Step 2 Peds Flashcards
This type of newborn hemorrhage is limited by the cranial bones. Where is the hemorrhage located? What is the treatment?
What is the “sister” component to this and how does it present differently?
Cephalohematoma. It is a subperiosteal hemorrhage - monitoring is sufficient b/c it resolves on it’s own mostly.
Caput Succedaneum is a diffuse swelling over suture lines, can be ecchymotic, and usually appears over the presenting vertex part of the baby’s scalp.
What would you be worried about with a child presenting with episodic apnea, pallor or cyanosis, poor suckling, abnormal eye movements, high-pitched cry, muscle twitching, convulsions, decreased hematocrit, metabolic acidosis, and shock? What might you find on PE?
Intracranial hemorrhage. Bulging or pulsatile fontanels.
What would you suspect the etiology to be of a depressed calvarium, resembling a “dented ping pong ball”?
Forceps delivery or fetal head compression. This is a depressed skull fracture.
Why do up to 2/3 boys experience transit gynecomastia during puberty? What’s the normal size of testicular volume in a prepubescent boy? *BONUS - what’s the name of the measuring device?
The testicles make a transient elevated level of estrogen and there’s an increase in peripheral prohormones into estrogen. < 3 mL for prepubescent testicular size measured via a Prader orchidometer.
How would IgA deficiency present? What are common infectious agents seen?
Recurrent sinopulmonary (Hemophilus & Streptococcus) and GI (Giardia) infections. They also can form antibodies against IgA so transfusions can cause an anaphylactic reaction.
What problem do you think of with deficient T cell synthesis, thymic aplasia, fungal infections, hypoparathyroidism with hypocalcemia, cleft palate, and congenital heart disease?
DiGeorge Syndrome - remember CATCH-22: 1) Cardiac anomaly (Tet Fallot = MC or Truncus Arteriosus) 2) Abnormal Facies 3) Thymic Aplasia 4) Cleft Palate 5) Hypoparathyroidism / Hypocalcemia Problem with Chromosome 22
What is deficient in X-linked Agammaglobulinemia? What is the common respiratory pathogen? How is this different from IgA Def?
B Cell Deficiency and all immunoglobulins. Pseudomonas. You won’t have an anaphylactoid reaction because you can’t mount any antibodies.
What do you think of in a child with thrombocytopenia, recurrent otitis media, and eczema? What is deficient in these kids?
Wiskott-Aldrich Syndrome. Combined deficiency in B and T cells.
What is the difference in kids with Hyper-IgM Syndrome and IgA Def?
The IgM levels are elevated in relation to IgA and IgG. But lymphoid hyperplasia is key to distinguishing this syndrome b/c both sinopulmonary and GI infections can present.
What are Cystic Fibrosis patients prone to getting?
Sinopulmonary infections (Pseudo), pancreatic insufficiency, infertility, and meconium ileus.
What do you think of in a child with thrombocytopenia, recurrent otitis media, and eczema? What is deficient in these kids?
Wiskott-Aldrich Syndrome. Combined deficiency in B and T cells.
What causes the arthropathy seen in hemophilic patients? What complications can occur do to this? What imaging is used to best see this? What prophylactic treatment helps prevent these?
Hemosiderin and Fe deposition in the joint causing synovitis and fibrosis. Complications include chronic worsening joint pain, swelling of the joint, contractures of the joint, and limited ROM. MRI is best. Early factor concentrates are used for prophylaxis.
How does each anti-epileptic work and what is it used for? Ethosuximide, Phenytoin, Carbamazepine, Phenobarbital.
BONUS - What two serious side effects do you look out for in the first several weeks of treatment with Phenytoin and Carbamazepine?
Ethosuximide - (childhood absence seizures) works on the thalamic neurons providing Ca-channel blockade
Phenytoin / Carbamazepine - (primary generalized tonic-clonic seizures or partial seizures) blocks neuron’s sodium channels. SEfx’s of Phenytoin = hirsutism, lymphadenopathy, gingival hypertrophy, and rash.
Phenobarbital - (second line) extends Chloride channel opening of GABA receptors
BONUS = Steven’s Johnson Syndrome or Toxic Epidermal Necrosis
How much do you expect a child’s weight and height to change in one year?
Increase height by 50% and weight should triple.
1) What congenital syndrome is associated with William’s Syndrome? (Happy elves)
2) What congenital syndrome is associated with PDA?
3) What congenital syndrome is associated with coronary artery aneurysms?
4) What congenital syndrome is associated with VSD?
5) What congenital syndrome is associated with MVP?
1) Supravalvular stenosis
2) Rubella and Char Syndrome
3) Kawasaki’s Disease
4) Aneuploidy (Trisomy 13, 18, 21)
5) Connective tissue d/o’s like Ehlers-Danlos, Osteogenesis Imperfecta, and Marfan’s
What abnormalities are common with 45 X karyotype? What should you order with this patient to exam for the above findings?
Bicuspid aortic valve, coarctation of the aorta, dilation of the aortic root (increased risk of aortic dissection), streak ovaries, broad chest with wide spaced nipples, amenorrhea, infertility, low-set ears, webbed neck, low hairline, narrowed high arch palate, horseshoe kidney. Order Echo and/or 4-extremity BP readings.
What congenital problem does a child with micrognathia, microcephaly, overlapping fingers, absent palmar crease, VSD, and rocker bottom feet?
Edward’s Syndrome = Trisomy 18
1) What congenital syndrome is associated with William’s Syndrome? (Happy elves)
2) What congenital syndrome is associated with PDA?
3) What congenital syndrome is associated with coronary artery aneurysms?
1) Supravalvular stenosis
2) Rubella / Char Syndrome
3) Kawasaki’s Disease
What abnormalities are common with 45 X karyotype? What should you order in all of these patients?
Bicuspid aortic valve, coarctation of the aorta, dilation of the aortic root (increased risk of aortic dissection), streak ovaries, broad chest with wide spaced nipples, webbed neck, low hairline, narrow high arched palate, low set ears, cubits valgus (angle of the arm is angled away from the body more than normal), horseshoe kidney.
Order an echo and BP measurement in all 4 extremities.
What do you suspect in a child who recently had a cold and now presents with symmetric palpable purpura on his lower extremities, colicky abdominal pain, hematuria on labs, and arthralgias with normal platelets? How do you treat this? What would renal bx show (not needed for dx)?
Henoch-Schonlen Purpura = IgA mediated vasculitis = leukocytoclastic (damage from the nuclear material in neutrophils).
Supportive care and NSAIDs for trmt.
Renal bx would show IgA deposition in the mesangium.
What causative organisms would come to mind in a kid with blue/black hemorrhagic, purpuric lesions?
Neisseria Meningitidis or Strep PNA. This is Purpura Fulminans = life threatening
What is the most common cause of poikilocytosis, anisocytosis, and elevated TIBC in a child?
Fe-def anemia 2/2 poor intake of Fe-fortified foods in the early years of life. Other causes = bleeding or parasitic infxns (elevated bili and eosinophelia would help distinguish the latter respectively)
- Anisocytosis = varying size of RBC’s
- Poikilocytosis = varying shape of RBC’s
What disease do you think of in a kid taking vitamins A, D, E, and K with pancrelipase? What’s the pathology behind this d/o? What are they at risk for?
This is Cystic Fibrosis - a mutation of the transmembrane regulator involving Chloride channels. They are at risk for recurrent PNA, chronic rhino sinusitis, obstructive lung disease leading to bronchiectasis, GI malignancy, obstructive azospermia leading to infertility in males, meconium ileum, clubbing, osteopenia leading to fractures, and kyphoscoliosis.
What are the most common pathogens causing PNA in a patient with CF as it relates to age?
S. Aureus (Gram + cocci in clusters) in infants and young children, Pseudomonas A. (Gram - Rods in adolescents and young adults)
What has occurred in a child with their arm held in a pronated position without any PE evidence to suggest trauma? How is it reduced?
Radial Head Subluxation = Nursemaid’s Elbow. The radial head has slipped from the proper placement in the annular ligament. Holding the child’s arm supinated with pressure on the radial head will most likely bring the radial head back into proper alignment with an audible click.
What would you suspect in a child who is an active sports, involved with throwing, player that complains of pain, “popping sounds”, and inability to rotate his forearm?
Panner’s Disease = Osteochondrosis of the capitellum (distal end of humerus) 2/2 to overuse causing decreased vascular supply to the area
What would you suspect in an older adolescent who has pain on palpation of the lateral epicondyl, pain with passive flexion of the wrist and with resisted extension of the wrist?
Tennis Elbow = Lateral Epiocondylitis 2/2 to overuse of the extensor muscles and their attachment point on the lateral epicondyl.
What are you concerned of in a child that presents with poor suckling, fatigue, rigidity, spasms, from an unimmunized mother with umbilical stump infection? What are your main concerns in the first and second weeks of life for the infant?
Clostridium Tettani causing tetanus. First week risk = apnea and second week risk = septicemia.
What kind of RBC d/o do you suspect in a patient with Coombs negative, jaundice, hemolytic anemia, elevated MCV, splenomegaly and + FM history?
What 2 tests are the gold standard for dx?
Hereditary Spherocytosis.
Acidified Glycerol Lysis Test and Eosin-5-Maleimide Binding Test (flow cytometry)
What d/o presents with a “baby-doll” (chubby face), short stature, thin extremities, protuberant abdomen, occasional hypoglycemic seizures, hypoglycemia, hyperlipidemia, hyperuricemia in a 3-4 month old child?
Type I Glycogen Storage Disease = Von Gierkes’ = G6PD Def. Affects the liver, kidneys, and gastric mucosa (hepatic labs are normal). Heart and spleen are normal.
What would you suspect with hepatomegaly, “floppy baby”, feeding difficulties, macroglossia, and heart failure in children within the first few weeks of birth?
Type II Glycogen Storage Disease = Acid Maltase Deficiency = Pompe’s. HF is 2/2 to progressive hypertrophic cardiomyopathy.
How would you distinguish Type III Glycogen Storage Disease from Type I?
Type III = Glycogen Debranching Enzyme deficiency. Common presenting factors = hepatomegaly, hypoglycemia, hyperlipidemia, and growth retardation. Distinguish based on NORMAL uric acid and lactate levels with ABNORMAL elevated liver enzymes and fasting ketosis. Also, spenomegaly is present with normal kidneys.
Type IV Glycogen Storage Disease = Amylopectinosis. What does the presenting patient have?
Progressive cirrhotic liver.
What could a patient have 2-4 weeks after having a Group A Streptococcus pharyngitis with migratory joint pain, carditis, subcutaneous nodules, erythema migrans, and Sydenhams chorea? What antibody level could you check?
Rheumatic Fever. Antistreptolysin-O titers
A child presents within 48 hrs of delivery with a high-pitched cry, poor feeding, irritability, poor sleeping, sweating, sneezing, seizures, diarrhea, vomiting, and tremors - what two drugs are you considering have caused this? Why might a mother been given one of these aforementioned suspected caustic agents? How is this treated?
Methadone or Heroin b/c opiates = MC cause withdrawal symptoms in newborns (t cause withdrawal
What are the MCC of hematochezia in a child? What do you suspect in a child with painless rectal bleeding and no abdominal tenderness or palpable findings? What should you order for this suspected dx?
Hemorrhoids, anal fissure, Meckel’s Diverticulum, Infectious Collitis, IBD, and intussusception.
Meckel’s Diverticulum = heterotopic gastric mucosa can be found by technetium-99m pertechenate scan.
What is the most common brachial plexus abnormality seen in delivery of a macrosomic baby? What nerve roots does this involve? How does it present? How’s the prognosis?
Erb-Duchenne Palsy - C5, C6, and C7 causing infraspinatous, deltoid, and wrist/finger extensors to be affected with compensation by opposing muscle groups - results in “waiter’s tip” appearance = extended elbow, pronated forearm, and flexed wrist. 80% spontaneously resolve with PT and massage by 3 months. If refractory, surgery can be attempted.
What are the common characteristics of Down Syndrome? What associated finding would cause bilious vomiting within the first 2 days of life? What clue would be seen on prenatal U/S? What further work-up should be done?
Flat facies, hypotonic child, curved fifth digit, increased space between first and second toe, macroglossia, slanted palpebral fissures, and low-set ears. Duodenal atresia. Polyhydramnios. Cardiac workup b/c of associated VSD/ASD problems.
When is meconium said to be “delayed”?
> 48 hrs
MCC of conductive hearing loss in children? What would distinguish an auditory problem vs. autism?
Recurrent ear infections. Autism would more likely have little affection, repetitive movements, and poor eye contact.
What is the only possible complication resulting from Hydroxyurea use?
Myelosuppresion causing thrombocytopenia, anemia, neutropenia.
What findings are associated with Celiac’s Disease? What would you order?
DM Type I, dermatitis herpetiformis, diarrhea, and anemia. IgA anti-tissue transglutaminase antibody assay - endoscopy with bx can also confirm
What is the MC piggy-back pathogen s/p influenza infection? What type of treatment would you begin w/ a hx of recurrent plum disease?
Staph A. - consider starting Vanco!
What is the spirochete responsible for Lyme Disease? What is the name of it’s vector?
Borrelia Burgdorferi carried by the Ixodes Tick
What are the indication for further w/u of neonatal jaundice?
1) Conjugated Hyperbilirubinemia >2mg/dL
2) Jaundice that appears in the first 24-36 hrs
3) Serum Bili that rises at a rate > 5mg/dL/24 hrs
4) Bili that is > 12 mg/dL (term) or >10-14 mg/dL (preterm)
5) Persistence of bilirubin for > 2 weeks
6) Signs of symptoms
What d/o do you think of with an elevated conjugated bilirubin?
Neonatal Cholestasis 2/2 to Biliary Atresia or from external compression of the biliary ducts.
What two d/o do you think of with elevated unconjugated bili?
1) Gilbert’s Syndrome = mild def of UDP glucuronyl transferase
2) Crigler-Najjar = absent UDP glucuronyl transferase
When does Breast Milk jaundice present and how is it managed?
Breast milk jaundice normally occurs in the 2nd week of life with elevated unconjugated bili levels reaching 30 mg/dL. Cessation of breast milk intake with replacement of milk-formula resolves symptoms in a day - return to breast milk after 2-3 days usually does not cause the hyperbilirubinemia to return.
When does physiologic jaundice present and resolve?
This jaundice (< 12 - 14 mg/dL) appears in the first days of life and resolves by the first week.
What is the MCC of nephrotic range proteinuria, edema, hypoalbuminemia in a child and adult respectively? What if the child has Hep B?
1) MCC of Nephrotic Syndrome in adults = Membranous and Focal Segmental Glomerulonephritis
2) MCC of Nephrotic Syndrome in children = Minimal change disease
Child with nephrotic syndrome + Hep B = Membranous type
Nephrotic Syndrome protein = 3g/day
What’s the MCC of…
1) Crescentic Glomerulosclerosis
2) Focal Segmental Glomerulosclerosis
1) Presents as rapidly progressive nephritic syndrome with renal insufficiency
2) African Americans & HIV
What stages of sleep do the following occur…
1) Night terrors
2) Somnambulism
3) Nightmares
1) Non-REM
2) Non-REM
3) REM
What RNA Togavirus do you suspect with a child who presents with a cephalocaudal proceeding rash lasting
Rubella (German Measles) - treat with acetaminophen and symptomatic care.
BONUS = Forschheimer Spots
When do vaccines get administered for preterm infants - according to what age scale?
Chronologic, NOT gestational. Exception is Hep B, child should be more than 2kg.
What is Eisenmenger Syndrome?
Cyanosis and dyspnea 2/2 to R-2-L shunting
