Topnotch Flashcards
Washing of the newborn should be delayed after?
After 6 hours
Cord clamping should be delayed at?
2 to 3 minutes
Non-separation of mother and newborn should for breast feeding should last for?
20 to 60 minutes
Newborn eye prophylaxis
0.5 % erythromycin; 1% tetracycline
Vitamin K dosage for newborn.
1.5 kg - 1.5 mg; less than 1.5 kg - 1.5 mg
NBS
CH; CAH; G6PD; PKU; Galactosemia; MSUD
NBS, republic act?
RA 9288
NBS should be done after how many hours?
48 hours
If NBS was done
2 weeks old
21 hydroxylase deficiency
CAH
Enzymes deficient in galactosemia.
Galactose 1 phosphate deficiency; Galactokinase deficiency; Galactose 4 epimerase deficiency
Most common manifestation without treatment of PKU?
Developmental delay
Flat, blue gray with well defined margin that can be seen in sacral area.
Monglian spots
Most common benign skin lesion.
Erythema toxicum
Lacy pattern on the skin similar to cobblestones.; Vasomotor response to cold stress.
Cutis marmorata
Subperiosteal bleed.; Does not cross the suture line.; Resolves in few weeks.
Cephalhematoma
Swelling of scalp due to birth trauma.; Involves presenting part.; Crosses the suture lines.; Resolves in few days.
Caput succedaneum
Erb duchenne palsy with C4 involvement.
Ipsilateral diaphragmatic paralysis
Klumpke palsy with T1 sympathetic fibers involvelement.
Horner syndrome
Accumulation of fluid in tunica vaginalis.
Hydrocoele
Surgical treatment of undescended testis should be done when?
Not later than 9 to 15 months
Funnel shaped chest
Pectus excavatum
Pigeon shape chest.
Pectus carinatum
Post term, AOG?
> 42 weeks
LGA, NB is hypoglycemic or hyperglycemic?
Hypoglycemic; Due to hyperinsulinism.
Ground glass pattern in CXR.
RDS
MCC of persistent pulmonary HPN?
Meconium aspiration syndrome
Contributory factor that leads persistent pulmonary HPN of the NB.
NSAID use during 3rd trimester
TB less than 5mg/kg/day, peaks at 15, DB less than 10% of TB
Physiologic jaundice
TB > 5 mg/dl/day peaks at 15; DB > 10% of TB
Pathologic jaundice
In ABO incompatibility, what is the blood type mother and baby?
Mother blood type O, baby type A or B
Type of jaundice, decreased milk intake with dehydration, reduced caloric intake.
Breastfeeding jaundice
Type of jaundice, presence of glucoronidase in breast milk.
Breast milk jaundice
Empiric treatment for neonatal sepsis.
Ampicillin + 3rd gen cephalosphorin or aminoglycosides.
Blueberry muffin rash
CMV AND RUBELLA
Most common congenital infection.
CMV
DOC for CMV
Ganciclovir
Cataract, PDA, MR, Deafness, Blueberry muffin
Congenital rubella syndrome
Chorioretinits. Microcephaly. Periventricular calcification. Blueberry muffin rash.
CMV
Chorioretinitis. Intracranial calcification. Hydrocephalus. Hepatitis. IUGR
Toxoplasmosis
Snuffles. Periostitis of long bone. Hutchinson teeth. Saddle nose.
Syphillis
Pneumatosis intestinalis
NEC
MC life threatening emergency of the GIT in neonates.
NEC
Greatest RF for NEC.
Prematurity
Triad: Intestinal ischemia. Enteral nutrition. Pathogenic organism.
NEC
Average weight of the new born
3kg
Average birth length of the newborn.
50cm
Average head circumference of the newborn.
33 to 35 cm
Approximate age where adult HC is attained.
6 years old
First tooth to erupt.
Mandibular central incisor
True or false, theres a 10% decrease in birth weight on the first week of life of a new born?
TRUE
Physiologic anorexia occurs when?
2nd year of life
Complete myelination occurs when?
2nd year of life
VA of 20/20
4 years old
All primary teeth errupted at?
3 years old
Best time to read poetry.
3 years old
Vaccines that cannot be given simultaneously
Yellow fever and cholera
Fully immunized child means?
1 dose of BCG at birth, within 12 months. 3 doses of BCG and OPV every 4 weeks. (Starting 2 months) 3 doses of Hepa B after birth. (0,1,6) 1 dose of measles vaccing at 9 months. Plus MMR (6 months after measles vaccine) and Hib (9 moths)
Polyarticular disease type of juvinile RA. HLA TYPE?
HLA DR4
Pauciarticular disease type of RA, HLA TYPE?
HLA DR8 & DR5
Reactive AS would present as?
Reiters syndrome
Sacroillitis in xray.
AS
More specific for lupus and reflects the degree of disease activity.
Anti-ds DNA
MC of the pediatric inflammatory myopathies.
Dermatomyositis
Earliest manifestation of scleroderma.
Reynauds phenomenon
Less than 5yo: Bilateral bulbar conjunctival injection, non purulent. Dry fissured lips, Strawberry tongue. Edema and erythema of the hands and feet in acute phase and periungual desquamation in the subacute phase. Truncal rash, polymorphus, non vesicular. Cervical LAD.
Kawasaki disease
BV most affect by kawasaki.
Medium sized artery (coronary artery)
Important PE finding in patient with kawasaki less than 1yo.
Perineal erythema
Fibrosis affecting the dermis and arteries of the lung, kidney and GIT.
Scleroderma
Vasculitis of all blood vessel esp medium sized arteries.
Kawasaki
IgA mediated vasculitis of small vessel.
HSP
MCC of nonthrombocytopenic purpura in children.
HSP
2 to 8 yo. Male. Palpable, raised purpura, red to brown, lasts for 3 to 10 days. Intermittent abdominal pain.
HSP
Hallmark of HSP.
Palpable petichae or purpura that evolve from red to brown that last from 3 to 10 days.
Skin biopsy finding of HSP.
Leukocytoclastic angitis
Renal biopsy finding of HSP.
IgA mesangial deposition
6yo; Female; Heliotrophic rash (periorbital violaceous erythema may cross the nasal bridge); Gottron papules (alligator skin like appearance); (+) ANA with speckled pattern in >60%.
Dermatomyositis
Tightness, thickening, non-pitting induration involving proximal to the MCP or MTP joints. Sclerodactyly. Digital pitting scars resulting from digital ischemia. Bibasilar pulmonary fibrosis not attributable to primary lung disease.
Scleroderma
Most common esophageal disorder in children of all ages
GERD
MC TEF
Type A
MC foreign object swallowed by 6 months to 3 years old?
Coins
MCC of nonbilious vomiting.
Pyloric stenosis
Acid base balance abnormality in patient with pyloric stenosis.
Hypochloremic metabolic acidosis
Firm, olive-shaped mass, post-prandial vomiting.
Pyloric stenosis
Barium: shoulder sign, double tract sign
Pyloric stenosis
Surgical procedure for pyloric stenosis.
Ramstedt pyloromyotomy
Bird’s beak sign. Inverted U sign. Coffee bean sign.
Volvulus
Double bubble sign. Bilious vomiting. Polyhydramnios. Jaundice. Failure to recanalize the lumen during 4th and 5th week AOG.
Doudenal atresia
MC type of malrotation.
Failure of the cecum to move into RLQ
Remnant of omphalomesenteric duct which connects the yolk sac to the gut in the embryo.
Meckels diverticulum
Intermittent painless rectal bleeding and brick colored stool. MC congenital GI anomaly
Meckel diverticulum.
Delayed passage of meconium. Chronic constipation. Dec blood flow and deterioration of mucosal barrier leading to enterocolitis.
Hirschprung disease
Currarino triad: Anorectal malformation. Sacral bone anomalies. Presacral masses.
Hirschprung disease in older patient.
Currant jelly stool. Doubles up (legs and knee are flexed with loud crying). Severe paroxysmal colicky pain that recurs at frequent intervals with straining efforts. Sausage shape mass in RUQ. BARIUM: coiled spring sign. UTZ: doughnut or target sign.
Intussusception
Standard ORS composition
Glucose : 75, Na: 75, Cl: 65, K: 20, Citrate: 10, Osm: 245mmol/l
Sentinel loop. Colon cut off sign. Ileus. Blurring in left psoas margin. Peripancreatic extraluminal gas bubbles.
Acute pancreatitis
Prognostic system for acute pancreatitis in adult. Not in children.
Ransons criteria and APACHE score
First clinical evidence of HBV infection.
ALT
Window phase of HBV infection.
IgM anti HBC
Inc risk of transmitting HBV.
HBeAg
Most valuable single serologic marker of acute HBV infection.
Anti HBcAg
Presence of this will confer lower risk of transmitting HBV.
Anti HBe
Microangiopathic hemolytic anemia, thrombocytopenia, uremia.
HUS
Helmet cell, Burr cell, Fragmented RBCs
HUS
Most common chronic glomerular disease worldwide.
IgA nephropathy
Complement decreases in APSGN.
C3
What major noxious products of complement activation are produced after c3 activation in APSGN?
Anaphylotoxin and c5a
Tea colored urine, hematuria. Periorbital edema. Hypertension. Oliguria.
APSGN
Best single Ab titer to document skin infection in patient with APSGN.
DNAse antigen
Mangement for APSGN.
Ten day course of penicilline. Furosemide 1mg/kg/dose IV. Sodium restriction. ACE inhibitor or CCB.
Bilateral flank mass. Potter facies.
PCKD
Most common cause of acute renal failure in young children.
HUS
Essential for newborn’s functioning of the visual pigment rhodopsin.
Docosahexaenoic acid (DHA)
Most commom acyanotic heart disease.
VSD
Major energy source in breastmilk.
Fat
MC type of VSD.
Perimembranous
Initial manifestation of vitamin A deficiency.
Nyctalopia
What chamber of heart enlarges in VSD?
Left side and PA
General softening of the bones. Rachitic rosary. Harrison groove. Winswept groove.
Rickets
Systolic regurgitant murmur at the left lower sternal border, loud and single s2.
VSD
Rachitic rosary
Rickets
Chamber of the heart that enlarges in PDA.
Left side and PA
Kasal’s necklace
Niacin
Most common cause of cyanotic congenital heart disease in new born.
TGA
Scorbutic rosary
Vitamin C
Egg shaped cardiac silhouette.
TGA
Pellagra
Niacin
RV tap along left sternal border. Systolic ejection murmur radiates at the back.
TOF
Microcytic anemia
Vitamin B6
Failure of development of the spiral septum.
Truncus arteriosus
Corckscrew hair
Vitamin C deficiency
All pulmonary veins drain to the RA. RV Volume overload.
TAPVR
Extreme exogenous obesity in which patient have severe cardiorespiratory distress with alveolar hypoventilation.
Pickwickian syndrome
Snowman sign.
TAPVR
Aim for the treatment of obesity.
Not weight loss but to slow or halt weight gain - weight maintenance
In truncus arteriosus what septal defect is always present?
VSD
Vitamin A dosage for ages 6 to 12 months
100,000IU
MC location of coarctation of aorta.
Descending aorta
Vitamin A dosage for age one year and older.
200,000IU
Congenital anomaly related to coarctation of aorta.
Turner’s syndrome
NTD is a failure of spontaneous closure of neural tube during?
3rd and 4th week
Hypertension in upper extremities. Rib notching in children 7 yo.
Coarctation of aorta
Folic acid will prevent the occurance of NTD from preconception until?
12th week AOG
Associated with congenital rubella, noonan, and william syndrome.
Pulmonic stenosis
Folic acid dosage
0.4mg OD
Harsh systolic ejection murmur at the Right upper sternal border. Systolic thrill - Suprasternal notch.
Aortic stenosis
Failure to closure of the rostral neuropore.
Anencephaly
Systolic ejection murmur at the left upper sternal border with radiation to the back.
Pulmonary stenosis
Severe form of NTD
Meningocoele
Surgery done in pulmonary stenosis.
Brocks procedure
Absent cerebral convolution and a poorly formed sylvian fissure.
Lissencephaly
Surgery done in aortic stenosis.
Ross procedure; Valve translocation from pulmonary valve.
Uni or bilateral clefts within the cerebral hemispheres.
Schizencephaly
Aschoff bodies
RHD
Presence of cyst or cavities within the brain.
Porencephaly
Most common valvular involvement in adults.
Mitral stenosis
Due to defective cleavage of the prosencephalon and inadequate induction of the forebrain structure.
Holoprosencephaly
Most common valvular involvement in children with RHD.
Mitral regurgitation
CSF is reabsorbed through what process?
Pinocytosis
Fish mouth buttonhole deformity. Weak peripheral pulses with narrow pulse pressure. Hemoptysis.
Mitral stenosis
CSF is reabsorbed by what cell?
Arachnoid villus cells
Systolic regurgitant murmur at the apex with transmission to the left axilla.
Mitral regurgitation
Setting sun sign, Long tract sign, Cracked pot sensation or mace wen sign, Chiari malformation (foreshortened occiput), Dandy walker malformation (prominent occiput)
Hydrocephalus
Chamber enlarge in MS.
LA and RV
Major complication of shunts?
S. epidermidis infection
Wide pulse pressure and bounding water hammer pulse. Diastolic murmur heard best at 3rd and 4th LCIS.
Aortic regurgitation.
Treatment for infantile spasm.
Vigabatran
Most common valvular heart disease.
MVP
Most common seizure disorders in childhood?
Febrile seizure
Most common complaint, MVP.
Palpitation
DOC for status epilepticus.
Phenytoin
Murmur at 2nd LICS with widely split S2.
ASD
Most prevalent type of migraine
Migraine without aura
Murmur at 2nd LICS with radiation to the upper back.
PS
Brain lesion consist of tubers located in the covolutions of the cerebral hemispheres at subependymal region that calcified and may produce a candle dripping appearance.
Tuberous sclerosis
Murmur at 2nd LICS with radiation to the interscapular area.
COA
Hamartomas located within iris
Lisch nodules
Murmur at 2nd RICS.
AS
Ash leaf skin, Shagreen path, Subungual or periungual fibromas
Tuberous sclerosis
Murmur at LLSB.
VSD
Murmur at LLSB with radiation to the left anterior axillary line.
MR
Sterile endocarditis, SLE
Libman sacks endocarditis
MCC of viral meningitis.
Echovirus
Osler nodes. Janeway lesion. Splinter hge. Roth spots.
Infective endocarditis
Brain abscess if common in age?
4 to 8 yo
Use to diagnose hyperpituitarism.
Serum somatomedin c (IGF-1)
MC site of brain abscess.
Cerebrum
Earliest sign of graves disease.
Emotional disturbance with motor hyperactivity.
Earliest and most constant sign of myasthenia gravis.
Ptosis and EOM weakness
Proximal muscle weakness, symptomatic late in the day.
Myasthenia gravis
MC cause of thyroid disease in children and adolescent.
Thyroiditis
Thought to be the site of Ach receptor antibodies.
Thymoma
MC endocrine metabolic disorder of childhood and adolescent.
DM
A short acting cholinestearse inhibitor use for clinical test of patient with guillain barret syndrome. Slight improvement in ptosis and ophthalmoplegia.
Edrophonium chloride IV Or Tensilon test
Aplastic anemia with microcephaly, microphthalmia, hearing loss, limb abnormalities.
Fanconis anemia
Not associated with other cranial neuropathies or brainstem dusfunction. Occurs after a systemic viral infection.
Bell’s palsy
Most impt sign of IDA.
Pallor
Virus associated with bells palsy.
EBV, HSV, Mumps virus
Definitive diagnostis test for alpha thalasemia.
Hb electrophoresis
Acute demyelinating polyradiculoneuropathy / symmetric ascending muscle weakness or paralysis.
Guillain barre syndrome
Target cell, heinz bodies
Alpha thalassemia
Landry ascending paralysis.
Gullain Barre Syndrome
Crew cut or hair on end appearance in skull radiograph.
Sickle cell disease * inc erythropoiesis cusing marrow expansion and new bone formation.
Last to resolve in guillain barre syndrome.
Tendon reflex and lower extremities
Howell jolly bodies.
Sickle cell disease
Used to eradicates nasopharyngeal carriage of diphtheria.
Erythromycin 40-50mg/kg/day x14days
MCC of thrombocytopenic purpura in childhood.
Idipathic thrombocytopenic purpura
MOT of diphtheria
Close contact via Airborne respiratory droplets
Fever. Anemia. Thrombocytopenia. Renal dysfunction. Nervous system changes. Inc bun and crea. Deficiency in metalloproteinase (ADAMTS-13).
Thrombotic thrombocytopenic purpura
Essential for new borns functioning of the visual pigment.
DHA
Omega 3
Linolenic acid. DHA.
Omega 6
Linoleic acid. Arachidonic acid.
Treatment for von willebrand disease.
Desmopressin and factor 8 concentrate
Explosive outburst in series of 5 to 10 rapid coughs in one expiration and ending in a high pitched whoop (forceful inspiratory gasp) often associated with suffusion of face or popping out of eyes and vomiting. Well in between paroxysm. Have petechial hge on the upper body.
Pertussis
MC posterior fosaa tumor in children.
Astrocytoma
Blood picture with pertussis.
Leukemoid reaction
MC supratentorial tumor in children.
Craniopharyngioma
DOC pertusis.
Erythromycin 40-50mg/kg/day q6 x14days
Abdominal mass that does not cross midline.
Wilms tumor
MOT meningococcemia.
Person to person through infected droplets
Abdominal mass that crosses the midline.
Neuroblastoma
Fever. Morbiliform rash > petechial rash > purpuric rash >echymotic rash
Meningococcemia
Sunburst pattern
Osteosarcoma
DOC meningococcemia
Pen G 250k-400k IV divided doses for atleast 5to7 days
Onion skin, moth eaten appearance.
Ewing sarcoma
Prophylaxis for meningococcemia.
Rifampicin
Osteosarcoma, what part of long bone?
Metaphysis
Rose spots
Salmonella
Ewing tumor, what part of long bone?
Diaphysis
Mainstay of diagnosis for salmonella.
Blood culture
Barking cough
LTB
DOC typhoid fever
Chloramphenicol 50-75 mg/kg/day x14-21days
Location of LTB.
Subglottic space
2 weeks High grade fever, abdominal pain, hepatosplenomegaly, anorexia, diarrhea, rash
Typhoid fever
Thumbprint or leaf sign.
Acute epiglotitis
MOT measles
Droplet spray
Steeple sign.
LTB
Branny desquamation
Measles
Location of acute epiglottitis.
Supraglottic
Vitamins given on complicated measles.
Vitamin A
Muffled voice, drooling.
Acute epiglotitis
3 day fever
German measles/rubella
Most common cause of brochilitis.
RSV
Forscheimer spot
German measles/rubella
Staccato cough.
Chlamydia
Blueberry muffin skin lesion
Congenital rubella syndrome
Most common significant pediatric cardiac arrhythmia.
SVT
DOC for SVT.
Adenosine
Familial nonhemolytic unconjugated hyperbilirubinemia.
Criggler najjar syndrome, Gilberts syndrome
Most frequent complication of mumps.
Meningoencephalitis
Inherited conjugated hyperbilirubinemia
Dubin johnson syndrome, Rotor syndrome
Roseola suppresses what cellular lineage within bone marrow?
All
Maternal treatment for toxoplasmosis.
Spiramycin
Nagayama spots - uvulopalatoglossal junction
Roseola
Paraventricular calcification.
CMV
Interruption of limb development at 6 to 12 weeks AOG. eye and brain involvement in 16-20 weeks AOG.
Congenital VZV.
When is the best time to give acyclovir in VZV.
Within 24 hours the onset of rash
Hydrocephalus with generalized calcifications.
Toxoplasmosis
Use to measure the bone age-reference standards.
Radiograph of left hand and wrist
Herpangina causative agent.
Cox A
Skeletal maturity is linked to? Sexual maturity or chronological age?
Sexual maturity
5th disease
Erythema infectiosum
Dominant protein in human milk.
Whey
Slapped cheek appearance
Erythema infectiosum
Dominant milk in cows milk.
Casein
Primary cell line affected by erythema infectiosum.
Erythroid cell line
Eczema. Thrombocytopenia. Recurrent infection. Decreased IgM. T and B cell deficiency
Wiskott-aldrich syndrome
Lacy, reticulated appearance rash, sparing the palm and soles without desquamation.
Eryhthema infectiosum
Prolonged detachment of the umbilical cord.
Chronic granulomatous disease
6th disease
Roseola
Associated with IM. Symmetric rash on the cheek. Erythematous papules.
Gianotti crosti syndrome
Most common congenital infection.
CMV
Moist, honey colored crust
Impetigo
Tender, warm, erythematous plaques with ill defined borders.
Cellulitis
Mild rubbing of the skin results in epidermal separation leaving a shiny, moist, red surface.
Nikolsky sign
Malassezia furfur invades what layer of epidermis?
Stratum corneum
Causative agent of scabies.
Sarcoptes scabei
Brown crusted nodules on the trunk; s-shaped burrows.
Scabies
White or yellow 1-6mm discrete papules with a central umbilication
Molluscum contagoisum
Thick silvery scales, nail involvement and isomorphic phenomenon.
Psoriasis
Oval or round, fixed, red skin lesionwith dusky central zone. Target lesion. Iris lesion. No systemic signs and symptoms. Due to HSV specific host response.
Erythema multiforme
Fetal CO depends on?
HR
Functional closure of DA.
10-15 hours
Anatomical closure of DA.
2-3 weeks
Strongest stimulus for constriction of the ductal smooth muscle.
Inc in oxygen saturation
Most common ASD.
Ostium secundum
Chamber enlarge in ASD.
Right side and PA
Systolic ejection murmur at LEFT 2nd ICS.
ASD
