RoshReview Flashcards
AC joint injury
1) MC mechanism of action
2) exam
3) Tx
4) Prognosis
1) fall to lateral shoulder, or blow to AC joint
2) pain over AC joint, Pain with adduction of the arm across the chest (clavicle displacement can be visible with higher grade injuries)
3) anywhere from sling to surgery
4) type 1- heal in 1 to 2 weeks
type II or III- heal in 1 to 3 months
Bleeding since birth with normal PT, PTT, von willebrand activity and plt number, think_______
plt function disorders, like Bernard-Soulier syndrome (a disorder of platelet adhesion) and Glanzmann thrombasthenia (a disorder of platelet aggregation).
most common congenital bleeding disorder
Von willebrand
Von Willebrand factor is a linking factor that allows functional platelets to bind to fibrin to form a clot
Bloody diarrhea and pharyngitis
pathogen?
Yersinia enterocolitica
Yersinia enterocolitica
duration?
Tx?
1) Up to 3 weeks
2) Antibiotics are not beneficial in the treatment of acute uncomplicated yersiniosis.
•Recurrent otitis media
-Definition?
episodes of acute otitis media (AOM) in the past 6 months or 4 episodes of AOM in the past 12 months
•Incontinentia pigmenti
-presentation?
vesicles in a linear arrangement at birth or within the first weeks of life.
Neonatal lupus
1) What is the pathogenesis?
2) Presentation
3) Course
1) tranference of maternal lupus antibodies (Ro and SSA) across the placenta
2) heart block starting in utero, discoid rash started from birth to starting 1-2 months after birth, Hepatosplenomegaly and Cholestasis
3) self-limited
NF type 1
café-au-lait macules, axillary and inguinal freckling, Lisch nodules, and neurofibromas and cognitive disability
Galactosemia
1) presentation
1) occurs the first few days after birth and symptoms vary in frequency. The most common findings are jaundice, vomiting, hepatomegaly, failure to thrive, poor feeding, lethargy, diarrhea, and sepsis. Gram-negative sepsis due to microorganisms like Escherichia coli is one of the key findings in galactosemia.
Drug of choice once the diagnosis of neonatal Gram-negative meningitis is confirmed?
Cefotaxime
Benign childhood epilepsy with centrotemporal spikes (BCECTS)
- When does it first appear?
- When does it occur?
- what does the seizure look like?
- most common epilepsy syndrome in childhood
- Most children will outgrow the syndrome (it starts around the age of 3-13 with a peak around 8–9 years and stops around age 14-18)
- occur shortly after falling asleep or before wakening
- The seizures typically consist of unilateral facial sensorimotor symptoms, oropharyngeal manifestations, speech arrest, and hypersalivation
Digeorge syndrome findings
Catch 22
- Cardiac abnormalities
- Abnormal facies (small mouth, a submucous cleft palate, abnormal and low set ears, upturned nose, and a widened distance between the inner canthi with short palpebral fissures)
- Thymic absense
- Cleft palate
- Hypocalcemia
Chromosome 22
Hypocalcemia what do you need to stabilize the heart
Calcium gluconate
Parkland formula
fluids in first eight hours=1/2[4 x %area of burn x kg+ maintenance fluids]
Lymphogranuloma venereum vs Chancroid
Lymphogranuloma venereum has a painLESS ulcer
Chancroid has a painFULL ulcer
Pertussis Tx
Azithromycin
Hepatoblastoma
1) who gets it?
2) sxs and labs
1) asymptomatic abdominal mass in children < 3. Associated with prematurity, hemihypertrophy, Beckwith-Wiedemann, familial adenomatous polyposis, Li-Fraumeni, and Trisomy 18
2) Anemia, thrombocytosis, elevated AST, ALT, and bilirubin levels. AFP is elevated in more than 90 percent of cases
scabies treatment
permethrin 5% cream
The entire family should be treated as well as all caretakers of the infested child. Clothing, bed linens, and towels should be washed in hot water and items that cannot be washed must be stored in bags for a week. If there are severe manifestations or the patient is immunocompromised, oral ivermectin given orally for two doses, two weeks apart, is recommended.
WAGR syndrome
Wilms tumor
Aniridia (no iris)
Genitourinary abnormalities
Retardation (mental)
thrombocytopenia skin findings vs vasculitis skin findings
Thrombocytopenia causes flat, non-palpable purpura, while vasculitis causes palpable purpura.
antidote for a tricyclic antidepressant overdose
Sodium bicarbonate
tx of otitis media
Amoxicillin 90 mg/kg per day orally in two divided doses
Testing for pheochromocytoma
Plasma metanephrines
Screening for patients with HSP
Needs a urinalysis to evaluate for glomerulonephritis, specifically to evaluate for blood, casts, and protein. Renal manifestations of HSP vary widely. While 20-30% of children develop gross hematuria, others develop a range of manifestations from asymptomatic hematuria or non-nephrotic range proteinuria to acute renal insufficiency. The child must be screened for development of renal disease over at least six months following presentation, as renal manifestations of HSP can continue to develop after other signs and symptoms have resolved.
Kerion
Patient with a history of tinea capitis (scalp ringworm)
Complaining of scalp rash
PE will show a scalp that is boggy with inflamed purulent nodules and plaques
Most commonly caused by delayed-type hypersensitivity reaction to the dermatophyte causing the fungal infection
Treatment is long-term oral griseofulvin
Comments: hair follicle is frequently destroyed leading to scarring alopecia
Hypocalcemia manifestations
Prolonged QTc, tetany, seizures
rickets and precocious puberty
McCune-Albright Syndrome
Fanconi syndrome
1) confirmatory test
2) labs
3) sxs
1) leukocyte cystine level
2) hyperchloremic metabolic acidosis and a low to low-normal serum potassium
3) present between 3 and 6 months of age with polyuria, polydipsia, acute dehydration, poor weight gain and poor growth. They may also have signs of rickets, such as frontal bossing.
macrophage activation syndrome
1) what is it?
2) symptoms
3) how to confirm dx?
1) rare but potentially fatal complication of systemic-onset juvenile idiopathic arthritis (JIA)
2) thrombocytopenia, elevated AST, leukopenia, hypofibrinogenemia, CNS dysfunction, hemorrhage, and hepatomegaly
3) bone marrow biopsy demonstrating macrophage hemophagocytosis
congenital hypopituitarism
- Hypoglycemia
- Direct hyperbilirubinemia
- Relative TSH deficiency results in a low free thyroxine level with a low or inappropriately normal TSH level.
- Due to gonadotropin deficiency, males may have a small penis and/or cryptorchidism.
patellofemoral pain syndrome
1) Hx
2) exam
1) chronic anterior knee pain without an inciting injury, pain with prolonged sitting, a feeling of instability with running, pain going up and down stairs
2) tenderness over the medial patellar facet, pain with patellar compression, and mild swelling
Anterior vs posterior mediastinal mass differentials
anterior- 4 Ts:teratomas, thymomas, thyroid cancers, and “terrible lymphomas.”
Posterior- likely a neuroblastoma
Allergic bronchopulmonary aspergillosis
1) who gets it?
2) symptoms
3) tx
1) 1% to 5% of patients with persistent asthma and less than 10% of cystic fibrosis patients will have ABPA
2) Recurrent asthma exacerbations, complicated by fever, malaise, bronchial obstruction, productive cough with dark brown mucus plugs, and even hemoptysis
3) The treatment for ABPA focuses on control of the inflammation to prevent lung injury with long-term systemic glucocorticosteroids followed by a very slow taper over 6 months. A triazole antifungal may be used.
DUKE criteria
Criteria for endocarditis
(need 2 major or 1 major and 3 minor or 5 minor)
Major:
- 2 separate blood cultures with typical endocarditis organisms
- ECHO evidence
Minor:
- temp >38
- predisposing heart condition or IV drug use
- vascular phenomenon
- immunologic phenomenon
- blood culture
Empiric treatment of endocarditis
Vanco and gentamicin
initial genetic testing for mental delay
fragile X testing and chromosomal microarray
Spinal epidural abscess
Sxs
Dx
Treatment
- ) fever, back pain, nerve compression sxs
- ) MRI , contrasted CT if MRI not available
- ) Vanco (most common cause is staph aureus in US) + 3rd gen cephalosporin
Empiric therapy for brain abscess
Vancomycin+cefotaxime+ metronidazole
- if has had recent neurosurgery need to cover for MRSA and pseudomonas, so do vancomycin + meropenem or cefepime
presentation for spinal muscular atrophy
presents in infancy with head lag; weak, hypotonic limbs; areflexia; paradoxical breathing; tongue fasciculations; and finger trembling. The muscles of facial expression are spared.
