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Sam: Peds > Specialty Disciplines -- Handler, Hoffman, Bordeau, Wiese, and Sears > Flashcards

Specialty Disciplines -- Handler, Hoffman, Bordeau, Wiese, and Sears Flashcards

1
Q

What is the most common congenital heart defect?

A

Ventricular Septal Defect

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2
Q

Hypoxemia confirms suspected ________ heart disease

A

Cyanotic

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3
Q

What is the mainstay of imaging for anatomy and hemodynamics of the heart?

A

Echocardiography

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4
Q

Cyanosis is more common with L to R shunt or R to L shunt?

A

R to L

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5
Q

What may find you find on physical exam when cyanosis is long standing?

A

Clubbing of fingers

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6
Q

If you give someone oxygen with a R to L shunt, will it help?

A

Nope

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7
Q

What do we call destruction of pulmonary vasculature (arteriolar) bed in presence of continuous pressure overload?

A

Pulmonary Vascular Obstructive Disease (PVOD)

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8
Q

Are small “restrictive” VSD’s well tolerated?

A

Yes!

Large resistance to flow through small hole; normal RVP and PAP; small L to R shunt

Most of these will close on their own

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9
Q

Harsh, holosystolic murmur along LSB should make you think of?

A

Ventricular septal defect

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10
Q

If someone has a large VSD, how will they present?

A

With symptoms of heart failure

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11
Q

What test identifies the size and location of the defect and the presence of shunting? This test is also diagnostic of VSD.

A

Echo-doppler

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12
Q

Having a large VSD also puts people at risk for developing?

A

Pulmonary Vascular Obstructive Disease (PVOD)

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13
Q

How do we properly manage someone with a small VSD compared to a large VSD?

A

Small – regular check ups. Periodic echo-doppler studies to confirm eventual closure.

Large – treat as if HF. Surgical repair once HF symptoms improve.

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14
Q

What is Eisenmerger’s physiology?

A

When a L to R shunt becomes a R to L. Shunt reversal!

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15
Q

In reference to the atrial septum, where do most Atrial septal defects occur?

A

Mid septum – due to lack of tissue for overlap.

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16
Q

80% of the time, atrial septal defects are due to this not completely developing

A

Ostium secundum

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17
Q

I don’t know how to make this a question but…

A

volume overload is a major issue with ASD

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18
Q

What type of symptoms does an ASD patient present with and at what age do they typically begin to show symptoms?

A

Start in early 20s with very vague symptoms – fatigue, dyspnea, decreased stamina

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19
Q

A fixed, widely split S2 through inspiration and expiration should make you think of?

A

ASD

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20
Q

As an ASD progresses, the murmur will change from a widely split S2 to??

A

Mid-systolic crescendo-decrescendo murmur at LSB

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21
Q

Incidence of this arrhythmia increases with each decade for someone with an ASD

A

A fib (and a flutter)

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22
Q

When this occurs, the RV develops concentric hypertrophy and reflects degree of obstruction at the valvular level.

A

Pulmonic stenosis

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23
Q

PV area must be reduced by how much (or more) to be hemodynamically significant?

A

60 percent

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24
Q

What is the major hemodynamic burden with pulmonic stenosis?

A

Rt ventricular pressure overload

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25
Q

Tell me about the murmur of pulmonic stenosis?

A

Early systolic click upper LSB

It is loud!

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26
Q

What is the first approach to management of pulmonic stenosis?

A

Balloon valvuloplasty

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27
Q

This normally closes within 2-3 days after birth. It runs from the origin of the LPA to the lower aortic arch just beyond the left subclavian artery.

A

Patent Ductus Arteriosus

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28
Q

Murmur is continuous (through systole and diastole) “machinery murmur”. This describes?

A

Patent Ductus Arteriosus

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29
Q

Maternal exposure to this disease may cause PDA?

A

Rubella

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30
Q

What drug do we give for closure of the ductus as 1st line therapy?

A

Indomethacin – causes constriction of the ductus

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31
Q

What do we call discrete narrowing of the distal segment of the aortic arch?

A

Coarctation of the aorta

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32
Q

What may you see on chest x-ray of someone who has coarctation of the aorta?

A

Rib notching

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33
Q

What is rib notching caused by?

A

Development of collateral arteries

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34
Q

What will an ECG of someone with coarctation of the aorta show?

A

Left ventricular hypertrophy

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35
Q

What is crucial for safe repair of the coarctation?

A

Adequate collaterals

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36
Q

What is tetralogy of fallot?

A

Biventricular origin of the aorta

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37
Q

What is the most common cause of sudden death in athletes

A

Hypertrophic cardiomyopathy

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38
Q

What should you think of you see a small child with profound dyspnea, that is relieved by squatting?

A

Tetralogy of Fallot

the squatting puts more blood into the the RV and more blood through pulmonary valve

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39
Q

What will you see on x-ray of someone with tetralogy of fallot?

A

“boot-shaped” heart

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40
Q

How will blood pressure above and below the coarctation compare?

A

Above the coarct will be high, below the coarct will be low.

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41
Q

What is “atopy”?

A

Asthma, allergic rhinitis, and atopic dermatitis

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42
Q

Allergic rhinoconjunctivitis (“hay fever”) frequently coexists with?

A

Asthma

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43
Q

What is the difference between intermittent and persistent allergies?

A

Intermittent – sx present less than 4 days/week

Persistent – sx present more than 4 days/week for greater than 4 weeks

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44
Q

What are some findings on physical exam of a child suffering from allergies?

A

“Allergic salute” and “allergic shiners”

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45
Q

What will the nasal turbinates look like in someone suffering from allergies?

A

Pale blue, edematous

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46
Q

What drugs should we use for prophylaxis for allergies?

A

Mast cell stabilizers and corticosteroids.

Antihistamines will help with control of itching, sneezing, and rhinorrhea

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47
Q

Nasal polyps in a kid should make you think of?

A

Cystic fibrosis

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48
Q

How do we manage children with eczema?

A

Hydration – stick them in luke warm water and then use moisturizer

Moisturizers – really thick ointments like vaseline

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49
Q

This occurs when large quantities of histamine rapidly release from mast cells and basophils after exposure to allergen

A

Anaphylaxis

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50
Q
  1. For children and adolescents, anaphylaxis is most often due to?
  2. Middle-aged adults?
  3. Older adults?
A
  1. Food-induced
  2. Venom-induced
  3. Medication – induced
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51
Q

What are the three most common food allergies?

A
  1. Cow’s milk
  2. Eggs
  3. Peanuts
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52
Q

What is the gold standard in detecting food allergies?

A

Blinded food challenge

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53
Q

What is the mainstay of management for food allergy sufferers?

A

Stay away from the food!

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54
Q

Kids with this disorder will commonly present with recurrent/severe bacterial infections and/or developmental delay.

A

Primary Immunodeficiency (PID)

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55
Q

This syndrome typically presents with recurrent URI’s, +/- otitis media and bronchitis. Spontaneous recovery usually occurs by 9-15 months of age.

A

Transient hypogammaglobulinemia (THI)

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56
Q

This syndrome presents with recurrent infections – opportunistic infections is they key. On exam you’ll find lack of lymphoid tissue.

A

Severe Combined Immunodeficiency (SCID)

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57
Q

Syndrome with repeated seizures without evidence of acute cause of provocation

A

Epilepsy

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58
Q

What is the most common neurlogic disorder of infants and young children?

A

Febrile seizures

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59
Q

What is status epilepticus?

A

Seizures lasting at least 15 minutes or series w/out complete recovery >30 minute period

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60
Q

What are the most common types of headache seen in children?

A

Migraine HA and tension-type HA

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61
Q

“Red flags” for headaches prompt further workup – what are some of these red flags?

A

Headache in child less than 5 years

Worst headache of life

Unexplained fever

Headache worse with straining

Postural headache

Posterior headaches

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62
Q

Physical exam that demonstrates spasticity, hyperreflexia, +/- ataxia, and involuntary movements should make you think of?

A

Cerebral palsy

63
Q

What is the most common etiology of cerebral palsy?

A

Prematurity

64
Q

Neurologic disorder manifested by motor and phonic tics

A

Tourette Syndrome

65
Q

What is considered an abnormal head size?

A

2 standard deviations above/below mean

66
Q

Microcephaly is most often due to?

A

genetic issue

67
Q

What is a common sign of macrocephaly?

A

Transillumination of the skull

68
Q

When does the anterior fontanelle typically close?

A

18-24 months

69
Q

What is the most common cause of conjunctivitis in a newborn?

A

Chlamydia from mom

70
Q

Wide spacing, deep spacing eyes, flattening of nasal bridge are symptoms of?

A

Down Syndrome

71
Q

Ear pits may be connected to what type of abnormality?

A

Kidneys.

72
Q

What is prune belly syndrome?

A

Muscle wall doesn’t form well in the abdomen, only skin is keeping innards in

73
Q

What is the Morrow reflex?

A

Pick up babies arms about one inch off table, and drop. Arms should go out then come back in

74
Q

What is nevus flammeus?

A

“Stork bite” – usually on back of neck or forehead

75
Q

What is a mongolian spot?

A

Usually on butt and back, looks like a bruise.

76
Q

What is the number one cause of infant death in the US?

A

1.Congenital malformations or chromosome abnormality

Low birth weight is number 2

77
Q

What does IUGR stand for?

A

Intra-uterine growth retardation

78
Q

What is LGA typically associated with?

A

Gestational diabetes

79
Q

Smoking puts babies at increase risk for?

A

IUGR and SGA – SIDS

80
Q

How many weeks is baby considered term?

A

37-42

81
Q

How many weeks is late pre-term?

A

34-36/7

82
Q

How does mom get toxoplasmosis?

A

exposure to cats and/or raw meat

83
Q

Hutchinson teeth and bone abnormalities should make you think of?

A

Syphilis

84
Q

Blueberry muffin rash, B and T cell deficiency – which TORCH infection?

A

Rubella

85
Q

Blueberry muffin rash, deafness, pneumonia – which TORCH infection?

A

CMV

86
Q

If mom has active Hep B, what should we give baby at birth?

A

IVIG

87
Q

We test all women for this at 36 weeks

A

Group B strep

88
Q

At what temperature should parents call peds?

A

100.4

89
Q

What is the most common cause of neonatal sepsis?

A

Group B strep

90
Q

How does hyperbilirubinemia presents?

A

Jaundice/scleral icterus and kernicterus

91
Q

Direct (conjugated) bilirubin is always pathologic, physiologic or both?

A

Pathologic.

92
Q

How soon after birth does direct hyperbilirubinemia typically present?

A

Within first 24 hours

93
Q

How soon after birth does indirect hyperbilirubininemia typically present?

A

After 24 hours

94
Q

Indirect hyperbilirubinemia is pathologic, physiologic, or both?

A

Can be both

95
Q

How do we treat hyperbilirubinemia?

A

Treat cause, phototherapy, exchange transfusion

96
Q

What is hematuria?

A

Blood in the urine

97
Q

What is hemoglobinuria?

A

The presence of hemoglobin FREE from red blood cells.

Occurs with rapid disintegration of red blood cells, exceeding the ability of blood protein to bind with hemoglobin

98
Q

If myoglobinuria is present, what else is likely to elevated?

A

Serum creatinine kinase

99
Q

If you have a child who is not acutely ill, and no other worrisome findings on exam besides hematuria. What do you do?

A

Repeat UA (first AM) on two other occasion within 1-2 weeks.

If hematuria persists, order urine culture, renal u/s, renal panel, CBC.

100
Q

What is benign familial hematuria?

A

Defined as isolated asymptomatic hematuria without renal abnormalities in multiple family members

101
Q

Most common bacteria causing UTI’s?

A

E. coli

102
Q

What presents with abdominal pain, flank pain, fever, lethargy, nausea, vomiting?

A

Pyelonephritis

103
Q

What is the DOC for pyelonephritis?

A

Macrobid

104
Q

What presents with dysuria, frequency, urgency, and sometimes odor. RARELY fever

A

Cystitis

105
Q

We must treat cystitis promptly to prevent progression to?

A

Pyelonephritis

106
Q

Asymptomatic bacteriuria is nearly exclusive to these two populations.

A

Girls and people with long-term catheters

107
Q

If a child’s first UTI is before the age of 5, what else should be done in terms of management?

A

Voiding cystourethrogram – typically done about 2 weeks after UTI to allow inflammation to resolve

108
Q

If proteinuria is found on dipstick with absence of other findings or concerns, what should you do?

A

repeat the dipstick on 2-3 other occasions (preferably first AM urine)

109
Q

If proteinuria persists after 3 dipsticks, what should the next step be?

A

24 hour collection

110
Q

What is the most common cause of persisting proteinuria in kids?

A

Orthostatic proteinuria

This is benign.

111
Q

Primary Nephrotic Syndrome is the loss of?

A

Protein

112
Q

We discussed three types of primary nephrotic syndrome – Minimal change disease, mesangial proliferation, and focal segmental glomerulosclerosis. Which one is the least common, most common, and most serious?

A

Least common – mesangial proliferation

Most serious – focal segmental glomerulosclerosis

Most common – minimal change disease

113
Q

How does primary nephrotic syndrome typically present?

A

Initial episode usually follows illness, facial and lower extremity edema, abdominal pain, diarrhea, and irritability

114
Q

Are HTN and hematuria common in primary nephrotic syndrome?

A

No

115
Q

How do we treat primary nephrotic syndrome?

A

Diuretics – closely monitored and corticosteroids

116
Q

In patients greater than 8 that presents with HTN, persisting hematuria, renal dysfunction, rash and/or arthralgia think of?

A

Secondary Nephrotic Syndrome

117
Q

This is caused by mutation of the NPHS1 gene on chromosome 19 – happens within first 3 months of life

A

Congenital Nephrotic Syndrome

118
Q

This is characterized by interstitial inflammation with sparing of the vessels and glomeruli. Triad of symptoms – fever, rash, arthralgia with steadily increasing creatinine. Hematuria and proteinuria are absent.

A

Tubulointerstitial Nephritis (Acute)

119
Q

How is chronic tubulointerstitial nephritis diagnosed?

A

Escalating creatinine levels, small kidneys on ultrasound, and history of chronic disease or exposure

120
Q

Sudden onset of hematuria, edema, HTN, and renal insufficiency should make you think of?

A

Post-streptococcal glomerulonephritis

121
Q

Will kidneys appear small or large on imaging with post-streptococcal glomerulonephritis?

A

Large

122
Q

What is the most common cause of acute renal failure in kids?

A

Hemolytic Uremic Syndrome

123
Q

What precedes 80% of cases of hemolytic uremic syndrome?

A

Acute GI illness

124
Q

This typically presents as an isolated disease. Diagnosis is made by biopsy, usually done in cases of persisting hematuria and proteinuria and lack of their explanation.

A

Membranous Glomerulopathy

125
Q

This is small vessel vasculitis characterized by purpuric rash, arthralgia, abdominal pain, and glomerulonephritis.

A

Henoch-Scholein Purpura Nephritis

126
Q

When should routine blood pressure screenings be done in children?

A

3 years

127
Q

What is vesicoureteral reflex?

A

Defined as retrograde flow of urine from bladder and renal pelvis

128
Q

How is vesicoureteral reflex diagnosed?

A

VCUG (voiding cystourethrogram??) something like that

129
Q

What is the cornerstone of treatment for vesicoureteral reflex?

A

Antibiotic prophylaxis.

DOC is bactrim.

130
Q

At what age are most kids dry through the night?

A

5

131
Q

What is it called when the urethral opening is located on the ventral surface of the penis?

A

Hypospaidus

132
Q

What is phimosis?

A

Inability to retract the foreskin

133
Q

What is the treatment for phimosis?

A

Circumcision

134
Q

What is it called when the foreskin is retracted beyond the glans penis and cannot be pulled forward again?

A

Paraphimosis

This is a medical emergency!

135
Q

What vaccinations are required for kindergarten entry?

A

5 DTP

4 Polio

2 MMR

1 Varicella

136
Q

As of 2010, how many vaccines are recommended for children?

A

16

137
Q

What is the bottom line in measuring effectiveness of vaccines?

A

You need LARGE field trials to measure effectiveness/complications.

138
Q

What is the virus that causes measles?

A

Paramyxovirus

139
Q

Children need 1 or 2 doses of MMR vaccine?

A

2

first dose at 12-15 months of age
second dose at 4-6 years of age

140
Q

What are the 3 stages of whooping cough?

A
  1. Catarrhal – watery eyes, low-grade fever, malaise, runny nose, late-phase nonproductive cough
  2. Paroxysmal – paroxysms (burst of coughing during a single exhalation) followed by an inspiratory “whooping” sound, post-tussive cyanosis, and vomiting
  3. Convalescent – paroxysms gradually improve but recur with respiratory infections
141
Q

How long is whooping cough considered infectious?

A

21 days after onset or until 5 days of abx completed

142
Q

__________ of susceptible persons is most important prevention strategy.

A

Vaccination

143
Q

What is the difference between DTap and Tdap?

A

Dtap – diphtheria and tetanus toxoid

Tdap – tetanus toxoid and reduced diphtheria toxoid

144
Q

How does Diphtheria present?

A

Insidious onset of exudative pharyngitis

145
Q

What is the ACIP?

A

Advisory Committee on Immunization Practices

146
Q

Is natural immunity better than vaccine-acquired immunity?

A

No.

Natural immunity may last longer – but not worth the risk.

147
Q

What three VPD are seen most commonly in schools?

A
  1. Influenza
  2. Pertussis
  3. Varicella
148
Q

If a child feels weak, has itchy rashes or blisters and complains of a headache, think of?

A

Varicella

149
Q

What are the two most common complications of shingles?

A
  1. Post herpetic neuralgia

2. Secondary bacterial skin infections

150
Q

What is the difference between the shingles vaccine and the varicella vaccine?

A

The shingles vaccine contains live attenuated varicella virus in an amount that is 14 times greater than that in regular varicella vaccine

151
Q

Abrupt onset of fever, chills, muscle aches, headache, and fatigue. Think of?

A

Influenza

152
Q

Low-risk HPV types cause?

High-risk cause?

A

Low-risk – genital warts

High-risk – serious cervical lesions, cervical cancer, and other genital cancers

153
Q

Over ____ percent of cervical cancers have HPV DNA detected with the tumor

A

99%

154
Q

Types 6 and 11 cause?

Types 16 and 18 cause?

A

6 and 11 – genital warts

16 and 18 – cervical cancer

Sam: Peds (5 decks)

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