up to 6 months, do US
after 6 months, do X-ray

if CLUNK: straight to ortho.

95
Q

conjunctivitis (bacterial) in neonates

A

first 24 hours - chemical from AgNO3 application - symptom management

days 2-5 - gonococcal (swelling and mucopurulent eye discharge) - IV or IM ceftriaxone or cefoxatime

Day 5-14 - chlamydia (blood-stained eye discharge, chemosis [thickened injected conjunctivae], conjunctival pseudomembrane, neovascularization PANNUS) - oral erythromycin

96
Q

Edwards syndrome. Genetics? Presentation? Prognosis?

A

trisomy 18

  1. ROCKER BOTTOM FEET
  2. ABSENT PALMAR CREASES
  3. overlapping fingers
  4. micrognathia + microcephaly +prominent occiput
  5. 50% of kids have an enormous VSD (HEART)

80% dead in 1 month, 90% by 1 year

97
Q

What is cri-du-chat associated with. genetics and other symptoms?

A

5p deletion

presentation microcephaly, hypotonia, short stature, with the cri-du-chat.

98
Q

What are the complications for small for gestational age babies? even those born full-term? what is cutoff

A

if <10th percentile, be worried for hypoxia, polycythemia, hypoglycemia, hypothermia, hypocalcemia

99
Q

Presentation of phenylketonuria? Biochem?

A
  1. MUSTY (“MOUSY”) ODOR
  2. fair complexion
  3. intellectual disability and seizures

Why? body can’t convert phenyalalnine to tyrosine leading to neurotoxicity.

tx: low phenylalanine diet.

100
Q

What is the x-ray of duodenal atresia?

A

double bubble

101
Q

what is the x-ray of jejunal atresia?

A

triple bubble

102
Q

Sturge weber presentation

A

4 year old with port-wine stain or nevus flamus along trigeminal nerve territory (congenital hemangioma). Seizures start at any age. Xray shows intracranial calcification in tramlines

S - sporadic
T - tram track calcification
U - upper left trigeminal stain
R - retardation
G - Glaucoma
E - Epilepsy
103
Q

What is a rare, fatal complication of meningococcemia?

A

Waterhouse-friderichsen.

It is when there is massive adrenal hemorrhage.

Characterized by sudden vasomotor collapse and large purpuric lesions on the flank and petechiae

104
Q

Supplementation of infants?

A

All breastfeeders: Vitamin D

Iron
at 4 months for normal babies
at birth for preemies

105
Q

Meckel’s diverticulum. Presentation? Dx? Tx?

A 
PAINLESS HEMATOCHEZIA (can be significant anemia)
recurrent intusussception (esp in kids >2)

dx: technetium-99 scan or exlap
tx: surgery

106
Q

Intussusception presentation? Considerations in a baby 2?

A

Presentation: sudden episode of excruciating abdo pain. kids draw legs up to make pain go away. currant jelly stool from ischemia of bowel wall. Target sign on x-ray.

107
Q

Marfan’s. Genetic? Presentation? complications

A

Autosomal dominant from fibrillin 1 mutation.

Presentation: JOINT HYPERMOBILITY, arachnodactyly (thumb sign), pectus excavatum, scoliosis

face: long, palate with high arch, crowded teeth
eye: lens dislocation, iridodonesis, myopia

Complications: AORTIC ROOT DILATATION and regurgitation (diastolic murmur). requires annual echos for aneurysm and dissection. Also, mitral valve prolapse (mid-systolic click and late systolic murmur)

108
Q

Congenital diaphragmatic hernia. presentation? US findings in utero? complications? tx in the newborn?

A

abdominal viscera herniate into the chest resulting in PULMOMARY HYPOPLASIA and PULM HTN. 85% on the left.

US: polyhydramnios due to esophageal compression

Tx: intubation

109
Q

Sudden back pain in a kid with stepoff? pathology? presentation? tx?

A

Spondylolisthesis is a developmental disorder where there is a slip forward of the vertebrae (usually L5 over S1) usually in preadolescent kids.

Presentation: back pain, neurologic stuff (incontinence), palpable stepoff at lumbosacral area

Tx: surgery

110
Q

Slipped capital femoral epiphysis (SCFE). presentation and epi? Risk factors? dx? tx? complication

A

usually boys 10-16 years (OBESE is major risk factor). insidious onset of dull hip pain or referred knee pain and altered gait WITHOUT trauma.

dx: x-ray of hip show a posteriorly and inferiorly displaced femoral head
tx: immediate surgical screw fixation
complication: without surgery will progress to AVN

111
Q

metatarsus adductus? risk factors? presentation? tx?

A

adduction of anterior aspect of the foot with medial concavity (kidney bean foot). found at birth

Risk factor: first born is stretching uterus and gets its foot molded.

tx: Type 1 - when push the foot, it’s normal. OVERcorrection with active and passive abduction. nothing
Type 2 - normal with active and passive abduction. Orthotics and other shoes
Type 3 - no correction with active or passive. serial casting

112
Q

What are the organisms that sicklers need to be wary of

A

The encapsulated ones that the spleen (infarcted and dead at an early age) clears

SHiN SKiS

S - strep pneumonia
Hi - haemophilus influenzae
N - Neisseria

S - salmonella
Ki - Klebsiella
S - Strep Group B

113
Q

What’s prophylaxis for sicklers?

A

BID penicillin and pneumococcal vaccination

114
Q

What condition predisposes to Vit K deficiency? What factors use it

A

any fat malabsorption thing (like CF).

Factors II, VII, IX, X and protein C and S

115
Q

What is hereditary spherocytosis? Inheritance? Triad of symptoms? dx?

A

HS is due to a defective membrane resulting in extravascular hemolysis as the RBC’s pass through the spleen.

It is Autosomal Dominant

Triad: Coombs-negative hemolytic anemia, jaundice, splenomegaly. Key finding is Mean Corpuscular Hemoglobin Concentration of >36%

Dx: acidified glycerol lysis test and flow cytometry (eoson-5-maleimide binding test)

116
Q

What anemia does HUS cause? What is dx?

A

HUS will occur after an acute diarrheal illness with e. Coli 0157, Shig, salmonella, yersinia, campylobacter. It is ACUTE RENAL FAILURE. GI bleeding is a common sx.

Microangiopathic Hemolytic Anemia (MAHA) will give schistocytes and giant platelets. Labs show thrombocytopenia and (due to increased RBC hemolysis) , increased LDH, indirect bili, and retics.

117
Q

What is the outlook for sickle cell trait kids? What do their electrophoreses look? any abnormal lab findings or general findings?

A

GOOD. They lead normal lives.

Normal electrophoresis: 99% hgb A
Sickler: 85-95% hgb S, 5-15% fetal
Sickle cell trait: 50-60% hgb A, 35-45% hgb S

weird finding is gross hematuria from sickling in the renal medulla.

118
Q

What is the classic finding in a pinealoma? where do these form? tx?

A

Parinaud syndrome:

  1. upward gaze (sun-setting sign)
  2. bilateral ptosis
  3. bilateral lid retraction (collier sign where sclera is visible above the superior corneal limbus)

Also, HYDROCEPHALUS with headaches and vomiting.

Occur in the quadrigeminal cistern blocking the aqueduct of sylvius

tx? surigcal resection, shunt, and/or radiation

119
Q

What’s a good story for IgA deficiency?

A

recurrent sinopulmonary and GI infections and ANAPHYLAXIS with transfusions

120
Q

what are lab and smears showing for acute lymphoblastic leukemia?

A

ALL is the most common leukemia. lymphoblasts lack peroxidase positive granules (like myeloblasts), but do stain brightly for periodic acid Schiff (PAS). ALSO, immunostain for TdT is + in most patients.

Presents with high grade fever that won’t go away with NSAIDS

121
Q

What are manifestations of fanconi’s anemia? What is it caused by pathophys?

A

aplastic anemia and progressive bone marrow failure.

HYPO/HYPERPIGMENTED AREAS, cafe au lait, large freckles

low-set ears, middle-ear problems (hears pounding), strabismus

Short stature, microcephaly, hypogonadism

pathophys - chromosomal breaks

122
Q

What is the most common primary bone tumor in children and young adults? Where does it present? How?

A

Osteosarcoma!!

involves metaphyes of long bones and will have a “sun burst” pattern and codman’s triangle. Physical shows a large and tender mass.

Alk Phos and LDH are high!

Tx: excision and chemo

123
Q

What is the presentation of an angiofibroma?

A

Epistaxis!

nasal obstruction, visible mass. most common in males

CUT IT OUT

124
Q

What syndromes is Wilm’s tumor associated with’?

A

WAGR (wilms tumor, aniridia, genitourinary, intellectual disability)

Beckwith-wiedemann

Denys-Drash

125
Q

What is presentation of a wilm’s tumor? Who? dx?

A

Toddlers with an abdominal mass. Most common renal malignany of childhood. often asymptomatic. does not cross midline

Maybe abdominal pain, HTN, hematuria

Dx: contrast CT

126
Q

What do you suspect with an abnormally low platelet count <100k (isolated), asymptomatic petechiae, mucocutaneous bleeding after a viral illness? Who is most common in? tx?

A

Idiopathic Thrombocytopenic Purpura!

Most common in kids 2-5.

Tx: no bleeding and platelets > 30k. Observation
bleeding OR platelets <30k: IVIG and corticosteroids.

127
Q

What is the presentation of acute lymphoblastic leukemia? who? dx? tx?

A

peak age 2-5 M>F. most common leukemia.

Features:

  • bone pain
  • lymphadenopathy
  • hepatosplenomegaly
  • pallor
  • petechiae
  • mediastinal widening

dx: bone marrow biopsy. >25% lymphoblasts is diagnostic.
tx: chemo

128
Q

What is the presentation of Vesicoureteral Reflux? complications? tx? pathophys? dx?

A

If kid is s will cause renal scarring which is bad.

dx: screening is with US for these kids. If problem persists, gold standard is voiding cystourethrogram

129
Q

Define Colic

A

> 3 hours per day, >3 days per week, for > 3 weeks in healthy infants

130
Q

What do you do with a kid who is having delayed puberty, but also had poor growth as a kid? Dx?

A

Constitutional growth delay.

Normal birth weight kid. between 6 months and 3 years, heigh velocity slows and kid drops on growth curve, but follows it at 5-10th percentile. puberty and adolescent growth spurt are delayed, but occur later. bone radiographs are also abnormal

131
Q

What is the workup for bilious emesis in a neonate with CF

A

x-ray to rule out pneumoperitoneum then water-soluble contrast enema.

microcolon should raise the concern for meconium ileus. giving hyperosmolar enema can break up the inspissated mass, but if this fails, then surgery

132
Q

What are some of the complications of constipation in children? urinary specifically?

A

Risk factors are things like introduction of solid food, toilet training, and school entry.

presentation is : straining with hard stools, crampy abdominal pain, S DUE TO STASIS (presents with suprapubic pain, dysuria, pyuria, and bactiuria)

tx: more dietary fiber, limit cows milk, laxative, suppository

133
Q

What are things characteristic of iron poisoning? What is antidote?

A

Big clue: ON X-RAY THERE WILL BE RADIOOPAQUE OPACITIES.

pregnant mom in the house

30minutes to 4 days
abdominal pain
hematemasis
shock
HIGH ANION GAP METABOLIC ACIDOSIS

Days 2: hepatic necrosis
2-8 weeks: pyloric stenosis

Tx: deferoxamine which makes it excretable in the urine

134
Q

Lead poisoning. Risk factors? presentation? screening and dx? tx?

A

risk factors:

homes built before 1978 with peeling paint
pica
sibling with lead poisoning
low SES
immigrant or international adoptee

Presentation: cognitive and behavioral problems

screening: capillary blood specimen for screening, but high false positive. confirmatory is venous lead level
tx: 75 = Dimercaprol + EDTA

135
Q

How to deal with a caustic ingestion?

A

SECURE AIRWAY

Decontamination
CXR
endoscopy within 24 hours

complications

  • upper airway compromise
  • perf
  • strictures
  • ulcers
  • cancer
136
Q

What is hallmark of TCA toxicity? What is tx?

A

TCA’s have crazy anticholinergic stuff:

CNS: seizures, respiratory depression, mental status changes

Cardiovascular: prolonged PR/QRS/QT intervals, sinus tach, arrythmia, hypotension

Anticholinergic: dry mouth, blurred vision, dilated pupils, urinary retention, flushing, hyperthermia

tx:

IF QRS>100 MSEC, SODIUM BICARBONATE: alleviates anticholingeric inhibitory action on fast sodium channels of heart improving hypotension and decreasing risk of fatal arrythmias.

Supportive therapy, charcoal within 2 hours of ingestion, IV fluids, oxygen

137
Q

Definition of primary amenorrhea? What is the next step?

A

Absence of menarche by age 15. Pelvic Ultrasound.

138
Q

What is conn’s Syndrome? presentation

A

aldosterone-secreting adenoma or bilateral adrenal hyperplasia.

hypokalemia and hypertension

139
Q

What is the most common cause of secondary hypertension in kids? Presentation? Diagnosis

A

fibromuscular dysplasia

HTN, headaches,
PE: soft to-and-fro bruits at the CV angle
R is more often affected than L

Dx: angiography with “string of beads” pattern

140
Q

What are things to consider for secondary enuresis?

A

psychological stress, UTI, DM type 1, Diabetes insipidus, OSA

141
Q

What is the most common cause of nephrotic syndrome in kids? Presentation? Pathology? tx?

A

Minimal Change Disease accounts for 80% of nephrotic syndrome.

Light microscopy looks normal. Electron microscopy shows podocyte effacement.

90% respond to steroid therapy

Presentation: Edema, fatigue, no hematuria
dx: proteinuria, hypoalbuminemia, renal biopsy that is normal

142
Q

Describe the basic pathology of renal tubular acidoses? Major findings to distinguish. Presentation in infancy

A

RTA 1 - Poor hydrogen ion secretion. urine pH is >5.5. K+ low
Cause: genetic disorder, med tox, autoimmune, NEPHROLITHIASIS

RTA 2 - poor bicarb resorption. Urine pH is <5.5 K+ HIGH.
Cause: CAH, obstructive uropathy. COMMON IN KIDS

Presentation: failure to thrive, chronic normal-anion gap acidosis, metabolic acidosis.

tx: oral bicarb replacement

143
Q

Cryptorchidism. When do testicles descend? What is tx? What are complications? Risk factors?

A

Testicle should descend by 6 months, if not, then orchiopexy

complications: inguinal hernia, testicular torsion, subfertility, testicular cancer

Risk factors: preemies, small for gestational age, low birth weight, neural tube and genetic defects, exposure to pesticides and DES

144
Q

Urine Dipstick shows proteinuria in an asymptomatic kid.

A

10% of school age kids have proteinuria. follow-up is to repeat the urine dipstick on 2 occasions.

Transient proteinuria (due to fever, exercise, seizures, stress, or volume depletion is commone) or orthostatic proteinuria (weird, right?)

145
Q

What is the most common cause of sepsis in sickle cell kids?

A

pneumococcus followed much later by salmonella

146
Q

What are the 4 centor criteria for Strep pharyngitis? tx?

A

exudative pharyngitis, fever, tender ANTERIOR cervical lymphadenopathy.

tx? penicillin or amoxicillin which reduces the incidence of rheumatic fever

147
Q

What is the triad presentation of infectious mononucleosis?What should you avoid for how long?

A

tonsillar exudates, fever and POSTERIOR cervical lympathdenopathy, +/- hepatosplenomegaly.

No contact sports 3 weeks

148
Q

What do you treat infectious mono with? What can be a consequence and describe it.

A

Treated with ampicillin or amoxicillin.

Consequence is a polymorphous maculopapular rash. This is NOT a drug rash and these drugs can be safely given in the future.

149
Q

What is the most classic presentation of PDA-dependent congenital heart diseases? What are the 5? What do you treat with?

A

An oxygen saturation of 70-90% that does NOT get better with oxygen + central cyanosis

‘1. coarctation of the aorta

  1. transposition of the great vessels
  2. tricuspid atresia
  3. hypoplastic left heart syndrome
  4. total anomalous pulmonary venous connection

Give prostaglandin E1 to keep it open

150
Q

What is a consideration for a cat bit? What bug is special? how do you treat?

A

watch for pasteurella multicoda cellulitis.

prophylax with amoxicillin/clavulanate

151
Q

What is Potter’s disease? Describe underlying pathophys, development and consequences? How do you see it on prenatal US? Newborn presentation?

A

It is when boys have posterior urethral valves causing urinary tract obstruction.

On prenatal US you will see crazy dilation of bladder, ureters, and kidneys.

Development is anuria/oliguria in utero and oligohydramnios leading to

  • pulmonary hypoplasia
  • flat facies
  • limb deformities
152
Q

Pertussis stages and presentation

What about labs? dx?

tx?

A 
First 2 weeks (catarrhal phase): mild cough and rhinitis
Weeks 2-6 (paroxysmal phase):
 - 20-30 minute paroxysms of coughing
 - inspiratory "whoop"
 - "staccato" cough
 - POSTTUSSIVE EMESIS

labs? lymphocyte-predominant leukocytosis
dx: throat PCR or pertussis culture

Tx: macrolides (azith, eryth, clarith)

153
Q

how to deal with dehydration? Mild and moderate? Acute? Mainenance

A

Mild - no signs or symptoms but decreased intake
Moderate - decreased urine output, tachy, delayed cap refill (2-3 seconds)
Severe - sunken fontanelle, sunken eyes, tachy, minimal to no urine output. Hypotension and shock

Mild - ORS

Moderate-Severe - bolus with isotonic.
Mainenance - give D5

154
Q

Duodenal atresia? Which kids are affected? how does it present?

A

Strongly associated with Down’s Syndrome.

Bilious vomiting in the first 2 days of life and a “double bubble” sign on X-ray

155
Q

What are some of the causes of intussusception? dx? tx?

A

75% have no lead point, but is thought to be a post-viral GI sequelae.

25% are due to Meckel’s followed by polyps and hematomas (from HSP)

dx: US showing target sign
tx: air or contrast enema

156
Q

What is the MAJOR way to tell breast milk jaundice from breastfeeding failure jaundice?

A

Breastfeeding failure jaundice has SIGNS OF DEHYDRATION.

Breastmilk jaundice has kids who are normovolemic.

157
Q

Describe and contrast pathophys of breastmilk vs. breastfeeding jaundice. time? Presentation?

A

Breastfeeding failure jaundice - Presents in 1st week with DEHYDRATION and suboptimal feeding
Breastmilk jaundice - starts day 3-5, PEAKS AT 2 WEEKS with adequate breastfeeding and normal examination

failure - little lactation leads to decreased bilirubin elimination and thus increased enterohepatic circulation.
breastmilk - high levels of beta-glucuronidase in breastmilk will deconjugate bilirubin in the intestine and increase enterohepatic circulation

158
Q

How much should neonates feed?

A

8-12 times per day for >20 minutes on each side

159
Q

What is cyclical vomiting syndrome. Give the criteria.

A

a recurent, predictable pattern of acute and frequent vomiting resolving sponateously. usually resolves in 5-10 years.

criteria:
>3 episodes in a 6 month period
family agrees it is sterotyped
lasts 1-10 days
vomiting at >4 times/hr  at peak
160
Q

What are the GI things associated with Down’s syndrome?

A

Duodenal atresia and hirchsprung disease.

161
Q

Contrast hirchsprung vs. meconium ileus

A

hirchsprung

  • associated with Down’s
  • obstruction at rectosigmoid
  • normal meconium
  • “squirt sign” positive (you put your finger in the rectum and an explosive squirt of gas and fecal matter jet out)

meconium ileus

  • associated with CF
  • obstruction at ileum
  • meconium is inspissated
  • no squirt when finger in rectum
162
Q

Describe epi of Milk or soy induced enterocolitis. clinical features? tx? prognosis?

A

Presents at 2-8 weeks with severe reflux or vomiting and/or painless bloody stools often with ECZEMA. family hx of allergies, eczema, and asthma are present often.

tx: eliminate soy and milk from maternal diet OR initiate hydrolyzed formula

Prognosis - resolved by 1 year

163
Q

Risk factors for Necrotizing Enterocolitis? Classic X-ray findings? Presentation?

A

85% of cases are PREMATURE BABIES. Also caused by reduced mesenteric perfusion due to congenital heart disease or hypotension.

X-ray shows pneumotosis, portal venous gas, pneumoperitoneum

Presentation: vomiting, bloody stool, abdominal distension/tenderness, vital sign instability, lethargy

164
Q

What is the triad of niacin deficiency. What number is niacin

A

Vitamin B3

triad (pellagra)

  • diarrhea
  • dermatitis
  • dementia
165
Q

What are the most common heart defects of Down’s syndrome?

A
  1. Complete atrioventricular Septal Defect (MOST COMMON BY FAR).
  2. VSD
  3. ASD
166
Q

What is the presentation of the most common cardiac defect in Down’s?

A

Complete atrioventricular septal defect leads to significant regurge leading to heart failure at 6 WEEKS.

Auscultation:

  • Loud S2 (due to pulmonary HTN)
  • systolic ejection murmur (loud systolic ejection murmur from increased flow across the pulmonary valve due to the R –> L shunt)
  • holosystolic murmur of VSD may be absent if defect is large
167
Q

What is the best abortive measure for anaphylaxis AND what receptors does it work on?

A

IM epinephrine.

B2 agonist blasts open the lung
A1 agonism vasoconstricts and raises the blood pressure and decreases airways edema

168
Q

Presentation of bronchiolitis? bug? Prevention for whom? Complications?

A

rhinorrhea and cough
wheezing/crackles and respiratory distress

Bug: RSV in kids < 2

169
Q

Respiratory distress syndrome. Pathology? Risk Factors? Findings on X-ray. Tx?

A

Path: immature lungs and surfactant deficiency

risk factors: prematurity and DIABETES (delays maturation of pulmonary surfactant production)

Findings on X-ray:

  • diffuse reticulogranular pattern (“ground-glass opacities”)
  • air bronchograms

tx: antenatal steroids, postnatal exogenous surfactant and respiratory support (CPAP)

170
Q

Hereditary angioedema. Presentation? Pathology? labs?

A

angioedema = rapid-onset edema of face, acral extremities, genitals, trachea and abdominal organs WITHOUT URTICARIA.

hereditary angioedema:

  1. noninflammatory edema of the face, limbs, and GENITALIE
  2. laryngeal edema (life-threatening)
  3. Edema of the intestines leading to colicky pain

Pathology: way too much bradykinin. Genetically acquired by a defect or deficiency of C1 inhibitor leading to elevated leves of C2b and bradykinin

Labs: LOW LEVELS of C4 for all
C1q, normal for hereditary; low for acquired later in life

171
Q

What are criteria for a real acute bacterial rhinosinusitis? common bugs? what is tx?

A
  1. symptoms greater than 10 days
  2. severe symptoms: temp >102, prurulent discharge, face pain
  3. worsening symptoms >5 days after improving

bugs: strep pneumo (30%), h. flu (30%), moraxella catarrhali (10%)
tx: amoxicillin-clavulanate

172
Q

Laryngomalacia. Presentation. pathology. dx. management

A

presents:

  • inspiratory stridor
  • WORSE WHEN SUPINE, BETTER WITH SITTING UP OR PRONE
  • present 4-8 months
  • better by 12-18 months

path: laxity of supraglottic structures
dx: laryngoscopy showing collapse of supraglottic structures with inspiration AND omega shaped epiglottis
management: reassurance, supraglottoplasty for severe symptoms (poor weight gain, apnea, cyanosis, worsening stridor)

173
Q

epiglottitis. bugs? triad of presentation? X-ray findings? tx?

A

bugs: HiB, nontypable HiB, strep, staph

triad:

  • distress (“tripoding” and insp stridor)
  • drooling
  • dysphagia

X-ray fidings:
“Thumbprint sign” (enlarged epiglottitis)
loss of vallecular space

tx: intubation

174
Q

Torticollis. presentation. causes. dx.

A

presentation:
neck swelling, decreased movement and weird positioning

causes: URI, trauma, cervical lymphadenitis, retropharyngeal abscess
dx: x-ray

175
Q

Retropharyngeal abscess. presentation? X-ray findings? epi? spread from where?

A

Presentation:

  • fever (acute onset high)
  • odynophagia
  • drooling
  • neck stiffness
  • MUFFLED VOICE
  • INABILITY TO EXTEND THE NECK
  • trismus (unable to open mouth all the way)

USUALLY UNILATERAL!!!

PE: A mass may be seen in the posterior pharyngeal wall on visual inspection.

X-ray: WIDENED PREVERTEBRAL SPACE. If patient has trouble breathing, a contrast CT should be used.

usually seen in kids 6 months to 6 years
Direct spread from pharyngitis, tonsillitis, otitis media, sinusitis.

176
Q

Rabies. Presentation? hosts?

A

Presentation:

  • HYDROPHOBIA
  • AEROPHOBIA (these two are pathognomonic)
  • pharyngeal spasm, spastic paralysis, agitation

ascending paralytic paralysis

Hosts? Wild carnivores and bats

177
Q

Difference between preseptal and orbital cellulitis. presentation?

A

Both have fever, leukocytosis, eyelid erythema, and swelling.

Red flags that distinguish orbital cellulitis:

  • decreased visual acuity
  • DIPLOPIA
  • opthalmoplegia
  • proptosis

both of these can come from local trauma, or extension from dental stuff or sinusitis.

preseptal can have outpatient abx
orbital requires inpatient

178
Q

Neonatal Sepsis. Characteristics and presentation. Most common bugs. tx?

A

poor PO, irritability, hyper-hypothermia, respiratory distress, vomiting, jaundice. bacterial meningitis may have hypotonia, full or bulging fontanelles, nuchal rigidity, seizures.

tx? AMP AND GENT

Neutrophilia with a significant left shift - bands >700 is sepsis and not infection

Bugs: GBS and E. Coli are most common. Early onset - consider listeria. Late onset in ICU- consider Klebsiella, Enterobacter, Pseudomonas

179
Q

Impetigo. micro, clinical features, tx. Complications

A

micro: staph and Group A strep

Clinical: painful, non-itchy, honey-crusted lesions
Bullae can also occur

tx: topical mupirocin for non-bullous. oral abx for bullous
complications: post-streptococcal glomerulonephritis

180
Q

lymphadenitis. What is it? tx?

A

rapidly enlarging, fluctuant, tender lymph nodes in children are usually caused by staph and strep. ALMOST ALWAYS UNILATERAL (if bilateral, could be a systemic process).

tx? I&D plus CLINDAMYCIN.

181
Q

What is post-exposure prophylaxis for VZV

A

Just give the vaccine. if immunocompromised give immunoglobulin too.

182
Q

Bug that causes nighttime anal pruritis? dx? Tx?

A

enterobius vermicularis (pinworm).

dx: eggs on tape test
tx: albendazole and pyrantel pamoate

183
Q

How do you treat Lyme disease in the children?

A

children 8 - doxycycline which covers against anaplasma

184
Q

Describe presentation of N. Meningitidis.

A

Meningeal signs that progress rapidly and 75% of people present with a PETECHIAL RASH in axilla, wrists, flanks, and ankles.

185
Q

What are jones criteria for rheumatic fever? minor criteria? tx?

A 
J - joints (migratory arthritis0
<3 - pericarditis
N - nodules (subcutaneous)
E - erythema marinatum (an evanescent pink rash with sharp edges)
S - syndeham chorea

minor: fever, arthralgias, elevated ESR/CRP, prolonged PR
tx: pharyngitis with penicillin x 10 days. If rheumatic fever, then benzathine penicillin G until adulthood.

186
Q

Congenital measles triad?

A

PDA, sensorineural hearing loss, cataracts/glaucoma

187
Q

congenital toxo triad?

A

chorioretinitis, hydrocephalus, intracranial calcifications

188
Q

congenital CMV?

A

periventricular calcifications, deafness, purpura, hepatosplenomegaly, jaundice

189
Q

What is the most common cause of osteomyelitis?

A

Staph Aureas

190
Q

Herpangina. Bug? Presentation? epi. tx?

A

Coxsackie A Virus

Presentation:

  • pharyngitis
  • fever
  • GRAY VESICLES ON POSTERIOR PHARYNX

epi
3-10 year olds in the summer/early fall

tx: supportive

191
Q

herpetic gingivostomatitis. Bug? Presentation? Epi? Tx?

A

HSV 1

Presentation:

  • fever
  • pharyngitis
  • CLUSTERS OF VESICLES ON OROPHARYNX/LIPS
192
Q

Strep pharyngitis. Presentation?

A

fever
pharyngitis
TENDER CERVICAL LYMPHADENOPATHY
TONSILLAR EXUDATES

193
Q

What are the most common causes of viral meningitis?

A

90% are caused by non-polio enteroviruses like echovirus and coxsackie viruses.

194
Q

What are criteria for a bacterial septic arthritis? Clinical? Physical? labs?

A

Clinical.

  • acute onset of fever and joint pain
  • fatigue or malaise
  • refusal to bear weight
  • often preceded by a skin or URI

Clinical

  • erythema
  • warmth and swelling
  • pain with ACTIVE AND PASSIVE rom

Labs

  • elevated WBC
  • elevated ESR and CRP
  • synovial WBC>50,000
195
Q

Most common bugs for bacterial arthritis (0-3 months, and >3 months) plus tx

A

birth to 3 months
staph and GBS and gram-neg bacilli
tx: naf or vanc PLUS gent and cefotaxime

> 3 months
staph Group A Strep and Strep Pneumo
tx: naf, clindamycin, cefazolin, or vanco

196
Q

What are x-ray findings of congenital syphilis?

A

metaphyseal dystrophy and periostitis

197
Q

What are some presentations of mumps? Complications?

A

parotitis, orchitis.

complications: aseptic meningitis, encephalitis

198
Q

bacterial meningitis in <1. Presentation. workup. indications for imaging. tx?

A

Presentation

  • fever
  • vomiting
  • decreased PO
  • altered mental status
  • NUCHAL RIGIDITY
  • POSITIVE KERNIG AND BRUDZINSKI
  • BULGING ANT. FONTANELLE

Workup

  • CBC + lytes
  • blood cultures
  • LP and CSF
Imaging considerations?
 - FOCAL NEUROLOGIC FINDINGS
 - hx of hydrocephalus or neurosurgery
 - hx of trauma
Kids <1 have open fontanelles and thus have a really LOW risk of herniation in the absence of these findings

tx?
ceftriaxone (cover strep pneumo and Neisseria meningitides, the big ones) and vanc. (resistant strains of strep pneumo)

199
Q

What is prophylaxis for contacts after a pertussis outbreak? How long do you isolate cases

A

age 1 month - any macrolide

respiratory isolation for first 5 days of abx

200
Q

What are the guidelines for chlamydia and gonorrhea testing?

A

All sexually active women <24 years should be tested.

201
Q

What’s a dangerous complications of eczema? presentation? tx?

A

eczema herpeticum.

Usually on healing atopic dermatitis lesions, after an exposure to HSV, you will find umbilicated vesicles. Often accompanied by fever and adenopathy.

Can be life-threatening. Treat with Acyclovir

202
Q

Measles vs. rubella distinguisher.

Presentation of rubella

A

Measles - Koplik Spots (blue spots on buccal mucosa). HIGHER FEVER. Darker spots than rubella
Rubella - FORSCHEIMER SPOTS (patchy erythema on the soft palate)

Rubella presentation:

  • low-grade fever
  • conjunctivitis, coryza, cervical LAD
  • cephalocaudal spreading of blanching, erythematous maculopapular rash
203
Q

Describe cystic hygroma. What is it?

A

it is a lymphangioma. It is a benign tumor consisting of dilated lymphatic spaces lined by endothelium.

Commonly occur on the neck. Physical exam lobulated, compressible, transilluminate with light.

204
Q

What is seborrheic dermatitis and what is outlook and tx?

A

transparent yellow papules and occasional scaling plaques on eyebrows, nasolabial folds, bases of eyelashes, and paranasal skin. Also on the scalp thus “cradle cap”

tx: moisturizers, topical antifungals, anti-dandruff shampoo, topical steroids

205
Q

Erythema Toxicum neonatorum. Presentation.

A

presentation:
- asymptomatic, scattered erythematous macules, papules, and pustules throughout the body.

Common in full-term infants. can change in appearance. It is eosinophilic.

206
Q

Cholesteotoma. Presentation. tx

A

Presentation:

new-onset hearing loss or EAR DRAINAGE DESPITE ABX THERAPY. GRANULATION TISSUE AND SKIN DEBRIS seen in the retraction pockets of the tympanic membrane on otoscopy.

207
Q

What type of immune rash is it to poison oak? What about anaphylaxis

A

Type IV - cellular immunity. Develops about 24 hours after exposure.

anaphylaxis is Type I - IgE mediated and happens immediately

Peds Shelf (3 decks)

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