Yellow book Flashcards
Gold standard for diagnosis of intestinal malformation?
Upper GI series
what is the most common Cause of Guillain barre?
Campylobacter jejuni. Molecular mimicry between microbial glycans and axonal surface molecules causes auto antibodies which causes nerve damage
What are some common isolates from dental abscesses?
Bacteroides, streptococcus, Peptostreptococcus, actinomyces and fusobacterium
What drug is used to treat dental abscesses?
Amp-sulbactam
What lab work up should pregnant women with Graves’ disease have in the second or third trimester?
TSH Receptor antibodies (TRab)
After a smoke inhalation injury, kid has tachycardia, hypertension, and tachypnea, what is the cause and treatment?
Cyanide and carbon monoxide poisoning. Hydroxycobalamin.
Define POTS syndrome diagnostic criteria
Lasts at least six months, increase heart rate of 30 beats and more, absence of orthostatic hypotension
What is the Parkland formula?
used to estimate the amount of fluid that needs to be given during the first 24 hours as (Percentage body surface area involved) × (Patient’s weight) x (4).
Half of this fluid should be given over the first 8 hours, with the remainder given over the next 16 hours
What is the rule of 9s to calculate BSA for adults and kids?
In adults:
head is 9%
each arm is 9%
each leg is 18%
anterior and posterior thorax are each 18%.
In infants:
18% for the head
18% each for the anterior and posterior thorax
9% for each arm
14% for each leg.
Superficial burns should not be included.
After undergoing hepatoportoenterostomy for biliary atresia, patients are increase risk for what causes of infection? Treatment?
Cholangitis due to post surgical changes in anatomy that lead to stasis and bacterial growth. Most common organisms include E. coli and other gram-negative bacteria, enterococcus, and anaerobes. Treatment is pippercillin/tazobactam
Appropriate antibiotic coverage for a dog bite to the head with fracture
Ceftriaxone and metronidazole
BRUE Guidelines state to consider which infection in lower risk infants with respiratory symptoms
Pertussis
What is first line treatment for a black widow spider bite with severe extremity pain
Opioid analgesics
Symptoms of beta blocker toxicity
Bradycardia, hypoglycemia, hypotension, seizures, mental status changes, delirium, coma
What has been proven to reduce admission to the hospital for severe acute asthma exacerbation?
Early administration of systemic corticosteroid within one hour of arrival.
Two or three doses of inhaled ipratroprium in combination with inhaled beta agonist.
Magnesium.
No evidence that supplemental 02, LABA/LTRA reduces admission
How does ADH work?
Regulates water balance in the body by increasing water reabsorption in the renal tubules and stimulating thirst.
It’s produced in the hypothalamus, stored the pituitary gland, secreted into circulation with increased plasma osmolarity. Then it binds vasopressin V2 in the kidneys to allow for water movement across the osmotic gradient to decrease plasma osmolarity. Pt develops polyuria, increased plasma osmolality, leads to hypernatremia.
What drugs cause QTC prolongation?
Macrolides, fluoroquinolones, azoles, antipsychotics, antidepressants, diphenhydramine, and opioids
When a kid with an organic academia has feeding intolerance and it is not confirmed yet whether they’re in metabolic crisis… What should be the next step with feeds and fluids?
Prompt initiation of high concentration dextrose and cessation of all protein intake
Contraindications to urinary catheterization
Pelvic fracture (may result in urethral injury), phimosis (moderate or severe) in a male
What are some risk factors for developing depression?
Parental history of mental illness puts the child at greatest risk. Other risk factors include medication‘s like glucocorticoid, isotretinoin, and some immunosuppressants and antivirals as well as chronic illness.
TORCH infections: what eye issues are seen in 1. Toxoplasmosis 2. Syphilis 3. Rubella 4. CMV.
- Chorioretinitis +++
- Interstitial keratitis +
- Cataracts ++
- Chorioretinitis +
Intracranial calcifications are seen in which two torch infections?
Toxoplasmosis (intracerebral) and CMV (periventricular)
TORCH infections: differentiate rashes in 1. Toxoplasmosis 2. Syphilis 3. Rubella 4. CMV.
- Maculopapular.
- Maculopapular.
- Extramedullary hematopoiesis resulting in blueberry muffin rash
- Petechiae, looks like blueberry muffin rash.
Side effects of haloperidol
Extrapyramidal side effects (inc dystonia and akathisia), neuroleptic malignant syndrome, QTc prolongation
Antihistamine side effects
Paradoxical rxn
Anticholinergic (dry mouth, dizzy, constipation, urinary retention, delirium, cardiac conduction abnormalities, flushing, mydriasis, dry skin)
How to medically treat delirium
Atypical antipsychotics like olanzapine, quetiapine, and risperidone
Psychotherapy and what medication is most effective in reducing binging and purging behaviors in an bulemic?
Fluoxetine and second line would be other SSRI’s like sertraline
After fundoplication, why would a patient experience tachycardia and hypoglycemia after bolus feeds?
Dumping syndrome, a known complication. Gastric contents are delivered more quickly to the small intestine due to decreased gastric volume after fundoplication. Undigested carbohydrate in the small intestine causes hyperinsulinemia, which causes hypoglycemia. Addition of complex carbohydrates to the formula can reduce this.
What is the difference between conduct disorder and oppositional defiant disorder?
Oppositional defiant disorder is diagnosed less than eight years old and a kid who is disobedient and hostile towards authority figures. Conduct disorder is an older children who have repetitive persistent behaviors, violating the basic rights of others, aggression towards people or animals, etc.
What does the SMART mnemonic for models of improvement stand for?
Specific
Measurable
Achievable/attainable
Realistic/relevant
Timely/time bound
Know the difference between the following variables in research studies: continuous, ordinal, nominal, dichotomous
Continuous data are on a numerical scale
Ordinal data is represented in a clear order from low to highest like mild moderate severe.
Nominal data are not related to each other by rank order like white, black, Asian, other.
Dichotomous data is nominal data that has only two mutually exclusive categories, like male versus female
The Plan-Do-Study-Act (PDSA) model is a four-step method for testing and improving processes or carrying out change. What are its components?
Plan: Develop a plan for testing the change
Do: Carry out the test
Study: Observe and learn from the results
Act: Determine what modifications should be made to the test
What do outcome measures look at?
Direct impacts on the patients or other customers of the process being measured, typically related to specific aims of the project for example nosocomial infections
What is a process measure?
Pertains to the interim actions that are likely to affect the outcome of interest like handwashing would be a process measure affecting nosicomial infections
What are the six steps for designing a new curriculum?
Identify the current approach used and do a literature search to figure out the ideal approach
Do a needs assessment of the targeted learners
Write goals and objectives for the curriculum.
Select the educational strategies that are most effective.
Implementation of the curriculum.
Perform evaluation of individual learners and the curriculum itself
What is a fish bone diagram?
A.k.a. cause-and-effect diagram or Ishikawa
Displays information showing all causes contributing to an effects occurring in a process… Allows identification of areas of improvement
What is a scatterplot used for in quality improvement?
Tool used to show the association between two measures
What is a Pareto chart used for in quality improvement?
Shows which factors make the most impact on an effect from largest to smallest contribution
What is a key driver diagram used for in quality improvement?
Diagram that shows which contributing factors will impact its ability to achieve the aim for a quality improvement project
What is a process map in reference to quality improvement?
A visual representation of the steps of a process. Used early on in a quality improvement project.
What vaccines should a new onset diabetic get before they leave the hospital?
All patients receive an Annual influenza and those over 2 receive PPSV23 (give at least eight weeks after the PCV13)
Assessment vs evaluation
Evaluation test what has been learned, happens if the end of a period of learning like board certification.
Assessment is an ongoing process aimed at determining how learning is going like feedback after an LP
Difference between a systematic review and Meta analysis
Systematic review: collecting and summarizing studies on a different topic and determining the quality and risk of bias in the studies.
Meta analysis: statistical method performed within a systematic review where the data from multiple studies are combined, basically creating a single larger trial therefore there has to be homogeneity
What does IPASS stand for?
Illness severity, patient summary, action list, situational awareness, synthesis by receiver
What are high reliability organization principles?
Preoccupation with failure, reluctance to accept variation, timely feedback in leadership about processes and outcomes, learning from under performance, allowing experts to design processes
Healthcare access is composed of what four key elements?
Coverage, services, timeliness, workforce
What is the difference between summative and formative feedback?
Formative feedback is giving during or after a particular encounter in order to make timely adjustments.
Summative feedback is a comprehensive assessment at the end of a rotation
What treatment is curative for Wiskott-Aldrich syndrome?
Hematopoetic stem cell transplant
Babies with Beckwith Wiedeman syndrome are at increased risk for what tumor?
Wilms tumor
What disease presents in the first six months of life with conjugated hyperbilirubinemia, poor growth, congenital heart disease, butterfly vertebrae, dysmorphic faces, renal dysplasia, developmental delay?
Alagile syndrome
Why is enoxaparin a better choice than IV heparin?
Can be administered on an outpatient basis after discharge
What is the most common organism responsible for septic arthritis?
Staphylococcus aureus… gram positive cocci in clusters
What condition results in exocrine pancreatic insufficiency, failure to thrive, steatorrea, deficiencies of fat soluble, vitamins, recurrent infections, tooth enamel defects, cleft palette, neurocognitive dysfunction
Schwachman diamond syndrome
What is there a long-term risk of developing in Schwachman diamond syndrome?
Leukemia
What is the most common cause of abnormal uterine bleeding?
Von Willebrand disease
If you suspect diabetes insipidus, what is the next best step in working it up?
Early morning serum sodium, serum osmolality, and urine osmolality
If a patient has a history of recent sinusitis now presenting with altered mental status, fever, left arm weakness, vomiting and you’re concerned for brain abscess, what would be your empiric antibiotic choice?
Ceftriaxone and metronidazole
Retropharyngeal abscesses can spread to where as a complication?
The chest (mediastinum) or parapharyngeal abscess if they spread laterally
Newborn presents with bulbous nose, cleft palate, you hear a heart murmur, and they have hypocalcemia (absent thymus). What is the cause?
DiGeorge syndrome
Which disease pathophysiology would be described as a thrombotic microangiopathy or abnormalities in the vessel wall of arterioles and capillaries leading to the creation of microvascular thrombosis
Hemolytic uremic syndrome
HUS can either be hereditary or acquired. Causes?
Hereditary causes include complement, gene mutations, and inborn errors of cobalamin C metabolism
Acquired causes include infections from shigatoxin producing E. coli, strep pneumonia, and HIV, as well as drug toxicity
what laboratory findings would be suggestive of juvenile dermatomyositis?
Increase muscle enzyme levels (CK and LDH) and anti-Jo-1 anti antibodies
Preferred parenteral treatment for pelvic inflammatory disease?
Doxycycline with either cefotetan or cefoxitin
Clindamycin and gentamycin
What are the features of Reiter syndrome?
Oligoarthritis, enthesitis (inflammation In joints), conjunctivitis, and sacroiliitis
Triad of arthritis conjunctivitis and urethritis is uncommon in children
Patient presents at 6 to 9 months of age with recurrent bacterial, respiratory infections, sinusitis, otitis media, failure to thrive and absence of adenoids and tonsils.
X linked agammaglobulinemia caused by a mutation in the gene that makes the BTK enzyme
Infant presents with vomiting, lethargic, severely dehydrated, and either hyper pigmentation of the scrotum or labial enlargement and fusion. What is the condition and what will the labs look like?
Congenital adrenal hyperplasia
Hyponatremia, hyperkalemia, hypoglycemia, and acidosis
Two week old baby with a newborn screen with elevated TSH. What can cause a false positive screen?
Maternal history of Graves disease
Inheritance pattern of hemophilia
x linked
Males are affected and females are asymptomatic carriers
Kid who presents with episodes of hypoglycemia in the morning after a prolonged fast. What is the diagnosis and what will the labs look like?
Ketotic hypoglycemia of childhood
Appropriately high ketones decreased insulin, glucogenic precursors so increased free fatty acids and amino acids, and increased cortisol and growth hormone since they are counter regulatory hormones
What are the three first line test for Cushing syndrome? Diagnosis requires abnormal results in at least two of these.
24 hour urinary free cortisol excretion.
Late night salivary cortisol
Overnight dexamethasone suppression test
What is PHACE syndrome?
Poster fossa anomalies
Hemangioma
Arterial lesions.
Cardiac abnormalities/coarctation
Eye anomalies
Acute acalculus cholecystitis is more common than those with what disorder?
Auto immune diseases like lupus
Which type of nephrolithiasis is least likely to respond to medical therapy alone
Struvite stones.
Often associated with urease producing bacteria, such as Proteus or klebsiella
Increased urine pH
Bacteria get into the stone creating a local environment
Which type of nephrolithiasis is least likely to respond to medical therapy alone
Struvite stones.
Often associated with urease producing bacteria, such as Proteus or klebsiella
Increased urine pH
Bacteria get into the stone creating a local environment
Kid with type one diabetes, fatigue, G.I. pain, weight loss, and decreasing insulin needs. What should you be concerned about?
Primary adrenal insufficiency or Addison’s disease.
Fatigue, low blood pressure, and hypoglycemia are concerning for adrenal disease.
Presents with high ACTH levels, hyponatremia, hyperkalemia, low cortisol and renin levels
A patient with migraines is experiencing excessive vaginal bleeding, fatigue, and anemia. What’s the most appropriate initial treatment?
Since she has migraines estrogen of any kind is contraindicated.
Give a progestin only oral contraceptive
What are the features of Sturge-Weber syndrome?
Port wine stain, unilaterally in a V1 or V2 distribution
Seizures
Leptomeningeal vascular malformations ipsilateral to the birthmark
Developmental delay/intellectual disability.
Hemiparesis, glaucoma, and other ocular vascular malformations
If a patient with Kawasaki disease receives IVIG, after how many hours would you consider the fevers to be refractory and give a second dose of IVIG?
36
What rhythms are shockable and what is the appropriate initial dose for the first shock?
Ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT)
2 J/kg and the second is 4 J/kg
Medical treatment for epiglotitis?
Vancomycin and ceftriaxone
Patient presents with the classic triad of hematuria, peripheral edema, and hypertension (proteinuria too) leading to a diagnosis of poststreptococcal glomerulonephritis. Which lab result would be consistent with this presentation?
Elevated ASO and anti-DNase B
Low C3, normal C4
UA with red blood cell casts
What is the cause of superior mesenteric artery syndrome?
Compression of the third segment of the duodenum between the aorta and the superior mesenteric artery due to loss of the mesenteric fat pad
Causes include rapid weight loss, scoliosis corrective surgery
How does superior mesenteric artery syndrome present? How is it diagnosed?
Like a small bowel obstruction with abdominal pain, vomiting, anorexia, relieved by laying prone, Bilious emesis
Diagnosed with a magnetic resonance arteriography (MRA)
A febrile infants CSF is positive for HSV PCR. What is the most appropriate course of acyclovir?
IV for 21 days followed by oral suppression for six months
A patient with methylmalonic acidemia is in metabolic crisis. They’re vomiting with altered mental status and hypoglycemia. What should be your next step?
10% dextrose with electrolytes at 8mg/k/min or one and a half times maintenance
What should be given to patients in metabolic crisis who have organic acidemia?
IV carnitine
What should you test pregnant mother’s with a history of Graves disease for?
Thyroid stimulating hormone receptor antibodies TRaB in the second or third trimester
If positive it is recommended to send the infant serum for TRaB, TSH, T4 at more than 48 hours of life and again at 10 to 14 days of life and then follow for 2 to 3 months
How do you plot ideal body weight on the growth chart using the McLaren method?
Plot the height, then move horizontally on the chart to the 50th percentile for height and then move vertically down to the 50th percentile for weight
What antibiotic regimen should be used for a kid that has had a kasai procedure presenting with concern for acute cholangitis?
One regimen would be pip/tazo
You need to cover for E. coli and also other gram-negative bacteria, enterococcus and anaerobes
Hypercalcemia in the setting of high PTH is mostly due to
Parathyroid adenoma
In a kid with small intestinal bacterial overgrowth (example preemie with shortgut and abdominal distention, foul smelling stools, difficulty advancing feeds) what complication can you see?
D lactic acidosis
Which of the following potential complications of an intraosseous access is the least common? Compartment syndrome, epiphyseal injury, air embolism, cellulitis, osteomyelitis.
Epiphyseal injury
What is the most common complication of NGT placement?
Incorrect insertion of the NG tube into the lung
Are antibiotics recommended after I&D for children under 12 months?
Yep
Management of a neonate born to a mom suspected to have HSV on genitals
First determine whether there was maternal history of HSV prior to pregnancy.
If yes (recurrent episode) neonate should have HSV surface cultures, blood PCR sent a 24 hours age. No acyclovir.
If no history, obtain HSV studies from maternal lesion.
If it is confirmed a first episode infection, the neo will need a full evaluation for HSV and start acyclovir
Criteria for failing the car seat test
Apnea longer than 20 seconds.
Bradycardia less than 80 bpm for more than 10 seconds.
Desaturation less than 90% for more than 10 seconds
In short bowel syndrome, what factor most helps for patients achieve full enteral autonomy
Residual bowel length.
Patient with less than 20 cm of viable bowel are less likely to be able to be weaned from TPN
Other positive factors are preservation of the ileocecal valve, presence of primary jejunal bowel remnant
If a patient has bilateral undescended testicles, severe hypospadias, or a unilateral undescended testicle with any degree of hypospadia and or micro penis, you should consider what diagnosis? Work up?
Disorders of Sexual development: a newborn with a male phallus and bilateral undefended testicles could be a genetic female with congenital adrenal hyperplasia.
Obtain electrolytes to look for hyponatremia, hyperkalemia, Karyotype and 17 hydroxy progesterone level
Patient with lupus admitted for flare who has started on pulse dose steroids yesterday and begins to be more confused and disoriented with hallucinations and delusions. Most likely cause?
Neuropsychiatric lupus.
Steroids can cause psychiatric features, but mostly in prolonged courses of higher doses
Patients are also at risk of strokes and seizures
In a patient with a peg tube who has nausea, postprandial vomiting, epigastric, pain, early satiety, abdominal distention, weight loss. Possible work up and cause?
Assess for gastric outlet obstruction with a peg tube contrast study
Newborn presents with tremors, hypertonicity, high-pitched cry, exaggerated sucking, and colostrum regurgitation. Mom‘s UDS is negative. What should you look for on history?
Check medication list to see if Mom’s on an SSRI because that can cause neonatal adaptation syndrome with the above symptoms
What is the most helpful laboratory test for ruling out type one diabetes
Absence of pancreatic islet auto antibodies
A high C peptide level supports a diagnosis of type two diabetes
What type of cardiomyopathy is associated with Duchene muscular dystrophy
Dilated
Kid with history of failure to thrive who falls and breaks his femur with x-ray evidence of osteopenia
Proximal renal tubular acidosis can cause failure to thrive and bony abnormalities due to renal losses of phosphate.
Diagnose using serum and urine electrolytes… Hyperchloremic metabolic acidosis
Indications for removal of a tunneled central line
Line is irreparably disrupted.
The patient is significantly ill.
Infection is disseminated.
Bacteria cannot be cleared after 48 to 72 hours of treatment.
Evidence of fungemia
What can cause a false positive on a newborn screen showing elevated thyroid stimulating hormone level?
A maternal history of Graves disease
What are the major Jones criteria for acute rheumatic fever?
- Joints. Migratory polyarthritis
- ❤️ Carditis
- Nodules. Subcutaneous nodules
- Erythema marginatum
- Sydenham Chorea
What are the minor criteria for acute rheumatic fever?
- Fever (>38.5°C)
- Polyarthralgia
- Prolonged PR interval (in the absence of carditis)
- Elevated acute-phase reactants (C-reactive protein >3 mg/dL and erythrocyte sedimentation rate >60 mm/h)
What are the symptoms of Vitamin A deficiency?
Corkscrew hair, follicular hyperkeratosis, and Bitot spots (buildup of keratin in the conjunctiva).
What are the symptoms of Zinc deficiency?
Alopecia and dermatitis, particularly affecting the perineum, chin, cheeks, and acral surfaces.
What are the symptoms of Copper deficiency?
Kinked hair, skin depigmentation, myelopathy presenting as sensory ataxia.
What are the symptoms of Iron deficiency?
Pallor, onychomadesis (periodic shedding of the nails), and koilonychia.
What are the symptoms of Vitamin C deficiency?
Poor wound healing; corkscrew hair; gingival swelling; ecchymosis; hyperkeratosis; koilonychia (flat, thin nails often with concavity); hemarthrosis; bony lesions or brittle bones; ocular hemorrhages; perifollicular hemorrhages (particularly in the lower extremities).
A patient with JIA who you suspect MAS, what lab finding may be decreased from baseline and will help you differentiate MAS from an infection or JIA flare?
ESR
Fibrin consumption causes a fall in ESR
Patient with red brown urine when he has cold like symptoms. No pain. Diagnosis and what would C3 and C4 levels be?
IGA nephropathy
Normal C3 and C4.
As opposed to post infectious GN where C3 is low
Patient presents with fever, oral aphthous ulcers, genital ulceration, skin lesions like erythema nodosum, vision problems. diagnosis and treatment?
Behcet disease.
Colchicine, steroids, azathioprine, TNF inhibitors
Patient has symptoms of compensated septic shock with an elevated heart rate but normal blood pressure. What is your next step?
Guidelines say maintenance IV fluids instead of a fluid bolus.
Give a bolus if child is hypotensive or dehydrated
