1-50 Flashcards
(98 cards)
1
Q
doxorubicin
A
anthracycline
high dose lifetime dose > 250 mg/m2= high dose exposure
cardiomyopathy - screening with echo
leukemia — anytime no screening
2
Q
cisplatin
A
platinum
sn hearing loss — to high frequency at the beginning
3
Q
fever and neutropenia
preferred method of thermometry?
A
oral
axillary is a ceptable if cant oral
never rectal - mucosal trauma and bacteremia
infrared thermometry ( tympanic or temporal) not reliable <6 mo
4
Q
preferred method of thermometey in non neutropenic pts in the first few years of age
A
rectal
( neutorpenic oral>axillary)
oral approxim 0.6 C lower than rectal
axillary most convenient the least consistent with rectal thermometry
5
Q
Advil adverse effects
A
gastritis
inhibition of platelet function
renal toxicity
varicella related group A strep infections
6
Q
malaria vs babesiosis
A
fever , hemolytic anemia, theombocytopenia
babesiosis
- tick born zoonosis
- northeast and upper midwestern
- blood smear - detection of tetrad ( Maltese-cross)
Malaria
- vector born parasite
7
Q
species of malaria
A
falciparum - mc , can cause severe malaria,
vibex - Asia and central &south america
.
8
Q
severe malaria treatment
A
must be treated in picu - aggressive supportive care and iv malaria chemotherapy
IV quinidine gluconate +tetracycline, clinda or doxy recommended
monitor for hypotension, hypoglycemia, cardiac dysehythmia while on quinidine
if cant tolerate IV quinidne - consult CdC hot line and access IV artesunate, course followed by 1 of the following other antimalarial agents ( atovaquone-proguanil, doxy, clinda, mefloquine)
9
Q
malaria diagnosis
A
thick and thin blood films ( Giemsa stain)
thick - more sn for detecting parasites
thin - aids in species identification and quantification
RDT ( rapid diagnostic test) for malaria antigen, FDA approved , do with microscopy, high FN and FP results
PCR - for detecting species
10
Q
blood film is negative fo malaria + high clincial suspicion
A
smears be repeated every 12-24 hrs over a 3 day period
11
Q
severe malaria
A
cerebral malaria (AMS) hypoglycemia renal failure ARDS shock met acidosis severe anemia gburia coagulopathy RBC parasitemis>5 %
12
Q
LV hypertrophy w/ MR in ….
A
obstructive left sided cardiac lesion
- aortic stenosis
- severe htn
13
Q
pulmonary arterial hypertension pathophysiology
A
- because of pulmonary vascular obstruction and recurent hypoxemia —- right heart failure due to pulmonary disease= cor pulmonale
- pulmonary htn ass with left to right intracardiac shunt —- increased
flow due to shunt
14
Q
Down syndrome are at rusk of pulmonary htn due to
A
1 congenital heart disease
2. pulmonary vascular bed abnornalities
15
Q
pulmonary htn on echo
A
- RV hypertrophy
- flattening of the interventricular septum
- TV regurg
16
Q
Fetal and neonatal erythropesisi
A
both stimulated by hypoxia
FHb has high affinity for oxygen than adult Hb — relative hypoxia in utero
Fetal EPO produced by liver, less sensitive ti hypoxia than in the kidney
Adult EPO produced by kidney and more sn to hypoxia
During 3 rd trimester maternal iron is transferred to the fetus — increased RBC production — prematurity no iron tranfer
17
Q
hematocrit values in newborn affected by
A
by gestational age
- no affected of tge neonate , maternal agr or Maternal BMi
at birth term neonates have a higher henatocrit than preterm
preterm
— decreases sn of hepatic sensors to hypoxia
- reduced iron stores( disnt tranfer from mother )
18
Q
newborn screen is positive for hypothyroidism, next step ?
A
a confirmatory venous sample should be aent for TSH and FT4
if the filter paper TSH level is higher 40 mIU/L, start immediately in levothyroxine w/out waiting for results
nexk us also may be consodered
ped endo consult is also indicated
19
Q
hypothyroidism on newborn screen and levothyroxine treatment
A
- conformatory venous sample TSH and FT4
- if filter pper >40 mIU/L — start Levothyroxine immediatey after sample
dose of levo 10-15 @g/kg per day, by 2 weeks
20
Q
levothyroxine for infants
A
10-15 @g/kg start by 2 weeks of age
liquid formulations not available
tab should be crished and given orally
give with finger or small amount of milk
not with bottle— dosing inaccurancies and meds affinity for plastic
TFT every 1-2 month first 6 month — goal FT4 upper half of the normal range and TSH normal range
21
Q
causes of newborn hypothyroidism
A
- Thyroid dysgenesis ( mc in USA) — no goiter
- dyshormomigenesis - affects met step of hormone production— goiter +
- iodine def in mothers
22
Q
cold panniculitis
A
rash caused by direct contact of the skin or muc to cold — local trauma
an erythematous plaque w/areas of indiration or bluish hue
appears sim
to cellulitis, but cool to touch+ no syst. sx
23
Q
cold panniculitis Rx
A
reaasurance
self resolving after disc exposure to the cold
24
Q
Narcolepsy
A
Rem sleep disorder 4 clinical features ar least 3 mo - excesaive sleepiness- cardinal - cataplexy - hypnagogic hallucinations - sleep paralysis core clinical feature hypersomnolence despite addquate and restorative nighttime sleep
25
cataplexy
sudden partial or complete paralysis of the voluntary muscles triggered by intense emotions
affects face before teunk and limb
26
types of narcolepsy
```
2 types
- type 1 caused by orexin(hypocretin) produced by hypothalamic neuronal loss
autoimmune
development after illnesses ( h1n1 flu)
suscept HLA DCB1
CSF low levels orexin
```
- type 2 — unknown etiology
both same clinical presentation
27
mngmnt of narcolepsy
- symptomatic
- stimulants for hypersomnolence
- antidepressant for cataplexy and psych conorbidities
- good sleep hygiene
- sodium oxybate dual therapy of excessive daytime sleepiness and cataplexy
28
sodium oxybate
dual therapy dor excessive daytime sleepiness abd cataplexy ( in narcolepsy)
29
confirmatory test narcolepsy
polysomnography followed by multiple sleep latency testing ( MSLT)
- overnight sleep — for sleep architecture. In N it is fragmented, early transition to REM sleep and excludes sleep apnea
- MSLT - falls asleep every 2 hrs for 20 mins — sleep onset and architecture is analyzed. N pt fall asleep quickly, onset of REM in at least 2-4 sleep periods
30
Actigraphy
measures limb movements throu a device worn on the wrist or ankle that peovides a graphical picture kf sleep behavior over tume
- for evalnof circadian rhythm sleep reated disorders
31
anticholinergic ( antihistamine, atropine) toxidrome
```
high HR
high BP
no chamge in RR
T high
neuro agotated, delirium
pupuls sluggish or large
skin
flushed
urinary incontinence
```
32
choliergic toxidrome
| organophosphate
```
decr HR
decr BP
incr RT
no change in RR
lethargy, sz, coma
weakness
pulils small
skin
diaphirerix
dirthea salivation emesis
```
33
Opiate
| morphine heroin
decr HR, BL, RR
euphoria somnolence coma
pintloint
no chamge in skin
34
sedative /hypnotic/benzo/alcohol
decr HR/BP/RR/temp
confused sommolent coma
no changes in pupil
no changes in skin
no other
35
sumpthomimetic ( cocaine amphetamine )
```
incr HR/BP
no change in RR
incr T
agitation paranoia hyperactivity
pupils large reactive
diaphorerix
```
36
acetaminophen antidote
N acetylcyateine
37
anticholinergic antidote
physiostigmine
38
anticholinesterases antidote
atropine
39
benzo antidote
flumazenil
40
BB antidote
glucagon
41
CCB antidote
calcium
42
nephrotic syndrome
```
proteinuria
- urine protein to cr ration > 2 mg/mg
- urine peotein >40 mg/m2/dL
hypoalbuminemia ( <2.5 mg/dL )
edema
hyperlipidemia
```
43
Nephrotic syndrome types
- primary idiopathic
- secondary underlying systemic disease
. antiniclear ab, hep B, hep C, HIV
44
Nephrotic syndrome
| changes in lab
proteinuria ( pr/cr 2, urine pr > 40 mg/m2/h)
hypoalbuminemia (<2.5 gm/dL)
hyperlipidemia
BUN /cr usually normal or mildly increased due to lower wffective intravascar volume
hypo Na - water retention, decrease intravascular volume, incr Antidiuretic
Serum Ca may be low ( hypoalbuminemia), ionized is normal
Hypo
45
NS treatment
Idiopathic
- prednisone is first line treatment
- starting dose 60 mg/m2/day( 2 mg/kg/day, BID) for 6 weeks, followed by
- 40 mg/m2/day ( 1.5 mg/kg/day) bid 4 weeks
46
NS single best predictor if long term prognosis
- reaponse to prednisolone therapy
| -
47
NS , poor prognosis
- no repaonse to prednisolone
- age ( <1 year)
- histology ither than min change disease
48
Diff diag of NS
- GN , gross hematuria , proteinuria, hypertension, azotemia
( albumin, renal function test, complement levels will help to diff)
- seasonal allergies ( periorbital swelling)
49
when renal us in Ns?
when renal vein thrombosis is suspected as a complication of NS
50
Lemierre syndrome
Jugular vein septic thrombophlebitis
MC mio Fusobacterium neceophorum
can lead to pulm emboli— resp manifest
classically ass with antecedent pharyngitis, head and neck infr, dental and otic inf
51
Jugular vein septic theombophlebitis
Jugular vein septic thrombophlebitis is the pathohnomoci feature of Lemire syndrome
mainly caused by fusobacterium which is anaerobic bacteria in human oral cavity and G.I. GU tract
52
 Anti-microbial agents with an anaerobic activity
```
Amoxicillin clavulanate
piperacillin tazobactam
cefoxitin
meropenem
clindamycin
metronidazole
bacteroid fragilisncan be resistant to cefoxitin and clindamycin
(Intra-abdominal infections metronidazole, pip/tazo plus gram-negative activity or meropenem)
```
53
The predominant pathogen of Lemoerre disease
```
Fusobacterium Lemierre syndrome
clostridium perfringens intestinal tract
bacteroid fragilis : colon
Prevotella species oral cavity.
Who is a bacterium linear
```
54
Hematopoietic stem cell transplant and H influenza vaccine
After stem cell transplant regardless of age and vaccin status 3 dose
55
children who dont receive H inf vaccine
- Younger than 6 weeks
| - those receiving radio or chemotherapy - those with severe allergic reaction two vaccine
56
< 24 mo and have contracted invasive HiB and had primary series.
vaccination ?
- Should receive primary series (they don’t produce adequate levels of antibody )
- start after one at least one month of the disease
57
splenectomy and HiB vaccine
A child of any age undergoing splenectomy should receive a vaccine at least two weeks before the procedure if previously incompletely immunized
58
HiB vaccine types
```
For vaccines against him are currently available in the US
- 3 monovalent vaccine
. hiberix
. acthib sanofin
. pedvaxhib glaxo 2 dose series
- 1combination vaccine
. pentacel
```
59
Previously unvaccinated children aged more 60 or up months who are not considered high risk hib
do not require catch up vaccine
60
high risk group
12-59 months
HiB vaccine ?
unimmunized or received 0 or 1 dose before age 12 mo— 2 doses, 8 wks apart
received 2 or more dose before 12 months — 1 dose 8 wks after last dose
if completed a primary seriws and recwived booster dose - no add doses
61
MCL sprain treatment
usually with bracing anf rehabilitation
62
Valgus test
Test the integrity and potential injury structures along the medial aspect of the knee this test is performed with a patient supine you start off by lifting the leg off the table using both hands the palm should be placed across the lateral aspect of the knee joint starting with the knee in full extension you’re gonna push across that knee joint and then you’re going to gradually put the knee into increasing angles of flexion until about 30° a positive alga stress test is noted by pain and laxity over the medial aspect of the knee
63
Lackman test
performed with the patient lying supine and the knees flexed to about 15° to 25° of flexion . the thigh is stabilized with the left hand of examining the right knee and the right hand stabilizes the tibia proximately again in about 15° of flexion with the stabilization force on the thigh there is a force poured anteriorly on the right hand well stabilizing the die in a firm or solid in point is felt in this patient with a firm ACL there that we’re gonna demonstrate on the injured side evaluation allotment so we’re going to reverse our hands so now the right hand stabilizes the thigh well the left side of the inner hand comes out on the tibia again about 15° of flexion here and
64
Ottawa knee rules
Validated screening tool designed to minimize unnecessary radiographs in patient presenting with a cute knee injury
radiographs should be obtained
- isolated tenderness of the patella
- tenderness at the head of the fibula
- inability to flex to 90°
- inability to bear weight for four steps
65
Treatment of suspected MCL injury
1. minimize swellin
- ice apply 10-15 mins 3-4x
- elastic compression applied to the knee and worn at all times while the awake
2. stabilize the injured ligament
- use of a hinged brace
- significant pain at night may choose to wear the brace at night
3. begin active rehabilitation
- encourage to ride the stationary bike or perform flutter kicks In the pool
4. Return to play show demonstrate full and pain-free range of motion. Strength normal gate before beginning of progressive return to sports activity
66
knee pain with ability to complete practice and the lack of a joint effusion
inconsistent with ACL injury maybe MCL injury
67
Knee injury when to get MRI
Suspected meniscus injury
68
Stickler syndrome
```
Connective tissue disorder m
mid facial hyperplasia
cleft palette
pierre robin sequence
hearing loss
eye abnormalities (high grade myopia cataracts increased risk for vitreous abnormalities, retinal detachment)
skeletal abn
```
69
Pierre robin sequence
```
Clinical constellation of
micrognathia
cleft palate
Glossoptosis
obstructive apnea and feeding difficulties in infant
```
70
Pierre Robin syndrome types
- Isolated
- PRS-Plus
Additional congenital malformations
- syndromic PRS
In association with a defined the genetic disorder
Most common genetic disorders associated with PRS
- 22q11.2
- Stickler
- Treachler Collins
71
Arrhythmias
1 tachy or brady
2 wide or narrow complex QRS
3 regular or irregular
72
narrow complex regular tachyAr
1. SVT
- AV nodal reentrant tachycardia
- orthodromic reciprocating tachycardia
2. atrial flutter
3. atrial tachycardia
73
wide complex regular tachyacardia
ventricular tachycardia
| SVT airh aberrancy
74
narrow complex irregular
atrial fib
75
wide complex irregular arrhythmias
ventricular fib
76
types and ex of tachycardias
```
1 narrow complex regular
- attial flutter
- SVT
—-orthodromic reciprocating tachycardia
—- AV nodal reentrant tachycardia
```
2. Narrow complex irregular
- Atrial fib
3. Wide complex regular
- Ventr tach
- SVT with aberrancy
4. Wide complex irreg
- Ventr fib
77
Obesity and screening for diabetes
| Risk factors
- Family history of DM 2 in first or second-degree relative
- high risk race ethnicity
- signs of insulin resistance in PE
- Maternal history of diabetes or gestational diabetes
start at 10 y
78
Otalgia causes
- intrinsic ( otogenic)
Otitis media Otitis externa
impacted cerumen
eustachian tube dysfunction abscesses foreign bodies in the ear canal
```
- extrinsic ( non otogenic)
Sensory innervation from the same nerve
Dental Caries
impacted teeth
abscesses
teething
```
79
Variables associated with the risk of post splenectomy sepsis
Reason for the splenectomy
- hematologic disorder
the patient age at the time splenect
- young
amount of time since splenectomy
- Recent
80
Post splenectomy sepsis causes
```
strep pneumo
HiB
Neiserria meningitidis
E coli
staph aureus
```
81
Prevention of post splenectomy sepsis
- Prophylactic antibiotics to
. younger than 5 years
. within 2 years postsplenectomy
. already experienced post/spl sepsis
- empiric broad spectrum parenterak AB when fever or severe illness w/o fever
- immunization - pneumo , HiB, meninngo
82
neuroaninidase inhibitors for flu infection
1. Oseltamivir oral , preferred
2. zanamivir, inhaled, for pt who can inhale the powder and no pulm dz
3. peramivir, IV
adamantane drugs, amantadine and rimantadine , not recommended — high level do resistance in influenza A viruses
83
rapid antigen testing for flu, SN
low and variable SN (20-90 %)
| if high risk pt and flu was suspected better start antiviral (oseltamivir) than rapid antigen testing, given SN
84
high risk for influenza comolications
| recommended for antiviral Rx of suspected or confirmed Flu
children < 5 yrs esp < 2 yrs
adults 50 and above
on immunosupp ( HIV meds)
pregnant, postpartum during flu season
< 19 yrs and on long term aspirin therapy
american Indian or Alaskan native
people people with extreme obesity BMI more than 40
residence of nursing homes and other chronic care facilities
hospitalized patient the terrace coffee influenza complications
people with chronic pulmonary cardiorenal hepatic your mother metabolic disorder neurologist Nuro developmental conditions stroke intellectual disability moderate to severe developmental delay muscular dystrophy your spinal cord injury
85
infant with ams, increased minute ventilation, neuro findings
no signs if infection
think of increased ICP (abusive head trauma)
| subdural hematoma
86
subdural hematoma
CT creacentic pattern
does not cross midline
tearing if bridging veins
( drain brain prenchyma to the cerebral venous sinuses)
increased ICP may present as resp distress — incr minute vent — less CO2 —- to decrease ICP
high suspicion dor child abuse when ams vomiting tachypnea
87
EDH
```
blood between periosteum and dura
CT lenticular pattern of density
does not cross sutures
mech blunt force to the temporal bone
middle meningeal artery
lucidity period
uncal herniation— 3 rd nerve palsy
(ipsilateral dukated and unresp pupil)
```
88
hoarseness in children
acute and chronic
acute
- mcc viral infection
- trauma, inflammation
```
chronic
- voice abuse ( mcc)
- steuctural anomaly
—— local ( vocal cord cyst, webs, cleft)
—— neuro ( Laryngeal nerve damage, CNS lesion)
- allergy
- G reflux
- h/o airway intubation
- local trauma
```
89
neonate with low grade fever, mild tremor, facial excoriations
- may be NAS ( opiate withdrawal synd)
- begins 3 day after birth when on long acting opiate ( methadone)
- path - stim of myu rpts on cortex
90
NAS clinical
```
generalized tremor
irritability
frequent loose bowel movements
low grade fever
facial excoriation
```
91
girl with polyuria, tachycardia, wt loss, lack if ur sx
| next step ?
glucose and lites ( DM1)
- gluc > 200 diagnostic
- bucarb - for acidosis and DKA
92
DKA
- plasma gluc > 200 mg/dL
- venous PH less than 7.3
- bicarb less than 15 mmol/L
- ketonemia plus ketonuria
93
infant 4.6 kg and heart failure
standard formula
how much milk?
```
HF kids. 140 kcal/kg/day
wt is 4.6 = 140x4.6 = 644 kcal/day
st formula 20 kcal per oz
to make 644 kcal/day to oz/day 644:20 = 32 oz/day
gonna take every 3 hrs ( 8x)
32/8= 4 oz every 3 hrs
```
94
myasthenic crisis
involvement of respiratory mm in MG
| requires resp support
95
RX of MG
1. Puridostigmine sx
2. immunimodulation ( CS, mogetil, azathiopine)
3. IVIG or Plasma ex for exacerbation and crisis
96
major classess of meds that can worsen weakness in MG
Aminoglycosides
fluroquinolones
magnesium
BB
97
blunt andominal trauma
E- Fast ( extended Fast)
suprapubic area, hepatorenal recess, splenorenal recess, subxiphoid view of the heart, sono of lung
- CT if fluid is seen on Fast
Hemo unstable - irrespective kf the FAST exam diagnostic laparotomy
98
C difficile rx
mild moderate
- oral metro ( 30 mg/kg/day) Q6H, 10 days or
- IV metro an alternative option
severe initial
- oral vanco (40mg/kg/day) Q6H 10 days
for initail episode
severe complicated
- oral vanco + IV metro
Pr w/ abdominal distrntion/ileus/ toxic colitis/
- vsnco enema Q8H 1
recurrence first
- same AB regimen
Recurrence addiyionsl
- oral vanco treatment dose followed by pulsed or tapered dosing regimen
- no metro for second recurrence ( concern for neurotoxicity)
