Rosh Stuff I Got Wrong (aka Murmurs and Derm) (Alice) Flashcards
mc pathogen associated w. bacterial meningitis based on age
neonates (</= 1 mo): e. coli, GBS
children (> 1 mo - 18 yo): s. pneumo, n. meningitidis
tx for pediatric meningitis based on age
neonate (</= 1mo): cefoxatime/gentamicin PLUS ampicillin
children (> 1 mo - 18): cefotaxime/ceftriaxone PLUS vanco
continuous cardiac murmur heard best at the infraclavicular region - softens w. supine and intensifies w. extension of head in seated position
vervical venous hum
innocent cardiac murmur w. vibratory or musical quality - heard best over lower left sternal border
still murmur
ASD results from increased flow across the _ valve 2/2 to _ shunting
pulmonary valve
left to right shunting
mc congenital heart defect
VSD
t/f: asthma is classified as a reversible obstructive airway disease
t!
bronchodilators and avoidance of allergens restore airways to normal diameter
known asthma triggers (8)
-respiratory infxns
-allergens (food vs inhaled vs ocupational)
-inhaled irritants (tobacco/cold dry air)
-temp/weather
-PA
-hormonal fluctuations
-meds
-emotional stressors
what meds exacerbate asthma (4)
ASA
NSAIDs
nonselective bb
ACEI
what murmur is associated w. TOF
harsh systolic crescendo-decrescendo at LSB
TOF murmur is worse w _ (2)
and is caused by _ outflow obstruction
crying/feeding
pulmonary obstruction
TOF murmur is relieved by
squatting
increases SVR
4 defects of TOF
PROVe
1. pulmonic stenosis
2. RV hypertrophy
3. overriding aorta
4. VSD
mc cyanotic congenital heart dz in childhood
TOF
2 HPI hallmarks of TOF
cyanotic/tet spells
squatting for relief
mc chromosomal abnl among liveborn infants
down syndrome
8 physical characteristics of down syndrom rosh stresses
brushfield spots (periphery of iris)
developmental delay
heart defects
large tongue
poor muscle tone
sandal toe deformity
single palmar crease
upward slanting eyes
congenital heart defect mc in pt w. down syndrome
complete ASD
gene associated w. CF
cystif fibrosis transmembrane conductance regulator -> CFTR
3 complications of CF to know
malabsorption (ADEK)
steatorrhea
pancreatic insufficiency
kid w. CF might also have _ on PE
nasal polyps
management of CF (6)
chest physiotherapy
bronchodilators
DNAse
pancreatic enzymes
anti pseudomonas abx
lung transplant
what is this showing
figure 3 sign -> coarctation of the aorta
4 sx of coarctation
HTN
pulsus paradoxus
HF sx
systolic murmur
ECG finding of coarctation
LVH
3 conditions associated w. coarctation
turner syndrome
bicuspid aortic valve
intracranial aneurysms
abrupt, rapid upstroke of peripheral pulse (percussion wave) followed by rapid collapse
water hammer pulse -> chronic aortic regurgitation
pulsus alternans/alternating beats is associated w.
HOCM
pulsus paradoxus is associated w.
cardiac tamponade
systolic murmur w. apical ejection click in left axilla w. radiation to interscapular area
coarctation
mcc of mitral stenosis worldwide
rheumatic fever
mc seen valvular pathology associated w. rheumatic heard dz
mitral regurgitation
midsystolic click
mitral valve prolapse
early diastolic high frequency snap
mitral stenosis
murmur associated w. rheumatic fever/mitral regurg
pansystolic
what is this showing
molluscum contagiousum
describe molluscum contagiousum (4)
small skin colored papules
umbilicated
central keratin plug
+/- prurutis/inflammation
molluscum contagiousum is caused by a _virus
pox
molluscum contagiosum is painless and mc appears on the _ (3)
it spares the _ (2)
face
torso
extremeties
spares: palms/soles
management of pediatric molluscum contagiousm (3)
self resolves
cryotherapy
curretage
congenital adrenal hyperplasia is caused by a mutation of the _ gene
and a deficiency of _
CYP21A2
21 hydroxylase
tx for congenital adrenal hyperplasia
hydrocortisone
fludrocortisone
NaCl
common presentation of congenital adrenal hyperplasia (4)
genital atypia
labial fusion
urogenital sinus
clitoral enlargement
rash associated w. n meningitidis
macular, non blanchable rash
petechiae/purpura fulminans
tx for n meningitidis
ceftriaxone asap
what is this showing
sunburst pattern -> perisosteal rxn -> osteosarcoma
mc sites affected by osteosarcoma
long bones (mc -> least common)
1. distal femur
2. proximal tibia
3. proximal humerus
4. middle/proximal femur
common presentation of osteosarcoma (3)
localized pain x several months
pain after injury
large, ttp soft tissue mass
pt w. osteosarcoma will be _ yo
10-20
2 XR findings of osteosarcoma
sunburst
codman triangle
5 common causes of allergic contact dermatitis
plants
metals
topical antimicrobials
fragrances
preservatives
describe rash associated w. allergic contact dermatitis
discrete red papules w. scaling edges
tx for allergic contact dermatitis (3)
topical steroids x 2-3 weeks
> 20% skin involvement: systemic steroids
antihistamines
mc source of epistaxis: anterior vs posterior
anterior: kiesselbach plexus
posterior: sphenopalatine a
tx for anterior nosebleed
- direct pressure
- oxymetazoline
- silver nitrate cautery
- packing
abrupt onset of severe HA, photophobia, vomiting, diarrhea, myalgia
PLUS
blanchable maculopapular reuption on palms/soles
RMSF (rickettsia rickettsii)
tx for RMSF for everyone, even kiddos
doxy…
always… don’t even think about anything else
similar to croup, but more toxic appearing
bacterial tracheitis
pathogen mc associated w. bacterial tracheitis
s. aureus
common presentation of bacterial tracheitis (7)
younger kid
fever
barking cough
stridor
rapid progression
pseudomembrane
mucopurulent secretions
management of bacterial tracheitis (4)
airway emergency
IV abx
IVF
bronchoscopy
indications for emergent care w. croup (4)
marked retractions
significant resp distress
stridor at rest
repeated doses of dex/epi
indicaton for dex/racemic epi for croup (3)
frequent barking cough
stridor at rest
mild-mod retractions
mc type of chronic obstructive airway dz
bronchiectasis
bronchiectasis makes you think of what pediatric pop
CF
common presentation of bronchiectasis
chronic cough w. foul smelling sputum
hemoptysis
repeated resp infxns
crackles/wheezing
CF
dx for bronchiectasis
CT
what is this showing
tram track appearance -> thickened bronchial walls -> bronchiectasis
3 CT findings of bronchiectasis
tram tracking
signet-ring sign (jewel on the ring)
tree in bud (air trapping)
BMI should be used in peds starting at what age
2
overweight/obese BMI parameters for >/= 2 yo
overweight: 85-94th %ile
obese: >/= 95th %ile
how to evaluate obesity in kids < 2 yo
height for weight
overweight: >/= 95th %ile
presentation of SSSS
-fever, prodrome, rash w. peeling skin
-erythroderma, large, flaccid bullae, desquamation
t/f: nikolsky sign is positive w. SSSS
t!
thick perioral crusting w. dried oatmeal appearance
hallmark of SSSS
first line tx for SSSS
nafcilin
oxacillin
pathogenesis of osgood schlatter dz
repetitive strain at the tibial tubercle apophysis
common presentation of osgood schlatter (3)
10-15 yo athlete
knee pain while running
tenderness over tibial tubercle
describe paraphimosis
swollen glans penis w. a constricting band just proximal to the corona
mcc of death and disability due to child abuse
abusive head trauma
moi for abusive head trauma (2)
blunt trauma
shaking
5 red flags for abusive head trauma
-lethargic
-difficulty breathing
-sz
-moi inappropriate for age (ex 9 mo old climbing out of crib)
-self inflicted injury
parental rf for abuse (5)
substance use
psych illness
young parents
single parents
victims of abuse
4 rf in kids for abuse
mental/physical disability
ftt
chronic illness
prematurity
_ is found in most peds who are victims of abusive head trauma
retinal hemorrhages
t/f: the severity of retinal hemorrhages correlates w. likelihood of abuse
t!
knee pain in a rapidly growing adolescent
osgood schlatter
scarlet fever/scarlatina triad
cirumoral pallor
strawberry tongue
pastia lines
what is this showing
pastia lines -> scarlet fever
scarlet fever is caused by
strep pyogenes
what type of rash is associated w. scarlet fever
sandpaper
2 complications of scarlet fever
PSGN
rheumatic fever
what med reduces fetus mortality/morbidity in hyaline membrane dz
dexamethasone
3 core features of anorexia
restriction -> low body weight
intense fear of gaining wt -> behavior mods
disturbance in body image
pathophys of refeeding syndrome
high BG -> high insulin -> increased cellular reuptake of phosphate -> hypophosphatemia
sx of refeeding syndrome
hypophosphatemia
hypokalemia
thiamine deficiency
HF
peripheral edema
5 types of erythema rashes
multiforme -> target
marginatum -> central clearing
nodosum -> nodules
migrans -> bull’s eye
infectiousum -> slapped cheek