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Pediatrics > Uworld Peds > Flashcards

Uworld Peds Flashcards

1
Q

thiamine deficiency causes what?

A
  • wet beriberi (dilated cardiomyopathy)
  • dry beriberi (peripheral neuropathy)
  • Wernicke-Korsakoff syndrome
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2
Q

B2 deficiency symptoms?

riboflavin

A
  • angular cheilosis
  • stomatitis
  • glossitis
  • normocytic anemia
  • seborrheic dermatitis
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3
Q

monosymptomatic enuresis tx

A
  • behavioral modifications
  • enuresis alarm
  • desmopressin = 1st line
  • TCAs = 2nd line (imipramine)
  • more common in boys
  • bed wetting is normal until 5YO; begin interventions after that age
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4
Q

Friedreich ataxia

A
  • autosomal recessive
  • excessive tocopherol transfer protein
  • necrosis & degeneration of cardiac muscle fibers –> myocarditis, MI, cardiomyopathy*, T wave inversion
  • ataxia
  • DB
  • scoliosis, hammer toes
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5
Q

immune thrombocytopenia etiology, tx

A

-post-viral infection Ab to platelets –> destruction in spleen –> thrombocytopenia –> bruising & bleeding

  • tx: observation for spontaneous recovery (within 6 months) in kids
  • 1st line: IVIg or glucocorticoids (kids that bleed or adults with plt<30K)
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6
Q

gynecomastia

A
  • enlarged benign glandular tissue in male breast
  • cause: inc testicular production of estrogen OR peripheral conversion of pro-hormones to estrogen OR androgen deficiency
  • 2/3 of pubertal boys
  • goes away within 2 years
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7
Q

excessive intake of cow’s milk can lead to deficiency of what?

A

iron

  • -> Fe deficiency anemia
  • occurs with greater than 24 ounces/ day of milk
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8
Q

myocarditis viral cause, px, tx

A

-coxsackievirus B, adenovirus

  • viral prodrome (fever, lethargy)
  • dilated cardiomyopathy*
  • respiratory distress (pulmonary edema)
  • hepatomegaly due to RHF/ congestion

-tx: diuretics, inotropes

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9
Q

compartment syndrome cause, px, tx

A
  • tissue pressure > perfusion pressure –> muscle & nerve ischemia
  • acute trauma
  • px: severe pain, pallor, poikilothermia, paresthesia, pulselessness, paralysis
  • tx: emergent fasciotomy (compartment release)
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10
Q

what disease can vitamin A be used in?

A

-measles

  • reduces M&M via immune enhancement
  • inc GI and respiratory epithelium to regenerate
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11
Q

Parinaud’s syndrome px, causes

A
  • paralysis of vertical gaze
  • eyelid retraction (Collier’s sign)
  • pseudo-Argyll Robertson pupil

-causes: pressure in rostral midbrain –pinealoma, germinoma

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12
Q

craniopharyngioma vs pituitary adenoma

A
  • cranio. has CALCIFIED cystic parasellar lesion
  • pituitary adenomas are not calcified
  • both produce bitemporal hemianopia, endocrine changes
  • pituitary adenoma often is a prolactinoma
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13
Q

Turner syndrome pt at risk for?

A

osteoporosis due to lower estrogen levels

–> inc risk for bone fractures

-tx: estrogen replacement for growth and prevention of fractures

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14
Q

vitamin A deficiency px

A
  • night blindness
  • photophobia
  • dry scaly skin
  • dry conjunctive, cornea
  • bitot spots = dry, sliver plaques on bulbar conjunctiva
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15
Q

vesicoureteral reflux

A

= urinary reflux from bladder into kidney –> hydroureter –> hydronephrosis, blunting of calices, renal insufficiency

-complications: parenchymal scarring, HTN, proteinuria, edema

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16
Q

acute rheumatic fever px, tx

A
  • Joints: migratory arthritis
  • <3: pericarditis, friction rub, diffuse ST elevations
  • Nodules: subcutaneous
  • Erythema marginatum
  • Syndeham chorea
  • tx: long acting IM benzathine penicillin G
  • until adulthood to eradicate bacterial carriage/ to prevent recurrent ARF
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17
Q

heart defect associated with DiGeorge syndrome?

A

truncus arteriosus

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18
Q

Ebstein’s anomaly

A
  • droopy tricuspid valve into right ventricle –> tricuspid regurgitation & RA enlargement
  • tall P waves, RAD

-associated with maternal lithium* use

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19
Q

tricuspid valve atresia

A
  • hypoplastic right ventricle
  • underdevelopment of pulmonary valve/ artery
  • decreased pulmonary markings
  • LAD
  • large P waves due to RA enlargement

-need ASD or VSD for survival

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20
Q

lead poisoning tx

A

-determine venous lead levels:

5-44mcg/dL –> no meds & remeasure in a month

45-69 –> DMSA (dimercaptosuccinic acid)

> 70 –> dimercaprol + EDTA

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21
Q

juvenile angiofibroma px, tx

A

nasal obstruction + visible mass + frequent epistaxis

  • dangerous bc composed of many blood vessels
  • benign, boys, nasopharynx

-tx only if angiofibroma is enlarging, obstructing airway, or causing chronic nosebleeds

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22
Q

serum sickness-like reaction time of onset? definition?

A

1-2 weeks

hypersensitivity reaction –> fever, urticaria, rash, arthralgias, lymphadenopathy

-resolves with withdrawal of offending agent

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23
Q

Bordatella pertussis infection

A
  • whooping cough
  • px: severe, paroxysmal cough, inspiratory whoop, posttussive emesis
  • dx: pertussis PCR or lymphocytic leukocytosis
  • tx: macrolides
  • prevention: DTaP & TdaP
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24
Q

congenital rubella px

A
  • sensorineural hearing loss
  • PDA
  • cataracts
  • glaucoma
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25
Q

DiGeorge syndrome px

A
  • Conotruncal cardiac defect = truncus arteriosus
  • Abnormal facies
  • Thymic aplasia/hypoplasia –> T-cell lymphopenia
  • Cleft palate
  • HypoCa <–parathyroid gland hypoplasia
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26
Q

empiric antibiotic tx =

A

-ceftriaxone + vancomycin

ceftriaxone –l Strep pneumoniae & Neisseria meningitidis

vancomycin –l resistant strep pneumo strains

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27
Q

breastfeeding contraindications?

A
  • active abuse of street drugs or alcohol
  • active untx TB
  • maternal HIV
  • herpetic breast lesions
  • varicella infections <5 days earlier OR 2 days after delivery
  • chemo, ongoing radiation, certain meds
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28
Q

nursemaid’s elbow

A

= subluxation of radial head

  • cause: child pulled, lifted, swung by arm
  • tx: closed reduction –apply pressure on radial head & hyperpronate forearm
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29
Q

neonatal sepsis px

A

-temp instability
(febrile in term infants; hypothermic in preterm infants)
-poor feeding
-irritability & lethargy

-resp distress, vomiting, seizures, jaundice

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30
Q

prostaglandin E1 vs indomethacin

A

keeps PDA open vs closes it

  • PGE = vasodilator
  • indomethacin = NSAID & PGE-inhibitor
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31
Q

Down syndrome associations?

A
  • complete AV canal
  • VSD, ASD
  • duodenal atresia
  • Hirschsprung disease
  • Alzheimer’s disease
  • ALL
  • hypothyroidism
  • DB type 1
  • atlantoaxial instability
  • hypotonicity
  • facial dysmorphisms
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32
Q

Hirschsprung disease site of obstruction?

A

level of rectosigmoid junction

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33
Q

MCC of congenital hypothyroidism

A

thyroid dysgenesis

aplasia, hypoplasia, ectopic gland

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34
Q

leukocoria

A

= white reflex

-retinoblastoma until proven otherwise –> refer to ophthalmologist

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35
Q

retinoblastoma

A
  • highly malignant tumor
  • MCC of childhood intra-ocular tumor
  • death from liver and brain mets
  • px: leukocoria
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36
Q

PANDAS

A

=pediatric autoimmune neuropsychiatric disorders

  • acute onset of OCD after recent group A streptococcal infection
  • tx: high dose SSRI, psychotherapy
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37
Q

classic vs late-onset congenital adrenal hyperplasia

A
  • classic = presents in neonates, adrenal insufficiency, ambiguous genitalia
  • late onset = late childhood, androgen excess (premature adrenarche/pubarche, cystic acne, accelerated linear growth, advanced bone age)
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38
Q

central vs peripheral precocious puberty

A

gonadotropic-dependent vs -independent precious puberty

  • differentiate with GnRH stimulation (should inc in -dependent form)
  • inc bone age in -dependent form
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39
Q

most common pathogen in children with CF?

A

Staph aureus

especially in the setting of concurrent influenza infection

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40
Q

racemic epinephrine effects in respiratory distress?

A

-alpha and beta andrenergic effects:

  • alpha –> dec bronchial secretions & mucosal edema
  • beta –> inc smooth muscle relaxation
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41
Q

upper GI series

A
  • tracks the movement of barium through upper GI via X-ray

- specific test to dx volvulus/ malrotation

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42
Q

tinea corporis

A

= ringworm = superficial fungal infection

  • px: erythematous, scaly, pruritic rash with central clearing
  • tx: terbinafine
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43
Q

pts with pyloric stenosis px with? at risk for?

A
  • projectile vomiting
  • olive shaped abdominal mass
  • poor weight gain
  • dehydration

-risk: hypochloremic metabolic alkalosis

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44
Q

orbital cellulitis

A

= infection of orbital soft tissue posterior to orbital septum

  • px: pain with eye movement, proptosis, ophthalmoplegia, diplopia
  • bacterial sinusitis MCC –due to proximity of sinuses to orbital space & valveless orbital venous system
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45
Q

contraindications to rotavirus vaccine

A
  • anaphylaxis to vaccine ingredients
  • hx of intussusception
  • hx of uncorrected congenital malformation (Meckel’s)
  • SCID
46
Q

respiratory distress syndrome cause, px in infants

A

-cause: surfactant deficiency; often premature neonates

  • tachypnea; RR>60
  • grunting; to inc end-expiratory pressure
  • nasal flaring; to dec nasal airway resistance
  • retractions; to pull in the compliant chest wall
  • hypoxia & cyanosis; from atelectasis

-diabetic mothers: insulin blocks maturation of sphingomyelin

47
Q

transient tachypnea of the newborn cause

A

inadequate alveolar fluid clearance at birth –> mild pulmonary edema

-usually resolves by DOL 2

48
Q

hemolytic uremic syndrome cause, px

A

-cause: E coli toxin release, Shiga toxin

  • uremia + thrombocytopenia + hemolytic anemia
  • jaundice, bloody diarrhea, renal insufficiency
49
Q

neonatal polycythemia

A
  • hct > 65%
  • px: ruddy/plethoric
  • hypoglycemia & hypoCa due to inc cellular uptake
50
Q

hyperIgM syndrome

A

-X-linked defect of CD40 ligand (present on T cells, which binds to CD40 on B cells)

  • recurrent sinopulmonary infections (acute otitis media, PNA, sinusitis)
  • inc viral infections
  • inc risk of opportunistic infections (PCP)

-tx: antibiotics prophylaxis & interval IVIg administrations

51
Q

meconium ileus

A
  • neonatal bilious emesis
  • common in CF pts
  • microcolon on imaging
  • dx: xray, enema
  • tx: hyperosmolar enema to break up/dissolve obstruction; surgery
52
Q

QT prolongation risk for? tx? avoid what?

A
  • syncope
  • ventricular arrhythmias
  • sudden cardiac death
  • tx: beta blocker + pacemaker
  • avoid: electrolyte derangement, vigorous exercise, meds that lengthen QT
53
Q

growing pains

A
  • bilateral, lower extremity pain
  • no systemic sx
  • worse at night*
  • children 2-12 YO
  • tx: reassurance, massage, NSAIDs
54
Q

positive “target sign” on ultrasound

A
  • diagnostic of intussusception

- illustrates bowel telescoped into larger lumen

55
Q

DMD vs BMD

A
  • Duchenne starts at an earlier age (3-5 YO) vs BMD at 5-15 YO
  • DMD has intellectual disability
  • DMD often wheelchair bound by adolescence due inc weakness
  • both have cardiomyopathy –> cause of death (earlier age of death in DMD)
56
Q

trachoma cause, px, tx, complications

A
  • Chlamydia trachomatis serotypes A-C
  • px: follicular conjunctivitis + pannus neovascularization
  • tx: topical tetracycline or oral azithromycin
  • scarring of cornea –> blindness
57
Q

“floppy baby” syndrome causes

A
  • Werdnig-Hoffman syndrome = autosomal recessive degeneration of anterior horn cells & cranial nerve motor nuclei
  • infant botulism (from honey or canned food)
58
Q

congenital hypothyroidism px

A
  • normal at birth*
  • apathy
  • weakness
  • hypotonia
  • large tongue
  • sluggish movement
  • abdominal bloating
  • umbilical hernia
59
Q

Fe deficiency anemia vs thalassemia

A

-both produce microcytic anemia

  • thalassemia microcytosis is more severe than Fe-def.
  • thalassemia: tear drop cells, target cells on peripheral smear
60
Q

acquired aplastic anemia causes, px?

A
  • injury to bone marrow
  • secondary to radiation, drugs, insecticides, toxins, infections (parvovirus B19)

-px: normocytic/ macrocytic anemia + leukopenia + reticulocytopenia + thrombocytopenia

61
Q

transient proteinuria

A
  • MCC of isolated proteinuria in children

- repeat urine dipstick on 2 other occasions to rule out persistent proteinuria

62
Q

septic arthritis tx

A

emergent surgical drainage + IV antibiotics

-often preceded by mild infection (cellulitis)

63
Q

infantile colic

A
  • excessive crying in an otherwise healthy infant
  • more than 3 hours/day, more than 3d/week, more than 3 weeks/month
  • resolves spontaneously by 4 months

-no recognized tx; often inconsolable

64
Q

breastfeeding failure jaundice

A

-lactation failure –> dec bili elimination & inc enterohepatic circulation

  • px: suboptimal breastfeeding, dehydration
  • during 1st week of life
65
Q

breast milk jaundice

A
  • high levels of beta-glucoronidase in breast milk –> deconjugated intestinal bill –> inc enterohepatic circulation
  • starts during 1st week, peaks during 2nd
66
Q

hand foot syndrome

A
  • vaso-occlusion in sickle cell anemia
  • -> dactylitis
  • due to vascular necrosis of metacarpals & metatarsals
67
Q

what do you give to an un-immunized pt who had VZV contact?

A
  • immunocompetent: varicella vaccine
  • immunocompromised: varicella immunoglobulin (VZIG)

-acyclovir for those with active varicella infections

68
Q

hydroxyurea effects, SE

A
  • inc fetal hemoglobin in circulation
  • -> reduces vaso-occlusive events

-SE: bone marrow suppression (leukopenia, anemia, thrombocytopenia)

69
Q

Kawasaki disease tx

A
  • aspirin – antithrombotic to prevent coronary aneurysms (despite risk of Reye syndrome)
  • IVIg – dec inflammation
70
Q

Kawasaki disease px

A
  • fever >5 days
  • bilateral nonexudative conjunctivitis
  • cervical lymphadenopathy
  • rash
  • swelling of feet/hands
  • mucositis, strawberry tongue
  • coronary aneurysm
71
Q

IgA deficiency px

A
  • recurrent sinus, pulmonary, GI infections (mucous membranes)
  • anaphylaxis to transfusions that contain IgA (may have Ab against IgA)

-inc susceptibility to Giardia –> diarrhea

72
Q

Tetralogy of Fallot murmur, px, changes with squatting?

A

harsh, systolic ejection murmur over the left upper sternal border

  • due to pulmonary stenosis
  • single S2

-“Tet spells” from exertion/ agitation
-cyanosis due RV outflow obstruction & R–>L shunting
(pre-, post-, intra-valvular stenosis; or atresia)

  • squatting –> inc afterload –> dec R–>L shunting across VSD –> improved cyanosis & inc systolic murmur
  • inhaled O2 stimulates pulmonary vasodilation & systemic vasoconstriction
73
Q

ventricular septal defect

A
  • holosystolic murmur at left lower sternal border –flow thru VSD
  • apical diastolic rumble –inc flow across the mitral valve
74
Q

ASD murmur

A

wide and fixed splitting of S2

-due to inc flow across the pulmonic valve

75
Q

RTA

A

1 – defective H+ secretion
2 – dec bicarp reabsorption in PCT
4 –defective Na/K exchange; hyperK, hyperCl acidosis

-px as failure to thrive

76
Q

sickle cell pts are at risk for infection by which organisms?

A
  • Strep pneumo (bacteremia)
  • H. influenzae type B
  • Neisseria meningitides
  • Salmonella (osteomyelitis)

-give prophylactic penicillin till age 5

77
Q

most common congenital heart disease?

A

ventricular septal defect

78
Q

Fanconi anemia

A
  • congenital aplastic anemia –> bleeding, fatigue
  • short, microcephaly, hypogonadism, hypo/hyperpigmented areas, strabismus
  • tx: hematopoietic stem cell transplantation
  • chromosomal breaks; autosomal recessive
79
Q

milk-protein allergy

A
  • only infants
  • non-IgE immune response to dairy/soy –> rectal/colonic inflammation –> painless bloody stools
  • reflux, vomiting, anemia, eczema
  • tx: mom avoids dairy/soy or give formula
  • often resolves by 1YO
80
Q

if an infant px with hemihyperplasia what do you screen for? how?

A

hepatiblastoma & Wilms tumor

-via alpha-fetoprotein & ultrasound

81
Q

tx for non-bullous vs bullous impetigo

A

-topical mupirocin
(staph or strep pyogenes)

-oral cephalexin, dicloxacillin, clindamycin
(stap)

82
Q

most common primary bone tumor in kids?

A

osteosarcoma

83
Q

osteosarcoma

A
  • metaphyses of long bones
  • tender soft tissue mass
  • “sunburst” pattern, periosteal reaction
  • inc alk phos & LDH
84
Q

Ewing sarcoma vs osteoid osteoma

A
  • osteolytic lesion + periosteal reaction –> reactive bone layers (“onion skin” appearance)
  • sclerotic, cortical* lesion + central lucency + pain worse at night
85
Q

rickets clinical findings

A
  • genu varum (bowing of tibia and femur)
  • delayed closure of anterial fontanelle
  • enlarged costochondral joints (“rachitic rosary”)
  • craniotabes = thinning of skull (“ping pong ball”)
86
Q

SCID

A

-recurrent sinus, pulmonary, opportunistic, viral infections; recurrent oral candidiasis, persistent diarrhea

  • absent lymph nodes, tonsils
  • lymphopenia
  • absent thymic shadow
87
Q

Bruton’s agammaglobulinemia

A
  • recurrent pyogenic infections (strep pneumo, H flu)
  • dec IgG, IgA, IgM, IgE
  • dec B cells
  • young boys

-common variable immunodeficiency has a similar px in older pts

88
Q

Wiskott-Aldrich syndrome

A
  • boy
  • eczema
  • thrombocytopenia
  • recurrent infection with encapsulated germs
  • low IgM; high IgA, IgE
89
Q

Reye syndrome

A
  • ASA use in children
  • hepatic failure + encephalopathy
  • microvesicular steatosis
  • cerebral edema
  • inc ammonia, ALT, AST
  • vomiting, change in mental status, agitation
90
Q

tx’s for what?

  • sodium bicarbonate
  • deferoxamine
  • EDTA
  • calcium gluconate
  • succimer
  • N-acetylcysteine
A
  • TCA or ASA overdose
  • Fe poisoning
  • mod-severe lead poisoning
  • cardio-protective in hyperK
  • mild-mod lead poisoning
  • acetaminophen toxicity
91
Q

most common cancer in children?

A

acute lymphoblastic leukemia

92
Q

sweat test for CF

A
  • quantitative policarpine iontophoresis

- chloride >60

93
Q

tx for TCA overdose? sx of TCA overdose?

A
  • sodium bicarbonate
  • seizure, hypotension, prolonged QRS
  • cholinergic agonist used to tx anticholinergic effects of TCA (dry oral mucosa, dilated pupils)
  • may need benzodiazepines to tx the seizure
94
Q

neonatal jaundice with conjugated hyperbilirubinemia is caused by?

A

neonatal cholestasis

  • from impaired hepatic excretion of bill due to:
  • extrahepatic obstruction
  • liver cell injury

-conjugated bili >2mg/dL

95
Q

eczema herpeticum

A

HSV + atopic dermatitis

= numerous vesicles over the area of atopic dermatitis
-tx: acyclovir

96
Q

enterobiasis

A

-helminthic infection by pinworm, Enterobius vermicularis

  • dx: “scotch tape test”
  • px: n/v, abdominal pain, vulvovaginitis
  • tx: mebendazole, albendazole; pyrantel pamoate
97
Q

conduct disorder

antisocial personality disorder

oppositional defiant disorder

ADHD

A
  • 18YO or younger –> disruptive behavior; aggression to others & animals; property damage, theft, violations of social rules
  • 18YO or older with conduct disorder
  • late childhood/adolescence; negative hostile, defiant
  • dx before 7YO; impulsivity, inattention, hyperactivity; can become conduct disorder
98
Q

when should you administer vaccines in preterm infants?

A
  • immediately, i.e. by chronologic age (NOT gestational age)

- unless infant weights <2kg

99
Q

most common complication of sickle cell trait?

A

painless microscopic or gross hematuria

100
Q

clubfoot tx

A

nonsurgical first:

  • stretching, manipulation, serial plaster casts, malleable splints, taping
  • surgery if above doesn’t work

-must tx immediately*

101
Q

developmental dysplasia of the hip

A

=dislocation of femoral head from acetabulum

  • must be dx before 6 months
  • infants screened until 1YO
  • dx: leg maneuvers, asymmetric leg-length or skin folds, ultrasonography
  • tx: hip harness
102
Q

acute cervical adenitis in children cause, tx

A
  • staph or strep

- tx: clindamycin

103
Q

MCC of viral meningitis

A

non-polio enteroviruses

  • echovirus
  • coxsackieviruses
104
Q

myotonic muscular dystrophy

A
  • adolescent/ adult-onset muscular dystrophy
  • autosomal dominant
  • myotonia, facial weakness, foot drop, dysphagia
  • cardiac conduction anomalies
  • cataracts
  • testicular atrophy
  • baldness
105
Q

clotting defect vs platelet aggregation defect px

A
  • hemophilias: hemarthroses, hematomas

- vWD: easy or prolonged mucosal bleeding, ecchymoses, petechiae

106
Q

aplastic anemia vs aplastic crisis

A
  • pancytopenia

- transient arrest of erythropoiesis secondary to parvovirus B19 infection

107
Q

leukocyte adhesion deficiency type 1 px

A

-leukocytosis (neutrophil predominance) + absence of neutrophils in inflamed/ infected tissue

  • recurrent bacterial infections
  • delayed umbilical cord separation*
  • necrotic periodontal infection
108
Q

McCune-Albright syndrome px

A
  • Precocious puberty
  • Pigmentation (cafe au lair spots)
  • Polyostotic fibrous dysplasia = bone defects

-associated with Cushing’s disease

109
Q

B cell vs T cell deficiency

A
  • bacterial infections

- viral & fungal infections

110
Q

neonatal abstinence syndrome px

A
  • irritability
  • high pitched cry
  • poor sleeping
  • tremors
  • seizures
  • sweating
  • sneezing
  • tachypnea
  • poor feeding
  • vomiting
  • diarrhea
  • heroin withdrawal within 48 hours
  • methadone withdrawal within 48-72 hours
111
Q

benign vs pathologic murmurs

A
  • grade II/IV, dec with standing

- grade III/IV, inc with standing, abnormal S2

Pediatrics (3 decks)

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