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Pediatrics > UW Peds > Flashcards

UW Peds Flashcards

1
Q

Management of septic arthritis in kid

A
  1. arthrocentesis
  2. blood & synovial fluid cx
  3. empiric abx
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2
Q

top three bugs in septic arthritis in kids > 3mos

A
  1. Staph aureus
  2. Group A strep
  3. S pneumo
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3
Q

Abx for septic arthritis in kids > 3mos

A

Nafcillin OR clindamycin OR cefazolin OR vanc

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4
Q

Top 3 bugs in septic arthritis in babies < 3 mos

A
  1. Staph aureus
  2. Group B strep
  3. Gram neg bacilli
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5
Q

Abx for septic arthritis in babies < 3 mos

A

Nafcillin OR vanc
PLUS
gent OR cefotaxime

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6
Q

Abx of choice for pertussis tx and post-exposure ppx

A

macrolides (azithro)

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7
Q

all close contacts of a kid with pertussis should get [WHAT?]

A

azithromycin

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8
Q

what pertussis tx/ppx should you give to babies < 1 mo?

A

azithro bc erythro is associated with pyloric stenosis and no avail safety date of clarithro

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9
Q

w/u of cyanotic breath holding spell

A

CBC looking for iron deficiency anemia

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10
Q

Tx uncomplicated acute bacterial rhinosinusitis?

A

oral amox-clavulanic acid (augmentin)

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11
Q

give augmentin for sinusitis if persistent sx > or = [how many days?] without improvement

A

10 days

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12
Q

give augmentin for sinusitis if severe sx, fever > 102, purulent nasal d/c, or face pain > or = [how many days?]

A

3 days

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13
Q

give augmentin for sinusitis if worsening sx > or = [how many days?] after initially improving viral URI

A

5 days

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14
Q

give augmentin for sinusitis in the following three situations

A
  • 10 days pers. sx
  • 3 days severe sx
  • sx 5 days s/p viral URI
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15
Q

confirm Lyme arthritis dx w/

A

serum ELISA or Western blot testing

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16
Q

Tx Lyme arthritis

A

oral doxy or amox

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17
Q

what dz causing limp and insidious hip pain classically occurs in obese adolescents? (avg age is 12 in girls and 13.5 in boys)

A

SCFE (slipped capital femoral epiphysis)

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18
Q

First step in management of newborn with respiratory compromise and susp congenital diaphragmatic hernia?

A

Endotracheal intubation!

Then gastric tube.

Bag-and-mask ventilation can exacerbate resp decline!

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19
Q

fancy name for chorlide sweat test

A

quantitative pilocarpine iontophoresis

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20
Q

Triad of HUS

A

anemia, thrombocytopenia, renal failure

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21
Q

Kid with LE purpura, arthritis, and hematuria

A

HSP

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22
Q

renal biopsy of HSP shows

A

IgA deposition in the mesangium

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23
Q

AD expansion of a CTG repeat in DMPK on 19q13.3 causing muscle wasting/weakness, cataracts, testicular atrophy, baldness

A

Myotonic muscular dystrophy

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24
Q

X-linked disorder characterized by eczema, thrombocytopenia, and hypogammaglobulinemia

A

Wiskcott-Aldrich

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25
Q

Pure red cell aplasia without macrocytosis in a 1 yo w/o congenital abnormalities

A

transient erythroblastopenia of childhood

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26
Q

AR dz w/ progressive pancytopenia and macrocytosis in ~8 yo a/w cafe-au-lait spots, microcephaly, micropthalmia, horseshoe kidneys, and absent thumbs

A

Fanconi’s

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27
Q

macrocytic pure red aplasia a/w short stature, webbed neck, cleft lip, shielded chest, and triphalangeal thumbs

A

Diamond-Blackfan syndrome

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28
Q

tx clubfoot

A

stretching and manipulation of the foot, followed by serial plaster casts, malleable splints, or taping. if no improvement, surgery between 3-6 mos.

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29
Q

3-4 mo w/ doll-like face (fat cheeks), thin extremities, short stature, & protuberant abd. w/ hypoglycemia (seizure), lactic acidosis, hyperuricemia, and hyperlipidemia = Type I GSD = Von Gierkes’ dz = deficiency of ?

A

glucose-6-phosphatase

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30
Q

3-4 mo w/ hypoglycemia, lactic acidosis, hyperuricemia, hyperlipidemia = glucose-6-phosphatase deficiency = Type 1 GSD = ?

A

Von Gierkes’ dz

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31
Q

2-3 wk old baby w/ feeding difficulties, macroglossia, & HF due to progressive HOCM = Type II GSD = Pompes’ dz = deficiency of ?

A

Acid maltase = alpha-1,4- glucosidase

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32
Q

hepatomegaly, hypoglycemia, hyperlipidemia PLUS elevated transaminases, fasting ketosis, and NL blood lactate & uric acid concentrations = Type III GSD = Cori’s dz = deficiency of?

A

Glycogen debranching enzyme

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33
Q

18 mo with HSM (progressive cirrhosis) and FTT = Type IV glycogen storage dz = deficiency of

A

Branching enzyme

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34
Q

benign course of hepatomegaly, growth retardation, mild hypoglycemia, hyperlipidemia, and hyper ketosis with nl lactic acid and uric acid levels

A

liver phosphorylase deficiency

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35
Q

AR disorder caused by cystathione synthase deficiency –> Marfanoid habitus, ID, DW lens dislocation, & hypercoag

A

homocystinuria

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36
Q

GSD V = McArdle’s dz = deposition of glycogen in muscles –> myoglobinuria and elevated CK = deficiency of

A

Muscle glycogen phosphorylase = myophosphorylase

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37
Q

tx homocystinuria

A

vitamin supplementation and anti platelet or anticoagulation to prevent thromboembolic events

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38
Q

beta hexoaminidase A deficiency

A

Tay Sachs

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39
Q

galactocerebrosidase deficciency

A

Krabbe dz

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40
Q

alpha-galactosidase deficiency

A

Fabry disease

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41
Q

baby with cyanosis, loud S2, and no murmur

A

transposition (give prostaglandin E1 to maintain PDA)

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42
Q

3 types of cyanotic heart disease that cause increased pulmonary flow

A

transposition, truncus, TAPVR

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43
Q

2 causes of neonatal cyanotic heart disease with severe HF

A

hypoplastic left heart syndrome, critical aortic valve stenosis

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44
Q

tet, tricuspid atresia/stenosis, ebstein’s anomaly, PV atresia/stenosis all cause cyanotic heart disease with [inc or dec?] pulmonary flow

A

decreased

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45
Q

children < 2 yo with first febrile UTI should be treated with 1-2 wks abx and what imaging?

A

renal and bladder u/s

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46
Q

deficiency that causes dry beriberi (peripheral neuropathy) or wet beriberi (dilated cardiomyopathy) or Wernicke-Korsakoff syndrome

A

Thiamine

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47
Q

Deficiency that causes pellagra (symmetric reddish rash, dementia, diarrhea)

A

niacin

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48
Q

deficiency that causes ecchymoses, petechiache, bleeding gums, hyperkeratosis, and coded hair

A

vitamin C deficiency

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49
Q

deficiency that causes angular chalets, stomatitis, glossitis, normocytic-normochromic anemia, and seborrheic dermatitis

A

riboflavin deficiency

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50
Q

deficiency that causes angular chalets, stomatitis, glossitis, normocytic-normochromic anemia, and seborrheic dermatitis

A

riboflavin deficiency

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51
Q

neonate with HSM, cutaneous lesions, jaundice, anemia, rhinorrhea, and on X-ray, metaphysical dystrophy and periostitis

A

congenital syphils

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52
Q

neonate with IUGR, HSM, petechiae or purport, chorioretinisis, hearing loss, and periventricular calcificiations

A

congenital CMV

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53
Q

neonate with IUGR, HSM, petechiae or purport, chorioretinitis, hearing loss, and periventricular calcifications

A

congenital CMV

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54
Q

how does refeeding syndrome cause arrhythmias and cardiopulmonary failure

A

carbs stimulate insulin activity, wh/ promotes cellular uptake of P, K+, and Mg++

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55
Q

how does refeeding syndrome cause arrhythmias and cardiopulmonary failure

A

carbs stimulate insulin activity, wh/ promotes cellular uptake of phosphorus, K+, mag

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56
Q

girl with precocious puberty, pigmentation (cafe au lait spots), and polyostotic fibrous dysplasia

A

McCune-ALbright syndrome

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57
Q

Herpangina is caused by coxsackie virus and p/w vesicles on the?

A

POSTERIOR oropharyng

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58
Q

Herpetic gingivostomatitis is caused by HSV1 and p/w vesicles on the?

A

ANTERIOR oropharynx

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59
Q

Herpangina is caused by coxsackie virus and p/w vesicles on the?

A

POSTERIOR oropharynx

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60
Q

Herpetic gingivostomatitis is caused by HSV1 and p/w vesicles on the?

A

ANTERIOR oropharynx

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61
Q

delayed separation of the umbilical cord

A

Leukocyte adhesion defect 1

62
Q

tx non-bullous impetigo

A

topical mupriocin

63
Q

new onset hearing loss or chronic ear drainage despite abx + granulation tissue and skin debris =

A

cholesteatoma

64
Q

elevated 17-hydroxyprogesterone

A

21 hydroxylase deficiency (CAH)

65
Q

abnormal serum lead w/u

A

measure venous lead level

66
Q

abnormal serum lead w/u

A

measure venous lead level

67
Q

bug for non-bulbous impetigo

A

staph aureus or group A strep

68
Q

bug for bullous impetigo

A

staph aureus

69
Q

tx bullous impetigo

A

oral abx such as cephalexin, dicloxacillin, or clinda

70
Q

repeat cystitis in pt w/ constipation

A

urinary stasis

71
Q

all vaccines should be adm by chronological not gestational age in premees, e/c

A

must be over 2 kg for first hep B

72
Q

gold standard for diagnosing malrotation

A

upper GI series (after abd xr)

73
Q

prenatal exposure to valproic acid

A

neural tub defects

74
Q

prenatal exposure to phenytoin

A

fetal hydantoin syndrome

75
Q

prenatal exposure to cocaine

A

jitteriness, hyperactive moro

76
Q

prenatal exposure to heroin

A

neonatal abstinence syndrome - irritability and high-pitched cry

77
Q

fetal alcohol syndrome

A

IUGR, long smooth philtrum, thin upper lip

78
Q

fetal alcohol syndrome

A

IUGR, long smooth philtrum, thin upper lip

79
Q

bug in cervical adenitis

A

strep or staph (in older kids w/ cavities can be oral anaerobes)

80
Q

tx cervical adenitis

A

clinda plus I&D

81
Q

amox covers what gram positives?

A

strep, not staph

82
Q

bactrim covers what gram positives?

A

staph (inc MRSA) but not group A strep

83
Q

well-appearing neonate has painless bloody stools

A

milk or soy protein prctocolitis

84
Q

triad of fever, severe morning or nocturnal headache, and focal neurologic defect or seizure

A

brain abscess

85
Q

risk factors for brain abscess

A

otitis media, mastoiditis, frontal or ethmoid sinusitis, dental infection; cyanotic heart disease, other bacteremia

86
Q

PEPpx for chickenpox in immunocompentent

A

vaccine w/i 3-5 days

87
Q

PEPpx for chickenpox in immunocompromised

A

immunoglobulin

88
Q

the following are complications of what?

  1. fractured clavicle
  2. fractured humerus
  3. Erb-Duchenne palsy
  4. Klupke palsy
  5. Perinatal asphyxi
A

shoulder dystocia

89
Q

extended elbow + pronated forearm + flexed wrist and fingers

A

“waiter’s tip” = erb-duchenne (5th and 6th cervical nerves)

90
Q

extended wrist + hyperextended MCPs + flexed IPs + absent grasp + horner

A

klumpke palsy (8th cervical and 1st thoracic)

91
Q

adolescent w/ epistaxis, localized mass, and bony erosion on back of nose

A

angiofibroma

92
Q

neonatal conjunctivitis w/i 24 hours of lief

A

chemical (silver nitrate pox), tx supportive

93
Q

neonatal conjunctivitis at 2-5 days (profuse, purulent)

A

gonococcal, tx: IM ceftriaxone or cefotaxime

94
Q

neonatal conjunctivitis at 5-14 days (watery or mucopurulent, w/ blood)

A

chlamydial, tx: oral erythromycin

95
Q

most common cause of bacterial PNA in CF (esp w/ coexisting flu)

A

Staph aureus, tx: IV vanc

96
Q

iron antidote

A

deferoxamine

97
Q

lead antidote

A

calcium EDTA

98
Q

prev healthy infant p/w bulbar palsies, constipation, & hypotonia

A

ask about honey! but still might have ingested botulism spores from environment.
tx: Botulism immunoglobulin

99
Q

most common causes of acute bacterial rhinosinusitis

A

strep pnemo and non-typeable H flu

100
Q

electrolyte abnormalities in pyloric stenosis

A

loss of HCl by vomiting –> met all + hypocholoremia; down H+ means down K+ (into cells, also aldo release in response to hypovolemia)

101
Q

mid systolic click with late systolic murmur

102
Q

BLANK can be a/w several cardiac abnormalities including supravalvular AS, PS, or septal defects

A

Williams syndrome

103
Q

continuous flow murmur at the LSB; mildly accentuated peripheral pulses

104
Q

characteristics of benign cardiac murmurs

A
  1. grade 2 or less
  2. early or mid-sstolic
  3. dec w/ standing and valsalva
  4. nl associated S2
  5. child o/w healthy
105
Q

kid w/ croup is deteriorating. what do you try before intubating?

A

racemic epinephrine

106
Q

most common cause of urinary tract obstruction in newborn boys

A

posterior urethral valves

107
Q

“rash that resembles a sunburn”

A

pellagra (niacin deficiency)

108
Q

management of caustic ingestion (oven cleaner)

A
  1. ABCs
  2. remove clothes, wash
  3. CXR if rest
  4. upper GI endoscopy
109
Q

brief episodes of impaired consciousness, staring spells, automatisms, POST ICTAL CONFUSION

A

partial complex; EEG normal or w/ brief d/cs

110
Q

brief episodes of impaired consciousness, staring spells, automatisms, NO POST ICTAL CONFUSION

A

absence; EEG shows 3Hz spike and wave

111
Q

adolescent with unilateral or bilateral myoclonic jerks in the morning

A

Juvenile myoclonic epilepsy

112
Q

child w/ seizures of mult types, impaired cog fxn, and slow spike & wave activity on EEG

A

Lennox-Gastaut

113
Q

w/u precocious puberty with high LH

A

MRI w/ contrast

114
Q

w/u precocious puberty w/ low LH

A

GnRH stimulation test

115
Q

w/u isolated proteinuria on dipstick?

A

repeat dipstick on 2 separate occasions

116
Q

4 anomalies of tetrology

A

PROVe

  • pulmonary stenosis
  • RVH
  • overriding aorta
  • VSD
117
Q

what causes a tet spell?

A

sudden spasm of RVOT during exertion

118
Q

murmur in tet?

A

harsh crescendo decrescendo systolic murmur over LUSB (PS)

119
Q

what do you call it when the aorta comes out of the RV and the pulmonary artery comes out of the LV?

A

transposition

120
Q

follicular conjunctivitis and pannus (neovascularization) formation in the cornea

121
Q

congenital marrow failure, poor growth, morphologic abnormalities, and macrocytic anemia in a kid

A

Fanconi anemia (caused by chromosomal breaks)

122
Q

tx neonatal clavicular fracture

A

nothing! (acetaminophen and reassurance)

123
Q

neonate with jaundice, large tongue, hoarse cry, and decreased activity

A

congenital hypothyroidism

124
Q

most common cause of congenital hypothyroidism in the US

A

thyroid dysgenesis

125
Q

hemolytic anemia, thrombocytopenia, ARF

126
Q

purpura, joint pain, NORMAL platelet count

127
Q

newborn with FTT, bilateral cataracts, jaundice, hypoglycemia

A

galactosemia (galactose-1-phosphate uridyl transferase deficiency)

128
Q

newborn with bilateral cataracts and NO OTHER SX

A

galactokinase deficiency

129
Q

how to distinguish iron deficiency and thalassemia trait

A

in iron deficiency, decreased ferritin, increased TIBC and RDW; these values are NORMAL in thalassemia trait

130
Q

most common cancer in children

131
Q

dx ALL

A

> 25% lymphoblasts on BMB

132
Q

osteosarcoma on xray

A

sunburst and codman

133
Q

ewing on xray

A

onion skinning

134
Q

impaired oxidative metabolism and susceptibility to catalase + orgs (aspergillus and staph)

135
Q

kid w. complement deficiency is susceptible to:

136
Q

genetic defect in SCID

A

adenosine deaminase

137
Q

pt > 6 mos who presents w. inc susc to giardia, h flu, and s pneumo

A

b cell deficiency

138
Q

bugs causing pediatric viral myocarditis

A

coxsackie B, adenomvrius

139
Q

viral prodrome + dyspnea, syncope, tachycardia, n/v, hepatomegaly + holosystolic murmur should make you think…

A

viral myocarditis

140
Q

diagnostic studies for viral myocarditis

A

CXR (cardiomegaly and pulmonary edema), EKG (sinus tach), echo (dec EF, diffuse hypkinesis), endomycoardial biopsy (gold standrd)

141
Q

what does endomyocardial biopsy show in viral myocarditis?

A

inflammatory infiltrate o fteh mycoardium with myocyte necerosis

142
Q

what is the gold standard for dx of ped viral myocarditis?

A

endomyocardial biopsy

143
Q

mortality of viral myocarditis

A

newborns (75%); older infants/kids (25%); of survivors, 1/3 have dilated cardiomyopathy or chronic HF

144
Q

all patients with history of rheumatic fever should received continuous antibiotic prophylaxis with

A

IM benzathine pencilllin G every 4 weeks

145
Q

EKG with shortened PR interval, slurred initial portion of the QRS (delta wave), widened QRS complex

146
Q

electrolyte derangements that can prolong QT interval

A

Hypo -calcemia, -kalemia, -magnesemia

147
Q

two inherited long QT syndromes

A

Jervell and Lange-Nielsen (AR)
AND
Romano-Ward (AD)

148
Q

AR long QT (~600 ms) syndrome caused by defects in potassium channels that is a/w congenital sensorineural deafness

A

Jervell & Lange-Nielsen

149
Q

Tx Jervell & Lange-Nielson

A

Beta blocker (ANY BUT SOTALOL, wh/ is class III)

150
Q

harsh crescendo-decrescendo systolic murmur over the LUSB

A

Tetrology (pulmonic stenosis murmur)

151
Q

distant heart sounds, distended jugular veins (or scalp veins in infants), and hypotension

A

Beck’s triad of cardiac tamponade; pulses paradoxus may also be present

Pediatrics (6 decks)

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