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2018 Peds Royal College Misc. > RC Peds lists > Flashcards

RC Peds lists Flashcards

1
Q

Clinical features of hypercalcemia

A
  1. Bony pain
  2. Nephrocalcinosis/nephrolithiasis
  3. Abdominal pain
  4. Polyuria/polydypsia
  5. Mood lability
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2
Q

Ddx secondary amenorrhea

A
  1. Pregnancy
  2. Polycystic ovary syndrome
  3. Hypo/hyperthyroidism
  4. Athlete’s triad (amenorrhea, osteopenia, disordered eating)
  5. Primary ovarian failure
  6. Anorexia nervosa
  7. Prolactinoma
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3
Q

Features suggesting basilar migraine

A
  1. Dizziness, vertigo
  2. Visual disturbances, diplopia
  3. Ataxia
  4. Tinnitus
  5. Dysarthria
  6. Decreased hearing
  7. Simultaneous bilateral parasthesias
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4
Q

Ddx linear growth delay and amenorrhea

A
  1. Turner syndrome
  2. Celiac disease
  3. Hypothyroidism
  4. Anorexia nervosa
  5. Inflammatory bowel disease
  6. Type 1 diabetes
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5
Q

Clinical features of neonatal thyrotoxicosis

A
  1. IUGR
  2. Goitre
  3. Exopthalmos
  4. Restlessness, irritability, hyperactivity
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6
Q

Cyanotic heart lesions with decreased pulmonary markings

A
  1. Tricuspid atresia
  2. Ebstein’s anomaly
  3. TOF
  4. Pulmonary atresia
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7
Q

Side effects of prostaglandin

A
  1. Apnea
  2. Hypotension
  3. Hyperthermia
  4. NEC/decreased gut perfusion
  5. Gastric outlet obstruction
  6. Skeletal changes
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8
Q

Causes of linear growth delay

A
  1. GH deficiency
  2. Celiac disease
  3. Hypothyroidism
  4. Constitutional growth delay
  5. Familial short stature
  6. Turner syndrome
  7. IBD
  8. NF1
  9. Anorexia
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9
Q

Causes of false positive sweat chloride

A
  1. Eczema
  2. Malnutrition/failure to thrive
  3. Anorexia nervosa
  4. CAH
  5. Adrenal insufficiency
  6. Hypothyroidism
  7. Nephrogenic DI
  8. Klinefelter syndrome
  9. Caregiver fabricated illness
  10. Ectodermal dysplasia
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10
Q

Ddx leukoria

A
  1. Retinoblastoma
  2. Cataracts
  3. Persistent fetal vasculature
  4. Retinopathy of prematurity
  5. Coat’s disease
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11
Q

Indications for headache imaging

A
  1. Focal neurologic symptoms on exam
  2. Associated neurological symptoms (eg. vision changes, ataxia)
  3. Papilledema on exam
  4. Headache on first awakening
  5. Pain wakens from sleep
  6. Sudden onset or thunderclap headache
  7. Pain worse with cough or valsalva
  8. Persistent morning time nausea/vomiting with headahce
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12
Q

Sequelae of lyme disease besides erythema migrans

A
  1. Facial nerve palsy
  2. Meningitis
  3. Heart block
  4. Arthritis
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13
Q

Ddx blueberry muffin rash

A
  1. Congenital CMV
  2. Congenital rubella
  3. Hemolytic disease of the newborn
  4. AML
  5. LCH
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14
Q

Complications of varicella

A
  1. Pneumonia
  2. Acute cerebellar ataxia
  3. Stroke
  4. Necrotizing fasciitis
  5. Thrombocytopenia
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15
Q

Causes of anemia in chronic renal disease

A
  1. Nutritional deficiency
  2. Frequent blood draws
  3. Hemolysis from dialysis equipment
  4. Decreased erythropoeitin production
  5. Chronic inflammation
  6. Impaired iron metabolism
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16
Q

Factors that increase risk of adverse outcomes in acute head injury

A
  1. GSC 5 or less
  2. Raised intracranial pressure
  3. Presence and severity of additional injuries
  4. Pre-existing ADHD
  5. Socioeconomic status
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17
Q

Extraintestinal manifestations of crohn’s

A
  1. Oral mucosal ulcerations
  2. Growth deficiency
  3. Delayed sexual maturation
  4. Erythema nodosum
  5. Fistulas
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18
Q

Reasons for a false positive TB test

A
  1. Latent TB
  2. Previous BCG vaccination
  3. Misread or incorrect technique
  4. Non-tuberculous mycobacterial infection
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19
Q

Bad prognostic indicators in CF

A
  1. Female
  2. Colonization with virulent organisms (burkholderia, pseudomonas, MRSA)
  3. Diabetes mellitus
  4. Malnutrition
  5. Cor pulmonale
  6. Pneumothorax
  7. Worsening pulmonary function
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20
Q

Reasons for failing inhaled corticosteroids

A
  1. Inadequate dose
  2. Poor adherence/technique
  3. Ongoing exposure to environmental triggers
  4. Untreated comorbidities (allergic rhinitis, GERD, OSA)
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21
Q

Complications of type 2 diabetes

A
  1. Retinopathy
  2. Nephropathy
  3. Neuropathy
  4. Dyslipidemia
  5. PCOS
  6. Non-alcoholic fatty liver disease
  7. Hypertension
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22
Q

Complications of GERD

A
  1. Erosive esophagitis
  2. Strictures
  3. Barrett’s esophagus
  4. Respiratory symptoms
  5. Dental erosions
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23
Q

Physical exam findings in allergic rhinitis

A
  1. Allergic shiners
  2. Mouth breathing
  3. Horizontal nasal crease
  4. Performing the allergic salute
  5. Pale, enlarged nasal turbinates
  6. Dennie Morgan lines
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24
Q

Medications for constipation maintenance

A
  1. PEG
  2. Docusate
  3. Milk of magnesia
  4. Lactulose
  5. Mineral oil
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25
Inherited causes of clotting
1. Protein C deficiency 2. Protein S deficiency 3. Factor V Leiden 4. Antithrombin deficiency 5. Homocystinuria
26
Advantages and disadvantages of IgE-specific testing (RAST)
Advantages: 1. Not affected by use of corticosteroids or antihistamines 2. No risk of systemic reaction 3. Can be performed if patient has skin disase Disadvantages: 1. False positives if elevated total IgE 2. Less sensitive than skin prick testing 3. More expensive than skin prick testing
27
Contraindications to breast feeding
1. Active TB (treat for 2 weeks) 2. HIV 3. Brucellosis 4. Mastitis or abscess with pus (don't feed from that breast) 5. High-dose flagyl (wait 12-24 hours after dose) 6. HSV on the breast (avoid direct breast feeding until lesions crusted over)
28
Skin findings in IBD
1. Erythema nodosum 2. Pyoderma gangrenosum 3. Polyarteritis nodosa 4. Psoriasis 5. Perianal skin tags 6. Epidermolysis bullosa acquisita 7. Sweet syndrome
29
Clinical features of rickets
1. Frontal bossing 2. Genu varus 3. Delayed fontanelle closure 4. Rachitic rosary 5. Delayed tooth eruption 6. Craniotabes 7. Bone pain 8. Widening of wrists and ankles
30
At risk for OSA
1. Down's syndrome 2. Obesity 3. Adenotonsillar hypertrophy 4. Choanal atresia 5. Deviated nasal septum 6. Micrognathia/retrognathia 7. Craniofacial trauma 8. Achondroplasia
31
Chest x-ray findings in RDS
1. Decreased lung volumes 2. Ground glass opacities 3. Air bronchograms
32
Indications for lymph node biopsy
1. Persistent fever 2. Failure to respond to 2 weeks of antibiotics 3. Systemic symptoms such as weight loss or bony pain 4. Diffuse lymphadenopathy 5. Not decreasing in size after 4-6 weeks 6. Mediastinal mass 7. CBC concerning for hematologic malignancy
33
Poor asthma control
1. 4 or more daytime symptoms per week 2. 1 or more nighttime symptoms per week 3. Physical activity limitations 4. Hospital admissions 5. Missing school 6. 4 or more rescue therapy per week 7. ICU admissions
34
Clinical signs of increased ICP
1. Papilledema 2. Cushing's triad (hypertension, bradycardia, resp changes) 3. Vertical gaze palsy (Parinaud syndrome) 4. Vision changes (vision loss, diplopia) 5. Altered LOC 6. Headache and/or vomiting on first awakening
35
Conditions at risk for brain tumours
1. Neurofibromatosis type 1 2. Tuberous sclerosis 3. Gorlin syndrome 4. Li-Fraumeni syndrome 5. Von Hippel-Landau
36
Causes of excess ADH
1. Intracranial lesion 2. Intrathoracic lesion 3. Post-operative 4. Pain 5. Nausea 6. Medications (morphine)
37
Acute complications of IBD
1. Small bowel obstruction 2. Intraabdominal abscess 3. Fistula 4. Sclerosing cholangitis
38
Indications for antibiotics in human bites
1. Deep wounds 2. Signs of infection 3. Bite on hand, face, feet or genitalia 4. Immunocompromised 5. Wound extending to bone or joint 6. Wound requiring surgical repair
39
Manifestations of CF
1. Sinus infections 2. Nasal polyps 3. Bronchiectasis 4. Pneumothorax 5. Hemoptysis 6. Meconium ileus 7. Pancreatic insufficiency 8. Malabsorption 9. Failure to thrive 10. Biliary obstruction 11. Insulin-dependent diabetes mellitus 12. Distal intestinal obstruction syndrome 13. Rectal prolapse 14. Male infertility 15. Congenital absence of the vas deferens
40
Cyanotic heart lesions with a murmur
1. Truncus 2. TOF 3. Tricuspid atresia 4. TAPVR 5. Ebstein's
41
Clinical features of iron deficiency anemia
1. Pallor 2. Neurocognitive dysfunction 3. Restless leg syndrome 4. Breath holding spells 5. Seizures 6. Stroke
42
Ddx primary amenorrhea
1. Turner syndrome 2. Hypothyroidism 3. Pregnancy 4. Celiac disease 5. Imperforate hymen 6. Anorexia nervosa 7. Inflammatory bowel disease 8. Complete androgen insensitivity
43
Ddx constipation
1. Hirschprung's 2. Hypothyroidism 3. CF 4. Celiac disease 5. Hypercalcemia 6. Hypokalemia 7. Anal stenosis 8. Pelvic mass 9. Spinal cord abnormalities 10. Abnormal abdominal musculature
44
Management of fulminant hepatic failure
1. Transfer to a tertiary care centre 2. Avoid hypovolemia 3. Avoid sedatives, which may aggravate or precipitate encephalopathy 4. Monitor liver function parameters 5. Restrict protein intake 6. Monitor closely for signs of SBP
45
Who should get surfactant?
1. RDS and intubated (give prior to transport) 2. MAS and intubated on FiO2 50% or more 3. Sick with pneumonia and oxygenation index >15 4. Intubated with pulmonary hemorrhage and clinical deterioration 5. Significant risk of RDS (prophylactic surf)
46
Ductal-independent cyanotic heart lesions
1. HLHS 2. Truncus 3. TAPVR 4. TGA
47
Types of intussusception not reducible by air enema
1. Lymphosarcoma 2. Polyp 3. Meckel's diverticulum 4. Small bowel intussusception
48
Candidates for fundoplication
1. Recurrent aspiration 2. Refractory esophagitis 3. Barrett's esophagitis 4. Reflux-associated apnea 5. Reflux-associated failure to thrive
49
Early warning signs of CP
1. Persistent primitive reflexes 2. Motor tone abnormalities (fisting, poor head control, oromotor patterns) 3. Delayed motor milestones (not sitting at 8 months, not walking at 18 months, commando crawling) 4. Early hand preference (< 18 months)
50
Recommendations for steroids in CLD
1. Don't use steroids in the first 7 days of life 2. Don't use high-dose dex to prevent or treat CLD 3. Don't routinely use low-dose dex on ventilated infants > 7 days 4. Don't use hydrocortisone 5. Don't use inhaled corticosteroids to prevent CLD 6. Weigh the risks and benefits of steroids - may use 7-10 days low-dose dex or inhaled steroids for severe CLD
51
Questions on history for allergic rhinitis
1. Nasal symptoms? Eg. itching, rhinorrhea, blockage, sneezing 2. Eye symptoms? Eg. tearing, itchiness 3. Environmental exposures? Eg. pets, seasonal 4. Personal history of atopy? 5. Family history of allergic rhinitis?
52
Red flags for constipation
1. Onset under 1 month of age 2. Delayed passage of meconium 3. Ribbon stools 4. Bloody stool 5. Failure to thrive 6. Bilious vomiting 7. Severe abdominal distension 8. Perianal fistula 9. Absent anal or cremasteric reflexes
53
Disorders associated with celiac disease
1. Type 1 diabetes 2. Hypothyroidism 3. Turner syndrome 4. Trisomy 21 5. William syndrome 6. Autoimmune hepatitis
54
Ddx neonatal unconjugated hyperbili
1. Breastfeeding jaundice 2. Breast milk jaundice 3. Blood-group incompatibility 4. G6PD deficiency 5. Crigler-Najjar 6. Hypothyroidism 7. Cephalohematoma 8. Trisomy 21
55
Non-pharmacologic interventions for GERD
1. Upright positioning after eating 2. Avoid acidic or reflux-inducing foods 3. Lose weight if overweight 4. Smoking cessation 5. Hypoallergenic diet 6. Surgery - fundoplication
56
Risk factors for liver disease in intestinal failure
1. Young age 2. Long duration of TPN 3. Short gut syndrome 4. Lack of enteral feeding 5. Intercurrent infections
57
Features of pertussis specific to adolescents
1. Chronic cough 2. Inspiratory whoop 3. Sequelae of forceful coughing- rib fractures, hernias, syncope
58
Reasons for a false negative TB test
1. HIV 2. Recent infection 3. Active TB 4. Mumps, measles or varicella infection 5. Fungal infection 6. Immunosuppression
59
Blood work for growth delay
1. Bone age 2. TSH and free T4 3. CBC 4. Celiac screen 5. IGF-1 6. Urinalysis
60
Ddx 46XY with ambiguous genitalia
1. Partial androgen receptor insensitivity 2. 5-alpha reductase deficiency 3. Leydig cell failure 4. Gonadal dysgenesis 5. CAH
61
Ddx neonatal thrombocytopenia
1. Maternal ITP 2. Neonatal alloimmune thrombocytopenia 3. TAR syndrome 4. Congenital CMV 5. Sepsis 6. Fanconi anemia 7. Wiskott Aldrich syndrome
62
Complications of AOM
1. Mastoiditis 2. Facial nerve palsy 3. Cranial nerve VI palsy 4. Labrynthitis 5. Venous sinus thrombosis 6. Meningitis 7. Cholesteatoma
63
Cyanotic heart lesions with increased pulmonary markings
1. TGA 2. HLHS 3. TAPVR 4. Truncus
64
Advantages and disadvantages of skin prick testing
Advantages: 1. Results within 15 minutes 2. More sensitive than RAST 3. High negative predictive value 4. Cost effective Disadvantages: 1. High false positive rate 2. Results affected by use of corticosteroids or antihistamines 3. Risk of systemic reaction (though low) 4. Cannot perform if skin disease at testing site
65
Long-term complications of OSA
1. RVH 2. Pulmonary hypertension 3. Systemic hypertension 4. Cor pulmonale 5. Polycythemia 6. Cardiovascular disease in adulthood
66
Side effects of indomethacin
1. Hypoglycemia 2. Renal impairment 3. Thrombocytopenia/bleeding risk 4. Decreased cerebral blood flow 5. NEC/GI perforation 6. Hyponatremia
67
High risk criteria for ALL
1. Age under 1 or over 10 years 2. WBC > 50 3. Minimal residual disease after induction therapy 4. Unfavourable cytogenetics 5. Testicular involvement 6. CNS involvement
68
When to start antibiotics in a cat bite
1. Deep wounds 2. Bite on hand, face, feet or genitalia 3. Signs of infection 4. Immunocompromised 5. Puncture wounds
69
Life-threatening complications of guillain barre
1. Respiratory failure 2. Aspiration pneumonia 3. Cardiac arrhythmias 4. Orthostatic hypotension 5. Hypertension 6. Paralytic ileus
70
Risk factors for severe hyperbilirubinemia
1. Previous sibling with severe hyperbilirubinemia 2. Cephalohematoma 3. Severe bruising 4. Jaundice under 24 hours 5. Gestation less than 38 weeks 6. Maternal age 25 years or older 7. Dehydration 8. Exclusive or partial breastfeeding 9. Male sex 10. Asian or European background
71
Causes of short gut syndrome
1. Congenital short bowel syndrome 2. Multiple atresias 3. Gastroschisis 4. Bowel resection - NEC, midgut volvulus, long-segment hirschprung's, crohn's, trauma
72
Posterior fossa brain tumours
1. Glioma 2. Ependymoma 3. Medulloblastoma 4. Astrocytoma
73
Risk factors for colon cancer in UC
1. Family history of colon cancer 2. > 8-10 years of disease 3. Pancolitis 4. Mucosal dysplasia 5. Primary sclerosing cholangitis
74
Clinical manifestations of OSA
``` Nighttime symptoms: 1. Loud snoring 2. Breathing pauses 3. Gasping or choking arousals 4. Restless sleep 5. Nocturnal diaphoresis 6. More frequent and severe events when in supine position 7. Unusual sleeping positions Daytime symptoms: 1. Mouth breathing/dry mouth 2. Chronic nasal congestion/rhinorrhea 3. Morning headaches 4. Hyponasal speech 5. Difficulty swallowing 6. Poor appetite 7. Secondary enuresis ```
75
Indications for growth hormone
1. GH deficiency 2. Turner syndrome 3. Prader willi 4. End-stage renal failure before kidney transplant 5. Idiopathic short stature with suboptimal growth velocirt
76
Complications of measles
1. Diarrhea 2. Encephalitis 3. Otitis media 4. Pneumonia
77
Mood/behaviour changes with OSA
1. Daytime sleepiness or drowsiness, difficulty with morning wakening, unplanned napping 2. Irritability, mood instability, emotional lability, depression/anxiety 3. Somatic complaints 4. Social withdrawal 5. Aggression, oppositional behaviour 6. Impulsivity, hyperactivity 7. Executive function difficulties (cognitive flexibility, task initiation, self-monitoring, planning, organization)
78
Non-infectious causes of hepatitis
1. Tyrosinemia 2. Alpha-1-antitrypsin deficiency 3. Autoimmune hepatitis 4. Wilson's disease 5. Drug-induced hepatitis
79
Who gets RSV prophylaxis
1. < 12 months with chronic lung disease requiring medical therapy 2. < 12 months with hemodynamically significant congenital lung disease 3. GA < 30 months and < 6 months of age without chronic lung disease 4. GA < 36 months and < 6 months of age in remote communities 5. Full term Inuit < 6 months of age in remote communities with high RSV admission rates 6. Consider in < 24 months of age with: Trisomy 21, home oxygen, prolonged hospitalization for resp disease, or immunocompromised
80
PFT's in asthma
1. Decreased FEV1/FVC < 90% predicted 2. Decreased FEV1 < 80% predicted 3. Decreased FEF 25-75 4. 12% improvement in FEV1 with bronchodilator
81
Radiographic features of rickets
1. Widening of growth plates 2. Osteopenia 3. Fraying of metaphyses 4. Pathological fractures
82
Allergic rhinitis environmental trigger avoidance
1. Dust Mites - Seal the mattress and pillow in airtight allergen impermeable covers - Wash bed linens weekly in hot water - Remove wall to wall carpeting - Replace curtains with blinds - Remove upholstered furniture - Reduce indoor humidity - Minimize bedroom and living room clutter 2. Animal Dander - Removing allergic pets and avoiding furred pets - Keep animals out of patient’s bedroom 3. Cockroaches - Control available food and water sources - Keep kitchen/bathroom surfaces dry and free of standing water - Seal cracks in walls - Use professional extermination services 4. Mold - Repair moisture prone areas - Avoid high humidity in patient’s bedroom - Use high efficiency particulate air (HEPA) filters in living areas - Repair water leaks - Replace carpets with hardwood floors - Regularly check basements, attics and crawl spaces for standing water and mold 5. Pollen (Note, this would be for seasonal allergy) - Keep automobile and house windows closed - Control timing of outdoor exposure - Restrict camping, hiking and leaf raking - Drive in an air conditioned automobile - Air condition the home - Install portable HEPA filters
83
Causes of CF disease progression
1. Worsening lung disease (bronchiectasis, fibrosis, atelectasis) 2. Chronic lung infection 3. Malnutrition 4. Allergic bronchopulmonary aspergillosis 5. CF-related diabetes mellitus 6. CF-related liver disease 7. Non-compliance with CF therapies
84
Causes of false negative sweat chloride
1. Dilution 2. Malnutrition (hypoalbuminemia) 3. Edema 4. Insufficient sweat quantity 5. Hyponatremia 6. CFTR mutation with preserved sweat duct function
85
Congenital cytopenias
1. Fanconi anemia 2. Dyskeratosis congenita 3. Schwachmann Diamond 4. Diamond Blackfan 5. Thrombocytopenia absent radii
86
Extraintestinal manifestations of UC
1. Pyoderma gangrenosum 2. Sclerosing cholangitis 3. Chronic hepatitis 4. Ankylosing spondylitis
87
Contraindications to air enema for intussusception
1. Peritonitis 2. Persistent hypotension 3. Free air/pneumoperitoneum
88
Non-pharmacologic migraine management
1. Sleep hygiene 2. Migraine elimination diet (caffeine, chocolate, cheese) 3. Discontinue possible triggering medications (analgesic overuse) 4. Biofeedback therapy 5. Family counselling 6. Hydration and diet
89
Clinical signs of infratentorial tumour
1. Ataxia 2. Cranial nerve VI palsy 3. Nystagmus 4. Diplopia 5. Upper motor neuron deficits 6. Issues with motor coordination
90
Ductal-dependent cyanotic heart lesions
1. Ebstein's anomaly 2. Tricuspid atresia 3. TOF 4. Pulmonary atresia/stenosis
91
Ddx neonatal conjugated hyperbili
1. Biliary atresia 2. Choledochal cyst 3. Sepsis 4. Hypothyroidism 5. Cystic fibrosis 6. Galactosemia 7. Alpha-1-antitrypsin deficiency 8. Idiopathic neonatal hepatitis
92
Symptoms of neuroblastoma
1. Horner syndrome 2. Opsoclonus myoclonus 3. Raccoon eyes 4. Secretory diarrhea 5. Paraneoplastic syndromes 6. Constipation, urinary retention 7. Paraspinal symptoms
93
How does MAS make baby sick?
1. Chemical and inflammatory pneumonitis 2. Airway obstruction 3. Infection 4. Surfactant disruption
94
Conditions at risk for leukemia
1. Trisomy 21 2. Neurofibromatosis type 1 3. Fanconi anemia 4. Diamond-Blackfan 5. Schwachmann-Diamond 6. Ataxia telangectasia 7. SCID 8. Wiskott-Aldrich
95
Side effects of surfactant
1. Pneumothorax 2. Bradycardia 3. Blocked ETT 4. Pulmonary hemorrhage
96
Complications of short gut
1. Parenteral nutrition complications (thrombosis, infection, cholestasis) 2. Deficiencies - B12, folate, iron, zinc, copper 3. Recurrent infections/bacterial overgrowth 4. Psychosocial challenges
97
Good asthma control
1. < 4 daytime symptoms per week 2. < 1 nighttime symptoms per week 3. Normal physical activity 4. Mild, infrequent exacerbations 5. Not missing school 6. < 4 rescue therapy per week
98
Behavioural strategies for constipation
1. Dedicate time for defecation 2. Provide a foot stool 3. Sit on the toilet for 3-10 minutes within 1 hour of meals 4. Praise for stooling and sitting on the toilet 5. Keep a stool diary with a bristol chart
99
Indications to treat H pylori
1. Peptic ulcer disease 2. Persistent iron deficiency anemia 3. First-degree relative with gastric cancer, MALT
100
Red flags in precocious puberty
1. Advanced bone age 2. Rapid progression (months) 3. CNS signs or symptoms 4. Predicted adult height beyond 2 standard deviations from mid-parental height
101
Non-bowel presentations of celiac disease
1. Dermatitis herpetiformis 2. Growth failure 3. Iron-deficiency anemia that fails to correct with iron supplementation 4. Delayed puberty 5. Osteoporosis 6. Arthritis/arthralgia
102
What to do for a child not responding to inhaled corticosteroids
1. Review compliance 2. Review technique 3. Confirm diagnosis 4. Environmental control 5. Treat comorbidities 6. Increase ICS dose 7. Add a second agent (LABA, LTRA)
103
Causes of protein-losing enteropathy
1. Celiac disease 2. Crohn's 3. CMV 4. Lymphoma 5. Eosinophilic gastroenteropathy 6. Primary intestinal lymphangectasia
104
Investigations for amenorrhea
1. Beta HCG 2. TSH, free T4 3. LH, FSH 4. Estradiol 5. Karyotype 6. Ultrasound 7. Prolactin
105
Ddx rectal prolapse
1. Marfan's 2. Ehler's Danlos 3. Pertussis 4. Chronic constipation 5. Cystic fibrosis 6. Ulcerative colitis 7. Diarrhea 8. Malnutrition
106
Ddx small intestinal flat villi
1. Giardia 2. Crohn's disease 3. Primary immunodeficiency 4. Lymphoma 5. Eosinophilic gastroenteritis 6. Bacterial overgrowth
107
Differential diagnosis vaginal ulcers
1. HSV 2. Syphillis 3. Mycoplasma 4. Chancroid 5. Behcet's disease
108
Sleep hygiene strategies
1. Reasonable and consistent bedtime 2. Sleep in only one hour later on weekends 3. Eliminated caffeinated beverages after noon 4. Have breakfast each morning 5. No late night or evening exercise 6. No TV in room
109
Syndromes with cafe au lait spots
1. NF-1 2. Tuberous sclerosis 3. Russel Silver 4. McCune Albright 5. Ataxia-telangectasia 6. Fanconi anemia 7. Gaucher disease 8. Proteus syndrome 9. Turner syndrome
110
Physical features of Turner syndrome
1. Webbed neck 2. Shield chest 3. Wide-spaced nipples 4. Low-lying hairline 5. Cubitus valgus 6. Madelung deformity 7. Lymphedema 8. Short stature 9. Short fourth metacarpals 10. Micrognathia
111
Facial features of fetal alcohol syndrome
1. Short palpebral fissures 2. Increased intercanthal distance 3. Flattened face with short nose 4. Absent or hypoplastic philtrum 5. Thin upper lip
112
Congenital neck masses
1. Thyroglossal duct cyst 2. Branchial cleft cyst 3. Cystic hygroma 4. Dermoid cyst 5. Teratoma 6. Thymic cyst 7. Hemangioma 8. Lymphangioma 9. Laryngocele
113
Acquired neck masses
1. Thyroid mass 2. Cervical adenopathy 3. Lymphoma 4. Rhabdomyosarcoma 5. Neuroblastoma 6. Melanoma
114
When to refer eso or exotropia
1. Constant strabismus at any age 2. Intermittent strabismus after 4-6 months of age 3. Infantile/congenital esotropia 4. Persistent esotropia after 4 months of age 5. Intermittent exotropia 6. Congenital CNIV palsy
115
Features of orbital vs periorbital cellulitis
1. Pain with extra-ocular eye movements 2. Proptosis 3. Vision defects, diplopia 4. Fever 5. Leukocytosis 6. Toxic appearance
116
Differential diagnosis for torticollis
1. Idiopathic muscle spasm 2. Retropharyngeal abscess 3. Cranial nerve VI palsy 4. Acute dystonic reaction 5. Cervical lymphadenitis 6. Cervical discitis 7. Cervical vertebral osteomyelitis 8. Wilson's disease 9. Psychogenic
117
Organisms for slow growing neck mass
1. Myocobacterium avium intracellulare 2. TB 3. Brucellosis 4. Bartonella 5. Toxoplasmosis
118
Complications of sinusitis
1. Pott's puffy tumour 2. Orbital cellulitis 3. Meningitis 4. Subdural empyema 5. Cavernous sinus thrombosis 6. Epidural abscess 7. Periorbital cellulitis
119
Differential diagnosis of red eye
1. Corneal abrasion 2. Conjunctivitis 3. Ruptured globe 4. Hyphema 5. Foreign body 6. Orbital fracture 7. Uveitis
120
Risk factors for anterior uveitis in JIA
1. Female 2. ANA positive 3. Young age 4. Oligoarticular disease
121
Complications of undescended testicle
1. Infertility 2. Increased risk of torsion 3. Increased risk of testicular cancer 4. Poor testicular growth 5. Psychosocial effects of empty scrotum
122
Causes of acute testicular pain
1. Testicular torsion 2. Torsion of the appendix testis 3. Epididymitis 4. Orchitis 5. Incarcerated inguinal hernia 6. Trauma
123
Autoimmune conditions associated with celiac disease
1. Autoimmune thyroiditis 2. Type 1 diabetes 3. Addison's disease 4. Vitiligo 5. Autoimmune hepatitis 6. Sjogren's
124
Management of sleep association disorder
1. Parent education 2. Consistent bedtime routine 3. Remove maladaptive sleep associations (rocking, feeding) 4. Keep bedroom dark and quiet 5. Extinction or graduated extinction
125
Investigations for end-organ consequences of hypertension
1. Echocardiography 2. Ophthalmology assessment 3. Urine albumin 4. Renal ultrasound 5. Renal function tests
126
Questions on history for cardiac cause of chest pain
1. Onset during exertion 2. Associated with palpitations 3. Associated with syncope 4. Associated with decreased exercise tolerance 5. Personal history of cardiac disease or surgery 6. Radiation to back 7. Family history of sudden cardiac death, cardiomyopathy 8. Family history of cardiac arrhythmia, pacemaker
127
Drugs for hypertensive crisis
1. Labetalol 2. Hydralazine 3. Nifedipine
128
GN with normal C3
1. IgA nephropathy 2. Minimal change disease 3. Mesangial proliferative disease 4. Focal segmental glomerulosclerosis
129
GN with low C3
1. Post-infectious GN 2. Membranoproliferative GN 3. Lupus nephritis
130
Features of Type I RTA
1. Distal 2. Hypokalemia 3. High urine pH 4. Nephrocalcinosis 5. Hypercalciuria
131
Features of Type II RTA
1. Proximal 2. Fanconi syndrome 3. Low urine pH 4. Hypokalemia 5. Phosphaturia 6. Glycosuria 7. Proteinuria
132
Features of Type IV RTA
1. Hyperkalemia | 2. Aldosterone impairment
133
SIADH
1. Euvolemia 2. High urine osm 3. High urine sodium
134
Nephrotic syndrome complications
1. Renal vein thrombosis 2. Spontaneous bacterial peritonitis 3. DVT 4. Hyperlipidemia 5. Renal dysfunction
135
Who gets the 23-valent pneumococcal vaccine?
1. Sickle cell 2. Nephrotic syndrome 3. Hereditary spherocytosis 4. Pre or post-splenectomy 5. Asthma 6. Malignancy 7. Past HSCT 8. Chronic cardiac or pulmonary disease
136
Diseases that the HPV vaccine prevents
1. Cervical adenocarcinoma 2. High-grade vaginal neoplasia 3. High-grade vulvar neoplasia 4. Genital warts
137
Causes of hypercalcemia
1. Hyperparathyroidism 2. Williams syndrome 3. Iatrogenic 4. Immobilization 5. Thiazide 6. Subcutaneous fat necrosis
138
Risk factors for vitamin D deficiency
1. Living in high latitudes 2. Dark skin 3. Maternal vitamin D deficiency 4. Prematurity 5. Lack of supplementation with exclusive breastfeeding 6. Overweight or obesity 7. Skin coverage by clothing
139
Bloodwork for rickets
1. Calcium 2. Phosphate 3. PTH 4. ALP 5. 25(OH)D 6. Urea, creatinine 7. 1,25(OH)D
140
Indications for stress-dosing hydrocortisone
1. Pre-op 2. Gastroenteritis 3. Burns 4. Febrile illness 5. Hospitalization 6. Psychological stress
141
Kocher criteria for septic arthritis
1. WBC > 12 2. ESR > 40 3. Fever 4. Inability to weight bear 5. CRP > 25
142
Antenatal hydronephrosis, indications for ultrasound before discharge
1. Bilateral severe hydronephrosis (>15mm) 2. Solitary kidney with hydronephrosis 3. Oligohydramnios 4. Urethral obstruction 5. Concern about parental compliance with post-natal evaluation
143
Hyperaldosteronism
1. Hypertension 2. Metabolic alkalosis 3. Hypokalemia
144
Associations with single umbilical artery
Renal > Cardiac > MSK
145
Causes of a false positive urine protein dipstick
1. Gross hematuria 2. Contamination with antiseptic agents 3. Urine pH > 7.0 4. Highly concentrated urine
146
Reasons for sodium-restriction in neonates
1. Reduced GFR/renal function | 2. Expect sodium and water diuresis, resulting in contracted extracellular fluid volume
147
Signs/symptoms of bacterial sinusitis
1. Nasal discharge/congestion and/or cough for 10 days without improvement 2. Fever and purulent rhinorrhea for at least 3 days 3. Worsening nasal congestion, rhinorrhea, cough and fever after a 3-4 day improvement in symptoms
148
Treatment of uncomplicated urogenital gonococcal infection
Cefixime 800mg + Azithro 1g x 1
149
Indications for VZIG
1. Immunocompromised and susceptible 2. Pregnant and susceptible 3. Newborn who's mother had onset 5 days prior or 48 hours after birth 4. Hospitalized infant > 28 weeks with susceptible mom 5. Hospitalized infant < 28 weeks regardless of maternal history
150
What does blood get tested for in Canada?
1. HIV 2. HBV 3. Syphillis 4. HCV 5. Bacteria 6. West nile virus 7. CMV (select) 8. HTLV
151
Risk factors for MRSA
1. Close skin-to-skin contact 2. Openings in the skin such as cuts or abrasions 3. Contaminated items and surfaces 4. Crowded living conditions 5. Poor hygiene
152
Who should get antibiotics for a skin abscess?
1. Child under 3 months 2. Significant associated cellulitis 3. Systemic signs of illness
153
Ways to prevent mosquito and tick bites
1. Daily tick checks 2. Wear loose-fitting clothing and closed shoes 3. Use a DEET-containing insect repellant 4. Use screens on windows and camping tents 5. Avoid tall grass areas in spring and fall 6. Put mosquito nets on strollers and cribs 7. Wear light-coloured clothing so ticks are easier to identify
154
Risk factors for group B strep
1. Maternal GBS colonization 2. Maternal GBS bacteriuria during pregnancy 3. Previous child with invasive GBS disease 4. Prolonged ROM 5. Intrapartum fever
155
Contraindications to ketamine
1. Psychosis 2. Hypertension 3. Stroke 4. Hypersensitivity/allergy
156
Anticholinergic antidote
Physostigmine
157
Indications for admitting burns
1. Suspected non-accidental injury 2. 3rd degree burns 3. Inhalational injury 4. Burns affecting > 15% total body surface area 5. Chemical burns 6. Electrical burns from high-tension wires or lightning 7. Burns to the face, hands, feet, perineum or overlying major joints
158
Causes of secondary brain injury in TBI
1. Hypoxia 2. Hypotension 3. Hyperthermia 4. Raised ICP
159
Poor prognostic factors in drowning
1. Duration of submersion > 5 minutes 2. Time to effective basic life support > 10 minutes 3. Resuscitation duration > 25 minutes 4. GCS < 5 5. Age < 14 years 6. Persistent apnea and requirement of CPR in the emergency department 7. Arterial blood pH < 7.1 upon presentation
160
Indications for head CT in minor head injury
Minor injury plus any 1 of: 1. GSC < 15 at 2 hours after injury 2. Suspected open or depressed skull fracture 3. Worsening headache 4. Irritability on examination 5. Sign of basal skull fracture 6. Large, boggy scalp hematoma 7. Dangerous mechanism of injury
161
Meckel's rule of 2's
1. 2% of the population 2. 2:1 males:females 3. 2 types of mucosal tissue 4. 2 feet from the ileocecal valve 5. 2 inches long 6. 2-4% develop complications, usually before the age of 2
162
Indications for splenectomy in hereditary spherocytosis
1. Severe anemia 2. Frequent aplastic crises 3. Poor growth 4. Cardiomegaly
163
Long-term effects of cyclophosphamide
1. Infertility 2. Renal fibrosis 3. Secondary malignancies
164
Side effects of vincristine
1. Peripheral neuropathy 2. Jaw pain 3. Constipation 4. SIADH
165
Side effects of asparginase
1. Anaphylaxis 2. Coagulopathy 3. Pancreatitis
166
Side effects of methotrexate
1. Myelosuppression 2. Mucositis 3. Stomatitis
167
Side effects of prednisone
1. Cataracts 2. Osteoporosis 3. Growth suppression 4. Hypertension 5. Hyperglycemia 6. Avascular necrosis 7. Peptic ulceration 8. Cushing's syndrome
168
Long-term effects of radiation
1. Impaired growth 2. Infertility 3. Hypothyroidism 4. Secondary malignancy 5. Cardiotoxicity 6. Pulmonary toxicity
169
Indications to treat hemangioma
1. At risk of scarring or disfigurement 2. Beard distribution (risk of airway hemangioma) 3. Functional compromise (eg. obscuring vision) 4. Severe ulceration
170
Stages of incontinentia pigmenti
1. Vesicular 2. Verrucous 3. Pigmented
171
Referrals for incontinentia pigmenti
1. Optho 2. Neurology 3. +/- development 4. Dental 5. Genetics
172
Differential diagnosis for tinea pedis
1. Contact dermatitis 2. Psoriasis 3. Dyshidrotic eczema
173
Causes of erythema nodosum
1. Inflammatory bowel disease 2. Mycoplasma 3. Group A strep 4. Sarcoidosis 5. Lymphoma
174
Smoking cessation strategies
1. Counselling 2. CBT 3. Phone or distance counselling 4. Nicotine replacement products (for regular smokers age 12-18) 5. Buproprion (use with caution)
175
Factors making a teen more likely to quit
1. Male sex 2. Older teen 3. Teen pregnancy 4. Academic success 5. Sport participation 6. Peer and family support 7. CYP2A6 slow nicotine metabolizer
176
Factors making a teen less likely to quit
1. Nicotine addiction 2. Mental health conditions 3. Drug/alcohol use 4. Chronic illness 5. Family stress 6. Peer and family tobacco use 7. Overweight, weight preoccupation 8. Developmental drive to experiment 9. Fear of peer rejection 10. Perceived lack of privacy and autonomy
177
5 A's for counselling cessation
1. Ask 2. Advise 3. Assess 4. Assist 5. Arrange
178
Components of motivational interviewing
1. Open-ended questions 2. Reflective listening 3. Affirmations 4. Summary statements 5. Eliciting change talk
179
Emergency contraception side effects
1. Headache 2. Fatigue 3. Nausea 4. Dizziness
180
Discussion points for emergency contraception
1. Possibility of failure 2. Next period may be early, late or on time 3. Pregnancy options 4. If sexually active before next period, use barrier with spermicide 5. May be at risk of pregnancy in the first few days after EC 6. Start a new pack of pills the day after taking EC 7. EC's don't prevent or treat STIs 8. Schedule follow-up ~1 week after expected next period 9. Pregnancy test if period > 1 week late or unusual
181
Differential for vaginal bleeding in an 8 year old
1. Menstruation 2. Vaginal foreign body 3. Genital trauma 4. Urethral prolapse 5. Infectious vaginitis 6. Sexual abuse 7. Lichen sclerosis 8. Condyloma accumulata 9. Vaginal hemangioma
182
Contraindications to oral contraceptives
1. Migraine with aura 2. Hypertension with blood pressure > 160/100 3. History of DVT or PE 4. Hepatocellular adenoma 5. SLE with positive antiphospholipid antibodies 6. Complicated valvular heart disease 7. Complicated solid organ transplant
183
Outpatient management of the suicidal teen
1. Provide clear instruction regarding the importance of communicating suicidal thoughts or behaviours to identified trusted adults 2. Advise the need for mental health follow-up care 3. Provide information for contacting local crisis services and telephone lines 4. Advise the use of the emergency department if necessary 5. Encourage parents to allow open communication with the adolescent, particularly regarding negative feeling states and suicidal thoughts 6. Ensure the home environment is safe
184
Differential for bronchiectasis
1. CF 2. PCD 3. Foreign body 4. Primary immunodeficiency 5. Impaired cough, such as with neuromuscular disease
185
Physical exam findings in bacterial pneumonia
1. Dullness to percussion 2. Increased tactile fremitus 3. Egophany 4. Reduced normal vesicular breath sounds 5. Increased bronchial breath sounds
186
Requirements for discharging for bronchiolitis
1. Work of breathing and tachypnea improved 2. Maintaining SpO2 > 90% off oxygen, or stable on home oxygen 3. Adequate oral feeding 4. Education provided and appropriate follow-up arranged
187
Management of vocal cord dysfunction
1. SLP 2. Treat underlying causes (GERD, rhinitis) 3. Counselling
188
Differential diagnosis of hemoptysis
1. Foreign body aspiration 2. Bronchiectasis (cystic fibrosis) 3. Upper airway/hematemesis 4. Congenital heart disease/pulmonary hypertension 5. Infection (other than CF) 6. Neoplasm 7. Pulmonary arterio-venous malformation 8. Pulmonary embolism 9. Pulmonary-renal syndrome (Goodpasture’s, SLE, GPA, MPA, HSP) 10. Idiopathic pulmonary hemosiderosis
189
Drugs that cause lupus
1. Hydralazine 2. Minocycline 3. Procainamide 4. Sulfonamides 5. Isoniazid
190
Features of osteogenesis imperfecta
1. Blue sclera 2. Long bone bowing 3. Hearing impairment 4. Wormian skull bones 5. Opalescent teeth 6. Increased joint laxity 7. Easy bruising
191
Indications to refer for scoliosis
1. Rapid progression 2. Atypical curve 3. Skeletally immature, > 20 deg 4. Skeletally mature, > 45 deg 5. Pain
192
High risk for scoliosis progression
1. < 12 years 2. Girls > boys 3. Premenarchal 4. Curves that present > 20 deg 5. Double curves 6. Thoracic curves
193
Long-term complications of arthritis
1. Osteoporosis 2. Impaired bone growth 3. Chronic arthritis 4. Permanent joint damage
194
Organisms that cause reactive arthritis
1. Chlamydia 2. Gonorrhea 3. Shigella 4. Campylobacter 5. Yersinia 6. Salmonella 7. GAS 8. Meningococcus
195
Risk factors for neonatal sensorineural hearing loss
1. Family history of permanent hearing loss 2. Craniofacial abnormalities 3. Congenital infections 4. Physical findings consistent with an underlying syndrome that predisposes to hearing loss 5. NICU stay > 2 days 6. NICU stay with any of: ECMO, assisted ventilation, ototoxic drugs, hyperbili requiring exchange transfusion
196
Signs a child is ready for toilet training
1. Able to walk to the potty chair (or adapted toilet seat) 2. Stable while sitting on the potty (or adapted toilet seat) 3. Able to remain dry for several hours 4. Receptive language skills allow the child to follow simple (one- and two-step) commands 5. Expressive language skills permit the child to communicate the need to use the potty (or adapted toilet seat) with words or reproducible gestures 6. Desire to please based on positive relationship with caregivers 7. Desire for independence, and control of bladder and bowel function
197
How to facilitate toilet training
1. Decide on the vocabulary to use 2. Ensure the potty chair and position are easily accessible. Allow the child to watch his or her parents use the toilet. 3. If a regular toilet is used, use a toilet seat adapter and a foot stool. 4. Encourage the child to tell a parent when he or she needs to void. Give praise upon success, even if the child tells the parent after the fact. Learn the child’s behavioural cues when he or she is about to void. 5. Encourage the child with praise. Do not expect immediate results; expect accidents. Avoid punishment and/or negative reinforcement. 6. Ensure the cooperation of all caregivers to provide a consistent approach. 7. After repeated successes, suggest the use of cotton underwear or training pants. Make this a special moment.
198
Differential diagnosis toe walking
1. Tethered spinal cord 2. Cerebral palsy 3. Muscular dystrophy 4. Autism 5. Idiopathic 6. Congenital contractures of the Achilles tendon
199
Nutrient deficiencies in vegan/vegetarian diets
1. Iron 2. Zinc 3. Calcium 4. B12 5. Vitamin D 6. Vitamin A
200
Tests for working up hypertension
1. Urea and creatinine 2. Urinalysis 3. Lytes 4. Echo 5. Renal ultrasound w doppler 6. Fasting glucose and lipid panel 7. Retinal exam 8. Urine drug screen 9. Polysomnography 10. CBC
201
Risks for readmission in late-preterm
1. Hypothermia 2. ALTE or apneas 3. Hyperbili 4. Feeding problems 5. Suspected sepsis 6. Breathing problems

2018 Peds Royal College Misc. (6 decks)

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