2014-03-07 USMLE peds - USMLE peds Flashcards Preview

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Flashcards in 2014-03-07 USMLE peds - USMLE peds Deck (500):
1

What should you do if birth screening test is positive

order a confirmatory test

2

Most states screen for what at birth?

- hypothyroidism
- phenylketonuria
- galactosemia
- sickle cell disease

3

Cow's milk should not be given before age

1 year

4

Hot water should be less than

110-120F

5

Start introducing solid foods at age

6 months

6

Head circumference should be measured routinely until what age

2 years

7

2 major causes of increased head circumference

- hydrocephalus
- brain tumor

8

TORCH infections =

Toxoplasmosis
"other": syphilis and viruses
Rubella
CMV
HSV

9

What percentage of childhood obesity is due to organic causes like cushings?

5%

10

Define failure to thrive

growth below 5th percentile for age

11

Most common case of failure to thrive

psychosocial reasons

12

Hearing screening should be done

- at birth
- every 2 years from 4 years old to adolescence

13

Vision should be screened

every few years starting at age 3

14

Absent red reflex may be sign of

CATARACTS
- congenital rubella
- other TORCH infections
- galactosemia
RETINOBLASTOMA

15

When is lazy eye normal

never, if persistant; may be occational until 3 months of age

16

2 infections classically associated with hearing loss

- meningitis
- recurrent otitis media

17

Who should always get iron supplements?

pre-term breastfed babies

18

First step in lead poisoning

stop the exposure

19

Classic behaviors/situations for lead poisoning

- eating paint chips
- living by battery recycling

20

Concerning lead level

if >10 ug/dl need close f/u

21

Treatment of severe lead poisoning

succimer or DMSA (chelation therapy)

22

First dentist appointment by age

3 years

23

Do you need to supplement fluoride?

no, almost always in the water

24

When should you start Vit D supplements?

6 months

25

High risk for INFANTS for Vit D defeciency

- inadequate maternal intake
- little sun
- exclusive breast feeding after 6 months

26

Screening for TB

only in high risk area or immigrant
- at 4-6 years AND
- at 11-16 years

27

Timing of Hep B vaccine

3 doses:
- 0-1 month
- 1-4 months
- 6-18 months

28

Timing of DTP vaccine

5 doses:
- 2 months
- 4 months
- 6 months
- 15-18 months
- 4-6 years
AND Td booster every 10 years

29

Timing of HiB vaccine

4 doses:
- 2 months
- 4 month
- 6 month
- 12-15 months

30

Timing of polio vaccine

4 doses:
- 2 months
- 4 months
- 6 months
- 4-6 years

31

Timing of MMR vaccine

2 doses:
- 12-15 months
- 4-6 years

32

Timing of pneumococcus vaccine

4 doses:
- 2 months
- r months
- 6 months
- 12-15 months

33

Timing of varicella vaccine

1 dose:
- 12-18 months

34

Avoid MMR vaccine in

- egg allergy
- neomycin allergy
- immunodeficiency (HIV ok)

35

If mom has Hep B, at birth give

both Hep B vaccince and immune globulin

36

Avoid polio vaccine in

- neomycin or streptomycin allergy

37

Avoid varicella vaccine in

- neomycin allergy
- immunodeficiency

38

What peds populations should (especially) get influenza vaccine?

- 6+ mo old with immunodefeciency
- severe heart/lung disease
- chronic ASA therapy

39

What peds populations should get pneumococcus vaccine?

If older than 2 years give if:
- immunodefeciency
- asplenic
- sickle cell disease

40

Screening test for sexually active female teens

- PAP smear
- GC/Chlamydia

41

Peds screening for urinary malformations is indicated when? What is test of choice?

- boys: 1st UTI if less than 6 years
- girls: 2nd UTI if less than 6 years
* use voiding cystourethrogram or renal US

42

When are Apgars done?

1 and 5 min (1 minute meaning immediately)

43

General categories of for Apgar

each with 2 points:
- HR
- Respiratory effort
- Muscle tone
- Color
- Reflex irritability

44

Apgar for HR

0- absent
1- less than 100
2- more than 100

45

Apgar for respiratory effort

0- no cry
1- weak cry
2- strong cry

46

Apgar for muscle tone

0- limp
1- some flexion
2- active motion

47

Apgar for color

0- blue all over
1- pink body, blue extrem
2- pink all over

48

Apgar for reflex irritabilty

0- none
1- grimace
2- grimace and strong cry/cough/sneeze

49

Important number on Apgar

resustitate/monitoring or to ICU until Apgar above 7

50

If only one umbilical artery is present, look for

renal malformations

51

At birth check the umbilical cord for

- 2 arteries
- 1 vien
- absence of urachus

52

swelling of scap at birth that crosses the midline =

caput succedaneum, benign

53

True or false: cephalohematomas from birth trauma do not cross the midline

true

54

What eval needs to occur with cepahlhematomas

- usually benign but may indicate underlying skull fracture, consider x-ray

55

Time course of cavernous hemangioma

- noticed a few days after birth
- increases in size then rapidly resolves within few years

56

Treatment of cavernous hemangioma

nothing, just wathc

57

Anterior fontanelle closes by

18 month

58

4 causes of delayed anterior fontanelle closure

- hypothyroidism
- hydrocephalus
- rickets
- IUGR

59

Moro reflex disapears at

6 months

60

Palmar grasp reflex disappears by

6 months

61

In premature infants, subtract the time for developmental milestone up until what age?

2 years

62

Age for social smile

1-2 months

63

Age for cooing

2-4 months

64

Age for lifts head to 90 degrees when prone

3-4 months

65

Age for rolls front to back

4-5 months

66

Age for voluntary grasp (no release)

5 months

67

Age for stranger anxiety

6-9 months

68

Age for sitting no support

7 months

69

Age for pulls to stand

9 months

70

Age for pat-a-cake

9-10 months

71

Age for first words

9-12 months

72

Age for imitates others' sounds

9-12 months

73

Age for voluntary grasp and voluntary release

10 months

74

Age for waves bye'bye

10 months

75

Age for separation anxiety

12-15 months

76

Age for walking

13 months

77

Age for build tower of 2 cubes

13-15 months

78

Age for understands 1 step command

15 months

79

Age for good use of cup and spoon

15-18 months

80

Age for runs well

2 years

81

Age for build tower of 6 cubes

2 years

82

Age for ties shoe laces

5 years

83

Average age of puberty for girls

10.5

84

Average age of puberty for boys

11.5

85

First event for male puberty

testicular enlargement

86

First event for female puberty

breast development

87

Tanner stage is based on what?

* pubic hair for both
- boys: testicular and penile growth
- girls: breast growth

88

Definition of delayed puberty in boys

No testicular enlargement by 14 years old

89

Definition of delayed puberty in girls

No breast or pubic hair by 13 years old

90

Most common cause of delayed puberty

constitutional delay (normal variant)

91

Most common cause of precocious puberty

idiopathic

92

McCune-Albright syndrome =

girls with:
- cafe'au'lait spots
- fibrous dysplasia
- precocious puberty

93

girls with:
- cafe'au'lait spots
- fibrous dysplasia
- precocious puberty

McCune-Albright syndrome

94

Causes of precocious puberty

- McCune-Albright syndrome
- ovarian tumors
- testicular tumors
- CNS disease/trauma
- adrenal neoplasm
- congenital adrenal hyperplasia

95

Congenital adrenal hyperplasia in boys is usually

21-hydroxylase deficiency

96

Congenital adrenal hyperplasia in girls usually causes

ambiguous genitalia

97

Risk of precocious puberty

premature closure of epiphyseal plate

98

Treatment of otherwise untreatable precocious puberty

GnRH agonists

99

Boys with recurrent nose bleeds and blood dyscrasia =

nasopharyngeal angiofibromas

100

Most common cause of nosebleeds

trauma

101

Fever, anemia and nosebleed =

leukemia

102

Rate of African Americans heterozygous for sickle cell in US

8%

103

Diagnosis of sickle cell disease

blood smear with sickles, high retic count; Hb electrophoresis

104

Aplastic crisis in sickle cell, look for

parvovirus B19

105

Look for this site problem in sickle cell with bone pain

osteonecrosis of femoral head

106

Renal complication of acute sickle cell crisis

papillary necrosis

107

When do symptoms of sickle cell start?

around 6 months (this is when adult Hb production starts)

108

When are antibiotics given in sickle cell prophylactically

From diagnosis until age 5 years

109

Classic presentation of sickle cell anemia in children

dactylitis (hand-foot syndrome)

110

Biggest key points for HUS

- children
- diarrhea

111

Biggest key points for Henoch-Schonlein purpura

- rash
- abdominal pain
- arthritis
- melena

112

Biggest key points for TTP in peds

- CNS changes
- young adults

113

Biggest key points for ITP

- antiplatelet antibodies

114

Most common age for HUS

children

115

Most common age for HSP

children

116

Most common age for TTP

young adults

117

Most common age for ITP

children or adults

118

Common previous infection for HUS

E. coli diarrhea

119

Common previous infection for HSP

URI

120

Common previous infection for TTP

none

121

Common previous infection for ITP

viral, esp in children

122

RBC count in HUS

Low

123

RBC count in HSP

Normal

124

RBC count in TTP

Low

125

RBC count in ITP

Normal

126

Platelet count in HUS

low

127

Platelet count in HSP

Normal

128

Platelet count in TTP

low

129

Platelet count in ITP

low

130

Features of peripheral smear in HUS

Hemolysis

131

Features of peripheral smear in HSP

Normal

132

Features of peripheral smear in TTP

Hemolysis

133

Features of peripheral smear in ITP

Normal

134

Kidney manifestations in HUS

- ARF
- hematuria

135

Kidney manifestations in HSP

- hematuria

136

Kidney manifestations in TTP

- ARF
- proteinuria

137

Kidney manifestations in ITP

none

138

Treatment of HUS

supportive (may need transfusion or dialysis)

139

Treatment of HSP

supportive (may need transfusion or dialysis)

140

Treatment of TTP

- Plasmaphoresis
- NSAIDs
* DO NOT give platelets

141

Treatment of ITP

- steroids
- splenectomy if meds fails

142

When do you give steroids in ITP?

- bleeding
- counts below 20-40

143

What do you NOT do for TTP

- do not give plts, they are likely to form clots

144

Constant machine like murmur in upper left sternal border

PDA

145

How do you close a PDA?

indomethacin, surgery

146

How do you keep a PDA open?

PGE 1

147

PDA is associated with

- Rubella
- high altitudes

148

Associated symptoms with PDA

- dyspnea
- possible CHF

149

Holostyolic murmur next to sternum

VSD

150

True or false: most VSDs resolve on their own?

true

151

What is the most common congenital heart defect?

VSD

152

What heart defect is asymptomatic until adulthood?

ASD

153

What heart defect often presents with palpitations?

ASD

154

What heart defect has a fixed split s2

ASD

155

Treatment of ASDs

No treatment unless very large

156

The 4 anomalies of tetrology of fallot

1. VSD
2. Right ventricular hypertrophy
3. pulmonary stenosis
4. overriding aorta

157

Most common cyanotic congenital heart defect

tetrology of fallot

158

Kids who squart after exertion likely have

tetrology of fallow

159

Upper extremity HTN =

coarctation or aorta

160

Radiofemoral delay =

coarctation or aorta

161

Systolic murmur heard over mid-upper back

coarctation or aorta

162

Heart defect with rib notching on x-ray

coarctation or aorta

163

Heart defect associated with Turner syndrome

coarctation or aorta

164

What heart defects need endocarditis prophylaxis?

All except asymptomatic secundum-type ASDs

165

What % of ASDs are asymptatic secundum-type?

80%

166

3 syndromes to think about in patient with VSD

- fetal alcohol syndrome
- TORCH infections
- Down syndrome

167

Teenager with sudden cardiac death =

hypertrophic obstructive cardiomyopathy

168

Treatment of hypertrophic obstructive cardiomyopathy

- B-blockers
- consider pacemaker placement

169

Where is fetal circulation O2 highest?

Umbilical vein

170

Where is fetal circulation O2 lowest?

Umbilical artery

171

In fetus, which has highest O2 content, blood to arms or legs?

Blood to arms

172

Resting HR over 100 is normal up to age

10 years

173

Medications that are contraindicated in obstructive hypertrophic cardiomyopathy

- positive ionotropes
- diuretics
- vasodilators

174

How does the foramen ovale close?

Increase in left-side heart pressures

175

Heart pressure changes at time of birth

- 1st breaths cause lung inflation and decreased pulmonary vascular resistance
--> increased arterial flow --> increase left sided pressures

176

What triggers closure of the ductus arteriosis?

increased O2 shuts off prostaglandin production

177

EKG finding of Wolff-Parkinson-White syndrome

delta wave

178

Delta wave on EKG =

Wolff-Parkinson-White syndrome

179

What causes symptoms in Wolff-Parkinson-White syndrome?

Transient arrhythmias conducted on accessory pathways

180

Treatment of pyloric stenosis

surgical

181

Treatment of duodenal atresia

surgical

182

Treatment of tracheoesophageal fistula

surgical

183

Treatment of Hirschsprung disease

surgical

184

Treatment of anal atresia

surgical

185

Treatment of choanal atresia

surgical

186

Presenating age of pyloric stenosis

0-2 months

187

2 month old with nonbilious projectile emesis likely has

pyloric stenosis

188

Gender predominance of pyloric stenosis

males MUCH more than females

189

"double-bubble" sign =

duodenal atresia

190

duodenal atresia is associated with this syndrom

Down syndrome

191

palpable olive shaped mass in epigastrium

pyloric stenosis

192

electrolyte findings in pyloric stenosis

- low chloride
- low potassium
- metabolic alkalosis

193

Presenting age of duodenal atresia

0-1 week

194

newborn with down syndrome and bilious emesis may have

duodenal atresia

195

Presenting age for tracheoesophageal fistula

0-2 weeks

196

1 week old with food regurgitation = concern for

tracheoesophageal fistula

197

Describe the most common variant of tracheoesophageal fistula

85% of cases have a fistula from bronchus to distal esophagus

198

CXR with NG tube coiled in esophagus and large air filled stomach is classic for

esophageal atresia

199

Age of presentation of Hirschsprung disease

0-2 years

200

2 year old with feculent emesis =

Hirschsprung disease

201

No ganglia seen on rectal biopsy =

Hirschsprung disease

202

Classic clinical features of Hirschsprung disease

- feculent emesis
- abdominal distention
- obstipation

203

Gender distribution of Hirschsprung disease

boys much more than girls

204

Presnting age of anal atresia

0-1 week; usually detected on exam in nursery

205

Gender distribution of anal atresia

boys much more than girls

206

Cyanosis with feeding that is relieved by crying =

choanal atresia; cannot pass NG tube

207

Presentation age of choanal atresia

0-1 week

208

Presenting age for intussusception

4 mo to 2 years

209

Presenting age for necrotizing enterocolitis

0-2 months

210

Presenting age for meconium ileus

0-2 weeks

211

Presenting age for midgut volvulus

0-2 years

212

Presenting age for meckel diverticulum

0-2 years

213

Presenting age for strangulated hernia

any age

214

2 GI manifestations of cystic fibrosis

- meconium ileus
- rectal prolapse

215

Current jelly stools (blood and mucus) is likely

intussusception

216

5month old with palpable sausage like mass

intussusception

217

Treatment of intussusception

air or barium enema (both diagnostic and therapeutic)

218

In what population does necrotizing enterocolitis occus?

premature infants

219

1 month old premie with fever, rectal bleeding, air in bowel wall

necrotizing enterocolitis

220

Treatment of necrotizing enterocolitis

- make NPO
- OG tube
- IV fluids
- antibiotics

221

Difference in radiographic findings in volvulus in peds vs. adults

- finding is "bird's beak" in both but..
- small bowel in peds, large bowel in adults

222

2 year old with bilious emesis, sudden onset abd pain, distention and rectal bleeding

midgut volvulus

223

Treatment of midgut volvulus

surgery

224

What is the rule of 2s for meckel diverticulum

- 2% of population
- 2 inches long
- within 2 feet of ileocolic junction
- presents in first 2 years of life

225

Meckels diverticulum usually presents with

bleeding, GI ulceration

226

Treatment of Meckels diverticulum

surgery

227

Character of emesis with strangulated hernia

bilious

228

Gender predominance of diaphragmatic heria

boys more than girls

229

Diaphragmatic hernia is more common on what side?

the left (this is Bochdalek type)

230

Bochalek is a type of

diaphragmatic hernia

231

Why is diaphragmatic hernia a problem in peds?

Can cause pulmonary hypoplasia

232

Patient presents with respiratory distress and bowel sounds in chest

diaphragmatic hernia

233

Treatment of diaphragmatic hernia

surgery

234

Prognosis in diaphragmatic hernia is based on

lung development (not on the hernia)

235

Meckel diverticulum is a remnant of

the omphalomesenteric duct

236

Features of omphalocele

- midline location
- sac with multiple abdominal organs
- no umbilical ring
- other anomolies are common

237

Features of gastroschisis

- on right side
- only small bowel exposed (no sac)
- umbilical ring is present
- other anomalies rare

238

Which process, omphalocele or gastroschisis, has the location midline

omphalocele

239

Which process, omphalocele or gastroschisis, has the location on right side

gastroschisis

240

Which process, omphalocele or gastroschisis, has the sac containing multiple abdominal organs

omphalocele

241

Which process, omphalocele or gastroschisis, has no sac and has small gowel exposed

gastroschisis

242

Which process, omphalocele or gastroschisis, has no umbilical ring

omphalocele

243

Which process, omphalocele or gastroschisis, has the umbilical ring

gastroschisis

244

Which process, omphalocele or gastroschisis, has associated anomolies

omphalocele

245

Which process, omphalocele or gastroschisis, has no associated anomolies

gastroschisis

246

Treatment of Henoch-Schoenlein purpura is

supportive

247

GI manifestations of Henoch-Schoenlein purpura

- GI bleed
- abdominal pain
- possible GI infection

248

Rash of Henoch-Schoenlein purpura is classically

on lower extremities and buttocks

249

Classic features of Henoch-Schoenlein purpura

- GI bleed/pain
- antecetent infection (URI or GI)
- swelling hands and feet
- rash on LE and buttocks
- arthritis
- hematuria/proteinuria

250

True or false: GI upset, nausea and vomiting with systemic illness is more common in kids vs. adults

true

251

Two categories of neonatal jaundice

- physiologic
- pathologic

252

First diagnostic step in neonatal jaundice

measure bilirubin (total, direct and indirect)

253

Main concern in neonatal jaundice

Kernicterus

254

What is Kernicterus

deposit of unconjugated bilirubin in the basal ganglia

255

5 classic symptoms that go with neonatal jaundice

- poor feeding
- seizures
- flaccidity
- opisthotonos
- apnea

256

Jaundice present at birth is

pathologic

257

Describe bilirubin findings in physiologic jaundice in term infant

- mostly unconjugated
- less than 12 mg/dl
- peak at day 2-5
- normal by 2 weeks

258

Describe bilirubin findings in physiologic jaundice in premature infant

- mostly unconjugated
- less than 15 mg/dl
- normal by 3 weeks

259

How common is physiologic jaundice?

- 50% of newborns
- higher in premature infants

260

6 general categories of pathologic jaundice in newborn

- breast milk
- illness
- hemolysis (Rh incompatibility)
- metabolic
- biliary atresia
- medications

261

Features and treatment of neonatal jaundice from breast milk

- bilirubin peaks 10-20 at 2-3 weeks of age
- hold breast milk until resolved

262

How does illness effect neonatal jaundice?

- prolong the jaundice
- lower threshold of kernicturis
* the youngest sickest infants are the most at risk

263

4 classic illnesses associated with higher risk of kernicteris in neonatal jaundice

- sepsis
- hypothyroidism
- liver disease
- cytic fibrosis

264

List 4 examples of metabolic causes of neonatal jaundice

- high uncojugated bili:
* Criggler-Najjar (very high)
* Gilbert (mildly high)

- high conjugated bili:
* Rotor disease
* Dubin-Johnson disease

265

Newborn presents with jaundice and clay colored stools

biliary atresia

266

Treatment of biliary atresia

surgery

267

Risk of sulfa drugs in newborns

- kernicterus
(sulfa drugs displace bilirubin from albumin)

268

Treatment of unconjugated hyperbilirubinemia in the neonate

- phototherapy
- last resort is exchange transfusion (bili over 20 or phototherapy failed)

269

Babies with ambiguous genitailia are usually _____ and 90% have _____

- girls
- 21-hydroxylase deficiency

270

Ambiguous genitalia often also has

adrenal insuffeciency

271

Female child with "bunch of grapes" from vagina

- sarcoma botryoides (malignant)

272

Newborn with ambiguous genitalia, hyponatremia, kyperkalemia and hypertension

adrenogenital syndrome

273

This hormone is elevated in adrenogenital syndrome

17-hydroxyprogesterone

274

Treatment of adrenogenital syndrome

steroids and IV fluids to prevent death

275

Boys with 21-hydroxylase deficiency experience

perecocious sexual development

276

Most vaginitis in peds is

nospecific/physiologic

277

Causes of pediatric vaginitis to look for on boards

- foreign body
- sexual abuse
- candida as presentation of diabetes

278

Vaginal bleeding in the neonate

- usually from withdrawl from maternal estrogen
- resolves in a few days

279

Most common primary immunodeficiency

IgA deficiency

280

What should you look for in patient with frequent respiratory and GI infections?

IgA deficiency

281

What should you look for if patient has anaphylaxis with immunoglobulin exposure?

IgA deficinecy

282

What therapy should be avoided in patients with IgA deficiency?

immunoglobulins

283

X-linked agammaglobulinemia is also known as

Bruton agammaglobulinemia

284

6 month old boy with Strep infections, low B-cells

Bruton agammaglobulinemia (x-linked)

285

Features of X-linked agammaglobulinemia

- X-linked recessive, so seen in boys
- low or absent B cells
- infections begin at 6 months (maternal antibodies dissapear)
- recurrent lung or sinus infections
- usually strep or HiB

286

Hypocalcemia and heart defect 24 hours after birth =

DiGeorge syndrome

287

Features of DiGeorge syndrome

- 3rd and 4th pharyngeal pouches don't form
- hypocalcemia
- tetany
- heart defects
- immunodeficiency from absent/small thymus

288

Inheritance of severe combined immunodefiency

- autosomal recessive or
- X-linked

289

Common cause of severe combined immunodefiency

adenosine deaminase deficiency (autosomal recessive)

290

Patient with severe recurrent infections early in life with both B and T cells low =

severe combined immunodefiency

291

Skin finding in patients with severe combined immunodefiency

usually have cutaneous anergy

292

Lymph nodes and thymus in severe combined immunodefiency are usually

hypoplastic or absent

293

Inheritance of Wiskott-Aldrich deficiency

- x-linked recessive

294

Triad of eczema, thrombocytopenia and reccurent infections =

Wiskott-Aldrich deficiency

295

Wiskott-Aldrich deficiency classic tria

eczema, thrombocytopenia and reccurent infections

296

Inheritance of chronic granulomatous disease

- usually x-linked recessive

297

Give 2 examples of catalase-positive organisms

- Staph aureus
- Pseudomonas

298

Test for chronic granulmoatous disease

deficient nitroblue tetrazolium dye reduction by granulocytes

299

nitroblue tetrazolium dye reduction test measures

respiratroy burst

300

2 organisms common in infections with chronic granulomatous disease

- Staph aureus
- Pseudomonas

301

Inheritance of Chediak-Higashi syndrome

- usually autosomal recessive

302

Oculocutaneous albinism with giant granules in neutrophils =

Chediak-Higashi syndrome

303

Chediak-Higashi syndrome findings

- Oculocutaneous albinism
- giant granules in neutrophils

304

Pathology of Chediak-Higashi syndrome

defect in microtubule polymerization

305

Recurrent neisserial infections likely have

complement deficiencies (C5 through C9)

306

complement deficiencies (C5 through C9) usually have

Recurrent neisserial infections

307

Cadidiasis with hypothyroidism may be

chronic mucocutaneous candidiasis

308

chronic mucocutaneous candidiasis is often associated with

hypothyroidism

309

Hyper-IgE syndrome is called

Job-Buckley syndrome

310

Job-Buckley syndrome is called

Hyper-IgE syndrome

311

Look for ______ in recurrent staph infections of the skin

Hyper-Ig E (Job-Buckley) syndrome

312

Features of hyper-Ig E (Job-Buckley) syndrome

- reccurent staph infections (usually skin)
- Very high IgE
- red hair
- fair skin
- eczema

313

3 most common organisms in otitis media

- Strep pneumoniae
- H. influenzae
- Moraxella ctarrhalis

314

8 classic complications of otitis media

- tympanic membrane perforation
- mastoiditis
- labyrinthitis
- CN VII and VIII palsies
- meningitis
- cerebral abscess
- venous thrombosis
- chronic otitis media

315

In what time frame does mastoiditis usually occur after otitis media

2 weeks

316

Treatment of cholesteatomas with marginal perforations

surgical excision

317

Antibiotics to use in otitis media

- amoxicillin
- 2nd gen cephalosporin
- TMP/SMX

318

Prolonged secretory otitis is from

an unresolved otitis

319

2 malformations to look for in kids under 5 with UTI

- vesicoureteral reflux (boys and girls)
- posterior urethral valves (boys)

320

Highest incidence of meningitis in kids is in what age group?

neonates

321

10 classic findings in neonatal meningitis

- lethargy
- fever or hypothermia
- poor muscle tone
- bulging fontanelle
- emesis
- photophobia
- altered consciousness
- hypotension
- jaundice
- respiratory distress

322

3 classic associated features of sepsis in neonates

- hypotension
- jaundice
- respiratory distress

323

What if you can't get a lumbar puncture in a kid you suspect of meningitis

treat with IVF and antibiotics (here treatemnt trumps diagnosis)

324

Herpes encephalitis in neonates is due to

HSV II

325

Herpes encephalitis in older kids and adults is due to

HSV I

326

Treatment of HSV encepalitis

acyclovir

327

Imaging findings in HSV encephalitis

temporal lobe abnormalities on CT or MRI

328

What do you need to do if a kid has Neisseria meningitis?

treat contacts prophylactically

329

Choices of antibiotics for Neiserria meningitis prophylaxis

- rifampin
- ceftriaone
- cipro (in adults)

330

Fever followed 3 days later by white spots on buccal mucosa

Measles

331

Measles is also known as

rubeola

332

rubeola is also known as

measles

333

Koplik spots are found in

Measles

334

Head to toe progression of rash with fever, conjunctivitis =

Measles

335

Progresion of rash in measles is

head to toe

336

4 classic complications of measles

- penumonia (giant cell)
- otitis media
- encephalitis (acute)
- subacute sclerosing panencephalitis

337

Classic finding in rubella

suboccipital and postauricular lymphadenopathy

338

What do you do if a pregnant woman has not had rubella immunization?

- DON'T give immunization during pregnancy
- follow and do titers if she has a febrile illness

339

Rash in rubella

milder than measles, but same progression of head to toe

340

High fever for 4 days, return to normal, rash on chest and abdomen =

Roseola infantum

341

Roseola infantum

HHV 6 (DNA virus)

342

Age group of roseola infantum

less than 3 years old

343

Roseola infantum aka

Exanthem subitum

344

Exanthem subitum aka

Roseola infantum

345

Erythema infectiousum aka

Fifth disease

346

Fifth disease aka

Erythema infectiousum

347

Erythema infectiousum caused by

parvovirus B19

348

2 things that parvovirus B19 causes

- Erythema infectiousum
- aplastic crisis in sickle cell disease

349

low fever and aches with red checks, next day rash on arms, legs and trunk =

Erythema infectiousum

350

Pathological findings in varicella

- do Tzanck smear from base
- shows multinucleated giant cells

351

Discrete macules on trunk that occur in crops and crust over =

varicella

352

When can you use varicella-zoster immunoglobulin?

- very debilitated patient (AIDS, leukemia, etc) within 4 days
- exposure of newborn if mom has chickenpox

353

Can a person with zoster causes chickenpox?

Yes in an uninfected/unimmunized person

354

How long are you contagious with chicken pox?

Until the last lesion crusts over

355

Organisms for scarlet fever

streptococcus (pharyngitis)

356

Sandpaper rash with circumoral pollar

scarlet fever

357

Strawberry tongue with rash on abdomen and trunk

scarlet fever

358

Erythrogenic toxin is from ____ and can cause ____

- streptococcus
- scarlet fever

359

Treatment of scarlet fever

PCN

360

Complication of scarlet fever

rheumatic heart disease

361

Mucocutaneous lymph node syndrome is aka

Kawasaki syndrome

362

Typical age for Kawasaki syndrome

under 5 years

363

Treatment of Kawasaki disease

* ASA
- immunoglobulin
- follow with ECHO for cardiac abnormalities

364

Diagnosis of Kawasaki disease

** fever for 5+ days
- trunk rash 1 day after fever (polymorphous)
- conjuctival injection
- changes in oral mucosal
- changes in extremities
- cervical lymphadenopathy
- arthritis
- cardiac issues

365

Infectious mononucleosis is causes by

EBV

366

Tests for EBV

* heterophile antibodies (monospot)
- EBV vial capsid antigen
- EBV nuclear antigen

367

EBV is associated with these neoplasms:

- nasopharyngeal carcinoma
- African Burkitt lymphoma

368

How do you differentiate mononucleosis from step pharyngitis?

Mono has:
- splenomegaly
- hepatomegaligy
- atypical lymphocytes
- anemia/thrombocytopenia
- heterophile anitbodies

369

Rocky mountain spotted fever is caused by

Rickettsia rickettsii

370

Rickettsia rickettsii causes

Rocky mountain spotted fever

371

Tick bite, fever, chills, rash

Rocky mountain spotted fever

372

Rash for Rocky mountain spotted fever

palms/wrist and soles/ankles and rapidly spreads to trunk and face (often pechitial)

373

Treatment of Rocky mountain spotted fever

** doxycycline
- chloramphenicol

374

Weeping skin lesion with yellow crust

impetigo

375

Most common organisms for impetigo

Staph and step

376

Treatment of impetigo

antistaph PCN

377

Acute laryngotracheitis is aka

croup

378

Typical age for croup

1-2 years old

379

Main organism causing croup

50-75% are parainfluenza virus, rest are influenza

380

Season typical for croup

fall/winter

381

Steeple sign =

croup

382

Radiologic finding for croup

steeple sign (subglottic edema)

383

Treatment of croup

- humidified O2
- racemic epinephrine

384

Typical age for epiglottitis

2-7 years old

385

3 major organisms for epiglottitis

- HiB (less w/ immunization)
- Strep pneumo
- Staph aurues

386

Sick kid with no prodrome, high fever, drooling =

epiglottitis

387

Is there cough with epiglottitis?

no

388

Thumb sign on x-ray

epiglottitis

389

X-ray finding for epiglottitis

thumb sign on lateral neck x-ray

390

Treatment of epiglottitis

- establish airway if needed
- 3rd generation cephalosporin

391

Bronchiolitis is usually caused by

RSV causes 75% of causes; rest by parainfluenza and influenza

392

Typical age for RSV

less than 18 months

393

Season for RSV infections

fall/winter

394

Viral URI follow 1-2 days later by rapid respirations, intercostal retraction and expiratory wheezing in 15 month old

RSV bronchiolitis

395

Classic x-ray findings in bronchiolitis

hyperinflation with flattening of diaphragms

396

General treatment for RSV

- supportive
- use Ribavarin only in severe cases or high risk

397

Prophylaxis for RSV

Palivizumab (use in premature or chonic lung disease during RSV season)

398

Diphtheria is caused by

Corynebacterium diphtheriae

399

Whooping cough is caused by

bordetella pertussis

400

oropharynx with gray pseudomembrances

diptheria

401

Diptheria is associated with

myocarditis

402

Treatment of diphtheria needs to include an

anti-toxin

403

Classic complications of strep pharyngitis

- rheumatic fever
- scarlet fever
- glomerulonephritis

404

Diagnosis of Rheumatic fever

history of Streptococcal pharyngitis and Jones criteria
- migratory polyarthritis
- carditis
- chorea
- erythema marginatum
- subcutaneous nodules
- minor criteria

405

List the minor Jones criteria

(rheumatic fever)
- elevated ESR
- elevated CRP
- elevated WBC
- elevated strep anitbody titer
- prolonger PR on EKG
- arthralgia

406

Treatment of rheumatic fever

- anti-inflammatories
- if carditis: steroids

407

Flat erythematous annulur rash, consider

rheumatic fever

408

Time course of strep infection to glomerulonephritis

- usually 1-3 weeks after strep skin infection or pharyngitis

409

Features of poststreptococcal glomerulonephritis

- abrupts hematuria
- mild proteinuria
- RBC casts
- smoke colored urine
- HTN
- edema (periorbital)
- elevated VUN/Cr

410

Treatent of post-strep glomerulonephritis

supportive; control BP, can use diuretics for severe edema

411

Smoke colored urine =

post-strep glomerulonephritis

412

Can glomerulonehpritis after strep by prevented by antibitotic therapy?

no

413

Most common cause of neonatal meningitis and sepsis

Group B strep (strep agalactiae)

414

Treatment of mom's with group B strep

amoxicillin

415

7 classic effects from TORCH infections

- mental retardation
- microcephaly
- hydrocephalus
- hepatosplenomegaly
- jaundice
- anemia
- IUGR

416

Defects specific to toxoplasmosis prenatal infection

- intracranial calcifications
- chorioretinitis

417

Maternal exposure to cats is a risk for

toxoplasmosis

418

Prenatal infection with varicella-zoster is associated with

- limb hypoplasia
- scarring of the sin

419

Prental infection with syphilis is associated with

- rhinitis
- saber shins
- Hutchinson teeth
- interstitial keratitits
- skin lesion

420

Newborn with Hutchingson teeth and interstitial keratitis likely had perinatal infection with

syphilis

421

4 defects specific to congenital rubella

- cardiovascular (PDA, VSD)
- deafness
- cataracts
- microphthalmia

422

Most common TORCH infection

CMV

423

3 defect specific to congenital CMV infections

- deafness
- cerebral calcifications
- microphthalmia

424

inheritance of Werdnig-Hoffman disease

autosomal recessive

425

Describe Wednig-Hoffman disease

- heritable
- degeneration of anterior horn cells
- slow and progressive
- all affected by 6 months
- treatment is supportive

426

Typical age of presentation of muscular dystrophy

3-7 years old

427

5 year old boy with weakness, elevated CPK and large calves

duchenne muscular dystrophy

428

inheritance of duchenne muscular dystrophy

X-linked recessive

429

What is the Gower sign?

Muscular dystrophy - walk hands up body in order to stand up

430

Life span of duchenne muscular dystrophy

most die by age 20

431

Inheritance of Becker muscular dystrophy

X-linked recessive

432

Myopathy with ragged red fibers on biopsy

mitochondrial myopathies

433

Mitochondrial myopathies classically have what feature on physical exam

ophthalmoplegia

434

inheritance of myotonic dystrophy

autosomal dominant

435

Age of onset of myotonic dystrophy

20-30

436

Define myotonia

inability of muscle to relax

437

3 classic co-features of myotonic dystrophy

- mental retardation
- baldness
- testicular or ovarian atrophy

438

Young patient with weakness and cramping after exercise should be considered for

McArdle disease

439

Triangular patch of hair over the lumbar spine

spina bifida occulta

440

Difference between meningocele and myelomenigocele

myeleomenigocele includes both meninges and CNS tissues outside the spinal canal

441

5 classic signs of hydrocephalus in peds

- increasing head circumference
- increased ICP
- bulging fontanelle
- scalp vein engorgement
- paralysis of upward gaze

442

3 most common causes of hydrocephalus in peds

- congenital malformations
- tumore
- inflammation/infection

443

Most common malignancy in children

ALL

444

Child with pancytopenia must be evaluated for

ALL

445

Syndrome risk factor for ALL

Down syndrome

446

Most common brain tumors in children

- crebellar astrocytoma
- medulloblastoma
- ependymoma

447

Most brain tumors in children are located where?

posterior fossa

448

Major differential diagnosis of flank tumor in a child

- Wilms tumor (kidney)
- neuroblastoma (usually adrenal)

449

Peak incidence of Wilms tumor in peds

2 years

450

Peak incidence of neuroblastoma in peds

2 years

451

True or false, neuroblastomas may regress spontaneously

true

452

Most common primary liver malignancy in children

hepatoblastoma

453

Most common kidney malignancy in children

Wilms tumor

454

Most common adrenal malignancy in children

neuroblatoma

455

Feature of inherited retinoblastoma

can be bilateral

456

Simple bone cyst is aka

unicameral bone cyst

457

10 year old wtih well-demarcated lesion in the proximal humerous likely has a

unicameral bone cyst

458

Typical age for osteosarcoma

10-20 year olds

459

Usual location of osteosarcoma

about the knee (distal femur, proximal tibia)

460

15 year old with leg pain with sunburst appearance on x-ray =

osteosarcoma

461

3 major causes of neonatal conjunctivitis

- chemical reaction
- gonorrhea
- chlamydial infection

462

Neonate with conjuantivitis within 24 hours after birth has

chemical reaction (often from drops for preventing gonorrhea)

463

Infant with extremely purulent conjunctivits 2-5 days after birth =

gonorrhea

464

Treatment of infant gonorrhea conjunctivitis

- erythromycin ointment
- IV or IM ceftriaxone

465

Mild to severe conjunctivitis that begins 5-14 days after birth, consider

Chlamydial infection (mom often asymptomatic)

466

Infant chlamydial conjunctivitis is aka

inclusion conjunctivtis

467

Common complication of infant chlamydial conjunctivitis is

chlamydial pneumonia

468

Treatment of infant chlamydial conjunctivitis

oral erythromycin

469

For the 3 most common forms of infant conjunctivitis, give the causes based on time of presentation after birth

- under 24 hours = chemical
- 2-5 days = gonococcal
- 5-14 days = chlamydial

470

Cataracts in infant =

- TORCH infections
- inherited metabolic disorder like glactosemia

471

Features of orbital cellulitis

- ophthalmoplegia
- proptosis
- severe eye pain
- decrased visual acuity

472

Most common causes of orbital and pre-orbital cellulitis

- Step pneumo
- Staph
- Strep

473

Complications of orbital cellulitis

- extension into the skull
- dural sinus thrombosis
- blindness

474

Treatment of preorbial or orbital cellulitis

- IV antibiotics
- blood cultures to direct therapy
- surgery if abscess

475

Age of presentation for congenital hip dysplasia

birth

476

Epidemiology of congenital hip dysplasia

- female
- first born
- breech delivery

477

Signs for congenital hip dysplasia

- Barlow's
- Ortolani's

478

Treatment of congenital hip dysplasia

harness

479

Age of presentation for Legg-Calve'-Perthes disease

4-10 years

480

Epidemiology of Legg-Calve'-Perthes disease

- male
- short stature
- delayed bone age

481

Symptoms of Legg-Calve'-Perthes disease

knee, thigh and groin pain
limb

482

Treatment of Legg-Calve'-Perthes disease

orthoses

483

Age of presentation of slipped capital femoral epiphysis

9-13 years old

484

Epidemiology of slipped capital femoral epiphysis

- overweight
- male
- adolescent

485

s/s of slipped capital femoral epiphysis

- knee, thigh groin pain
- limb

486

Treatment of slipped capital femoral epiphysis

surgical pinning

487

Pediatric hip problems present in adults as

arthritis

488

Age of presentation of Osgood-Schlatter disease

10-15 years

489

Describe Osgood-Schlatter disease

- osteochondritis of tibial tubercle
- often bilateral

490

13 year old boy with pain, swelling and tenderness to palpation of the knee should be considered for

Osgood-Schlatter disease

491

Treatment of Osgood-Schlatter disease

- rest/activity restriction
- NSAIDs

492

In juvenile rheumatoid arthritis, RF is often

negative

493

Most cases of mental retardation are

idiopathic

494

IQ range for mild mental retardation

55-70

495

Number one preventable cause of mental retardation

fetal alcohol syndrome

496

TORCH cause of autism

congenital rubella

497

Antisocial personality disorder must have what diagnosis as child

conduct disorder

498

Classic conduct disorder

- fire starting
- cruelty to animals
- lying
- stealing
- fighting

499

Child that is hostile towards adults but normal with peers may have

oppositional-defiant disorder

500

3 criteria for anorexia

-15% below weight
- intense fear of gaining weight
- amenorrhea