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Med School Rotations > Falcon Review Pediatrics 2 > Flashcards

Falcon Review Pediatrics 2 Flashcards

1
Q

Activated charcoals is ineffective against what type of poisonings

A 
Hydrocarbons
cyanide
metals
Li
acids and bases
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2
Q

What are the stages of acetaminophen toxicity

A

Stage 1: 1st 24 hours
- Nausea, vomiting, diaphoresis

Stage 2: 24-48 hours
- clinical improvement

Stage 3: 72-96 hours
- peak liver functional abnormalities

Stage 4: 4 days - 2 weeks
- hepatitis resolves

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3
Q

How do you diagnose acetaminophen tox

A

measure plasma level 4 hours after ingestion.

Use Rumack-matthew Nomogram to plot level and predict hepatoxicity

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4
Q

What is the treatment for acetaminophen tox

A

Consider activated charcoal with in 1 hour of ingestion

Antidote: N-acetylcysteine (mucomyst)

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5
Q

What are the signs and symptoms of amphetamine toxicity

A

Diarrhea, palpitations, arrhythmia, syncope, hyper pyrexia, hyperreflexia, may progress to convulsions

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6
Q

What are the signs and symptoms of anti-histamine toxicity

A

It ranges from drowsiness to restlessness and seizures

anticholinergic effects such as hot as here; blind as a bat; reticent beat; dries the bone; mad as a Hatter.

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7
Q

What is the treatment for antihistamine overdose

A

Consider activated charcoal within the first hour

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8
Q

What is the most common cause of drug poisoning

A

Aspirin overdose

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9
Q

Where the signs and symptoms of aspirin overdose

A

mild: vomiting, fever, lethargy, mental confusion, hyperpnea

Severe: convulsions, coma, respiratory / cardiovascular collapse

chronic: hyperventilation, dehydration, bleeding disorders, seizures, coma

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10
Q

What are the three phases of aspirin toxicity

A

Phase 1 for 12 hours.
Respiratory alkalosis, sodium and potassium excretion urine.

Phase II within 12 to 24 hours.
Paradoxical acid urea.

Phase III
Metabolic acidosis with dehydration and hypokalemia.

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11
Q

How is salicylate toxicity level determined

A

Clinical course is predicted by measuring salicylate levels at six hours after ingestion

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12
Q

What is the treatment for salicylate toxicity

A

Alkalinization of urine to increase excretion

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13
Q

What is the affinity of carbon monoxide

A

250 times that of oxygen

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14
Q

Greater than what percentage of carbon monoxide is lethal

A

70%

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15
Q

How effective is using a pulse ox symmetry to determine carbon monoxide poisoning

A

Poor

Pulse oximetry just measures saturation of hemoglobin whether it is oxygen or carbon monoxide

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16
Q

What are the complications of carbon monoxide poisoning

A

Behavior change.
Memory loss.
Blindness may occur in 10 to 30% of cases

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17
Q

What are the signs and symptoms of caustics ingestion

A

burns of mucous membranes and drooling often refusing to swallow

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18
Q

What are the steps to diagnose caustic ingestion

A

First ensure airway patency then endoscopy to evaluate the extent of damage

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19
Q

Should you treat the caustic ingestion with

A

No

The burns on the way down then it will burn on the way back up

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20
Q

What are the signs and symptoms of cocaine use

A

Perforated nasal septum.
Euphoria,
CNS stimulation.
Myocardial infarction

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21
Q

How long may the symptoms be delayed for hydrocarbon ingestion

A

Up to six hours

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22
Q

What are the signs and symptoms of iron toxicity

A

Stage one: 30 minutes to six hours.
-After ingestion nausea vomiting diarrhea abdominal pain hemorrhagic gastroenteritis.

Stage II: six to 12 hours.
The honeymoon phase shows improvement.

Stage III.
24 to 48 hours progressive circulatory collapse, hepatorenal failure, bleeding, metabolic acidosis, Coma

Stage IV
1-2 months with G.I. scoring in obstruction

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23
Q

What level of serum iron is considered severe

A

Greater than 500 mcg/dL

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24
Q

What is the anecdote for iron toxicity

A

Deferoxamine

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25
Q

What will a peripheral blood smear show for lead toxicity

A

anemia with basophilic stippling

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26
Q

What is the treatment for lead toxicity

A

Mild: decrease environmental exposure

Moderate: oral succimer

Severe: intravenous calcium EDTA

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27
Q

What are the signs and symptoms of opiates

A

Respiratory depression, constricted pupils, bradycardia, hypertension, hypothermia, hyperreflexia, coma

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28
Q

What are the signs and symptoms of organophosphate ingestion

A

Multi system affect

Muscarinic
Salvation, lacrimation, urination defecation

Nicotinic
Cramps, fasciculations, twitching, weakness, areflexia, paralysis of voluntary muscles

CNS
Anxiety, ataxia, dizziness, headache, convulsions, coma

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29
Q

What is the treatment for organophosphate ingestion

A

Atropine

Pralidoxime

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30
Q

The signs and symptoms of tricyclic antidepressant overdose

A

Drowsiness, delirium, was nation, seizure coma, hypertension, arrhythmias including QRS widening and QTc prolongation

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31
Q

What are the treatment options for tricyclic antidepressant overdose

A

Consider activated charcoal within the first hour

Sodium bicarbonates decreased cardiac toxicity by decreasing free fraction of drug

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32
Q

The most common causes of non-organic failure to thrive

A

P. A. I. D.

Poverty
Abuse
Ignorance
Depression

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33
Q

What IQ was determined mental retardation

A

IQ of 70 or less

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34
Q

Defined learning disorder

A

Academic functioning below what would be appropriate for age, IQ and education

Discrepancy between achievement test and cognitive test

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35
Q

What is the difference between conduct disorder and oppositional defiant disorder

A

A conduct disorder is more associated with actions; show aggressive behavior towards others, animals, and property

Oppositional defiant disorder is more associated with the attitude they lose control they have negativity, hostility, defiance

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36
Q

What is required to diagnose Tourette’s syndrome

A

Disorder of multiple severe tics both vocal and motor

Must be before the age of 18 for one year nearly daily without a tic free period Greater than three months

Highly associated with ADHD

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37
Q

What are the signs and symptoms of depression

A

SIG E CAPS

S leep 
I nterest (loss): 
G uilt (worthless): 
E nergy (lack): 
C ognition/C oncentration: 
A ppetite (wt. loss); 
P sychomotor: agitation (anxiety) or retardations (lethargic)
S uicide/death preocp.
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38
Q

What are the signs and symptoms of schizophrenia

A

Positive symptoms which are treatable include delusions, hallucinations, disorganized speech and behavior

Negative symptoms which are difficult to treat include flat affect, apathy, anhedonia

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39
Q

What is anorexia nervosa

A

Condition of weight loss resulting from disturbed body image and fear of obesity

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40
Q

What are the signs and symptoms of anorexia nervosa

A

Weight loss, amenorrhea, bradycardia, hypotension, hypothermia, lanugo hair growth, cardiac fluid and electrolyte disturbances

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41
Q

What is bulimia

A

Eating disorder characterized by binge eating, induced vomiting, laxative abuse

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42
Q

What are the signs and symptoms of ADHD

A

Inattention, hyperactivity, impulsivity, symptoms must be present by age 7 and last for six months and occur in more than one setting and impair function

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43
Q

What is autism

A

Impaired social, communication language, and behavior

Develops before 30 months

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44
Q

What is aspergbers syndrome

A

Type of autism with more communication and appear more socially aware

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45
Q

What is Rett syndrome

A

Neurodegenerative disorder affecting females. X-linked dominant

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46
Q

What are the signs and symptoms of Rett syndrome

A

Loss of milestones.

Acquired microcephaly onset of one year of age

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47
Q

What is Munchhausen by proxy

A

Patient fabricates or induces an illness in the child. They may be in the healthcare profession or regarded as a model parent

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48
Q

What is strabismus

A

Misalignment of the eyes “lazy eye”

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49
Q

Transient strabismus is common up to what age

A

Four months

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50
Q

How is strabismus diagnosed

A
  1. Hirschberg test: look for asymmetric corneal reflex

2. covered test: movement of affected eye. With strabismus the eye will wonder when the cover is removed

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51
Q

What is amblyopia

A

Decreased visual acuity resulting from an unclear image falling on the retina

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52
Q

What are the risk factors for amblyopia

A

Strabismus or deprivation (opacity in visual axis) such as congenital cataract

53
Q

What is the treatment for amblyopia

A

Put a patch over the good to strengthen the bad

Surgery for congenital cataract

54
Q

What are concerning signs and symptoms of pediatric headache

A

Awakens the patient from sleep or early-morning headaches, focal neurologic findings

55
Q

What is the most common cause of recurrent headaches in childhood

A

Migraines

56
Q

What are the risk factors for migraines

A 
Stress, 
exercise, 
head trauma, 
food, 
menstruation
57
Q

What are the signs and symptoms of migraine

A

Throbbing headache, photophobia, photophobia, aura, nausea and vomiting

58
Q

What is the first-line treatment for pediatric migraines

A

NSAIDs

59
Q

What is a pseudotumor cerebri

A

Also known as idiopathic intracranial hypertension

Is increased intracranial pressure in the absence of intracranial lesion or infection

60
Q

Where the signs and symptoms of a pseudotumor cerebri

A

Headache,
diplopia,
nausea vomiting
papilledema

61
Q

What is the treatment for a pseudotumor cerebri

A

Therapeutic lumbar puncture to decreased fluid levels.

Acetazolamide

62
Q

What are the major types of neural tube defects

A

Spina bifida occulta
Meningocele
Myelomeningocele

63
Q

What are the signs and symptoms of spina bifida occulta.

A

May have sinus dental or hair over the defects often asymptomatic

May develop bladder incontinence to the tethering of the cord

64
Q

One of the signs and symptoms meningocele

A

The meninges herniate through defective posterior vertebral arches
Fluctuant Midline mass along the vertebral column does not contain spinal cord

Highly associated with hydrocephalus

65
Q

What is used for definitive diagnosis of meningocele

A

MRIs definitive but ultrasounds maybe use first in the newborn

66
Q

What is a myelomeningocele

A

Note to defect with protrusion of the spinal cord usually in the lumbosacral region

67
Q

What are the risk factors to a myelomeningocele

A

Inadequate folate intake during pregnancy

Celiac disease

68
Q

Is the biochemical marker for a myelomeningocele

A

AFP is a Biochemical Marker

69
Q

What is a complication of a myelomeningocele

A

80% will have hydrocephalus. May require a VP shunt

70
Q

What is the most common seizure disorder pediatrics

A

Febrile seizures

71
Q

What are the signs and symptoms of febrile seizures

A

Generally occur from six months to five years of age. Generalized, tonic clonic, less than 15 minutes, normal neuro exam and return to baseline

Atypical seizures: are focal, greater than 15 minutes, or multiple seizures, and have an abnormal neuro exam

72
Q

What are the signs and symptoms of an infantile spasm

A

Brief symmetric contractions of the neck, talk and extremities in infancy
Associated with tuberous sclerosis.

73
Q

What will an EEG show for infantile spasms

A

hypsarrhythmia (bilateral asynchronous slow wave activity)

74
Q

What are absence seizures

A

Sudden cessation of motor activity, blank staring, no aura or postictal state, occurring for less than 30 seconds.

Greater than five years, maybe provoked with hyperventilation

75
Q

Want to limit EEG reveal for absence seizures

A

3 Hz spike and wave pattern

76
Q

What is the treatment for absence seizures

A

ethosuximide

77
Q

What are the signs and symptoms of a generalized tonic clonic seizure

A

Tonic clonic movements with loss of consciousness
Associated with aura
Postictal period

78
Q

What is the treatment for generalized tonic clonic seizures

A

Phenytoin
Valproic acid
Phenobarbital

79
Q

What are pseudoseizures

A

They are not true seizures.

It’s thrashing. Consider sexual abuse

80
Q

What is myoclonic epilepsy

A

Brief symmetric contractions with loss of tone.

patients will often slump or fall forward

81
Q

What is the treatment for myoclonic epilepsy

A

Valproic acid

82
Q

What are signs and symptoms of partial seizures

A

Simple

  • 10 to 20 seconds maybe conducive text
  • Motor activity
  • consciousness not impaired

Complex
-May have auras, automatism, EEG- temporal lobe waves and spikes

83
Q

What is cerebral palsy

A

Static and nonprogressive impairment of motor function and posture.
Prenatal complications are the most common cause

84
Q

What are the types of cerebral palsy

A
  • Spastic diplegia
  • Spastic quadriplegia
  • Spastic hemiplegia
  • Extrapyramidal
  • Ataxia
85
Q

What is spastic diplegia cerebral palsy

A

Increased muscle tone, increase DTR, contractures, lower extremities worse, may have seizures

86
Q

What is spastic quadriplegia cerebral palsy

A

4 extremities are equally involved: scoliosis is more common

87
Q

What is spastic hemiplegia cerebral palsy

A

-Involves one side of the body

88
Q

What is extrapyramidal cerebral palsy

A

-Hypotonia, choreoathetosis, dystonia

89
Q

What is ataxic cerebral palsy

A

-Hypotonia, brisk reflexes, cognitive delays

90
Q

What is an Arnold Chiari type I malformation

A

Displacement of the cerebellar tonsils below the foramen magnum causing obstruction of caudal portion of the fourth ventricle.

91
Q

What is an Arnold-Chiari type II malformation

A

Displacement of cerebellar tissue below the foramen magnum

- progressive hydrocephalus

92
Q

What is Friedrichs ataxia

A

Is a defect in Alpha tocopherol transfer protein causing intracellular deficiency of vitamin E

Autosomal recessive is more common.

93
Q

What are the signs and symptoms of Friedrichs ataxia

A

Neurologically: ataxia before 10 years, explosive dysarthria and nystagmus, absent DTRs, loss of vibration and position sense.
Skeletal: scoliosis and foot deformities

94
Q

What is a major complication of Friedrich ataxia

A

Hypertrophic cardiomyopathy in 90%

95
Q

What is leukodystrophy

A

Abnormal white matter or abnormal myelin

96
Q

What is Krabbe leukodystrophy

A

Deficiency of lysosomal hydrolase galactosylceramide beta-galactosidase (GALC) resulting in myelin destruction

97
Q

What causes the pathology of Krabbé leukodystrophy

A

Buildup of galctosylceramides

98
Q

What are the signs and symptoms of Krabbé leukodystrophy

A

Will present in the first few months of life

Irritability, hypertonia, feeding problems, opisthotonus-followed quickly by rapid deterioration

99
Q

What is opisthotonus

A

Hyperextension or specificity of the head and neck for me and arching position

100
Q

What is adrenoleukodystrophy

A

X-linked
Adrenocortical insufficiency and demyelination the presents later in life typically between five and 15 years
Will develop abnormal skin pigmentation from adrenocortical insufficiency

101
Q

What is the treatment of adrenoleukodystrophy

A

Mixture of MCG’s or Lorenzo’s oil to prevent body’s production of VLCFAs

102
Q

What is the problem of having a buildup of VLCFAs

A

Buildup of VLCFAs leads to demyelination

103
Q

What is mucopolysaccharidoses

A

Deficiency of lysosomal enzymes needed for the degradation of glycosaminoglycans resulting in accumulations of GAGS

104
Q

What are three major types of mucopolysaccharidoses

A

Hurler
SanFillippo
Hunter (X-linked)

105
Q

What are the signs and symptoms of mucopolysaccharidoses

A

Course facies is the biggest clue
Skeletal abnormalities, mental retardation, visceromegaly

Hurlers and Sanfilippo will have corneal clouding. Not seen with hunters

106
Q

What is the pathology behind Tay-Sachs disease

A

Lysosomal accumulation of GM2 gangliosides in the nervous system due to a deficiency of hexoseamidase A

107
Q

What are the signs and symptoms of Tay-Sachs disease

A

Developmental regression at six months, seizures, hypotonia, blindness (macular cherry red spot)

108
Q

What is the prognosis for Tay-Sachs disease

A

Death between three and four years of age

109
Q

What is Werdnig Hoffman disease

A

Infantile spinal muscular atrophy

A degenerative disease of motor neurons causing atrophy of the anterior horn cells

110
Q

What are the signs and symptoms of Werdnig Hoffman disease

A

On set before two years

Generalized weakness hypertonia, Frog leg position, tongue fasciculations, normal IQ

111
Q

What is the prognosis of Werdnig Hoffman disease

A

Death by two

112
Q

What’s kind of pediatric patient history would be suggestive of hypotonia due to botulism

A

Recent ingestion of honey
Associated with spores in the soil that can be dug up a new construction site
Constipation

113
Q

What is Guillain Barre

A

Postinfection polyneuropathy with demyelination usually associated with a viral infection or Campylobacter or Mycoplasma

114
Q

What are the signs and symptoms of Guillain Barre

A

Ascending weakness or paralysis 10 days after nonspecific viral infection, absent DTRs, may compromise cardiorespiratory status

115
Q

What’s for a lumbar puncture demonstrate suggested of Guillain Barre

A

CSF protein elevated,
CSF WBC less than 10
Normal glucose

116
Q

What is the treatment Guillain Barre

A

Supportive care only follow the negative inspiratory force to determine the time or need for intubation

117
Q

What is the area affected for Guillain Barre

A

Peripheral neuron is the most often affected

118
Q

What are the signs and symptoms of Duchenne muscular dystrophy

A

The most common hereditary neuromuscular disease, X-linked
Dystrophin absent
Proximal muscle weakness and depressed reflexes
Pseudohypertrophy of the calf
Positive Gower sign

119
Q

How’s Duchenne muscular dystrophy diagnosed

A

The gold standard is genetic testing

120
Q

What inheritance pattern is suggested if the mothers brother is affected

A

Consider X-linked

121
Q

What is needed to diagnose type I neurofibromatosis

A

Need to of the following seven

  • Greater than six café au lait spots greater than 5 mm prepubertal or six café au lait spots greater than 15 mm post pubertal
  • Axillary / inguinal freckling
  • Greater than two iris lisch nodules
  • Greater than 2 neurofibromas
  • First-degree relative with NF 1
  • Optic Glioma
  • Osseous lesion
122
Q

What is needed to diagnose type II neurofibromatosis

A

Need one of the following

  • Bilateral acoustic neuromas
  • Positive family history and unilateral acoustic neuroma
123
Q

What is a hamartoma

A

Tissue that is in the correct location but growing in a disorganized fashion

124
Q

Type one neurofibromatosis are at a greater risk for developing what

A

Optic glioma

Pheochromocytoma

125
Q

What is tuberous sclerosis

A

Neurocutaneous syndromes of Facial fibroangiomas, hypopigmentation, seizures/infantile spasms and high incidence of MR

126
Q

One of the classic cutaneous findings of tuberous sclerosis

A

Ash leaf spots
Shagreen patches
Sebaceous adenomas

127
Q

What are the clinical features of tuberous sclerosis

A

Benign CNS tumors (tubers)
Angiomyolipoma’s kidneys
Rhabdomyomas myocardium
Depigmented nevi

128
Q

What are the signs and symptoms of Sturge-Weber

A

Portwine stain facial nevus on trigeminal region (V1) of the face
MR and seizures possible
Glaucoma on ipsilateral side

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