UWorld: Step 2 CK - "Pediatrics" Flashcards
Periorbital cellulitis needs to be differentiated from what serious infection?
Orbital cellulitis
Periorbital cellulitis (also called pre-septal cellulitis) is an infection that is superficial to the orbital septum. Orbital cellulitis (post-septal cellulitis) is deeper than the orbital septum and is very serious.
Diplopia, ophthalmoplegia, and proptosis are more common in post-septal cellulitis.
What are the three maneuvers that decrease preload?
- Valsalva
- Nitro
- Abrupt standing
What is the one maneuver that increases preload without affecting afterload?
•Leg raise
What is the difference between squatting and sustained hand grip?
Hand grip increases afterload only. Squatting increases afterload and preload.
HOCM increases with which maneuver?
Valsalva
Remember that decreasing preload increases the sound of HOCM.
According to UWorld, ____________ is the preferred first-line treatment for constipation in children.
stool softeners
PreTest says enema then stool softeners.
What is trismus?
The inability to open the mouth completely
Prolonged intubation can cause _______________.
subglottic stenosis
What ratio of labs are suggestive of malnutrition?
Low albumin and high protein (suggesting a catabolic state)
What are the treatments of QT prolongation?
Pacemaker and propranolol
_____________ are usually reserved for cases of ITP in which the kid is bleeding.
IVIG or steroids
Which part of the CBC can help differentiate iron deficiency from thalassemia?
The RDW is increased in IDA and normal in thalassemia.
List five lab findings of JIA.
- Elevated inflammatory markers (ESR/CRP)
- Anemia
- Thrombocytosis
- Hyperferritinemia
- Hypergammaglobulinemia
The most common predisposing factor to orbital cellulitis is ______________.
bacterial sinusitis
If a vaccinated patient with sickle cell anemia presents with bacteremia, the most likely cause is _______________.
Streptococcus pneumoniae
Those with SCD are most at risk for bacteremia from encapsulated organisms, and the vaccines for Neisseria and Haemophilus are effective in preventing most infections. There are more serotypes of S. pneumoniae that are not vaccine-preventable, however, and this is why those with SCD should take prophylactic penicillin.
Fibroadenomas are most tender ______________.
before menses
Evaluation after menses should show shrinking and decreased tenderness.
Kids may ____________ the neck when they have epiglottitis.
hyperextend
Why do those with excessive vomiting develop hypokalemia?
They become hypovolemic due to vomiting and the aldosterone system is ramped up (excreting H+ and K+ which worsens the alkalosis and hypokalemia).
Which enzyme is elevated in CAH, 17-hydroxyprogesterone or 17-hydroxypregnenolone?
17-hydroxyprogesterone
Benign murmurs are usually heard best over ______________.
the lower-left sternal border
The most common cause of late-neonatal meningitis is _______________.
GBS
Don’t be fooled by questions that tell the child was delivered via c-section with no chorioamnionitis. Late GBS is horizontally transmitted.
A rare but potentially life-threatening complication of infectious mononucleosis is _______________.
acute airway obstruction from extreme tonsillar enlargement
Small vaginal foreign bodies can be removed via _______________.
warm water irrigation
Both CMV and T. gondii cause intracranial calcifications. How are they different?
- CMV = periventricular
* T. gondii = diffuse
A school-age child with signs of biliary obstruction may have ____________.
a bile duct cyst
Adolescents with diabetes who present with iron deficiency anemia should be screened for ______________.
celiac disease
CD goes with TM. CD also causes malabsorption that leads to anemia.
A child with distant heart sounds one week after heart surgery may have _______________.
pericardial effusion
What is eczema herpeticum?
HSV superimposed on eczema
True or false: IUGR and maternal hypertension increase the risk of RDS.
False
Those stressors in utero are thought to stimulate lung maturation and actually decrease the risk of RDS.
What maternal disease increases the risk of neonatal RDS?
Gestational diabetes
The thymus is normally visible in children younger than ______.
three
What is the percent fetal hemoglobin in someone with sickle cell disease?
5% to 10%
Theirs is elevated at baseline. If they take hydroxyurea it can be even higher (greater than 15%).
Classically, those with constitutional growth delay will have what finding on growth charts?
A deceleration in growth between six months and three years followed by a normal velocity on the lower end of the percentiles until puberty at which time they catch up
What are official recommendations for sunscreen use?
Apply a layer 15-30 minutes before sun exposure and then again every two hours.
Remember, the only cyanotic heart disease that presents with left axis deviation is ________________.
tricuspid atresia; the hypoplastic right ventricle leads to EKG and PE findings of left axis deviation
(You missed this twice already.)
Suppurative lymphadenitis is most often caused by _________________.
S. aureus (#1) and S. pyogenes (#2)
If a grade-school-age child suddenly develops what appears to be an immunodeficiency, then you might give them what treatment?
IVIG
Sudden development of weird infections like recurrent sinusitis and Giardia without drinking river water should alert you to the diagnosis of CVID, which is treated with IVIG.
Follicular conjunctivitis –the leading cause of blindness worldwide –is also called _____________.
trachoma (from the bacteria that causes it: Chlamydia trachomatis)
What is the pathology of congenital hypothyroidism?
Thyroid dysgenesis
How can you differentiate Marfan’s syndrome from homocystinuria?
Those with homocystinuria are pale-skinned and have intellectual disability.
Strawberry hemangiomas are also called _____________.
superficial hemangiomas
Other than asking about the frequency of feeding, what can help you determine if jaundice is from breastfeeding failure or breastmilk failure?
Dehydration
If the infant appears dehydrated or has features from the history that suggest dehydration –like few diapers or urate crystals in the diaper –then it is likely breastfeeding failure.
A child has fever, pharyngitis, and vesicles with grayish ulcerations on the tonsillar pillars. What is the likely cause?
Coxsackie virus
Severe anemia and rapidly enlarging splenomegaly are concerning for _____________ in a person with SCD.
splenic sequestration crisis
A child with Down syndrome has cardiac auscultation findings similar to that of tetralogy of Fallot. What is the likely diagnosis?
Complete atrioventricular septal defect (CAVSD)
They have a VSD (like TOF). The ASD and VSD together lead to increased RV output, so there can be a pulmonic ejection murmur; this will be milder than that heard in pulmonic stenosis, however, so they will likely mention that it is II/VI or similar.
In addition to prematurity, babies with _____________ are also at increased risk of necrotizing enterocolitis.
congenital heart disease (due to poor mesenteric perfusion)
Recurrent skin and mucosal infections are common in which immunodeficiency?
Leukocyte adhesion deficiency
How is the vaccine schedule modified for premature infants?
It is not. As long as the preemie is stable, vaccines should be given according to the chronological age.
What causes death in rabies?
Ascending flaccid paralysis
Hemophilics can develop joint pain due to _______________.
recurrent iron/hemosiderin deposition leading to synovitis and fibrosis
This can be prevented with factor replacement.
What is an important question to ask in taking a history for GERD?
“Does he/she seem uncomfortable when spitting up?”
Usually, those with GERD will be in distress (e.g., have facial grimacing, back arching) when spitting up. Normal spitting will usually not bother the child.
Localized impetigo should be treated with what?
Topical mupirocin
Extensive impetigo should be treated with oral cephalexin.
The only RTA that presents with high urine pH is ___________.
type 1 (the most distal); this is because the other RTAs present with a functioning distal collecting duct that can reacidify the urine
Fever, urticaria, and polyarthralgia after taking Bactrim may be signs of ________________.
serum sickness
This can happen with penicillin, too.
True or false: viral exanthems typically don’t blanch.
False
Dr. Suchon said they don’t, but UWorld says they do.
How can you use the physical exam to differentiate vascular rings from laryngomalacia in a stridulous infant?
- LM: worsens when supine; primarily inspiratory
* VR: worsens when prone; biphasic
Infants’ hearts should not exceed ____% of the thorax.
60
___________ is a complication of chronic constipation.
Recurrent cystitis
Rectal distention can occlude the urethra.
How might seborrheic dermatitis be described?
Yellow, oily scales on an erythematous base
IgA nephropathy is also called ____________.
Berger’s
Don’t forget that _____________ can also present with fever, bone pain, and elevated ESR.
bone cancer
If you discover isolated proteinuria in an otherwise healthy child, how should you proceed?
Recommend two further UAs
Severe coughing paroxysms can lead to what rare physical exam finding?
Subcutaneous emphysema
Untreated ______________ can lead to scarring of the kidney parenchyma and blunting of the renal calyces.
VUR
Don’t forget that these kids are usually on prophylactic antibiotics.
Go through the categories for grimace and activity in the APGAR scoring system.
• Grimace:
- O: no reaction to stimulation
- 1: grimace to stimulation
- 2: cough/cry/sneeze to stimulation
•Activity:
- 0: limp
- 1: some flexion
- 2: spontaneous movement
What three food-borne pathogens cause vomiting as the main symptom?
- S. aureus
- B. cereus
- Norovirus
In addition to the classic frank blood in stool, NEC can also present as __________________.
nonspecific constitutional signs (lethargy, decreased intake) and other GI signs (vomiting, abdominal distention, poor PO intake)
NEC presents with pneumatosis intestinalis and ____________ on abdominal x-ray.
air in the portal vein
What features of lymph nodes warrant further workup?
- Hard
- Immobile
- Greater than 2 cm
- Occurrence with systemic symptoms
All sexually active women younger than _________ should be screened for Chlamydia.
24
Bedwetting is considered normal up to age ____.
5
____________ is treated by hyperpronation.
Radial head subluxation
What does the “triple bubble” sign indicate?
Jejunal atresia –the three bubbles are stomach, duodenum, and jejunum
Look for the cocaine or tobacco use in the mom!
Describe the pathophysiology of spondylolisthesis.
The lumbar spine slips forward, causing a step-off which can disrupt the cauda equina
