usmlerx peds 2 Flashcards
1
Q
Linear erythematous plaques with slight crusting
A
Contact Dermatitis (note linear)
2
Q
What are the rules for telling parents about their kids private information?
A
Minors are exempt from parental consent/involvement for STIs, Pregnancy, Drug Rehab
3
Q
Newborn tests positive for HIV
A
Retest at 10 months or after -Passive maternal IgG transmission
4
Q
Etiology: Ataxia Telengiectasia
A
Auto-recessive defective DNA repair results inmutated ATM gene
5
Q
Ataxia telengiectasia
A
IgA deficient (often E and M too) Ataxia (
6
Q
HLA DR5/8
A
JRA
7
Q
HLA 17
A
Psorias (also 13 and B27)
8
Q
Juvenile strokes; Hypercoaguable states
A
Homocysteinuria Factor 5 Leiden Protein C S defic
9
Q
APGAR 1s
A
Appearance= +1= only limbs are blue Pulse= +1= <100 Grimace= +1= grimace to stimulate Activity= +1=some limb flexion Resp= +1=Slow, irregular
10
Q
greasy, scaly, yellow plaques
A
Seborrheic Dermatitis
11
Q
Tx: Seborrheic Dermatitis
A
Scalp: Emollients only corticosteroids/keto/selenium if it doesnt work OR if its not on the scalp
12
Q
Joint pain, Hematuria, purpura on extensors and buttocks
A
HSP
13
Q
Genital ulcers, canker sores, ocular Dz
A
Behcet’s Vasculitis
14
Q
Tx: Preductal Aortic Coarctation
A
PGE 1 until surgery (maintains the PDA. The PDA is currently supplying the lower extremities)
15
Q
Sx: Gaucher’s
A
Deficient Glucocerebrosidase Glucocerebrosides in Brain, Liver, Spleen, Bone “Crinkled Paper” in Marrow (Sx: hepsplenmegaly, anemia, pancyto, neuro)
16
Q
S. Pneumo vaccine
A
23 Polysacc
17
Q
Hib vaccine
A
Conjugate
18
Q
Tx: 1st seizure
A
Acetaminophen -EEG for persistant seizures
19
Q
sfx: Doxycycline
A
Tooth discoloration (for peds)
20
Q
Complications of Kawasaki
A
Coronary Aneurysms if untreated
21
Q
Etiology Meningitis, 0-3 mos
A
GBS
22
Q
Radiolucent nidus surrounded by sclerotic bony formation
A
Osteoid Osteoma
23
Q
Codman triangle with destruction of bone cortex
A
Osteosarcoma
24
Q
Osteolysis in diaphysis
A
Enchondromas/Chondromas
25
Osteolysis with periosteal reactivity and onion skinning
Ewing's Sarcoma
26
Nocturnal bone pain responding to aspirin
Osteoid Osteoma Or Osteosarcoma
27
Sx: Eisenmeiger's
initial L?R shunt??PHTN? Reverses shunt Cyanosis, clubbing Loud systolic murmur Fixed Split S2
28
Systolic murmur loudest below L Scapula
Coarctation of the Aorta (ie Turners)
29
Explain Prader Willi/Angelman
Normal= One gene expressed, one silent(/imprinted) In angelman, the paternal gene is imprinted/silenced as normal BUT the problem is that the maternal gene is also fuucked up and thus not expressed.
30
Retinal hemorrhages can lead to
Amblyopia
31
delayed appearance of dermal melanocytes
Mongolian Spots
32
Well demarcated blue-green spots
Mongolian spots (more like bluish-brown in my opinion)
33
Dysplastic melanocytes
Dysplastic Nevus
34
Sx: Mastoiditis
Pain, erythema behind ear Pus conductive hearing loss
35
Sx: Cholesteatoma
Basically Otitis Media with facial nerve palsy, HA
36
Epitrochlear lymph node enlargement
EBV/Infective Mono
37
Dx: EBV
Monospot test (Pt's RBCs agglutinate Horse RBCs) 2nd choice is Heterophile Antibody test for IgG/M
38
Dx: Slipped Capital Femoral Epiphysis
Bilateral Hip Xrays
39
Etiology: Scissor Gait
Cerebral Palsy -Idio, perinatal asphyxia, premature, restricted intrauterine growth, infxn, brain malformation, neonatal cerebral hemorrhage, trauma
40
Dx: Suspected Abuse
Skeletal survery (all of body)
41
Tx: X Linked Agammaglobulinemia
Amoxicillin for infxn and IVIG
42
Blue Sclera is due to
Choroidal veins showing from a Collagen 1 defect in Osteogenesis Imperfecta
43
Lympadenopathy on anterior neck
Cat Scratch- Bartonella Henselae
44
Tx: RSV
Supportive (USMLERx says Ribavirin has not been proven effective except in vitro)
45
Dx: Constitutional Growth Delay
Bone Age Assessment also address parents puberty age, underlying causes etc
46
Dx: Developmental Dysplasia of Hip
U/S is most sensitive!
47
Indications for Bacterial Endocarditis Prophylaxis
Prosthetic Valve Unrepaired(/partially) Cyanotic Dz NO Prophylaxis is needed anymore for bicuspid, acq aortic or mitral valve Dz-MVP/MR, HCM
48
MOA Indomethacin
Prostaglandin Synthesis Inhibitor
49
Vaccinations at 2 mos
Hep B dTAP Hib IPV Pneumo
50
Bilateral abdominal masses
ARPKD
51
Tx: ALL
Vincristine and Prednisone (98%!)
52
perinatal growth acceleration, macroglossia, linear ear creases
Beckwith Wiedemann Syndrome
53
Complications of Beckwith Wiedemann
Gonadoblastoma ("Balls") Hepatoblastoma Wilms Neuroblastoma (BeckwitH WiedemanN)
54
Exophthalmos, macroglossia, transient neonatal hypoglycemia
Beckwith Wiedemann Syndrome
55
Tx: Wilm's Tumor
Nephrectomy and chemo
56
Complications of Varicella
Varicella Pneumonia
57
Full fontanelles, irritability, low BP
consider Lumbar puncture for Meningitis
58
Test to order when you see papilledema
CT of head w/o
59
Jehovah's
You CAN give blood in life threatening cases to minors, regardless of parents desires
60
Chance of having another febrile seizure after the first
30%
61
Tx: Waterhouse Friderichsen
Antibiotics Hydrocortisone (for Adrenal Insufficiency)
62
Orbital Cellulitis vs. Conjunctivitis
Orbital will have same Sx but ALSO proptosis, painful eye movements and ophthalmoplegia
63
Duchenne Complications
Death due to Pulmonary Congestion due to Heart Failure
64
IGF vs. GH levels
GH is not useful for diagnostic because it is released in a random pulsatile fashion
65
Tx: Cardiac Hyperkalemia
Calcium Gluconate (Calcium antagonizes the K+ effects at membrane)
66
JRA can lead to
Blindness (uveitis)
67
Dx: JRA
Clinical presentation and also Slit lamp examination for uveitis
68
Tx: Precocious Puberty
GnRH AGONIST to prevent closure of epiphysis and also desensitizes the pituitary to GnRH
69
Interstitial Nephritis differs from PSGN
by having Eosinophils (even 5% is enough of an increase)
70
AOM Criteria
1. abrupt onset inflamm and effusion 2. bulging TM, no motility, otorrhea, air fluid level 3. TM erythema
71
Operate on ASDs if
symptomatic or after age 2
72
Eisenmeiger's leads to
Tacchyarrhythmias PHTN
73
Hi fever, desquamating rash, extraordinary tenderness
Staph Scalded skin Syndrom (aka Ritter's)
74
Tx: Cerebral Palsy
Baclofen
75
Indications for emergent fasciotomy
Pain with passive motion Increasing pain after cast pain out of proportion
76
Tx: Croup
Hospitalize and Racemic epinephrine
77
Tx: Wiskott Aldrich
IVIG and prophylactic antibiotics
78
Erythema toxicum
Rash in first 48 hours benign, self limiting often starts on face or trunk Eosinophilia No known etiology
79
Hallmark of Munchausen by proxy
Symptoms go away when parent leaves
80
Pallor, Leukophilia, Marrow shows increased cellularity and lymphoblast predominance
ALL
81
TTN vs NRDS
NRDS is more deadly TTN doesnt require more than 40% O2 and resolves in 3 days
82
Erythrocytes in alveoli and interstitial spaces
Pulmonary Hemorrhage
83
Tx: NRDS
Surfactant after birth Use corticosteroids in ante natal care -produces surfactant and phospholipids and matures fetal lung
84
Excessive saliva, Dry cough, quick onset
Inhaled foreign body
85
Clear lungs with decreased pulmonary vascular markings
Persistant Pulmonary HTN
86
Perihilar streaking in the interlobular fissures
TTN
87
Hyperinflation with coarse infiltrates
Meconium Aspiration (or RSV???)
88
Dx: Bronchiolitis
no tests unless its severe and the baby is getting admitted,
89
Tx: Bronchiolitis
self limiting
90
Dx: Bronchiolitis vs Croup
Croup has a barking cough and inspiratory stridor
91
Tx: Epiglottitis
Nasotracheal intubation!! Antibiotics (ceftriaxone)
92
widened nose bridge, nasal polyps, chronic sinusitis
CF
93
Nebulizers for bronchiolitis contains
racemic epinephrine
94
Retinopathy of Prematurity occurs from
giving O2 (usually >.7) to premature babies
95
Organism Pulm infections of CF Pts
Babies/toddlers= S. Aureus Teens= P. Aeruginosa
96
Rb Gene
Tumor Suppressor, loss leads to Retinoblastoma (autodom 2-hit hypothesis)
97
conjunctival pallor, ab pain, cognitive impairment, behavioral problems, anemia, basophilic stippling
Lead Poisoning
98
Tx: Cryptochordism
Orchiopexy after 1 yoa
99
Sx: Congenital Hypothyroidism
CUMJEL Coarse facies/Cry (hoarse), Umbilical hernia, Macroglossia, Jaundice, Enlarged fontanelles, Lanugo
100
Etiology of Congenital Hypothyroidism
Idiopathic or PTU/Methimazole
101
Sx: 5 alpha reductase
incomplete virilization Boy that looks like a manly woman
102
G+ cocci in pairs and chains
GBS
103
Developmental Dysplasia of Hip leads to
Osteoarthritis as an adult
104
Fever, bacteruria, pyuria
Vesicoureteral reflux (more common than posterior urethral valves)
105
HLA-DR2
Goodpasture's MS
106
HLA-DR3
DM1 SLE Grave's
107
HLA-B27
Ank Spond, Reiter's
108
HLA-51
Behcet's
109
HLA-D11
Hashimoto's
110
Sx: Angioedema
Eyes, cheeks, lips swell up Pulmonary conditions are often unresponsive to meds
111
arm rash with clear center
Lyme's
112
Tx: Lyme's Dz
Amoxicillin
113
Genetics: Duchenne's
X linked recessive
114
Tx: PDA
Indomethacin
115
Age: Writes first name
5 yoa
116
Age: Rides a tricycle
3 yoa
117
Age: Hop, skip, jump
4 yoa
118
Age: recites poems, songs
4 yoa
119
Plasminogen Activator Inhibitor-1 is elevated in
Sepsis
120
newborn with fleshy sac on sacral spine
Neural Tube Defect/Spina Bifida (teratogenic drugs, ie Carbamazepine)
121
Etiology of Otitis Media
S. Pneumoniae nontyp H. Influ
122
Age: Pulls to a stand
10 months
123
salmon colored macular rash, spiking fever, lymphadenopathy, hepatosplenogmegaly
JRA
124
Sx: Osteogenesis Imperfecta
Fragile Bones Hearing Loss Blue Sclera
125
Trisomy 21 is associated with
ALL and Alzheimer's
126
Tx: Septic Hip
Immediate IV antibiotics Surgical irrigation and debridement
127
Dimpled/Umbilicled center papules
Molluscum Contagiosum
128
Prognosis: Tay Sachs
death by 4-5 usually
129
Papilledema, meningitis
Do CT of head first!! to prevent a cerebral herniation from doing a lumbar puncture
130
Renal Angiomyolipoma associated with
Tuberous Sclerosis
131
Sx: Tuberous Sclerosis
Hamartomas in CNS and skin -Adenoma sebaceum (cutaneous angiofibroma) -Mitral regurg -Ash-leaf spot of hypopigmentation -Rhabdomyoma (cardiac) -Tuberous sclerosis -autOsomal dominant -Mental retardation -renal Angiomyolipoma -Seizures
132
Anaphylactoid Rxn in blood transfusions
IgA deficiencies (anti IgA antibodies)
133
Tx: RTA 1
Potassium Bicarbonate
134
Tx: RTA 2
Potassium Bicarbonate
135
posterior and occipital lymphadenopathy
Rubella
136
Indications for Tympanostomy
>3 ear infections in 6 mos, or 4 in one year
137
Etiology Meningitis, 1-3 mos
E. Coli Meningococci
138
Normal C3; IgA deposits in kidney
Berger's/IgA nephropathy
139
Tx: Scabies
Permethrin
140
Steeple Sign with subglottic narrowing
Croup
141
A kid with Tetralogy is not cyanotic IF...
he has a large VSD with minimal right ventricular outflow obstruction
142
atopic dermatitis, infections, low platelets
Wiskott (T.I.E.)
143
Skull fractures crossing suture lines
are complex fractures and very rare except in abuse cases
144
Rathke's pouch, MC supratentorial tumor
craniopharyngioma
145
small blue poorly differentiated cells in Homer-Wright Rosettes
Medulloblastoma
146
pinkish gray mass in vermis, papilledema, vomiting
Medulloblastoma
147
Rash secondary to HSV, mycoplasma
Erythema Multiforme
148
Target-like pink rash
Erythema Multiforme
149
Gram -, rod
Pseudomonas Aeruginosa
150
Acute Pharyngotonsillitis can result in
Peritonsilar abscess with Group A Strep
151
Sx: West's Syndrome
Infantile spasms arrested psychomotor development hypsarrhythmia on EEG
152
Etiology: Impetigo
S. Aureus
153
Lumpy Bumpy Immunoflourescence
Acute PSGN (Group A Strep)
154
Tram- track double layered membrane
Membranoproliferative nephropathy
155
Spike and dome with IgG C3 deposits
Membranous Nephropathy
156
Linear anti glomerular basement membrane deposits
Goodpasture's
157
Renal Dz associated with Hep C
Membranoproliferative Nephropathy
158
Renal Dz associated with Hep B
Membranous nephropathy
159
Renal Dz associated with SLE
Membranoproliferative Nephropathy
160
Circumision is contraindicated in
Hypo/epispadias
161
Tx: Vesicoureteral Reflux
Ureteral stents if not repaired by puberty age
162
Tx: Ebstein's
Leads to SVTs. Need to radiofrequency ablate
163
Tx: Spastic Cerebral Palsy
Diazepam (Muscle relaxant) and PT
164
Maternal Diabetes puts child at risk for
Macrosomia Shoulder Dystocia
165
Silvery hair
Chediak Higashi
166
velvety dark thickening of skin around neck, axillae and groin
PCOS
167
Labs: Tumor Lysis Syndrome
Hyperkalemia Hypocalcemia Hyperuricemia
168
Tx: Tumor Lysis Syndrome
Allopurinol day before chemo
169
Spiral Fracture of Humerus
Child abuse
170
CSF for bacterial meningitis
Hi Neuts Hi Proteins Lo Glucose
171
X-Linked Immunedeficiencies
Chronic Granulomatous Dz Wiskott
172
S. Aureus, Aspergillus infxns
Catalase positive, think CGD
173
Tetralogy of Fallot
VSD Overriding Aorta RVH RV Outflow obstruction
174
Sickle Cell is associated with inxfns by
Salmonella
175
Breast Feeding Jaundice vs. Breast Milk Jaundice
Breast Feeding Jaundice= inadequate intake leads to fewer BMs so less bilirubin is removed Breast Milk Jaundice= Biochemical, the milk inhibits Glucuronyl Transferase and other aspects leading to increased indirect bilirubin
176
Sx: NEC
in first 2 weeks Abdomen distention Gas/Bubbly bowels (Pneumatosis intestinalis) Bloody Stools/Melena
177
Bloody Stools
NEC, Intussusception, Meckel's
178
Bull's Eye
Intussusception
179
Currant Jelly stools
Intussusception
180
Double Bubble
Duodenal Atresia
181
Double Track
Pyloric Stenosis
182
Phenylalanine is a precursor to
Tyrosine (so supplement with tyrosine in PKU)
183
Failure to pass meconium in first 72 hours
Meconium Ileus (part of CF)
184
Tx: GERD
Positional Change first! Then PPIs
185
Tx: Intussusception
Air contrast barium enema
186
RUQ mass, ? BMs, Vomiting
newborn= Pyloric Stenosis Older babies= Intussusception
187
Breast Milk Jaundice Starts Peaks Subsides
~3 days 2 weeks 1-3 Month
188
Level to treat Jaundice
>20 Bilirubin
189
bilious, nonbloody vomiting hours after first feeding
Duodenal Atresia
190
nonbilious, nonbloody vomiting after feedings
Pyloric Stenosis
191
Complications of Meckel's Diverticulum
MC= Intussusception -also bleeding, volvulus, obstrxn Most Feared= Perforation (rare)
192
Tx: Omphaloceles
Surgery when stable -Cover it with jelly and gauze
193
Gastroschisis vs. Omphalocele
Omphacele has a sac/membrane Both present with polyhydramnios in utero
194
Dx: Conjugated Hyperbilirubinemia
Abdominal U/S (ie biliary atresia, lack of GB)
195
Polyhydramnios
in ability to swallow the amniotic fluid -Omphacele -Gastroschisis -Duodenal Atresia -Potter's Syndrome
196
Tx: Duodenal Atresia
NG tube, fluids, and then surgery
197
Level for Physiologic Jaundice
always < 14 total bilirubin
198
Dubin Johnson Syndrome
Conjugated Hyperbilirubinemia
199
Rotor Syndrome
Conjugated Hyperbilirubinemia
200
Gilbert's Syndrome
Unconjugated Hyperbilirubinemia
