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Peds Flashcards

1
Q

Definition of Colic? When does this stop?

A

3hr for 3 d for 3 wk . Resolves in 4 months. Reassure

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2
Q

Ingestion protocol.

What if sx?

When to give charcoal? aa

A

Upper Gi endoscope w/in 24 hours - If sx after upper GI, Do a water barium in 2-3 days for followup.

Avoid NG lavage in all cases.
Avoid charcoal in all cases

EXCEPT TYLENOL - give charcoal .

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3
Q

Breast Milk

  • For how long
  • When and what to supplement?

Cows milk?
- What to supplement?

A

Breast milk - 6mo minimum, 1+ preferred.
Must supplement with Vit D.

Cows Milk - Causes Iron deficiency

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4
Q

Enuresis - when does it begin? When should it end?

First line in tx?

A

Occurs at 2 -> Goes on normally until ~5y.o.

After 5, consider

  1. Incontinence alarm
  2. DDAVP
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5
Q

Jaundice.

2 major timelines at birth. What are the causes?

A
  1. Dehydration - breast feeding failure.
    - Can start within first days.
    INC enterohepatic circulation and DEC blirubin excretion.
  2. Breast milk jaundice - milk has HIGH lvl of bilirubin
    Can start at 4 days and peaks at 2 wk.
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6
Q

Breath holding? What to do?

A

Check Ferritin and CBC - associated. If normal - reassure

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7
Q

Timeline of normal?
Separation anxiety

Stranger Anxiety

A

Separation - 9-18mo ok

Stranger - Up until 3y.o

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8
Q

H& W change by 1 year?

A

heigh INC by 50 percent,

Weight x3

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9
Q

What vaccines do you give at birth?

When do you give the rest?

A

Birth - Hep B

2 mo - Hep B x 2 , Rota, Tdap, Hflu, Pneumococus, Inactivated polio

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10
Q

When do start vision test?

A

3 y.o - similar timeline as stranger danger!

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11
Q

What is the ppx and t x for conjuncitivitis in neonate
timeline?

GC

CT

A

GC - 2-5 d

  • ppx w topical erythromycin
  • tx - IM/IV cefotaxime (NOT ceftriaxone!)

Chlamydia

  • ppx is tx mom
  • Tx - PO erythromycin
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12
Q

When is rotovirus contraindicated?

A

Intussusception, Meckles, SCID

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13
Q

GENERAL PRINCIPLES

B cell def

vs

T cell - when do they present? Tx?

A

After 6mo - Tx IVIG except IgA

T cell - 1-3 mo - Fungal viral intracelllualr bacteria

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14
Q

list 3 B cell def

A

X linked agamma - Tyrosine kinase
DEC/ABSENT B cells = Low Ig

Common Variable - Acquried - 20-30 y.o . INC risk of autoimmune conditinos and lymphoma. Normalish Cell count, DEC Ig

IgA - after viral/GI infection. Anaphylaxis to IgA/blood. Normal IgG, IgM

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15
Q

4 T cell def

A

Di george - DEC T Cell, PTH, Ca. FISH testing

IL -12 (AR) - DEC Th1 - Disseminated mycobacterial/fungal. DEC IFNgamma (Th1) . May occur after Anti-Tb vaccine

HyperIgE (Jobs - AD) - DEC Th17, DEC N! recruitment - FATED - Coarse facies, Abscess (Cold), Teeth (primary retained), IgE INC, Ezcema (Derm)

Cronic Mucocutaneous Candidiasis - T cell dysfunction - NO SYSTEMIC since B cells are fine.

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16
Q

4 types of Combined immunodef

A

SCID - AR - ADA
SCID XR - IL2,7. Absent thymic shadow, no GC, T cels. MUST IRRADIATE RBC in transfer

Ataxia- Telangiectasia - DNA breaks (ATM gene) - INC AFP, DEC IgA, G, E

Hyper IgM - XR - CD40L - class switch prblem - Pyogenic infections etc. INC IgM, DEC A, E, G

Wiskott Aldrich - XR - WAS gene - T cell actin cytoskeleton - Thrombocytopenia (small), Eczema, Infections. INC autoimmune risk . INC IgE,A, DEC IgG, M

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17
Q

List 3 types of phagocyte disfunction

A

Leuk Adhesion - CD18 - Recurrent skin/mucosal infection. NO PUS- Delayed umbilical separation. INC N! but NOT at the site ofinfcetion.

Chediak Higashi - AR - phagolysosome microtubule problem - Staph/Strep, ALBINISM, NEUROPATHY, PANCYTOPENIA - Giant granules in N!

Chronic Granulomatous D - Xr - NADPH oxidase - o respiratory burst - Catalase negative infections - Nitroblue test is clear. Tx - IFNg

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18
Q

VSD - What to do if heard?

A

75% resolve by 2.yo

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19
Q

Congenital Heart block?

heart failure?

Transposition?

A

Heart block - lupus

HF - thyrotoxicosis

Transposition - DM

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20
Q

PDA - presentation - more than just machine like

A

Continueous - Loud S2, wide pulse pressures. Bounding pulses

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21
Q

Long QT tx?

A

B blocker. _ Pacemaker

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22
Q

Hirshsprungs - Dx/Tx?

A

Barium enema

Biopsy . ACH

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23
Q

Timeline:
Dx?

pyloric stenosis

Malrotation

Biliary atresia?

A

Pylori stenosis - 3k - first bone marle, erythromycin,. US if needed

malrotation w/in 1 month - Upper GI dx -> birds beak,.

w/in 2 months - Cong hyperbili. Light stool. CHOLANGIOGRAM. Tx Kasai -> Liver tx

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24
Q

NEC

workup and tx?

Complications?

A

Serial abd films Q6h. NPO, Abx.

if worsens -> surgery

Complications - stricture, short bowel syndrome

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25
Q

Biliary cyst ? Presentation? Location?

A

Mass and jaundice

Can be extra OR intra

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26
Q

Laryngomalacia

vs
Vascular ring

(presentation, timecourse?)

A

Laryngomalacia - improves w/ prone . Peaks at 4-8 months in presentation. Most resolve by 18mo. Dx - Laryngoscopy.

Vascular ring - improves with neck extension. If sx - Surgery

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27
Q

COngential Diaphragmatic Hernia?

Dx? Tx?

A

If cliical suspicion and unstable vitals -> intubate BEFORE cxr. NG decompress. DO NOT bag mask! as it may worsen.

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28
Q

Diamond BLackfan

vs

Turners?

A

Diamond blackfan - Macrocytic Anemia, No hyperseg N!
Short, cleft lip, shield chest, webbed neck, abdnormal thumbs. Tx Steroids.

Turners - Webbed neck, shield chest etc, Coarctation, Bicuspid A, OSTEOPOROSIS. Lymphadema, HORSEHOE KIDNEY

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29
Q

Edwards presentation

A

T18. Rocker bottom, micrognathia, ABSENT PALMAR CREASE (shaked off hand), VSD

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30
Q

Prader Willi - presentations and risk factors

A

Paternal - DMT2, hyperphagia, gastric rupture!

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31
Q

Neuroblastoma - presentation? When?

Wilms Tumor

A

Neuroblastoma - Mass - irregular, corsses midline. \
By 1 year. OPSOCLONUS MYOCLONUS.

Wilms Tumor - 2-5 yr. Abd mass w/ HEMATURIA. . Beckwith W, Anaridia.

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32
Q

McCune Albright rpesenetation?

A

Precocisous puberty, cafe au lait spots, bone defects.

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33
Q

Beckwith Wiedeman presentation

Screening?

A

Macrosomia, hemihyperplasia. Omphaloceine/umbilical hernia. DONT confuse w/ DM.

In these pt screen for Wilms tumor.

AFP + Abd US q3mo until they are 4-8 y.o

Renal US until adolescent after 8.

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34
Q

Hipl dysplasia - screening methods?

A

Hip dysplasia

US 2wk - 6mo

4/6 mo or more, use Hip Xray.

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35
Q

IVH- screening? prevention?

A

Newborns.

Screen w/ US. Maternal steroids can prevent.

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36
Q

Legg Calve Perthe

Vs

Slipped Femoral Cap

vs

Osgood Shattler

A

Legg Calve Perth - Avasc Necrosis - 4-5 yo bohys

Femoral - 12 y.o B

Osgood shatller - patellar shatters off by being pulled.

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37
Q

Spondylolisthesis presentation?

A

Boney step off - (palpable) - slipped vertebra - DEVELOPMENTAL DISORDER

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38
Q

Metatarsus Adductus

A

If foot overcorrects - reassure

if does not overcorrect - IMMEDIATE CAST

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39
Q

Clavicular fracture at birth -What to do?

A

Analgesics - restri motions. Heals in 7-10 d./

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40
Q

Torticollis cause? presentation - what to do?

A

From trauma, URI, Abscess, AA subluxation

MUST get a c spine xray to rule out AAs.

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41
Q

Presentation in neonates

Syph

CMV

Rubella

A

Syph - HSM - ulcers on palms/feet, JAUNDICE, ANEMIA, rhinorrhea

CMV - HSM - Chorioretinits, Hearing, Petechiea

Rubellma - HSM - Cataracts, Hearing, PDA

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42
Q

Bacterial Meningitis

Tx algorythm?

Tx?

A

Blood cultures, Tx, LP last

Neonate - Amp + Cefotaxime/Gent

Adult - Ceftriaxone Vanc+ STEROIDS. If it comes back as NOT strep pneumo, then take off roids.

43
Q

Unilateral cervical adenitisi.

What is it?

Tx?

A

staphy/strep

Tx - Clinda + I and D

44
Q

Impetigo

vs

Cellulits

Culture?

A

Impetigo - nonbullous - GAS - Mupirocin (topical) of no

Impetigo bullous - Staph - Oral ceph, diclox, clinda

Clinical dx - DO NOT NEED TO CULTURE!!! Unless fail initial tx.

Cellulitis - poorly demarkated - staph/strep.

45
Q

Herpetic gingivostomatitis?

Herpangina?

Presentation and age?

A

Herpetic gigivostomatitis - 6m to 5y.o. - Herpes. Vesciesl.

Herparnagina 3-10 y.o Coxsackie - Vescles - aka NOT strep

46
Q

Varicella - post exposure tx?

Normal and ICH

A

Varicella post exposure - give vaccine.

In ICH - give Varicella Antibodies

47
Q

Tachoma - wpresentation cause?

A

Blindness, folliculitis, conjuncitivit.s

CHlamydia A-C

48
Q

Minimal Changes disease - Dx?

A

Clinical diagnosis - Do not need to Bx.

49
Q

UTI in infant- workup??

A

Culture - CATH - No clean catch in babies!
2mo-2y.o - Bladder and renal US.

IF RECURRENT - Voiding cysorethrogram.

50
Q

Acute Hepatitis tx in neonate?

A

Active and passive Ig.

51
Q

Rheumatic Fever tx?

A

IM penicilling Q4w for YEARRRS.

52
Q

Lyme Tx?

In kids?

A

Amox, Cefuroxieme, DOxy are all about the same.

In kids - amox.

Dont give doxy to anyone under 8 y.o

53
Q

Bronchiolitis?

VS Croup?

Causes and Tx?

A

Bronchiolitis - Run of the mill RSV> Para

Tx - O2, Albuterol, NO STEROIDS

  • Ribavarin in comorbid
  • Palivizumab PPX in winter in HIGH RISK COMORBID PT LESS THAN 2 YEARS OLD

Croup - Paraflu - Barking, steeple sign.

O2, Racemic Epinephrine, STEROIDs,

54
Q

Epiglotitits - presentation/causes

tX/

A

Rapid. Strep, H flu, Viral.

High fever, drooling. Better in SNIFF dog position. THUMPRINT SIGN.

ET tube in OR, IV cetriaxone/cefuroxime

55
Q

Tracheitis - Causes - presentation

A

Tracheitis - S aureus > Viral. Prodomal. Sublgottic narrowing.

56
Q

Bordetella - whoooping cough.

Presentation - Tx?

A

Lymphocytosis >70% - Culture is gold standard.

Tx - Erythromycin/Azithromycin (MACROLIDE) 14d to kid AND PEERS/CONTACTS.

Tx - Erythro - 14 d. Azithro - 5d

57
Q

Acute Bacterial Rhinosinusitis

predisposition pathway

Tx

A

Strep > Hflu > Moraxella

viral sinusitis -> bacterial sinusitis -> orbital sinusitis

Tx - Amox Clavulonic.

58
Q

Acute Otitis Media - Causes tx?

A

Strep H flu, moraxella

HIGH DOSE amox x 10 d

59
Q

Bilious Emesis

  • Dx pathways -
A

NPO, NG, X ray (rule out pneumoperitoneum)

  • Upper GI - malrotation - corkscrew sign

Lower - Meconium, Hirshprungs - Water contrast enema

60
Q

Intususseption - Dx? Tx?

RISK FACTORS

A

Dx - US . Tx/dx - air contrast bariun enema

Less tahn 2 - peyes patches

Greater than 2- meckles.

61
Q

Febrile seizure -At what age what do you do.

A

Less than 6 mo - sepsis workup. If >18 mo - no workup.

62
Q

Chloroma - dx/workup?

A

Green/colored tissue in skin/spinal cord.

Bone marrow aspirate - CXR to rule out mediastinal mass.

63
Q

Kawasaki tx?

A

Aspirin and IVIG.

64
Q

CVID inc risk of what?

A

LYMPHOMA!

65
Q

Cherry red macula WITH HSM, without?

A

WITH - NP

WITHOUT - Tay sacks

66
Q

Cystic hygroma - mech and appearance

A

– benign klymphangioma in neck – soft, transilluminates. Asosc w/ Turner and Trisomy 21,18,13

67
Q

Club foot

A

– tx immateied stretching, manipulation w/ serial plasters/splints. Surgery between 3-6mo if not working.

68
Q

Neonatal polycythemia can cause … how?

A

respiratory distress by hyperviscocity

69
Q

Downs findings

A

– Low AFP, estriol. INC bhcg, inbhitinA

A and E

70
Q

Breast feeding supplement

A

– Add VitD within 1st month of life (this is correct!), + - Iron (if preterm until age 1). Introduce pureed food at 6mo, cows milk at 1.

71
Q

Acute otitis media vs otitis media with effusion

A

OM w E is just effusion. Acute has inflammatory signs.

72
Q

Vaccines by chronological or gestational, meaning?

A

Chronological. Regardless of preme, give Hep B AT BIRTH and others 2mo after birth. Youre not going not delay giving hep b because they are preterm.

73
Q

Normocytic normochromic RBC with low retic and low Hb in preterm baby?

A

– Anemia of prematurity, low retic w/ normocytic and normochromic anemia.

74
Q

DTap frequency and contraindication

A

– 5 doses of DTap from 6wk to 6 years. If pt has a febrile seizure that’s fine – continue to immunize. Only stop if anaphjylaxis or encephalopathy.

75
Q

Rash after birth

A

erythema toxicum neonatorum – benign evanescent. Common in first 2 wk of life. Spares palms/sole

76
Q

Milk/soy protein induced colitis presentation, etiology, mech prognosis

A

2-8 wk – painless bloody stools, may have eczema . Eliminate soy/milk from maternal diet. Start formula if needed. NON-IGE MEDIATED!! – Bleeidng usually stops 2 wk after eliminating products and as a whole Usu spontaneously resolves by 1 y.o,

77
Q

Classic Galactosemia

A

– infantile cataracts, failure to thrive, HSM, E Coli Sepsis – Galactose 1p Uridyltransferase def/

78
Q

Glactokinase def

A

– infantine cataracts only, nothing else.

79
Q

Homocysteine vs Marfans

A

– Homocysteine will have fair complexion, devo delay, and CVA

80
Q

Cholesteatoma vs Otosclerosis

A

chronic middle ear infection – granulation tissue, hearing loss. EAR DRAINAGE PRESENT in cholesteosteatoma.

81
Q

Transiet synovitis

A

viral disease + joint pain without septic appearance (no fever, able to bear weight), but may still have abducted and externally rotated hip. Ibuprofen, rest and followup.

82
Q

Bacterial and giardia infections in kid think?

A

B cell – IgA in particular, but Giardia is IgA def, not necessarily T cell.

83
Q

ARDS surfactant deificency risk factors (2

A

prematurity and maternal DM.

84
Q

Henoch SP raises risk for what GI

A

– ileo ileo! Intussusception

85
Q

Strep throat vs Viral/EBV

A

both can have white exudates and LAD. Difference is EBV/viral have clear viral signs aka COUGH, RHINORRHEA AND CONGESTION. Strep throat will not. If many signs of strep (fever, no cough, etc, can rapid strep with empiric penicillin).

86
Q

In first week of life, how many wet diapers?

A

Every day should have the same number of diapers, 4d -> 4+ wet diaperes.

87
Q

How frequently should bebes be breastfeeding in first month?

A

Every 2-3 hr for 10-20 minutes.

88
Q

What abx do SS kdis get?

A

BID ppx penicillin until 5 y.o . Also PCV13 of course.

89
Q

Intestinal atresia etiology

A

vascular accident in utero

90
Q

Biliary atresia presentation timeline and workup

A

6-8wk old, sweat test to rule out other problems, PHENObARBITAL with HIDA scan followup in 1 wk. If that fails, surgery.

91
Q

Unilateral Undecended testes

A

no tx until 1 year of age! Then surgery.

92
Q

Defect in the iris is?

A

Workup? Coloboma of iris. CHARGE (Coloboma, Heart, Atresia of Choana, Retardation, GU, Ear)

93
Q

Double bubble ddx –

A

duodenal atresia, annular pancreas, malrotation, volvulus.

94
Q

Failure to pass meconium algorithm

A

– Rectal exam, then Bariun enema.

95
Q

Which bili causes kernicterus. Tx.

A

Unconju. Water insoluble, but can cross the BBB. Tx immediate exchange transfusion.

96
Q

Baby in withdrawal from opioids what to do?

A

Tx opioids and phenobarbital. NEVER naloxone (suden withdrawal -> seizures )

97
Q

Malabsorption workup

A

Initial screening: Sudan blak stain .Comfirmatory 72 hr stool fecal fat.

98
Q

GERD in baby workup , tx

A

GERD in baby workup – Usually normal. If severe, interfereing with weigeht gain, dx clinical, but initial test is esophageal pH monitor. Thicken feeds and H2 receptor blockers in kids.

99
Q

Intussusception workup

A

Ab Xray to rule out obstruction. Air enema. US not ideal but usually occurs due to practicality.

100
Q

When can you begin to give sulfonamides in kids? Example of its use?

A

Can give sulfa to kids after 1 mo. Giving to kids with vesicoureteral reflux , as they need antibiotic prophylais for the 1st year following diagnosis to revent kidney scarring.

101
Q

PSGN tx in kids

A

penicillin. Complete recovery in 95% of kids.

102
Q

When do kids get anemia? Nadir? What is acceptable?

A

? Nadir at 12 wk w/ hg of 9-11. No tx needed. Response in preterms is earlier3-6wk and 7-9 hc. May need transufion.

103
Q

Fever without a focus , age, workup and tx –

A

Until 3 y.o. Pan culture and give IM ceftriaxone if well appearing. Toxic IV abx.

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