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Sam: Peds > Specialty Disciplines -- Fortie, Michaud, Sherrill, and Hayes > Flashcards

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

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2
Q

Immature face, infantile voice, sparse/thin hair growth, delayed puberty should make you think of?

A

Growth hormone deficiency

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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

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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.

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5
Q

How do we treat growth hormone deficiency?

A

Give growth hormone exogenously – sub q injections

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6
Q

When giving glucose, what should happen to growth hormone levels?

A

Decrease

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7
Q

How do we treat excessive growth hormone?

A

Somatostatin or if tumor, resect

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8
Q

___________ will present with thick tongue, hypotonia, hypothermia, and bradycardia.

A

Hypothyroidism

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9
Q

What is the most common etiology of hypothyroidism/

A

Hashimoto’s

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10
Q

What medications can cause Hashimoto’s?

A

Amiodarone, lithium

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11
Q

What populations are more at risk for developing hypothyroidism?

A

Down syndrome and diabetics

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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.

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13
Q

What mobilizes calcium from bone, increases renal absorption of calcium, and increases phosphate excretion?

A

Parathyroid hormone

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14
Q

What increases intestinal absorption of calcium?

A

Vitamin D

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15
Q

What increases bone deposition of calcium?

A

Calcitonin

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16
Q

Normal levels of this element are required for parathyroid gland function.

A

Magnesium.

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17
Q

Hypoparathyroidism is associated with hypo or hypercalcemia?

A

Hypocalcemia

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18
Q

How do we treat primary hypoparathyrodism?

A

Replace the calcium

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19
Q

People with Ricketts have the inability to absorb calcium — what must we replace so they can?

A

Vitamin D

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20
Q

What presents with polyuria, polydipsia, and acanthosis nigracans?

A

Type 1 DM

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21
Q

What is the first step in treating DKA?

A

Hydration to help correct the acidosis.

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22
Q

What is the SRY gene?

A

Sex determining gene on the Y chromosome

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23
Q

Autosomal recessive – deficiencies in the enzyme for production of cortisol.

What is this?

A

Congenital Adrenal Hyperplasia

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24
Q

How do we diagnose congenital adrenal hyperplasia?

A

cortisol and aldosterone level testing

may have elevated ACTH to stimulate more production

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25
Q

What is androgen insensitivity?

A

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.

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26
Q

If you see a patient with uveitis, what do you have to think of?

A

A rheumatological disorder

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27
Q

This type of arthritis will present with high intermittent fevers, a rash you can make pop up by rubbing the skin, and hepatosplenomegaly

A

Systemic Arthritis – or Stills Disease

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28
Q

This type of arthritis usually presents in younger children – starts in 1 or 2 joints, and then spreads to 5 joints within 6 months.

A

Polyarthritis

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29
Q

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.

A

Oligoarthritis

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30
Q

This type of arthritis is more typically associated with tendons – SI joint tenderness is a common complaint.

A

Enthesitis-related arthritis

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31
Q

This type of arthritis affects females more than males. DIP is often affected and may present with nail pitting.

A

Psoriatic arthritis

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32
Q

How do we treat rheumatological disorders? What is the progression?

A
  1. NSAIDs
  2. Corticosteroids
  3. Non-biologic DMARDs
  4. Biologic DMARDs
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33
Q

This is the most common vasculitis in children and presents with rash, palpable purpura, and small vessel inflammation

A

Henoch Scholien Purpura

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34
Q

This disease presents with a strawberry tongue and dry cracked mucosa. Often conjunctival hemorrhage as well.

A

Kawasaki disease

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35
Q

What do we have to worry about with Kawasaki disease?

A

Aneurysm formation

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36
Q

What presents with a malar rash, photosensitivity, raynaud’s, and mucosal sores?

A

Systemic Lupus Erythematous

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37
Q

How do we treat Lupus?

A

Corticosteroids, NSAIDs, Hydroxychloroquine (for skin issues)

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38
Q

What test is mandated by government to screen for a wide variety of metabolic disorders?

A

Tandem Mass Spectrometry

*This is the only thing I took away from that entire lecture

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39
Q

What are some signs of pediatric respiratory distress?

A

Tachycardia, retractions – intercostal and sternal, grunting, nasal flaring, head bobbing, abdominal breathing, tripod position

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40
Q

What presents with a “seal, barky” cough, “steeple sign” on x-ray, and inspiratory stridor?

A

Croup

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41
Q

What causes croup?

A

Parainfluenza virus

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42
Q

How do we treat croup?

A

Single dose of Decadron

Moderate to severe Croup: Racemic epi, oxygen, IV

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43
Q

This disease has a very rapid onset. Presents with drooling, stridor, and kids are often found sitting in tripod position

A

Epiglottitis

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44
Q

What vaccine has decreased incidence of epiglottitis?

A

HiB vaccine

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45
Q

What do you see on x-ray of someone with epiglottitis?

A

“thumb sign”

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46
Q

What must be your first line of treatment with someone suffering from epiglottitis?

A

Secure an airway

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47
Q

How do you diagnose influenza?

A

PCR nasal swab

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48
Q

What causes bronchiolitis?

A

RSV

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49
Q

What are signs and symptoms of RSV?

A

gradual onset o respiratory distress, fever, poor feeding, expiratory wheezing, and “junky” lung sounds

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50
Q

How do we diagnose RSV?

A

Nasal swab

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51
Q

How do we treat pertussis?

A

Macrolides (azithromycin)

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52
Q

What are the most common pathogens causing pneumonia?

A

Strep pneumoniae, H. flu, and mycoplasma

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53
Q

Fever and cough, rapid breathing/tachypnea, dyspnea, low oxygen saturation, lethargy, focal crackles, rales on auscultations are symptoms of?

A

Pneumonia

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54
Q

How do we treat pneumonia?

A

First Amoxicillin, then a macrolide – (in kids!)

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55
Q

What will a chest x-ray of pneumonia look like?

A

Consolidation, “round” appearing

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56
Q

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?

A

Admit a child to the hospital

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57
Q

Abnormalities of salt and water transport across epithelial surfaces affecting the lungs and GI system describes?

A

Cystic Fibrosis

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58
Q

Greasy, foul-smelling stools and recurrent respiratory infections are symptoms of?

A

Cystic Fibrosis

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59
Q

How do we diagnose cystic fibrosis?

A

Positive sweat test

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60
Q

Chronic airway inflammatory disorder affecting mast cells, eosinophils, lymphocytes that cause inflammation leading to bronchospasm, bronchial edema, and increased mucus.

A

Asthma

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61
Q

How do we diagnose asthma?

A

PFT’s: if FEV/FVC improves by 12% with bronchodilator

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62
Q

How do we treat asthma?

A

Step-wise approach

I’ll leave it at that.

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63
Q

Room sharing, breastfeeding, pacifier during sleep, and placing infant on back to sleep are all?

A

Methods to reduce risk of SIDS

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64
Q

Few hours after birth baby goes into respiratory distress, you get an x-ray and it shows “ground-glass appearance”. Dx?

A

Hyaline Membrane Disease

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65
Q

How do we treat hyaline membrane disease?

A

Give surfactant

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66
Q

Kids stick things in places they shouldn’t. How do symptoms differ between an upper airway obstruction versus a lower airway obstruction?

A

Upper airway: stridor, choking, cough, cyanosis.

Complete obstruction – no cough or choking

Lower airway: unilateral wheezing, recurrent pneumonia, cough

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67
Q

Introduction of solid foods, toilet training, start of school, hypothyroid are all causes of?

A

Constipation

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68
Q

What might you find on PE of a kid with constipation?

A

Abdominal distension, palpable stool mass, soiled underwear, impacted stool on rectal exam

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69
Q

How do we treat constipation in infants?

A

Glycerin suppository, sorbitol-containing juices

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70
Q

How do we treat constipation in children?

A

Polyethylene glycol, disimpaction, diet change

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71
Q

How do we define diarrhea in peds?

A

Passage of loose or watery stools three or more times per day

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72
Q

What might be causes of bloody diarrhea?

A

Salmonella, hemolytic uremic syndrome, intussusception, toxic megacolon

73
Q

By what age does GERD typically resolve?

A

18 months

74
Q

How do we treat GERD in peds?

A

Lifestyle modifications, PPIs or H2 blockers

75
Q

What is commonly associated with GERD?

A

asthma

76
Q

What is incomplete separation of the trachea and esophagus?

A

Tracheoesophageal fistula and esophageal atresia

77
Q

How do you diagnose TEF/EA?

A

inability to pass NG tube into the stomach – definitive test is an upper GI series with endoscopy for direct visualization

78
Q

Baby presents with projectile vomiting and on PE you find an “olive-shaped” mass – what is it?

A

Pyloric stenosis

79
Q

This presents with sudden onset of bilious vomiting (green vomit), severe abdominal pain and the baby/child will be inconsolable

A

Volvulus

80
Q

What will a volvulus look like on barium swallow?

A

Bird-beak cut off and corkscrew

81
Q

What will a volvulus look like on x-ray?

A

Double bubble sign

82
Q

How do we treat a volvulus?

A

Emergent surgery

83
Q

What is the most common congenital anomaly of the small intestine?

A

Meckel’s Diverticulum

84
Q

Meckel’s Diverticulum – rule of 2’s – what are they?

A

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
Q

What is the most common abdominal emergency in children less than 2

A

Intussusception

86
Q

How does intussusception present?

A

Sudden onset of intermittent severe abdominal pain, inconsolable crying, drawing legs/knees toward the abdomen

87
Q

What does intussusception look like on ultrasound?

A

“target sign” or “bulls eye”

88
Q

Currant-jelly stools – think of?

A

Intussusception

89
Q

Anorexia, periumbilical pain, migration to RLQ, vomiting, fever, peritonitis are all symptoms of?

A

Appendicitis

90
Q

What do we call protrusion of an organ or tissue through an abdominal opening in the wall that normally contains it

A

Hernia

91
Q

What’s the difference between an incarcerated and strangulated hernia?

A

Incarcerated – blood supply is not compromised

Strangulated – blood supply is compromised

92
Q

Do direct hernias pass through the inguinal canal?

A

NO

93
Q

What is immune mediated inflammation of the small intestine caused by sensitivity to gluten?

A

Celiac Disease

94
Q

Symptoms of celiac?

A

Diarrhea, steatorrhea, weight loss, vitamin deficiency

95
Q

How do we diagnose lactose intolerance?

A

Lactose breath hydrogen test, lactose absorption test

96
Q

When do we measure head circumference?

A

Each visit until 36 months

97
Q

When does the posterior fontanelle usually close?

A

2 months

98
Q

What is craniosynostosis?

A

Premature fusion of cranial sutures

99
Q

What suture is most commonly affected by craniosynostosis?

A

Sagittal

100
Q

How will you be able to tell the difference between positional plagiocephaly and craniosynostosis?

A

With plagiocephaly the ear will be displaced anteriorly to differentiate from craniosynostosis.

101
Q

What is an anomaly of the eye alignment which can occur in either eye and in any direction?

A

Strabismus

102
Q

What is Hering’s Law?

A

agonist muscles in both eyes receive equal innervation to ensure coordinated movement (right eye abducts and left eye will adduct)

103
Q

What is Sherrington’s Law?

A

agonist/antagonist muscle pairs within each eye receive reciprocal innervation

104
Q

What are pseudocysts of the sublingual glands and submandibular ducts?

A

Ranulas

105
Q

What is the number one ED visit for peds?

A

URI

106
Q

What is the number one reason for admission?

A

Pneumonia

107
Q

What is a normal heart rate and respiratory rate in a newborn?

A

RR 30-60

HR 100-160

108
Q

What is the most common cold caused by?

A

Rhinovirus

109
Q

What is the most frequent diagnosis in sick children in the US?

A

otitis media

110
Q

Who do we need to treat for ear infections?

A

Children under 2 years.

Children over 2 years with minimal symptoms can be observed

111
Q

What is sinusitis most commonly caused by?

A

Viral infection associated with the common cold

112
Q

When should you suspect sinusitis?

A
  1. cough
  2. rhinorrhea
  3. 10 days of symptoms and not improving
113
Q

How do we treat sinusitis?

A

Augmentin

114
Q

What causes hand, foot, and mouth disease?

A

Group A coxsackievirus

115
Q

Fever, oral vesicles, tender lesions on the hands, feet, and buttocks are symptoms of?

A

Hand, Foot, and Mouth Disease

116
Q

Lymphadenopathy, nagayama spots, and irritability are symptoms of?

A

Roseola

117
Q

What is Roseola caused by?

A

herpesvirus 6

118
Q

With roseola, does the rash and fever happen simultaneously?

A

No – fever then rash

119
Q

What is Fifth’s Disease caused by?

A

Parvovirus B-19

120
Q

What causes impetigo and how do we treat it?

A

Staph aureus

Mupirocin

121
Q

If a patient says they think they have a spider bite, what should you think of?

A

MRSA

122
Q

How do we treat MRSA?

A

Bactrim

123
Q

What causes Epiglottitis?

A

H. influenzae type B

124
Q

What causes strep pharyngitis?

A

Group A strep

125
Q

Migratory arthritis, pancarditis/valvulitis, and CNS involvement are all symptoms of?

A

Rheumatic Fever

126
Q

What causes rheumatic fever?

A

Group A strep

127
Q

If a patient has a “hot potato” voice, is drooling, and has trismus, think of?

A

Peritonsillar Abscess

128
Q

How do we treat a peritonsillar abscess?

A

Drain it and augmentin!

129
Q

What is the primary cause of infectious mononucleosis?

A

Epstein-Barr Virus

130
Q

Although rare, what is an acute complication of mono?

A

Splenic rupture

131
Q

What common pediatric malignancy is associated with Epstein-Barr?

A

Burkitt lymphoma

132
Q

If a child has been coughing more than 14 days, regardless of vaccination status, what should we think of?

A

Whooping cough

133
Q

How do we treat Kawasaki’s disease?

A

IVIG within the first 10 days

134
Q

High fever may be the only symptoms of this in infants?

A

Urinary Tract Infection

135
Q

What are the 4 C’s? And what disease are they connected

A

Measles

Conjunctivitis, Coryza, Cough, and Koplik Spots

136
Q

When talking about measles, what is the exanthem phase?

A

Maculopapular rash beginning on face and spreading to the body in a craniocaudal patttern. Sparing of palms and soles

137
Q

Parotitis and orchitis, low-grade fever, headache, and myalgias are symptoms of?

A

Mumps

138
Q

Chicken pox is often more dangerous in adults. What do they die of?

A

Pneumonia

139
Q

Does the rubella rash spread more or less quickly than measles rash?

A

More quickly

140
Q

Most common pathogen for community acquired pneumonia?

A

S. pneumoniaes

141
Q

Generalized hip laxity, malformed acetabulum, shape of femoral head, and issues with soft tissues are all hip abnormalities associated with?

A

Developmental Hip Dysplasia

142
Q

What two tests do we do in newborns to diagnose hip dysplasia?

A

Barlow’s (dislocation), and Ortolani (relocation test)

143
Q

If a baby is female and breech, when should we do an ultrasound?

A

At 6 weeks according to AAP guidelines

144
Q

How do we treat DHD?

A

Braces/harnesses – Pavlik brace. Best under 6 months of age.

Casting if older than 6 months

145
Q

Idiopathic osteonecrosis of the femoral head

A

Legg-Calve-Perthes Disease

146
Q

Legg-Calve-Perthes – What do you see on x-ray?

A

Crescent sign

147
Q

What type of x-rays must you order with Legg-Calve-Perthes?

A

AP and frog lateral

148
Q

Slippage of the femoral epiphysis

A

Slipped Capital Femoral Epiphysis (SCFE)

149
Q

Does the femoral epiphysis usually move posteriorly or anteriorly?

A

Posteriorly

150
Q

Tell me about the kids who usually present with SCFE

A

BIG KIDS – 90 to 95th percentile, male

Will complain of pain in hip, groin, thigh or knee

151
Q

How do we treat SCFE?

A

Have to do surgery – the slippage will progress if not fixed

152
Q

Inflammation of the hip with no apparent cause

A

Transient Synovitis of the Hip

153
Q

How do we treat transient synovitis of the hip?

A

Watchful waiting – rest

154
Q

In-toeing and Out-toeing are caused from either femoral _________ or tibial ___________

A

anteversion/retroversion

torsion

155
Q

What is the most common cause of tibial torsion?

A

Internal tibial torsion

156
Q

We look at foot progression angles to diagnose rotational disorders – what is a normal angle?

A

0 to 30 degrees

157
Q

Measurement of thigh-foot angle is used to assess?

A

Amount of tibial rotation

158
Q

Inflammation of the tibial tubercle apophysis?

A

Osgood-Schlatter’s Disease

159
Q

What are symptoms of Osgood-Schlatter’s?

A

Pain worsens with jumping, running, kneeling

160
Q

How do we treat Osgood-Schlatter’s?

A

Ice, heat, NSAIDs, REST

161
Q

What is the difference between metatarsus adductus and talipes equinovirus (club foot)?

A

Metatarsus adductus will be flexible

162
Q

How do we treat metatarsus adductus?

A

Treatment usually not necessary – will spontaneously resolve by 6 months

163
Q

How do we treat talipes equinovirus?

A

Immediate casting

164
Q

What is then number one cause of scoliosis?

A

Idiopathic

165
Q

How do we diagnose scoliosis?

A

Forward bend (Adam’s test)

166
Q

What is the name of the angle we measure when diagnosing scoliosis?

A

Cobb angle

167
Q

If the angle is greater than ______, we must treat scoliosis with surgery.

A

50

168
Q

Unilateral contraction of the sternocleidomastoid muscle

A

Torticollis

169
Q

Torticollis —- baby’s head will be tilted _______ affected side and rotated _______ from affected side

A

Toward

Away

170
Q

What is the most common elbow injury in children

A

“nursemaid’s elbow” – subluxation of the radial head

171
Q

Type 1 Salter-Harris fractures

A

fracture is transverse through the physis

172
Q

Type 2 Salter-Harris fractures

A

transverse through physis into the metaphysis

173
Q

Type 3 Salter-Harris fractures

A

Transverse trough the physis into the epiphysis

174
Q

Type 4 Salter-Harris fractures

A

fracture through the metaphysis, physis, and epiphysis

175
Q

Type 5 Salter-Harris fractures

A

Compression/crush injury to the physis

176
Q

What type of Salter-Harris fracture is most common?

A

Type 2

177
Q

When should a pediatric fracture be referred to an orthopedic specialist?

A

Everytime

178
Q

What is osteogenesis imperfecta?

A

Defect in type 1 collagen

179
Q

What are symptoms of osteogenesis imperfecta?

A

short stature, lax ligaments, blue sclera

Sam: Peds (5 decks)

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