UWorld Tidbits 2 Flashcards
Workup for UTI: in diapers vs. not in diapers
Workup for UTI
- not in diapers: can do clean catch mid stream
- if in diapers: need to do straight catheterization for a sterile specimen b/c of frequent contamination of stool and skin flora
Effect of the following on HOCM murmur intensity
(a) Squat
(b) Sustained hand grip
(c) Valsalva
HOCM murmur
- murmur intensity increases w/ decreased preload
- murmur intensity decreases w/ increased preload or increased afterload
(a) Squatting increases afterload and increases preload => decreases murmur intensity
(b) Sustained hand grip increases afterload => decreases murmur intensity
(c) Valsalva decreases preload => increases murmur intensity
Trendelenburg sign
(a) What is it
(b) Indicates weakness in what muscle?
(a) Trendelenburg sign = drooping of contralateral hemipelvis during monopedal stance (aka if stand on left foot, right hip/pelvis tips downwards)
(b) Weakness or paralysis of gluteus medius/minimus
Huge laboratory distinction btwn HUS and HSP
HUS = thrombocytopneia
HSP = purpura w/ normal platelet count
Bone tumor w/ pain quickly relieved by NSAIDs
Osteoid osteoma
Workup for simple febrile seizure
Reassurance- no EEG needed
5 major criteria for acute rheumatic fever
(a) Etiology
JONES
J- joints (migratory arthritis) O (shape of a heart)- carditis N- nodules E- erythema marginatum (rash) S- sydenham chorea
(a) Etiology = strep pyogenes
Serum sickness-like reaction
(a) What is it
(b) Features
(c) How to distinguih from ARF
(a) Type III hypersensitivity 1-2 weeks after starting beta-lactam or bactrum abx
(b) Features = fever, uticaria, polyarthralgia
(c) ARF extremely rare after proper abx tx of strep pharyngitis
Physical exam finding of coarctation
Upper extremity hypertension
Explain why there is a single S2 in TOF
Stenotic pulmonic valve
Effect of squatting on ToF murmur
Squatting decreases r –> l ventricular shunting => improves cyanosis but increases murmur intensity b/c of the increased blood flow thru the RVOT
Next step in evaluation of primary amenorrhea if
(a) Uterus present
(b) Uterus absent
Primary amenorrhea workup if
(a) Uterus present- FSH levels
- if FSH high: karyotype
- if FSH low: cranial MRI
(b) Uterus absent- karyotype
Bugs of CF pneumonia
(a) GNR
(b) GN coccobacilli
(c) GP cocci in chains
(d) GP cocci in clusters
CF pneumonia
(a) GNR: pseudomonas, B. cepacia, strenotrophomonas maltophilia
(b) GN occcobacilli = H influenza
(c) GP cocci in chains = strep pneumo
(d) GP cocci in clusters = staph aureus
Describe the murmur heard from a large VSD
Pansystolic murmur best heard over LLSB + diastolic rumble at apex (due to increased flow across the mitral valve)
Features in addition to inspiratory stridor
(a) Laryngomalacia
(b) Vascular ring
Inspiratory stridor +
(a) Layrngomalacia = worse when supine, improves when prone
(b) Vascular ring- improves w/ neck extension, aways presents before 1 yoa, associated w/ presence of other cardiac abnormalities
Musty/mousy body odor
Mousy body odor- buzzword for PKU
5 mo old w/ 2 days of projective vom, diarrhea, one GTC seizure
-eczematous rash
Musty odor of urine- think PKU
First line pharma tx for Tourette’s
Antipsychotics
-Haloperidol, pimozide, risperidone
Next step:
Child w/ ALL, parents refusing chemotherapy
Obtain court order for chemo
-non-emergency by fatal medical condition
Best bet for abx choice for 3 yo CF pt w/ pneumonia
Staph aureus = most common cause of bacterial pneumonia in young kids w/ CF => tx for IV Vanc
First line tx for pinworm
Pinworm (scotch tape test on anus) tx = Albendazole
Acute stroke sydnrome in child after foreign body injury to soft palate
Internal carotid artery dissection
-confirm dx w/ brain MRI
5 yo w/ difficulty swallowing, copious drool, facial grimacing
- fever, chills, malaise, muscle aches
- refusing water
(a) Dx
(b) Reservoir
(c) Tx
(a) Rabies: hydrophobia/aerophobia (feeling of water or air triggers involuntary pharyngeal muscle spasms) pathognomonic
(b) Racoon
(c) Post-exposure rabies prophylaxis = both rabies immune globulin and rabies vacine to prevent progression to life-threatening encephalitic or paralytic disease
Hydrophobia/aerophobia
Refuses to drink fluids, pathognomic for rabies b/c feeling or air/water triggers involuntary pharyngeal muscle spasms
of words for a
(a) 24 month old
(b) 30 mo old
(a) 24 month old: 150-300 words
- correct use of pronouns
- stranger understands about 1/2 of the child’s speech
(b) 30 mo: about 1,000 words
- 3-4 word sentences
Next step:
25 hr old CF pt w/ bright green vomitting
- hasn’t passed BM
- distended abdomen
- Xray showing dilated bowel loops w/ no rectal air and no free air
Next step: contrast enema to assess for level of obstruction. After determining level of obstruction => surgery
14 yo F w/ irregular menstrual periods
-oral progesterone => withdrawal bleeding for 3 days
Cause?
HPG axis immaturity = common cause of irregular menstrual cycles in women shortly following menarche
= insufficient gonadotropin secretion
Bony prominences of the costochondral junctions and genu varum
Vitamin D deficency rickets
-costochondral joints = rachitic rosary
Most common cause of nephrotic syndrome in teenager w/ HepB
MCD is the most common in younger children and children overall, but teenager + active Hep B infection = membranous nephropathy
