Surgery Flashcards
type of pain experiences with pancreatic cancer?
epigastric abdominal pain that is insidious. gnawing, and worse at night
Young male (20s) without trauma has pneumothorax?
Primary spontaneous pneumothorax
Varicocele-signs? Diagnostic method?
soft mass that worsens with standing and Valsalva maneuvers, but decreases when supine, does not transilluminated Diagnostic- US
Risk factors for acute mesenteric ischemia?
Atherosclerosis Embolic source hypercoagulable disorders
What are the signs of arterial occlusion?
Pain, pallor, paresthesias, pulselessness, and coolness to the touch
Mediastinal mass with nomral b-HCG and AFP?
Thymomas
diaphoretic
Sweating heavily
How can you minimize the risk of infection from a PICC?
Remove it as soon as treatment/use is complete
How does mesenteric ischemia present?
sudden periumbilical abdominal pain out of proportion to examination findings
Signs of esophageal stricture?
Dysphagia, no abdominal succussion splash
blunt thoracic trauma, respiratory distress despite bilateral chest tubes
Flail chest, demonstrate tachypnea, shallow breaths
Signs of gallstone ileus
stuttering episodes of nausea and vomiting, pneumobilia, hyperactive bowel sounds, dilated loops of bowels
Morton neuroma
inflammation of the common digital nerve in the third space
Syndrome associated with arterial occlusion at the bifurcation of the aorta?
Leriche Syndrome
Cause of pretibial edema?I
Increased pulmonary vascular resistance
Elevated serum b-HCG with normal AFP?
seminoma
Trochanteric bursitis- definition? Signs?
definition- inglammation of the curse surrounding the insertion of the gluteus medius onto the femur’s trochanter signs- hip pain when pressure is applied and with external or resisted abduction
How does an anterior should dislocation occur?
forceful abduction and external rotation a the glenohumeral joint; risks damage to the axillary nerve
Back pain in woman who recently has breast cancer?
Metastatic spread, diagnose with MRI
borborygmi
a rumbling or gurgling noise made by the movement of fluid and gas in the intestines
pneumomediastinum and pleural effusions-cause?
esophageal rupture
blunt abdominal trauma, hypotension, right chest/abdominal wall injury, and free intraperitoneal fluid
Hepatic laceration
Pulmonary contusion-CXR results
patchy irregular alveolar infiltrate
What treatments should be provided for a through-and-through extremity gunshot wound?
Tetanus prophylaxis
Uropelvic junction obstruction signs
Intense pain when large diuresis occurs (beer drinking)
Signs of primary adrenal insufficiency?
hyponatremia and hyperkalemia
“tip of the finger remains flexed when the rest of the fingers are extended
Malley
migratory RLQ pain, nausea, vomiting, fever, leukocytosis
acute appendicitis
Cause of blood in rectum from child?
Merkel’s diverticulum, workup with technetium scan
Initial management of non-displaced scaphoid bone fracture?
Wrist immobilization for 6-10weeks, with x-rays in7-10 days
Signs of Zollinger-Ellison disease
Refractory to other treatments, multiple ulcers
Amblyopia
vision impairment resulting from interference with the processing of images by the brain during the firs t6-7 years of life
Why a newborn does not urinate during the first day after birth?
posterior urethral valves
How does venous insufficiency present?
worsens throughout the day and resolves overnight when the patient is recumbent
What should be the first step in the treatment of a woman with breast cancer?
Resect the mass, then treat with chemo/rad
Sites for ischemic colitis? Imaging signs? How to confirm?
Splenic flexure, rectosigmoid junction CT scan may show thickened bowel wall Confirm with colonoscopy
Varicocele treatment?
NSAIDS or surgical correction
Physical signs of pulmonary contusions?
tachycardia, hypoxia, tachypenea
How to treat acalculous cholecystitis acutely? Definitively?
Acutely- percutaneous cholecystostomy and antibiotics Definitively- cholecystectomy with drainage of associated abscessess
If a patient is stable, which test is most sensitive for blood?
CT
C6 radiculopathy
(one of the most common), causes pain and/or weakness along the length of the arm, including the biceps (the muscles in front of the upper arms), wrists, and the thumb and index finger.
epigastroc pain/tenderness and weight loss with nonspecific systemic symptoms with significant smoking history
pancreatic adenocarcinoma
What should be the first step in management of an unknown mass on an HIV patient?
Biopsy
C8 radiculopathy
causes pain from the neck to the hand. Patients may experience weakness in hand grip, and pain and numbness can radiate along the inner side of the arm, ring, and little fingers.
Femoral nerve innervation
hip joint and skin of the anterior and medial thigh and leg
First step in the workup for pancreatic cancer?
CT of the abdomen
Signs of cardiac temponade?
hypotension (unresponsive to IV fluids), tachycardia, and elevated jugular venous pressure after blunt thoracic trauma
How to treat acute rejection?
Tacrolimus or Mycophenolate mofetil with/without steroids
Signs of arterial thrombosis
Slow, progressive narrowing of the vascular lumen Pulses are diminished bilaterally (normally)
Signs of PE?
pleuritic (sudden onset), sob, diaphoretic, tachycardic, distended veins in neck and face
Long-term growth (> 6 months) on glans penis with negative VDRL test?
Penis cancer
In patients with variceal bleeding, what should be the main goal?
Fluid resuscitation
Use of NSAIDS with episodic postprandial epigastric pain?
Perforated peptic ulcer
When do you give tetanus immune globulin?
severe or dirty wound with unsure vaccination history
What does A sengstaken-Blakemore tube do?
Balloon tamponade of variceal bleeding if endoscopy is unavailable
How do you test an animal for rabies?
Kill the animal and scan its brain
How can heart failure develop from an aneurysm?
Lead to the development of a fistula
How do you treat testicular cancer?
platinum-based therapies
Gallbladder distension and wall thickening, presence of pericholecystic fluid, without gallstones
acalculous cholecystitis
When can early excision and grafting be used?
Small (
acute epididymitis- treatment
Abx and sonogram to rule out torsion
What is the postoperative cause of fever 1-4 weeks post surgery?
Other organisms (nor GAS, C. perfringens), C difficile, drug fever, PE/DVT
Signs of rotator cuff impingement
pain with abduction, external rotation subacromial tenderness normal range of motion with positive impingement tests (Neer, Hawkins)
Where do you biopsy a basal cell carcinoma?
Edge of the lesion
Diffusely enlarged thyroid gland with neck swelling and no symptoms of decreased thyroid?
Chronic lymphocytic thyroiditis (Hashimoto disease)
Contraindication to organ donation?
Positive HIV status
Tetanus prophylaxis in a clean or minor wound?
Tetanus toxoid-containing vaccine only if
Signs of adrenal insufficiency?
hypoension/shock weakness nausea, vomiting, abdominal pain, fever
Organism most likely responsible for infection from intravascular devices?
Coagulase negative s. epi
how to diagnose meniscal tears?
MRI
Clinical signs of acute mesenteric ischemia?
Rapid onset of periumbilical pain Pain out of proportion to examination findings hematochezia
What is a major complication risk from AAA repair?
MI
C5 radiculopathy
can cause pain and/or weakness in the shoulders and upper arms. Especially may cause discomfort around the shoulder blades. It rarely causes numbness or tingling.
How to treat rib fractures in the elderly?
Local nerve block and epidural catheter
Symptoms in arterial embolism?
sudden and severe, with diminished pulses in the affected limb, but normal in the unaffected
Important steps in the preoperative management of a patient taking Warfarin?
Check INR, reverse with fresh, frozen plasma
Effects of uncal herniation?
- Ipsilateral hemiparesis 2. parasympathetic loss (mydriasis (early) ptosis, 3. Contralateral homonymous hemianopdia 4. altered level of consciousness
Signs of urethral injury?
blood at the urethral meatus, inability to void, high-riding prostate on DRE
Double bubble with normal gas
Malrotation
1 week post- otitis media infection: projectile vomiting, seizures, blurred vision, severe headache
Brain abscess
How is duodenal hematoma treated?
NG suction and parenteral nutrition
Trashing around with sudden pain?
Stone stuck in ureter
What is required when starting Warfarin?
Heparin bridge- warfarin activates proteins C and S causing a transient prothrombotic state
Tetanus prophylaxis in a dirty or severe wound?
Tetanus toxoid-containing vaccine only if booster > 5 years ago If unsure, tetanus toxoid-containing vaccine plus tetanus immune globulin
Mediastinal mass with elevated AFP and b-HCG?
mixed cell germ tumor
In a patient with weakness and decreased pain in both legs, what type of injury is suspected? Action?
Lower spinal cord injury, insert urinary catheter to assess for urinary retention and prevent bladder injury
What is the postoperative cause of fever 1-7 days after surgery?
Nosocomial infections, Group A streptcoccus, or C. perfringens
Osgood-Schkatter disease
Painful lump below the kneecap in children during puberty, can cause a limp
Signs of retroperitoneal abscesses?
fever, child, and deep abdominal pain may initially be missed by a CT scan
How do you manage sigmoid volvulus?
Sigmoidoscopy-guided placement of a rectal tube
What can cause narrowing of the biliary ducts?
cancer (specifically pancreatic), strictures (trauma)
Classic association with pancreatic cancer? Name?
migratory thrombophlebitis Trousseau sign
How to treat a pancreatic abscess
Immediate placement of a percutaneous drainage catheter, culture of the drained fluid and surgical debridement
Intervention for UPJ stones larger than 7mm
extraperitoneal shock-wave lithotripsy
How are intertrochaneric fractures treated?
ORIF with anticoagulation
Standard bolus for burns
1000mL/hr 30-120mL/hr
Signs of elevated intracranial pressure?
HTN, bradycardia, respiratory depression (Cushing’s reflex)
What is the postoperative cause of fever 0-2 hours after surgery?
Prior trauma/infection, blood products, malignant hyperthermia
How does pneumonia that is developing into septic shock present? Treatment?
acidosis, low urine output, hypotension, tachypnea, fever Tx- IV normal saline
Acute edematous pancreatitis
Alcoholics of gallstones Pain after large meal or EtOH _> constant, radiates to back-> nausea, vomiting, retching
Sudden testicular pain, pyuria, fever
acute epididymitis
Patient response to atelectasis?
Hyperventilation -> respo. alkalosis, decreased pCO2
When do patients show signs of pulmonary contusions?
Approx. 4 hours post-injury when hypoxia, respiratory distress, pulmonary edema set in
Signs of compartment syndrome?
- Pain out of proportion to injury 2. Pain increasing on passive stretch 3. rapidly increasing & tense swelling 4. paresthesia (early)
Leriche syndrome
bilateral hip, thigh, buttock claudication impotence symmetric atrophy of the bilateral extremities due to ischemia
soft mass that worsens with standing and Valsalva maneuvers, but decreases when supine; does not transilluminate
varicocele
Should volume support or patient transport during traumas come first?
Urban areas with close trauma center - transport All other areas- resuscitate
Child class factors to deny surgery
albumin below 2, INR 2 x normal, ascites
Signs of diaphragmatic hernia?
blunt abdominal trauma with mild respiratory distress and abnormal xray **smaller hernias present with nausea/vomiting and are delayed
Square root sign
Chronic constrictive pericarditis
How do you counteract the effects of propofol?
Dopamine
Preferred anticoagulant in end-stage renal failure patients?
Warfarin
When should you suspect diaphragmatic rupture?
History of blunt trauma/MVA, abnormal CXR, left lower lung opacity, elevated hemidiaphragm, and mediastinal deviation
C7 radiculopathy
(the most common) causes pain and/or weakness from the neck to the hand and can include the triceps (the muscles on the back of the upper arms) and the middle finge
Signs of abdominal aortic aneurysm rupture?
severe back pain, syncope, profound hypotension
How to diagnose bladder trauam?
Retrograde cystogram with post-void films
Treatment for impotence-first line?
Sildenafil, tadalafil, vardenafil
How do you obtain samples from a breast?
US guided imaging
acute abdominal pain followed by lower GI bleeding after an episode of hypotension?
Ischemic colitis
How to treat lumbar disk herniation?
MRI of L4-S1, pain control with nerve blocks
Child with current-jelly stools?
Intussusception
Workup for squamous cell carcinoma of the mucosa?
Panendoscopy
How to treat perforated peptic ulcers?
NG suction, bowel rest, intravenous fluids, broad-spectrum antibiotics, IV PPI
bilateral pulmonary infiltrates with low PO2
ARDS, PEEP
How do you store an amputated limb?
Place in saline moistened gauze and then in a plastic bag on ice…bring it wherever the patient goes.
How does cervical impingement present?
pain and paresthesias of the neck and arm along with upper extremity weakness
What type of catheter is used for embolectomy of an atrial clot from a. fib?
Fogarty
Cause of infertility from varicocele?
Increased scrotal temperature
What is mandatory for all abdominal bullet wounds?
Ex Lap
Complications from cardiac catheterization
pseudoaneurysm, arteriovenous fistular formation, arterial dissection, acute thrombosis
Written description of C- Diff infection?
Patchy, white mucosa on colonoscopy
pneumothorax despite chest tube, pneumomediastinum subcutaneous emphysema
tracheobronchial perforation (right bronchus is most common
Where are squamous cell carcinoma found?
Lower lip and below on face
When should you considerd surgical interventions for anal fissures?
When medical management has failed
Hoe do you treat anal fissures?
topical anesthetics, vasodilators (nifedipine) Sitz baths stool softeners high-fiber diet & adequate fluid intake
How do patients with duodenal hematomas present? Etiology?
epigastric pain and vomiting d/t blood collection between the submucosal and muscular layers of the duodenum
How to treat intussusception?
Control enema
What someone falls from a height, what X-rays should be ordered?
C-spine
Holosystolic murmur heart of the left sternal border?
Pulmonary regurgitation
How do you counteract a decrease in blood pressure after administration of propofol?
Administer dopamine
What are burns near the eyes covered with?
Triple abx ointment
Etiology of adrenal insufficiency?
adrenal hemorrhage/infarction acute illness/injury/surgery in patient with chronic adrenal insufficiency or long-term glucocorticoid use
Patient passing stone suddenly spikes a fever
ER immediately, nephrostomy tube placement
cardiac catheterization, anticoagulation, sudden hypotension, tachycardia, flat neck veins, back pain
retroperitoneal hematoma
Signs of meniscal tears?
pain, clicking, or catching
What is erythema nodosum?
Acute, nodular, erythematous eruption on the extensor aspects of the lower legs. Associated with hypersensitivity reactions
Chubby 13 year old boy limping, complaining of knee pain, sole of affected foot points towards the other one
slipped capital femoral epiphysis
arm held close to the body
Posterior shoulder dislocation, axillary/scapula xrays needed for diagnosis
Torus palatinus? Tx?
benign, bony growth located on the mid-line suture of the hard palate No treatment necessary unless systemic effects develop or it interferes with speech
How do you manage small pneumothorax? Large?
Small- supplemental O2 Large- Needle thoracostomy/chest tube
Signs of septal perforation?
whistling noise during respiration, caused by post-operative septal hematoma
Best management of acute appendicitis?
Laparoscopic appendectomy
Physical signs of a meniscal tear?
joint line tenderness, pain or catching in the provocative tests (Thessaly, McMurray
Initial management for perforated peptic ulcer
NG suction, bowel rest, intravenous fluids, broad spectrum Abx ad intravenous PPI
Knee to chest position in children?
Ependymoma
When are US and CT used in acute appendicitis?
when classic presentation/signs are not present
5 days after pancreatoduodenectomy , what type of feeding should be used?
Enteral tube feedings
Postoperative cholestasis-signs?
hypotension, blood loss into tissues, massive blood load (transfusion), decrease liver functionalty, decreased renal bilirubin excretion with normal ALT/AST
In an ejection, what should always be imaged?
C-spine (CT scan)
What is the cause of postoperative fever more than 1 months post-surgery
Viral infections, indolent organisms
Differential for anterior mediastinal mass?
- Thymoma 2. teratoma 3. thyroid neoplasm 4. Lymphoma
post-operative thoracic surgery, fever, tachycardia, chest pain, leukocytosis, and sternal wound drainage or purulent discharge?
Acute mediastinitis, TX- surgical debridement and antibiotic therapy
Signs of fat embolism?
severe respiratory distress, petechial rash, subconjuctival hemorrhage, tachycardia, tachypnea, and fever
Classic description of pain in pancreatic cancer?
Abdominal pain that is insidious, gnawing, and worse at night
Vascular rings
stridor, “crowing”, baby assumes hyperextended neck Bronchoscopy shows segmental compression of the trachea Tx- surgical division
Signs of SBO strangulation?
peritoneal signs (rigidity, rebound) signs of shock (fever, tachycardia, leukocytosis)
What is the first step in management of damage to the urethral meatus?
retrograde urethrogram
NSAID use with several-day history of epigastric pain followed by acute-onset sevfere constant pain?
perforated peptic ulcer
Signs of sepsis
worsening hyperglycemia, leukocytosis, thrombocytopenia, milk hypothermia, tachypnea, tachycardia
Most common organism causing lymphangitis?
Strep pyo (group A)
Small, raised, waxy lesion
Basal cell carcinoma
When should conservative management be used for menscal tear? Examples?
Short-term pain, elderly Example: rest, NSAIDs
Initial management of coughing with large amounts of blood (>600mL or 100mL/hour)?
Secure airway
Legg-Calve-Perthes disease
Blood flow is interrupted to the femoral head in children, can cause necrosis
Signs of deep vein thrombosis?
alf tenderness with pain worsened by passive stretching of the calf.
Cause of subcutaneous emphysema?
Tension pneumothorax
Signs of acute adrenal insufficiency?
Severe and often refractory hypotension, vomiting, abdominal pain and fever
Common cause of coma in a cirrhotic patient with bleeding varices?
Ammonium toxicities
What degree of angulation is unacceptable in children (compared to adults)
Larger amounts
Hemoptysis with upper lung lobe involvment? Initial step?
TB, Isolation
What should be done with all gunshot wounds to the abdomen?
Exploratory Laparotomy
Complications associated with supracondylar fracture of the humerus
Brachial artery injury Median nerve injury Cubitus varus deformity Compartment syndrome/Volkman ischemic contracture
Old man with blood on the outside of his stool?
Hemorrhoids
First step in workup for a palpable breast mass?
US guided core biopsy
Sources of inflammation in the left lower quadrant of women?
Diverticulitis, tube, ovary Diagnose with CT
Stumbling around and truncal ataxia in children?
Medulloblastoma
periumbilical pain out of proportion to examination and hematochezia?
acute mesenteric ischemia Gold standard diagnosis is mesenteric angiography
Liters of drainage from an upper GI wound?
fluid replacement, nutritional support, protection of the abdominal wall
non-healing ulcer?
Basal cell carcinoma
Signs of pyloric strictures
postprandial pain, vomiting with early satiety, succussion splash on the epigastrium
How to treat trigeminal neuralgia?
Anti-convulsants (carbamazapine)
Epigastric pain/tenderness, weight loss in the setting of nonspecific systemic symptoms and significant smoking history?
Cancer of the upper GI or associated organs…think gallbladder, liver, pancreas
What is the drop arm test?
Detects a tear in the supraspinatus; arm is abducted passively above head and they are instructed to lower it slowly
Abdominal mass that moves up and down in a baby
Malignant tumor of the liver ie-hepatoblastoma or hepatocellular carcinoma
What is a pneumatocele?
cavity in the lung parenchyma filled with air that may result from pulmonary trauma during mechanical ventilation
How to workup claudication?
Doppler studies
When giving large amounts of packed RBC’s, what must be added?
Platelets
How to granulosa cell tumors present in children?
Post-menopausal woman?
Diagnostic findings?
Children: Precocious puberty, Large adnexal mass
Post-menopausal: bleeding/endometrial hyperplasia
Diagnostic findings: Inc. estrogen,
Pelvic US: ovarian mass, thickened endometrium
Adolescent with nasal obstruction, visible nasal mass, frequent nosebleeds, and bony erosions on hte back of the nose, suspect?
Angiofibroma
Signs of increased intracranial pressure?
Morning vomiting and noctural headaches
Varicella immunization protocol
2 doses, 1st at 1 year, 2nd at 4 years
Treatment for vaicella zoster exposure in an individual without complete immunity?
Postexposure prophylais with VAV vaccines (if within preceeding 5 days)
If unable to receive live vaccine: varicella immunoglobulin (includes individuals less than 1 year of age)
Seborrheic dermatitis:
Erthematous plques and/or yellow, greasy scales
What is the next step in management after capillary samples tested positive for increased lead?
Venous blood lead level
What is the treatment for mild lead levels?
Moderate lead levels?
Severe lead levels?
Mild: No medication, retest in <1 month (5-44mcg/dL)
Moderate: DMSA (Meso-2,3-demercapto-succinic), (45-69mcg/dL)
Severe: Dimercaprol (British anti-lewisite) plus EDTA (>69mcg/dL)
What congenital heart defects are present in patients with Down syndrome? Presentation?
Complete atrioventricular septal defect
Signs: Loud S2 d/t pulmonary hypertension
Systolic ejection murmur (increased flow across pulmonary valve from left to right shunt)
Holosystolic murmur of VSD (soft or absent if defect is large)
First step in management for a harsh, holosystolic murmur best heart at the left lower sternal border?
Echocardiogram to evaluate ventricular septal defect
What should all sexually active women under 24 be screened for?
Chlamydia trachomatis and neisseria gonorrhoeae
Most common cause of pneumonia in children?
Adults?
Children: S. aureus
Adults: Pseudomonas
Children under 8 years of age should be treated for erythema hronicum migrans from lyme disease with?
Over 8?
Under 8: Amoxicillin
Over 8: Doxycycline
When should IV ceftriaxone be used to treat lyme disease?
Lyme meningitis and heart block
How to determine B lymphocytes from total lymphocytes?
Subtract T-lymphocytes from total lymphocytes
X-linked agammaglobulemia?
Alternative name?
Low B-cells, low Ig levels
AKA: Bruton’s agammaglobulinemia
Job syndrome?
Normal levels of B-cells, Ig, except with hyper IgE
When does neonatal conjunctivitis from Chlamydial infections occur? Treatment?
5-14 days after delivery?
Treatment: ORal erythromycin
Signs of hemophilia?
Hemarthrosis and Deep tissue hematomas
Increased aPTT
What diseases can lead to a vitamin K deficiency?
Cystic fibrosis, IBS, Celiac, biliary atresia, frequent Abx use, malnutrition
Infectious mononucleosis, signs?
Test?
Fever, Tonsillitis/pharyngitis, psterior or diffuse cervical lympadenopathy, significant fatigue, hepatosplenomegaly
Test: Heterophile antibody test
Aplastic anemia vs aplastic crisis?
Aplastic anemia: pancytopenia due to bone marrow failure
Aplastic crisis: Chronic anemia with compensatory reticulocytosis
Croup vs Epiglottitis
Croup: Bark-like cough, stridor, hoarse voice
Epiglottitis: Unvaccinated children, sore throat, dysphagia, drooling, tripod position
2 days fever and facial swelling with delayed vaccination schedule? Most common complication?
Mumps
Common complication: Aseptic meningitis, orchitis, parotitis
How do you confirm the type of leukemia?
Bone marrow biospy
Signs of HIV in infancy?
Failure to thrive, chronic diarrhea, lymphadenopathy, pneumocystis pneumonia
Severe combined innumodeficiency: Signs
lymphopenia, recurrent infections, and failure to thrive,
ADA deficiency
Signs of sepsis?
Fever, chills, hypotension, leukocytosis, bandemia
Most common cause of sepsis in sickle cell patients?
S. pneumoniae
condensed nuclear chromatin, small nucleoli with scant agranular cytoplasm
Lymphocytes
High blast count with strongly positive periodic acid schiff (PAS) reaction, in a 2-10 year old?
Lymphoblastic leukemia
Aeur rods are found in which type of cancer/
Acute myelocytic leukemia`
What infections are common in sickle cell patient?
H influenza, N meningitidis, S. pneumoniae
Al
What type of vaccination prevents S. pneumoniae?
Conjugate capsular polysaccharide
Signs of Diamond-Blackfan syndrome?
Macrocytic anemia, low reticulocyte count, congenital anomalies
Average age of onset is 3 months
Clincal features of pineal gland masses?
Limited upward gaze, upper eyelid retraction, puils non-reactive to light, reactive to accomidation
Clinical features of medulloblastomas?
Ataxia and truncal instability
Patient with meningitis and petechial rash?
Neisseria meningtides
What type of CT should be ordered for head trauma?
Non-contrast
Marfan syndrome vs Homocystinurea
Marfan: AD, normal intellect, Aortic root dilation,
upward lens dislocation
Homocystinurea: AR, intellectual disability, thrombosis, downward lens dislocation, megaloblastic anemia, fair complexion
Ehlers-Danlos syndrome
scoliosis, joint laxity, skin hyperelasticity
Breath-holding spells
Types?
Episodes of apnea precipitated by frustration, anger, pain.
Types
Cyanotic: crying followed by breath-holding, cyanosis and loss of consciousness
Pallid: Minor trauma followed by breath-holding, pallor, diaphoresis, and loss of consciousness
Neuroblastoma?
Most common extracranial tumor of childhood
- Adrenal gland or retroperitoneal ganglia
- Calcifications and hemorrhages are seen on xray/ct
What are the catecholamines?
homovanilic acid and vanillylmandelic acid
Infants born to diabetic mothers are at risk for?
Hypoglycemia, hypocalcemia, hyperbilirubinemia, polycythemia
Cardiomyopathy, GI atresia, urinary malformations, hyaline membrane disease
Galactosemia
“mouse-like” odor, hyperbilirubin, elevated liver function tests, low glucose, cataracts, ascities
Increased risk for E. Coli sepsis
Maple syrup urine disease
dystonia, poor feeding, lethargy, vomiting, ketouria
Ornithine transcarbamylase deficiency
vomiting and poor feeding, seizures, increased ammonia, altered mental status
Signs of hypothyroidism? Lab?
Decreased activity, horse cry, jaundice
*However, majority are asymptomatic at birth
Lab: Increased TSH, decreased T4
Todd paralysis
self-limited, focal weakness that occurs after focal or generalized seiure; presents in the postictal period with partial or compelte hemiplegia involving ipsilateral arm
What can cause isolated adrenarche? Clincal manifestations? Lab findings?
Adrenal angrogen secretion in obese individuals
Signs: oily hair/skin, acne, pubic hair, axillar hair
Lab findings: Increased DHEA-S, low testosterone
Mental retardation, pronounced startle reflex, serizures, hyperacusis, loss of vision, macrocephaly
Tay sachs disease, beta-hexosaminidase A
Tests used to screen for DM Type 2?
Hemoglobin A1c, fasting glucose, 2 hour oral glucose, 1,5-anhydroglucitol
Tests used to diagnose DM type 1?
glytamic acid decarboxylase (GAD65), IGF-1, IGFBP
Signs of pinworm infections?
Perianal puritus, especially at night, may extend into the volvula in pre-pubertal women
Signs on leukocyte adhesion deficiency?
Recurrent skin and mucosal infections, no pus, poor wound healing
Signs on defective intracellular killing?
No neutrophilia, infections with catalse-positive organisms
Common complication of individuals with sickle cell trait?
Hematuria
Inability to extend the beck and widened prevertebral space suggests?
Retropharyngeal abscess
Signs of syphilis in a newborn?
Profuse rhinorrhea, desquamating skin rash, abnormal long-bone radiographs (metaphyseal lucencies)
Signs of congenital CMV?
pericentricular calcifications (microcephaly, if severe)
Hereditary spherocytosis
Inc. mean corpuscular hemoglobin concentration
Spherocytes on peripheral smear
Negatove coombs test
Increased osmotic gragility on acidiied glyceral test
Abnormal eosin-5-meleimide binding test
Measles vs Rubella
Measles: High fever (>104), cephalocaudal rash over multiple days , cervical adenopathy
Rubella: maculopapular cephocaudal rash over 24 hours (sparing palms and soles), polyarthralgia
Complications of hemophilia A and B
Hemophilic arhropathy -> iron/hemosiderin deposition leading to sunovitis and fibrosis
Herpangina: cause, signs
Cause: Coxachie A virus
Signs: Feverm pharyngitis, gray vesicles/ulcers on posterior oropharynx, hands, feet
Herpetic Gingitcostomatitis: Cause, Signs
Cause: HSV1
Signs: Fever, Pharngitis, Erythematous gingiva, Clusters of small vescicles on anerior oropharynx
Causes of aplastic anemia?
Most common in children?
Acquired causes: Drugs (NSAIDS, sulfonamides)
Toxic chemicals (benzene, glue)
Idiopathic
Viral infecitions (HIV, EBV)
Immune Disorders
Thymoma
Most comon in children: Fanconi anemia (chromosomal break)
Signs on Gonadotropin-independent precocious puberty?
Boy under 9 with severe facial ance, advanced pubic and axillary hair, normal testicular volume
Non-classical congenital adrenal hyperplasia (late-onset)
Premature adrenarche/pubarche, sever cystic acne (resistent to treatment), accelerated linear grwoth, advanced bone age
What gross motor milestones should occur at 18 months?
Run, kicking a ball
What can cause flaccid paralysis? How?
Infant botulism- ingestion of C. botulinum spores from dust
Foodborne- C. botulinum toxin from food
Guillain-Barre syndrome- Autoimmune peripheral nerve demyelination
Signs of botulisism?
Bilateral bulbar palsies (ptosis, sluggish pupillary response to light, poor sucking), constipation, drooling, and summetric descending flaccid paralysis
Clincal signs of glucose-6-phosphatase deficiency?
Lab Findings?
Doll-like face, thin extremities, short stature, protuberant abdomen
Lab findings: Hypoglycemia, high blood uric acid, total cholesterol, triglymerides, lactic acid levels
Aldolase B deficiency causes?
Fructose intolerance- vomiting, poor feeding, lethargy, serizures or enxephalopathy
Signs of hydrocephalus
Tense and bulging fontanelle, prominent scalp veins, poor feeding, irritability, rapidly increasing head size
Cephalohematoma
subperiosteal hemorrhage, not visable until several hours after birth
Caput seccedaneum
diffuse, sometimes ecchymotic swelling of the scape. Usually involved the portion of the head presenting during vertex delivery. May extend across midline and suture lines
What is the most common event prior to a seizure? During?
Prior: Aura
During: Tongue Laceration
What factors increase the risk for intraventricular hemorrhages?
Preterm and loss birth weight
Signs of intraventricular hemorrhage?
Hypotension, cyanosis, seizures, focal neurological signs, bulding or tense hontamel, anpea, and bradycardia; however, may be asymptomatic
How to diagnose intraventicular hemorrhage?
transfontanel ultrasound
How to diagnose hereditary spherocytosis?
Osmoti gragility on acidified glycerol lysis test
Erythrocte CD55 and CD59 are present in which disease?
Paroxysmal noctural hemoglobinuria
Clinincal manifestations of PNH?
hemolytic anemia, cytopenias, and hypercoagulability
Clincal manifestation of Edwards Syndrome?
Trisomy 18
Signs: Closed fists, with overlapping fingers, micrognathia, prominent occiput, rocker-bottom feet, severe intellectual disability
Signs of hyper-IgM syndrome?
Normal B cells, decreased IgG/IgA, increased IgM
What are signs of turner syndrome?
Coarctation of aorta, broad chest, short stature, horse-shoe kidney, streak overies
What are turner’s syndrome at increased risk for?
Osteoporosis- they lack protective estrogen production -> increased bone reabsorption
How to manage epiglottitis?
Endotracheal intubation, antibiotics
How to treat a patient with a “barky” cough?
Racemic epinephrine and corticosteroids
What type of rash spares the palms and soles? What type of precaution should be used for this infection?
Measles, should use airborne precaution
Cough, coryza, conjunctivitis with subsequent exanthema?
Measles
Howell Jolly bodies?
nucleated remnant of red blood cells
Heinz bodies
Aggregates of denatured hemogobin, seen in patients with hemolysis due to G6PD deficiency and thalassemia
What is a patient with recurrent infections and congenital heart disease at risk for?
Brain abscess
Triad of brain abscesses
Headaches (noctural and/or morning), focal neurologic changes, fever
Signs of refeeding syndrome? Cause?
Arrhythmia, congestive heart failure, seizures, wenicke encephalopathy
Cause: Increased insulin secretion -> decreased phosphorus, magnesium, potassium, thiamine, with increased water and sodium
What is the defect in duchenne and becker muscular dystrophy?
Deletion of dystrophin on chromosome Xp21
Neimann-Pick vs. Tay sachs
Neimann-pick: Sphingomyelinase deficiency with hyporeflexia/areflexia and hepatosplenomegaly
Tay Sachs: beta-hexosaminidase A with hyperreflexia without hepatosplenomegaly
Most common cause of orbital cellulitis?
Bacterial sinusitis
Early onset puberty iwth high basal LH? Next step?
Gonadotropin-dependent precocius puberty
Next step: Brain MRI wtih contrast
What causes the trendelenburg sign?
Weakness of the gluteus medius and gluteus minimus muscles, where are innervated by the superior gluteal nerve
What are cholesteatoma? Cause? Complications?
retraction pocket in the tympanic membrane that fills with granulation tissue and skin debris
Cause: Chronic middle ear infections or congenital in nature
Complications: Hearing loss, cranial nerve palsies, vertigo, brain abscesses or meningitis
Meniere’s disease?
Ear condition associated with fluid in the inner ear that leads to hearing loss, vertigo, tinnitus
Signs of foreign body ingestion?
Difficulty swallowing, feeding refusal, vomiting
Erythema marginatum of Rheumatic fever
What is spondylolisthesis? Signs?
Developmental disporder characterized by forward slip of vertebrae (L5 over S1)
Signs: Chronic back pain, neurological dysfunction, palpable step-off
Acute Rheumatic fever: Major and minor signs
Major: Migratory Arthritis, Carditis, Subcutaneous nodules, Erythema marginatum, Sydenham Chorea
Minor: Fever, arthralgias, Elevated ESR, CRP, Prolonged PR interval
Henoch-Schonlein purpura: Signs?
transient migratory arthritis (lower extremities) and rash (puritic)
Cause of edema in a child with turners syndrome? Type of edema?
Dysgenesis of the lymphatic network
Type: Non-pitting
What signs should suggest possible child abuse
Abrupts onset of mood changes, bedwetting, and/or academic difficulties
Trachoma? Signs?
Chlamydia trachomatis serotype A-C, major cause of blindness
Signs: follicular conjunctivitis and pannus (neovascularization) of the cornea
Signs of orbital cellulitis?
Abrupt onset of fever, proptosis, restriction of extraocular movements and swollen, red eyelids
Clincal manifestations of medulloblastoma?
increased intracranial pressure, trucal and gait ataxia
Short statute, primary amenorrhea, abscent thelarche
Turner’s Syndrome
Head tilt to one side with chin deviation away
Congenital muscular torticolis
Eczema, regurgitation/vomiting, and painless bloody stools
Milk protein-induced enterocolitis
ill-appearing neonate with bilious emesis and poor apetite?
malrotation with mid-gut volvulus
First step in the evaluation of a neonate with emiesis?
Cessation of enteral feeds, NG tube decompression, IV fluids, XRay to rule out pneumoperitoneum
Mongolian spots, beling flat, blue-grey patches
Fade spontaneously, reassure parents
Acute management of a sickle cell patient with signs of stroke?
Exchange transfusion, dilutes amount of sickled cells in blood
Cafe au lait spots, precocious pubert, multiple bone defects (polyostotic fibrous dysplasia)?
McCune Albright syndrome, remember the 3 P’s: Precocious puberty, pigmentation, polyostotic fibrous dysplasia
Heroin intoxication in a fetus, signs?
Interuterine growth retadation, irritability, high-pitched cry, poor sleeping, tremors, sweating, sneezing, diarrhea
Phenttoin exposure in-utero
Fetal hydantoin syndrome- nail and digit hypoplasia, dysmorphic facies, mental retardation
Fetal exposure to cocaine
Jitteriness, excessive sucking, hyperactive moro reflex
Chediak-Higashi syndrome
AR disorder characterized by oculocutaneous albinism and recurrent cutaneous infections
Staph. aureus and Strep pyogenese are most common
Cyanosis that is aggrevated by feeding and improved by crying
Choanal Atresia
Cyanotic when stressed and asymptomatic at rest?
Tetralogy of Fallot
Defect in Prader-Willi syndrome
Deletion of the paternal copy of chromosome 15q11-q13
Clinical manifestations of Prader-Willi? Common complications?
Poor suck and feeding problems in infancy, compulsive binge-eating and obesity-related problems
Complications: Sleep Apnea, DM type II
Alternative name for Wilms tumor?
Nephroblastoma
How do you management Autism spectrum disorders?
Early diagnosis and intervention (speech, behavioral), adjunct pharmacotherapy for psychiatric comorbities
How to manage a hydrocele in a newborn? 2 year old?
Newborn: Observation
2 year old: Surgical correction
**Most spontaneously recover within 12 months
Wiskott-Aldrich syndrome: Clincal manifestations? Defect? Problem?
Eczema, recurrent infections, thrombocytopenia
Defect: WASP protein
Conequence: Impaired cytoskeleton changes in leukocyte, platelet
Linear lesions with pruritus and erythematous streaks with edema and vesicles after camping?
Poison Ivy- Contact Dermatitis
Cause of intussusception in children younger than 2? Older?
< 2: recent viral illness or rotavirus vaccination
>2: Meckel’s diverticulum, HSP, Celiac disease, intestinal tumor, polyps
When should formula supplementation be considered?
Greater than 7% loss of birth weight
OsGood-Schlatters Disease; traction apophysitis
What are pink stains or “brick dust” in neonatal diapers?
Uric Acid crystals
Adolescent male
Benign bone tumor, osteoid osteoma
Pain is relieved by NSAIDS
Osteosarcoma
Findings: Soft tissue mass, “sunburst pattern”, periosteal elevation (Codman traingle)
Tinea Capitis, dermatophyte infection
Tx: Oral terbinefine, friseofulvin, itraconazole, fluconazole
Beckwith-Wiedemann syndrome: Cause? Clincal Manifestations? Complications? Surveillance?
Cause: Desregulation of imprinted gene expression on 11p15
Manifestations: Fetal meacrosomia, rapid growth, macroglossia, hemihyperplasia, medial abdominal wall defects
Complications: Wilms tumor, hepatoblastoma
Surveillance: Serum AFP, abdominal/renal US
Risk factors for ARDS in a newborn?
Prematurity, maternal diabetes, male sex, perinatal asphyxia, c-secton without labor
Ewing Sarcoma
“onion skin”, “moth eaten”, extension into soft tissue
How to assess pulmonary function in a guilllain-barre patient?
Spirometry, peak flow could be used as an alternative
What is the squirt sign?
Explosive gas and stool associated with Hirsprung Disease
Signs of breastfeeding faliure jaundice?
1st week of life,
Filaure of transition to yellowish or green stools (inadequate milk ingestion), decreased wet diapers
When does alloimmune hemolytic disease occur?
“A” and “B” offspring of “O” mothers
Glomus tumor triad
severe intermittent pain, tenderness, sensitivity to touch
benign tumor of vascular system
Fibrosarcoma
Malignant spindle cell neplasm found in patiens 30-60. Painful mass. Osteolytic lesion whose margins can be well-defined or ragged and moth-eaten
Focal Serizures
Originated from 1 cerebral hemisphere +/- loss of consciousness
Cannot respond to stimuli during episodes with confusion afterwards
>2-3 minutes in length
Lennox-Gastaut syndrome
Presents by age 5, intellectual disability and sever seizures of varying types. EEG demonstrated a slow spike-wave pattern
How to follow-up an incidental urine proteinuria in an adolescent?
Repeat dipstick testing on two subsequent occaisions to determine orthostatic, persistent, or transient proteinuria
Risks of maternal diabetes?
Macrosomic getus, shoulder dystocia (crepitus, asymmetric moro reflex), clavicle fracture, brachial nerve palsies, perinatal asphyxia, neonatal hypoxic encephalopathy, polycythemia
Red flags for type 1 DM
Polyuria, polydipsia, enuresis (increased urinary incontinence)
Difference between iron deficiency anemia and thalassemia?
Iron deficiency: Increaed RDW, decreased MCW, RBC #
A-thalassemia: Normal RDW, RBC #; decreased MCV, normal hemoglobin electrophoresis
B-thalassemia: Normal RDW, RBC #; decreased MCV, increased hemoglobin A2 with electrophoresis
Hemiparesis, aphasia after injury tot he posterior pharync
Cervical internal cartid artery
**Can occur when falling with an object in mouth
When should chilren be toilet trained?
daytime: around 3
Nighttime: Any time up until 5 is considered normal
Most common cause of abnormal uterine bleeding in adolescents?
Immature hypothalamic-pituitary-ovarian axis -> anovulation cycles
Medication treatment of abnormal uterine bleeding?
High-dose IV or oral estrogen
High-dose combined oral contraceptive pills
High-dose progestin pills
Tranexamic acid
Diagnostic test for Chronic Granulomatous disease?
Neutrophil function testing
- Dihydrohodamine 123 test
- nitroblue tetrazolium test
Purpose of the CH50 test?
Determines total complement levels
Riboflavin deficiency signs:
Angular choelosis, stomatitis, glossitis, normocytic anemia, seborheic dermatitis
Niacin (b3) deficiency
Pellegra (dermatitis, diarrhea, delusions, glossitis)
Pyridoxine (B6) deficiency
Cheilosis, stomatitis, glossitis, irritability, confusion, depression
recurrent sinusitis, point of maximal impulse displaced to the left, bronchiectasis?
Primary ciliary dyskinesia (Kartagener syndrome,
What increases the murmur n Hypertrphic cardiomyopathy? Decreases?
Increases: Decreased preload: Valsava, abrupt standing, nitroglycerine
Decreases: Increased afterload/preload: Sustained hand grip, squatting, passive leg raises
What prophylaxis should be used for cat bites in children?
Amoxicillin/Clavulanate due to activity again pasteurella multocida
When legal guardians of a patient deny a life-saving procedure, how do you proceed?
Obtain a court order to force compliance
Most common cause of otitis externa?
P. Aeruginosa, S. aureus
Tx: Fluoroquinolone
Extraintestinal signs of Celiac disease?
Short stature, weight loss, iron deficiency anemia, dermatitis herpetiformis
Celiac disease risk factors?
First-degree relative
Autoimmune thyroiditis
Type 1 DM
Down syndrome
Selective IgA deficiency
Signs on congenital rubella infection?
Sensorineural hearing loss
cataracts
PDA
Urinary in ontinence in children over 5?
Workup: Urinalysis, urological imaging
Management: Avoid caffeine, void regularly, drink fluids early, reward system, enuresis alarm (1st line after behavioral, pharmocotherapy (desmopressin, tricyclic antidepressants)
abdominal pain, palpable mass, jaundice
Biliary cyst
Biliary atresia
Obstructive jaundice, acholic stools, presents early in infancy
Most common bacterial infection in children with CF?
S. Aureus, especially with concurrent influenza.
What are risk facors of Henoch-Schonlein purpura?
Gastrointestinal hemorrhage or intussusception: Cause by bowel edema and hemorrhage
How does a person with a volvulus present?
vomiting (often bilious)
Characteristics of oppositional defiant disorder?
Angry/urrutale mood and argumentative/defiant behavior towards authority figures
Signs of ADHD?
Inattentive, hyperactive/impulsive symptoms, prior to age 12
Selective mutism
Refusal to speak in a specific social situation, but engaged in normal communications where she feels comfortabe.
Diagnosis required 1 month or more in situations where they are required to talk (school), despite speaking in other situations
What cardiovascular abnormalities are in turner’s syndrome?
Bicuspid aortic valve
What disorders are commonly associated with mitral valve prolapse?
Connective tissue disorders (Marfan, Ehlers-Danlos sundrome, osteogenesis imperfecta, etc)
How should a urine sample be collected in infants with diapers?
Urethral catheterization, urinalysis, urine culture
Signs of cardiac temponade?
Distant heart sounds, distended jugular veins, (scalp veins in infants) and hypotension
What complications are CF patients at risk for?
Infertility (95% of men, 20% of womeN)
Pancreatitis (~10%)
What is the first step in evaluating primary absence of menarche by age 15?
Pelvic US, to detect ovaries, uterus, and vagina
Signs of Turner’s Syndrome?
Narrow, high arched palate, low hairline, webbed neck , broad chest, coarctation of the aorta, bicuspid aortic valve, horse-shoe kidney, streak ovaries, amenorrhea, infertility
Congenitial CMV infections signs? Treatment?
Growth restriction, microcephaly, periventirular calcification, hepatosplenomegaly, thrombocytopenia
Treatment: Valganciclovir
Congenital Toxoplasmosis infection signs?
Macrocephaly, diffuse parenchymal calcifications
Signs on Shigella infection?
Rapid onset, high fever, abdominal pain, watery diarrhea with mucous +/- blood, +/- seizures in children
In which population in the cyclic vomiting syndrome the highest?
Children of parents who have a history of migraines
In a child less than 24 months, what should occur after the treatment of her first febrile UTI?
Renal and bladder ultrasound
Meconium obstruction at th level of the ileum and narrow, underdeveloped colon?
Cystic fibrosis
Whem should PEEP be employed in a newborn? Chest Compressions?
Heart rate less than 100, irregular breathing
Chest compressions: Less than 60bpm
Family history of sudden death, congenital sensorineural deafness, and QT interval of 600ms?
Jervell and Lange-Nielsen syndrome
Signs of Meckel’s diverticulum? Diagnosis? Treatment?
Asymptomatic incidental finding, painless hematochezie, intussusception, intestinal obstruction, volvulus
Diagnosis: Technetium-99m pertechnetalte scan
Treatment: Surgey for symptomatic patients
Differences in blood pressure in coarctation of the aorta?
Hypertension in the upper body and hypotension in the lower
Murmur in Tetralogy of Fallor?
crescendo-decreasendo systolic murmur with a single S2 in left upper sternal border
Signs of Tetralogy of Fellot?
Tet spells-sudden hypoemia and cyanosis during exertion or agitation
Why are menstral cycles in pubertal girls irregular?
Immaturity of the hypothalamic-pituitary-honadal axis -> decreased gonadotropin secretion
What homronal imbalances causes polycystic ovary syndrome?
Excess LH secretion
Hemolytic uremic syndrome: Signs? Lab findings? Treatment?
Signs: Diarrhea, lethargy, irritability, pallor, bruising or petechiae, oliguria, edema
Lab findings: Hemolytic anemia, thrombocytopenia, Incresed hematuria, proteinuria, casts, increased bilirubin
Treatment: Fluid/electrolyte management, blood transfusion, dialysis
Presentation of immune throbocytopenic purpura?
Thrombocytopenia and purpura, no anemia or renal invovlement
Early adolescent obese male that presents with hip or knee pain of insidious onset that causes limping? Treatment?
Slipped capital femoral epiphysis
x: surgical pinning
Workup for a newborn with bilious vomiting without a bowel movement?
Abdominal Xray -> contrast enema
What is a small for gestations age newborns at risk for developing?
Hypoxia, perinatal asphyxia, meconium aspiration, hypoglycemia, hypothermia, hypocalcemia, and polycythemia (due to hypoxia)
Drugs used to treat Tourette disorder?
Haloperidol, pirmozide, risperidone (preferred), clonidine, guanfacine
Methylphenidate-Use?
ADHD
Signs of pancreatic deficiency?
Bruises (vitamin K), Vitamin D deficiency, poor growth
When should you suspect tricuspid atresia?
Cyanotic infant with left axis deviation, small or absent R waves,
Total anomalous pulmonary venous return
4 pulmonay veins fail to make the normal connection to the left atrium. Righ atrium received blood from both pulmonary and systemic venous system.
Signs: right venticle hypertrophy, and right axis deviation
Child has a desire to kill his mother and must recite a prayer 10-12 times to overcome it. Diagnosis? Treatment?
Diagnosis: Obsessive-compulsive disorder- can be obsessive (symmetry), or compulsive (must hurt mother)
Treatment: First-line: SSRI (Fluoxetine) or CBT
Second-line: Clomupramine and antipsychotic augmentation
Third-line (refractory): Deep-brain stimulation
Treatment for migraines in pediatric populations?
Acetaminophen or NSAID and supportive mangement (dark room, etc)
Burton agammaglobulinemia- Lab findings
Normal T-cells, absent B cells, low serum immunoglobulin, absent lymphoid tissue
Severe combined immunodeficiency- lab findings? Treatment?
Failure of T-cell development, b-cell dysfunction due to low T-cells, absence oflymphoid tissues
Treatment: Stem cell transplant
What is the generic name for the plan B pill? MoA
Levonorgestrel
MoA: Delays ovulation
Most effective form of emergency comtraception?
Copper IUD
Gold standard for confirming muscular dystrophies?
Genetic analysis
Heart defect associated with Edwards Syndrome? Murmur description?
VSD
Holosystolic murmur that is heard beast at the lower left sternal border
Developmental milestones at 12 months?
Stands well, walks first steps, 2-finger pincer, says first words, separation anxiety, comes when called
Diagnosis?
Treatment?
Diagnosis: Atopic dermatitis
Treatment: Emolients +/- steroid topicals
Diagnosis?
Eczema Herpeticum-complication of atopic dermatitis
Painful vescibles with “punched out” erosions and hemorrhagic crusting superimposed on a child with atopic dermatitis?
HSV
When should gonads be removed in complete androgen insensitivity?
After puberty, the benefits of gonad-stimulated puberty outweigh the risk of malignancy
Risk of gonad-derived cancer in turners syndrome compared to general population?
10-30 times higher (15-30%). Gonad development should be closely monitored and an earlier gonadectomy could be required.
Signs of fetal alcohol syndome
Small head, small palebrl fissures (eyes), smooth philtrum, thin vermilion border (lip)
Alternative name for strawberry hemoangiomas?
Superficial infantile hemangioma
When is a murmur benign?
Normal activity levels, early of mid-systolic, Grade I or II, low-putched muscicle or squeaky tone at LLSB (still’s murmur) or high-pitched at LUSB (pulmonary flow murmur)
How to diagnose Laryngomalacia?
Confirmation by flexible laryngoscopy for moderate-severe cases
Components of DiGeorge’s Syndrome?
Conotruncal cardiac defects
Abnormal Facies
Thymic aplasia/hypoplasia
Cleft palate
Hypocalcemia
(t-cell lymphopenia is present)t
What findings of a pediatric burn would suggest child abuse?
Sparing flexor surfaces
What substance maintains the PDA? Closes it?
Maintains: Prostoglandin E2
Closes: Indomethicine
What type of vasculitis is Henoch-Schlnlein purpura? Complications?
Immunoglobulin A-mediated
Complications: renal involvement; microscopic or macroscopic hematuria, red cel casts, mild to moderate proteinuria, with normal-slightly elevated serum creatinine
**Can lead to nephrotic syndrome, HTN, acute renal failure
What solutions should be used to resusitate an infant that is hypovolemia, but hypernatremia?
0.9% NS
Cause of chronic nasal obstruction refractory to conventional treatment?
Adenoid hypertrophy
Tinea Corporis
Findings suggestive of hypertrophic adenosis?
Postnasal drip, elongated facial heatures, mucopurulent nasal discharge, loud mouth breathing
Myotonic musculodystrophy-Onset? Inheritance? Comorbidies? Prognosis?
Edema, hypoalbuminemia, markedly elevated urine protein in a teen with Hep. B? Pathogenesis
Membranous nephropathy (nephrotic syndrome)
Pathogenesis: Deposition of HbeAb and its corresponding antibody in the glomeruli
Kallman Syndrome
X-linked recessive disorder of migration of fetal gonaotropin-releasing hormoes and olfactory neurons.
Clincal Signs: short stature, delayed or absent puberty, normal genotype and internal reproductive organs, anosmia/hyposmia
47 XXY
Klinefelter syndome, male phenotype with small testicles.
Clinical manifestations of congenital diaphragmatic hernia? Managemtn?
Pulmonary hypertension, polyhydramnios, barrel-shaped chest, concave abdomen
Management: Emergency intubation with caution ventilation
Treatment for Impetigo?
Oral cephalexin (widespread)
mupirocin (topical, localized)
Primary dusmenorrhea? Treatment?
Lower abomdinal cramping with menses in the absense of other pathology
**pain during the first few days of menses is cause ny uterine contractions triggered by prostaglandins
Treatment: NSAIDS
Primary vs.Secondary dysmenorrhea
Primary- normal physical examination
Secondary - abnormal physical examination
Treatment for Tinea Corporis?
First line (localized): Topical (clotrimazole, terbinafine)
Second-line (generalized): Oral antifungals (terbinafine, griseofulvin)
Signs of renal tubular acidosis?
Normal anion gap acidosis, failure to thrive, alkalotic urine without known etiology of acidosis, low serum bicarb and hypercalemia
Type 1 RTA?
Defect: Poor hydrogen secretion into urine
pH: > 5.5
Potassium: Low-normal
Cause: Genetic disorder, medication toxitiy, autoimmune
Tetralogy of Fallot murmur?
Harsh systolic ejection murmur over the left upper sternal border, single S2
VSD murmur description?
Pansystolic murmur hear loudest at the left lower sternal border and a diastolic rumble at the apex due to increase flow across mitral valve
What is the management of an adolescent with suspected fibroadenoma?
Observation and reassurance (follow-up shortly after next menses
Pyloric Stenosis: Onset age? Characteristics?
Onset: 3-5 weeks
Clinical presentatin: Nonbilious, hugry vomiter, poor weight gain, dehydrated, “olive-shaped” abdominal mass
Clincal features of Epiglottitis?
Abrupt onset Distress (“tripod”, stridor), dysphagia, drooling, thumbprint sign on Xray
Alternative name for laryngotracheititis?
Croup
Legg-calve-perthes disease
Average onset 4-10, incisious onset, antalgic gait (less time on one side), long-term pain
Signs of vitamin D deficiency in an infant?
Delayed fontanel closure, enlarged skull, costochondral joints (achitic rosary), long-bone joint widening, genu varum (bowed legs)
VACTER
Vertebral, anal atresia, cardiac abnormalities, radial (skeletal) and renal
Baby that is cyanotic when feeding, pink when crying? Associated abnormalities?
Choanal atresia
Associated: CHARGE: Coloboma, heart defects, retarded growth, GU abnormalities, ear abomalies, deafness
Big tongue, umbilical hernia?
hypothyroidism
Tetralogy of Fallot components?
VSD + RA hypertrophy + over riding aorta, pulmonary stenosis
