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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
What are features of Horner Syndrome?
Miosis Anhydrosis Ptosis * small ptosis compared to CN III palsy - Related to compression of the sympathetic chan
26
Which babies requiring screening for ROP?
- Any baby under 31 weeks OR less than 1250 g
27
When does screening start?
For infants less than 27 weeks GA- at 31 weeks | For infants > or equal to 27 weeks then at 4 weeks of age
28
What are risk factors for developing eye disease with JIA?
``` - Remember this is a chronic disease* and initially will be asymptomatic Young age Female gender Pauciarticular (oligoarthritis) ANA postive RF negative ```
29
What are risk factors for developing acute anterior uveitis? What are clinical features of this?
- Typically greater than 12 years old HLA-B-27 positive Spondyloarthropathy Ciliary flush with progressive severe pain and photophobia
30
What pathogens typically colonize children with CF based on age?
Baby: Staph aureus Toddler: H flu Child: pseudomonas, stenotropomonas Teen: Burkholderia cephacia
31
What are features of Kartagener Syndrome?
situs inversus, pansinusitis and bronchiectasis +PCD
32
What are features of PCD?
``` Neonatal respiratory distress in a term baby Chronic nasal congestion Chronic wet cough Recurrent otitis media Laterality defects* ```
33
What are the asthma control criteria?
``` 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 ```
34
How long after IVIG can live vaccines be given?
11 months
35
What is the most sensitive test for lupus?
ANA- rarely see normal ANA in lupus
36
What is the most specific test for lupus?
Anti dsDNA | Anti Smith
37
What is the risk for coronary artery aneurysm in untreated KD?
25%
38
How long should ASA be continued in KD?
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
39
In which rheumatologic condition does NOT present with asymptomatic uveitis?
Enthesitis associated JIA
40
What is the most common variant of JIA?
Oligoarthritis | Less than or equal to four joints in the first 6 months
41
What is the average age for first sexual intercourse in Canada?
16.5 years
42
What are absolute contraindications to OCP use?
Migraine with aura* association with cerebrovascular events Severe liver disease (cirrhosis) History of DVT Unexplained vaginal bleeding
43
At what age do children differentiate between genders?
Between 2-3 years
44
At what age is gender identity usually stable?
By 4-5 years but may change when child becomes older
45
At what age is expression of gender reduced?
By 6-7 years
46
What is the treatment for chlamydia?
Azithromycin 1 g PO x once | - Can also do doxycycline or erythromycin
47
If a patient is positive for gonorrhea, what should you also treat for? What do you treat with?
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
For an infant born to a untreated mother who is positive for gonorrhea and has a vaginal delivery, what should be done?
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
For an infant born to a untreated mother who is positive for chlamydia and has a vaginal delivery, what should be done?
- 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
What are indications to hospitalize a patient with PID?
``` Failure of outpatient oral therapy Concern regarding adherence Tubo-ovarian abscess Pregnancy High fever or systemically unwell ```
51
14 year old presents with new genital lesions. Other than HSV, list 4 other etiologies:
Syphilis (chancre) Chanchroid Behcet's disease EBV/CMV related
52
What is Behcet's Disease?
Triad of aphthous ulcers, genital lesions, and recurrent eye inflammation (anterior or posterior uveitis)
53
What is defined as high risk for the development of a food allergy?
Personal history of atopy | Having a first degree relative with an allergic condition
54
What is the cross reactivity between penicillin and cephalosporins?
2%
55
When should you suspect an underlying primary immunodeficiency?
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
What are skin lesions that might mimic a bruise?
slate-grey nevi, hemangiomas, skin staining from dyes or other skin discolourations
57
What are child factors that may increase the risk for abuse?
``` Prematurity Low birth weight Physical/developmental disabilities Behavioural concerns Intrauterine drug exposure ```
58
What are social factors that make increase the risk for abuse?
* Social isolation * Poverty * Lower levels of education * Large family
59
What are environmental factors that make increase the risk for abuse?
* Substance use * Mental illness * Interpersonal violence * single/teen parent * Unrelated adult in the home
60
What two conditions are associated with anterior lenticonus?
Alports | Ehlers Danlos
61
What two conditions are associated with ectopia lentis?
Marfan's | Homocystinuria
62
What are contraindications to air enema for intussception?
Pneumoperitoneum Peritonitis Persistent hypotension
63
What is the most common type of TEF?
Type C with EA with distal tracheoesophageal fistula (84%)
64
What is the most common indication for tympanostomy tubes?
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
What are the most common complications of AOM?
Mastoiditis TM perforation Cholesteatoma
66
What are risk factors for the development of AOM?
Inuit or First nations, smoking, crowded home, craniofacial abnormalities, pacifier use, short breast feeding duration, bottle while lying down, family history
67
What are risk factors for SNHL?
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
What is the most common non-genetic cause of hearing loss?
CMV
69
What are contraindications to flying?
Uncontrolled HTN Eisenmenger's syndrome Uncontrolled SVT
70
What features on history would be red flags for further evaluation prior to starting a stimulant?
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
What are primary causes of Fanconi Syndrome?
Cystinosis, galactosemia, tyrosinemia, hereditary fructose intolerance, Wilson disease, mitochondrial disease
72
What are causes for false positive sweat chloride test?
Eczema, malnutrition, CAH, adrenal insufficiency, hypothyroidism, anorexia nervosa, G6PD (long list) Hypogamaglobulinemia
73
What are causes for false negative sweat chloride test?
Dilution, insufficient sweat, malnutrition, edema, hyponatremia, CFTR mutation with preserved sweat gland function
74
What is Lemierre's syndrome?
Oropharyngeal infection leading to secondary septic thrombophlebitis of the internal jugular vein - Fusibacterium often a cause
75
What is a complication of mastoiditis?
Meningitis, brain abscess Periostitis Facial nerve palsy
76
What is the most common comorbidity with ADHD?
Intellectual disability | More severe and less likely to remit
77
What genetic syndromes are associated with ASD?
Rett, NF1, TS, Down Syndrome, Angelman, Fragile X
78
What are comorbidities with ADHD?
Anxiety, DCD, OCD, mood disorders
79
In which populations is ADHD particularly difficult to treat?
More treatment resistant in ASD kids and kids with intellectual disability
80
How is the diagnosis of ADHD made?
Need 6/9 inattentive criteria | Need 6/9 hyperactive criteria
81
What are other diagnoses that are misdiagnosed as ADHD?
``` Learning Disorder Intellectual Disability Sleep Disorder Anxiety Disorder ODD ```
82
What features help differentiate tantrums in a child with ASD vs a neurotypical child?
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
What are 4 features of dyslexia?
1. Normal intelligence and cognition in other domains 2. Difficulty with comprehension of written word 3. Difficulty reading aloud 4. Appropriate verbal comprehension
84
How do you manage ODD?
First step is parent behavioural training and if that fails then you could consider pharmacologic management
85
What are causes of CENTRAL delay puberty?
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
What are causes of CENTRAL precocious puberty?
Idiopathic, tumour, congenital anomaly, infection/post infectious (meningitis/encephalitis), radiation, ischemia
87
What are causes of PERIPHERAL precocious puberty?
Gonadal steroid: Mc Cune Albright, familial precocious puberty, primary hypothyroidism, exogenous steroids Adrenal steroid: CAH, 11 hydroxylase, adrenal tumour, exogenous tumour
88
What are risk factors for cerebral edema?
``` Young age (<2 at dx) Severe acidosis New onset (first DKA) Extracellular water depletion ```
89
How should thyroid medication be given?
Congenital Hypothryoidism - Crushed in small amount of liquid - Do not give with iron, calcium, or soy formula Dose adjust q1-2 months
90
What labs would you order for Hashimoto's thyroiditis?
Hyper to hypothyroidism - Will see elevated TSH Anti TPO and anti-thyroglobulin - Treat with levothyroxine
91
What labs would you order for Grave's disease?
HYPERthyroidism - low TSH, high T4 Thyrotropin receptor inhibitor immunglobulin (TRAbs) Thyroid stimulating immunoglobulin - Treat with methimazole; radioactive iodine
92
When is a subtotal or total thyroidectomy indicated?
Large thyroid gland Failed medical management, low RAI uptake Severe eye disease
93
``` What are the GOLD standard tests for the following conditions? Adrenal suppression Pheochromocytoma DI Cushing's Syndrome Precocious puberty ```
Adrenal suppression: ACTH Stim Pheochromocytoma: 24 hr urine catecholamines DI: water deprivation test Cushing's Syndrome: dexamethasone supression test Precocious puberty: GnRH stimulation
94
What should be done for all children being evaluated for GDD/ID?
Audiology Visual Testing (Ophtho or Optometry) Thorough hx and pe! If suspecting seizures- then EEG
95
What are TIER 1 investigations for ID and GDD?
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
What is the single test with the highest yield for GDD/ID work up?
Microarray
97
When would head imaging be indicated?
Abnormal neuro exam Micro/macrocephaly Seizures

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