Uworld 13 Flashcards
Management of traumatic brain injury (concussion)
head CT scan w/o contrast
observation for 4-6 hours
at what age can a child state their age and their gender
3
what age can a child understand the irreversibility of death?
7-8
rapid hematoma expansion in an epidural hematoma can turn into
elevated intracranial pressure (impaired consciousness uncal herniation (ipsilateral oculomotor nerve palsy)
manangement of febrile seizure
most are discharged home with no evaluation
fetal alcohol syndrome facial features
palpebral fissues
smooth philtrum
thin vermilion borders
microcephaly
Fragile X syndrome: facial features
prominent jaw
large ears
macroorchidism
how is Friedriech ataxia inherited
autosomal recessive
Parents have one child who is has friedriech ataxia, she is pregnant and worried about her 2nd child have the disability. What do you advice her?
genetic counseling
newborn or young infant with failure to thrive, bilateral cataracts, jaundice and hypoglycemia
galactosemia
what is the enzyme deficiency for galactosemia
galactose-1-phosphate uridyl transferase deficiency
a newborn or young infant with only cataracts and otherwise asymptomatic? enzyme deficiency
Galactokinase deficiency (Uridyl diphosphate galactose-4-epimerase deficiency)
difference between homocytinuria and Marfan
Homocytinuria:
intellectual disability
downward lens dislocation
hyper coagulability
how do you treat homocystinuria
vitamin supplementation
antiplatelet or anticoagulation to prevent thromboembolic events
next step in management for a child who comes in with a big head circumference and signs of increased intracranial pressure
CT scan of brain
inability to extend the knee while the hip is flexed?
Kernig sign = meningitis
Most common cause of acute and recurrent headaches in pediatric population
migraine
treatment for migraine
1st: NSAIDs
2nd: Triptans
prophylactic treatment for migraines
topiramate
beta blockers
amitriptyline
how is myotonic dystrophy inherited
autosomal dominant
what are some distinctive clinical features of myotonic dystrohpy
facial weakness
hand grip
cataracts
what is seen in x-ray and CT scan for neuroblastoma? and lab?
calcifications and hemorrhages
serum and urine catecholamines and HVA and VMA elevated
a child has optic glioma. what do you associate that with?
Neurofibromatosis type 1
Brushfield spots in eye
Down Syndrome
what is the clinical difference between Niemann-Pick disease vs. Tay-Sachs disease?
Nieman pick: hepatosplenamegaly and areflexia
Tay-Sachs: hyperreflexia
Intellectual disability
fair complexion
eczema
musty or “mousy” body order
PKU
Phenylketonuria
Adlose B deficiency
Hereditary fructose intolerance
absent galactose-1-phosphast uridyl transferase activity
galactosemia
Lennox-gastaut syndrome
intellectual disability
severe seizures of varying types
3-Hz spike-wave discharges during episodes
absence seizure
Port wine stain leptomeningeal capillary-venous malformation seizures glaucoma intellectual disability
Struge-Weber
Diagnostic study of Struge-Weber
MRI of brain with contrast
PANDAS
pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections
frist line treatment for Tourette
clinidine
A child with meningococcemia with sudden vasomotor collapse and skin rash due to adrenal hemorrhage?
Waterhouse-Friderchsen
what bacteria do you think of for dog or cat bite?
pasteurella multocida
is fever and mild rash after MMR vaccine okay
yes!
clinical feature of scarlet fever
fever
pharyngitis
sandpaper, maculpapular rash
1-mm gray vesicles on the tonsillar pillars and posterior oropharynx that progress to fibrin-coated ulcerations
herpangina–> coxsackie A virus –> supportive management
when do you give varicella immunization to children
1 and 4
rules for varicella post-exposure prophylaxis
got vaccines: observe
no, immunocompetent: give vaccine
no, immunocompromised: VZIG
Who is not eligible for either varicella vaccine immunoglobulins
children under 1 age
Enterobius vermicularis? treatment?
pinworm
albendazole or pyrantel pamoate
treatment for Strongyloidiasis
Ivermectin
Treatment for acute airway obstruction from EBV
corticosteroids
Chronic inspiratory stridor that begins in the neonatal period and is worse in the supine position.
Laryngomalacia: collapse of supraglottic structures
so infectious symptoms
most common cause of acute, unilateral cervical lymphadenitis in children
Staph aureus
most common causes of meningitis in children less than 3 months
Group B strep
E. coli
Listeria
HSV
most common causes of meningitis in children 3 months to 10 years
Streptococcus Pneumoniae
Neisseria meningitidis
most common causes of meningitis in children greater than 11
Neisseria meningititids
treatment for Haemophilus influenza type B meningitis
Dexamethasone
most common cause of viral meningitis in children
echovirus
coxackie virus
acute poor feeding, jaundice, and lethargy. well until 2 days ago
congenital hypothyroidism
most common cause of osteomyelitis in healthy children
Staphylococcus aureus
how is the pertussis diagnosis confirmed
PCR testing of nasopharynx
center criteria. meaning
fever
tender anterior cervical lymphadenopathy
tonsillar exudates
absence of cough
4: abs
2-3: test
0-1: not it
maternal-fetal transmission of rubella virus is most teratogenic during what trimester
first
what viruses make a mother have a C-section
HIV and HSV
describe the sandpaper rash in Scarlet fever
prominent along skin folds(axillae, groin)
desquamation ( as illness resolves, desquamation of the rash results in peeling of hands and feet).
most common cause of osteomyelitis in sickle cell patients
salmonella
Staph. aureus
how is sickle cell inherited
autosomal recessive
Maintenance for a child who was born with sickle cell anemia
pneumococcal vaccine
penicillin until age 5
Folic acid supplementation
hydroxyurea
most common cause of acute bacterial rhinosinusittis
- Strep pneumo
2. Monty-able H. flu
most common cause of chronic bacterial rhinosinusitits
inflammation of rhino sinuses for greater than 12 weeks
staph. aureus
treatment for impetigo skin
mupirocin
specific findings that is highly suggestive of congenital syphilis are
copious rhinorrhea
maculopapular rash that may desquamate or become bullous
what causes umbilical stump infection? clinical feature?
neonatal tetanus
- trismus
- spasms
- hypertonicity
main difference between botulinum and tetanus
botulinum: hypotonic
tetanus: hypertonic
what is a risk factor for toxo you don’t thin of
unwashed fruits/vegetables
what can be done in a child when an emergency access is necessary and peripheral access cannot be obtained
intraosseous vascular access
General rule for wet diapers
number of wet diapers = age in days for first week
after first week = greater than 6 diapers
when is birth weight regained
age 10-14
What are “pink stains” or “brick dust” in neonatal diapers
uric acid crystal
normal
no treatment
what sexual development disorder has minimal to absent axillary/pubic hair
complete androgen insensitivity syndrome
What is the phenotype and genotype for complete androgen insensitivity syndrome
phenotype: female
genotype: 46XY
what is management of complete androgen insensitivity syndrome
bilateral gonadectomy after completion of puberty
-decreases risk of gonadal malignancy
3 things you first no matter what in primary amenorrhea
- FSH, if no breast development
- If FSH, decreased. Pituitary MRI
- FSH increased, Karyotyping
First step in management of Turner syndrome
pelvis U/S to evaluate internal female anatomy
Immunostaining for terminal deoxynucleotideyltransferase (TdT)
ALL
Diamond-Blackfan anemia
- presents in first 3 months of life with pallor and poor feeding
- PURE RED CELL APHASIA
- cleft palate, webbed neck and triphalangeal thumbs
treatment for Diamond-Blackfan anemia
corticosteroids
red blood cell transfusions
Fanconi anemia
pancytopenia bone marrow failure
congenital anomales
most common primary bone tumor in children and young adults and typically involves the metaphyses of long bones
osteosarcoma
Limited upward gaze
bilateral eyelid retraction
light-near dissociation
parinaud syndrome
pineal gland masses
“dancing eyes and feet”
neuroblastoma
average age for Fanconi’s anemia
8 years
hemosiderin deposition leading to synovitis and fibrosis within the joint. who gets it?
Hemophilia
difference between hemarthrosis and hemosiderin
hemarthrosis: acute onset
hemosiderin: more chronic
what is considered excessive intake of cow’s milk
greater than 24 oz
difference between iron deficiency thalassemia and iron deficiency
elevated red cell distribution in iron deficiency anemia
children who develop isolated thrombocytopenia and petechiae after viral infection
immune thrombocytopenia
treatment for immune thrombocytopenia
skin only: observation
bleeding: IVIG or steroids
what prophylaxis is needed for sickle cell anemia
pneumococcal vaccination plus penicillin prophylaxis
define polycythemia in neonate
hematocrit greater than 65 percent
what are 3 risk factor for neonatal polycythemia vera
delayed cord clamping
maternal hypertension
maternal diabetes mellitus
what is the primary mechanism of action of hydroxyurea
increase fetal hemoglobin
which dilutes the amount of sickle hemoglobin
Difference between aplastic crisis and splenic sequestration crisis in acute severe anemia in sickle cell disease
AC: decrease reticulocyte count
SSC: increased
most common complication of sickle cell
painless hematuria
what is physiologic jaundice
unconjugated hyperbilirubinemia
after frist 24 hours of life, resolves within a week of life
what diagnosis muscular duchenne and what is gold standard confirmation
diagnosis: muscle biopsy
gold standard confirmation: genetic testing
