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Peds > BRS Ch. 6-10 > Flashcards

BRS Ch. 6-10 Flashcards

1
Q

What is a normal growth rate for kids between 3 yo and puberty?

A

2 inches per year

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2
Q

What are two subsets of pathologic short stature?

A

Proportionate (normal U/L ratio) and disproportionate (abnormal U/L ratio)

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3
Q

What are the two main causes of disproportionate short stature?

A

Ricket’s and congenital skeletal dysplasias

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4
Q

What tests should be initiated for pathologic short stature?

A

CBC, ESR, T4, serum Ca/PO4, IGF-1. X-ray imaging.

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5
Q

What are some causes of growth hormone deficiency?

A

Brain tumors (craniopharyngioma), autoimmune, trauma, CNS defects

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6
Q

How is precocious puberty defined?

A

Girls: breast development/pubic hair before 7 yrs, menarche before 9 yrs
Boys: testicular changes, penile enlargement, pubic hair before 9 yrs

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7
Q

What are the two main categories of precocicous puberty and how are they different?

A

Central: early activation of hypothalamus, leads to high FSH/LH, high sex steroids
Peripheral: high sex steroids w/o activation of hypothalamus, no response to GnRH stimulation testing, INDEPENDENT OF HPGA

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8
Q

What are two categories of delayed puberty?

A 
Hypogonadotropic hypogonadism (low LH/FSH)
Hypergonadotropic hypogonadism (high LH/FSH)
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9
Q

How do the two male fetal hormones cause male sexual differentiation?

A

Testosterone (by Leydig): development of wolffian ducts, DHT stimulates masculinization of male genitalia
Anti-mullerian hormone (by Sertoli): inhibits development of the mullerian (female) structure

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10
Q

What is the difference between Cushing syndrome and Cushing disease?

A

Both are causes of hypercortisolism. Cushing syndrome occurs with adrenal tumors. Cushing disease occurs with pituitary tumors (excessive ACTH). Test with a dexamethasone suppresion test.

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11
Q

What distinguishes hypercortisolism from obesity?

A

Hypercortisolism has growth impairment and delayed bone age, whereas obesity has normal to fast growth and advanced bone age.

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12
Q

What two haplotypes and what antibody are associated with Type I diabetes?

A

DR3 or DR4 and Islet cell antibodies

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13
Q

Why do Type 1 diabetics see a “honeymoon” period (reduction in insulin reqs)?

A

Transient recovery of residual islet cell function, resulting in endogenous release of insulin

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14
Q

How is the Somogyi phenomenon treated with Type 1 diabetics?

A

Somogyi - large nighttime dose of insulin causes AM hypoglycemia and subsequent endogenous AM glucose production/release, leading to high blood glucose.
Tx: REDUCE nighttime dose of insulin

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15
Q

How is diabetic ketoacidosis (DKA) defined?

A

Hyperglycemia > 200mg/dL, serum bicarbonate level < 7.30

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16
Q

What are common lab findings in DKA, and how is it treated?

A

Anion gap metabolic acidosis, hyperglycemia/glucosuria, ketonemia/ketonuria, hyperkalemia
Tx: fluid/electrolyte therapy w/ isotonic saline, gradual decline in osmolarity (to prevent cerebral edema), potassium repletion, regular insulin

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17
Q

What are three signs of hypothyroidism?

A
  1. ) Subotimal growth velocity
  2. ) Goiter
  3. ) Myxedema
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18
Q

What are four etiologies of congenital hypothyroidism?

A
  1. ) Thyroid dysgenesis
  2. ) Thyroid dyshormonogenesis
  3. ) PTU during pregnancy
  4. ) Maternal AI thyroid disease
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19
Q

What are two lab tests conducted for the two autoimmune thyroid disorders?

A

TSH/T4
Hashimoto’s: high TSH, low T4
Graves: low TSH, high T4

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20
Q

Tetany and seizures along with a prolonged QT interval can signal what endocrine disorder?

A

Hypocalcemia

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21
Q

What are risk factors for the disease that is caused by a deficiency of Vitamin D?

A

Rickets. Risk factors include exclusively breast-fed infants with minimal sunlight, anticonvulsants, renal/hepatic failure

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22
Q

What are three forms of Rickets and what is the most common form?

A

Vitamin-D dependent (enzyme deficiency)
Vitamin-D resistant (most common, renal tubular phosphorus leak, typical bowing of legs)
Oncogenous (bone pain/myopathy)

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23
Q

Diabetes insipidus is characterized by an insufficiency or unresponsiveness to what hormone? And how does it present?

A

Anti-diuretic hormone. Central DI = lack of ADH. Peripheral DI = unresponsiveness.
Hypernatremic dehydration and inappropriately dilute urine (remember, DI = inability to concentrate urine). Give DDAVP.

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24
Q

What four etiologies must be considered on the differential for hypoglycemia

A

Ketotic hypoglycemia, ingestions, inborn errors of metabolism, hyperinsulism

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25
Q

What is the epidemiology of fever in infants <3 months?

A

3-10% of well-appearing infants, 17% of toxic-appearing infants have serious bacterial infections

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26
Q

What criteria are used to hospitalize infants between 1 and 3 months that present with a fever?

A

Infants 1-3 months should be hospitalized if they have any of the following:

  1. ) toxic appearance
  2. ) suspected meningitis
  3. ) pneumonia, pyelonephritis, bone/soft tissue infections
  4. ) uncertain outpatient care and follow-up
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27
Q

What are two common causes of fever in children 3-36 months?

A
  1. ) Strep pneumoniae (most common)

2. ) H. flu type B (HIB)

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28
Q

When is the highest incidence of bacterial meningitis?

A

During the first month of life

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29
Q

What are some clinical features of bacterial meningitis?

A

Bulging fontanelle (infants), alteration in consciousness, nichal rigidity (Kernig and Brudzinski signs), seizures, photophobia, emesis

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30
Q

What is the empiric treatment of bacterial meningitis?

A

Antibiotics, corticosteroids (to reduce risk of hearing loss)\

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31
Q

A patient that presents with low-grade fever, rhinorrhea, cough and sore throat likely has…

A

Viral URI

32
Q

What are the three most common etiologies of sinusitis? (3 bugs)

A

Strep pneumoniae, H. flu, M. catrrhalis (look for nasal discharge AND cough, with headache and low-grade fever)

33
Q

What are common viral and bacterial etiologies of pharyngitis?

A

Viral: similar as URI (rhino, parainflu, corona, RSV)
Bacterial: Group A strep (STREP THROAT)

34
Q

What distinguishes bacterial from viral pharyngitis?

A

Lack of URI symptoms, fever, scarlatiniform rash (scarlet fever)

35
Q

What are the three cardinal symptoms of otitis media? And the one sign needed to dx?

A

Fever, ear pain, decreased hearing. Identification on fluid in the middle ear space. Treat with amoxicillin

36
Q

What is the difference between unilateral and bilateral parotitis?

A

Unilateral: bacterial (staph, strep, myco tuber)
Bilateral: MUMPS

37
Q

What are four complications of GABHS infections?

A
  1. ) glomerulonephritis
  2. ) rheuamatic fever
  3. ) post-streptococcal arthritis
  4. ) PANDAS
38
Q

What are some classic symptoms of infectious mono?

A

Fever, malaise, pharyngitis, posterior cervical lymphadenopathy, hepatosplenomegaly

39
Q

What are some compications to be aware of for infectious mono?

A 
Neurologic complications
Upper airway obstruction
Amoxicillin-associated rash (GABHS mis-diagnosis)
Splenic rupture
Malignancy
40
Q

I say measles. You think:

A 
3 C's: cough, coryza, conjunctivitis
Koplik spot (gray papules on buccal mucosa)
41
Q

There are three common innocent heart murmurs. What are they, where are they heard and what are their characteristics?

A
  1. ) Still’s murmur: LLSB, thought to be LVOF, twanging/vibratory
  2. ) Pulmonic systolic murmur: ULSB, blowing, high-pitched
  3. ) Venous hum: turbulence at junction of R jugular and subclavian veins, disappears if supine, changes with neck flexion/extension
42
Q

How and why is acyanotic congenital heart disease treated?

A

Closure by heart surgery to prevent right-sided heart failure, pulmonary HTN, atrial dysrhythmia and paradoxic embolism.

43
Q

Why are ASDs, VSDs, PDAs, coarctations and aortic and pulmonic stenoses considered acyanotic?

A

There is left to right blood flow, so there is no admixture of deoxygenated blood into the systemic circulation.

44
Q

What providees perfusion of the lower abdomen and descending aorta in the setting of severe coarctation?

A

A patent PDA. Symptoms of CHF develop and progress as the PDA closes. The PDA can be maintained with prostaglandin E (PGE).

45
Q

Where are peripheral and central cyanosis visualized?

A 
Peripheral = vasomotor instability, vasoconstriction (cold temperature)
Central = tongue and inner mucous membranes, cardiac and non-cardiac causes
46
Q

What are the five most common causes of central cyanotic congential heart disease?

A

Tetralogy of Fallot (look for a squat)
Transposition (requires site of mixing)
Tricuspid atresia (ASD/PFO is always present, tx with Fontan procedure)
Truncus arteriosus
Total anomalous pulmonary venous connection (PV goes to systemic circulation, O2 blood is just recycled)

47
Q

What group of bacteria are most commonly responsible for bacterial endocarditis?

A

Gram-positive cocci

48
Q

What is the most common cause of pericarditis in children?

A

Viral infection

However, purulent pericarditis is most commonly caused by bacterial infection and can lead to tamponade

49
Q

What are the three types of cardiomyopathy in children?

A 
Dilated
Hypertrophic (assymetric hypertrophic septum, autosomal dominant)
Restrictive (amyloidosis, infiltrative disorders)
50
Q

What are the two types of SVT, which is the most common dysrhythmia of childhood?

A

AVRT: retrograde conduction through an accessory pathway leads to SVT
AVNRT: cyclical conduction within the AV node itself

51
Q

What are the five categories of chest pain etiologies?

A 
Cardiac (pericarditis)
Gastrointestinal (GERD)
Respiratory
Musculoskeletal
Psychological
52
Q

How will a case of HIB or GABHS epiglottitis present?

A

High fever
Muffled speech
Dysphagia
Sitting forward in tripod position

53
Q

What are the two forms of croup (inflammation and edema of subglottic space)?

A

Viral croup (most common cause of stridor, M:F 2:1)
Spasmodic (caused by hypersensitivity to antigen)
tx: cool mist

54
Q

What is the difference between bronchiolitis and pneumonia?

A

Bronchiolitis is inflammation of the bronchioles themselves, whereas pneumonia is inflammation of the lung parenchyma.

55
Q

Pertussis is characterized by 3 stages. What are they?

A
  1. ) Catarrhal stage (1-2 wks)
  2. ) Paroxysmal stage (2-4 wks)
  3. ) Convalescent stage (wks to mos)
56
Q

What long-term sequelae of RDS leads to oxygen dependency beyond 28 days of life?

A

Chronic Lung Disease (CLD) or Bronchopulmonary Dysplasia (BPD). Note that symptoms of CLD diminish over time.

57
Q

What should always be considered for a child 3mo-5yrs with chronic respiratory problems?

A

Foreign body aspiration

58
Q

Short gut syndrome, which can be caused congenitally or iatrogenically, manifests with what symptoms?

A

Steatorrhea, dehydration, hyponatremia, hypokalemia. Tx: TPN

59
Q

What is the primary caused of GERD in childhood, and what else plays a role?

A

Transient Lower Esophagesal Sphincter Relaxation (TLESR) and gastric emptying delay.

60
Q

What is the gold standard for diagnosis of GERD?

A

pH probe measurement. Continuous monitoring for at least 18 hours, and results are correlated with clinical presentation.

61
Q

How can GERD be treated?

A
  1. ) Positioning, thickening of feeds, acid inhibition
  2. ) Motility agent (increase gastric emptying): metoclopramide
  3. ) Surgery
62
Q

What are five obstructive GI disorders (which all have male predominance) that can result in vomiting?

A

Hypertrophic pyloric stenosis (first-born white males, nonbilious, PROJECTILE)
Malrotation (bilious, sudden onset of pain)
Atresia (duodenal = double bubble, jejunal)
Intussusception (ileocolic, coil spring on contrast enema)
Hirschsprung’s

63
Q

What’s the difference between the two types of malnutrition, marasmus and kwashiorkor?

A

Marasmus - low-energy intake and all types of energy deficiency, occurs <1yo
Kwashiorkor - normal energy intake but low protein, leads to edema

64
Q

What is the course of symptoms when a child of 10-12 years presents with acute abdominal pain?

A

Pain first (peri-umbilical then RLQ), then vomiting, then fever. Perforation occurs in 36-48 hours without treatment

65
Q

Though pancreatitis is uncommon in children, what are the two most common causes?

A

1.) Trauma
2.) Idiopathic
Look for Gray-Turner or Cullen signs (bluish discolorations), elevated serum amylase/lipase

66
Q

Acute cholecystitis, which presents with RUQ pain and Murphy’s sign, is predisposed by what three conditions?

A

Sickle cell disease, cystic fibrosis or prolonged TPN therapy.

67
Q

When a child presents with constipation or encopresis, what should you think of first?

A

Functional causes.

Organic causes include Hirschsprung’s, low-fiber, systemic disease (dehydration, hypothyroidism, CF)

68
Q

How are the two main types of IBD (UC and Crohn’s) diagnosed and managed?

A
  1. ) Dx: labs, stool studies, US/CT, biopsy

2. ) Tx: Sulfasalazine, corticosteroids, immunosuppressives, metronidazole

69
Q

How is occult blood in the stool identified?

A

Positive guaiac testing, which tests for the peroxidase activity of hemoglobin

70
Q

How does age help in diagnosing the etiology of newborns?

A

Newborn: necrotizing enterocolitis

Beyond infancy: juvenile polyps (most common!)

71
Q

When evaluating hepatic injury/disease, what three hepatocellular and two biliary enzymes should you evaluate?

A

HC: 1.) AST, ALT, LDH
Biliary: 1.) alkaline phosphatase 2.) GGTP and 5NT

72
Q

Elevation of what suggests cholestatic disease, and what differential is generated?

A

Prolonged elevation of direct bilirubin.

Etiologies: infections, metabolic derangements, extra/intrahepatic obstructions, A1AT

73
Q

What are three common cholestatic diseases of infancy?

A
  1. ) neonatal hepatitis: idiopathic hepatic inflammation, tx: urso
  2. ) biliary atresia: progressive fibrosclerotic disease, polysplenia,tx: re-establish bile flow
  3. ) Alagille syndrome: paucity of intrahepatic bile ducts, pruritis, multiorgan involvement
74
Q

What are the two most common viral hepatitis agents?

A
  1. ) HepA: fecal-oral, most common, 2-6 wk incubation, mostly asymptomatic, IgM and ALT rise first then IgG
  2. ) HepB: blood/vertical exposure, long incubation, rare symptoms, look at surface antigen/Ab, e antigen/Ab, core Ab IgM/IgG
75
Q

How are the two types autoimmune hepatitis identified?

A

Type 1: ANA or ASMA (anti-smooth muscle antibody)
Type 2: anti-liver antibodies
In both cases, look for elevated serum transaminases, hyperIgG, circulating autoantibodies

Peds (6 decks)

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