Review Course Flashcards
For a kid with a suspected effusion what is the first diagnostic modality
Ultrasound
Patient with acalculus cholecystitis. Thickened gallbladder and positive Murphys with upper respiratory symptoms and findings. Management?
Supportive care
Probably EBV or other virus
ESRD and mircrocytic anemia needing a transfusion. What to tell the blood bank?
Leukoreduced PRBCs
Is development of right or left handedness normal before 24 mos?
No
R/o CP
Retropharyngeal abscess has pain with what movement? Best study to dx?
Extension
CT
Patient mycoplama induced rash and mucosotis. Dx?
Mycoplasma pneumoniae-induced rash and mucositis (MIRM)
Kid has signs of interstitial nephritis and is on frequent NSAID dosing for fever. Dx and tx?
AIN
DC NSAID and give fluids
Initial antibiotic treatment for PID
Clindamycin and gentamicin (parenteral recommendation) or cefoxitin/cefotetan and doxycycline
Kid has allergic transfusion rxn with just hives. Infusion stopped and they improve. What to do next?
Resume transfusion
No steroids or fluids needed
9 mos old with microcytic anemia. What work up to do
Consider Thalassemia or lead poisoning so do hemoglobin electrophoresis which will differentiate iron deficiency anemia with Mentzer index
First line treatment of excessive menstrual bleeding
25 mg of conjugated equine estrogen
Patient with neurocysticercosis
(Tapeworm in brain). Tx?
Albendazole and dexamethasone
Patient with intracranial hypertension or pseudotumor cerebri. She has a fulminant case with rapid visual changes and evidence of swelling of optic nerve sheaths. What is the definitive treatment for that patient?
Cerebrospinal fluid diversion procedure
What is Wolfram syndrome
is the combination of diabetes insipidus and mellitus with optic atrophy and bilateral neurosensory hearing loss. A mutation in a gene in the 4p16 region predisposes to multiple mitochondrial DNA deletions in families with Wolfram syndrome
Pt on carbamazepine with unsteady wide based gait (cerebral ataxia). Multiple caregivers. Work up?
Serum carbamazepine level
Signs of congenital hypothyroidism
Umbilical hernia, poor feeding, constipation, hyperthermia, sleepy, hyperbilirubinemia
How to manage heat stroke? Hyperthermic, confused, temp over 40
Immersive cooling
If young child or infant, don’t do it because bradycardia
How do you treat diabetes inspitus?
Desmopressin challenge
Nonspecific findings that seem like sepsis in a newborn or neonate, with no reported fever in addition to poor feeding, emesis, sleepiness, abnormal tone, and in particular when it’s in the first two weeks of life. Increased anion gap metabolic acidosis. Hypoglycemia with ketones, increased tone, sleepy
Think about inborn errors of metabolism
Maple syrup urine disease
GALT deficiency on NMS is what? Poor feeding lethargy and jaundice on presentation
Change to soy based formula for galactosemia
Associated with E. coli sepsis
The patient has poor feeding over the three days of her illness, and her weight was on the lower end of the percentile, and then with the hypoglycemia is seen on lab work and ketones in the urine. This is a pretty classic case for ketotic hypoglycemia. How to diagnose?
Elevated beta hydroxybutyrate
Can breastfeeding moms use THC?
Review health risks with mom
It does transfer to milk but no recommendations for DC breastfeeding
First time DKA treatment without hypovolemic shock
10 ML/kg isotonic fluid bolus, second bolus within first hour as needed, start insulin infusion at 0.1 units per/kg/hr after initial hour of fluid resuscitation
Witnessed Non fatal drowning with stable patient and exam with rales in the lung base
Supportive care and monitoring
CXR leads to over diagnosis of PNA
Usually symptoms will develop by around seven hours after the incident
3 cm dog bite cleaned and closed in the operating room. Dog vaccinated. What antibiotics do you need?
Amoxicillin clavulanate for 3 to 5 days
What is becks triad? Tx?
Beck’s triad is a set of three clinical signs that indicate cardiac tamponade, a medical emergency that occurs when fluid builds up around the heart:
Low blood pressure (hypotension)
Bulging neck veins
Muffled or distant heartbeats
Pericardiocentesis
Patient with CP worse w a deep breath, better leaning forward, friction rub. Dx? Cause?
Pericarditis
Viruses like adenovirus
Patient with endocarditis (positive blood culture and vegetations). Treatment?
Need to use a bacteriocidal antibiotic. Vancomycin (clindamycin is bacteriostatic)
Viral URI prodrome which seems to improve but then leads to symptoms of heart failure. Dx and work up?
Cardiomyopathy - diagnostically need cardiac magnetic resonance imaging
In order for testing for CMV to be accurate in a neonate, it needs to be ordered no later than
3 weeks
It becomes difficult to differentiate between congenital CMV and postnatal acquired CMV
After placing an NG tube, what is the best way to confirm placement?
Radiographic verification
What to do when tracheostomy tubes are displace?
DOPE
The mnemonic DOPE is used to troubleshoot potential causes of acute deterioration in a patient on a ventilator, such as desaturation:
D: Displacement of the endotracheal tube from the trachea
O: Obstruction of the endotracheal tube or airways
P: Pneumothorax, pulmonary embolism, or pulmonary edema
E: Equipment failure
Patient with sickle cell disease and acute chest syndrome with new pulmonary infiltrate. Should start what additional med besides abx
Oseltamivir
Nephrotic syndrome puts patient in a hypercoagulable state. Gold standard if worried about PE is
CT with pulmonary angiography
Pt with MCAD with vomiting and diarrhea who is improving. How to manage fluids?
PO ad lib and D10 MIVF
Child suspected of having juvenile dermatomyositis, what is the test of choice?
MRI of proximal muscle
Patient with nephrotic syndrome. What can increase the risk of thromboembolism in this patient?
Increased hepatic production of factor 5 and 8 (pro)
Patient with severe neonatal alloimmune thrombocytopenia. Treatment?
Transfusion of random donor platelets
Presentation include cyanosis at less than two weeks of life. It’s caused by a right ventricular outflow of obstruction and ductal dependent pulmonary circulation. What are some examples and what is the initial management?
Tetralogy of fallot with significant pulmonary stenosis
Pulmonary atresia.
Critical pulmonary stenosis.
Epstein anomaly.
Initial management is prostaglandin E
This presentation will include a gray baby with systemic circulatory collapse/shock at less than two weeks of life. It’s caused by left ventricular outflow obstruction and is also ductal dependent. What are some examples and what is the initial management?
HLHS
Severe aortic stenosis.
Severe coarctation of the aorta.
Interrupted aortic arch
Pink babies present age 1-6 mos with symptoms of heart failure, tachypnea, and failure to thrive. There’s an increase left to right shunting as the PVR falls leads to increased pulmonary blood flow, which causes congestive heart failure. What are some examples and initial management?
PDA
VSD
AV canal defects.
Pink TOF.
Initial management is diuresis
Purple baby. Present with heart failure and mild cyanosis at age 1 to 6 months. They have a mixing lesion or obstructed pulmonary venous return which increases pulmonary blood flow. Examples and initial management?
Truncus arteriosus.
TAPVR
PAPVR
DORV
D-TGA with VSD
Baby cries and turns blue with pulse ox 68%. Dx?
TOF
Tet spell
Patient with decompensated heart failure, and cardiogenic shock may present with poor feeding, increase work of breathing, and fatigue with a viral prodrome. Diagnosis and cause?
Dilated cardiomyopathy.
Viral ideologies include Pavo B19, flu, Epstein-Barr, HIV, coxsackievirus, herpes, adenovirus
Genetic disease diseases, chemotherapy, idiopathic
Duke criteria for endocarditis
Need 2 major, 1 major and 3 minor, or 5 minor, positive pathology
BE TIMER
Blood Culture POSITIVE > 2 times 12 hrs
apart.
Echocardiographic evidence of Endocardial
Involvement
• Temperature > 38 ° C (Fever)
• Immunological phenomena (Osler’s nodes, Roth spots)
• Microbiological Evidence (Positive blood culture not
meeting a major criterion)
• Embolic Phenomenon (Arterial emboli, septic emboli, conjuctival hemorrhage &
painless skin lesions.)
• Risk Factors - (Congenital heart condition or IV drug use)
Presentation will include acute heart failure symptoms, perhaps mimicking MI with arrhythmias, sudden death, syncope. May have viral prodrome. Dx and gold standard for dx?
Myocarditis
Endomyocardial bx
First line is often echo. Cardiac MRI is good too
Chest pain, worse with deep breaths, and improved by sitting upright and leaning. forward. Viral prodrome
Pericarditis
PE pericardial friction rub (scratchy sound over the LSB), becks triad for tamponade
Treatment of pericarditis
High dose NSAIDs, colchicine possible adjunct for recurrent pericarditis
Management of SVT
If stable: vagal maneuvers, rapid bolus, adenosine followed by saline flush
If unstable: synchronized cardioversion, amiodarone/procainamide
Sudden Onset syncope with excitation or during exercise (boards like to use someone jumping into the pool to swim.). May have family history of sudden cardiac event. Torsades de pointes
Long QTc syndrome
Failed hearing screen, bilateral cataracts, and a murmur
Rubella. Half of them have a PDA.
What to remember about the AFP, hCG, estriol, and inhibin for neural tube effects, trisomy 21, trisomy 18
Neural tube defects will have an increased AFP (decreased in 21 and 18)
Trisomy 21 is the only one with increased hCG
Trisomy 18 is the only one where everything is decreased
Signs of nephrotic syndrome
Proteinuria, hypoalbuminemia, edema, hyperlipidemia
Inpatient treatment of pelvic inflammatory disease
Ceftriaxone Q 24, Doxy Q 12 and metronidazole Q 12
Cefoxitin Q6 and Doxy Q 12
Cefotetan Q 12 and Doxy Q 12
Clindamycin, Q6 and gentamycin Q8 (allergy)
Simple partial and complex partial seizures usually respond to what class of antiepileptics?
Sodium channel drugs, like oxycarbamazepine, carbamazepine, and phenytoin
Generalized seizures like absence seizures, myoclonic, atonic, generalized tonic clonic do not respond well to
sodium channel antiepileptics.
Who should you consider a lumbar puncture for after a febrile seizure?
If under one year-old or not vaccinated
Acute management for seizures
Benzodiazepines.
If that fails: keppra, valproic, fospheny, phenobarb loads
Most common causes of infectious meningitis from three months to 10 years
Strep pneumo-and then N meningitidis
Most common cause of infectious meningitis over 10 years old
First Neisseria and then strep pneumonia
What infectious complication can arise from having cochlear implants?
Meningitis due to pneumococcus
Chronic headaches are defined as
> 15 days a month for at least 3 mos
Medication overuse
Papilledema, headache, visual changes or vision loss, patient is on excessive vitamin A or tetracycline, has sleep apnea. Diagnosis and treatment.
Pseudotumor cerebri.
Lumber puncture is diagnostic and therapeutic.
MRI for imaging.
Treat with carbonic anhydrase inhibitors, diuretics, migraine medication’s
One sign on physical exam that could differentiate botulism from SMA
Kids with botulism will have paralyzed pupils and pupils are unaffected in SMA.
Both conditions will have constipation, hypotonia, decrease, poor, gag, dry mouth, etc..
What is the treatment for botulism stratified by less than one year-old and over one year-old?
Those that are less than a year get human derived botulism IG those are greater than a year equine serum botulism antitoxin
Patient with ascending weakness and you get an LP. What will you find?
Guillain Barre has cytoalbuminologic dissociation on lumber puncture >100-150 protein, <10 WBC
Weakness without sensory defects, presenting with weakness of eye muscles, slurred speech, difficulty swallowing. Diagnosis and cause and treatment?
Myasthenia gravis
Anti-acetylcholine receptor antibody
Treatment with anti-cholinesterase inhibitors and immunosuppressants.
Patient newly diagnosed with Duchene muscular dystrophy. What is the best step?
Always get an echo because there can be heart involvement.
You will also need to check CPK, muscle biopsy
Staph aureus producing epidermolytic toxin
Bullous impetigo
Staph aureus producing exfoliative toxin
Staph scalded skin syndrome
Target lesion with red outer and dusky center
Erythema multiforme
Absent thymic shadow on chest x-ray
Severe combined immunodeficiency
Lack of NADPH
Chronic granulomatous disease.
Nitroblue tetrazolium test or oxidative burst test
Failure of neutrophil migration. Persistent umbilical stump, abscesses without puss
Leukocyte adhesion deficiency
Dx of HIV in neonate
Neonates: Use HIV NAT like DNA PCR or RNA assay
Serial testing
Children: HIV antibody ELISA with confirmatory western Blot
