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
erythema multiforme is associated w. (3)
infectious
meds
AI
erythema marginatum is associataed w.
rheumatic fever
erythema migrans is pathognomonic for
lyme dz
erythema infectiousum is associated w.
parvovirus
common drugs that cause erythema multiforme
SOAPS:
sulfa
oral hypoglycemics
anticonvulsants
pcn
nsaids
mcc of erythema multiforme
HSV
erythema multiforme minor vs major
minor: localized w/ minimal/no mucosal involvement
major: one or more mm involved
estimating infant burn BSA
estimating child burns BSA
dx criteria for kawasaki
fever >/= 5 days
PLUS
4/5 CRASH:
conjunctivitis
rash
adenopathy
strawberry tongue
hand/foot edema
tx for kawasaki
IVIG
PLUS
asa
mc complications of varicella (chickenpox)
- bacterial skin infxn
- pneumonitis
- encephalitis
acyclovir can be used for varicella starting at age
> 12 yo
HOCM is autosomal _
dominant
describe HOCM murmur (3)
crescendo-decrescendo systolic
increases: valsalva
decreases: squatting
pharm for high risk HOCM pt’s (2)
bb
ccb
what murmurs increase w. inspiration
right sided:
tricuspid stenosis
pulmonary regurg
what is this showing
preseptal cellulitis
same same preorbital cellulitis
how to differentiate periorbital/preseptal cellulitis from orbital/septal cellulitis
preseptal does NOT involve the globe
tx for preseptal cellulitis
bactrim vs clinda
PLUS
amoxicillin vs augmentin vs cefpodoxime
mc route of infxn for preseptal/septal cellulitis
ethmoid sinuses
what is this showing
lichen planus
4 p’s of lichen planus
pruritic
purple
polygonal
papules
colarette scale
pityriasis rosea
where does lichen planus mc present (2)
ankles
wrists
wickham striae
white lines in rash -> lichen planus
tx for lichen planus
steroids
5 precipitating factors for DKA
infxn
nonadherence to insulin
MI
cocaine
SGLT2 inhibitors
dx criteria for dka (3)
BG > 250
anion gap metabolic acidosis
positive urine and plamsa ketones
2 lab findings of DKA
venous pH < 7.3
bicarb < 15
management of DKA
- NS
- add dex once BG < 200
- replenish K+
- IV insulin until anion gap closes
- subq insulin 2 hr prior to stoppin IV insulin
contraindication for IV insulin w. DKA
K + < 3.3
5 rf for AOM
viral URI
fam hx
daycare
tobacco smoke exposure
pacifier use
known protective factor for AOM
bf’ing
tx for AOM + TM perf
oral amoxicillin vs augmentin
mcc of intestinal obstruction in infants btw 6-36 mo old
intussusception
tx for intussusception
air or hydrostatic (contrast vs saline) enema
3 stages of lyme dz
- erythema migrans (viral prodrome)
- myocarditis, bilat bells palsy
- chronic arthritis, chronic encephalopathy
tx for lyme dz in peds
amoxicillin vs doxy (if used < 21 days)
2 pathognomonics for lyme
erythema migrans
bilat facial nerve palsy
scoliosis is caused by an idiopathic _ curvature of the spine
lateral
tx for scoliosis
cobb angle < 20: obs
cobb angle 20-49: bracing
cobb angle >/= 50: surgery
describe erythema multiforme
-target like rash
-central dark papule surrounded by a pale area and a halo of erythema
3 hallmarks of congenital toxoplasmosis
chorioetinitis
hydrocephalus
intracranial calcifications
prevention of congenital toxoplasmosis (3)
no raw/undercooked meat
wash f/v
do not change cat litter
tx for congenital toxoplasmosis
pyrimethamine
PLUS
sulfadiazine
PLUS
leucovorin
for baby and mom
rash that begins after a fever resolves
roseola infantum
blanching macular or maculopapular rash w. a distribution at the neck and trunk region that spreads to the face/extremities
roseola
pathogen associated w. peritonsillar abscess
- GAS
- s. aureus
5 characteristics of innocent murmurs
grade </= 2 intensity
relieved when supine
short systolic
minimal radiation
musical/vibratory
murmurs w. </= 2 intensity can be described as (2)
still
flow
what med when taken during pregnancy is associated w. pyloric stenosis
erythromycin
reduction of nursemaid’s elbow (2)
hyperpronate
vs
supinate-flex
flu vaccination recs
> /= 6 mos: annually
6 mos - 8 yo: 2 doses for first season of vaccination
dx of vitamin D deficiency is made through what test
25OHD (serum 25-hydroxyvitamin D) < 12
tx of vitamin D deficiency in kids > 12 mo old
initial: vit D 50 mcg qd x at least 6 weeks
maintenance: 600-1,000 IU qd
dx criteria for CF
clinical features
PLUS
elevated sweat chloride > 60
dx criteria for systemic juvenile idiopathic arthritis
persistent, unexplained arthritis in >/= 1 joint x 6 weeks in kid < 16 yo
fever x at least 2 weeks
which juvenile arthritis is associated w. uveitis
oligoarticular
describe the rash associated w. systemic juvenile idiopathic arthritis
salmon colored
transient w. fever
evanescent
what does quotidian fever + joint pain make you think of
systemic juvenile idiopathic arthritis
complication of systemic juvenile idiopathic arthritis
macrophage activation syndrome
common complication of influenza
AOM
infants should double their birthweight in _ mos,
and triple their birthweight in _ mos
double: 4 mos
triple: 12 mos
when should the modified checklist for autism in toddlers (MCHAT) be administered
18 mos
24 mos
moderate risk kids should get second stage of questionaire
what are the two autism screening tools to know
MCHAT: 18 mos, 24 mos
developmental behavior checklist: 4-18 yo WITH disabilities
when should PHQ be used in kids
> /= 12 yo
when is the pediatric symptom checklist used
3-18 yo
identifies emotional/behavioral probs
describe uticaria
raised, erythematous plaques
uticaria is _ cell mediated rxn to an allergen
IgE
when would you use steroids for uticaria
if associated w. angioedema
pansystolic murmur best heard at the LSB in the 3rd/4th ICS
VSD
tx for VSD
most close spontaneously by adulthood
pathogens associated w. bacterial endocarditis: R vs L
R: s. aureus
L: strep viridans, s. aureus
what is this showing
blotchy, erythematous patches w. central pustules -> erythema toxicum neonatorum
dx for erythema toxicum neonatorum
wright-stained smear showing numerous eosinophils
white papules on neonates caused by retention of keratin and sebaceous material in pilosebaceous follicles
milia
what increases the murmur heard w. VSD
increases: hand gripping/squatting
malignant otitis externa is caused by
pseudomonas
resolution of reflexes:
moro:
palmar grasp:
rooting:
parachute:
rooting: 2-3 mos
palmar grasp: 3-4 mos
moro: 3-6 mos
parachute: persists throughout life
infant is held upright w. back to examiner - body is rotate quickly forward as if falling - infant reflexively extends upper extremities towards the ground as if to break a fall
parachute reflex
prominent LAD plus cephalocaudal spreading rash
rubella
rash, microcephaly, IUGR, heaptosplenomegaly
congenital CMV
sensorineural hearing loss, periventricular calcifications, blueberry muffin rash
congenital CMV
what is this showing
thrombocytopenia, petechiae, purpura -> blueberry muffin rash -> congenital CMV
3 complications of congenital rubella
senosirneural hearing loss
heart dz
congenital cataract
what is this showing
wilms tumor
describe wilms tumor
hard, round, smooth, nontender mass that does not cross midline
what 3 congenital abnl’s are associated w. wilms tumor
WAGR
denys-drash syndrome
beckwith-wiedemann syndrome
age range associated w. wilms tumor
< 15 yo
<15 yo kid w. abd pain, anorexia, abd distension, vomiting, hematuria
wilms tumor
mc solid kidney tumor of childhood
wilms tumor
newborns shold pass meconium w.in
48 hr
by what age should kids have a daily BM
3 yo
absent stool in vault makes you think
hirschprung
common presentation of functional constipation (4)
toilet training
stool withholding behaviors
painful BM
large bulky stool
tx for functional constipation (3)
osmotic laxatives: polyethylene glycol, lactulose
stimulants: senna, bisacodyl
stool softeners: docusate
t/f: fleet enema is contraindicated in infants
t!
due to hypocalcemia
fever followed by rash =
roseola
why can’t i remember this
tx for varicella
< 12 yo: supportive
immunocompromised OR > 12 yo: acyclovir
mc pna pathogen by age
0-3 wk: GBS, e.coli, listeria, s.aureus
3wk-3 mos: chlamydia trachomatis
1 mo-5 yo: RSV
6-8 yo: mycoplasma pna
early s/sx of autisim
-parental concerns about social skills/language/behavior/tantrums/intolerance to change
-delayed language/communication skills
-no babbling by 9 mos
-no pointing/gestures by 12 mos
-lack of orientation to name by 12 mos
-no single words by 16 mos
-lack of pretend/symbolic play by 18 mos
-no spontaneous/meaningful 2 word phrases by 24 mos
-any loss of language/social skills at any age
2 screenings recommended in pt w. suspected autism or developmental delay
audiologic
lead
mcc of anemia in infants btw 6-9 weeks old
physiologic anemia
suspect _ toxicity in victims of industrial fires
CN
describe parotitis associated w. mumps
unilateral parotid swelling and tenderness that becomes bilateral
physical characteristics of fanconi anemia (8)
absent or hypoplastic thumb
short stature
low set ears
deafness
strabismus
skin hyper vs hypopigmentation
cafe au lait spots
kidney abnl
lab findings of fanconi anemia
macrocytic anemia
elevatee fetal Hgb
mc form of inherited aplastic anemia
fanconi anemia
what is this showing
SJS
drugs associated w. SJS
sulfas
antiepileptics
allopurinol
nsaids
prodrom of SJS (4)
cutaneous lesions
mucosal lesions
urethritis
flu-like
h/o recent viral infxn
non-blanching petechiae/purpura
gingival bleeding
thrombocytopenia
primary immune thrombocytopenia
tx for primary immune thrombocytopenia (4)
activity restriction
obs
glucocorticoids + IVIG
severe: IV anti-D
what med exacerbates hypercalcemia
hctz
hallmark hpi clue for rubella
child born to mom who immigrated
mc congenital anomaly of the GIT
meckel diverticulum
incomplete obliteration of the omphalomesenteric (vitelline) duct during the 7th week of gestation
meckel diverticulum
gs dx for meckel diverticulum
technetium scan
rule of 2’s for meckel diverticulum (5)
2 yo
2 ft from ileocecal valve
2” long
2% of population
2 epithelial types (gastric vs pancreatic)
presentation of meckel diveritculum
< 5 yo
painless rectal bleeding
APGAR score
when is apgar calculated
1 and 5 min after birth
HPV vaccination schedule
9-14 yo: 2 doses -> 0, 6-12 mo
15-45 yo: 3 does -> 0, 2, 6 mo
moa for ethosuximide
inhibits firing patterns by binding to t-type voltage sensitive calcium channels that mediate the entry of calcium ions into excitable cells
only oral DM med approved for kiddos
metformin
moa for metformin
-decreases hepatic glucose production and intestinal glucose absorption
-increases insulin sensitivity
moa for fetal coarctation of the aorta in utero
blood flow thru the PDA bypasses aortic coarctation -> results in hemodynamic instablity
2 rf for cryptochordism
low birth weight
prematurity
indications for emergent surgery w. inguinal hernias (4)
toxic
peritonitis
intestinal obstruction
gangrenous bowel
otherwise try to manually reduce
rapid fire repetitive coughing followed by an inspiratory stridor and post tussive emesis
pertussis
indications for emergent hospitalization w. suicidal ideations (4)
having a plan
expressing imminent intent for self harm
access to planned means to attempt suicide
inability to contract for safety
rf for suicide
sad persons:
sex - male
age - teenage vs >/= 45
dpn
previous attempt
ethanol or drugs
rational thinking loss
social support lacking
organized plan
no spouse
sickness
2 protective factors against suicide
marriage
pregnancy
most completed suicides involve what means
firearms
hearing screening test for kids 4-21 yo (3)
pure tone audiometry
OAE testing
tympanometry
one at every WCC
all infants w. sensorineural hearing loss should be tested for
cmv
what PE test for hip dysplasia shows uneven knee heights
galeazzi
3 indications for US at 4-6 weeks to evaluate for hip dysplasia
breech at > 34 weeks
FH DDH
hx clinical instability on exam
mcc of developmental hip dysplasia
decreased pressure of femoral head against acetabulum -> shallow socket
tx for otitis conjunctivitis syndrome
augmentin
tx for cystitis in kiddos
- cephalosporins
- bactrim if pcn allergy
tx for enterobiasis/pinworm
albendazole
tx for poison ivy dermatitis
clobetasol propionate 0.05% ointment bid x 14 days
low dose topical steroids won’t work
4 mc agents associated w. allergic contact dermatitis
nickel
poison ivy
soaps
neomycin
5 irritants mc associated w. irritant contact dermatitis
water
detergents
solvents
acids
alkali
lab value associated w. adult RA, but rarely seen in idiopathic juvenile arthritis
RF