UWorld Week 1-3 Flashcards
Suspicions for strep throat, what next
Rapid strep antigen test, then tx
What is the most common cause of isolated proteinuria in children
Transient proteinuria (orthostatic proteinuria is an example - increased protein when upright, return to nrml when laying). Repeat urine dip x2 to r/o persistent (if + then consider US, 24hr urine, bx)
Acute abnormal uterine bleeding most common cause, w/u, management
Immature hypothalamic pituitary ovarian axis. W/u include CBC, pregnancy test, coagulation studies. 1st line tx with high dose oral estrogen/progestin OCP. This stabilizes endometrium and stops menstrual bleeding
AUB w/ abnormal PT/PTT, w/u for what
Hemophilia A (factor 8 def) or B (factor 9 def)
Primary dysmenorrhea clinical findings
Pelvic cramping during first days of menses; caused by increased prostaglandin release from endometrial sloughing during menses
Tx of croup (laryngotracheitis - inflammation of larynx/trachea) mild vs moderate/severe
Mild (no stridor at rest): humidified air + dex
Mod/severe (stridor at rest, retractions): dex + racemic epi
Tetralogy of Fallot key findings (4)
Right ventricular outflow tract obstruction
RVH
Overriding aorta
VSD
Clinically, tet spells occur when agitated or feeding (deoxy blood goes to aorta instead of PA due to increased pulmonary resistance). Immediate mgmt is knee-chest positioning to increase systemic resistance thereby shunting blood to PA instead of aorta. Look for cres-decres over LUSB for pulmonic stenosis
Absent breath sounds on left, heart sounds on right, scaphoid abdomen, digestive sounds on left
Congenital diaphragmatic hernia. Tx endo tube
Down syndrome and associated GI finding
Duodenal atresia: look for inability to pass meconium, soft abdomen w/o distention or bilious vomiting, and double-bubble sign on abdl x-ray suggesting duodenal obstruction (vs meconium ileus and CF)
Increased gastric residual volume, vomiting, abdl distention in a preterm neonate. Also, pneumatosis intestinalis (intramural air) and portal venous air
Necrotizing enterocolitis
Mechanism of majority of intussusception ages <2yo
Following a viral illness -> hypertrophy of Peyer patches in lymphoid rich terminal ileum and serves as a nidus for telescoping. Look for different pathological lead point in older children with recurrent intussusception
1mo infant well appearing, w/ eczema, regurgitation soon after breastfeeds, and painless bloody stools
Milk or soy protein induced protocolitis. Non-IgE mediated immuno response to PROTEIN in formula OR breast milk that causes colonic/rectal inflammation. Eliminate dairy and soy from mother (breastfeeding) and formula (hydrolyzed formula only). Resolves within weeks; tolerate dairy/soy by 1yo
CF deltaF508 -> meconium ileus -> bilious emesis, no BMs in 24-48hrs of newborn, w/u with abdl x-ray to look first for pneumoperitoneum -> then water soluble contrast enema -> tx with gastrografin to break up meconium and dissolve the obstruction
Neonatal bilious emesis = signifies bowel obstruction -> requires immediate x-ray to r/o perf -> contrast studies in stable patients to determine the level of obstruction
Microcephaly, micrognathia, overlapping fingers, absent palmar creases, ROCKERBOTTOM feet, VSD
Trisomy 18: Edwards syndrome, death in months
Vacuum assistance required for pregnancy, complications include
Cephalohematoma: look for scalp swelling that is firm, non-tender, does not cross suture lines (since subperiosteal), NO skin discoloration. Will resorb spontaneously week/months. Look for hyperbilirubinemia d/t hematoma breakdown
Macrosomia (>4kg or about 9lbs), crepitus over clavicle, absent moro reflex, crying/pain w/ passive motion
Clavicle fracture following shoulder dystocia (difficult shoulder delivery). Dx with x-ray, tx reassurance/gentle handling will heal in a week
Allergic contact dermatitis is what type of rxn
T cell mediated type IV hypersensitivity rxn presents with erythema, edema, and vesicles >12 hrs after contact w/ allergen
Seizures, port whine stain along trigeminal nerve distribution, leptomeningeal cappilary venous malformations affecting brain and eye, visual field defects, intellectual disability
Sturge-Weber
T1DM, dermatitis herpetiformis, iron deficiency anemia
Celiac, dx with anti-tissue transglutaminase antibody IgA
Which supplement reduces morbidity and mortality in patients with measles
Vitamin A
Ddx besides erythema toxicum rash in newborn
Neonatal HSV (vesicles on skin, eyes, mucous, tx Acyclovir) Neonatal varicella (fever and vesicles) Staph scalded skin syndrome (fever, irritable, diffuse erythema and blistering/exfoliation, positive Nikolsky's sign (blistering), tx with oxacillin/nafcillin)
Neonate, vomiting, FTT, jaundice, HSM, convulsions, cataracts
Galactosemia: metabolic disorder d/t galactose-1-phosphate uridyl transferase deficiency. Tx eliminate galactose
Food-borne diseases symptom presentation/organism
Vomiting predominant: staph aureus, bacillus cereus, noroviruses
Watery diarrhea: C perfringens, E coli, enteric viruses, cryptosporidium, cyclospora, intestinal tapeworms
Inflammatory diarrhea: Salmonella, campylobacter, shiga toxin E coli, shigella, vibrio, yersinia
Non-GI symptoms: botulism (desc paralysis), listeria (meningitis), Hep A (jaundice)
Distress (tripod position, sniffing position, stridor), dysphagia, drooling, high fever
Epiglottitis (HiB), manage with e-tube, abx, look for thumbprint sign
Infant with seizure, disproportionately large head circumference, and retinal hemorrhages, “rolling off bed at two months”
Abusive head trauma, shaken baby syndrome, shearing of subdural veins
Bloody diarrhea followed by abdl pain, fatigue, decreased urination
HUS, shiga toxin by E. coli O157:H7. Microangiopathic hemolytic anemia, thrombocytopenia, AKI (poor urine output, edema, elevated Cr and BUN). HUS = systemic vascular endothelial injury and subsequent platelet microthrombi formation. Tx with fluid electrolyte mgmt, blood transfusions, dialysis
Cough/rhinitis for 1-2 weeks, cough w/ inspiratory whoop and posttussive emesis 2-6 weeks. Symptoms gradually resolve weeks to months
Pertussis: bordatella pertussis, dx with cx PCR, tx with macrolides, ppx with TDaP
Cafe-au-lait spots, multiple neurofibromas, Lisch nodules
NF1
Bilateral acoustic neuromas
NF2
Bronchiolitis in children <2yo tend to have lower respiratory tract involvement. What else clinically, tx, and ppx
Look for wheezing, crackles, dx is clinical and tx is supportive (hydration, saline nasal drops, nasal bulb suction). Ppx with palivizumab monoclonal antibody against RSV for high risk (premies, chronic lung disease of prematurity, congenital heart dz)
Bronchiolitis in older children presentation
Self-limiting, mild, upper respiratory tract infection (nasal congestion, rhinorrhea)
Congenital adrenal hyperplasia findings
Dehydration (depressed fontanelle, dry membranes), salt wasting, hyper K, virilization (in girls d/t excess T). Most commonly caused by deficiency in 21-hydroxylase: decreased aldosterone, decreased cortisol (hypoglycemia), increased 17-hydroxyprogesterone which is a precursor to testosterone. THIS is classic CAH w/ excess testosterone and def aldo/cortisol
First line tx in <8yo kid with Lyme dz
Amoxicillin oral since doxycycline causes teeth decay
Peripheral smear findings: SCD, lead/metal poisoning, G6PD/thalassemia, DIC/HUS/TTP (traumatic microangiopathic hemolytic anemia)
Howell-Jolly bodies (normal nuclear remnants of RBCs removed by spleen)
Basophilic stippling
Heinz bodies (G6PD - oxidation of hemoglobin causing precipitation)
Schistocytes or helmet cells (fragmented RBCs from trauma)
Newborn presenting with pallor, seizure, focal neuro signs, bulging tense fontanelle. Blood in germinal matrix, ventricles, and parenchyma
Intraventricular hemorrhage associated with prematurity and low birth weight infants
Most common pediatric CNS tumor
Pilocytic astrocytoma
Grip myotonia (delayed muscle relaxation), facial weakness, foot drop, dysphagia, cardiac conduction anomalies, testicular atrophy
Myotonic muscular dystrophy *auto-dominant
12wk old exclusively BF develops apathy, weakness, hypotonia, large tongue, sluggish movement, abdominal bloating, umbilical hernia (normal up to 3mo then s/s)
Congenital hypothyroidism (most commonly caused by thyroid dysgenesis - can be aplasia, hypoplasia, ectopic gland). Normal baby at birth d/t maternal thyroid, disease will progress, tx with levo
Pineal gland mass findings (parinaud syndrome)
Limited upward gaze, upper eye lid retraction, pupils non-reactive to light but reactive to accomodation. Also look for obstructive hydro w/ papiledema, HA, vomiting, ataxia
VUR is a risk factor for
Recurrent UTI, which can lead to renal scarring. Children with first febrile UTI 2-24mo should undergo renal US; recurrent UTIs should then undergo voiding cystourethrogram to evaluate for VUR
Anemia in SS disease is caused by two mechanisms
Aplastic crisis: look for dec retic, transient arrest of erythropoiesis 2/2 infection
Splenic sequestration: dec platelets as they are trapped in spleen, increased retic, splenic vaso-occlusion rapidly enlarging spleen and occurs prior to autosplenectomy (pooling of RBCs within spleen)
Newborn, decreased activity, hoarse cry, jaundice, elevated TSH, low T4
Congenital hypothyroidism - thyroid dysgenesis is the most common cause. Tx with levo
Neonatal conjunctivitis at age 5-15 days, bug?
Chlamydia trachomatis, tx with oral erythromycin (watch our for pyloric stenosis). At age 2-5 days, gonococcal (more marked swelling, profuse discharge, corneal edema), tx with IM dose Ceftriaxone. At <24 hrs think chemical, tx with eye lubricant. Chemical, gonococcal, chalmydia
Sickle cell disease 1st line tx and its side effects
Hydroxyurea, agranulocytosis. Works by increasing fetal hemoglobin, overcompensating for sickle hemoglobin
Self mutilation, neurologic features (mental retardation, dystonia, choreoathetosis, spasticity), gouty arthritis, tophus formation
Hypoxanthine-guanine phosphoribosyl transferase deficiency (purine metabolism error). Lesch-Nyhan syndrome
Most common cancers in peds
Leukemia, CNS tumors, then neuroblastoma (most common extra cranial mass, neural crest cells affected so think sympathetic chain and adrenal medulla)
Iron poisoning findings
Abdl pain, vomiting (hematemesis), diarrhea, hypotensive shock, metabolic acidosis. Look for radiopaque pills on x-ray. Tx with whole bowel irrigation, deferoxamine, supportive care for ABCs
Acute drop in Hgb, low retic count w/o splenomegaly, sudden halt in RBC production (normal leukocytes), in SCD kid is what sickle mechanism (aplastic crisis or splenic sequest)
Aplastic crisis: most common cause 2/2 parvovirus B19 infection infects erythrocyte precursors. Tx blood transfusion
Precocious puberty w/u what first
Check bone age -> if older than chronological age then check LH -> if bone age is normal then think isolated premature thelarche/adrenarche -> with older bone age, w/ high basal LH think central precocious puberty, if low LH and still low after Gnrh agonist think preipheral
Exposure to pertussis (whooping cough), prophylaxis to household contacts?
Yes, azithro/clarithro/erythro for 5, 7, 14 days of tx for kids > 1mo. Azithro x5 days for age <1mo since erythro causes pyloric stenosis
Edema, fatigue, abdl pain, proteinuria
Nephrotic syndrome, minimal change diseae (80% of nephrotic syndrome in kids). Look for normal renal architecture, normal immunofluorescence staining of glomeruli, but diffuse effacement of foot processes of podocytes. Tx with corticosteroid
Step off, decreased sensation, bed wetting, back pain, straight leg negative
Spondylolisthesis: developmental disorder, forward slip of vertebrae (L5 over S1 usually)
Turner syndrome findings
Clinically: short stature, primary amenorrhea, absent thelarche
Hormones: ovarian dysgenesis -> low estrogen/progesterone (premature ovarian failure and no breast development). With low estrogen -> feedback loop will cause increase in FSH/LH. Tx with estrogen replacement
Meconium ileus associated with what congenital disease
Cystic fibrosis! Obstruction at the level of ileum vs obstruction at rectosigmoid seen in Hirschsprung disease
5yo who did not receive two doses of VZV vaccine at 1, 4yo. Presents with first time infection, management?
For immunocompetent pt with VZV, administer varicella vaccine. Self-resolving but look for pneumonia, CNS disease (cerebellar ataxia), and skin infections
CF, increased PT, normal PTT
Vit K deficiency due to poor fat absorption (CF and exocrine pancreatic insufficiency) -> factor VII deficiency
Gestational diabetes and pregnancy complication: hyperglycemia -> s/s include increased birth weight, plethoric appearance (polycythemia)
Shoulder dystocia (obstetric emergency), complications include clavicle fracture, brachial nerve palsies, perinatal asphyxia, and neonatal hypoxic encephalopathy
Nonclassic CAH
Similar to CAH in that there is 21-hydroxylase def resulting in excess testosterone BUT normal aldo/cortisol levels. Patients are precocious, accelerated growth and bone age, and low LH levels
Delayed prolonged bleeding mild trauma/procedure, hemarthrosis, intramuscular hematomas, GI/GU bleeding
Hemophilia A/B, tx with factor 8 for A and 9 for B, look for prolonged PPT, normal platelets/bleeding time/PT, and decreased factor 8/9
Transposition of the great vessels findings
Cyanosis with 24 hrs, single S2 on auscultation (absent pulmonic component since the aorta is anterior to PA), and narrow mediastinum on x-ray (egg on a string). Tx with prostaglandins to keep patent foramen ovale open - enables mixing. Ductus ateriosus or VSD works too but if present, audible murmur
HSP findings
IgA mediated small vessel vasculitis, palpable purpura on LE, athralgia/athritis, abdl pain, renal disease (hematuria, proteinuria). Tx is supportive hydration and NSAID for most; hospitalization/steroids for severe
Three types of pediatric abdl wall defects
Umbilical hernia, gastroschisis (defect lies right of cord and contains bowel), omphalocele (midline abdl wall defect, contains organs)
Hematuria, pain crises, ethnicity - sickle cell anemia. Look out for what kind of infection
Splenic autoinfarction in sickle cell anemia -> encapsulated organisms like S. pneumoniae, H. influenzae, N. meningitidis. Vaccinate with conjugate capsular polysaccharide
What to do with palpable cervical lymph nodes in children and young adults
Observation! Unless concerning findings: >2cm, firm, immobile nodes, signs of systemic/constitutional illness. Small, soft, mobile, non tender is not pathologic
G6PD deficiency mechanism
Lack of enzyme causes oxidation of hemoglobin leading to insoluble precipitants called Heinz bodies
Recurrent cutaneous abscesses, lung abscesses d/t staph aureus
CGD - check with nitro blue or dihydrorhodamine test
Prenatal US findings of bladder distention, bilateral hydroureters, and bilateral hydronephrosis (w/ resultant amniotic oligohydramnios)
Posterior urethral valves most common cause of urinary tract obstruction. Look for oligohydramnios in 2nd trimester causing restriction of fetal mvmt and lung dvlpt. POTTER sequence: tract issue -> anuria/oliguria in utero -> oligohydramnios -> pulmonary hypoplasia, flat facies, limb deformities
Breast-feeding jaundice
1st week of life, lactation failure, sub-optimum breast feeding, signs of dehydration
Breast-milk jaundice
3-5 days peaks at two weeks, high levels of beta-glucoronidase in breast milk (enzyme problem), adequate breastfeeding, normal examination
ALL newborns have mild unconjugated hyperbilirubinemia d/t
High hemoglobin turnover and immature hepatic UDP glucuronsyltransferase activity
Short stature, pre-pubertal, delayed bone age (bone age younger than chronological), not had pubertal growth spurt =
Constitutional growth delay, f/u in 6mo
Clinical findings for osteogenesis imperfecta
Blue sclerae, hearing loss, recurrent fractures, and opalescent teeth (normal intelligence).
Down syndrome, upper motor neuron symptoms (leg spasticity, hyperreflexia, positive Babinski sign, clonus), behavioral changes, torticollis, urinary incontinence, vertebrobasilar symptoms
Atlantoaxial instability, tx with surgical fusion of C1 and C2
Most common predisposing factor for acute bacterial sinusitis
Viral URI
Fever, severe HAs, focal neuro changes = classic triad for
Brain abscess. Risk factors include - recurrent otitis, sinusitis, dental infection, bacteremia from other sites, cyanotic heart disease (shunts!)
SGA infants (wt under 10th percentile) are at risk for what complications
Hypoxia, polycythemia (hypoxia leads to increased EPO activity), hypoglycemia d/t decreased glycogen stores, hypothermia due to dec subcutaneous fat, and hypocalcemia d/t dec calcium transfer across placenta
Fever, dysphagia, inability to extend neck, muffled voice, lateral x-ray showing widened prevertebral space
Retropharyngeal abscess
Neonate exposure: diaphoresis, irritability, high pitched cry, sweating, sneezing, tremors/seizures, poor feeding
Heroin exposure (the sneezing!)
Fetal alcohol syndrome
Long smooth philtrum, small palpebral fissues, thin upper lip, mental retardation, withdrawal not seen in infants unless mother was drinking just prior to delivery
HSP laboratory findings
Normal platelet and coag. Normal to elevated Cr. HEMATURIA, maybe casts, maybe proteinuria
Refeeding syndrome electrolytes to pay attention to
Phosphorus, potassium, magnesium all shifted intracellularly d/t insulin
16yoM, 2 month left leg pain, worse at night, not associated with activity, improved with Ibuprofen, x-ray with small round lucency with sclerotic margins and sometimes central ossification
Osteoid osteoma: benign bone forming tumor. CTM, self resolving in years, surgery if refractory. Vs Ewing sarcoma (look for swelling and deformity, subperiosteal new bone formation)
Pediatric HTN in UE, decreased perfusion to LE, heart failure, cardiogenic shock, palpable pulsations of intercostal vessels
Coarctation of the aorta. Thickening of tunica media near junction of ductus arteriosus and aortic arch
Chronic oligoarthritis, chronic fever, and a rash
Systemic onset juvenille idiopathic arthritis: r/o leukemia, bacterial arthritis, tx with NSAIDs, glucocorticoids
Most common cause of central precocious puberty in very young kids
Hypothalamus harmatoma, tx leuprolide to suppress axis
