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► Med Misc 06 > Falcon Review Pediatrics 3 > Flashcards

Falcon Review Pediatrics 3 Flashcards

1
Q

A patient presents with a history of sweating while feeding, what pathology does this suggest

A

Suggestive of cardiac disease

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2
Q

What physical exam findings are suggestive of cardiac disease pediatrics

A 
Poor growth or failure to thrive
Abnormal heart rate blood pressure
Crackles suggest of left-sided failure
Hepatomegaly suggestive of right-sided failure
Cyanosis or clubbing
Murmur
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3
Q

What is the best diagnostic test for pediatric cardiovascular disorders

A

Echocardiography

Other studies are helpful such as chest x-ray EKG MRI and cardiac catheterization

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4
Q

Generally speaking define innocent murmurs

A

Usually soft
Never just diastolic
Never associated with a thrill or a click

Do not require additional work up

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5
Q

Name the four major types of innocent murmurs

A

Stills
Pulmonary flow murmur
Pulmonary ejection murmur
Venus hum

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6
Q

Describe a stills murmur

A

3 to 6 years old

Soft vibratory or musical systolic ejection murmur heard at left lower to mid sternal border

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7
Q

Describe a pulmonary flow murmur

A

0 - 6 months of age
High-pitched blowing systolic murmur at upper left sternal border due to turbulent flow at the origin of the right and left pulmonary arteries
Transmits to back and axilla

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8
Q

Define pulmonary ejection murmur

A

Similar to pulmonary flow murmur
8 to 14 years of age
Blowing early systolic murmur at upper left sternal border due to increased flow over the pulmonary valve

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9
Q

Define a Venus hum

A

Not a true murmur
3 to 6 years of age
Continuous (starts in systole and spills into diastole) murmur
Heard in supraclavicular or infraclavicular areas, disappears with compression of jugular vein Institute and supine position

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10
Q

What other concerns should you have for a patient with a congenital heart disease

A

30% of patients will have other anatomic abnormalities

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11
Q

What are the common causes of cyanosis

A

Cardiac
Pulmonary
Hematologic
Neurologic

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12
Q

What is the best test isolates the cause of cyanosis

A

Hyperoxia test

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13
Q

What are the expected results for cardiac disease causing cyanosis on the hyperoxia test

A

Before oxygenation less than 40 PaO2
after oxygenation less than 50 PaO2.

With complete mixing before you have 50 PaO2 after oxygenation you’ll have less than 150 PaO2

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14
Q

What valves open with systole

A

Aortic and pulmonic

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15
Q

What valves close with systole

A

Tricuspid and mitral

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16
Q

What is the most common congenital heart malformation

A

VSD

Ventricular septal defect

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17
Q

Will a large or small ventricular septal defect have a soft murmur

A

large

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18
Q

What are the symptoms of a large ventricular septal defect

A 
Congestive heart failure
Active precordium
Hepatomegaly
Crackles
BVH or LVH
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19
Q

What is Eisenmenger’s physiology

A

Initially there is a left to right shunt
Then right ventricular hypertrophy and increased pulmonary vascular resistance
Then a right to left shunt develops
Blood is bypassing lungs and leads to cyanosis

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20
Q

What murmur is highly suggestive of a the ventricular septal defect

A

Holosystolic murmur (Harsh or soft) at lower left sternal border

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21
Q

What is the prognosis of a ventricular septal defect

A

30 to 50% of cases will close spontaneously by two years

Surgical closure for failure to close and large defects

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22
Q

What is the normal cardiac to rib cage ratio

A

Less than 0.5

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23
Q

When does pulmonary vascular resistance reached its nadir in pediatrics

A

Eight weeks

You will begin to get an increase in left to right shunting

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24
Q

What is the most common type of ASD

A

Ostium secundum type

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25
Q

Most patients with ASD or asymptomatic until when

A

Third decade of life

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26
Q

What murmur is suggestive of an atrial septal defect

A

Systolic ejection murmur and left mid and upper sternal border,

Wide fixed split S2 due to an increased blood in the right atrium and ventricle being pushed through the pulmonic valve

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27
Q

Discuss normal physiology of a split S2

A

With inspiration the pulmonic valve closes a little later

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28
Q

What many seen on X-ray with an atrial septal defect

A

An enlarged right atrium in ventricle

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29
Q

What is the biggest risk factor for endocardial cushion defect

A

Trisomy 21

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30
Q

What murmur is associated with endocardial cushion defect

A

Holosystolic murmur heard at apex (AV valve insufficiency)

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31
Q

What is a PDA

A

Patent ductus arteriosus
Failure of closure of ductus resulting in blood flow from aorta to pulmonary artery
Common in prematurity

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32
Q

What symptoms are associated with a large PDA

A

Pulmonary overload
Wide pulse pressure
Bounding arterial pulses

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33
Q

In infants what may be used to help close the PDA

A

Indomethacin

prostaglandin inhibitor

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34
Q

What cardiac malformation is highly associated with Turner’s syndrome

A

Coarctation of the aorta

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35
Q

What murmur is associated with coarctation of aorta

A

Short systolic murmur at the left upper sternal border with radiation to left back

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36
Q

What chest x-ray findings are associated with coarctation of the aorta

A

Marked cardiac enlargement
Increased pulmonary vascular markings
Rib notching (from enlarged collaterals)

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37
Q

What congenital malformations are associated with cyanotic heart disease

A

The five T’s

Truncus arteriosus
Transposition of the great arteries
Tricuspid atresia
Tetrology of Fallot
Total anomalous pulmonary venous return

Pulmonary atresia
Large VSD

The last two or associated with cyanotic heart disease after Eisenmenger’s physiology

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38
Q

What’s the most common cause of congenital cyanotic heart disease

A

Tetralogy of Fallot

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39
Q

What are the findings associated with tetralogy of Fallot

A

Ventricular septal defect
Pulmonary stenosis
Hypertrophy of right ventricle
Overriding aorta

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40
Q

What determines the cyanotic yet spells associated with Tetralogy of Fallot

A

Ventricular pressure determines the direction of bloodflow

Acyanotic tetralogy is associated with sufficient pulmonary bloodflow shunting across the VSD is balanced

Paroxysmal cyanosis tet spells occur when systemic resistance drops or pulmonary resistance increases

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41
Q

What will reverse the paroxysmal cyanosis associated with pathology of Fallot

A

Increasing the left side pressures will reverse the right to left shunt such as bringing the knees to the chest or squatting

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42
Q

What are the murmurs associated with tetralogy of Fallot

A

VSD over the lower left sternal border

Pulmonic Stenosis

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43
Q

What chest x-ray finding do you expect to have with tetralogy of fallot

A

Boot shaped heart

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44
Q

What is the transposition of great vessels

A

Aorta arises from right ventricle, pulmonary artery arises from left ventricle resulting in a parallel circulation
Must be some communication atrial, septal or ductal levels to be compatible with wife

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45
Q

What is the most common cause of extreme cyanosis within the first 24 hours of life

A

Transposition of the great vessels

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46
Q

Will the cyanosis correct with oxygenation for a transposition of the great vessels

A

No

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47
Q

What is the treatment for transposition of the great vessels

A

Prostaglandin to maintain ductus open is life-saving used PGE
Surgical correction is definitive

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48
Q

What do you expect to find with pulmonary atresia on EKG

A

Tall spiked P waves suggestive of right atrial enlargement, right ventricular hypertrophy

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49
Q

What is the treatment for pulmonary atresia

A

Maintain ductus open until surgery

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50
Q

What murmur is associated with pulmonary stenosis

A

Harsh systolic ejection murmur with ejection click at left upper sternal border

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51
Q

What findings suggestive of tricuspid atresia

A

Cyanosis at birth
Systolic murmur along left sternal border
Single S2
Left axis deviation in the infant

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52
Q

What findings on X-ray are suggestive of a total anomalous pulmonary venous return

A

The snowman or figure 8 with cardiomegaly

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53
Q

What murmur is associated with total anomalous pulmonary venous return

A

Systolic murmur at left upper sternal border

S2 fixed and widely split

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54
Q

Increase flow over the pulmonic valve will cause what heart sound

A

Split S2

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55
Q

What is truncus arteriosus

A

Single vessel arises from the ventricles supplying systemic/pulmonary/coronary circulation

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56
Q

What the complications of a hypoplastic left heart

A

Inadequate systemic circulation and pulmonary venous hypertension
Small aorta

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57
Q

What is the most common cause of myocarditis

A

Viral etiology is most common enterovirus (coxsackie) virus and adenovirus

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58
Q

What are the causes of a dilated cardiomyopathy in infants

A

Often idiopathic

Maybe associated with neuromuscular disease, drug toxicity, and chemotherapy (including doxorubicin)

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59
Q

What is the diagnostic study for cardiomyopathies

A

Echocardiogram

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60
Q

What causes acute rheumatic fever

A

GABHS

1 to 3 weeks after preceding streptococcal infection is commonly in 5 to 15-year-olds

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61
Q

What is required to diagnose acute rheumatic fever

A

The Jones criteria

- Must have two major criteria or one major and two minor criteria plus evidence of preceding strep infection

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62
Q

What are the Major Jones criteria

A 
Carditis
Arthritis
Erythema marginatum
Chorea
Subcutaneous nodules
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63
Q

What are the minor Jones criteria

A 
Fever 
arthralgia 
elevated acute phase reactants
Prolonged ER
Previous rheumatic fever
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64
Q

What is the treatment for acute rheumatic fever

A

Treat streptococcal infection and monthly penicillin prophylaxis
Salicylates to decrease myocardial inflammation
Steroids for carditis

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65
Q

What is a complication of acute rheumatic fever

A

Valvular heart disease

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66
Q

What are the most common organisms that cause endocarditis

A

Staff aureus

Streptococcus Viridans

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67
Q

What are the signs and symptoms of endocarditis

A

Acute or insidious onset
Persistent fever, chills, arthralgias, new murmur, petechiae
Oslers nodes (painful)
Janeway lesions (painless) splinter hemorrhages

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68
Q

How is endocarditis diagnosed

A

Echocardiogram

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69
Q

What preventative measures must be taking with endocarditis

A

Prophylactic antibiotics prior to dental visits

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70
Q

How is hypertension diagnosed in pediatrics

A

What pressure above 95% for age 3 review measurements

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71
Q

What is the most common cause for pediatric hypertension

A

Most commonly secondary

Renal is 75 to 80%

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72
Q

What are the risk factors for pediatric arrhythmias

A 
Congenital, acquired or functional heart disease
Electrolyte abnormalities
Drug toxicity
Poisoning
Collagen vascular disease
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73
Q

What are some causes of sinus bradycardia pediatrics

A

Increased vagal tone
hypothyroidism
increased intracranial pressure
anorexia nervosa

Most commonly a normal finding in healthy athletic children

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74
Q

What is the difference between a Mobitz type I and a Mobitz type II heart Block

A

Type one will have a prolongation of PR then a drop a QRS

Type II will just drop the QRS

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75
Q

What maternal diseases associated with a third degree heart block in infancy

A

Maternal lupus

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76
Q

What are the causes of sinus tachycardia

A 
Hypovolemia
Shock
Anemia
Fever
Sepsis
Pulmonary embolism
Medications
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77
Q

What do you expect to see on an EKG for supraventricular tachycardia

A

A runn of three or more premature supraventricular beats a greater than 230 beats permitted
Abnormal or absent P waves

Key association with WPW syndrome

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78
Q

What is WPW syndrome

A

Anomalous conduction pathway to ventricles bypassing the AV node which leads to premature and prolonged depolarization of ventricles
Predisposes to SVT

On the EKG: shortened PR, Delta wave, wide QRS

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79
Q

What is the treatment for long QT syndrome

A

Beta blocker

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80
Q

What is apnea of prematurity

A

Premature infants less than 36 weeks of gestation holding their breath for periods of less than 15 seconds

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81
Q

What is the treatment of apnea prematurity

A

Theophylline/caffeine as central stimulant

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82
Q

What is the obstructive sleep apnea

A

Prolonged partial airway obstruction intermittent cessation of breathing disrupting sleep and breathing

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83
Q

What are the pediatric risk factors for obstructive sleep apnea

A

Adenotonsillar hypertrophy
trisomy 21
Anatomical abnormalities

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84
Q

What is used to diagnose obstructive sleep apnea

A

Polysomnography

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85
Q

What are the complications of obstructive sleep apnea

A

Cor pulmonale
Poor growth
Poor school performance

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86
Q

What is cyanotic breath holding

A

Breath holding spells between the ages of one and three years old usually associated with temper tantrums or angry outbursts

It’s self-limited and very benign

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87
Q

What is Pallad Breath holding

A

Associated with fright
Patient becomes pale and hold breath
loses consciousness

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88
Q

What is the most commonly aspirated food

A

Peanuts

Popcorn, grapes, hot dogs are also common

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89
Q

What are the signs and symptoms of a foreign body aspiration

A

Cough, Strider, shortness of breath, cyanosis

Localized wheezing or new onset wheezing

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90
Q

How will a chest x-ray demonstrate foreign body aspiration

A

With an expiratory expiratory film. The effected side is the same appearance for both inspiration and expiration

Ball valve mechanism

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91
Q

What is the treatment for foreign body aspiration

A

Bronchoscopy

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92
Q

What is the pneumothorax

A

Intrapleural accumulation of air, maybe spontaneous or traumatic

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93
Q

What are the causes of the pneumothorax

A

CF, congenital lobar emphysema, asthma, pertussis,

Due to excessive cough

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94
Q

What is croup

A

Laryngotracheobronchitis

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95
Q

What are the most common causes of croup

A

Parainfluenza is the most common
Adenovirus, RSV, influenza

Most common three months to five years of age

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96
Q

What is the expected x-ray finding for croup

A

Staple sign

Suggestive of subglottic swelling

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97
Q

What is the treatment for croup

A

Humidified air in mild cases such as the steam from a shower

For ill children you can use corticosteroids

98
Q

What is spasmodic croup

A

episodic and recurrent stridor associated with croup without the associated viral symptoms

99
Q

What is the most common cause of bacterial tracheitis

A

Staph aureus

100
Q

What are the signs and symptoms of bacterial tracheitis

A

Strider, respiratory distress, toxic appearance, “Brassy” cough, purulent airway secretions

101
Q

What is epiglottitis

A

Acute inflammation of the epiglottis

Most commonly H influenza type B, can be strep pneumo-, nontypeable H. influenzae

Most common 2 to 7 years of age

102
Q

What are the signs and symptoms of epiglottitis

A

Sudden onset of high fever, dysphasia, drooling, muffled voice, respiratory distress, tripod position, neck hyperextension

103
Q

What is the main concerns with epiglottitis

A

The number one priority is securing the airway

TONGUE BLADE EXAM SHOULD NOT BE DONE OR ANY AGITATION PROCEDURE

104
Q

What is bronchiolitis

A

Lower respiratory tract infection caused by inflammatory obstruction of the small airways
Usually less than two years of age
RSV is most common

105
Q

What are the signs and symptoms of bronchiolitis

A

URI, rhinorrhea, fever, may progress to respiratory distress and poor feeding

Tachypnea, wheezing, crackles, retraction, cyanosis

106
Q

What is pneumonia

A

Inflammation of pulmonary tissue associated with consolidation of alveolar spaces
Most commonly viral

107
Q

What are the signs and symptoms of pneumonia

A

Fever
Tachypnea
Cough

108
Q

What are the likely causes of pneumonia in neonates

A 
Gram-negative rods
E. coli
Lysterria
Enterococcus
Klebsiella
109
Q

What are the most likely causes of pneumonia in preschool age children

A

Strep pneumonia
Staph aureus
Viral is the most common

110
Q

What is the most likely causes of pneumonia and school-age and up

A

Mycoplasma/chlamydia
Strep pneumonia
Staph aureus
Viral most common

111
Q

What will viral pneumonia show on a chest x-ray

A

Streaky infiltrates, peribronchial coughing

No consolidation

112
Q

What will a bacterial pneumonia show on a chest x-ray

A

Lobar consolidation

113
Q

What is the treatment for mycoplasma pneumonia

A

Macrolides or quinolones

Most commonly azithromycin

114
Q

Who is most likely to get chlamydia trachomatis pneumonia

A

Six weeks to six month olds

115
Q

What type of cough is associated with chlamydia trachomatis pneumonia

A

Staccato cough

116
Q

What is the treatment for chlamydia trachomatis pneumonia

A

Erythromycin

117
Q

What is the treatment needed for aspiration pneumonia

A

Anaerobic coverage such as clindamycin in addition to usual bacterial coverage

118
Q

What is asthma

A

Reversible obstructive airway disease affecting small and large airways

119
Q

What are the components of asthma such as clinical findings

A

Bronchospasm
Mucus production
Airway inflammation

120
Q

What are the triggers to asthma

A 
Infection
Exercise
Cold
Allergens
Smoke
121
Q

What can be used for serious acute exacerbations of asthma

A

Magnesium sulfate

Terbutaline confusion

122
Q

What is mild intermittent asthma

A

Daytime symptoms less than two times per week

Nocturnal symptoms less than two times per month

123
Q

What is mild persistent asthma

A

Daytime symptoms greater than two times per week but less than one times per day

Nocturnal symptoms greater than two times per month

124
Q

What is moderate persistent asthma

A

Daily symptoms

Nocturnal symptoms greater than one time per week

125
Q

What is the severe persistent asthma

A

Continuous symptoms

Frequent nocturnal symptoms

126
Q

What is the treatment for mild intermittent asthma

A

No daily medication

Short acting bronchodilator as needed

127
Q

What is the treatment for mild persistent asthma

A

One daily medication- low dose inhaled corticosteroid

Short acting bronchodilator as needed

128
Q

What is the treatment for moderate persistent asthma

A

One daily medication-medium acting inhaled corticosteroid and a long acting bronchodilator
Short acting bronchodilator as needed

129
Q

What is the mutation associated with cystic fibrosis

A

Deletion

Most common mutations Delta 508

130
Q

What is the major problem associated with cystic fibrosis

A

Abnormality of the chloride transport
Thick mucus and impaired pancreatic secretions

Average age is 30 years

131
Q

What are the signs and symptoms of cystic fibrosis

A 
Meconium illeus, rectal prolapse, failure to pass meconium in first 24 hours
Recurrent respiratory infections
Stearrhea
Vitamin deficiency A,D,E and K
Nasal polyps
Diabetes mellitus
Delayed sexual development
132
Q

What is the gold standard to diagnose cystic fibrosis

A

Sweat chloride test

133
Q

What is the treatment for cystic fibrosis

A
  1. clear secretions
    - VEST, Chest PT, inhalation therapy, DNAse
  2. nutrition therapy
    - Pancreatic enzyme replacement, Vitamins

3.treat infection aggressively

134
Q

What is a duodenal atresia

A

Obstruction resulting from failure to re-canalize the duodenal lumen

135
Q

What are the risk factors for duodenal atresia

A

Trisomy 21

136
Q

What are the signs and symptoms of duodenal atresia

A

Bilious vomiting, often on the first day of life

Usually no abdominal distention

137
Q

What’s will an x-ray show for a duodenal atresia

A

Double bubble

First bubble is air in the stomach
Second bubble is air in proximal duodenum
No air in the rest of the intestines

138
Q

What is Hirschsprung’s disease

A

Absence of ganglion cells of bowel wall

139
Q

What are signs and symptoms of Hirschsprung disease

A

Failure to pass meconium in 24 hours

Obstruction leads to bowel dilation

140
Q

What is the treatment for Hirschsprung disease

A

Surgical resection

141
Q

What is meconium ileus

A

Abnormally thick meconium can cause in utero or neonatal blockage
Volvulus and bowel infarction can occur

142
Q

What is the risk factors for meconium ileus

A

Cystic fibrosis

90% of patients with meconium ileum have cystic fibrosis

143
Q

What is appendicitis

A

Blockage of appendiceal lumen

Most commonly caused by lymphoid hyperplasia, feoclith

144
Q

What are the causes of gastroesophageal reflux

A

Inappropriate LES relaxation, hiatal hernia, delayed gastric emptying

Common in all

145
Q

When is gastroesophageal reflux considered pathological

A

Infants not gaining weight
Pain and discomfort
Aspiration

146
Q

What are the signs and symptoms of gastroesophageal reflux

A

Vomiting, chronic cough, wheezing, apnea, failure to thrive, substernal chest pain

147
Q

What is the treatment for gastroesophageal reflux

A

Head elevation
Thickening of seeds (rice, bananas)

Medical managements: H2-blockers, proton pump inhibitors, prokinetic’s

Surgical correction: Nissen fundoplication

148
Q

What are the risk factors for pyloric stenosis

A

Firstborn males

149
Q

What are the signs and symptoms of pyloric stenosis

A

Nonbileus projectile vomiting usually beginning of 3 to 4 weeks of age

Happy vomiter

150
Q

What happens with excessive vomiting

A

Hypokalemic, hypochloremic, metabolic alkalosis

With vomiting you lose hydrogen which leads to alkalosis. Also vomiting chloride which leads to hypochloremia.
Because you are alkolotic, your kidneys begin excreting potassium instead of hydrogen to maintain the hydrogen which leads to hypokalemia

151
Q

What will ultrasound demonstrates for pyloric stenosis

A

Thickened elongated pylorus

152
Q

What is the treatment for pyloric stenosis

A

REHYDRATION AND ELECTROLYTE CORRECTION FIRST

Then surgical correction

153
Q

What is colic

A

Rules of three

  1. Usually seen three weeks to three months of age
  2. Crying for greater than three hours per day
  3. More than three times per week for no other reason
154
Q

What are the signs and symptoms of small bowel instruction

A

Bilious vomiting

155
Q

What are the two classifications of diarrhea

A

Infectious

Malabsorptive

156
Q

One of the two mechanisms of diarrhea

A

Osmotic
- stool volume depends on diet and decreases with fasting

Secretary
- Stool volume is increased and does not increase with diet

157
Q

What is the most common cause of infectious diarrhea

A

Viral is most common: rotavirus

Bacterial
Parasitic

158
Q

What are the features of rotavirus

A

Watery diarrhea for 7 to 10 days

Maybe associated with vomiting

159
Q

What is associated with enteropathogenic E. coli

A

Nurseries and daycare

160
Q

What are the features of enterotoxigenic E. coli

A

hemorrhagic colitis

Associated with hemolytic uremic syndrome

161
Q

What are the features of Yersinia associated diarrhea

A

Transmitted by pest, contaminated food
Maybe associated with arthritis and rash
Often confused with IBD
Pseudo-appendicitis

162
Q

What is the onset of time for staph aureus toxin mediated associated diarrhea

A

Within 12 hours of ingestion

Other food toxins will take closer to 24 hours before symptoms manifest

163
Q

What is the treatment for diarrhea

A

Ensure adequate hydration

164
Q

What is the most common cause of constipation

A

Functional (voluntary withholding)

Other causes include: meconium ileus (CF) Hirschsprung disease, botulism, hypothyroidism

165
Q

What is encopresis

A

Fecal incontinence after age 4 years

166
Q

What are the signs and symptoms of encopresis

A

Leakage of loose stool around obstruction

167
Q

What is hematemesis

A

Blood stained vomitus
Usually indicates bleeding proximal to the ligament of Treitz
(Dividing line between duoden and jejunum)

168
Q

What is allergic proctocolitis

A

Streaks of blood in stool
Typically not ill appearing with history of milk use or exposure

Hematochezia in infancy one day to three months of age is typical

169
Q

What is the treatment for allergic proctocolitis

A

Partially hydrolyzed formula

Hypoallergenic formula

170
Q

What is Meckel’s diverticulum

A

Known as the happy bleeder
Most common congenital G.I. anomaly

Vestigial remnant of the omphalomesenteric

Disease of 2’s
2% infants, two years, 2 cm, 2 feet from ileocecal valve

171
Q

What are the signs and symptoms of Meckel’s diverticulum

A

Painless rectal bleeding

172
Q

What will hard stools induce

A

Anal fissures

173
Q

What is an intussusception

A

Portion of G.I. tract telescopes into portion Distal to it; most are ileocolic

6-24 months

Associated with lympoid hyperplasia (peyer’s patches), Meckel diverticulum

174
Q

What are the signs and symptoms of intussusception

A

Acute onset of cramping intermittent pain, lethargic, currant jelly stool, soft sausage shaped mass on rectal exam

175
Q

What is both diagnostic and therapeutic for intussusception

A

Barium enema

Surgical intervention needed if failed reduction with enema twice

176
Q

What are the signs and symptoms of Crohn’s

A 
Weight loss
Fever
Abdominal pain
Growth failure
Diarrhea
Perianal disease or mouth ulcers
177
Q

What does a colonoscopy and biopsy demonstrate for Crohn’s disease

A

Skip lesions
Transmural inflammation
Noncaseating granuloma’s

178
Q

What is the treatment for Crohn’s disease

A

Steroids

Immunosuppression

179
Q

What are the signs and symptoms of ulcerative colitis

A

Involves only the colon
Bloody diarrhea with mucus
Abdominal pain symptoms

must be present for at least 3 to 4 weeks to make a diagnosis of exclusion

180
Q

What is the complication of ulcerative colitis

A

colon cancer

181
Q

How is a obesity determined in pediatrics

A

BMI greater than 95% for age/sex

BMI greater than 30 in adolescence

182
Q

What are signs and symptoms of obesity in pediatrics

A

Striate
Pseudogynecomastia
Early puberty

183
Q

What are the causes of obesity in pediatrics

A

Endocrine (cushion, hypothyroidism, Prader-Willi)

Genetic (turner)

Most commonly lifestyle

184
Q

What is celiac disease

A

Gluten sensitive enteropathy
Develop when gluten containing foods (wheat, rye, barley) introduced 6 to 12 months, depending on preference leading to failure to thrive

185
Q

What is the pathophysiology of celiac disease

A

Intraepithelial lymphocytes in villi causing villous blunting

Associated with dermatitis herpetiformis

186
Q

What is the dermatitis herpetiformis

A

Erythematous vesicles distributed symmetrically over elbows and knees

187
Q

What are the rest factors for celiac disease

A

Down syndrome
Type I diabetes mellitus
Autoimmune disease

188
Q

What testing is available for celiac disease

A

Tissue transglutiminase
Anti-enodmysial antibody

Must obtain an IgA level at the same time to prevent a false negative

189
Q

What’s will biopsy demonstrate for celiac disease

A

Villus blunting and second biopsy following gluten-free diet with normalization of architecture

190
Q

What is failure to thrive

A

Failure to gain weight or deceleration of weight growth
Less than 10 percentile
Crosses two or more percentile marks for growth curve

191
Q

What are the causes for failure to thrive

A

Nonorganic (deprivation, neglect, abuse) is the most common cause

Malnutrition
Mal absorption
Allergies
Immune deficiency states
Chronic disease
192
Q

What is the first thing to notice with caloric deprivation failure to thrive

A

Weight

193
Q

What is affected more for failure to thrive due to hyporthyroidism and growth hormone deficiency

A

Height

194
Q

What is constitutional growth delay

A

The child will follow the growth curves and will ultimately reach adulthood with a delayed growth spurt

195
Q

What is familial short stature

A

Adult height will be below the growth curve

Normal curve throughout, just below the normal percentages

196
Q

How do you tell the difference between a constitutional growth delay and familial short stature

A

By using a bone age

  • If bone age is less than chronological age then the diagnosis constitutional growth delay
  • If bone age equals chronological age, then diagnosis is from familial short stature
197
Q

What is the symptoms of vitamin A deficiency

A

Ocular lesions (xerosis)
Night blindness
Dry skin

198
Q

What are the symptoms of a thiamine (B1) sufficiency

A

Beriberi neuritis
Heart failure
Encephalopathy

199
Q

What are the symptoms of the niacin deficiency

A

Pellagra

Diarrhea
Dermatitis,
Dementia

200
Q

The symptoms of a pyridoxine (B6) deficiency

A

Seizures
Neuritis
Dermatitis
Anemia

201
Q

What are the symptoms of a vitamin C deficiency

A

Scurvy
Pseudoparalysis
Mucous membrane hemorrhages

202
Q

What are the symptoms of vitamin D deficiency

A

Rickets

Craniotabes
Rachitic rosary
Bowlegs tetany

203
Q

What are the symptoms of vitamin E deficiency

A

Creatinuria
Muscle weakness
Anemia

204
Q

What are the symptoms of vitamin K deficiency

A

Hyporprothrombinemia

Bleeding

205
Q

What are the symptoms are riboflavin (B2) deficiency

A 
Seborrheic dermatitis
Anemia
chelitis/bursitis/stomatitis
Photophobia
Sore throat
edmatous oropharyngeal mucosa
206
Q

What is the problem with adolescent pregnancy

A

Higher rates of illness and death from both mother and infant

207
Q

What is pelvic inflammatory disease

A

Ascending spread of organisms from lower genital tract to cervix, endometrium and fallopian tubes

208
Q

What is the most common calls of pelvic inflammatory disease

A

Chlamydia and gonorrhea

209
Q

What are the signs and symptoms of pelvic inflammatory disease

A

Abdominal pain, cervical motion tenderness, adnexal tenderness;
May have fever, leukocytosis

210
Q

What is the treatment for pelvic inflammatory disease

A

Gonorrhea: IM ceftriaxone
Chlamydia: 14 days of doxycycline

211
Q

What is the reason we treat for pelvic inflammatory disease

A 
To prevent complications such as
Tubo-ovarian abscess
Increase risk for ectopic pregnancy in the future
Decreased fertility
Fitzhugh Curtis syndrome
212
Q

What is Fitzhugh Curtis syndrome

A

Perihepatitis

PID plus right upper quadrant pain in transaminase elevation

213
Q

What are the signs and symptoms of gonorrhea

A

Purulent vaginal discharge, dysuria, abdominal pain, arthritis (large joints)

214
Q

What is the treatment for gonorrhea

A

Cefiximine for anything less than PID
Ceftriaxone for PID

Treat concurrently for chlamydia
Emperic testing for comorbid STDs

215
Q

What complication is associated with gonorrhea

A

Fitzhugh Curtis-perihepatitis

216
Q

What is chlamydia

A

Intracellular obligate parasites

Most common STD

217
Q

What is gonorrhea

A

Gram-negative intracellular diplococci

218
Q

What are the signs and symptoms of chlamydia

A

They are often asymptomatic; use a routine screen

Urethritis, cervicitis, PID

219
Q

What is the treatment for chlamydia

A

Azithromycin or seven days doxycycline for urethritis/cervicitis

14 days doxycycline for PID

220
Q

Legally how are adolescents affected by reproductive health

A

There considers emancipated minors

221
Q

Herpes simplex virus type I most often affects what region

A

Make calls genital disease but usually oral and CNS infections

222
Q

Herpes simplex virus type II soft effects what region

A

More common causes genital infection

223
Q

Where the signs and symptoms of herpes

A

Fever, regional adenopathy, dysuria, painful vesicles and ulcers

224
Q

How’s herpes diagnosed

A

Most often clinical but may use a tzanck smear

225
Q

What is the treatment for herpes

A

Acyclovir for outbreaks-early in the course (within a day)

If genital disease, evaluate for other STDs

226
Q

What is Trichomonas vaginalis

A

Mobile flagellated protozoan

227
Q

What are the signs and symptoms of trichomonas vaginalis

A

Malodorous, frothy, yellow-green discharge and vaginal itching

228
Q

How is trichomonas vainalis diagnosed, what technique

A

What prep to look for leukocytes and Mobile trichomonads

229
Q

What is the treatment for trichomonas vaginalis

A

Metronidazole

230
Q

What causes bacterial vaginosis

A

Gardnerella vaginalis,

Mycoplasma hominis

231
Q

What are the signs and symptoms of bacterial vaginosis

A

Send, white, foul-smelling discharge that smells “fishy” when mixed with KOH

Vaginal pH > 4.5

232
Q

What will a wet prep demonstrate for bacterial vaginosis

A

Clue cells

233
Q

What is the treatment for bacterial vaginosis

A

Metronidazole

234
Q

What are the signs and symptoms of vaginal candidiasis

A

Thick, white, vaginal discharge with vaginal itching and burning

235
Q

What will a wet prep demonstrate for vaginal candidiasis

A

KOH prep to look for yeast and pseudohyphae

236
Q

What are the causes for amenorrhea in pediatrics

A

Primary: chromosomal (turner syndrome) or congenital (imperforate hymen)

Secondary: malnutrition (anorexia), endocrine disorders/hypothalamic

237
Q

What are the steps to diagnose amenorrhea

A

Evaluate for pregnancy and presents/absence of virilization
Progesterone challenge test: withdrawal bleeding will occur with normal endometrium tract presents
Check FSH, LH (elevated level suggest primary gonadal failure), TSH and prolactin

238
Q

What are the causes of dysmenorrhea

A

Primary: absence of pelvic condition and related to prostaglandin production
Secondary: structural abnormality, endometriosis

239
Q

What is the treatment for dysmenorrhea

A

Consider NSAIDs, OCP

240
Q

What is polycystic ovarian syndrome

A

Excessive levels of LH resulting and increased ovarian androgen production
Associated with peripheral insulin resistance

241
Q

One of the signs and symptoms of polycystic ovarian syndrome

A

Multicystic ovaries, hirsutism, menstrual irregularities

242
Q

What is the treatment for polycystic ovarian syndrome

A

Consider OCP’s

► Med Misc 06 (27 decks)

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