Specialty Disciplines -- Fortie, Michaud, Sherrill, and Hayes Flashcards
1
Q
If you have autonomous overproduction of hormones, how will this affect trophic hormone levels?
A
Trophic hormone levels will decrease
2
Q
Immature face, infantile voice, sparse/thin hair growth, delayed puberty should make you think of?
A
Growth hormone deficiency
3
Q
What component of the physical exam is very important in evaluating growth hormone deficiency?
A
Neuro – make sure there isn’t a tumor causing the symptoms
4
Q
How do we diagnose growth hormone deficiency?
A
Provocative testing – give insulin which should stimulate growth hormone release. Helps determine where the growth hormone issue is.
5
Q
How do we treat growth hormone deficiency?
A
Give growth hormone exogenously – sub q injections
6
Q
When giving glucose, what should happen to growth hormone levels?
A
Decrease
7
Q
How do we treat excessive growth hormone?
A
Somatostatin or if tumor, resect
8
Q
___________ will present with thick tongue, hypotonia, hypothermia, and bradycardia.
A
Hypothyroidism
9
Q
What is the most common etiology of hypothyroidism/
A
Hashimoto’s
10
Q
What medications can cause Hashimoto’s?
A
Amiodarone, lithium
11
Q
What populations are more at risk for developing hypothyroidism?
A
Down syndrome and diabetics
12
Q
Whats the difference between an acute and subacute thyroiditis?
A
Acute is typically a systemic infection. Thyroid is tender. Also presents with fever, chills, and sore throat.
Subacute is usually a viral presentation and thyroid isn’t as red and tender.
However – thyroiditis as a whole – think red and tender thyroid.
13
Q
What mobilizes calcium from bone, increases renal absorption of calcium, and increases phosphate excretion?
A
Parathyroid hormone
14
Q
What increases intestinal absorption of calcium?
A
Vitamin D
15
Q
What increases bone deposition of calcium?
A
Calcitonin
16
Q
Normal levels of this element are required for parathyroid gland function.
A
Magnesium.
17
Q
Hypoparathyroidism is associated with hypo or hypercalcemia?
A
Hypocalcemia
18
Q
How do we treat primary hypoparathyrodism?
A
Replace the calcium
19
Q
People with Ricketts have the inability to absorb calcium — what must we replace so they can?
A
Vitamin D
20
Q
What presents with polyuria, polydipsia, and acanthosis nigracans?
A
Type 1 DM
21
Q
What is the first step in treating DKA?
A
Hydration to help correct the acidosis.
22
Q
What is the SRY gene?
A
Sex determining gene on the Y chromosome
23
Q
Autosomal recessive – deficiencies in the enzyme for production of cortisol.
What is this?
A
Congenital Adrenal Hyperplasia
24
Q
How do we diagnose congenital adrenal hyperplasia?
A
cortisol and aldosterone level testing
may have elevated ACTH to stimulate more production
25
What is androgen insensitivity?
x-linked recessive
Can present in several different ways
Can be complete androgen insensitivity syndrome (CAIS) -- born with normal appearing female genitalia
Partial androgen insensitivity syndrome (PAIS) -- have testes that have not descended. Females will grow up and never get their period.
Mild androgen insensitivity syndrome (MAIS) -- very few symptoms
This card sucks. Sorry.
26
If you see a patient with uveitis, what do you have to think of?
A rheumatological disorder
27
This type of arthritis will present with high intermittent fevers, a rash you can make pop up by rubbing the skin, and hepatosplenomegaly
Systemic Arthritis -- or Stills Disease
28
This type of arthritis usually presents in younger children -- starts in 1 or 2 joints, and then spreads to 5 joints within 6 months.
Polyarthritis
29
This type of arthritis presents similarly to polyarthritis, but typically even in younger ages (2-3), and has no additional joint involvement after 6 months.
Oligoarthritis
30
This type of arthritis is more typically associated with tendons -- SI joint tenderness is a common complaint.
Enthesitis-related arthritis
31
This type of arthritis affects females more than males. DIP is often affected and may present with nail pitting.
Psoriatic arthritis
32
How do we treat rheumatological disorders? What is the progression?
1. NSAIDs
2. Corticosteroids
3. Non-biologic DMARDs
4. Biologic DMARDs
33
This is the most common vasculitis in children and presents with rash, palpable purpura, and small vessel inflammation
Henoch Scholien Purpura
34
This disease presents with a strawberry tongue and dry cracked mucosa. Often conjunctival hemorrhage as well.
Kawasaki disease
35
What do we have to worry about with Kawasaki disease?
Aneurysm formation
36
What presents with a malar rash, photosensitivity, raynaud's, and mucosal sores?
Systemic Lupus Erythematous
37
How do we treat Lupus?
Corticosteroids, NSAIDs, Hydroxychloroquine (for skin issues)
38
What test is mandated by government to screen for a wide variety of metabolic disorders?
Tandem Mass Spectrometry
*This is the only thing I took away from that entire lecture
39
What are some signs of pediatric respiratory distress?
Tachycardia, retractions -- intercostal and sternal, grunting, nasal flaring, head bobbing, abdominal breathing, tripod position
40
What presents with a "seal, barky" cough, "steeple sign" on x-ray, and inspiratory stridor?
Croup
41
What causes croup?
Parainfluenza virus
42
How do we treat croup?
Single dose of Decadron
Moderate to severe Croup: Racemic epi, oxygen, IV
43
This disease has a very rapid onset. Presents with drooling, stridor, and kids are often found sitting in tripod position
Epiglottitis
44
What vaccine has decreased incidence of epiglottitis?
HiB vaccine
45
What do you see on x-ray of someone with epiglottitis?
"thumb sign"
46
What must be your first line of treatment with someone suffering from epiglottitis?
Secure an airway
47
How do you diagnose influenza?
PCR nasal swab
48
What causes bronchiolitis?
RSV
49
What are signs and symptoms of RSV?
gradual onset o respiratory distress, fever, poor feeding, expiratory wheezing, and "junky" lung sounds
50
How do we diagnose RSV?
Nasal swab
51
How do we treat pertussis?
Macrolides (azithromycin)
52
What are the most common pathogens causing pneumonia?
Strep pneumoniae, H. flu, and mycoplasma
53
Fever and cough, rapid breathing/tachypnea, dyspnea, low oxygen saturation, lethargy, focal crackles, rales on auscultations are symptoms of?
Pneumonia
54
How do we treat pneumonia?
First Amoxicillin, then a macrolide -- (in kids!)
55
What will a chest x-ray of pneumonia look like?
Consolidation, "round" appearing
56
Oxygen sat lower than 92%, RR greater than 70 in infants and > 50 in children, intermittent apnea or grunting, and dehydration are all reasons to?
Admit a child to the hospital
57
Abnormalities of salt and water transport across epithelial surfaces affecting the lungs and GI system describes?
Cystic Fibrosis
58
Greasy, foul-smelling stools and recurrent respiratory infections are symptoms of?
Cystic Fibrosis
59
How do we diagnose cystic fibrosis?
Positive sweat test
60
Chronic airway inflammatory disorder affecting mast cells, eosinophils, lymphocytes that cause inflammation leading to bronchospasm, bronchial edema, and increased mucus.
Asthma
61
How do we diagnose asthma?
PFT's: if FEV/FVC improves by 12% with bronchodilator
62
How do we treat asthma?
Step-wise approach
I'll leave it at that.
63
Room sharing, breastfeeding, pacifier during sleep, and placing infant on back to sleep are all?
Methods to reduce risk of SIDS
64
Few hours after birth baby goes into respiratory distress, you get an x-ray and it shows "ground-glass appearance". Dx?
Hyaline Membrane Disease
65
How do we treat hyaline membrane disease?
Give surfactant
66
Kids stick things in places they shouldn't. How do symptoms differ between an upper airway obstruction versus a lower airway obstruction?
Upper airway: stridor, choking, cough, cyanosis.
Complete obstruction -- no cough or choking
Lower airway: unilateral wheezing, recurrent pneumonia, cough
67
Introduction of solid foods, toilet training, start of school, hypothyroid are all causes of?
Constipation
68
What might you find on PE of a kid with constipation?
Abdominal distension, palpable stool mass, soiled underwear, impacted stool on rectal exam
69
How do we treat constipation in infants?
Glycerin suppository, sorbitol-containing juices
70
How do we treat constipation in children?
Polyethylene glycol, disimpaction, diet change
71
How do we define diarrhea in peds?
Passage of loose or watery stools three or more times per day
72
What might be causes of bloody diarrhea?
Salmonella, hemolytic uremic syndrome, intussusception, toxic megacolon
73
By what age does GERD typically resolve?
18 months
74
How do we treat GERD in peds?
Lifestyle modifications, PPIs or H2 blockers
75
What is commonly associated with GERD?
asthma
76
What is incomplete separation of the trachea and esophagus?
Tracheoesophageal fistula and esophageal atresia
77
How do you diagnose TEF/EA?
inability to pass NG tube into the stomach -- definitive test is an upper GI series with endoscopy for direct visualization
78
Baby presents with projectile vomiting and on PE you find an "olive-shaped" mass -- what is it?
Pyloric stenosis
79
This presents with sudden onset of bilious vomiting (green vomit), severe abdominal pain and the baby/child will be inconsolable
Volvulus
80
What will a volvulus look like on barium swallow?
Bird-beak cut off and corkscrew
81
What will a volvulus look like on x-ray?
Double bubble sign
82
How do we treat a volvulus?
Emergent surgery
83
What is the most common congenital anomaly of the small intestine?
Meckel's Diverticulum
84
Meckel's Diverticulum -- rule of 2's -- what are they?
Occurs in 2% of the population
2:1 Males to Femamles
Within 2 feet of ileocecal valve
Can be 2 inches long
Usually present before age 2
85
What is the most common abdominal emergency in children less than 2
Intussusception
86
How does intussusception present?
Sudden onset of intermittent severe abdominal pain, inconsolable crying, drawing legs/knees toward the abdomen
87
What does intussusception look like on ultrasound?
"target sign" or "bulls eye"
88
Currant-jelly stools -- think of?
Intussusception
89
Anorexia, periumbilical pain, migration to RLQ, vomiting, fever, peritonitis are all symptoms of?
Appendicitis
90
What do we call protrusion of an organ or tissue through an abdominal opening in the wall that normally contains it
Hernia
91
What's the difference between an incarcerated and strangulated hernia?
Incarcerated -- blood supply is not compromised
Strangulated -- blood supply is compromised
92
Do direct hernias pass through the inguinal canal?
NO
93
What is immune mediated inflammation of the small intestine caused by sensitivity to gluten?
Celiac Disease
94
Symptoms of celiac?
Diarrhea, steatorrhea, weight loss, vitamin deficiency
95
How do we diagnose lactose intolerance?
Lactose breath hydrogen test, lactose absorption test
96
When do we measure head circumference?
Each visit until 36 months
97
When does the posterior fontanelle usually close?
2 months
98
What is craniosynostosis?
Premature fusion of cranial sutures
99
What suture is most commonly affected by craniosynostosis?
Sagittal
100
How will you be able to tell the difference between positional plagiocephaly and craniosynostosis?
With plagiocephaly the ear will be displaced anteriorly to differentiate from craniosynostosis.
101
What is an anomaly of the eye alignment which can occur in either eye and in any direction?
Strabismus
102
What is Hering's Law?
agonist muscles in both eyes receive equal innervation to ensure coordinated movement (right eye abducts and left eye will adduct)
103
What is Sherrington's Law?
agonist/antagonist muscle pairs within each eye receive reciprocal innervation
104
What are pseudocysts of the sublingual glands and submandibular ducts?
Ranulas
105
What is the number one ED visit for peds?
URI
106
What is the number one reason for admission?
Pneumonia
107
What is a normal heart rate and respiratory rate in a newborn?
RR 30-60
HR 100-160
108
What is the most common cold caused by?
Rhinovirus
109
What is the most frequent diagnosis in sick children in the US?
otitis media
110
Who do we need to treat for ear infections?
Children under 2 years.
Children over 2 years with minimal symptoms can be observed
111
What is sinusitis most commonly caused by?
Viral infection associated with the common cold
112
When should you suspect sinusitis?
1. cough
2. rhinorrhea
3. 10 days of symptoms and not improving
113
How do we treat sinusitis?
Augmentin
114
What causes hand, foot, and mouth disease?
Group A coxsackievirus
115
Fever, oral vesicles, tender lesions on the hands, feet, and buttocks are symptoms of?
Hand, Foot, and Mouth Disease
116
Lymphadenopathy, nagayama spots, and irritability are symptoms of?
Roseola
117
What is Roseola caused by?
herpesvirus 6
118
With roseola, does the rash and fever happen simultaneously?
No -- fever then rash
119
What is Fifth's Disease caused by?
Parvovirus B-19
120
What causes impetigo and how do we treat it?
Staph aureus
Mupirocin
121
If a patient says they think they have a spider bite, what should you think of?
MRSA
122
How do we treat MRSA?
Bactrim
123
What causes Epiglottitis?
H. influenzae type B
124
What causes strep pharyngitis?
Group A strep
125
Migratory arthritis, pancarditis/valvulitis, and CNS involvement are all symptoms of?
Rheumatic Fever
126
What causes rheumatic fever?
Group A strep
127
If a patient has a "hot potato" voice, is drooling, and has trismus, think of?
Peritonsillar Abscess
128
How do we treat a peritonsillar abscess?
Drain it and augmentin!
129
What is the primary cause of infectious mononucleosis?
Epstein-Barr Virus
130
Although rare, what is an acute complication of mono?
Splenic rupture
131
What common pediatric malignancy is associated with Epstein-Barr?
Burkitt lymphoma
132
If a child has been coughing more than 14 days, regardless of vaccination status, what should we think of?
Whooping cough
133
How do we treat Kawasaki's disease?
IVIG within the first 10 days
134
High fever may be the only symptoms of this in infants?
Urinary Tract Infection
135
What are the 4 C's? And what disease are they connected
Measles
Conjunctivitis, Coryza, Cough, and Koplik Spots
136
When talking about measles, what is the exanthem phase?
Maculopapular rash beginning on face and spreading to the body in a craniocaudal patttern. Sparing of palms and soles
137
Parotitis and orchitis, low-grade fever, headache, and myalgias are symptoms of?
Mumps
138
Chicken pox is often more dangerous in adults. What do they die of?
Pneumonia
139
Does the rubella rash spread more or less quickly than measles rash?
More quickly
140
Most common pathogen for community acquired pneumonia?
S. pneumoniaes
141
Generalized hip laxity, malformed acetabulum, shape of femoral head, and issues with soft tissues are all hip abnormalities associated with?
Developmental Hip Dysplasia
142
What two tests do we do in newborns to diagnose hip dysplasia?
Barlow's (dislocation), and Ortolani (relocation test)
143
If a baby is female and breech, when should we do an ultrasound?
At 6 weeks according to AAP guidelines
144
How do we treat DHD?
Braces/harnesses -- Pavlik brace. Best under 6 months of age.
Casting if older than 6 months
145
Idiopathic osteonecrosis of the femoral head
Legg-Calve-Perthes Disease
146
Legg-Calve-Perthes -- What do you see on x-ray?
Crescent sign
147
What type of x-rays must you order with Legg-Calve-Perthes?
AP and frog lateral
148
Slippage of the femoral epiphysis
Slipped Capital Femoral Epiphysis (SCFE)
149
Does the femoral epiphysis usually move posteriorly or anteriorly?
Posteriorly
150
Tell me about the kids who usually present with SCFE
BIG KIDS -- 90 to 95th percentile, male
Will complain of pain in hip, groin, thigh or knee
151
How do we treat SCFE?
Have to do surgery -- the slippage will progress if not fixed
152
Inflammation of the hip with no apparent cause
Transient Synovitis of the Hip
153
How do we treat transient synovitis of the hip?
Watchful waiting -- rest
154
In-toeing and Out-toeing are caused from either femoral _________ or tibial ___________
anteversion/retroversion
torsion
155
What is the most common cause of tibial torsion?
Internal tibial torsion
156
We look at foot progression angles to diagnose rotational disorders -- what is a normal angle?
0 to 30 degrees
157
Measurement of thigh-foot angle is used to assess?
Amount of tibial rotation
158
Inflammation of the tibial tubercle apophysis?
Osgood-Schlatter's Disease
159
What are symptoms of Osgood-Schlatter's?
Pain worsens with jumping, running, kneeling
160
How do we treat Osgood-Schlatter's?
Ice, heat, NSAIDs, REST
161
What is the difference between metatarsus adductus and talipes equinovirus (club foot)?
Metatarsus adductus will be flexible
162
How do we treat metatarsus adductus?
Treatment usually not necessary -- will spontaneously resolve by 6 months
163
How do we treat talipes equinovirus?
Immediate casting
164
What is then number one cause of scoliosis?
Idiopathic
165
How do we diagnose scoliosis?
Forward bend (Adam's test)
166
What is the name of the angle we measure when diagnosing scoliosis?
Cobb angle
167
If the angle is greater than ______, we must treat scoliosis with surgery.
50
168
Unilateral contraction of the sternocleidomastoid muscle
Torticollis
169
Torticollis ---- baby's head will be tilted _______ affected side and rotated _______ from affected side
Toward
Away
170
What is the most common elbow injury in children
"nursemaid's elbow" -- subluxation of the radial head
171
Type 1 Salter-Harris fractures
fracture is transverse through the physis
172
Type 2 Salter-Harris fractures
transverse through physis into the metaphysis
173
Type 3 Salter-Harris fractures
Transverse trough the physis into the epiphysis
174
Type 4 Salter-Harris fractures
fracture through the metaphysis, physis, and epiphysis
175
Type 5 Salter-Harris fractures
Compression/crush injury to the physis
176
What type of Salter-Harris fracture is most common?
Type 2
177
When should a pediatric fracture be referred to an orthopedic specialist?
Everytime
178
What is osteogenesis imperfecta?
Defect in type 1 collagen
179
What are symptoms of osteogenesis imperfecta?
short stature, lax ligaments, blue sclera
