Quick Facts Flashcards
What type of seizures are characterized by brief, frequent, ‘jackknifing’ movements in infants, especially in the morning?
Infantile spasms
What does sixth cranial nerve palsy indicate?
Elevated ICP, if normal imaging think pseudotumor cerebri
infant with poor feeding and constipation?
Think botulism
erratic behavior progressing to altered mental status with CSF pleocytosis?
Anti-NMDA encephalitis (teen girls think ovarian teratoma)
newborn with bounding pulses, widened pulse pressure, and pulsatile fontanelle?
Arteriovenous malformation
What is the most accurate imaging study for stroke?
MRI with DWI (if can be done ASAP)
Pt w progressive weakness who had a diarrheal illness a month ago
Guillain-Barré syndrome (triggered by Campylobacter jejuni infection)
Evidence of a CNS infection and focal neurological findings. What imaging study is needed
Head CT with contrast (brain abscess)
What is a warm, tender neck mass in the anterior triangle indicative of?
Infected branchial cleft cyst
febrile child with a hot-potato voice and inability to extend the neck?
Suggestive of retropharyngeal abscess
cyanosis that improves with crying?
Choanal atresia
What is commonly associated with nasal polyps?
Cystic fibrosis
What is the management for nasal septal hematoma?
Needs urgent drainage to prevent ischemia of the septal cartilage
What does nontender unilateral lymphadenopathy with violaceous overlying skin suggest?
Possible nontuberculous mycobacterial infection
What is the most common cause of parotitis in an unvaccinated patient?
Mumps
neonate with fever and swollen parotid gland?
Acute suppurative parotitis due to Staphylococcus aureus
What is the most common source of orbital cellulitis?
Ethmoid sinusitis
tearing, pain, and foreign body sensation in the eye?
Corneal abrasion
What is concerning for delayed passage of a newborn’s first meconium?
CF
stridor in a neonate that resolves after intubation
Laryngeal web
What should be considered for a 2-year-old with sudden-onset wheeze that doesn’t respond to albuterol?
Possible foreign body aspiration
How should rising CO2 levels be managed in a mechanically ventilated patient?
Increase the respiratory rate or tidal volume
high fevers, drooling, and respiratory distress in an unvaccinated child? Management?
epiglottitis
Intubate in the OR ASAP and don’t upset the child
What is the most common etiology and timing of stridor?
Extrathoracic obstruction and inspiratory
What is the most common etiology and timing of wheeze?
Intrathoracic obstruction and expiratory
What is the preferred imaging to evaluate parapneumonic effusion?
Ultrasound
What condition may be indicated by unilateral pleural effusion after thoracic surgery?
Chylothorax
What does a tachypneic patient with normal PaCO2 suggest?
Impending respiratory failure (should have low PA CO2)
What is the most common organism in bacterial tracheitis?
S. aureus
Murmur worsens after standing up?
Hypertrophic cardiomyopathy
What is the most common cause of myocarditis in children?
Coxsackie B
diffuse ST segment elevations?
Pericarditis
What chest x-ray finding is described as a boot-shaped heart?
TOF
What chest x-ray finding resembles an egg-on-a-string?
Transposition of the great arteries
What chest x-ray finding is described as a snowman-shaped mediastinum?
Total anomalous pulmonary venous return
What cardiac defect is associated with Down syndrome?
Endocardial cushion defect (atrioventricular canal defect)
Name a reversible cause of cardiac arrest.
H’s and T’s:
hypovolemia, hypoxia, hydrogen (acidosis), hypoglycemia, hypo-/hyperkalemia, hypothermia
tension pneumothorax, tamponade (cardiac), toxins, thrombosis (pulmonary or coronary)
What occurs in a patient in shock that worsens after a normal saline bolus?
Cardiogenic shock
Which rhythms require an unsynchronized shock?
Ventricular fibrillation and pulseless ventricular tachycardia
What is the first-line medication for supraventricular tachycardia?
Adenosine
Patient has liver disease and low albumin but high total protein
Auto immune hepatitis (high protein due to elevated IGG)
Two month old infant has projectile vomiting and hyperbilirubinemia
Pyloric stenosis (icteropyloric syndrome)
Intussusception in a 10-year-old should prompt an evaluation for
A lead point (lymphoma or meckel’s)
Neonate with Bilious emesis: what imaging is gold standard for diagnosis?
Upper G.I. series (malrotation/volvulus)
What is the test for protein losing enteropathy?
Stool alpha one antitrypsin
Well appearing three month old with bloody stools. What is the treatment?
Hydrolyzed formula or elimination diet for breast-fed mom
Painless, bright red blood per rectum
Meckel’s diverticulum
Neonate with direct hyperbilirubinemia and high ferritin
Neonatal hemochromatosis
Fever, abdominal pain, jaundice
Cholangitis (charcot triad))
Patient with ulcerative colitis presents with pruritis
Primary sclerosing cholangitis
Diarrhea and seizures
Shigella
Signs of toxin, mediated infectious diarrhea
Watery, non-bloody, symptoms come on with an hour not days.
S aureus, B cereus
Urinalysis with blood, but no red blood cells
Rhabdomyolysis
Kidney disease with low C3 and normal C4
Post infectious glomerulonephritis
Kidney disease with low C3 and low C4
Lupus glomerulonephritis
Persistent microscopic hematuria with a family history of stones
Hypercalciuria.
Get a urine calcium to creatinine ratio.
Bilateral hydronephrosis in a male infant
Posterior urethral valves
Which stones are radio opaque
Anything with mineral: calcium oxalate, calcium phosphate, Mag/ammonium/phos (struvite)
What do white blood cell cast and eosinophiliuria indicate?
Acute interstitial nephritis.
Fever, rash, exposure to medication’s
Patient with nephrotic syndrome, develops fever and abdominal tenderness
Spontaneous bacterial peritonitis likely caused by strep pneumonia
Testicular pain relieved by lifting the testicle
Epididymitis
Sexually active female with pleuritic upper quadrant pain
Fitz Hugh Curtis syndrome from gonorrhea
Thrombocytopenia, microangiopathic hemolytic anemia and acute kidney injury
Hemolytic uremic syndrome
Patient on chronic steroids developed hip pain
Osteonecrosis of the femoral head
Radiographic evidence of supracondylar fracture
Anterior sail sign a posterior fat pad
Two year-old with osteomyelitis not improving on vancomycin. What organism should you consider?
Kingella kingae. Give a cephalosporin.
Fever and refusal to bear weight
Septic joint (versus transient synovitis in which they can bear weight)
Joint pain with daily transient fever and rash
JIA, treat with NSAIDs first line
HSP develops worsening abdominal pain
G.I. complications like intussusception or ischemia
Newborn presents with heart block
Neonatal lupus.
Check anti-ro (SS-A) and anti-la (SS-B) antibodies
How long after high dose IVIG should you wait to give live vaccines?
11 months
Most specific marker of SLE flare
Anti-double-stranded DNA
Hypoglycemia, omphalocele, and hemihypertrophy
Beckwith Wideman syndrome
Blood test to confirm congenital adrenal hyperplasia
17 hydroxyprogesterone
Delayed Fontenelle closure
Congenital hypothyroidism
Hyperammonemia with acidosis
Organic acidemias
Hyperammonemia with alkalosis
Urea Cycle disorders
Positive urine reducing substances
Galactosemia
Hypoglycemia without ketones
Hyperinsulinism versus fatty acid oxidation disorder
A patient on long-term prednisone presents with sepsis. What treatment to consider?
Hydrocortisone for adrenal insufficiency
Frenulum injury
Think forced feeding or forced pacifier
Other diagnosis to consider with subdural hematoma
Glutaric aciduria
Other diagnosis to consider with multiple fractures
OI
Fracture is more likely to be from abuse
Posterior rib, scapular, sternal, spinous process, metaphyseal avulsion
Most common physical exam finding in sexual abuse
Normal exam
Beard distribution of hemangiomas is concerning for
Internal or airway hemangioma
Infection associated with recurrent erythema multiforme
HSV
Those common cause of necrotizing fasciitis
Group a strep
Rashes associated with IBD
Erythema nodosum, pyoderma gangrenosum
Skin and mucosal blistering a few weeks after new medication
SJS/TEN
Eczema and absent thymic shadow
SCID
Eczema and thrombocytopenia
Wiskott Aldrich syndrome
Common organism in osteomyelitis in sickle cell patients
Salmonella
Hemolysis after cotrimoxazole
G6PD
Peripheral smear with schistocytes
Intravascular hemolysis
Peripheral smear with spherocyte
Extravascular homolysis or spherocytosis
Peripheral smear with Howell Jolly bodies
Asplenia
Peripheral smear with target cells
Thalassemia
Who’s platelets should be transfused into a baby with neonatal alloimmune thrombocytopenia
Mother’s
G.I. bleed at 2 to 7 days of life
Think classic vitamin K deficiency bleeding
Patient with recent chemotherapy, fever, acute abdomen
Typhlitis
Clotting factors in the common pathway
One, two, five, 10 (think small bills)
Omphalitis, severe leukocytosis
Leukocyte adhesion deficiency
Dextrocardia on chest x-ray. What infections is the patient at risk for?
Encapsulated organisms (heterotaxy syndrome, associated with polysplenia)
Skin infections, deep organ abscesses, inflammatory bowel disease
Chronic granulomatous disease
Fever, rash, lip, swelling, diffuse lymphadenopathy after a medication
DRESS syndrome, check eosinophils
Foods most likely to cause fatal or near fatal allergic reactions
Peanuts, tree nuts, soy, cows milk, fish, shellfish
Toddler with recurrent respiratory tract disease and absent lymph node/tonsils
X linked agammaglobulinemia
Toddler with no response to vaccines with multiple life-threatening infections
SCID
Activated charcoal is not indicated for which ingestions
Alcohol, caustics, heavy metals, lithium, hydrocarbons
Which coin is the most corrosive when swallowed?
Penny because it has zinc in it
Which which type of snake bite always requires anti-venom
Coral snakes because they release neurotoxins
Cherry red lips, headache, headaches, malaise
Carbon monoxide poisoning
Recognize, hemotympanum, cerebral spinal fluid leaking from the nose
Basilar Skull fracture
Facial trauma, can’t look up, decrease sensation over cheek
Orbital blowout fracture
Teenager with episodes of nausea and vomiting, relief by hot baths
Cannibinoid hyper emesis syndrome
Organism associated with puncture wound in the foot
Pseudomonas
Hyperthermia, agitation, clonus, in a patient with depression
Serotonin syndrome
Glycol or methanol overdose
Give fomepizole
Iron over dose
Give deferoxamine
Anticholinergic overdose
Give physostigmine
Cholinergic (organophosphate) overdose
Atropine, pralidoxime
Calcium channel blocker overdose
Give calcium gluconate
Tricyclic antidepressant or salicylate overdosed
Give sodium bicarbonate
Benzodiazepine overdose
Give flumazenil
Electrolyte abnormalities in cystic fibrosis
Hyponatremic hyperchloremic alkalosis
First step in management of hyperkalemia
Give calcium (doesn’t lower potassium, but prevents life-threatening arrhythmias)
Management of refractory, opioid induced constipation
Methyl naltrexone
When feeding a severely malnourished patient at what electrolyte abnormalities are expected
Hypophosphatemia, hypokalemia, hypomagnesmia, and hypocalcemia
Patient with lupus developed psychosis that worsens with treatment
Think steroid induced psychosis
Melanosis coli
Laxative abuse
Patient started on antipsychotics and develops trismus and torticollis. How to treat?
Benztropine or diphenhydramine for acute dystonia
Newborn with severe thrombocytopenia
NAIT (maternal antibodies to newborns platelets containing paternal antigens)
Torch, most likely to cause hearing loss
CMV
Torch with cardiac defects
Rubella
Opisthotonus (neck and trunk arching) and high-pitched cry
Severe Bilirubin encephalopathy
How do you manage respiratory distress in a newborn with congenital diaphragmatic hernia?
Intubate (Do NOT bag, mask, ventilate), place NG for decompression
Contraindications to G-tube replacement
First 4 to 6 weeks post placement, peritonitis
Contraindication to ketamine for sedation
Increased ICP
Contraindication to etomidate for sedation
Septic shock
What’s the difference between a run chart and a control chart?
Control chart has upper and lower control limits
Test with high sensitivity
Patient with disease will have a positive test
Test with high specificity
Healthy patient will have a negative test
The positive or negative predictive value of any test depends on this measurement
Prevalence of the condition in the population being tested
Correlation coefficient interpretation
1=strong positive association.
0=no association.
-1=strong negative association
When to use a T test?
Comparing two groups with continuous variables like an IQ score
When to use a paired T test?
To compare the same patients like before, and after
When to use a Fisher exact test or chi-squared test
Comparing two groups with categorical variables, like insured or uninsured
What is a type I error in hypothesis testing
A false positive, P value = chance of type I error
Type II error in hypothesis testing
False negative, prevented with a power calculation
What percentage of data on a normal curve falls within two standard deviations
95%
68% within one standard deviation
99.7% within three standard deviation
