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PEDS UWORLD > Random problems > Flashcards

Random problems Flashcards

1
Q

Crying that occurs in otherwise healthy infant for >3 hrs daily (usually evening), >3 times a wk and for a duration of >3 wks

A

Colic

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2
Q

Colic rx

A

calming techniques

feeding patterns checked

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3
Q

Gynecomastia in pubertal boys causes

A

transient increased testicular production of estrogen over testosterone and peripheral conversion of prohormones to estrogen

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4
Q 
kid with Fever> 5 days,
conjunctivitis
oral muosal changes
rash
cervical LAD
A

Kawasaki Disease
acute vasculitis of small/medium arteries
Peak age: 18-24 months

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5
Q

Do Dx kawasaki what do you need?

A

Should have fever >5 days and 4/5 findings:
Conjunctivits: bilat, nonexudative, spares limbus
Oral mucosal changes: erythema, fissured lips, “Strawberry tongue”
Rash
Extremity: erythema, edema
desquamtion of hand/ft, (usually last manifestation)
Cervical LAD: >1.5cm

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6
Q

Supporting lab values for Kawasaki Disease

A

Increased CRP/ ESR
leukocytosis w/ neutrophilia
Reactive thombocytosis
Sterile pyuria on urinalysis

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7
Q

Complications of Kawasaki disease

A

Coronary artery Aneurysms

MI or ischemia

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8
Q

Rx of Kawasaki disease

A

Aspirin plus IVIG

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9
Q

What to be aware with Rx of kawasaki and when to stop?

A

Aspirin can cause Reye syndrome: hepatic encephalopathy
but it prevents coronary thrombosis
Clopidogrel can be substitued during acute influenca or VZV

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10
Q

Intussusception can be assoc with

A

Henoch-Schonlein purpura

Meckels diverticulum

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11
Q

Mongolian spots are

A

congenital dermal melanocytosis
benign usually on lower back and buttock
Fade by 1st decade of life

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12
Q

Adrenal enzyme: 21-hydroxylase deficiency symptoms

A 
Ambigous genitalia in girls
Salt wasting(vominting, hypotension, Decrease Na, increased K)
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13
Q

Dx 21 hydroxylase def

A

Inc 17-hydroxyprogesterone
inc testosterone
decr: cortisol/aldosterone

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14
Q

Adrenal enzyme 11B-hydroxylase deficiency symptoms

A

Ambigous genitalia in girls
Fluid and salt retention
HTN

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15
Q

DX 11B hydroxylase def?

A

Incresed testosterone and 11-deoxycorticosteone & 11 deoxycortisol
Decreased Cortisol and aldosterone

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16
Q

Adrenal enzyme 17a hydroxylase deficiency C/F

A

All patients: phenotypicaly female
Fluid&salt retention
HTN

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17
Q

Dx 17a hydroxylase

A

Decreased cortisol & testosterone
Increased Mineralocorticoids
Increased corticosterone

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18
Q

Normal anion gap acidosis
failure to thrive
urine alkolotic
Dx?

A

Renal tubular acidosis

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19
Q

RTA type 1

A

Distal: poor H ion secretion into Urine
Urine pH> 5.5
Serume K: low to normal

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20
Q

Causes of RTA1

A

Genetic disorders
medication toxicity
AI disorders (SS, RA)

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21
Q

RTA type 2

A

Proximal: poor hCO3 resorption
urine pH: below 5.5
Serum K-low to normal

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22
Q

Causes of RTA2

A

Fanconi syndrome (glucosuria, phosphaturia, AAuria)

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23
Q

RTA type 4

A

Aldosterone resistance
Urine pH: Below 5.5
Serum potassium: High

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24
Q

Causes of RTA4

A

Obstructive uropathy

Congenital adrenal hyperplasia

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25
Q

Kid with sickle cell comes in with ABD pain and jaundice. type of blood issue

A

Chronic hemolysis: extravascular
Increased LDH, unconjugated bilirubin, reticulocytes
Low haptoglobin

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26
Q

Seperation anxiety is normal when

A

9-18 months

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27
Q

Child (9 months)with history of otitis media and used to babble but stopped. raises concern for?

A

Hearing problem

Do a audiology evaluation

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28
Q

Girl seen due to hair loss for a week. Mom has vitiligo

P/E: scaling slightly erythematous patch on scalp; no LAD

A

Tinea capitis infection

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29
Q

Tinea capitis C/F

A 
Scaly, erythematous patch on scalp
Hair loss w/ residual black dot
Possible painful LAD
Blacks
Human->huma or fomite transmission
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30
Q

Dx/Rx tinea

A

KOH exam of hair shaft to document spores

Rx: Griseofulvin or oral terbinafine

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31
Q

Smooth and discrete circular areas of hair loss w/out scaling… DX?

A

Alopecia areata

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32
Q

well demarcated plagues, inflammation and scarring of hair follicles, cutaneous lesions, and maybe photosensitivity…. Dx?

A

Discoid lupus erythematosus

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33
Q

Itchy scalp, neck and ears or asymptomatic. Whole family some how got it… Dx?

A

Lice: Pediculosis humanus capitis

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34
Q

MCC of 2ndry HTN in kids

A 
Fibromuscular dysplasia (FMD)
20% of all cases of renal htn
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35
Q

Physical exam for FMD in kid with HTN?

A

hum or bruit in the costovertebral angle due to well -developed collaterals
R renal artery more affected than L

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36
Q

Angiography pattern in FMD

A

“string of beads” pattern to the renal artery

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37
Q

Kid OD’s on grandmas TCA meds cause he is a moron. What to give him to help?

A 
SUpplemental O2, intubation
IV fluids
Charcoal within 2 hrs
Seizures= BZs
IV Sodium Bicarb for QRS widening or ventricular arryhthmias
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38
Q

Kid comes in with bleeding from bottom, bruises, multiple pneumonias, and thrombocytopenia.. Dx?

A

Wiskot aldrich syndrome
X-linked WAS gene
T cells cunable to reorganize atin cytoskeleton

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39
Q

Wiskot aldrich syndrome mnemonic?

A 
WAS gene
A: IgA/IgA Increased
Infections
Thrombocytopenia= purpura
Eczema= truncal
Response to bacterial polysacharides decreased
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40
Q

typical infections in WAS?

A

S. pneumonia
N. meningitis
H.influenzae

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41
Q

Febrile seizure R/Fs?

A

Fever from mild viral or bacterial infection (influenza, adenovirus, HHV-6)
Immunizations (DTaP, MMR)
Family Hx

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42
Q

Dx febrile seizure

A 
Age 6m- 6 yrs
Temp>38 (100.4)
No hx of seizure
No CNS infection
No acute systemic metabnolic cause of seizures
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43
Q

Rx Febrile seizure

A

Reassurance/education

44
Q

Kid with a infection, conjunctival redness, rhinorhea and high fever spike next day. Has seizure. upon arrival to ER feels better. Dx?

A

Febrile seizure

45
Q

Bacterial vs viral conjunctivitis?

A

B- thick mucopurulent discharge

V- watery

46
Q

Kid comes in with a scotal swelling after a fever and cough which progress for 2 weeks. Also has rash on buttock, bloody urine. Dx?

A

Henoch-schonlein purpura

47
Q

HSP C/F

A 
Palpable purpura
Arthritis/arthralgia
Abd pain, intussusceptions
Renal disease similar to IgA nephropathy
Severe cases: scrotal pain
48
Q

Cause of HSP?

A

IgA mediated leukocytoclastic vasculitis

49
Q

Rx of HSP

A

Supportive: hydrate and NSAIDS

Hospitilization and systemic steroids if severe

50
Q

R/F for cholecystitis

A

Sickle cell anemia
Hereditary spherocytosis
obesity

51
Q

Increased incidence of colonic diverticula and abd wall/inguinal hernia are seen in?

A

ADPKD

52
Q

Recurrent Sinopulmonary infections, chronic cough, Nasal polyps, and digital clubbng…. Dx?

A

Cystic fibrosis

53
Q

episodes of impaired consciousness, failure to respond to various stimuli during the episode, staring spells, automatism and post ictal confusion. Dx?

A

Complex partial seizure

EEG-normal

54
Q

Brief (few s) periods of impaired consciousnes, have automatisms, NO post ictal state

A

typical abscence seizure

EEG generalized 3hz spike waves

55
Q

EEG slow spike and wave activity with frquency less than 2.5 hz, 20 second impaired consciousness, Dx?

A

Atypical absence seizure

56
Q

Adolescent w/ unilateral or bilateral myoclonic jerks

usually in Am and precipated by sleep deprivation, Dx?

A

juvenile myoclonic epilepsy

57
Q

Childhood seizures of multiple types, impaired cognitive function, Spike and wave activity on EEG; Dx?

A

Lennox-Gastaut syndrome

58
Q

Cyclic vomiting syndrome

A 
>3 epidose in 6 month period
last 1-10 days
vomits >4 times/hr at peak
no symptoms btw vomiting episodes
no underlying condition
59
Q

Rx CVS

A

Hydration
antiemetics
reassurance to parents

60
Q

CVS is associated w/

A

FH of migraine headaches in parents

more like a abd migraine

61
Q

Vomiting electrolyte imbalance

A 
Hypochloremic, hypokalemic M. alkalosis
ph: high- alkalosis
PaCO2: increased
HCO3: increased
K: decreased
Cl: decreased
62
Q

Fever, uriticaria and polyarthralgia 1-2 wks after first exposure;
H, Edema, LAD & splenomegaly less common

A

Serum sickness- like reaction

usualy from antibiotics (B-lactams, sulfa)

63
Q

Breath holding spells

A

Cyanotic: crying followed by breath holding in forced expiration, apnea, cyanosis, limpness & LOC
Pallid: Minor trauma followed by LOC, breath holding, pallor & diaphoresis

64
Q

Rx: breath holding spells

A

Check CBC

Serume ferritin

65
Q

Refeeding syndrome in purger

A

Increased insulin:
Incred glycogen synthesis
increased protein synthesis
inc intracellular uptake of phosphorus, K, Mg, thiamin

66
Q

In refeeding syndrome electrolyte issues

A

Drop in Phosphorus, K, Mg
decreased thiamine
Increased Na and H2O

67
Q

Clinical manifestations of refeeding syndrome

A

Arrhythmia
CHF (pulmonary edema, peripheral edema)
Seizures
Wernicke encephalopathy

68
Q

when to check lipid levels in kids?

A

screen for dyslipidemia 9-11 and 17-21

relatively stable just prior and after puberty

69
Q

normal weight loss in newborn in first 5 days of life?

A

7% birth weight

regained by 10-14 days

70
Q

Heroin abuse in mom, kid has… c/f

A

Neonatal abstinence syndrome (NAS):
irritability, high-itched cry, poor sleeping, tremors, seizures, sweating, sneezing, tachypnea, poor feeding, V/D
W/drawal around 48hrs

71
Q

Methadone withdrawal in newborn occurs when

A

48 to 72 hrs after birth

72
Q

prenatal exposure to cocaine, c/f of kid

A

jitteriness,
excessive suckling
hyperactive MORO relfex
long term, behavior, attention and intelligence problems

73
Q

infants shouldnt drink cow milk until what age? and why?

A

until age 1 and

74
Q

Continued ear drainage for several weeks despite appropriate antibiotic therapy think of

A

Cholesteatoma

75
Q

Cholesteatoma is what

A

Chronic middle ear disease leads to formation of a retraction pocket in tympanic membrane which can fill with granulation tissue and skin debris

76
Q

Rx a cholesteatoma

A

referr to otolaryngologist

possibly Ct or surgical visualization to confirm Dx

77
Q

erythematous vesicle symmetrically distributed on extensor surfaces

A

Dermatitis herpetiformis

78
Q

Newborn with cyanosis that is aggravated by feeding and relieved by crying; dx?

A

Choanal atresia

79
Q

watery Diarrhea, dermatitis, dementia(poor concentration, mental status change, aggressive), beefy red tongue

A

Pellagra, Def of Vit B3= Niacin

80
Q

Cheilosis, glossitis, seborrheic dermatitis (often affecting genital areas), pharyngitis, edema or erythema of mouth; Dx?

A

Def of Vit B2: Riboflavin

81
Q

Breastfeeding benefit for kid

A

Improved immunity
Improved GI function
Prevents infections: Otitis media, gastroenteritis, Resp Illness, UTI
Decreased risk of childhood cancer DMI, NEC

82
Q

Maternal benefit to breastfeeding

A

Reduced risk of ovarian and breast cancer
rapid uterine involution and decreased postpartum bleed
faster return to prepartum weight
improved child spacing
Bonding

83
Q

Lethargic newborn, hoarse cry,, poor feeding, constipation, jaundice, scleral icterus, dry skin,
TSH high, low free T4; Dx?

A

Congenital hypothyroidism

mcc: Thyroid dysgenesis

84
Q

C/I to rotavirus vaccine

A

Anaphylaxis to vaccine ingredients
History of intussusception
Hx of uncorrect congential malformation of GI tract (e.g meckels)
SCID

85
Q

Late onset (nonclassical) congenital adrenal hyperplasia C/F

A

severe facial acne, advanced pubic/axillary hair, normal testicular volume, advanced bone age;

86
Q

Late onset CAH labs

A

LH low at baseline and doesn’t increase with GNRH stimulation

87
Q

Vit B2: riboflavin def c/f

A 
Angular cheilitis: fissures
Glossitis: hyperemic tongue
Stomatitis: hyperemic/edematous oropharyngeal mucous membranes, sore throat
Normocytic-normochromic anemia
Seborrheic dermatitis
88
Q

Drugs for Enuresis management

A

1st line: Desmopressin

2nd: Imipramine, amitriptyline, desipramine

89
Q

Lead poisoning screened by capillary blood; next step?

A

Venous lead measurements

90
Q

Rx to lead poisoning 3 types:

A

Mild: 5-44 mcg/dl- no meds, repeat in 1 month
Moderat: 45-60- DMSA
Severe: >70- Dimercaprol + EDTA (calcium disodium edetate)

91
Q

Congenital hypothyroidism C/f

A 
Apathy
weakness
hypotonia
large tongue
sluggish mvts
abd bloating
umbilical hernia
prolonged jaundice
92
Q

Maternal factors that lead to abnormal fetal growth(5)

A 
Preeclampia
malnutrition
placental insufficiency
multiparity
drug use
93
Q

Infants who are small for gestational age are at risk for (7)

A 
hypoxia
perinatal asphyxia
meconium aspirationi 
hypothermia
hypoglycemia
hypocalcemia
polycythemia
94
Q

Large for gestational age infants are at risk of

A

hip subluxation

talipes calcaneovalgus

95
Q

SSSS is what

A

exfoliative toxin producing strains of S.aures;

toxins against desmoglein: keratinocyte adhesion in superficial epidermis

96
Q

In SSSS what starts in 24-28 after fever, irritability, skin tenderness

A

erythema starts on faces and generalizes in that ime

97
Q

Nikolsky sign

A

gentle lateral pressure on skin surface adjacent to a blister causes slipping and detachment of a superficial layer of skin

98
Q

Cystic fibrosis most patients will have

A

Pulmonary and pancreatic insufficiency

95% f men: infertile: congenital bilateral absence of vas deferens

99
Q

hyperaldosteronism causes

A

Hypokalemia
hypernatremia
hypercholeremia
alkalosis

100
Q

SIADH causes

A

Hyperkalemia
hypernatremia
inability to take in water,(Concentrate urine)

101
Q

Addisons crisis labs

A

hyponatremia
hypokalemia
shock

102
Q

Glucose 6 phosphatase def na/k labs

A

as a rule are hyperlipidemic: increased TG concentration decreases the volume of aqueous compartment
hypokalemia, hyponatremia can be factiticously seen

103
Q

Neonatal presentation with neonatal thyrotoxicosis

A 
mom with Hx of Graves
low birth weight
tachycardia
warm skin
irritability
104
Q

Rx neonatal thyrotoxicosis

A

dx: anti-TSH R ab transplacental
Rx: methimazole and B-Blocker if severe

105
Q

What are infants of diabetic mothers at increased risk for?

A

Hypoglycemia/Hypocalcemia
Caudal regression syndrome
Congenital heart disease/septal hypertrophy
polycythemia
RDS (insulin delays surfactant production)

106
Q

What is acrodermatitis enteropathica?

A

Zinc deficiency with chronic diarrhea, alopecia, and rash around the mouth/anus/hands/feet

PEDS UWORLD (9 decks)

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