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Peds 6th > some Q > Flashcards

some Q Flashcards

1
Q

How many calories do infants consume a day?

A

~ 120 kcal/kg/day

should be fed at least 8 times a day

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2
Q

How many calories do Breast milk give?

A

~ ​60- 70cal/100 mL​

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3
Q

Screening tests for newborn

A

● Heel stick test
● Ultrasound ~ 4-6 weeks: brain, abdomen, hip
● Orthopedic manual examination: hip, feet
● Hearing test: brainstem evoked response audiometry (BERA)
● Ophthalmoscope examination of the retina (retinoblastoma)

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4
Q

Clinical presentation EBV

A

● Fever
● Sore throat (more painful than strep) +/- exudate
● Cervical lymphadenopathy commonly anterior and posterior cervical lymph node (may compromise the airway)
● Splenomegaly (90%); 2–3 cm below the left costal margin is typical
● Hepatomegaly (10%)
● Fatigue and malaise (might take from 6 months to few years to improve)
● Rash

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5
Q

EBV incubation time

A

1-2 months

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6
Q

Scarlet Fever ​incubation time

A

2-4 days

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7
Q

Scarlet Fever rash

A

Erythematous, ​sandpaper-like rash​ from neck to trunk and extremities.
Blanches on pressure.

Palms and soles typically spared, but may desquamate afterwards.

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8
Q

Rubella incubation time and lymphadenopathy

A

14-21 days

lymphadenopathy (specifically ​postauricular​ / ​occipital​)

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9
Q

Enterobius vermicularis (Pinworm)

  • spread
  • Sx
  • Dx
A

feco-oral route / Autoinfection
Sx:
• Anal and vulvar itching (more at night)
• Enuresis
Dx:
• Visualizing the adult worm at night on the perineum
• Transparent tape collected

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10
Q

perinatal infections

A

Bacterial:

  • GBS, Listeria. (bacteremia, meningitis)
  • Neisseria gonorrhoeae​ and ​Chlamydia trachomatis (neonatal eye infx)

Viral:

  • HIV (85-90% during birth)
  • HBV
  • HSV
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11
Q

TORCH infx

A

Toxo - ​hydrocephalus​, ​diffuse cerebral calcifications​, and ​chorioretinitis
Rubella - eye, ear, and heart are affected
CMV - ​periventricular calcifications​, ​microcephaly​, and ​sensorineural hearing loss
HSV - severe brain destruction​, ​chorioretinitis, and ​skin lesions​
Other:
Syphilis - saddle nose, CNS involvement, and Hutchinson’s triad (peg-shaped upper central incisors, deafness, and interstitial keratitis)

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12
Q

Early neonatal sepsis

A

Early – onset sepsis​: <48 hrs after birth
● Source: birth canal, amniotic fluid
● GBS, E.coli, staph epidermidis, listeria, haemophilus influenzae

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13
Q

Late neonatal sepsis

A

Late –onset sepsis​: >48 hrs after birth
● Source: environment
● Coagulase – negative staphylococcus​ (S. epidermidis), S. aureus, Enterococcus faecalis, E.coli, Pseudomonas, Klebsiella, Serratia

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14
Q

Hodgkin typical

A

16 year old (15-19) boy with weight loss, fever, night sweats (B Sx) and a large non-tender cervical node (or supracalvicular)

Spread contiguously
CD 15/30 |. Reed-sternberg

Tx: ABVD +- radio

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15
Q

Non-Hodgkin

A

spread non-contiguously
more ​extralymphatic involvement

Lugano classification

Tx: R-CHOP +- radio

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16
Q

Leukemia presentation / Dx

A

5 y.o boy w/ limp; low fever, URI, HSM

Signs of anemia, thrombocytopenia, and leukopenia (pallor, bruising, petechiae, infections, etc.)
Bone pain!!! limp!!

Dx: Marrow aspirate ​> 20% blasts

17
Q

Idiopathic Thrombocytopenic Purpura (ITP)

A

Antiplatelet antibody
Petechiae, ecchymoses, epistaxis

Tx: ○ IVIG​, ​Steroids
○ Splenectomy if > 4 years of age with severe ITP longer than 1 year

18
Q

Platelet Disorders Thrombocytopenia

A

● Decreased Production
■ Amegakaryocytic Thrombocytopenia
■ Thrombocytopenia Absent Radius Syndrome (TARS)
● Increased Platelet Destruction​ (Normal to increased megakaryocytes in bone marrow)
○ Immune
■ Idiopathic Thrombocytopenic Purpura (ITP)
■ Drugs​ (e.g., HIT)
○ Non-Immune
■ Thrombotic Thrombocytopenic Purpura (TTP)
■ Hemolytic uremic syndrome (HUS)​
■ DIC
■ Infection
■ Cardiac​ (e.g., prosthetic valve)
● Abnormal Platelets
○ Congenital
■ Wiskott–Aldrich Syndrome
■ Bernard–Soulier Syndrome​ (GPIb receptor deficiency)
■ Glanzmann’s Thrombasthenia​ (GPIIb/IIIa receptor deficiency)
○ Acquired:
■ Uremia
■ Drugs

19
Q

Signs of DKA

A

○ Abdominal pain and emesis (due to acidemia) + Nausea/Vomiting
○ Abnormal heart rhythm (due to hyperkalemia)
○ Kussmaul - Shortness of breath (respiratory compensation for acidosis)
○ Confusion, stupor, or coma: due to cerebral edema
○ Death (from profound acidosis, hyperkalemia, cerebral edema)

20
Q

diabetic ketoacidosis (DKA) levels

A

○ Serum pH <7.3
○ Serum glucose > 16 mmol/L
○ Serum bicarbonate low

21
Q

most common cause of death in pediatric patients with DKA

A

Cerebral edema.

may be worsened by overhydration and rapid correction of hyperglycemia

22
Q

Most common CAH main points

A 
21-Hydroxylase deficiency (AR)
Salt wasting form: ambiguous genitalia in females / risk in males (may not be screened)
Sac is black (ACTH - MSH increase)
Hyperkalemia! (and hypotension)
US: adrenals + int. genitelia
BA > CA
23
Q

Hormones in 11-ß-hydroxylase deficiency

A

decreased aldosterone, but shunted towards production of DOC which is an active mineralocorticoid with no negative feedback

24
Q

Low potassium, hypertension, and males w/ ambiguous genitalia.

Which enzyme is deficient?

A

17-α-hydroxylase deficiency

25
Q

PTH is released in response to:

A

Low calcium

High phosphate

26
Q

PTH function

A

Increases Ca reabsorption from kidney
Increases Ca/Po release from bones
Increases Vit D activation

Overall: Ca increase / Po decrease

27
Q

Vit D function

A

Increases Ca/Po absorption from GI
Increases Ca/Po release from bones

Overall: Ca increase / Po increase

28
Q

causes of hypoCa

A

● Early neonatal hypoCa (maternal illness e.g. diabetes or HPT, or complications during birth, such as asphyxia or toxemia.)
● Late neonatal hypoCa (dietary phosphate intake, family history of calcium abnormalities, or possible maternal vitamin D deficiency

29
Q

causes of hyperCa

A

Primary HPT (evaluate for MEN1 or MEN2A!!)

FHH (defective CaSR requires higher than normal Ca to suppress PTH secretion)

30
Q

UTI Sx

A

<2 years: fever + poor feeding (may be the only)

> 2 years: more classic symptoms. Fever, dysuria, frequency, urgency, incontinence, abdominal or back pain, hematuria; pyelonephritis suggested by fever, chills, flank pain, and vomiting.
○ Secondary enuresis in a previously toilet-trained child

31
Q

Antibiotics for UTI

A

Babies: TMP-SMX

3rd gen. Cephalosporin

32
Q

VUR grades

*VUR must be ruled out in young children presenting with recurrent UTI

A

● Grade I: reflux into ureter without dilation
● Grade II: reflux into ureter and collecting system without dilation
● Grade III: reflux into ureter and collecting system with mild dilation of ureter and blunting of calyces
● Grade IV: reflux into ureter and collecting system with more significant dilation of ureter and blunting of calyces
● Grade V: massive reflux with dilation and tortuosity of ureter and dilation of collecting system

33
Q

3 disorders of amino acid metabolism main points

A 
Phenylketonuria (PKU)
* deficiency of phenylalanine hydroxylase
* musty urine and body odor, light pigmentation
* avoid phenylalanine
Maple syrup urine disease (MSUD)
* BCKD
* Thiamine + Limit Leu, isoLeu, Val
Homocystinuria
* Marfanoid habitus, Lens subluxation
* Low protein diet, B6, B9, B12
34
Q

Acute Bronchitis

A

no fever (or mild fever) + normal chest X-ray

viral: RSV, rhinovirus, influenza
(Bacterial causes include Mycoplasma / Chlamydophila pneumoniae, Bordetella pertussis, Streptococcus pneumoniae, and Haemophilus influenzae)

35
Q

CF presentation

A

Respiratory: productive cough, dyspnea, and recurrent infections of lungs and
sinuses (S. aureus, H. influenzae, and Pseudomonas)

GI: meconium ileus, GERD, malabsorption sx (pancreatic insufficiency, biliary obstruction)
hyperglycemia

Males: absence of vas deferens- infertility

36
Q

congenital heart disease Murmurs

A

VSD - Holosystolic L SB (radiates to back)
ASD - Wide fixed split S2, systolic ejection at upper L SB
PDA - Continuous machinery
ToF - Systolic ejection at upper L SB

37
Q

Intussusception main points

A 
Boys 3:1 (age 3mo-3yr)
Ileocolic region
Triad:
○ Periodic abdominal pain
○ Vomiting
○ „redcurrant jelly" stool
def Dx: US (target sign)

US guided hydrostatic desinvagination
Surgical

38
Q

Hydrocephalus types

A

Obstructive -
* posterior fossa tumors, Arnold–Chiari Type II malformations, Dandy–Walker
syndrome
Nonobstructive - villi cannot absorb CSF
* subarachnoid hemorrhage, intraventricular hemorrhage (premature infants),
meningitis

39
Q

Meningitis clinical

A

Clinical features:
● Infants: inconsolable crying, hyper-/hypo-thermia, lethargy, grunting, poor feeding, arched back + bulging fontanelle
● Older children: fever, vomiting, headache, photophobia (viral), confusion, seizures, sore/stiff neck
● Meningeal Signs: nuchal rigidity, Brudzinski and Kernig signs

Peds 6th (3 decks)

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