TrueLearn Flashcards
Oral hypoglycemic overdose that is refractory to glucagon and dextrose infusion should be managed next with ______
octreotide
Differentiating cerebral salt wasting and SIADH
SIADH has low UOP (and can look euvolemic), while cerebral salt wasting tends to have higher UOP (and look hypovolemic)
[bonus: differentiating hyponatremic dehydration from SIADH: hyponatremic dehydration has low urine sodium]
Pediatric HTN requires _____ readings to diagnose, and it’s important to check a manual BP.
Pre-HTN is defined as > ____ percentile
Stage I is defined as ______ percentile + 5 mm Hg
Stage II is defined as ______ percentile + 5 mm Hg
3 readings
Pre-HTN is defined as > 90th percentile
Stage I is defined as 95th-99th percentile + 5 mm Hg
Stage II is defined as >99th percentile + 5 mm Hg
Which IBD are these associated with?
arthritis
erythema nodosum
episcleritis
gallstones
Crohns
7 y/o previously healthy comes in with with jaundice, declining school performance, decline in handwriting performance, more impulsive behavior, scleral icterus, drooling, dysarthric speech, LFT elevation, normal CBC (aka HEPATIC + NEURO SXS)
Disease, confirmatory test, and treatment
Wilson disease
Confirm with liver biopsy (may see low serum ceruloplasmin and elevated urinary copper excretion, but liver bx is the confirmatory test if dx uncertain)
Tx is penicillamine
lesions with erythematous border surrounding a clear ring with purplish center
erythema multiforme
True/False: Randomized control trials are limited in that results are difficult to generalize beyond population studied
True
[aka external validity is poor – but internal validity (accuracy) is great in a well-designed study]
best way to avoid cholestasis in neonates on TPN
increase rate of infusion, so as to cycle TPN over 12-14 hrs – this reduces insulin exposure and allows for mobilization of fats
4 year old comes in with signs of meningitis + petechial rash – what bacteria?
Neisseria meningitidis
[Strep pneumo is most common cause in that age, but does NOT cause petechial rash]
how do you test for CMV in immunocompromised/transplant patient?
CMV blood PCR
[IgG, IgM, and urine CMV unreliable in this population]
What syndrome?
dysmorphic facies- anteverted nares, broad alveolar ridges, cleft palate
polydactyly or syndactyly
intellectual disability
growth retardation
ambiguous genitalia
Smith-Lemli-Opitz
[AR, abnl cholesterol biosynthesis]
False positive test = Type ___ error
Type I error
Live virus vaccines should be given simultaneously if appropriate, or greater than or equal to ____ days apart for optimal immune response
28
Acute anaphylaxis to blood transfusion is usually secondary to _______ deficiency
IgA
[check IgA levels]
Most common Salter Harris fracture – extends through the physis to the metaphysis
Type II
Marfanoid appearance, cognitive deficits, downward displacement of the lens
Homocystinuria
[contrast with Marfan syndrome which does not have cognitive deficit, and displacement of the lens is upward]
Abnormal facies
Cardiac abnormalities
Butterfly vertebrae
Direct hyperbili
Alagille syndrome (JAG1 mutation)
[Qstem had ToF, prominent forehead, hypertelorism, saddle nose, small chin; liver biopsy with paucity of bile ducts with giant cell transformation)
Toddler presents with seizures, low grade temp, and cardiac arrhythmia (tachycardia, irregular PVCs, prolonged QRS), found to have metabolic acidosis, stem mentions maternal hx depression. What is this and what do you do?
TCA overdose – give sodium bicarb
triple bubble sign
jejunoileal atresia
What should you think about with trio of fair skin, eczema, and intellectual disability?
PKU
Patients with hx of uncontrolled seizures should not receive what vaccine?
any vaccine containing pertussis component (DTaP, TDaP, etc)
other c/I include progressive neurologic disorders, hx of brief seizure within 3 days of vaccine in the past, history of shock like picture within 48 hrs of DTaP administration, or hx of encephalopathy or prolonged seizure within 1 week of DTaP
Patient with Addison’s disease in adrenal crisis – what happens to their sodium and potassium levels?
Hyponatremia
Hyperkalemia
Acute _______ intoxication may present with euphoria, agitation, hyperthermia, hypertension, tachycardia, diaphoresis, mydriasis, and “bugs on the skin” hallucinations. First line management is with a benzodiazepine; for severe hyperthermia, rapid cooling should be initiated, and for severe refractory HTN, _______ should be used.
cocaine; phentolamine
Differentiate laryngomalacia vs tracheomalacia
laryngomalacia peaks at 6 months; inspiratory stridor
tracheomalacia has expiratory stridor, monophonic wheeze, most resolve by 6-12 mo
infant of diabetic mother at risk of ____ blood glucose, ____ calcium, and ____ magnesium
low; low; low
General mixing instructions for infant formula (powdered)
1 scoop per 2 oz water
When is the routine 2-dose series of serogroup A, C, W, Y meningococcal vaccine given?
11-12 years
16 years
[at-risk kids will get earlier]
To meet criteria of Tourette syndrome, the tics (which are suppressible for a period of time) must have occurred for more than ____ months with the presence of BOTH vocal and motor tics at some point during the course
12 months
study type good for assessing prevalence
cross sectional
Phenotypic male incidentally found to have uterus and Fallopian tubes during an abdominal surgery. There is normal male external genitalia.
Persistent mullerian duct syndrome
What to do in immunosuppressed person who presents 4 days after exposure to varicella
Varicella-zoster immune globulin (can be given up to 10 days after exposure, start ASAP though)
If unable to give VIG, start acyclovir PEP starting 7 days after exposure
False negative test = Type ___ error
Type II error
Transfusion associated lung injury (TRALI) occurs when _______ from the donor are activated in the pulmonary system causing acute hypoxia or respiratory distress during or within 1-2 hrs of transfusion. Tx is supportive and may require intubation
neutrophils
determining ETT size (cuffed and uncuffed)
Cuffed ETT size = (age in years/4) + 3.5
Uncuffed ETT size = (age in years/4) + 4
inheritance of fragile X
X-linked dominant
most common ingredient to be allergic to in MMR, varicella vaccines
gelatin
T/F: a patient who presents with nits following treatment with permethrin for lice represents a re-infestation
False – this is treatment failure! Try a different topical like malathion. If that fails, can move to oral ivermectin
In children with medical conditions like diabetes mellitus, Hodgkin disease, lymphoma, and chronic renal failure, OR if child is younger than 4 years, born in or traveled to high TB prevalent area, or children frequently exposed to adult with HIV or is homeless, incarcerated, drug user, or living in nursing home, a TST is considered positive if induration is greater than _____
10 mm
_________ _________ = deficits in both intellectual and adaptive functioning starting in the developmental period
intellectual disability
male gynecomastia is a red flag at what stage(s) of puberty?
late stage like 4-5
Which of the following do you do for concerns of uteroplacental insufficiency and/or inability to tolerate labor?
A. Nonstress test
B. Stress test
C. Biophysical profile
B. Stress test
stress test evaluates fetal response to contractions over 15-20 mins
most common ingredient to be allergic to if child given MMR, varicella, and polio vaccines
neomycin, streptomycin (gelatin used in MMR and varicella but not polio)
When would you perform a biophysical profile?
after 2 nonreactive non-stress tests. BPP includes assessment of fetal movement, fetal tone, fetal breathing, and amniotic fluid volume. If BPP <4, you would induce labor or take for C-section
[Note: non stress test measures fetal HR in response to fetal movements]
16 y/o female found to have vagina ending in blind pouch, absence of uterus, presence of testes in abdomen, karyotype is 46 XY, testosterone levels are elevated
Androgen insensitivity syndrome
when is hepatitis A vaccine routinely given
2 doses, separated by at least 6 months starting at age 12 months
pathophys of meckel diverticulum
failure of closure of omphalomesenteric duct during gestation
2 components of risk stratification in near-drowning
O2 saturation (>95 is good px)
GCS (>13 is good px)
_________ _________ consists of micrognathia, glossoptosis, and high-arched, or cleft palate. Recognition early in life will help prevent future complications like cor pulmonale which can be seen on _____
Pierre Robin sequence; echocardiogram
Infants born to parents with hepatitis C virus should receive screening for perinatally acquired HCV when?
between 2-6 months of age with HCV RNA
HSV 1 vs HSV 2 – either one can be associated with HSV infections anywhere on the body. But which one is more likely associated with GU infections?
HSV-2
Immunosuppression levels of steroids include dosing of prednisone at 2 mg/kg/day for 4-6 weeks. For children receiving immunosuppression therapy or who have immunosuppressive condition like HIV, TST is positive at greater than _____
5 mm
[note that having lymphoma or Hodgkin disease requires 10 mm induration to be considered positive]
4p vs 5p deletion
4p deletion is Wolff Hirschorn – hypertelorism, micrognathia, short philtrum, microcephaly, abnormal ears, CHD
5p deletion is Cri du chat – LBW, microcephaly, down slanting palpebral fissures, hypotonia, cat-like cry
A clavicle fracture located where is considered higher risk for neuromuscular injury?
medial
study type good for incidence
cohort
Per NRP, if at 30 seconds of life or after, the newborn is not breathing spontaneously, is only gasping, or has a HR below _____, PPV should be the next intervention
100 bpm
If a patient has a benign murmur, what do you expect to happen when they move from supine to sitting?
Softens or disappears
Treatment for acute cluster headache
O2 + Triptans
[CCBs for prevention]
Chronic suppurative otitis media (CSOM) is defined as persistent discharge/otorrhea through a perforated tympanic membrane for greater than 6 weeks. What are the 2 most common pathogens?
Pseudomonas
Staph aureus
Can mom still breastfeed if she is HBsAg positive?
yes
Hypotension, hypoglycemia (with possible seizure), and wheezing (2/2 bronchoconstriction) = signs of what toxicity?
Beta blocker
Car seat stuff is most likely to be tested based on age, since different car seats have different height and weight requirements. Generally kids should be in their car seat until they exceed the height and weight limitations of that car seat. What are general age ranges for the rear facing, forward facing, booster seat, and seat belt?
rear facing = birth to 2-4
forward facing = 2-4 to at least 5 years
booster seat = 5 years to 57 inches tall
A seat belt generally fits properly around 9 to 12 years of age, when the child is around 57 inches (~4’ 9”)
bottle propping increases the risk of what?
AOM
most common ingredient to be allergic to in yellow fever vaccine
embryonated egg or gelatin
Cold poorly perfused extremities, hepatomegaly, lethargy, diaphoresis, and pallor are signs of what type of shock?
cardiogenic
[also see hypotension, tachycardia, tachypnea]
Reducing nursemaids elbow
supination of forearm with full flexion of elbow
[alternatively hyperpronation with moderate pressure on radial head]
Patient has what looks like nummular eczema (even has hx of atopy), but then reports story of Koebner phenomena (lesions appearing at sources of trauma – i.e., on elbow after hitting it on car door)
Psoriasis
17 y/o F with no menses, no breasts, sensorineural deafness, seizure disorder, no pubic hair, normal cervix and uterus
Kallman syndrome
[low/no GnRH, low FSH/LH, low estradiol/testosterone]
Differentiate balanitis from balanoposthitis
balanitis = inflammation of glans (erythema, edema, discharge)
balanoposthitis = inflammation of glans + foreskin
CHARGE syndrome
Coloboma (notched iris)
Heart defects
Atresia of choanae
Retardation of growth
Genital abnormalities
Ear anomalies/deafness
What drug: Hypertension, tachycardia, miosis, horizontal and vertical nystagmus
PCP
Inverted nipples, strabismus, GERD, hypoproteinemia secondary to protein-losing enteropathy
congenital disorders of glycosylation
which is better for premies with moderate to severe BPD – inhaled corticosteroids or diuretic therapy?
Diuretics! data for ICS use is mixed. Typically long term therapy with thiazide diuretic and spironolactone
rare genetic disorder characterized by adenomatous GI polyps, osteomas, supernumerary teeth, and multiple family members with the diagnosis. Management consists of screening colonoscopies and EGDs until eventual colectomy to prevent colon cancer
Gardner syndrome
[pt in question stem presented at age 12 with bloody diarrhea, non-tender hard nodule on mandible, and FHx colon cancer]
ADHD diagnosis requires input from at least 2 sources. Patients must have at least _____ symptoms consistent with inattention, hyperactivity, or impulsivity present for at least ______ months to qualify. Furthermore, these symptoms must have started prior to age _____.
6 symptoms; 6 months; age 12
when does the stepping reflex disappear?
2 months
1 day old with diffuse rash with pinpoint pustules, ruptured pustules with small ring of surrounding scale, and tiny hyper pigmented macules. What is it?
transient neonatal pustular melanosis (neutrophils)
Contrast with erythema toxicum which is small yellow-white papules with surrounding erythema (eosinophils)
Phenotypic female with normal vagina, uterus, and Fallopian tubes, found to be 46 XY, low testosterone levels
Swyer syndrome
[low testosterone levels distinguish from androgen insensitivity which has high testosterone]
Normal Hep B vaccine schedule
Birth, 2 months, 6 months
recall bias is particularly problematic in what type of study?
case-control
[ppl w/disease are more likely to remember/report certain exposures]
How many Hib vaccines are in the PRIMARY series?
depends on the vaccine used! there are 2 options in the US
DTaP-IPV/Hib (PRP-T) - 3 dose primary series at 2, 4, and 6 months (4 dose total with 12-15 month booster)
Hib-HepB (PRP-OMP) - 2 dose primary series at 2 and 4 months (3 dose total with 12-15 month booster)
Kingella kingae arthritis tends to have a more indolent course, note that it can be preceded by MOUTH ULCERS. It must be treated with ______ if suspected
cephalosporins (i.e., cefazolin)
A triglyceride level >100 is considered high for pts younger than 10, while >130 is high for age 10-19. When fasting TG is > 500, ____ can be used as an adjunctive treatment mostly to prevent pancreatitis
fibrates (i.e., fenofibrate)
Patient with hand-foot-mouth disease and cardiac murmur, what infectious etiology?
Coxsackie A
[Note that Coxsackie B can also cause myocarditis, but causes a flu-like illness with GI symptoms, headache, fever, and Myalgias – no oral lesions or rash]
measurement of lysosomal alpha-galactosidase in leukocytes would help confirm ______ disease, which is the most prevalent lysosomal storage disorder characterized by neuropathic limb pain, telangiectasias and angiokeratomas, corneal opacities, hypohydrosis, and abnormal kidney function
Fabry
What type of hypersensitivity reaction is ITP?
Type II (antibody-mediated)
Other examples of type II are bullies pemphigoid, Goodpasture, and myasthenia gravis
A patient with hypertrophic cardiomyopathy will have a systolic murmur that _______ in intensity with standing and Valsalva, and ________ with squatting.
increases; decreases
The ___________ vaccine is recommended in a 2- or 3-dose series starting at age 10 for children with sickle cell disease, asplenia, or persistent complement deficiency
serogroup B meningococcal (MenB)
Note that these kids will typically have already gotten their usual ACWY meningococcal
When does the rooting reflex disappear?
4 months
what is abnormal LDL
> 130 – lifestyle changes
if >250, start statin right away
Kid looks like Hurler syndrome (macrocephaly, coarse features, HSM) but presents later (age 4-5) after losing milestones
Sanfilippo syndrome
What syndrome?
Very small posterior set jaw
Hypertelorism, droopy eyes
Bilateral colobomas
Eyelash aplasia
Hypoplastic zygomatic arches
Congenital hearing loss
Treacher Collins
[AD, malformation of 1st pharyngeal arch]
T/F - breastfeeding can be recommended to compliant mothers who are stable in methadone treatment programs
true
Common sites for relapse of ALL
bone marrow
CNS
testes
ROP affects up to 50% of all infants born at less than 1500 g, or is born at less than ______ weeks. Screening is done either at 31 weeks PMA, or at _____ weeks of life, whichever is LATER
30 weeks; 4 weeks
Hypokalemia
Metabolic alkalosis
Answer choices include Liddle, Bartter, Gitelman - how to differentiate?
Liddle = hypertension (others have low-normal BP)
Bartter = looks like Gitelman but presents in infancy
Gitelman = looks like Bartter but tends to present late childhood or adulthood
9 mo male with FTT, seizures, hypoglycemia, ketosis, lactic acidosis, hyperuricemia, abnormal lipid panel
glycogen storage disease (long term management is oral cornstarch)
Type ___ errors are more likely in tests with poor sensitivity
Type II errors
Birth trauma injury that does NOT cross suture lines
Cephalohematoma
T/F - an anaphylactic reaction to contrast media is IgE-mediated
False – treated the same as a type 1 hypersensitivity, but it is caused by histamine release from basophils and mast cells independent of IgE
fracture extends across metaphysis, physis, and epiphysis into the joint space – what salter Harris?
type IV
[type III similar but no metaphyseal involvement – look at photos]
Which IBD are these associated with?
Pyoderma gangrenosum
Sclerosing cholangitis
Chronic hepatitis
Ankylosing spondylitis
Ulcerative colitis
2 Ottawa ankle criteria
Cannot bear weight
Point tenderness involving the tip or POSTERIOR aspect of EITHER ankle malleolus
[also note Low Risk Ankle Rule states that if a child has tenderness and swelling isolated to either the distal fibula and/or any adjacent lateral ligaments distal to the tibial anterior joint line, radiography not necessary]
______________ can result in bacterial neonatal meningitis. CSF gram stain will typically be negative for bacteria, but CSF pleocytosis will be present.
Listeria
what 3 fracture types have the highest risk of neuromuscular injury?
Supracondylar (distal humerus)
Distal femur
Scaphoid
Drug options for anaerobic coverage
Penicillin + beta lactamase inhibitor (pip/tazo, augmentin)
Metronidazole
Carbapenems
Mom is diagnosed with chorioamnionitis after baby is delivered. Baby is well-appearing. What are 3 risk factors to evaluate for in your decision to observe vs. culture/abx?
GBS colonization/appropriate tx
Prolonged ROM >18 hrs
Preterm labor
Testing for hereditary angioedema
C4 and C1 inhibitor
T/F: HSV-2 genital infections are more likely to cause recurrence than HSV-1
true
HSM
Pancytopenia
Erlenmeyer flask deformities of long bones
Gaucher disease (dx by measurement of glucoserebrosidase activity in leukocytes)
Murmurs associated with HoCM _______ with valsava maneuver
increase
[dynamic obstruction of the left ventricular outflow tract is exaggerated by underfilling of the left ventricle. Valsalva decreases systemic venous return to the heart, therefore decreasing left ventricular preload, which accentuates the murmur]
risk of recurrence for trisomy 21 for maternal balanced translocation
10-15%
unbalanced translocation = 1%
paternal balanced translocation = 2-5%
nondisjunction = 1% + age related risk in mom<35
What is the general rule for resumption of contact sports after EBV infection
4 weeks after illness onset
Classic triad of toxoplasmosis
Chorioretinitis
Hydrocephalus
Intracranial calcifications
Differentiate phimosis from paraphimosis
phimosis = can’t retract foreskin
paraphimosis = retracted foreskin cannot be replaced
The AAP does not recommend using insect repellent in children younger than _________
2 months
T/F: There is no evidence that sensitivity to seafood or iodine predisposes to radiocontrast media reactions
True
Measles exposure. If unvaccinated, get vaccine within _________, and ideally get immunoglobulin within _______. If no prophylaxis given, you skip work for 21 days
3 days
6 days
Baby weighing 1850 g at birth and Hep B positive mom. How many total doses of Hep B vaccine will baby get in lifetime?
4 (HBV and HBIG now, repeat at 1-2 months, 3-4 months, and 6 months)
This is the case because baby is <2000 g at birth – if baby was >2000 g at birth, would only get 3 doses (get HBV and HBIG now, then 2 additional doses per usual schedule)
