Rosh Stuff I Got Wrong (aka Murmurs and Derm) (Alice) Flashcards
1
Q
mc pathogen associated w. bacterial meningitis based on age
A
neonates (</= 1 mo): e. coli, GBS
children (> 1 mo - 18 yo): s. pneumo, n. meningitidis
2
Q
tx for pediatric meningitis based on age
A
neonate (</= 1mo): cefoxatime/gentamicin PLUS ampicillin
children (> 1 mo - 18): cefotaxime/ceftriaxone PLUS vanco
3
Q
continuous cardiac murmur heard best at the infraclavicular region - softens w. supine and intensifies w. extension of head in seated position
A
vervical venous hum
4
Q
innocent cardiac murmur w. vibratory or musical quality - heard best over lower left sternal border
A
still murmur
5
Q
ASD results from increased flow across the _ valve 2/2 to _ shunting
A
pulmonary valve
left to right shunting
6
Q
mc congenital heart defect
A
VSD
7
Q
t/f: asthma is classified as a reversible obstructive airway disease
A
t!
bronchodilators and avoidance of allergens restore airways to normal diameter
8
Q
known asthma triggers (8)
A
-respiratory infxns
-allergens (food vs inhaled vs ocupational)
-inhaled irritants (tobacco/cold dry air)
-temp/weather
-PA
-hormonal fluctuations
-meds
-emotional stressors
9
Q
what meds exacerbate asthma (4)
A
ASA
NSAIDs
nonselective bb
ACEI
10
Q
what murmur is associated w. TOF
A
harsh systolic crescendo-decrescendo at LSB
11
Q
TOF murmur is worse w _ (2)
and is caused by _ outflow obstruction
A
crying/feeding
pulmonary obstruction
12
Q
TOF murmur is relieved by
A
squatting
increases SVR
13
Q
4 defects of TOF
A
PROVe
1. pulmonic stenosis
2. RV hypertrophy
3. overriding aorta
4. VSD
14
Q
mc cyanotic congenital heart dz in childhood
A
TOF
15
Q
2 HPI hallmarks of TOF
A
cyanotic/tet spells
squatting for relief
16
Q
mc chromosomal abnl among liveborn infants
A
down syndrome
17
Q
8 physical characteristics of down syndrom rosh stresses
A
brushfield spots (periphery of iris)
developmental delay
heart defects
large tongue
poor muscle tone
sandal toe deformity
single palmar crease
upward slanting eyes
18
Q
congenital heart defect mc in pt w. down syndrome
A
complete ASD
19
Q
gene associated w. CF
A
cystif fibrosis transmembrane conductance regulator -> CFTR
20
Q
3 complications of CF to know
A
malabsorption (ADEK)
steatorrhea
pancreatic insufficiency
21
Q
kid w. CF might also have _ on PE
A
nasal polyps
22
Q
management of CF (6)
A
chest physiotherapy
bronchodilators
DNAse
pancreatic enzymes
anti pseudomonas abx
lung transplant
23
Q
what is this showing
A
figure 3 sign -> coarctation of the aorta
24
Q
4 sx of coarctation
A
HTN
pulsus paradoxus
HF sx
systolic murmur
25
ECG finding of coarctation
LVH
26
3 conditions associated w. coarctation
turner syndrome
bicuspid aortic valve
intracranial aneurysms
27
abrupt, rapid upstroke of peripheral pulse (percussion wave) followed by rapid collapse
water hammer pulse -> chronic aortic regurgitation
28
pulsus alternans/alternating beats is associated w.
HOCM
29
pulsus paradoxus is associated w.
cardiac tamponade
30
systolic murmur w. apical ejection click in left axilla w. radiation to interscapular area
coarctation
31
mcc of mitral stenosis worldwide
rheumatic fever
32
mc seen valvular pathology associated w. rheumatic heard dz
mitral regurgitation
33
midsystolic click
mitral valve prolapse
34
early diastolic high frequency snap
mitral stenosis
35
murmur associated w. rheumatic fever/mitral regurg
pansystolic
36
what is this showing
molluscum contagiousum
37
describe molluscum contagiousum (4)
small skin colored papules
umbilicated
central keratin plug
+/- prurutis/inflammation
38
molluscum contagiousum is caused by a _virus
pox
39
molluscum contagiosum is painless and mc appears on the _ (3)
it spares the _ (2)
face
torso
extremeties
spares: palms/soles
40
management of pediatric molluscum contagiousm (3)
self resolves
cryotherapy
curretage
41
congenital adrenal hyperplasia is caused by a mutation of the _ gene
and a deficiency of _
CYP21A2
21 hydroxylase
42
tx for congenital adrenal hyperplasia
hydrocortisone
fludrocortisone
NaCl
43
common presentation of congenital adrenal hyperplasia (4)
genital atypia
labial fusion
urogenital sinus
clitoral enlargement
44
rash associated w. n meningitidis
macular, non blanchable rash
petechiae/purpura fulminans
45
tx for n meningitidis
ceftriaxone asap
46
what is this showing
sunburst pattern -> perisosteal rxn -> **osteosarcoma**
47
mc sites affected by osteosarcoma
long bones (mc -> least common)
1. distal femur
2. proximal tibia
3. proximal humerus
4. middle/proximal femur
48
common presentation of osteosarcoma (3)
localized pain x several months
pain after injury
large, ttp soft tissue mass
49
pt w. osteosarcoma will be _ yo
10-20
50
2 XR findings of osteosarcoma
sunburst
codman triangle
51
5 common causes of allergic contact dermatitis
plants
metals
topical antimicrobials
fragrances
preservatives
52
describe rash associated w. allergic contact dermatitis
discrete red papules w. scaling edges
53
tx for allergic contact dermatitis (3)
topical steroids x 2-3 weeks
> 20% skin involvement: systemic steroids
antihistamines
54
mc source of epistaxis: anterior vs posterior
anterior: kiesselbach plexus
posterior: sphenopalatine a
55
tx for anterior nosebleed
1. direct pressure
2. oxymetazoline
3. silver nitrate cautery
4. packing
56
abrupt onset of severe HA, photophobia, vomiting, diarrhea, myalgia
PLUS
blanchable maculopapular reuption on palms/soles
RMSF (rickettsia rickettsii)
57
tx for RMSF for everyone, even kiddos
doxy...
always... don't even think about anything else
58
similar to croup, but more toxic appearing
bacterial tracheitis
59
pathogen mc associated w. bacterial tracheitis
s. aureus
60
common presentation of bacterial tracheitis (7)
younger kid
fever
barking cough
stridor
rapid progression
pseudomembrane
mucopurulent secretions
61
management of bacterial tracheitis (4)
airway emergency
IV abx
IVF
bronchoscopy
62
indications for emergent care w. croup (4)
marked retractions
significant resp distress
stridor at rest
repeated doses of dex/epi
63
indicaton for dex/racemic epi for croup (3)
frequent barking cough
stridor at rest
mild-mod retractions
64
mc type of chronic obstructive airway dz
bronchiectasis
65
bronchiectasis makes you think of what pediatric pop
CF
66
common presentation of bronchiectasis
chronic cough w. foul smelling sputum
hemoptysis
repeated resp infxns
crackles/wheezing
CF
67
dx for bronchiectasis
CT
68
what is this showing
tram track appearance -> thickened bronchial walls -> bronchiectasis
69
3 CT findings of bronchiectasis
tram tracking
signet-ring sign (jewel on the ring)
tree in bud (air trapping)
70
BMI should be used in peds starting at what age
2
71
overweight/obese BMI parameters for >/= 2 yo
overweight: 85-94th %ile
obese: >/= 95th %ile
72
how to evaluate obesity in kids < 2 yo
height for weight
overweight: >/= 95th %ile
73
presentation of SSSS
-fever, prodrome, rash w. peeling skin
-erythroderma, large, flaccid bullae, desquamation
74
t/f: nikolsky sign is positive w. SSSS
t!
75
thick perioral crusting w. dried oatmeal appearance
hallmark of SSSS
76
first line tx for SSSS
nafcilin
oxacillin
77
pathogenesis of osgood schlatter dz
repetitive strain at the tibial tubercle apophysis
78
common presentation of osgood schlatter (3)
10-15 yo athlete
knee pain while running
tenderness over tibial tubercle
79
describe paraphimosis
swollen glans penis w. a constricting band just proximal to the corona
80
mcc of death and disability due to child abuse
abusive head trauma
81
moi for abusive head trauma (2)
blunt trauma
shaking
82
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
83
parental rf for abuse (5)
substance use
psych illness
young parents
single parents
victims of abuse
84
4 rf in kids for abuse
mental/physical disability
ftt
chronic illness
prematurity
85
_ is found in most peds who are victims of abusive head trauma
retinal hemorrhages
86
t/f: the severity of retinal hemorrhages correlates w. likelihood of abuse
t!
87
knee pain in a rapidly growing adolescent
osgood schlatter
88
scarlet fever/scarlatina triad
cirumoral pallor
strawberry tongue
pastia lines
89
what is this showing
pastia lines -> scarlet fever
90
scarlet fever is caused by
strep pyogenes
91
what type of rash is associated w. scarlet fever
sandpaper
92
2 complications of scarlet fever
PSGN
rheumatic fever
93
what med reduces fetus mortality/morbidity in hyaline membrane dz
dexamethasone
94
3 core features of anorexia
restriction -> low body weight
intense fear of gaining wt -> behavior mods
disturbance in body image
95
pathophys of refeeding syndrome
high BG -> high insulin -> increased cellular reuptake of phosphate -> hypophosphatemia
96
sx of refeeding syndrome
**hypophosphatemia**
hypokalemia
thiamine deficiency
HF
peripheral edema
97
5 types of erythema rashes
multiforme -> target
marginatum -> central clearing
nodosum -> nodules
migrans -> bull's eye
infectiousum -> slapped cheek
98
erythema multiforme is associated w. (3)
infectious
meds
AI
99
erythema marginatum is associataed w.
rheumatic fever
100
erythema migrans is pathognomonic for
lyme dz
101
erythema infectiousum is associated w.
parvovirus
102
common drugs that cause erythema multiforme
**SOAPS:**
sulfa
oral hypoglycemics
anticonvulsants
pcn
nsaids
103
mcc of erythema multiforme
HSV
104
erythema multiforme minor vs major
minor: localized w/ minimal/no mucosal involvement
major: one or more mm involved
105
estimating infant burn BSA
106
estimating child burns BSA
107
dx criteria for kawasaki
**fever >/= 5 days**
PLUS
**4/5 CRASH:**
conjunctivitis
rash
adenopathy
strawberry tongue
hand/foot edema
108
tx for kawasaki
IVIG
PLUS
asa
109
mc complications of varicella (chickenpox)
1. bacterial skin infxn
2. pneumonitis
3. encephalitis
110
acyclovir can be used for varicella starting at age
> 12 yo
111
HOCM is autosomal _
dominant
112
describe HOCM murmur (3)
crescendo-decrescendo systolic
increases: valsalva
decreases: squatting
113
pharm for high risk HOCM pt's (2)
bb
ccb
114
what murmurs increase w. inspiration
right sided:
tricuspid stenosis
pulmonary regurg
115
what is this showing
preseptal cellulitis
*same same preorbital cellulitis*
116
how to differentiate periorbital/preseptal cellulitis from orbital/septal cellulitis
preseptal does NOT involve the globe
117
tx for preseptal cellulitis
bactrim vs clinda
PLUS
amoxicillin vs augmentin vs cefpodoxime
118
mc route of infxn for preseptal/septal cellulitis
ethmoid sinuses
119
what is this showing
lichen planus
120
4 p's of lichen planus
pruritic
purple
polygonal
papules
121
colarette scale
pityriasis rosea
122
where does lichen planus mc present (2)
ankles
wrists
123
wickham striae
white lines in rash -> lichen planus
124
tx for lichen planus
steroids
125
5 precipitating factors for DKA
infxn
nonadherence to insulin
MI
cocaine
SGLT2 inhibitors
126
dx criteria for dka (3)
BG > 250
anion gap metabolic acidosis
positive urine and plamsa ketones
127
2 lab findings of DKA
venous pH < 7.3
bicarb < 15
128
management of DKA
1. NS
2. add dex once BG < 200
3. replenish K+
4. IV insulin until anion gap closes
5. subq insulin 2 hr prior to stoppin IV insulin
129
contraindication for IV insulin w. DKA
K + < 3.3
130
5 rf for AOM
viral URI
fam hx
daycare
tobacco smoke exposure
pacifier use
131
known protective factor for AOM
bf'ing
132
tx for AOM + TM perf
oral amoxicillin vs augmentin
133
mcc of intestinal obstruction in infants btw 6-36 mo old
intussusception
134
tx for intussusception
air or hydrostatic (contrast vs saline) enema
135
3 stages of lyme dz
1. erythema migrans (viral prodrome)
2. myocarditis, bilat bells palsy
3. chronic arthritis, chronic encephalopathy
136
tx for lyme dz in peds
amoxicillin vs doxy (if used < 21 days)
137
2 pathognomonics for lyme
erythema migrans
bilat facial nerve palsy
138
scoliosis is caused by an idiopathic _ curvature of the spine
lateral
139
tx for scoliosis
cobb angle < 20: obs
cobb angle 20-49: bracing
cobb angle >/= 50: surgery
140
describe erythema multiforme
-target like rash
-central dark papule surrounded by a pale area and a halo of erythema
141
3 hallmarks of congenital toxoplasmosis
chorioetinitis
hydrocephalus
intracranial calcifications
142
prevention of congenital toxoplasmosis (3)
no raw/undercooked meat
wash f/v
do not change cat litter
143
tx for congenital toxoplasmosis
pyrimethamine
PLUS
sulfadiazine
PLUS
leucovorin
for baby and mom
144
rash that begins after a fever resolves
roseola infantum
145
blanching macular or maculopapular rash w. a distribution at the neck and trunk region that spreads to the face/extremities
roseola
146
pathogen associated w. peritonsillar abscess
1. GAS
2. s. aureus
147
5 characteristics of innocent murmurs
grade
148
murmurs w.
still
flow
149
what med when taken during pregnancy is associated w. pyloric stenosis
erythromycin
150
reduction of nursemaid's elbow (2)
hyperpronate
vs
supinate-flex
151
flu vaccination recs
>/= 6 mos: annually
>6 mos - 8 yo: 2 doses for first season of vaccination
152
dx of vitamin D deficiency is made through what test
25OHD (serum 25-hydroxyvitamin D) < 12
153
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
154
dx criteria for CF
clinical features
PLUS
elevated sweat chloride > 60
155
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
156
which juvenile arthritis is associated w. uveitis
oligoarticular
157
describe the rash associated w. systemic juvenile idiopathic arthritis
salmon colored
transient w. fever
evanescent
158
what does quotidian fever + joint pain make you think of
systemic juvenile idiopathic arthritis
159
complication of systemic juvenile idiopathic arthritis
macrophage activation syndrome
160
common complication of influenza
AOM
161
infants should double their birthweight in _ mos,
and triple their birthweight in _ mos
double: 4 mos
triple: 12 mos
162
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*
163
what are the two autism screening tools to know
MCHAT: 18 mos, 24 mos
developmental behavior checklist: 4-18 yo WITH disabilities
164
when should PHQ be used in kids
>/= 12 yo
165
when is the pediatric symptom checklist used
3-18 yo
identifies emotional/behavioral probs
166
describe uticaria
raised, erythematous plaques
167
uticaria is _ cell mediated rxn to an allergen
IgE
168
when would you use steroids for uticaria
if associated w. angioedema
169
pansystolic murmur best heard at the LSB in the 3rd/4th ICS
VSD
170
tx for VSD
most close spontaneously by adulthood
171
pathogens associated w. bacterial endocarditis: R vs L
R: s. aureus
L: strep viridans, s. aureus
172
what is this showing
blotchy, erythematous patches w. central pustules -> **erythema toxicum neonatorum**
173
dx for erythema toxicum neonatorum
wright-stained smear showing numerous eosinophils
174
white papules on neonates caused by retention of keratin and sebaceous material in pilosebaceous follicles
milia
175
what increases the murmur heard w. VSD
increases: hand gripping/squatting
176
malignant otitis externa is caused by
pseudomonas
177
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
178
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
179
prominent LAD plus cephalocaudal spreading rash
rubella
180
rash, microcephaly, IUGR, heaptosplenomegaly
congenital CMV
181
sensorineural hearing loss, periventricular calcifications, blueberry muffin rash
congenital CMV
182
what is this showing
thrombocytopenia, petechiae, purpura -> blueberry muffin rash -> congenital CMV
183
3 complications of congenital rubella
senosirneural hearing loss
heart dz
congenital cataract
184
what is this showing
wilms tumor
185
describe wilms tumor
hard, round, smooth, nontender mass that does not cross midline
186
what 3 congenital abnl's are associated w. wilms tumor
WAGR
denys-drash syndrome
beckwith-wiedemann syndrome
187
age range associated w. wilms tumor
< 15 yo
188
<15 yo kid w. abd pain, anorexia, abd distension, vomiting, hematuria
wilms tumor
189
mc solid kidney tumor of childhood
wilms tumor
190
newborns shold pass meconium w.in
48 hr
191
by what age should kids have a daily BM
3 yo
192
absent stool in vault makes you think
hirschprung
193
common presentation of functional constipation (4)
toilet training
stool withholding behaviors
painful BM
large bulky stool
194
tx for functional constipation (3)
osmotic laxatives: polyethylene glycol, lactulose
stimulants: senna, bisacodyl
stool softeners: docusate
195
t/f: fleet enema is contraindicated in infants
t!
due to hypocalcemia
196
fever followed by rash =
roseola
*why can't i remember this*
197
tx for varicella
< 12 yo: supportive
immunocompromised OR > 12 yo: acyclovir
198
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
199
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
200
2 screenings recommended in pt w. suspected autism or developmental delay
audiologic
lead
201
mcc of anemia in infants btw 6-9 weeks old
physiologic anemia
202
suspect _ toxicity in victims of industrial fires
CN
203
describe parotitis associated w. mumps
unilateral parotid swelling and tenderness that becomes bilateral
204
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
205
lab findings of fanconi anemia
macrocytic anemia
elevatee fetal Hgb
206
mc form of inherited aplastic anemia
fanconi anemia
207
what is this showing
SJS
208
drugs associated w. SJS
sulfas
antiepileptics
allopurinol
nsaids
209
prodrom of SJS (4)
cutaneous lesions
mucosal lesions
urethritis
flu-like
210
h/o recent viral infxn
non-blanching petechiae/purpura
gingival bleeding
thrombocytopenia
primary immune thrombocytopenia
211
tx for primary immune thrombocytopenia (4)
activity restriction
obs
glucocorticoids + IVIG
severe: IV anti-D
212
what med exacerbates hypercalcemia
hctz
213
hallmark hpi clue for rubella
child born to mom who immigrated
214
mc congenital anomaly of the GIT
meckel diverticulum
215
incomplete obliteration of the omphalomesenteric (vitelline) duct during the 7th week of gestation
meckel diverticulum
216
gs dx for meckel diverticulum
technetium scan
217
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)
218
presentation of meckel diveritculum
< 5 yo
painless rectal bleeding
219
APGAR score
220
when is apgar calculated
1 and 5 min after birth
221
HPV vaccination schedule
9-14 yo: 2 doses -> 0, 6-12 mo
15-45 yo: 3 does -> 0, 2, 6 mo
222
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
223
only oral DM med approved for kiddos
metformin
224
moa for metformin
-decreases hepatic glucose production and intestinal glucose absorption
-increases insulin sensitivity
225
moa for fetal coarctation of the aorta in utero
blood flow thru the PDA bypasses aortic coarctation -> results in hemodynamic instablity
226
2 rf for cryptochordism
low birth weight
prematurity
227
indications for emergent surgery w. inguinal hernias (4)
toxic
peritonitis
intestinal obstruction
gangrenous bowel
*otherwise try to manually reduce*
228
rapid fire repetitive coughing followed by an inspiratory stridor and post tussive emesis
pertussis
229
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
230
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
231
2 protective factors against suicide
marriage
pregnancy
232
most completed suicides involve what means
firearms
233
hearing screening test for kids 4-21 yo (3)
pure tone audiometry
OAE testing
tympanometry
*one at every WCC*
234
all infants w. sensorineural hearing loss should be tested for
cmv
235
what PE test for hip dysplasia shows uneven knee heights
galeazzi
236
3 indications for US at 4-6 weeks to evaluate for hip dysplasia
breech at > 34 weeks
FH DDH
hx clinical instability on exam
237
mcc of developmental hip dysplasia
decreased pressure of femoral head against acetabulum -> shallow socket
238
tx for otitis conjunctivitis syndrome
augmentin
239
tx for cystitis in kiddos
1. cephalosporins
2. bactrim if pcn allergy
240
tx for enterobiasis/pinworm
albendazole
241
tx for poison ivy dermatitis
clobetasol propionate 0.05% ointment bid x 14 days
*low dose topical steroids won't work*
242
4 mc agents associated w. allergic contact dermatitis
nickel
poison ivy
soaps
neomycin
243
5 irritants mc associated w. irritant contact dermatitis
water
detergents
solvents
acids
alkali
244
lab value associated w. adult RA, but rarely seen in idiopathic juvenile arthritis
RF
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