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MTB STEP 2 (R) > MTB 2 CK - Pediatrics > Flashcards

MTB 2 CK - Pediatrics Flashcards

1
Q

once the baby is delivered what do you do next

A

mouth and nose is suctioned then cutting/clamping of the umbilical cord, then dried/wrapped in clean towels and placed under a warmer.

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2
Q

what is the normal heart rate in a baby

A

120-160 beats per minute

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3
Q

what is the respiratory rate in a newborn

A

40-60 breaths per minute

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4
Q

conjunctivitis most likely at day 1

A

chemical irritation

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5
Q

conjunctivitis at 2-7

A

gonorrhea

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6
Q

conjunctivitis after more than 7 days

A

chlamydia trachomatis

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7
Q

conjunctivitis after 3 weeks or more in newborn

A

herpes infection

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8
Q

newborns should receive what 2 types of antibiotics

A

erythromycin ointment or tetracycline ointment

silver nitrate solution

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9
Q

neisseria gonorrhea conjunctivitis tx

A

ceftriaxone

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10
Q

chlamydia conjunctivitis tx

A

oral erythromycin

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11
Q

herpes conjunctivitis tx

A

systemic acyclovir and topical vidarabine

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12
Q

give rhogram at what weeks

A

28-32 weeks and during delivery

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13
Q

what week do you check for gbs

A

35-37 weeks

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14
Q

amlodipine a/e

A

edema

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15
Q

what should be given to newborn prophylactically

A

single IM dose of vitamin K
hep b vaccine
but newborns with HbSAg positive mother should get hep b vaccine and HBIG

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16
Q

what is transient tachypnea of the newborn

A

when newborn passes thru vaginal canal, compression of rib cage helps in removal of fluid from lungs
newborns delivered with c-section- have excess fluid in lungs and are hypoxic
if hypoxic for more than four hours, get urine and blood culture

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17
Q

when should you do a csf analysis with lumbar puncture on newborn

A

neuro signs like irritability, lethargy, temp irregularity, and feeding problems

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18
Q

transient hyperbilirubinemia in newborn

A

infant spleen removign excesss rbc with hbF- excess breakdown of rbc- leads to physilogical release of Hb and a rise in bilirubin

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19
Q

subconjunctival hemorrhage in newborn

A

due to increased intrathoracic pressure of chest as being compressed while passing thru birth canal

tx- none

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20
Q

newborn skull fractures from least dangerous to worst

A

linear-most common
basilar- most fatal
depressed- can cause cortical injuries but no surgical intervention

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21
Q

caput succedaneum and cephalohematoma

A

do not cross suture lines

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22
Q

duchenne-erb paralysis presentation in newborb

A

cant abduct shoulder, cant externally rotate, and cant supinate

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23
Q

dx of ducehenne-erb palsy

A

clinical dx and tx with immoblization

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24
Q

klumpke paralysis of newborn

A

claw hand with horner syndrome

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25
Q

facial nerve plasy in newborn causes

A

forcep use in delivery

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26
Q

tx of facial nerve palsy in newborn

A

improvement occurs gradually over weeks to months

if no improvement then surgical repair of nerve

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27
Q

polyhydramnios def

A

too much fluid because the fetus is not swallowing

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28
Q

causes of polyhydramnios

A

werdnig hoffman syndrome

intestinal atresia

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29
Q

oligohydramnios

A

too little fluid because the fetus cant urinate

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30
Q

causes of oligohydramnios

A

prune belly- lack of abdominal muscles so cant bear down and urinate
-tx of prune belly is serial foley catheter placements but carries high risk of uti
renal agenesis- assoc with potter syndrome and incompatible with life
flat facies

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31
Q

where is the defect in morgagni

A

retrosternal or parasternal

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32
Q

where is the defect in bochdalek

A

posterolateral

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33
Q

omphalocele cause

A

failure of gi sac to retract at 10-12 weeks

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34
Q

gastroschisis occurs where

A

lateral to midline with no sac covering

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35
Q

umbilical hernia is highly associated with what

A

congenital hypothyroidism

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36
Q

tx of umbilical hernia

A

90 percent close spontaneously by age 3 but if doesn’t after age 4, then surgical intervention to prevent bowel strangulation and subsequent necrosis

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37
Q

wilms tumor caused by

A

hemihypertrophy of one kidney due to increased vascular demands

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38
Q

presentation of wilms tumor

A

constipation, n/v, abdominal pain, palpable abdominal mass, aniridia

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39
Q

dx of wilms tumor

A

abdominal ultrasound is the best initial

most accurate is the contrast enhanced ct scan

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40
Q

tx of wilms

A

nephrectomy with chemo and radiation

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41
Q

neuroblastoma dx

A

hypsarrhythmia on eeg and opsomyoclonus

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42
Q

hydrocele

A

painless swollen fluid filled sac, transilluminates
remanant of tunica vaginalis
resolve w/n 6 m.
dx with ultrasound

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43
Q

varicocele best initial test

A

Physcial exam coinciding with a bag of worms sensation

ultrasound of scrotal sac showing dilatation of pampiniform plexus

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44
Q

cryptorchidism tx

A

orchipexy to bring testicle down into scrotum after age 1 to avoid sterility

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45
Q

cryptorchidism increase risk of malginancy regardless of surgical intervention true or false

A

true

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46
Q

what is contraindicated in hypospadias

A

circumcision bc diffficulty in surgical correction then

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47
Q

hypospadias highly associated with what

A

cryptorchidism and inguinal hernia

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48
Q

epispadias highly associated with what

A

urinary incontinence; evaluate for concomitant bladder exstrophy

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49
Q

why does squatting help in TOF

A

increase in preload increases systemic circulation resistance, decreases R to left shunt, leading to increased pulmonary blood flow and increase blood oxygen sat

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50
Q

tx of transposition of great vessels

A

prostaglandin E1 to keep patent ductus arteriosisu open
nsaids/indomethacin contraindicated
two surgeries are necessary

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51
Q

pulsus alterans seen in what

A

left ventricular systolic dysfunction

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52
Q

pulsus bigeminus seen in what

A

hocm

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53
Q

pulsus bisferiens seen in what

A

AR

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54
Q

pulsus tardus seen in what

A

AS

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55
Q

hypoplastic left heart syndrome

A

left ventricular hypoplasia, mitral valve atresia, and aortic valve lesions
gray cyanosis rather than blue
precordial hyperactivity, loud second heart sound, weak pusles

56
Q

truncus arteriosus

A

severe dyspnea, early and frequent resp infections within first few days

57
Q

tx of truncus arteriosus

A

surgery to prevent pulmonary htn which develops within 4 months

58
Q

TAPVR with obstruction

A

early in life with resp distress and severe cyanosis

59
Q

dx of TAPVR with obstruction

A

chest xray shwoing pulm edema

echo is definitive

60
Q

TAPVR without obstruction

A

1-2 years of age with right heart failure and tachypnea

61
Q

tapvr without obstruction dx

A

CXR showing snowman or figure 8 sing

most accurate is echo- have to diagnose with this

62
Q

VSD conservative tx

A

diuretics and digoxin otherwise larger or more symptomatic lesions require surgery

63
Q

vsd and asd dx

A

cardiac cath is the most definitive test

but echo is less invasive and just as effective

64
Q

prolong qt syndrome

A

hearing loss, syncope, normal vitals and exam, fm hx of sudden cardiac disease

65
Q

3 sign on chest xray signifies what

A

coarctation of aorta

66
Q

tx of coarctation of aorta

A

surgical resection of narrowed segment and then balloon dilation if recurrent stenosis occurrs

67
Q

hyperbilirubinemia is pathological when?

A 
appears on first day of life
bilirubin increases more than 5 a day
direct bilirubin is above 2
bilirubin arises above 19.5 in a term child
persists after second week of life
68
Q

tx of hyperbilirubinemia

A

blue green light helps break down bilirubin to excretable components
consider exchange transufson if bilirubin arises above 20-25

69
Q

tx of Trachoesophageal fistula

A

surgical repair in two wteps
antibiotic coverage for anaerobes
fluid resus before surgery to prevent dehydration

70
Q

string sign and olive seen seen where

A

pyloric stenosis

71
Q

doughnut sign seen where

A

intusseption

72
Q

best intial test for pyloric stenosis

A

abdominal ultrasound showing thickened pyloric sphincter

73
Q

when is pyloric stenosis seen

A

first month of life but can be seen upto six months after birth

74
Q

shoulder sign is what in pyloric stenosis

A

filling defect in the antrum due to prolapse of muscle inward

75
Q

what is mushroom sign in pyloric stenosis

A

hypertrophies pylorus against the duodenum

76
Q

railroad track sign in pyloric stenosis

A

excess mucosa in the pyloric lumen resulting in two columns of barium

77
Q

best intial test for chaonal atresia

A

pass NG tube

most accurate: ct scan

78
Q

first step in management of choanal atresia

A

secure airway

79
Q

tx of choanal atresia

A

surgery to perforate the membrane and reconnect the pharynx to the nostrils

80
Q

dx of duodenal atresia

A

abdominal xray and double bubble

first day of life

81
Q

first step in management dudoenal atresia

A

iv fluids

82
Q

tx of pyloric stenosis

A

replace lost volume with iv fluids, replace lost electrolytes especially potassium
NGT to decompress the bowel
surgical myotomy

83
Q

CHARGE syndrome

A 
coloboma of eye 
heart defects
atresia of choanae
retardation of growth
genital defects
ear anomalies
84
Q

hirschsprung disease

A

do not pass meconium for over 48 hours or fail to pass meconium at all
extreme constipation followed by large bowel obstruction
rectal eaxm shows extremely tight sphincter; cant pass flatus

85
Q

dx of hirschsprung disease

A

plain xray shows distended bowel loops with lack of air in rectum
contrast enema shows retention of barium for greater than 24 hours
manometry will show high pressures in the anal sphincter
mainstay of dx is full thickness biopsy revealing lack of ganglionic cells in submucosa

86
Q

VACTERL syndrome

A 
veretebral anomalies
anal atresia
cardivascular anomalies
tef
esopghaeal atresia
renal anomalies
limb anomalies
87
Q

dx of imperforate anus

A

not being able to pass meconium and physical exam will reveal no anus

88
Q

dudoenal atresia is associated with what

A

down syndrome and annular pancreas

89
Q

duodenal atresia presentation

A

bilious vomiting within 12 hours of birth

xray shows classic double bubble sign

90
Q

tx of duodenal atresia

A

replace lost volume with IV fluids
replace potassium
NGT to decompress the bowel
surgical duodenostomy-most common/definitive tx

91
Q

birds peak appearance seen in what two situations

A

volvulus and achalasia

92
Q

volvulus presentation

A

vomiting and colicky abdominal pain
multiple air fluid levels seen
first year of life

93
Q

best initial therapy for volvulus is

A

iv fluids

endoscopic decompression

94
Q

most effective tx if endoscopy fails in volvulus

A

surgical decompression

95
Q

intussusception associated with

A

previous rotavirus vaccine and HSP

96
Q

intussusception caused by what

A

polyp, hard stool, lymphoma, or even have a viral origin

97
Q

intussusception presentation

A

bilious vomiting, currant jelly stool, and colicky abdominal pain
right quadrant sausage shaped mass can be palpated
first year of life

98
Q

dx of intussusception

A

ultrasound will show doughnut sign or target sign

99
Q

most accurate test for intussusception

A

barium enema both diagnostic and therapeutic

100
Q

tx of intussusception

A

fluid resus and balancing electrolytes
NGT decompression of bowel
barium enema- must observe bc 10 percent recur w/n 24 hours
if barium enema not curative then emergent surgical intervention

101
Q

norwalk virus

A

explosive cramping pain, epidemic, short lived 1-2 days

102
Q

necrotizing enterocolitis

A

seen in premature infants with low birth weight, vomiting/abdominal distention, fever

103
Q

dx of necrotizing enterocolitis

A

abdominal xray shows pneumatosis intestinalis- air within bowel wall and ct with air in the portal vein, dilated bowel loops
frank or occult blood can be seen in stool

104
Q

tx of necrotizing enterocolitis

A

feeding discontinued
iv fluids immediately
ngt for bowel decompression
if these does not help then surgery to remove affected bowel

105
Q

small left colon syndrome seen where

A

in infants of diabetic mothers
congenitally smaller descending colon leads to distention from constipation
tx with repeated smaller and more frequent feeds

106
Q

major cardiac change seen in infants of diabetic mothers

A

asymmetric septal hypertrophy- bc obliteration of left ventricular lumem causing decreased cardiac output
dx with ekg and echo
tx with bb and iv fluids

107
Q

CAH dx

A

increased 17-OH progesterone level at birth

108
Q

17 alpha hydroxylase def

A

increase in aldosterone decrease in sex steroids and cortisol

female: normal at birth
male: pseudohermaphrodite

109
Q

21 hydroxylase def

A

decrease in aldosterone and cortisol
increase in sex hormones
female: virilized
male: normal at birth

110
Q

11 b hydroxylase def

A 
decrease in aldosterone and cortisol
increase in sex hormones
girls: virilized
boys: normal at birth
11-doc increased
111
Q

children at what age are most susceptible to rickets

A

6-24 months

112
Q

infants who are exclusively breast fed should be given what

A

vitamin d supplements at 2 months of age

113
Q

tx of neonatal sepsis

A

gentamicin and ampicillin

cefotaxime

114
Q

neonatal taxoplasmosis

A

chorioretinitis, hydrocephalus, mutiple ring enchancing lesions on ct

115
Q

neonatal taxoplasmosis dx

A

elevated igM to taxoplasma- best initial

most accurate: pcr

116
Q

tx for taxoplasmosis

A

pyrimethamine and sulfadiazine

117
Q

rubella

A

pda, cataracts, deafness, hps, thrombocytopenia, blueberry muffin rash, and hyperbilirubinemia

118
Q

dx of rubella

A

maternal igM along with clincal diagnosis

119
Q

tx of neonatal rubella

A

supportive

120
Q

neonatal cmv

A

periventricular calcifications with microencephaly, chorioretinitis, hearing loss, and petechiae

121
Q

dx of cmv

A

best initial: urine or saliva viral titers

most accurate: urine or saliva PCR for viral DNA

122
Q

tx of scarlet fever

A

penicillin, azithromycin, or cephalosporin

123
Q

croup

A

barking cough, coryza, inspiratory stridor, difficulty breathing when lying down, signs of hypoxia like acessory muscle use or peripheral cyanosis

chest xray: steeple sign

124
Q

dx of croup

A

made clinically, rarely need xray

125
Q

tx of croup

A

mild symptoms: steroids

moderate/severe: epinephrine

126
Q

tx of epiglottis

A

intubate the child in the OR
administer ceftriaxone for 7-10 days
rifampin given to all close contacts

127
Q

what do the three stages of whooping cough present with

A

catarrhal stage: congestion and rhinorrhea-14 days
paroxysmal stage: severe coughing with extreme gasp for air followed by vomiting-14-30 days in duration
convalescent stage: decrease of frequency of coughing-14 days

128
Q

tx of whooping cough

A

erythromycin or azithryomycin only in catarrhal stage

isolate child and macrolides for all close contacts

129
Q

tx of diphtheria

A

antitoxin

130
Q

pharyngitis

A

cervical adenopathy, petechiae, fever above 104, other URI symptoms, acute rheumatic fever and GN

131
Q

dx of pharyngitis

A

rapid DNAse Ag detection test

132
Q

tx of pharyngitis

A

oral pcn for ten days or macrolides if pcn allergry

133
Q

what is Legg Calve Perthes disease

A

avascular necrosis of femoral head showing painful limp

134
Q

dx of legg calve perthes

A

xray showing joint effusion and widening

135
Q

tx of legg calve perthes

A

nsaid and rest

follow with surgery on both hips

MTB STEP 2 (R) (12 decks)

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