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Flashcards in 9 Deck (73):
1

most important initial test to do when thinking Guillain-Barre

spirometry to assess respiratory function
(spinal MRI is nonspecific)

2

stridor in laryngomalacia vs vascular ring

stridor in LGM is inspiratory and improves with prone positioning, in vascular rings it is biphasic (insp. and exp.) and it improves with neck extension

3

hx of easy bruising, bleeding after dental procedure, recurrent joint swelling, and family history of similar, consider?
mechanism?

hemophilia leading to hemophilic arthropathy
iron/hemosiderin deposition in the joints leading to synovitis and fibrosis in the joint

4

neonate presenting with poor sucking, fatigue, rigidity, spasms after lack of pre/postnatal care and swollen umbilical cord at delivery, think ?

tetanus

5

infant presenting with irritability, high-pitched cry, poor sleeping, tremors, seizures, sweating, sneezing, tachypnea, poor feeding, vomiting, diarrhea, think mom abused ? while pregnant

heroin
neonatal abstinence syndrome is caused by infant withdrawal to opiates, presents in 1st few days of life

6

hypotonia, areflexia, hepatosplenomegaly, and cherry red macula

Neimann-Pick disease (sphingomyelinase deficiency)
ddx from Tay-Sachs (B-hexosaminidase A deficiency); which will not present with areflexia or hepatosplenomegaly

7

Down syndrome pt with upper motor neuron findings, think?

atlantoaxial instability

8

SGA infants are at risk for

hypoxia-->polycythemia (from increased EPO), hypoglycemia, hypocalcemia, hypothermia

9

if transient proteinuria (i.e. 2+ on dipstick is found)

reevaluate with 2x repeat urine dipstick to rule out persistent proteinuria

10

Osgood-Schlatter is caused by ?
findings?

a traction apophysitis of the tibial tubercle
anterior tissue swelling, lifting of tubercle from shaft and irreg/fragment of tubercle

11

life-threatening complication days-months after cardiac surgery

postpericardiotomy syndrome: pericardial effusion
distant heart sounds, hypotension, distended jugular veins
-requires drainage

12

triad of thrombocytopenia (sm plts too), eczema, and recurrent infection

Wiskott-Aldrich

13

left-axis deviation on neonatal EKG and decreased pulmonary markings

NEVER normal, hypoplasia of RV and pulmonary outflow tract
i.e. tricuspid valve atresia

14

if thinking malrotation with midgut volvulus after abdominal Xray, what is the next diagnostic step?

Upper GI series (barium swallow)
finding of Ligament of Treitz on the right side of the abdomen reflects malrotation while contrast in a corkscrew pattern indicates volvulus
fix with the Ladd procedure

15

what conditions are contrast enemas used for

Hirschsprung and meconium ileus

16

most common complication of patients with sickle cell TRAIT
Hbg % ?

painless hematureia
HbA: 50-60%
HbS: 35-45%
HbF: less than 2%

17

nonimmune, asymptomatic healthy pt older than 1 exposed to varicella, what to do?

receive varicella vaccine (post-exposure prophylaxis)

18

kids younger than 1 year are more likely to have ? hematomas; ? hematomas are more common in older children

subdural
epidural

19

seizure are more common with epidural or subdural hemorrhage?

subdural

20

which has a higher mortality; epidural or subdural hemorrhage?

epidural, but subdural has more significant long-term morbidity; brain parenchyma is more often involved.

21

approximately ? of CT-identified subdural hemorrhages have an associated skull fracture; almost all are ? in origin, and approximately ? are bilateral

1/3
venous
3/4

22

symptom timeline of acute, subacute, or chronic subdural hemorrhage

acute: 1st 48 hrs after injury
subacute: 3-21 days
chronic: after 21 days

23

Chronic subdural hematomas are more common in older children or infants?
symptoms may include ?
imaging?

older children
chronic emesis, seizures, hypertonicity, irritability, personality changes, inattention, poor weight gain, fever, and anemia
MRI over CT

24

? of epidural hemorrhages are associated with skull fracture
most adult epidural hemorrhages are arterial in origin, but in kids about ?originate from venous injuries
Most are unilateral or bilateral?

2/3
50%
unilateral,located in the temporoparietal region

25

symptoms of ICP in infants with open sutures

may be nonspecific and include lethargy, vomiting, separated sutures, and a bulging fontanelle

26

treatment of ICP in epidural vs subdural hemorrhage

Epidural hematomas are frequently rapidly progressive and may require urgent surgical evacuation with identification of the bleeding source
Subdural hemorrhage usually does not require urgent evacuation but may require evacuation at a later date

27

how to treat symptomatic hypoglycemic infants

IV bolus of dextrose, the D-isomer of glucose (200 mg/kg), is given over 5 minutes (2 mL/kg of 10%dextrose in water [D10])
followed by the continuous administration of parenteral dextrose infusion at a rate of 6 to 8 mg/kg of dextrose per minute

28

The maximum dextrose concentrations for fluid administered through a peripheral IV catheter or a low lying umbilical venous catheter is ?%, and through a central venous catheter (including a centrally positioned umbilical venous catheter) is ?%

12.5%
25%

29

febrile seizure

A seizure occurring in the absence of a CNS infection with an elevated temperature in a child between the ages of 6 months and 6 years

30

simple vs complex febrile seizure

simple: less than 15 min, short post-ictal state, no recurrence in 24 hrs, 80% of febrile seizures
complex: either focal, lateralizing signs, prolonged, or recurrent, 20%

31

when to get an LP with febrile seizure

-neurologic examination is abnormal after the seizure, the seizure occurred several days into the illness, or if the child is unable to provide adequate feedback during a neck examination, in child less than 9mo with fever and seizure particularly those infants with deficient or unknown immunizations
-if less than 1 yr consider CT, EEG +/- LP

32

Seizures lasting longer than 5 minutes may be interrupted with ?
if unresponsive to those, try ?

lorazepam or diazepam
fosphenytoin

33

Children younger than 12 months at the time of their first seizure have a ?% chance of having another febrile seizure; older children have a ?% chance of recurrence

50% to 65%
20% to 30%

34

kids at highest risk for developing epilepsy after febrile seizure

preexisting neurologic problems and have complex febrile seizures; these children have 30 to 50 times the baseline risk of developing epilepsy.

35

ddx febrile seizure

meningitis, bacterial enteritis, subdural hematoma/head trauma, stroke from SCD, CP

36

Self-limited scaly, erythematous, and/or crusty eruption limited to areas of the skin with a high concentration of sebaceous glands (cradle cap

seborrheic dermatitis

37

General term for a skin condition consisting of acutely inflamed papules and plaques, frequently associated with serous discharge and pruritus; eczematous eruptions include atopic, seborrheic, and contact dermatitides

eczema

38

most cases of AD are precipitated by ? and not ?

environmental stress on genetically compromised skin and not by interaction with allergens

39

ddx atopic dermatitis

seborrheic dermatitis (cradle cap), scabies, irritant dermatitis (perioral fruit juice dermatitis), allergic contact dermatitis (poison ivy, oak, sumac (Toxicodendron)), and eczematoid dermatitis (infectious lesion near a draining ear)

40

rare ddx of dermatitis

ichthyosis, severe combined immune deficiency (SCID), Wiskott-Aldrich syndrome (eczema, thrombocytopenia, and immunodeficiency), zinc deficiency, and drug reactions.

41

good rash questions

how long? previous episodes? pruritic? itching at night? irritable? worse with exposure to cold, wool, sweat, stress? family members with eczema, asthma, allergies? +fever or other signs of infection?

42

good products for atopic dermatitis

nonsoap cleansers (Cetaphil), Lubricants (Eucerin), products with urea (Nutraplus) or lactic acid (Lac-Hydrin)

43

only FDA-approved topical corticosteroid creams for infants as young as 3 months

Fluticasone propionate 0.5% cream (Cutivate) and desonide 0.05% gel (Desonate)

44

Fluorinated corticosteroids are generally avoided on the ? because they may depigment and thin the skin

face, genitalia, and the intertriginous area

45

nonsteroidal, immunomodulator topicals FDA approved for the treatment of AD in children 2 years and older (if not adequately responsive to, or intolerant of, conventional therapy)

Tacrolimus 0.03% (Protopic) and pimecrolimus 1% (Elidel)
**black box warning for association with LN/skin malignancies

46

reduce itching in AD with

hydroxyzine, diphenhydramine (night)
loratadine (Claritin) and cetirizine (Zyrtec)- less sedating
Doxepin (Sinequan): TCA and antihist. effects
don't use topical antihists: (Caladryl)

47

to reduce secondary bac infection with AD

mupirocin (Bactroban) -for staph aureus

48

"id" reaction

widespread pruritic papules in nonexposed areas

49

In infancy, the itchy eruption of AD is found ?; by childhood, the rash is noted ?

on the face and cheeks
in flexural areas

50

how to tx seborrheic dermatitis

baby shampoo
antidandruff shampoo containing antifungal medication (Nizoral) or selenium
ketoconazole
low-to-medium-potency topical corticosteroids

51

oral lesions, weight loss, and lymphadenopathy think?

immunodeficiency

52

Recommended assay to diagnose HIV infection in children younger than 18 months

HIV DNA PCR (2x)
instead of ELISA (Ab test) because of placental transfer of maternal antibodies

53

used to assess response to antiretroviral therapy (ART) in patients diagnosed with HIV

HIV RNA PCR

54

Detects HIV immunoglobulin G (IgG); initially detectable 2 weeks to 6 months after exposure

ELISA

55

CD4+ T helper cells bind to antigens presented by the ? on the surface of antigen presenting cells (APCs), prompting ?

Class II MHC molecules
chemokine release and immune activation; rendered dysfunctional in HIV infection.

56

causes of Primary (syndromic) immunodeficiency

SCID, thymic dysgenesis in DiGeorge syndrome, phagocytic cell deficiency (chronic granulomatous disease due to impaired respiratory burst), complement deficiency (autoimmune disease or serious bacterial infection due to C2 deficiency), and neutrophil dysfunction (autosomal-recessive leukocyte adhesion deficiency)

57

treatment of primary immunodeficiency

compensating for the defective response (IV immune globulin in humoral defects) or, in severe cases, reconstitution of the immune system via bone marrow stem cell transplant

58

causes of secondary immunodeficiency

HIV infection, diabetes mellitus, sickle cell disease, malnutrition, hepatic disease, autoimmune disease, aging, and stress

59

If HIV+ mother received ART during pregnancy, how to treat infant?
if HIV+ did not receive ART?

-6 weeks of ART in the form of zidovudine starting in the first few hours of life
-three doses of nevirapine added to standard zidovudine therapy during the first week of life (reduced transmission rate to 2.2%)

60

If an infant is diagnosed by two positive DNA PCR tests ?

zidovudine monotherapy should be discontinued, and the child referred to a pediatric HIV specialist for combination ART and monitoring
PCP prophylaxis in the form of TMP-SMX at 6 wks

61

adverse effects for all ARTs

common: headache, emesis, abdominal pain, and diarrhea
-Osteopenia and drug rash
-anemia, neutropenia, elevated transaminases, hyperglycemia, and hyperlipidemia

62

current pediatric ART recommendation consists of three drugs:

two NRTIs and either a protease inhibitor or a NNRTI

63

Immunizations for HIV+ kids

should be kept current EXCEPT live vaccines such as measles, mumps, and rubella (MMR) and varicella for symptomatic HIV-infected children with a CD4 count less than 15%.

64

if high suspicion of HIV and initial ELISA is negative, consider what next test?

HIV RNA PCR to detect replicating virus
(CD4 count is premature)

65

leukocyte adhesion deficiency (LAD)

inheritable disorder of leukocyte chemotaxis and adherence characterized by recurring sinopulmonary, oropharyngeal, and cutaneous infections with delayed wound healing
Neutrophilia is common with (WBC) counts typically more than 50,000 cells/mm3
Severe, life-threatening infection is possible with Staphylococcus species, Enterobacteriaceae, and Candida species

66

precocious puberty, elevated LH, and advanced bone age, consider ?
what diagnostic step?

Gonadotropin dependent precocious puberty (GDPP)
brain MRI with contrast

67

pts with HSP are at risk for what GI condition?

intussusception

68

absence seizures are associated with ?

ADHD

69

most common cause of bacterial pneumonia in young child with CF

S. aureus
Pseudomonas more common in adults (older than 20)

70

difficulty moving R arm and R leg after found unresponsive, think ?

Todd paralysis (after seizure)

71

aplastic anemia vs aplastic crisis

aplastic anemia shows pancytopenia due to BM failure
aplastic crisis shows severe anemia in SCD pts; low Hgb and retic (less than 1%), lack of hepsplenmeg, Parvovirus B19 is common trigger

72

pts with Tourette syndrome have an increased risk of developing what conditions

ADHD, OCD (other psych conditions as well)

73

how to tx Lyme disease in kid less than 8

amoxicillin (not doxy)