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Quick Review RC Flashcards

1
Q

What are features of Cholinergic toxidrome

A

DUMBELLS

Diaphoresis
Urination
Miosis
Bradycardia/bronchorrhea
Emesis
Lacrimation 
Lethargy
Salivation

Antidote: supportive care (do not use succhinylcholine), clean skin, atrophine q5 min, inhaled Atrovent

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2
Q

List three example of cholinergic drugs

A

Organophosphates
Carbamates
Alzeheimer’s Meds (donepezil)

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3
Q

What are features of anti-cholinergic toxidrome

A 
Mad as a hatter
Dry as a bone
Red as a beet
Blind as a bat
Hot as a desert
  • confused, dry mouth, urinary retention, hyperthermia, flushed skin, mydriasis

Antidote: Benzo, sodium bicarbonate if prolonged QRS (seen with TCAs) supportive care, cooling,
May consider physostigamine or activated charcoal

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4
Q

What are features of sympathetic toxidrome

A 
Mydriasis
Diaphoresis
Tachycardia
Hypertension 
Agitation 
Hypertheria
Seizures 
Psychosis

Symptomatic management- will often use benzodiazepines to treat both hypertension and agitation

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5
Q

How can you differentiate anticholinergic vs sympathomimetic toxidromes?

A

Like antiperspirants, anti-cholinergics KEEP YOU DRY!

Diaphoresis* with sympathomimetics is a differentiating feature!

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6
Q

What are symptoms of LSD ingestion?

A 
Mydriasis
Hypertension
Tachycardia 
Diaphoresis
Hyperreflexia*
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7
Q

What are features of opioid toxidrome?

A 
Bradycardia 
Hypotension 
Respiratory Distress
Miosis
Coma
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8
Q

What are features of NMS? What are features of serotonin syndrome? How do you differentiate between the two syndromes?

A

NMS- associated more commonly with typical antipsychotics; related to blockade of dopamine
Features: fever, agitation, lead pipe rigidity, mental status changes

Serotonin Syndrome: related to elevated levels of serotonin; typically occurs with antidepressants

Features: fever, autonomic instability, rigidity, mental status changes
Hyperreflexia and myoclonus* differentiating features
Usually shorted onset* associated with medication changes

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9
Q

When is defibrillation indicated? What is the dose?

A

Indicated for pulseless VF and V Tach

Starting dose: 2 J/kg–> next to 4 J/kg –> max dose of 10 J/kg (adult dose)

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10
Q

What is the dose of epinephrine in PALS Cardiac Arrest Algorithm?

A
  1. 01 mg/kg at concentration of 1/10 000 IV or IO

- Translates to 0.1 mL/kg (but never order it this way)

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11
Q

What is the dose of epinephrine in PALS for Anaphylaxis?

A
  1. 01 mg/kg at concentration of 1/1000 IM ONLY!

- Translates to 0.01 mL/kg

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12
Q

What genetic syndromes are associated with ASD?

A 
Tuberous Sclerosis 
Down Syndrome
NF1
Rett Syndrome
Angelman Syndrome
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13
Q

What genetic syndromes are associated with increased risk of leukemia?

A 
Trisomy 21
Li Fraumeni
NF-1 (JMML, AML)
Constitutional mismatch repair-deficiency syndrome
Noonan (JMML)
Fanconi anemia
Diamond-Blackfan anemia (AML)
Shwachman-Diamond syndrome (AML)
Bloom syndrome
Ataxia telangiectasia
Wiskott-Aldrich syndrome
X-linked agammaglobulinemia (Bruton disease)
Severe combined immunodeficiency (SCID)
Congenital or cyclic neutropenia
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14
Q

What genetic syndromes are predisposed to the development of brain tumours?

A

NF1, NF2, Gorlin Syndrome, Li Fraumeni, Turcot Syndrome, Gardner Syndrome, Von Hippel Lindau

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15
Q

What is Denys Drash Syndrome?

A

AD condition

Triad: diffuse mesangial sclerosis, male pseudohermaphroditism & Wilm’s tumour

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16
Q

What are some genetic syndromes associated with Wilm’s tumours?

A

Beckwith- Weidman
Denys Drash
Li Fraumeni
WAGR

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17
Q

What are examples of alkylating agents? What are common side effects?

A

Examples: cyclophosphamide, Ifosfamide, Melphalan, Busulfan, Dacarbazine, Temolozamide

Side effects: hemorrhagic cystitis, gonadal toxicity, myelosupression, nausea and vomiting

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18
Q

What are examples of heavy metal alkylating agents? What are common side effects?

A

Examples of Alkylating Agents (Heavy metals) - cisplatin and carboplatin

Side effects: 
Highly emetogenic - Common to have delayed N&V
* Ototoxicity
* Nephrotoxicity
* Peripheral neuropathy
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19
Q

What are examples of plant alkaloids? What are some side effects?

A

Examples: vincristine, vinblastine, etoposide, topotectan, paclitaxel

Acute side effects: neurotoxicity (acute), vocal cords, foot drop or paresis, constipation, jaw drop

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20
Q

What are examples of anthracyclins? What are some side effects?

A

Examples: Anthracyclins - Doxorubicin, Daunorubicin, Mitoxantrone, Idarubicin, Epirubicin

Major acute: myelosuppression, mucositits, N/V
Late effects: cardiac* permanent cardiomyopathy - need to monitor with serial echos

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21
Q

What is an important side effect associated with bleomycin?

A

Pulmonary fibrosis

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22
Q

What are side effects of methotrexate?

A

Acute: mucositis, hepatic toxicity, nephrotoxicity and neurotoxicity with high doses, myelosuppression

Late: renal toxicity, hepatic toxicity, reduced BMD

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23
Q

What is an important side effect of asparginase?

A

Anaphylaxis!

  • Can also cause coagulopathy, hyperglycemia, hepatotoxicity, acute pancreatitis, and cerebral toxicity
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24
Q

What is the classic triad for Wiskott Aldrich Syndrome?

A

Immune deficiency
Thrombocytopenia
Eczema (severe)

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25
Q

What are features of Horner Syndrome?

A

Miosis
Anhydrosis
Ptosis * small ptosis compared to CN III palsy
- Related to compression of the sympathetic chan

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26
Q

Which babies requiring screening for ROP?

A
  • Any baby under 31 weeks OR less than 1250 g
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27
Q

When does screening start?

A

For infants less than 27 weeks GA- at 31 weeks

For infants > or equal to 27 weeks then at 4 weeks of age

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28
Q

What are risk factors for developing eye disease with JIA?

A 
- Remember this is a chronic disease* and initially will be asymptomatic 
Young age
Female gender
Pauciarticular (oligoarthritis)
ANA postive 
RF negative
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29
Q

What are risk factors for developing acute anterior uveitis? What are clinical features of this?

A
  • Typically greater than 12 years old
    HLA-B-27 positive
    Spondyloarthropathy

Ciliary flush with progressive severe pain and photophobia

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30
Q

What pathogens typically colonize children with CF based on age?

A

Baby: Staph aureus
Toddler: H flu
Child: pseudomonas, stenotropomonas
Teen: Burkholderia cephacia

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31
Q

What are features of Kartagener Syndrome?

A

situs inversus, pansinusitis and bronchiectasis +PCD

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32
Q

What are features of PCD?

A 
Neonatal respiratory distress in a term baby
Chronic nasal congestion
Chronic wet cough
Recurrent otitis media
Laterality defects*
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33
Q

What are the asthma control criteria?

A 
Daytime symptoms <4 days per week
Night time symptoms <1 day per week
Normal physical activity
No absence from school
B agonist < 4 doses/week
FEV1 or PEF >90% personal best
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34
Q

How long after IVIG can live vaccines be given?

A

11 months

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35
Q

What is the most sensitive test for lupus?

A

ANA- rarely see normal ANA in lupus

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36
Q

What is the most specific test for lupus?

A

Anti dsDNA

Anti Smith

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37
Q

What is the risk for coronary artery aneurysm in untreated KD?

A

25%

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38
Q

How long should ASA be continued in KD?

A

Should be continued until 6-8 weeks post diagnosis at 3-5 mg/kg/day until last ECHO is normal
- Likely would be continued on an anti-platelet agent more permanent if concern for permanent damage

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39
Q

In which rheumatologic condition does NOT present with asymptomatic uveitis?

A

Enthesitis associated JIA

40
Q

What is the most common variant of JIA?

A

Oligoarthritis

Less than or equal to four joints in the first 6 months

41
Q

What is the average age for first sexual intercourse in Canada?

A

16.5 years

42
Q

What are absolute contraindications to OCP use?

A

Migraine with aura* association with cerebrovascular events
Severe liver disease (cirrhosis)
History of DVT
Unexplained vaginal bleeding

43
Q

At what age do children differentiate between genders?

A

Between 2-3 years

44
Q

At what age is gender identity usually stable?

A

By 4-5 years but may change when child becomes older

45
Q

At what age is expression of gender reduced?

A

By 6-7 years

46
Q

What is the treatment for chlamydia?

A

Azithromycin 1 g PO x once

- Can also do doxycycline or erythromycin

47
Q

If a patient is positive for gonorrhea, what should you also treat for? What do you treat with?

A

MUST TREAT FOR CHLAMYDIA TOO!
If positive:
- Cefriaxone 250 mg IM x 1 and Azithromycin 1 g PO x1
- Cefixime 800 mg PO x1 and Azithromycin 1 g PO x1

48
Q

For an infant born to a untreated mother who is positive for gonorrhea and has a vaginal delivery, what should be done?

A

Given dose of Ceftriaxone 50 mg/kg (up to 125 mg) x1 along with conjunctival cultures
- If unwell- then full septic w/u including LP

49
Q

For an infant born to a untreated mother who is positive for chlamydia and has a vaginal delivery, what should be done?

A
  • Nothing but should continued to be monitored
  • We don’t give empiric treatment due to risk of pyloric stenosis with oral erythromycin
  • If the child is symptomatic, then:
  • Erythromycin 50 mg/kg TID x14 days
  • Azithromycin 20 mg/kg x3 days
50
Q

What are indications to hospitalize a patient with PID?

A 
Failure of outpatient oral therapy
Concern regarding adherence
Tubo-ovarian abscess
Pregnancy
High fever or systemically unwell
51
Q

14 year old presents with new genital lesions. Other than HSV, list 4 other etiologies:

A

Syphilis (chancre)
Chanchroid
Behcet’s disease
EBV/CMV related

52
Q

What is Behcet’s Disease?

A

Triad of aphthous ulcers, genital lesions, and recurrent eye inflammation (anterior or posterior uveitis)

53
Q

What is defined as high risk for the development of a food allergy?

A

Personal history of atopy

Having a first degree relative with an allergic condition

54
Q

What is the cross reactivity between penicillin and cephalosporins?

A

2%

55
Q

When should you suspect an underlying primary immunodeficiency?

A

Indications to investigate for immunodeficiency (2 of the following 10)

  1. 4 or more cases of acute otitis media per year
  2. 2 or more pneumonias a year
  3. 2 or more sinus infections within 1 year
  4. 2 or more months of antibiotics with no improvement
  5. 2 or more deep seated infections - meningitis, pneumonia, sepsis
  6. Candidiasis infection not clearing in 2 months – difficult to treat thrush or diaper rash
  7. IV abx when should be okay with PO
  8. Recurrent deep skin or organ abscesses
  9. Failure to thrive
  10. Family history of primary immunodeficiency
56
Q

What are skin lesions that might mimic a bruise?

A

slate-grey nevi, hemangiomas, skin staining from dyes or other skin discolourations

57
Q

What are child factors that may increase the risk for abuse?

A 
Prematurity
Low birth weight
Physical/developmental disabilities
Behavioural concerns 
Intrauterine drug exposure
58
Q

What are social factors that make increase the risk for abuse?

A
  • Social isolation
  • Poverty
  • Lower levels of education
  • Large family
59
Q

What are environmental factors that make increase the risk for abuse?

A
  • Substance use
  • Mental illness
  • Interpersonal violence
  • single/teen parent
  • Unrelated adult in the home
60
Q

What two conditions are associated with anterior lenticonus?

A

Alports

Ehlers Danlos

61
Q

What two conditions are associated with ectopia lentis?

A

Marfan’s

Homocystinuria

62
Q

What are contraindications to air enema for intussception?

A

Pneumoperitoneum
Peritonitis
Persistent hypotension

63
Q

What is the most common type of TEF?

A

Type C with EA with distal tracheoesophageal fistula (84%)

64
Q

What is the most common indication for tympanostomy tubes?

A

Bilateral otitis media with effusion with chronic hearing loss
- Other indications: recurrent AOM with effusions, unilateral/bilateral OME with other problems (school performance, vestibular, discomfort)

65
Q

What are the most common complications of AOM?

A

Mastoiditis
TM perforation
Cholesteatoma

66
Q

What are risk factors for the development of AOM?

A

Inuit or First nations, smoking, crowded home, craniofacial abnormalities, pacifier use, short breast feeding duration, bottle while lying down, family history

67
Q

What are risk factors for SNHL?

A

TORCH infection, prolonged NICU stay (ECMO, exchange transfusion), hyperbilirubinemia (needing exchange), family hx, craniofacial abnormality, oxtoxic medications, PE consistent with underlying genetic syndrome associated with hearing loss

68
Q

What is the most common non-genetic cause of hearing loss?

A

CMV

69
Q

What are contraindications to flying?

A

Uncontrolled HTN
Eisenmenger’s syndrome
Uncontrolled SVT

70
Q

What features on history would be red flags for further evaluation prior to starting a stimulant?

A

Symptoms of exercise intolerance, syncope or palpitations, positive family history of arrhythmia or death <35 years or abnormality on physical exam
If known CHD (unrepaired) or arrhythmia, then discuss with Cardiology first

71
Q

What are primary causes of Fanconi Syndrome?

A

Cystinosis, galactosemia, tyrosinemia, hereditary fructose intolerance, Wilson disease, mitochondrial disease

72
Q

What are causes for false positive sweat chloride test?

A

Eczema, malnutrition, CAH, adrenal insufficiency, hypothyroidism, anorexia nervosa, G6PD (long list)
Hypogamaglobulinemia

73
Q

What are causes for false negative sweat chloride test?

A

Dilution, insufficient sweat, malnutrition, edema, hyponatremia, CFTR mutation with preserved sweat gland function

74
Q

What is Lemierre’s syndrome?

A

Oropharyngeal infection leading to secondary septic thrombophlebitis of the internal jugular vein
- Fusibacterium often a cause

75
Q

What is a complication of mastoiditis?

A

Meningitis, brain abscess
Periostitis
Facial nerve palsy

76
Q

What is the most common comorbidity with ADHD?

A

Intellectual disability

More severe and less likely to remit

77
Q

What genetic syndromes are associated with ASD?

A

Rett, NF1, TS, Down Syndrome, Angelman, Fragile X

78
Q

What are comorbidities with ADHD?

A

Anxiety, DCD, OCD, mood disorders

79
Q

In which populations is ADHD particularly difficult to treat?

A

More treatment resistant in ASD kids and kids with intellectual disability

80
Q

How is the diagnosis of ADHD made?

A

Need 6/9 inattentive criteria

Need 6/9 hyperactive criteria

81
Q

What are other diagnoses that are misdiagnosed as ADHD?

A 
Learning Disorder
Intellectual Disability
Sleep Disorder
Anxiety Disorder
ODD
82
Q

What features help differentiate tantrums in a child with ASD vs a neurotypical child?

A
  1. Goal oriented - goal oriented for neurotypical kids vs often related to being overwhelmed in ASD kids
  2. Tantrums need an audience- do not need an audience in an ASD kid!
  3. Not limited to young children
  4. Proceeded by signs of distress
83
Q

What are 4 features of dyslexia?

A
  1. Normal intelligence and cognition in other domains
  2. Difficulty with comprehension of written word
  3. Difficulty reading aloud
  4. Appropriate verbal comprehension
84
Q

How do you manage ODD?

A

First step is parent behavioural training and if that fails then you could consider pharmacologic management

85
Q

What are causes of CENTRAL delay puberty?

A

Hypogonadotropic hypogonadism (low LH, low FSH): Kallman syndrome, idiopathic, septoptic dysplasia, isolated gonadotropin deficiency, Prader Willi, functional deficiency- AN, chronic illness, CNS tumour, CNS rads, LCH, hypothyrodism

Hypergonadotropic hypogondism:
Congenital- Turners (girls), Klinfelters (boys), Noonans, LH/FSh reisstance, radiation, chemo, infection (mumps), infarction, primary ovarian failure

86
Q

What are causes of CENTRAL precocious puberty?

A

Idiopathic, tumour, congenital anomaly, infection/post infectious (meningitis/encephalitis), radiation, ischemia

87
Q

What are causes of PERIPHERAL precocious puberty?

A

Gonadal steroid: Mc Cune Albright, familial precocious puberty, primary hypothyroidism, exogenous steroids
Adrenal steroid: CAH, 11 hydroxylase, adrenal tumour, exogenous tumour

88
Q

What are risk factors for cerebral edema?

A 
Young age (<2 at dx)
Severe acidosis
New onset (first DKA)
Extracellular water depletion
89
Q

How should thyroid medication be given?

A

Congenital Hypothryoidism
- Crushed in small amount of liquid
- Do not give with iron, calcium, or soy formula
Dose adjust q1-2 months

90
Q

What labs would you order for Hashimoto’s thyroiditis?

A

Hyper to hypothyroidism
- Will see elevated TSH
Anti TPO and anti-thyroglobulin
- Treat with levothyroxine

91
Q

What labs would you order for Grave’s disease?

A

HYPERthyroidism - low TSH, high T4
Thyrotropin receptor inhibitor immunglobulin (TRAbs)
Thyroid stimulating immunoglobulin
- Treat with methimazole; radioactive iodine

92
Q

When is a subtotal or total thyroidectomy indicated?

A

Large thyroid gland
Failed medical management, low RAI uptake
Severe eye disease

93
Q 
What are the GOLD standard tests for the following conditions?
Adrenal suppression
Pheochromocytoma
DI
Cushing's Syndrome
Precocious puberty
A

Adrenal suppression: ACTH Stim
Pheochromocytoma: 24 hr urine catecholamines
DI: water deprivation test
Cushing’s Syndrome: dexamethasone supression test
Precocious puberty: GnRH stimulation

94
Q

What should be done for all children being evaluated for GDD/ID?

A

Audiology
Visual Testing (Ophtho or Optometry)
Thorough hx and pe!
If suspecting seizures- then EEG

95
Q

What are TIER 1 investigations for ID and GDD?

A

CBC, Glucose, Cr, urea, lytes, ALT, AST
TSH, CK, ammonia, lactate. AA, acyclcarnitine profile, homocysteine, ferritin, B12, lead level
Urine organic acids

Also- Fragile X and microarray

96
Q

What is the single test with the highest yield for GDD/ID work up?

A

Microarray

97
Q

When would head imaging be indicated?

A

Abnormal neuro exam
Micro/macrocephaly
Seizures

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