Uworld Flashcards
what are the signs of iron deficiency anemia
reactive thrombocytosis decreased erythrocyte count microcytic anemia
what does a smear for aphla/beta thalassemia look like
target cells
what is the number of RBCs in alpha/beta thal
normal
what is MCV for alpha/beta thal
decreased.
what will the iron, TIBC and ferritin be for iron deficiency
iron low and ferritin low
TIBC elevated
what is the hemoglobin electrophoresis for alpha and beta thal
normal for alpha and increase hemoglobin A2 for beta
what will happen to the number of RBC in iron deficiency anemia
they will go down because there will be a decrease in the production
what is the role of the eustachian tube
drain middle ear, equalize pressure in the middle ear and prevent reflux of the nasopharyngeal secretions
what are the signs and symptoms of Eustachian tube dysfunction
ear fullness, tinnitus, conductive hearing loss, popping sensation, retracted tympanic membrane
why does the tympanic membrane come retracted in Eustachian tube dysfunction
because of the negative pressure in the middle ear
what is the most likely cause of intussudcetion in a child younger than 2
75% occur following a viral illness and are thought to be caused by hypertrophied Peyers patches in the lymphoid rich terminal illeum
what is the most likely cause of intussusception in an older child
meckels
what is the next step for an adolescent that presents with a breast lump and what is the most likely diagnosis
fibroadenoma
follow up after menses
what is the main presentation of pertusis and the likely cause
coughing for prolonged periods (whooping with cough) vomiting with cough
likely due to waning immunity
when does CNS herpes usually develop in the neonate and what is the presentation
second to third week of life with signs of encephalitis including seizure, lethargy and poor feeding with increased intracranial pressure. usually presents with temporal lobe abnormalities such as hemorrhage.
what’s the treatment for neonatal herpes encephalitis
Acyclovir
what is the classic triad of congenital rubella
murmur (PDA), cataracts, sensorineural hearing loss.
how does rubella present to the mother
as a self-limiting feverish illness followed by joint pain
what is the cause of methemagobinemia
exposure to oxidiziung substances such as topical analgesics, dapsone, nitrates.
what is the presentation of methemaglobinemia
dark chocolate colored blood with pulse ox at 85 and cyanosis
constitutional growth delay presents how
as decreased bone age, delayed puberty and delayed growth spurt. parents are usually normal, but sometimes delayed themselves
when should males be at tanner stage 2
11 pubic hair
when should males be at tanner 3
13 voice changes and muscles
when should males be at tanner 4
14 acne and armpit
tanner 5 males what age
15 facial hair
what is a commonly found on nasal examination of a child with CF
grey or yellow masses in the turbinates –these are nasal polyps. highly associated with CF
remember that this can have a prolonged presentation
what can precipitate a headache from concussion
cognitive exertion, visual tasks such as moving eyes between two points. light and noice are common things that worsen the headache
why does knee-to-chest maneuver work for tet spells
increases the systemic vascular resistance.
the large VSD allows blood back and forth.
what percentage of SCFE is bilateral and what is the presentation
<40%
bilateral SCFE will usually produce a waddling gait
what is the prestentation of iliopsoas bursitis
pain due to overuse. usually with bilateral pain in the hip, limited range of motion and a palpable click
what is the appropriate timing of physiologic valgum
2-5
what is calcaneal apophysitis (severs)
the most common cause of heel pain in young athletes. due to overuse and is due to micro trauma to the heel growth plate. running or jumping sports
what are the diagnostic findings of severs
calcaneal compression test palpation of the base of the heel over the apophysis results in pain. dorsiflexion of the ankle results in pain
what is the treatment for severs
supportive with stretching, ice, NSAIDs and a heel cup for cushioning
what is the underlying cause of cysteinuria
amino acid transport abnormality
post exposure prophylaxis for pertusis is what
macrolide antibiotics regardless of vaccination status
what is the most likely cause of sepsis in sickle patients
could be any of the encapsulated bacteria but most likely strep pneumo
what are the risk factors for respiratory distress syndrome
prematurity (most important), male sex, perinatal asphyxia, maternal diabetes, C section without labor.
why does maternal diabetes cause RDS
because of high levels of insulin which antagonizes cortisol and blocks the maturity of sphingomyelin a vital component of surfactant
what is streptococcal perianal dermatitis
superficial group A strep infection. usually school aged children. presents with sharply demarcated rash around the anus. fissures are likely. itching is also likely. blood streaked stools. a close contact with strep pharyngitis is possible –patients themselves do not usually have it
what does hypoplastic thumbs, short stature, and hypo or hyperpigmented spots indicate. –usually in the context of pancytopenia
DNA repair defect –fanconis anemia
autosomal recessive
can also present with polydactyly
what is another name for Mongolian spiot
congenital dermal melanocytosis
these can be extensive.
what is the treatment for abnormal uterine bleeding
high dose OCPs are first line therapy
hyposthenuria
inability of the kidneys to concentrate urine. there will be urinary frequency, despite refraining from water intake. There will also be a low urine specific gravity.
what is hyposthenuria associatefd with
sickle cell trait
what is the presentation of primary polydipsia
hyponatremia with increased urine output excessive drinkning
what is routine screening for preterm infants
head ultrasound for intraventricular hemorrhages. many are asymptomatic. ruptured germinal matrix is the cause
what are the guidelines for head ultrasound in premature infants
<32 weeks requires ultrasound at age 1-2 weeks.
when do intraventricular hemorrhages typically occur
within the first 3-4 days of life
what are the symptoms of IVH
bulging fontanelle, anemia, apnea, seizures.
what is the treatment for intraventricular hemorrhage of the premature neonate
mostly symptomatic management –antiseizure meds, and blood pressure management
how can you tell the difference between a pneumothorax and a congenital diaphragmatic hernia
scaphoid abdomen
what is the most likely cause of pneumonia in CF in a younger patient
staph aureus
what is the most common cause of pneumonia in a CF in an adult
pseudomonas
what are the associated complications of mumps
parotitis, orchitis and aseptic meningitis
what is a common source of non-typhoidal salmonella
inadequate refrigeration of prepared foods.
mostly undercooked poultry or eggs
what is acute cervical lymphadenitis
commonly caused by staph aureus or streptococcus pyogenes usually involves the submandibular nodes or cervical.
what is the empiric treatment of cervical lymphadenitis
clindamycin
when do you order a CT scan for a child with acute bacterial rhinosinusitis
when they have altered mental status, periorbital edema, vision abnormalities
routine screening for newborns is
pulse ox
what is an exudate
leakage of fluid around the capillary cells do to inflammation
also direct leakage of chyle
what is a transudate
is leakage of fluid due to high vascular pressures
what are the causes of an exudate
tuberculosis, malignancy, chylothorax and empyema
what is the cause of coarctation of the aorta
this is caused by thickening of the tunica media of the aortic arch near the junction of the ductus arteries
what is the presentation of coarctation
initially fine, when the ductus closes infants may develop heart failure, tachypnea, poor feeding, fussiness, lethargy, metabolic acidosis and decreased renal perfusion
what is the most common cause of bacterial sinusitis
nontypable H flu, strep pneumonae, morexella catarrhalis
is PT extrinsic or intrinsic
extrinsic
what is the extrinsic pathway
factor VII
why would cystic fibrosis cause coagulation deficits
because of the malabsorption. vitamin K would be low and this would cause VII or the extrinsic pathway
what is the next best diagnostic step for isolated proteinuria in a child
early morning protein and creatinine
chronic granulomatous disease is caused by what
deficits in NADPH oxidase which is responsible for the respiratory burst
what organisms are people with CGD susceptible to
fungal organisms and catalase positive bacteria such s staph aureus and serratia
what are the tests that confirm CGD
dihydrorhodamine 123 and nitro blue tetrazolium
what is WAGR syndrome
wilms tumor, aniridia, genitourinary abnormalities, and retardation
what is otitis media with effusion and what is the management
this typically occurs after acute otitis media or viral infections and only causes mild discomfort. The tympanic membrane will show reduced movement on insufflation
how can transient synovitis present
As a small intracapsular fluid collection.
common in children after a mild viral illness
treatment for transient synovitis
NSAIDs
what are the clinical presentation of Legg-calve perthes
positive trendelenberg, insidious limp, restricted hip abduction and internal rotation,
do x rays always show Legg calve perthes
no. early x rays are often normal
most common cause of osteomyelitis in healthy children
staph aureus
most common cause of osteomyelitis in children with sickle cell
salmonella and staph aureus
what are the risk factors for iron deficiency anemia
prematurity, lead exposure, delayed introduction o solids (exclusive breast feeding > 6 nonths). > 24 oz of milk cows ,
what are the labs for iron deficiency anemia
low RBCs, high iron binding, low hemagoblin, decreased MCV, increased RDW
are there triggers for cyclic vomiting syndrome
yes. usually infection or stress
what is a consequence of hemophilic arthropathy
hemosiderin deposit and fibrosis which leads to destruction of the cartilage and bone
are pink stains in the urine soaked diaper normal
yes. those are uric acid crystals from hyperuricemia of the newborn. totally normal
what are the features of bronchiolitis
cough, congestion and increased work of breathing which is usually due to a lower respiratory tract infection such as RSV
presents with increased expiratory phase and wheezes
What is FSH stimulation dependent on
GnRH
what is the presentation of syndehams chorea
grimacing and writhing
what is the most common cause of pericarditis
coxsackie virus
what is another cause of carditis instead of coxsackie
strep pyogenes
what is the renal findings for henoch sheinlon purpura
IgA mesangial deposition
very similar to IgA nephropathy
what is HSP
IgA vasculitis
what is the next step if bilious vomiting, after X ray with dilated bowel
contrast enema
what is the immediate workup for bilious emesis
stop feeds, NG decompression, IV fluids and abdominal X ray.
what is the finding for meconium ileus on contrast enema
microcolon
hypoplasic left heart syndrome presents hw and what is required for survival and why
PDA is required rope survival. as the PDA is closing during the first few days of life the baby will become hypotensive, cyanotic and will not respond to oxygen
treatment is prostaglandin
what antibiotics should be considered in a patient with CF and pneumonia and why
cefepime and vancomycin
cefepime has good coverage for pseudomonas and MSSA, while MRSA is likely and thus requires vancomycin
what are the complications of mononucleosis
acute airway obstruction, splenic rupture, autoimmune hemolytic anemia and thrombocytopenia
what is the cause and treatment for acute airway obstruction from mono
severe oropharyngeal and tonsillar inflammation and enlargement. corticosteroids
what are the risk factors for infant HIV
high maternal viral load
breast feeding by the affected mother
what are the clinical findings of infancy HIV
failure to thrive, chronic diarrhea, lymphadenopathy and pneumocystis pneumonia
what is the treatment of UTI in child
cefixime
does penicillin have gram negative activity
NO
what are the renal manifestations of childhood HSP
hematuria
what should be done with a newborn with severe hyposapdius
karyotyping
becuase it is associated with disorders of sexual development
when is dextrose fluid given
maintenance fluids. this is not used for initial rehydration
when is an upper GI series necessary
if the initial imaging is not diagnostic
what component is hemophilia A and what is the presentaiton
VIII. more common in males, as it is X-linked recessive. the presentation is hemarthrosis
what is a common coagulopathy that cause heavy menstrual bleeding with a normal PT and PTT
von wile brand disease
what does renal biopsy of alport sydnrome
longitudinal splitting of the glomerular basement membrane
what is the gene for alport
type IV collagen
what is the difference between acute lymphoblastic leukemia and aplastic anemia
ALL has painful bone morrow.
what is the pathophysiology of giardiasis
local epithelial disruption.
what is the treatment for giardiasis
tinidazole
what is the cause of scarlet fever
erythrogenic exotoxins from strep pyogenes
what is the vaccination schedule for varicella
ages 1 and 4
what is the post exposure prophylaxis for varicella
provide the vaccine if not immunized with both.
if cannot receive the vaccine then give immunoglobulin.
who cannot receive the varicella vaccine
pregnant and immunocopmpromised
What are the complications of varicella and who do they typically happen to
pneumonia, serious skin infections and CNS infections, usually happen adolescents and adults.
what is the diagnosis treatment for central precocious puberty
MRI to exclude tumor. If idiopathic PP then treat with GnRH agonist
what is 21 hydroxylase deficiency and what does it do
reduces mineralocorticoids and glucocorticoids leading to increased adrogens leads to virilization and severe hypotension due to a lack of aldosterone.
accumulation of 17-hydroxyprogesterone
decrease in 11-deoxycortrisol
what is the presentation of D-transposition of the great vessels
immediate cyanosis
is seizure after administering DTap a contraindication
no.
contraindications are anaphylaxis and encephalopathy
what is the classic presentation of osteoid osteoma
lytic-looking lesion with sclerotic edges. NSAIDs relieve pain worse at night, pain unrelated to activity
treatment for osteoid osteoma
NSAIDs and monitor
what type of bilirubin is elevated in Crigler-Najjar and Gilbert which are the same
Unconjugated and and thus indirect
what are the complications of drowning injury
cerebral edema (if submerged for >5 min), respiratory insufficiency, pneumonia
what is empiric treatment for epiglottitis
vancomycin and cetriaxone
what are other causal organisms besides H flu that can cause epiglottis
other H flu strains, streptococcal (pneumonae and pyogenes) and staph aureus
does G6PD occur in females
not usually X linked disorder
what is the MCHC in G6PD
typically normal
what is the MCHC in beta thalasemia
usually low
when does beta thalassemia usually occur
after 6 months because thats when the fetal hemoglobin goes away
what is the MCHC in hereditary spherocytosios
usually elevated
Does spherocytosis occur in females
yes
what is a common metabolic deficit in people with sickle cell disease
folic acid
what is the follow up for VSD
echocardiogram to determine the location and size and to rule out other defects
what is the treatment for tinea capitis
griseofulvin or terbenifine
what are the causes of neonatal cataracts
rubella and galactosemia
be careful and don’t jump to congenital infection
rubella will also have microcephaly and a heart defect; otherwise they present exactly the same
brutons agammaglobimemia is defined how
with low antibodies and low B cells normal everything else
how to determine the difference between Brutons and common variable
the B cells with be low in Brutons
what is the presentation of VUR
dilation of the ureter and blunted calyces
what is the long term consequence of VUR
Interstitial fibrosis.
how to tell the difference between post strep gliomerulonephritis and IgA neophropathy
IgA occurs within days, PSGN occurs weeks after
IgA is due to IgA nesangial depostis while post strep is due to mesangial immune complex deposition.
PSGN also presents with low complement, hypertension, edema
what is the treatment for long QT syndrome
beta blockers and pacemaker
are calcium channel blockers used for long qt
no.
what are the labs for DIC
anemia, thrombocytopenia and elevation of the PT and PTT
what are the peripheral blood smear findings of HUS
schistocytes due to the intravascular lysis of RBC
what determines the immunization schedule
chronological age
what is the presentation of G6PD
treatment with some drugs causes hemolysis. there are Heinz bodies due to precipitation from reduced glutathione
higher incidence in africans and Mediterranean populations.
inheritance of g6pd
x linked recessive
what’s the initial wound management for animal puncture wounds
irigation and removal of debris. weigh the options for leaving open or closing
for cosmetic purposes closure is usually performed. infections are likely with closure. leaving the wound open and allowing closure by secondary intent is sometimes better –must think of hemostasis as well
what is the presentation of a button battery ingestion
corrosive esophagitis and a double density sign on x ray
what is the presentation of molluscum
centrally located dimpled umbilication of the lesions
what is the course of molluscum
self-limiting and usually no treatment, can take years to resolve. liquid nitrogen can be used.
what are the majority of cases of viral meningitis caused by
enteroviruses such as coxsackie b virus
what medications should be avoided in G6PD
dapsone, isobutyl nitrate, nitrofurantoin, primaquine, rasburicase
what is the histological impression of hepatic biopsy for reye syndrome
microvesicular steatosis
what is the karyotype of kallman
normal –will have isolated gene mutation
what is the presentation of diamond Blackman anemia
pure macrocytic RBC anemia with triphalagnial thumbs and hypertelorism, webbed neck
treatment for immune thrombocytopenia
rituximab, thrombopoietin receptor agonists or splenectomy
what is a modifiable risk factor for acute otitis media
smoking/second hand smoke
what are the chances of a 17 year old female with a joint effusion having hemophilia
low. usually arises in childhood and is an X linked trait
what is an early manifestation of sickle cells
dactylitis or vasoocclusive disease of the hands and feet
what is the defect in nearsightedness (myopia)
anterior-posterior diameter of the eye
Can the varicella vaccine cause an infection
yes.
can an undescended testicle have torsion
yes. 10X more likely
what is an alternative to stimulant therapy for ADHD
atomoxetine
this is a norepinephrine reuptake inhibitor
is valproate used for ADHD
no
what is a potential side effect of hydroxyurea for SCD
myelosuppression
what hormone causes refeeding syndrome
insulin
how should patients with beckwith-weideman syndrome be monitored
with abdominal ultrasound and AFP measurements every three months from birth to age 4 and renal ultrasound every three months from 4-8 Years for risk wilms tumor and hepatoblastoma
what supplements should be given to preterm infants
iron and vitamin D. should be given to infants until 1 year of age
what is the characteristic stridor for laryngeomalacia
inspiratory stridor
do people with CF have nose bleeds
yes they can because of decreased vitamin K from the pancreatic insufficiency
what peripheral blood smear finding is associated with sickle cell disease, other than sickled cells
holly-jolly bodies
nuclear remnants from lack of splenic function
can a two month old have a pain crisis
not likely as they still have fetal hemoglobin
when is fetal hemaglobin replaced
about 3-6 months
what are the symptoms of B2 defieicny
angular cheilosis, stomatitis, glossitis, normocytic anemia, seborrheic dermatitis
what are the symptoms of B6 defeiicny
cheilosis, stomatitis, glossitis
what is the presentation of leukocyte adhesion deficiency
lymphocyte and monocyte decrease. marked leukocytosis with neutrophilia.
presents with multiple skin infections and severe periodontal disease
what is the characteristic rash for niacin
pruritic dermatitis in the sun exposed areas.
what are the soft palate findings for rubella
petechiae or erythematous papule known as forchheimer spots
what is the presentation of sickle cell trait
usually asymptomatic but can have hematuria
what are the findings for DiGeorge syndrome
or velocardiofacial syndrome
CATCH
conotruncal cardiac defects (tetralogy of fallot, truncus arterioles, interrupted aortic arch), abnormal facies, thyme agenesis/hypoplasia, craniofacial deformities (cleft palate), hypoparathyroidism/hypocalcemia.
what is the treatment for pinworm
pyrantel pamoate and albendazole
what causes obstructive sleep apnea in children
FUCKING TONSILS
what is the underlygin cause of concussion
neuronal functional disturbance
what are the features of a pathologic murnur
harsh, holosystolic, diastolic, grade III intensity or higher, increases with standing/valsalva
Loud, fixed split, or single s2, harsh, holosystolic, diastolic, grade III intensity or higher, increases with standing/valsalva
Loud, fixed split, or single s2,
what are the features of a benign murmnur
early or mid-systolic, grade I or II intensity, decreases with standing or valsalva, low-pitched, musical, pure or squeaky tone, or high-pitched at the LUSB
what causes the development of prolonged activated PTT in hemophilia treated with recombinant VIII
inhibitor development. antibodies recognize the factor
heart defect in turners
bicuspid aortic valve and coarctation
what do intentional burns look like
sparing the flexural creases. zebra striped pattern
what is the most common cause of conengital hypothyroidism
thyroid dysgenesis
is fibrosarcoma a childhood disorder
no. >30. presents exactly like ewings
what is the plan b pill
levonogestrel
croup is edema and narrowing where
the proximal trachea
what is PEP for new born for hep B
immunoglobulin and vaccine
what increases the murmur of HCM
valsalva
what should you think if you see jaundice hepatomegaly and an increased risk of e coli infetins
galactosemia
also associated with elevated transaminases hemolytic anemia and cataracts
does continuous positive airway pressure CPAP, increase risk of pneumothorax
yes
what is the difference between primary dysmenorrhea and endometriosis
endometriosis lasts throughout the cycle and usually has a palpable mass or finding in the exam
what is required of people with beta thalassemia
chronic transfusions and chelation therapy due to iron overload
what are the features of mccune albright
precocious puberty, fibrous dysplasia of the bone and cafe au lait macules
polycythemia presentation in the newborn
plethora, respiratory distress, low glucose
what is the workup for primary amorrhea
first look at uterus. if they have one look at look to the FSH if they dont have a uterus then karyotype.
if the FSH is normal then they have an imperforate Hyman. if its high look to karoytoe. if its low then look at the other hormones (TSH, prolactin). if both are high then hypothyroidism. if prolactin high then prolactinoma. and if normal functional hypothalamic amorrhea
what is the presentation of iron toxicity
presence of pills on x ray. metabolic acidosis. abdominal pain, nausea and vomting, diarrhea, hematemesis
what is the presentation of salicylate poisoning
very similar to iron. although often tinnitus will be present first and the pills are not found on x ray
what causes the metabolic acidosis of iron toxicity
increases oxygen radicals cause lactic acidosis
what are people with hereditary hemorrhagic telangiectasia at risk for and how does it present
hemorrhagic stroke. presents with sudden weakness and focal neurological symptoms. with hyper dense fluid collections with irregular margins in the cortex.
what is the cause of vitamin K bleeding disorders
decreased carboxylation of coagulation factors
what are the risk factors for DDH
breech position, family history and tight swaddling
what are the causes of infectious bloody diarrhea
salmonella, shigella, campylobacter and E coli o157 H7
what are the complications of e coli o157 H7 infection
HUS
what are the complications of shigella
HUS, seizure
what are the complications of camplobacter
GBS
what are the complications of salmonella
bacteremai
what is the first line treatment for all bloody diarrheas
supportive care only unless severe
what is the characteristic presentation of fragile X
marcoorchidism, behavioral issues, long narrow face, large ears, prominent forehead and chin
what is bronchiolitis and the complications
common winter respiratory tract infection csaueds ny RSV. children are at risk for developing apnea and respiratory failure
what are the labs for turners syndrome hypothalamic axis
high FSH/LH, low estrogen
what gene should be tested fro CHARGE
CHD7
what is the genotype-phenotype correlation in kallman and what is the casue
they are the same. thus a female is female.
this is hypogonadotropic hypogonadism
what are the FSH/LH in females with kallman
LOW
