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UT High Yiedl Flashcards

1
Q

What does APGAR tell you?

A

General info about how newborn tolerated labor and how responding to resuscitation

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2
Q

What does APGAR not tell you?

A

Not predictive of outcome, does not guide therapy

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3
Q

What does it mean if arm extended and medially rotated after birth?

A

Erb Duchenne = waiters tip
C5-C6

Tx: refer at 3-6 mo for surgery

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4
Q

What does it mean if you feel crepitus at clavicle in newborn? What should you do?

A

clavicle fracture

tx: reassurance and watch

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5
Q

What is edema on baby’s head that crosses suture lines?

A

caput

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6
Q

What is fluctuant mass on baby’s head that does not cross suture lines?

A

cephalohematoma

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7
Q

What are mongolian spots made of?

A

arrested melanocytes

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8
Q

What is pale pink vascular macules on nuchal area and face?

A

salmon patch = nevus simplex

less sharply demarcated than hemangiomas

facial regress, nuchal stick around

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9
Q

What is firm white papule on day of life 1 w/ keratin?

A

milia

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10
Q

When do you see neonatal acne?

A

week of like 1-2

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11
Q

Firm yellow white pustules/papules on erythematous base?

A

filled with eos

erythema toxicum

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12
Q

What is area of alopecia w/ orange colored nodular skin?

management?

A

nevus sebaceous

remove before adolesence b/c risk of malignant degeneration

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13
Q

What is treatment for cradle cap?

A

mild shampoo or antifungal

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14
Q

What are two disorders screened for in every state?

A

galactossemia

PKU

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15
Q

What is PKU? How does it present?

A

deficient Phe hydroxylase

see sx a few months later, MR, delay, athetosis, seizure, vomit

fiar hair, eyes, skin, musty

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16
Q

What is galactosemia? How does it present?

A

Deficient G1P uridyl-trasnferase

G1P accumulates to damage kidney/liver/brain

sx right away b/c galactose crosses the placenta

MR, direct hyperbili, jaundice, low glucose, cataracts, seizure

predisposed to E coli sepsis

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17
Q

What is physiologic jaundice?

A

b/c liver conjugation not mature, gone by day 5, bili

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18
Q

What is breastfeeding jaundice mech?

A

increased enterohepatic circulation –> reabsorb deconjugated bili

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19
Q

What is breast milk jaundice?

A

breast milk has glucoronidase that deconjugated bili in infant GI tract

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20
Q

Causes of direct hyperbili?

A 
galactosemia
hypothyroid
choledochal cyst
CF
biliary atresia
SEPSIS!
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21
Q

Inherited indirect hyperbili?

A

gilbert + crigler-najjar

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22
Q

Inherited direct hyperbili?

A

rotor (no black liver) + dubin johnson (black liver)

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23
Q

What is mech of phototherapy?

A

isomerizes unconjugated bilirubin so can be excreted

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24
Q

Treatment for diaphragmatic hernia?

A

give lungs 3-4 days to mature then do surgery

*deliver at a facility with ECMO

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25
Q

Resp distress w/ excess drooling: dx? what else should you look for?

A

place feeding tube, take xray

look for VACTERL: vertebral, anal atresia, cardiac, radial, renal

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26
Q

What should you think if 1 wk old cyanotic when feeding but pink when crying? What else should you look for?

A

choanal atresia

CHARGE: coloboma, heart defects, retarded growth, GU anomalies, deafness

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27
Q

How do you diagnose RDS prenatal?

A

L/S ratio

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28
Q

Treat RDS?

A

O2 therapy w/ nasal CPAP to keep alveoli open

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29
Q

When do you use theophylline in NICU?

A

for central apnea

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30
Q

What is pathophys in TTN? signs in CXR?

A

path: retained fluid

CXR: perihilar streaking, retained fluid in fissures, air trapping

risks: C section

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31
Q

Meconium aspiration syndrome next best step? complications?

A

intubate + suction before stimulation

complications: pneumonia, pneumonitis, pulm artery HTN

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32
Q

What is defect lateral to midline w/o sac?

A

gastroschisis

not associated w/ other anomalies

problem –> bowel exposed gets scarred –> bowel resection –> etc

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33
Q

What is defect in midline covered by sac?

Associated w/ what disease

A

omphalocele

associated w/ beckwith wiedemann = big baby w/ big tongue, ear pits, low glucose

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34
Q

When do we treat umbilical hernia?

A

if persists past age 2-3

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35
Q

Metabolic complication w/ pyloric stenosis?

A

hypochloremic metabolic alkalosis

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36
Q

2 wk old w/ biliious vomiting + polyhydramnios?

A

duodenal atresia

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37
Q

1 wk old baby w/ billious vomiting, draws up legs, ab distension?

A

malrotation and volvulus

–> ladds bands can kink the duodenum

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38
Q

3 day old has not passed meconium?

A

CF –> gastrograffin enema = Dx/Tx

HIrshprungs –> squirt sign = explosion of poo w/ enema, tx ganglia

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39
Q

What do you see on CXR w/ ENC?

A

pneumocystitis intestinalis (air in the wall)

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40
Q

What is treatment for NEC?

A

NPO, TPN (if necessary), abx, resent necrotic bowel

risk: prematurity

most important = stop feeding

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41
Q

Newborn male w/ no palpable testes – where are they? next best test?

A

usually in inguinal canal

if not there –> do US

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42
Q

What is prune belly syndrome?

A

problem w/ ventral musculature of abdomen, have cryptorchidism

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43
Q

When do you surgery for cryptorchidism?

A

at 1 yr, decreases sterility makes it easier to detect cancer

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44
Q

What is it called if newborn has urethral opening on ventral surface?

A

hypospadia

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45
Q

What do you not do in hypospadias?

A

circumcise –> foreskin used for repair

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46
Q

What is treatment for 21 hydroxylase?

A

give hydrocortisone and fludrocortisone

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47
Q

Baby w/ anterior midline mass that doesnt pee?

A

posterior urethral valves = common cause of anuria

Tx: catheterize then surgical correction

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48
Q

Associations w/ pre-existing maternal DM?

A

IUGR, congenital, caudal regression, small left colon

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49
Q

Associations w/ gestational DM?

A

LGA, hypoglycemia, hypocalcemia, polycythemia, jaundice

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50
Q

Risks of LGA?

A

increased risk of birth trauma –> clavicle, erbs, TTN

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51
Q

What are complications of neonatal hypoglycemia?

A

seizure

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52
Q

Why polycythemia in LGA?

A

big baby needs more O2 = hypoxia –> more EPO

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53
Q

What should you order in baby

A

CBC w/ diff, CXR, blood culture, urine culture (w/ catheter), LP

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54
Q

What are risk factors for neonatal sepsis?

A

premature, chorioamnionitis, intrapartum fever, maternal leukocytosis, prolonged rupture of membranes (>18 hrs), GBS+ mom

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55
Q

What are most common bugs for neonatal sepsis? empiric treatment?

A

GBS, E Coli, Listeria

ampicillin + gentamicin

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56
Q

Neonate w/ maculopapular rash on palm/soles, snuffles, periostitis?

treat?

A

syphilis

Tx: penicillin

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57
Q

Neonate w/ hydrocephalus, intracranial calcifications, chorioretinitis? Treat?

A

toxo

Tx: sulfadiazine + leucovorin

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58
Q

Neonate w/ cataracts, deafness, heart defects (esp PDA/VSD), extramedullary hematopoiesis? Treat?

A

Rubella

Tx: none

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59
Q

Neonate w/ microcephaly, periventricular calcifications, deafness, thrombocytopenia, petechiae? Treat?

A

CMV

Tx: ganciclovir

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60
Q

Neonate w/ limb hypoplasia, cutaneous scars, cataracts, chorioretinitis, cortical atrophy? Treat?

A

Congenital varicella

if mom infected 5 days before or 2 days after delivery –> baby gets VZIG

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61
Q

Treat gonococcal conjuncitivits?

A

topical erythromycin and IV 3rd gen Ceph

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62
Q

Treat chlamydia conjunctivitis (mucopurulent/mucoid)?

A

oral erythromycin

complication = chlamydia pna

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63
Q

IQ in Down syndrome?

A

moderate MR and dev delay

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64
Q

Associations w/ Down syndrome: Heart? GI? Endocrine? MSK? Neuro? Cancer?

A 
Heart: endocardial cushion, VSD
GI: hirshprung, duodenal atresia
Endocrine: hypothyroid
MSK: atlantoaxial instability
Neuro: alzheimers (APP on 21)
Cancer: ALL
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65
Q

Associated anomalies w/ turner? treatment?

A

coarctation of aorta, bicuspid aortic valve, horseshoe kidney

treat: give estrogen to undergo puberty and avoid osteoporosis

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66
Q

What are associations w/ klinefelters?

A

increased risk of gonadal malignancy

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67
Q

What syndrome: manidublar hypoplasia, glossoptosis, cleft soft palate, w/ FAS or edwards?

A

Pierre robyn seuqence

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68
Q

What syndrome: broad square face, short stature, self injurious, del 17?

A

smith mcguinnes

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69
Q

What chr is prader willi?

A

chr 15

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70
Q

What chr is williams?

A

chr 7

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71
Q

What syndrome: IUGR, hypertonia, distinct facies, limb malformations, self injurious behavior, hyperactive?

A

cornelia de lange

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72
Q

What is genetics of fragile X?

A

CGG repeats on X chr

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73
Q

What syndrome: AD, w/ advanced paternal age, short palpebral fissures, white forelock, deafness

A

Waardenburg

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74
Q

Multiple infecitons and no tonsils?

A

Bruton agammaglobulinemia

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75
Q

B cells normal but low Igs in later kid? complication?

A

CVID –> increased lymphoid tissue so increased risk lymphoma

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76
Q

Most common B cel defect w/ recurrent URIs and diarrhea?

A

IgA deficiency

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77
Q

3 wk old w/ seizure, truncus arteriosus, micrognathia?

A

DiGeorge, chr 22

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78
Q

Inheritance of SCID? treat?

A

MC XR, also AR ADA deficiency

tx –> BM transplant by age 1 or death

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79
Q

Dx chronic granulomatous disease?

A

nitrotetrazolium blue, flow cytometry

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80
Q

What disease w/ severe eczema, petechiae, recurrent ear infections? What IG make up?

A

wiskott aldrich

high IgE/IgA, low/normal IgG/IgM

prolonged bleeding after circumcision

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81
Q

When do you double length by?

A

4-5 years

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82
Q

Breast milk vs formula?

A

breast milk = whey, more lactose, more long chain fatty acids, less Fe but better absorbed

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83
Q

What should you think if kid always 5% in height, parents late bloomers? Bone age?

A

constitutional growth delay

bone age

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84
Q

What is bone age in obesity?

A

bone age > real age b/c of estrogen

85
Q

When do you have moro? grasp? rooting? placing?

A

birth to 4/6 mo for all

86
Q

When is parachute?

A

from 6-8 mo for rest of life

87
Q

When can baby roll over?

88
Q

When can baby skip + copy triangle?

89
Q

When can baby walk alone?

90
Q

When can baby walk upstairs w/ alternating feet?

91
Q

When can baby copy cross and square

92
Q

When can baby sit unsupported + pincer grasp?

93
Q

When can baby walk downstairs, copy circle, jump w/ both feet?

94
Q

When is 1/2 of speech comprehensible and 2-3 word sentences

95
Q

When can baby social smile, start to coo?

96
Q

When should achieve urinary continence? What are medical causes to rule out?

A

by 5 years, after that = pathologic

medical causes: UTI (do UA), constipation (disimpact), or DM (check sugar)

97
Q

When shoul achieve fecal continence?

A

4 yrs

treat: disimpact, stool softeners

98
Q

What vaccines at 2, 4 6mo?

A

hep B, rota, DTap, HIB, IPV, pneumococcal

99
Q

What vaccines due at 12 mo?

A

MMR, varicella, Hep A

100
Q

What are contraindication to MMR?

A

neomycin/streptomycin allergy

101
Q

Stills murmur?

A

systolic ejection murmur 2/5

102
Q

Venous hum?

A

best heard in anterior neck, disappears when jugular vein compressed

disappears when supine

103
Q

Newborn cyanotic at brith and o2 does not improve? associated with what? murmur? Tx?

A

transposition

more common in infants of DM mothers

no murmurs

Tx: PGE1

104
Q

Associated murmur w/ tet? treat?

A

systolic ejection murmur of VSD

treat: O2 and knee checst

105
Q

What is presentation of ebstein anomaly? associated arrhythmia?

A

holosystolic murmur worse on inspiration

associated w/ WPW

106
Q

What does it mean if murmur worse on inspiration?

A

R sided murmur

107
Q

Heart defect w/ DiGeorge?

A

truncus arteriosis

108
Q

CXR finding in truncus arteriosus?

A

increased pulm blood flow and biventricular hypertrophy

109
Q

What are two conditions associated w/ PDA?

A

prematurity, congenital rubella

110
Q

Murmur of HOCM

A

systolic ejection murmur
louder standing, exercise, valsalva
quieter squat, handgrip

111
Q

Tx HOCM?

A

no sports give B Blockers or CCB

alcohol ablation or surgical myotomy for definitive

112
Q

What are signs at birth of CF?

A

meconium ileus –> dilated loops, ground glass

can also have rectal prolapse w/ chronic diarrhea, FTT, floating stools, recurrent resp infections, nasal polyps

113
Q

What is treatment for thick resp secretions in CF?

A

DNAse(mucolytic), albuterol/saline nebs

114
Q

What is treatment for pna in CF?

A

usually pseudomonas or Burkholderia

treat –> piperacillin + tobramycin or ceftazidime

115
Q

What is treatment for pancreatic insufficiency in CF?

A

replace enzymes w/ meals

116
Q

What is treatment for electrolyte loss through skin in CF?

A

adequate fluid replacement when exercise or hot

117
Q

What does it mean if normal PCO2 in asthma exacerbation?

A

means impending resp failure –> need to intubate

PCO2 should be low

118
Q

Next step if DKA?

A

start insulin drip + IVF, monitor blood gluc and anion gap

start K, bridge w/ glargine once tolerating PO

119
Q

What are diagnostic criteria for DM?

A

fasting gluc > 125 (twice)
2hr OGTT > 200
any gluc > 200 + sx

120
Q

super high fever then rash later?

A

HHV6 = roseola

121
Q

slapped cheek rash?

A

parvovirus B19 = erythema infectiosum

122
Q

maculo-papular desquamating rash on chest and spreads to neck, trunk, extremities + strawberry tongue?

A

scarlet fever

treat: penicillin

123
Q

cough, runny nose, fever, rash spreads down + gray spots on buccal mucosa?

A

measles

treat: vit A

124
Q

sore throat, joint pain, fever, pinpoint rash on face spreads down, rose spots on palate?

A

rubella (b/c joint pain + sore throat w/ rash)

125
Q

complications of mumps?

A

orchitis leading to sterility

126
Q

complications of lyme?

A

heart block, meningitis, arthritis, bells

treat: amoxicillin 8

IV ceftriaxone if menignitis

127
Q

rickettsia complications? treatment?

A

complications = vasculitis and gangrene

tx: doxy no matter what age

128
Q

scabies treatment?

A

permethrin for everyone in the house

129
Q

DX: honey crusted plaque? treatment?

A

impetigo, MC bug is staph if bullous

tx: topical muciprocin

130
Q

Inflamed conjunctiva + multiple blisters, Nikolsky +? Treat?

A

staph scalded skin syndrome
from exfoliative toxin

treat: IV ABx

131
Q

Meningitis post brain surgery?

A

staph aureus

132
Q

Treatment for lyme meningitis?

A

IV ceftriaxone

133
Q

First step if suspect meningitis?

A

start empiric treatment
then check CT if signs of increased LP
then do LP

134
Q

Fever to 102, tympanic membrane red and bulging: what test to dx? treatment?

A

Dx: limited mobility on insufflation or air fluid level

risks: daycare
treatment: amoxicillin 10 days
complication: deafness from effusions

135
Q

Pain behind ear and thick exudate from ear? treatment?

A

otitis externa

treat: topical cipro (think pseudomonas)

136
Q

Complication of otitis externa?

A

malignant otitis externa –> can invade temporal bone –> facial paralysis, vertigo

need CT and IV abx, may need surgery

137
Q

Sore throat w/ exudative pharyngitis w/ tender cervical lymph node – next step?

A

rapid strep antigen –> if negative do culture

138
Q

treatment for strep throat?

A

penicillin or erythromycin

139
Q

muffled voice, stridor, refuse to turn head to left? Dx? Treat? Complications?

A

Retropharyngeal abscess (prevents turning head)

treat: aspirate, treat with 3rd gen ceph + amp or clinda
complications: mediastinitis b/c communicates w/ mediastinum

140
Q

Hot potato voice and uvula deviated to R 2/2 bulge? Dx? Treat?

A

Peritonsilar abscess

I&D + abx

tonsillectomy if recurrent

141
Q

Dx mono?

A

monospot, blood smear w/ atypical lymphocytes

142
Q

What disease do you see steeple sign? clinical sx? treatment?

A

Croup –> parainfluenza

barking cough, loud noises on inspiration

tx: mist, epinephrine neb, steroids

143
Q

What disease should you think if fever, drooling, intercostal retractions, tripod position? xray buzzword? next step? treat?

A

epiglottitis –> strep pyogenes/strep pneumo/staph or h flu

xray: thumb sign

next step: intubate in OR

treat: anti staph abx + 3rd gen ceph

144
Q

PNA vs bronchitis?

A

bronchitis = cough, funky yellow/green sputum, runny nose, but normal lung exam

145
Q

MC PNA in neonate

A

GBS, e coli, lysteria

146
Q

MC PNA 1-3 mo?

A

Chlamydia, RSV, paraflu, strep pneumo

147
Q

MC PNA 4-5 mo?

A

VIRAL then s pneumo

148
Q

9 mo w/ runny nose, wheezy cough, RR 60, retractions, pulse ox 91%? DX? CXR findings? treatment?

A

RSV bronchiolitis

CXR: atlectasis, hyperinflation

treat: hospitalize if resp distress, treat w/ nebs

149
Q

Who gets RSV vaccine?

A

preemie, CHD, lung disease, immune disease

150
Q

lab findings in bordetella pertussis?

A

high lymphocytes

151
Q

treatment for bordetella pertussis?

A

erythromcyin for 14 days

152
Q

Dx UTI?

A

urinalysis, catheterize to get clean catch for culture

153
Q

Treat UTI?

A

trim-sulfa or nitrofurantoin

154
Q

Treat pyelo?

A

14 days IV ceftriaxone or amp + gent

155
Q

MCC limping kid?

156
Q

risk factor DHD?

A

1st born, F, + FH, breech position

157
Q

5 yo w/ painless limp no pain in thigh?

A

legg-calve-perthes = avascular necoris

158
Q

next best step if transient synovitis?

A

bed rest for 1 wk + NSAIDs

159
Q

Treatment SCFE?

A

need surgery to prevent osteonecrosis

160
Q

Good and bad prognostic factors w/ JIA?

A

good: ANA+
bad: RF+, polyarticular, older age at onset

161
Q

Treatment JIA?

A

1st line = NSAIDs
2nd = methotrexate
last = steroids

162
Q

lab findings in kawasaki?

A

lymphocytosis, thrombocytosis (esp wk 2-3), sterile pyuria, high LFTs, high CSF protein

163
Q

best 1st test in kawasaki?

A

echo and EKG

164
Q

Diffuse bone pain w/ petechiae/pallor/infections?

165
Q

Sudden drop in HCT with decreased retic in sickle?

A

aplastic crisis

166
Q

recurrent RUQ pain after meals in sickel?

A

pigment gallstones –> cholecystectomy

167
Q

resp distress + emergent tonsillectomy in sikcle?

A

hyperplasia of lymphoid –> need to do tonsillectomy

168
Q

MC cause sepsis in sickel?

A

strep pneumoe

169
Q

MCC death in sickle? treat?

A

acute chest

treat = abx and exchagne transfusion

170
Q

assess risk for stroke in sickle?

A

transcranial doppler

171
Q

Physiologic anemia?

A

drop in 1st 2-3 mo

172
Q

Folate deficiency risk?

A

sickle, goats milk diet

173
Q

baby w/ normal plts, WBCs but hb 4, low retics, triphalangeal thumsb?

A

blackfan diamond anemia

174
Q

baby w/ low plts, low WBC, profound anemia, cafe au lait, microcephaly, absent thumbs/radii?

A

fanconi anemia

175
Q

Tx for lead?

A

succimer if 70

176
Q

15 yo w/ recurrent epistaxis, heavy menses & petechiae, only platelets low? treat?

A

ITP

treat: IVIG then prednisone then splenectomy

177
Q

15 yo w/ recurrent epistaxis, heavy menses, petechiae, normal plts increased BT and PTT? treat?

A

vWF

treat: DDAVP

178
Q

7 yo M recurrent bruising, hemarthrotsis, increased PTT wthat corrects w/ mixing? dx?

A

hemophilia

179
Q

1 wk old, bleeding from umbilical stump, bleeding diasthesis? dx?

A

vit K deficiency = hemorrhagic disease of newborn

180
Q

9 yo w/ wilsons disease and fulminant liver disease – first factor depleted? two factors not depleted?

A

1st depleted: VII

not depleted: VIII, vWF

181
Q

Treat HUS?

A

dialysis, NO PLATELTS OR ABX

182
Q

HSP MCC? treat?

A

upper resp infection

treat = symptomatic

183
Q

New onset seizure ataxia HA 2 most common causes?

A

astrocytoma = most common, in cerebellum

2nd: medulloblastoma –> can cause hydrocephalus, bad prognosis

184
Q

Associations w/ wilms tumor?

A

WAGR

Beckwith Wiedemann

185
Q

Best test for wilms tumor?

A

ab CT, do CXR to check for lung met

186
Q

Dx for neuroblastoma?

A

high urine HVA/VMA

187
Q

3 yo, HSM, petechiae, pallor, cells CALLA and TdT+? Dx? Poor prognostic factors?

A

ALL

dx: bone marrow biopsy –> > 30% lymphoblasts
treat: chemo, including intrathecal methotrexate

prognostic: 10yo, > 100K WBC

188
Q

best test for hodgkins lymphoma?

A

excisional biopsy –> then stage (CT)

treat: chemo and radiaotion

189
Q

7 yo girl w/ nonproductive cough and large anterior mediastinal mass on CXR? test? treat?

A

nonhodgkin lymphoma

best test: biopsy

treat: surgery then radiation

190
Q

What is treatment for secretory diarrhea?

A

oral rehydration therapy

191
Q

What should you think if nephrotic syndrome + fever?

A

empirically treat b/c increased risk encapsulated peritonitis, pneumonia, sepsis

192
Q

What is pathogenesis of VUR?

A

shortened submucosal tunnel in which ureter inserts through bladder wall

193
Q

What happens in renal vein thrombosis?

A

sudden onset gross hematuria, U/L or B/L flank mass

194
Q

What type of RTA has hyperkalemia?

A

Type IV, also have urine pH

195
Q

What do you see in urine in type 2 RTA?

A

type 2 RTA = fanconi

see glucose, AA, phos in urine

normal/low K, urine pH

196
Q

What is inheritance pattern of Alport?

197
Q

What is the workup for an ALTE?

198
Q

What lab findings in chlamydia PNA?

A

eosinophilia

199
Q

What is most common cause of abdominal mass in newborn?

A

hydronephrosis

200
Q

What are common etiologies of PPHN? treatment?

A

perinatal asphyxia

treat = O2 –> causes vasodilation in pulm

201
Q

What should you expect to occur in 100% O2 test in heart disease w/ increased pulm flow, decreased pulm flow, and in primary lung pathology?

A

increased pulm flow (ex. truncus) –> small increase in PaO2

decreased pulm flow (Tet, transposition) –> minimal/no increase in PaO2

lung disease –> very increased PaO2

202
Q

What is the management of fever of unknown origin in kid?

A

need to rule out bacteremia + UTI

–> give empiric ceftriaxone

203
Q

What is empiric treatmnet for meningitis?

A

vanc + 3rrd gen cef (cefotaxime/ceftriaxone)

204
Q

What should you think if sandparper rash + fever?

A

scarlet fever

205
Q

What bacterial GI infection can mimic appendicitis?

A

mesenteric adenitis

206
Q

What infection causes blue color on cheeks? organism?

A

buccal cellulits = H flu type B

207
Q

What type of bacterial infection causes well demarcated erythema?

A

erysepalas

208
Q

What are the two inherited long QT syndromes?

A

jervell lang neilson –> AR, deafness

Romano ward –> AD, no deafness

209
Q

When is pain with pericarditis worst?

A

when supine –> improved by leaning forward

Peds Clerkship (10 decks)

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