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1
Q

Refeeding syndrome

A

Hypokalemia
Hypophosphatemia (hallmark)
Hypomagnesemia

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2
Q

Active antirabies vaccine dose, route, days administered

A

0.5ml IM days 0, 3, 7, 14, 28

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3
Q

Passive rabies vaccine

A

HRIG 20 U/kg 1/2 IM, 1/2 infiltrated around the wound
ERIG 40 U/kg (skin test needed)

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4
Q

Rabies Immunization
CAT II
Immunologically naive vs Previously immunized

A

2 sites ID day 0,3,7
Or
1 site IM day 0,3,7 and between 14-28
Or
2 sites IM day 0 and 1 site IM day 7,21
—————
1 site ID day 0,3
Or
4 sites ID day 0
Or
1 site IM day 0,3

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5
Q

Rabies Immunization
CAT III
Immunologically naive vs previously immunized

A

CAT II management plus RIG
to be infiltrated as much as possible to wound area, no need to give remaining via IM
———————
Same as CAT II
No RIG

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6
Q

Tetanus prophylaxis
Clean minor wound
Uncertain or <3 doses

A

Give TDAP or TD
No need for TIG

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7
Q

Tetanus prophylaxis
Clean minor wound
3 or more doses given

A

No need for TDAP OR TD (Except if 10 or more years)
No need for TIG

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8
Q

Tetanus prophylaxis
All other wounds (Dirty etc)
3 or more doses given

A

No need for TDAP or TD (Except if 5 years or more)
No need for TIG

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9
Q

Tetanus prophylaxis
All other wounds (dirty etc)
Uncertain or <3 doses

A

Give TDAP or TD
Give TIG

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10
Q

Iron supplementation

A

LBW 15/0.6 0.3ml PO OD at 2 mos until 6 mos
6-11 mos 30/0.6ml 0.6ml OD x 3 mos
1-5 y/o 30/5ml 5ml OD x 3 mos
Adol 60mg iron/400mcg FA OD

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11
Q

Deworming

A

Albendazole
12 mos to 23 mos 200mg single dose q6 mos
14 mos and up 400mg single dose q6 mos

Mebendazole
12 mos and up 500 ng single dose q6 mos

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12
Q

Ideal body weight computation

A

<6 months - age in months x 600 + BW
>6 months - age in months x 500 + BW
1-6 age in years x 2 + 8

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13
Q

Expected length and height during the 1st yr

A

0-3 mos 9 cm
4-6 mos 8 cm
6-9 mos 5 cm
10-12 mos 3cm

Ave gain during 1st yr 25 cm

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14
Q

Estimated length or height computation

A

Cms - age in years x 5 + 80
Inches - age in years x 2 + 32

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15
Q

Quick sheet in anthropometrics

A

BW doubled at 4 mos
BW tripled at 1 year
1/2 mature height for boys at 2
3 ft tall at 3
2x birth length at 4
3x birth length at 13
Attained 90% adult head size at 2
Approximates adult head size at 6

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16
Q

Abd pain, vomiting, +/- distention
Cant pass NG tube, severe pain, emesis, coffee or omega sign

A

Volvulus

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17
Q

Abd pain, vomiting, +/- distention
Bloody currant jelly stools, sausage shaped RUQ mass on UTZ, absent bowel sounds on RLQ, coiled spring sign

A

Intussusception

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18
Q

Abd pain, vomiting, +/- distention
Post prandial vomiting, nonbilious, down’s syndrome, olive shaped mass, barium studies: shoulder sign, double tract

A

Pyloric stenosis

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19
Q

Abd pain, vomiting, +/- distention
Normal
Hx or recurrent obstructive symptoms
Painless rectal bleeding
Intermittent pain
Technetium 99m pertechnetate Scintigraphy scan to detect gastric tissue

A

Meckel Diverticulum

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20
Q

Meckel Diverticulum Rule of 2

A

2% of population
2x more males than females
2 y/o
2 inches long
2 ft from ileocecal valve
2 types of tissue gastric and pancreatic

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21
Q

Osmotic vs Secretory Diarrhea

A

Osmotic
<200 ml/day
Stops with fasting
<70 meq/l Na
Reducing substances (+)
Stool ph <5

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22
Q

First clinical evidence of HBV infection

A

ALT elevation at 6-7 weeks after exposure

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23
Q

Most valuable single serologic marker of acute HBV infection

A

Anti HBc Ag

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24
Q

Marker of active viral replication, identification of infected people at risk of transmitting HBV

A

HBe Ag

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25
Q

First serologic marker to appear, coincides with the onset of symptoms

A

HBs Ag

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26
Q

Identification if people who have resolved infection, immunity after immunization

A

Anti HBs

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27
Q

Identification of infected people with lower risk of transmitting HBV

A

Anti HBe

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28
Q

Identification of people with acute, resolved, or chronic HBV

A

Anti HBc

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29
Q

Identification of people with acute or recent HBV including HBs Ag neg during window period

A

IgM anti HBc

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30
Q

Nephritic
(HOHA)

A

Hypertension
Oliguria
Hematuria
Azotemia

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31
Q

Nephrotic
(PALE)

A

Proteinuria (nephrotic range)
Albumin low
Lipids high
Edema

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32
Q

Cafe au lait that spares the face, axillary or inguinal freckling, lisch nodules, optic glioma, CT scan or MRI, genetic counseling and early detection of treatable complications

A

Neurofibromatosis
Von Recklinghausen

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33
Q

Multisystemic, siezures, mental retardation, tubers in cerebrum (candle dripping), ash leaf, shagreen patch, CT/MRI of brain, heart, abdomen, 2d echo, renal utz
Seizure control, multidisciplinary approach

A

Tuberous sclerosis

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34
Q

Upper respi obstructive symptoms
Patchy infiltrates and ragged tracheal column

A

Bacterial tracheitis
Tx: clinda/metro + 3rd gen ceph

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35
Q

Upper respi obstructive symptoms
Thumbs sign or leaf sign

A

Acute Epiglottitis
If vaccinated: staph aureus
If unvaccinated: Hib

Tx: 3rd gen cepha + ampisul/clinda

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36
Q

Thrombocytopenia
Infections
Eczema
WASP mutation

A

Wiskott Aldrich Sydrome

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37
Q

Di George Syndrome
TCATCH-22

A

T cell d/o
Cardiac defect (TOF)
Abnormal facies
Thymic aplasia
Cleft palate
Hypocalcemia (seizure)
22q11.2 chromosomal deletion

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38
Q

No antibody production
Lacks of B cells
Bacterial infections and esp enteroviruses
Small to absent tonsils
No palpable lymph nodes

A

XLA or Bruton agammaglobulinemia
Tx Gammaglobulin IM once a month

39
Q

Low igg with normal b cells, later age of onset, normal nodes and tonsils, inc risk of granuloma

A

CVID

40
Q

Low or absent IgA
Respi and GI (giardia) infections
Urogenital tract infections

A

Selective IgA deficiency

41
Q

Failure to produce IGG IGA IGE
Normal or inc IGM
Symptomatic during 1at or 2nd yr of life
Recurrent pyogenic infections
Profoundly neutropenic
P. Jiroveci pneumonia

A

Hyper IgM syndrome

42
Q

Low Ig, lack of anti EBNA and long lived T cell immunity
Inadequate immune response to EBV
Healthy males until they acquire EBV
Fatal infectious mononucleosis, lymphomas, acquired hypogammaglobulinemia

A

X linked lymphoproliferative disease or Duncan disease

43
Q

Low number of T cells and impaired t cell function
CATCH 22
Susceptible to fungi, viruses, P jiroveci

A

Thymic hypoplasia or Digeorge Syndrome

44
Q

Poor response to candida antigen
Chronic and severe candida skin and mucous membrane infections in the 1st month if until 2nd decade of life

A

Chronic mucocutaneous candidiasis

45
Q

Absence of T and B cell
Poor Ab production to polysaccharides
1st mo of life recurrent and persistent diarrhea, penumonia, OM, sepsis, skin infection with opportunistic agents
Unable to reject foreign tissue

A

SCID

46
Q

Coarse facies, coronary artery anuerysm, mortality in adulthood, pathologic fractures
Recurrent bacterial infection (S. Aureus, pneumococcus, H influenzae)
Aspergillus, mucocutaneous candidiasis

A

Hyper IgE syndrome (AD or sporadic or Job syndrome)

47
Q

Decreased chemotaxis, degranulation and bactericidal activity
Impaired NK function
Recurrent pyogenic infection
Bleeding diathesis
Albinism
Peripheral neuropathy
Prolonged BT with normal platelet
Neutropenia, hepatosplenomegaly

A

Chediak Higashi Syndrome

48
Q

Impaired neutrophil adhesion and platelet activation
Dec binding of c3bi to neutrophils
Neutrophilia, lack of pus formation, delayed umbilical cord separation, slow healing, S aureus, e coli, candida, aspergillus

A

Leukocyte adhesion deficiency
AR

49
Q

Failure to activate neutrophil respiratory burst leasing to failure to kill catalase positive microbes
Recurrent pyogenic inf w catalase positive microorg
S aureus, serratia, B cepacia, candida, pneumonia, osteomyelitis, skin inf
Hallmark: granuloma formation and inflammatory process

A

Chronic Granulomatous Disease

50
Q

Classification of DKA

A

Mild
Ph <7.3 hco3 <15
Oriented alert but fatigued
Moderate
<7.2, <10
Kussmaul, oriented but sleepy
Severe
<7.1, <5
Kussmaul or depressed respi, depressed sensorium/coma

51
Q

SIADH

A

Serum Na low
UO N or low
Urine Na high
Intravascular volume N or high
Serum uric acid low
Vasopressin level high

52
Q

CSW

A

Serum Na low
UO high
Urine Na very high
Intravascular volume low
Serum uric acid N or high
Vasopressin low

53
Q

Central DI

A

Serum Na high
UO high
Urine Na low
Intravascular vol low
Serum uric acid high
Vasopressin low

54
Q

Normal linear growth velocity for age
Bone age consistent with chronological
Normal age of onset of puberty

A

Familiar short stature

55
Q

Delayed growth in one parent but average final stature
Normal birth hx and growth for first few mos
Chronologic age is greater than bone age

A

Constitutional short stature

56
Q

Coryza, cough, conjunctivitis
High grade fever
Rashes at peak of fever, cephalocaudal
Koplik spot
4 day before and 4 days after communicability

A

Measles (Rubeola)

57
Q

Low grade fever
Cephalocaudal rash
Posterior auricular LN
Forchheimer spots
7 days before and 7 days after communicability

A

Ribella (German measles)

58
Q

Fever 3-5 days
Fussiness
Seizures
Rash appears when fever abates
Nagayama spots

A

Roseola Infantum
Exanthem Subitum or 6th Disease

59
Q

Fever, malaise 1-2 days before rash
Different stages of rash at time of presentation
Trunk first (like Roseola)
1-2 days before rash to 7 days after rash or til all lesions have crusted

A

Varicella

60
Q

Ulcers in tongue, buccal mucosa
Tender ulcers on hands and feet

A

HFMD
Coxsackie Virus A16

61
Q

Slapped cheek
Spread to trunk
Spares palms and soles
Complication: Aplastic crisis

A

Erythema infectiosum
5th disease

Parvovirus B19

62
Q

Hbs Ag (+)
Hbe Ag (+)
Anti HBS, Anti HBC (-)

A

Incubation period

63
Q

Hbs Ag (+)
Anti Hbs (-)
Igm Anti Hbc (+)
Hbe Ag (+)

A

Acute Infection

64
Q

Anti Hbc IgM (+)
Hbs ag, anti hbs, hbe ag (-)

A

Window period

65
Q

Anti Hbc IgM (+)
Hbs ag, anti hbs, hbe ag (-)

A

Window period

66
Q

Anti hbc igg (+)
Anti hbs (+)
Hbs Ag (-)
Hbe Ag (-)

A

Complete recovery

67
Q

Anti hbc igg (+)
HbsAg (+)
Anti Hbs (-)
Hbe ag (-)

A

Chronic carrier

68
Q

Anti hbc igg (+)
HbsAg (+)
Anti Hbs (-)
Hbe ag (+)

A

Chronic active

69
Q

Anti hbc (-)
HbsAg (-)
Anti Hbs (+)
Hbe ag (-)

A

Vaccinated

70
Q
  1. Handedness
  2. Bedwetting
  3. Ties shoes
  4. Language explosion
  5. Interest in basic sexuality
A
  1. 3 y/o
  2. Upto 4 y/o in girls, upto 5 y/o in boys
  3. 6 y/o
  4. 2 y/o (20-50 words by end of 2nd yr)
  5. 4-5 y/o
71
Q

Management of Sporotrichosis

A

Itraconazole
Amphotericin B for the severely Ill

72
Q

Empiric treatment for Lymphogranuloma Venereum

A

Doxycycline 100 mg orally BID x 21 days

73
Q

Drug of choice of Syphilis

A

Single dose of Benzathine Penicillin G 2.4 M U IM

74
Q

DOC for W. Bancrofti

A

DEC (contraindicated in onchocerciasis) + Doxycycline 200 mg/day 4-6 weeks

75
Q

DOC for Mycobacterium marinum

A

Clarithromycin and Ethambutol + Rifampicin if with deeper organ involvement such as osteomyelitis

76
Q

DOC for Actinomyces

A

High dose IV Penicillin 18-24 million U daily for 2-6 weeks followed by oral Penicillin or Amoxicillin for 6-12 mos.

77
Q

DOC for Nocardiosis

A

TMP-SMZ but if with sulfa allergy, Imipenem, Ceftriaxone, and Linezolid are options

78
Q

DOC for Bacillus anthracis (anthrax)

A

Ciprofloxacin 30mkday q8 (max 400) + Clindamycin 40 mkday q8 (max 900)

79
Q

DOC for Borrelia Burgdorferi

A

Doxycycline 2.2mg/kg BID X 10-14 days (best CNS penetration), Amoxicillin, Cefuroxime

79
Q

DOC for Pasteurella Multocida

A

Co-amoxiclav

80
Q

DOC for Bartonella Henselae

A

Most cases are self-limited
May Give Azithromycin

81
Q

DOC for rickettsia (Rocky Mountain Spotted Fever)

A

Doxycycline

82
Q

PEP for measles

A

Measles IG for prevention and attenuation within 6 days of exposure
Measles active vaccine for susceptible children >1 y/o within 72 hours, if <6 mos, pregnant, and immunocompromised - give IG

83
Q

PEP for Rubella

A

Active vaccine within 72 hours
Use of IG not routinely done except if termination of pregnancy is not an option (0.55ml/kg IM)

84
Q

A chronic progressive infection developing usually on a distal location on the limbs

A

Mycetoma caused by Nocardia

85
Q

PID with liver involvement

A

Fitz-Hugh-Curtis

86
Q

Disseminated Gonococcal Infection characterized by fever, chills, skin lesions, polyarthralgia (wrists and hands), negative synovial culture

A

Tenosynovitis-dermatitis syndrome

87
Q

Delirium with mumbling speech, tachycardia, dry, flushed skin, dilated pupils, myoclonus, slightly elevated temperature,
urinary retention, and decreased bowel sounds. Seizures and dysrhythmias may occur in severe cases

A

Anticholinergic Toxicity

  • Antihistamines, antiparkinsonian medication, atropine, scopolamine, amantadine, antipsychotic agents, antidepressant
    agents, antispasmodic agents, mydriatic agents, skeletal muscle relaxants, and many plants (notably jimsonweed and
    Amanita muscaria).
88
Q

Delusions, paranoia, tachycardia (or bradycardia if the drug is a pure α-adrenergic agonist), hypertension, hyperpyrexia,
diaphoresis, piloerection, mydriasis, and hyperreflexia. Seizures, hypotension, and dysrhythmias may occur in severe cases.

A

Sympathomimetic Toxicity

  • Cocaine, amphetamine, methamphetamine (and its derivatives 3,4-methylenedioxyamphetamine, 3,4-methylenedioxymethamphetamine,
    3,4-methylenedioxyethamphetamine, and 2,5-dimethoxy-4-bromoamphetamine), some synthetic marijuana,
    and OTC decongestants (phenylpropanolamine, ephedrine, and pseudoephedrine). In caffeine and theophylline
    overdoses, similar findings, except for the organic psychiatric signs, result from catecholamine release.
89
Q

Coma, respiratory depression, miosis, hypotension, bradycardia, hypothermia, pulmonary edema, decreased bowel sounds,
hyporeflexia, and needle marks. Seizures may occur after overdoses of some narcotics, notably propoxyphene.

A

Opiate, Sedative, Ethanol Intoxication

  • Narcotics, barbiturates, benzodiazepines, ethchlorvynol, glutethimide, methyprylon, methaqualone, meprobamate, ethanol,
    clonidine, and guanabenz.
90
Q
A
91
Q

Confusion, central nervous system depression, weakness, salivation, lacrimation, urinary and fecal incontinence,
gastrointestinal cramping, emesis, diaphoresis, muscle fasciculations, pulmonary edema, miosis, bradycardia or
tachycardia, and seizures.

A

Cholinergic Toxicity

  • Organophosphate and carbamate insecticides, physostigmine, edrophonium, and some mushrooms.
92
Q

Normal size and weight at birth
Apnea, cyanosis, severe hypoglycemia, with or without seizures
Round and the face is short, broad, prominent frontal bone, depressed nose bridge and saddle shaped, nose is small, mandible and chin underdeveloped, teeth late eruption, high pitched voice, small genitals, delayed puberty

A

Congenital hypopituitarism

AAA Pedia Cram Notes (1 decks)

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