Sicular day 1 - peds rheum, pulm, nephro,& infx Flashcards
1
Q
super cardiac shadow –> ?
A
Total Anomalous Pulmonary Venous Return
2
Q
cyanotic baby –> which type of congenital heart deformaties?
A
T’s!
R–> L shunts
3
Q
Marfans has what type of murmur?
A
aortic regurgitation (diastolic decrescendo murmur @ sternal border) sometimes MVP
4
Q
Diastolic murmurs = (acronym?)
A
ARMS
AR = Aortic Regurg
MS = Mitral Stenosis
5
Q
Pansystolic apical murmur radiating to the axilla = ?
A
Mitral regurg
6
Q
strawberry tounge = (2)?
A
- Kawasaki
- Scarlet fever
7
Q
Palms and Soles rash = diff dx(6)?
A
- kawasaki
- Syphillis (stage 2)
- Rocky mountain spotted fever
- Coxsackie
- Strep + Staph –> toxic shock
- Neisseria meningitis + gonnerhea
8
Q
Kawaski monitoring forward?
A
Echo looking for artery aneurysms
9
Q
Kawasaki treat?
A
IVIG + Aspirin
10
Q
“Tibial tuberosity” - think what?
A
Osgood Schlatters
- can also be called osteochondritis
11
Q
Best test to confirm Duchenne dx?
A
PCR DNA testing (specific)
12
Q
confirm = think?
A
Specificity (look for specificity answers)
13
Q
lacy redness cheeks = think?
A
Parvo B19 (esp preg women or kids)
14
Q
Parvo B19 risky for those w/?
A
- Hereditary spherocytosis
- Sickle Cell Disease
*Things that cause anemia already will be worsened byt the virus
15
Q
kid, joint problem, has Ab –> think?
A
serological spondoarthropathies
16
Q
Most appropriate screening test to prevent morbidity from disease in JIA?
A
Slit lamp exam! (screen for uveitis)
17
Q
screening = think?
A
Less invasive, sensitive test
18
Q
most specific test lupus
A
Serum anti-ds DNA Ab
19
Q
Shallow ulcers in nose =diff dx (4)?
A
- Cocaine/drug abuse
- Lupus
- Behcet
- Wegners
*Autoimmune disease v illegal drugs
20
Q
reasons for dialysis = ?
A
- High potassium (esp >6)
-
21
Q
Plasmapheresis used for what hemolytic issue?
A
TTP
22
Q
Kids with leg pain = diff dx?
A
- Growth pains (bilateral, at night)
- Osteoid Osteoma (unilateral, at night, aspirin relief)
- Cancer (day pain)
23
Q
next step = think?
A
Sensitive test, initial test
24
Q
Best step = think?
A
Specific, confirmatory test
25
next, best step = think?
Next wins --> sensitive, initial test
26
WBC >50,000 in joint aspiration = think?
septic arthritis
27
painful joint w/ fever and high WBC joint aspiration = think?
septic arthritis
28
upward lens displacement/subluxation = ?
Marfans! (defect in fibrillin gene)
29
Adams test = is? and for what?
Adams test is a forward bend test to see if hips are level or not
Good Screen for scoliosis
30
minute long coughing spells = think?
pertussiss
31
What organism gives you a significant pulmonary xray with high lymphocytes + non-productive cough?
Mycoplasma!!! --> atypical walking pneumonia
32
Treat mycoplasma with what?
Macrolides!
33
pt allergic to penicillin and has strep, treat w/ what?
Erythromycin
34
Diaphragmatic Hernia steps in emergent treatment?
- NG tube
- Intubate
- Surgery
*don't bag mask ventilate
35
Newborn w/ breathing difficulties main two causes?
- Transient Tachypnea of Newborn
| - Respiratory Distress Syndrome
36
Fissural fluid in newborn w/ breathing difficulties = think?
Transient Tachypnea of Newborn
37
Transient Tachypnea of Newborn can be related to?
Delayed resorption of fetal lung fluid
38
Term breakdown of breathing difficulties? (pre, full, Post)
Preterm - RDS
Full term - TTN
Postterm - Meconium aspiration
39
horizontal crease over nasal bridge w/ clear rhinorrhea = think?
Allergies!!!
| - crease b/c sneezing so often
40
Allergy treatment based on mild, moderate, or severe?
mild - antihistamine
mod - intranasal steroids
severe - oral steroids
41
Asthma treatment based on mild, moderate, or severe?
mild - bronchodilators
mod - inhaled steroids
severe - oral steroids
42
OSA treatment for adult, steps ?
1) CPAP
| 2) Surgery (uvulopalatopharyngoplasty)
43
OSA treatment for kids, steps?
1) Surgery (adenotonsillectomy)
| 2) CPAP
44
when you treat strep throat what complication may still arise?
Glomerulonephritis
45
inspiratory stridor = diff dx?
- Laryngomalacia (neonate/newborn)
- Croup (HAS COUGH, infectious indications, 1-3yo, aka Acute laryngotracheobronchitis, steeple sign)
- Aspiration of foreign body (1-2yo, no other infx symp)
- Epiglottitis (drooling, thumb print sign, unimmunized)
46
If need to give fast dose of penicillin what do you give?
Single dose Benzathine Penicillin G intramuscularly
| oral is multi day, procaine PN multiple IM doses
47
crying breathing improves in neonate = think?
choanal atresia
48
2 ways to test for choanal atresia are?
- Insert catheter through nose (initial dx)
| - CT scan w/ contrast of the head (confirm dx)
49
Bronchiectasis = diff dx?
- Cystic Fibrosis
- Primary ciliary dyskinesia (Kartagener's)
- Allergic bronchopulmonary aspergillosis
50
Bronchiectasis, failure to thrive, repeat infx = think?
Cystic Fibrosis
51
Tests for cystic fibrosis (screening, confirmatory)?
```
Screening = sweat test
Confirmatory = DNA
```
52
Avoid what exam in epiglottitis?
Examining oropharynx -- finger in passage can make worse.
53
Dystrophin found where?
plasma membrane on muscle fibers
54
choanal atresia, low set ears, cruptorchidism, b/l optic disc clefts = think?
CHARGE syndrome
55
Chonal atresia associated w/ ?
CHARGE syndrome
56
CHARGE syndrome =?
```
C
H
A
R
G
E
```
57
Ataxia telangiectasia would have absence of what Ig?
low IgA and IgE
58
Wiskot Aldrich syndrome has what issues with Ig?
High IgA and IgE
59
Ataxia telangiectasia and Wiskot aldrich are opposites how?
AT - LOW IgA and IgE
| WA - HIGH IgA and IgE
60
Preme issues by system?
GI - think NEC
Pulm - think RSD
Eyes - think retinopathy of prematurity
Brain - think Germinal matrix hemorrhage
61
Child abuse steps?
1) Dx labs - CT scan, skeletal survey, CBC, Chem panel, fundoscopy, coag studies. -- NEED TO PROVE
2) Immediate hospitalization
3) Report to Child Protection Services
62
Gaucher Disease = clinical findings?
...
63
Enlarged liver and spleen, osteopenia of vertebral bodies, undertubulation (flaring) of distal femurs = think?
Gaucher disease
64
Flaring of femurs (erlenmyer flask flaring of femur) = think?
Gaucher disease
65
Neimann-Pick disease = classic finding?
cherry red spot on macula
66
Hunter disease = classic finding?
Cataract
67
CP patients are at an inc risk of dev what?
- Constipation
- Contractures
- Urinary retention
68
Fetal alcohol syndrome, distinguishing feature?
Dysmorphic facial features
69
Barbituates effect on neonates, distinguishing feature?
dec breathing at birth
70
Cocaine vs Opiates in neonates?
Both irritable, tremulous, inconsolable, small baby, & high pitched cry
Main difference b/t 2 -- Opiates have additional weird symp
Opiates - GI problems (diarrhea), parasympathetic effects (tachycardia), yawning/sneezing a lot, tired
71
39wkr born to mom w/ DM, hypOthyroid, cocaine use found to have neural tube defect, heart murmur, rib & vertebral column malformations, low-set ears -- Cause?
DM I/II (not gestational)
heart - transposon defect
spinal - sacral agenesis, other neural tube + vertebral defects
72
Mom w/ hypothyroidism effects or doesn't effect baby?
DOESN'T bc baby has own thyroid
73
Iodine deficiency in utero --> ?
- criatism
| - Mental retardation, small, umbilical hernia, big tongue, jaundice
74
Fragile X carriers can or cannot present w/ disease (ie girl)?
YES! Women can have even just as carriers bc can have skewed X inactivation --> nL X inactivated --> defective X causes disease
75
Confirmatory test for lisch-nyhan?
HPRT enzyme level
76
neurofibromatosis type I pneumonic =?
CaFe O'Lait Spots!
```
Ca- cafe o'lait spots
Fe - Freckles
O - Optic gliomas
La - Lish nodules
Sp - Sphynoid displasia
```
77
Tuberous sclerosis has what classic finding?
Ash-Leaf Spot (pale spots -- find w/ black light)
78
Sturge Weber classic findings (2)?
- Port wine stain
| - Cerebral calcifications
79
Neck things in kids = (4)?
- Torticollis (muscle hypertrophy pull head to one side)
- Cystic hygroma (fluid dense, associated w/ turner's syndrome)
- Branchial cleft cyst (lateral fluid dense structure next to sternoclidomastoid m.)
- Thyroglossal duct cyst (midline fluid dense structure)
80
maximal impulse felt on the RIGHT side = think?
primary dyskinesia (Kartagener's)
81
smiling in neonates when?
2mo
82
Laughing in neonates when?
4mo
83
Night terrors vs Nightmares?
Night terror - don't remember, moving, stage 4 problem
| Nightmare - remembers, REM problem
84
Reyes syndrome =?
Aspirin to kids --> reye's --> effects liver --> elevated ammonia
85
Reye's syndrome measure what?
Serum ammonia level
86
Alport main 2 clinical findings (generally)?
- Kidney issues
| - Hearing issues
87
Alport inherted how?
X-linked Dominant
88
X-linked dominant (2)?
- Alport Syndrome
| - Hyperphosphatemia Ricketts
89
posterior urethral valves in 1st day of life causing urinary retention --> next step management?
```
Urethral catheter (prevent kidney damage)
after, confirm w/ VCUG
```
90
retrograde urethrogram for?
adults w/ penile trauma
91
primary hyperaldosteronism, electrolytes levels?
High Na
| Low K
92
Bartter syndrome = ?
Idiopathic renin syndrome
93
Abdominal undescended testis --> orchipexy, why?
need to palpate to screen for testicular CA
94
kid w/ multiple UTIs --> test w/?
U/S of urinary tract + VCUG
95
Wilms tumor associations?
- Beckwith Wederman
| - WAGR
96
Wilms tumor caused by?
Deletion on chromosome 11
97
Transillumination test -->
Just tells you there is fluid there (sensitive)
- clear = hydrocele
- bloody = hematocele
- Could be hernia too
98
hexagonal crystals =?
cystine stones
6 sides = 6stine ("sixtine")
99
micorhematuria in kids --> manage how?
Urologic workup starting w/ sonogram
Microhematuria is NOT normal and needs to be followed up (unlike mild proteinuria)
100
musty smelling urine = think?
PKU, can't process phenylalanine
101
minimal change disease, treatment?
Prednisone
102
Trichomoniasis testing (confirmatory vs initial)?
Initial: vaginal discharge microscopy
Confirmatory: vaginal culture
103
Treat trichomoniasis w/?
Metronidazole (for partner too!!!)
104
Most serious complication of varicella?
Pneumonia!
105
red crusty patches = think?
eczema
106
First line treatment for eczema?
cutaneous hydration w/ emollients
107
myringotomy is what?
cutting the tympanic membrane to allow fluid out
108
Go to Mexico and now have diarrhea, think?
- E.coli infx
| - Entamoeba histolytica infx (abscess in liver)
109
Entomebic infx treat w/?
Metronidazole
110
What is metronidazole 1st line for?
GET BACk to the METRO
```
G- gardnerella, giardia
E - entamoeba
T- trichomonis
Ba - bacteroides
C - c diff
```
111
Dx entamoeba histolytica how?
Serum antibody
112
infx --> abx --> skin response, what is it?
mild - erythema multiforme (only skin rash)
moderate - Stevens- Johnson (rash + ulcers in mouth)
severe - Toxic epidermal necrolysis (skin falling off + ulcers)
113
Kids w/ rash in diaper area =diff dx (2)?
1) candidiasis (creases affected)
| 2) irritant contact dermatitis (creases unaffected)
114
Absence of thymic shadow = diff dx (2)?
- SCID (absence of B and T cells --> bacterial, viral , & fungal infx)
- DiGeorge (absence of T cells --> viral & fungal infx)
low B cell --> bacterial infx
low T cells --> viral & fungal infx
