Pediatrics Flashcards by Charlene Omekwu

APGAR Scoring

Appearance 
Pulse
Grimace
Activity 
Respiration

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1point on APGAR means

A- Pale blue extremities 
P- <100/min
G- grimace on suction/stimulation 
A- some flexion
R- irregular, shallow gasps

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2 points on APGAR means:

A- pink
P- > 100
G- cry on stimulation
A- flexion that resists extension 
R- robust crying

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What does the one minute APGAR Score tell?

How labor was tolerated by the newborn

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5 mins APGAR score tells …….

Response of the newborn to resuscitation

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Moro response on a LGA (Large gestational age) newborn: R arm remains limply adducted, medially rotated.

Diagnosis?

Erb- Duchenne palsy (C5-C6)

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Moro response on a LGA (Large gestational age) newborn: R arm remains limply adducted, medially rotated.

Management?

Physical therapy

- Surgery for severe cases

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Paralysis of newborn hand +/- Horner syndrome

Klumpke palsy (C7 - C8 + T1)

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Palpate the clavicle on LGA newborn- Crepitus and discontinuity on L.

Diagnosis?

Clavicular fracture

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In a newborn: edema crosses suture lines

Caput succedaneum

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In a newborn:
Fluctuance does not cross suture lines.

Diagnosis?

Cephalohematoma

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Lacy, reticulated vascular pattern over most of body when baby is cooled; improves over first month; abnormal if persists

Diagnosis?

Cutis marmorata

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White papules, retention of keratin and sebum in hair follicles

Diagnosis?

Milia

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Inflammatory papules and pustules

Diagnosis?

Neonatal acne

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Pale, pink vascular macules; found in nuchal area, glabella, eyelids; usually disappears

Diagnosis?

Salmon patch (Nevus simplex)

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Blue to slate-gray macules; seen on presacral, back, posterior thighs; > in on white infants; arrested melanocytes; usually fade over first few years;

Diagnosis? And differential?

Mongolian spots

Child abuse

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Firm, yellow-white papules/pustules with erythematous base; peaks on second day of life; contains eosinophils; benign

Erythema toxicum neonatorum

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Vomiting,seizures, developmental delay (1st few months), intellectual disability + fair hair, eyes, skin, musty smell

Diagnosis?

Phenylketonuria

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Jaundice, vomiting, HSM, FTT, poor feeding+ liver dysfunction, susceptibility to infection/ sepsis (E.coli), cataracts

Most common deficiency?

Galactose-1-phosphate uridyl transferase (GALT)

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Diseases screened in new born: 8

Phenylketonuria 
Galactosemia
Cystic fibrosis 
Hypothyroidism 
21- hydroxylase deficiency 
Tyrosinemia
Hb SS
Hb C

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Thick, yellow/white oily scale on inflammatory base

Management ?

Gently clean with mild shampoo (seborrheic dermatitis)

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Area of alopecia, with orange-colored modular skin

Management?

Remove before adolescence (nevus sebaceous)

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5 advantages of breast milk

maternal-infant bonding
premixed, right temperature and concentration
less diarrhea, intestinal hemorrhage, chronic illnesses later in life
maternal weight loss and faster return of uterus to preconception size
decreased allergies accompanied to formula fed

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Holds head steadily; rolls from prime to supine; coos

Age?

4 months

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Sits with support (tripod); unilateral reach; transfers object; recognizes that someone is a stranger Age?

6 month

“Mama”, “dada”; crawls well; pulls to stand; immature pincer grasp; Age?

9 months

50 words; 2-word sentences; follows 2-step commands; parallel play Age?

24 months

Alternates feet going up the stairs; pedals tricycle; >/= 250 words; 3 word sentences; group play; Age?

3 years

Hops and skips; dresses completely; knows colors; play cooperatively Age?

4 years

Prints first name; asks what a word means; knows alphabet; skips alternating feet; abides by rules Age?

5 years

Infant ______ birth weight by 6 months and _______ by 1 year

Doubles Triples

Bone age=chronological age Normal cause

Ideal Genetic (familial) short stature

Bone age= chronological age Abnormal cause?

- Genetic | - Chromosomal

Bone age < chronological age Normal cause?

Constitutional delay

Bone age < chronological age Abnormal cause?

- chronic systemic disease | - endocrine related

Bone age > chronological age Normal cause?

Obesity (tall) Familiar tall stature

Bone age > chronological age Abnormal cause?

- precocious puberty - congenital adrenal hyperplasia - hyperthyroidism

Immunization at birth?

HepB

Immunization at 2,4 and 6 months?

HepB, DTaP, Hib, PCV13, IPV

Immunization at 6 months and then yearly?

Influenza

Immunization at 12 months ?

MMR, Varicella HepA

Immunization at 4-6 yrs (before start of school)?

DTaP, IPV, MMR, Varicella

Immunization at 12 years?

Tdap, HPV, meningococcal meningitis

Upward slanting palpebral fissures; inner epicanthal folds; single palmar crease; hypotonia; hearing loss Diagnosis?

Down syndrome (trisomy 21)

Most common cardiac anomalies seen in Down syndrome

Endocardial cushion deficiency

Most common cancer seen in Down syndrome

Acute lymphocytic leukemia AML if in the first 3 yrs of life

Low-set, malformed ears, microcephaly, micrognathia, prominent occiput, clenched hands, rocker bottom feet, omphalocele. Diagnosis?

Edwards syndrome (trisomy 18)

Holoprosencephaly, microcephaly, microphthalmia, cutis aplasia, single umbilical artery, severe cleft lip, palate, or both Diagnosis?

Patau syndrome (trisomy 13)

Hypogonadism and hypogenitaliam; long limbs; decreased IQ; most common findings manifest at puberty Diagnosis?

Klinefelter syndrome (XXY)

Large ears, dysmorphic facial features, large jaw, long face, intellectual disability, large testes Diagnosis?

Fragile X syndrome

Macrosomia, macroglossia, pancreatic B cell hyperplasia, omphalocele Diagnosis?

Beckwith- Wiedemann syndrome

Cafe at lait spots, soft tumors on nerves, seizures, CNS tumors, bone lesions

Neurofibromatosis

Micrognathia, retroglossia, cleft soft palate, associated with FAS or Edward's Diagnosis?

Pierre Robin sequence

Obesity, small puffy hands and feet, small genitalia, intellectual disability, hypothalamic-pituitary dysfunction Diagnosis?

Angelman syndrome (happy puppet syndrome)

Short palpebral fissure, maxillary hypoplasia, short and smooth philtrum-vermillion border, symmetric IUGR

Fetal Alcohol Syndrome

When is hyperbilirubinemia pathologic?

- appears on 1st day of life - Bili > 19.5mg/do (term baby) - Bili increases >5mg/dL/day - direct bili > 2 mg/dL (any time) - persists beyond 2nd week of life

Newborn- Hypoxemia then hypercarbia, respiratory acidosis, ground-glass appearance, air bronchogram Management?

Oxygen then intubation then exogenous surfactant (respiratory distress syndrome)

Tachypnea after birth, slow absorption of fetal lung fluid Best test and what are the findings?

CXR Air trapping, fluid in fissures, perihilar streaking (Transient tachypnea of the new born

Pulmonary hypoplasia, respiratory distress, scaphoid abdomen, bowel sounds in chest Best test to confirm diagnosis?

CXR (diaphragmatic hernia)

Infant (<28 days) with fever > 100.4 F =? Until proven otherwise

Sepsis

Most common pathogens associated with sepsis

Group B strep E.coli Listeria monocytogenes

Empiric treatment when suspicious of sepsis in a newborn

Ampicillin + Gentamicin x 48

Sepsis in neonates + meningitis suspected?

Cefotaxime + ampicillin

TORCH meaning?

``` Toxoplasmosis Others - syphilis, varicella, HIV, parvovirus B19 Rubella CMV Herpes ```

Maculopapular rash (palms+ soles), snuffles, periostitis, chorioretinitis Diagnosis?

Congenital syphilis

Maculopapular rash (palms+ soles), snuffles, periostitis, chorioretinitis Treatment?

Penicillin

Hydrocephalus, intracranial calcifications, chorioretinitis in neonates Diagnosis

Toxoplasmosis

Hydrocephalus, intracranial calcifications, chorioretinitis in neonates Treatment?

Pyrimethamine, sulfadiazine, leucovorin

Hydrocephalus, intracranial calcifications, chorioretinitis in neonates Prevention?

Mother should not change at little Spiramycin to decrease transmission

Cataracts, deafness, cardiac defects (PDA, VSD, etc), extra medullary hematopoiesis (“blueberry muffin spots”) Diagnosis?

Rubella

Microcephaly, IUGR, periventricular calcification, decrease platelets, petechiae Diagnosis?

Cytomegalovirus

Microcephaly, IUGR, periventricular calcification, decrease platelets, petechiae Treatment?

Ganciclovir

Limb hypoplasia, scars, cataracts, chorioretinitis, cortical atrophy Diagnosis?

Congenital varicella

Fever, seizure, bulging anterior fontanelle; mom has vesicles on perineum Diagnosis ?

Congenital herpes simplex

1-3 DOL (day of Life): red conjunctivae, tearing Diagnosis?

Chemical conjunctivitis

3-5 DOL: purulent conjunctivitis leading to corneal ulceration Diagnosis?

Gonococcal conjunctivitis

3-5 DOL: purulent conjunctivitis leading to corneal ulceration Treatment ?

IM ceftriaxone + saline irrigation | Gonococcal conjunctivitis

7-14 DOL: red tarsal conjunctivitis with mucoid discharge, lid swelling Diagnosis?

Chlamydia conjunctivitis

7-14 DOL: red tarsal conjunctivitis with mucoid discharge, lid swelling Treatment?

Erythromycin + saline irrigation

Early, systolic, soft, vibratory/ musical, heard best at lower sternum

Still’s murmur

Continuous murmur heard best in anterior neck which disappears when jugular vein is compressed Diagnosis?

Venous hum

When is a murmur not benign

Diastolic murmur, holosystolic murmur, > II/VI, harsh or blowing quality

Common cyanotic heart diseases? 5 T’s

``` Tetralogy of fallot Truncus arteriosus Tricuspid atresia Transposition of Great vessels Total anomalous pulmonary venous return ```

CXR: “egg on a string” appearance Loud, single S2 PDA closes leads to cyanosis, tachypnea Diagnosis?

Transposition of the Great arteries

Components of tetralogy of fallot

- pulmonary stenosis and infundibular stenosis (obstructed RV outflow) - VSD - Overriding aorta (overrides VSD) - Right ventricular hypertrophy

Bipolar mom gives birth to infant with holosystolic murmur c/w tricuspid regurgitation Diagnosis?

Ebstein anomaly

Newborn: continuous machine-like murmur, bounding pulses, wide pulse pressure Diagnosis?

Patent ductus arteriosus

Infant with normal brachial pulses, weak femoral pulses, rib notching on CXR Diagnosis?

Coarctation of the aorta

ASD: what do you hear on heart auscultation?

Loud S1, fixed Split S2

VSD: what do you hear on heart auscultation? Diagnosis?

Holosystolic murmur among the LLSB with a palpable thrill

When is surgery indicated for VSD?

FTT in first year, pulmonary hypertension, pulmonary blood flow X2 systemic blood flow

15 y.o. athlete suddenly collapses on the football field Management?

BB or CCB

6 y.o. female w/severe joint pain (elbows, wrists), fever x 1 week, sore throat 1 month ago, exam reveals new murmur Diagnosis?

Acute rheumatic fever

Newborn Caucasian mail fails to pass meconium in first 24 hrs of life. Diagnostic test?

Sweat chloride test

Respiratory infection in cystic fibrosis: Early- Then- Later-

Nontypeable H. influenza and S. aureus Then colonization with P. aeruginosa Later colonization with Burkholderia cepacia

Failure of umbilical ring closure in an infants Diagnosis?

Umbilical hernia

Management of small umbilical hernia in an infant

Watch and wait- resolves in 1-2 years without treatment

When should surgery be considered for umbilical hernia?

- enlarging after 1-2 years - symptoms (strangulation, incarceration) - persistent after age 4 years

Defect in abdominal wall with bowel outside laterally with no sac; high maternal AFP; not usually associated with other disorders Diagnosis?

Gastroschisis

Bowel midline outside the abdominal cavity in a sac; associated with other disorders Diagnosis?

Omphalocele

4- weeks old non-bilious vomiting + palpable “olive” Diagnosis?

Pyloric stenosis

2- wk old w/ bilious vomiting (polyhydramnios in pregnancy) Diagnosis?

Intestinal atresia (annular pancreas)

Premature infant presents with bloody stools, apnea, lethargy and abdominal distention (after perforation) Diagnosis?

Necrotizing enterocolitis

Pathognomic finding on X-ray for necrotizing enterocolitis is

Pneumatosis intestinalis ( air in bowel wall)

Premature infant presents with bloody stools, apnea, lethargy and abdominal distention (after perforation) Management?

Cessation of feeds Gut decompression Systemic antibiotics Supportive care

6-12 months old; colicky abdominal pain, currant jelly stool, sausage shaped palpable mass in RUQ Diagnosis and treatment?

Intussusception Barium or air enema, surgery if recurs

Bright red blood per rectum (BRBPR) +/- RUQ (mimics appendicitis) Diagnostic test?

Technetium scan | Meckel’s diveriticulum

12 years old Male presents with edema, HTN, hematuria with colored urine, reports diagnosis of impetigo 1 month ago. U/A shows dysmorphic RBCs + RBC casts Renal biopsy reveals?

Lumpy-bumpy Ig and complement deposits on GBM

12 y.o. Male wi th bloody urine; U /A shows dysmorphic RBCs +RBC casts + just started runny nose, sore throat and cough yesterday

IgA nephropathy (Berger's disease)

12 y.o. Male wi th bloody urine; U /A shows dysmorphic RBCs +RBC casts + has hemoptysis Diagnosis?

Anti-GBM Antibody disease (Goodpasture's)

12 y.o. Male wi th bloody urine; U /A shows dysmorphic RBCs +RBC casts + bilateral sensorineural hearing loss + ocular abnormality

Alport's syndrome (hereditary nephritis)

What mutation is seen in Alport syndrome?

Genes encoding for type IV collagen

Kidney stones <5mm Management?

Hydrate- most pass spontaneously

Stones 5mm- 2cm Management?

Extracorporeal shock wave therapy)

Stones > 2 cm

Endoscopic or open surgical removal

>3.5g protein/ 24hrs., hypoalbunimemia, edema, hyperlipidemia (fatty/ waxy casts) Most common cause in children?

Minimal change disease

Electron microscopy of minimal change disease shows?

Foot process fusion (effacement)

Newborn Male, no palpable testes Diagnosis?

Cryptorchidism

Newborn Male, no palpable testes Next best test?

Ultrasound

Newborn Male, ventral urethral opening

Hypospadias

Newborn Male, ventral urethral opening Contraindication

Circumcision

Newborn w/ ambiguous genitalia at 1 mo with vomiting, decreased Na, increased potassium, acidosis Diagnosis?

Congenital adrenal hyperplasia

Newborn w/ ambiguous genitalia at 1 mo with vomiting, decreased Na, increased potassium, acidosis What is deficient?

21-hydroxylase

Newborn w/ ambiguous genitalia at 1 mo with vomiting, decreased Na, increased potassium, acidosis Definitive test

17- OH progesterone before and after ACTH bolus

Newborn w/ ambiguous genitalia at 1 mo with vomiting, decreased Na, increased potassium, acidosis Treatment?

Hydrocortisone + fludrocortisone

Teenage boy, Acute pain, swelling, tenderness, testicle in transverse lie Diagnostic test?

Doppler color flow ultrasound

Acute painful scrotal swelling in sexually active male;

Epididymitis

Palpable, hard mass, does not trans-illuminate, usually painless

Testicular tumors

Pharmacotherapy for primary enuresis?

Oral desmopressin (DDAVP)

9.5 lb. newborn, jittery, ruddy with heart murmur

Infant of a diabetic mother

Metabolic abnormalities seen in infants of a diabetic mother

Hypoglycemia, hypocalcemia, hypomagnesemia

12 y.o. female w/ vomiting, wt. loss over the last month despite polyphagia and polydipsia + polyuria Most likely diagnosis?

Type 1 DM

First line management of diabetic keto acidosis

IVF + insulin drip

Diagnosis of DM 1 made by symptoms + elevated glucose FBG ? 2hrs OGTT ? Random BG ?

FBG > 126 OGTT > 200 after 2hrs RBG > 200

Renal threshold for glucose reabsorption =?

180mg/dL

In DM 1, there are antibodies against ________, __________, _________ or ________

Insulin, glutamine acid decarboxylase, tyrosine phosphatase or zinc transporter 8

8 y.o. African American boy w/ fever, chest pain, SOB, wheezing, hypoxemia

Acute chest syndrome (sickle cell disease)

In sickle cell disease blood smear shows what?

Sickled cells, increased reticulocytes, Howell jolly bodies (nuclear remnants), targets cells (Hb SC)

How do you monitor for risk of stroke in a patient with sickle cell disease?

Transcranial doppler

Progressive decrease in Hb over first 2-3 months (to Hb of 9-11g/dL)

Physiologic anemia of infancy

18 mo- old female "picky eater" who drinks a lot of cow's milk, Hb = 6.5 g/dL, Hct = 20%, MCV = 65fL

Iron deficiency anemia

Iron study changes seen in iron deficiency anemia

Decrease ferritin, increase TIBC

Short stature, craniofacial deformities, upper extremities defects (triphalangeal thumbs), profound anemia by 2-6 mos is consistent with

Blackfan-Diamond

18 mos old w/ pancytopenia, cafe-au-lait spots, microcephaly and absent thumbs Most likely diagnosis?

Fanconi anemia

2 y.o. w/ hyperactivity, impaired growth, abdominal pain, constipation, microcytic, hypochromic anemia, basophilic stippling of RBCs Most likely diagnosis?

Lead poisoning

Treatment of lead poisoning

Chelation

4 y.o. w/petechiae, purpura, and excessive bleeding from oral mucosa

Immune thrombocytopenic purpura

15 y.o. female w/ heavy menses, petechiae but normal plts, increased bleeding time, prolonged PTT Most likely diagnosis?

von Willebrand disease

Treatment of von willebrand disease

DDAVP, vWF replacement

1 week old born at home with bleeding from umbilical stump Likely diagnosis?

Vit K deficiency

Treatment for vit K deficiency

Fresh frozen plasma

3 y.o. w/bloody diarrhea Nd decreased urination;5 days ago; fever & vomiting after a family picnic; patient appears pale and lethargic

Hemolytic uremic syndrome

Etiologies of hemolytic uremic syndrome

E.coli 0157:H7, shigella, salmonella, campylobacter, viruses, drugs

6 y.o. Male with palpable purpura, abdominal pain and knee pain Most likely diagnosis?

IgA vasculitis Henoch-Schonlein purpura)

Panhypopituitarism, growth failure, visual field defects Tumor?

Craniopharyngioma

3 y.o. with abdominal mass noted by mother + HTN Most likely ________

Nephroblastoma (wilms tumor)

3 y.o. with periorbital ecchymosis, proptosis, bluish skin nodules and tender abdominal mass Most likely diagnosis?

Neuroblastoma

4 y.o. female with limp and rash; exam: fever, HSM, petechiae Most likely diagnosis?

Acute lymphoblastic leukemia

16 y.o. male w/ fever, wt loss, drenching sweats, nontender cervical LNs

Hodgkin lymphoma

7 y.o. female with persistent cough and mediastinal mass... | Suspect?

Non-hodgkin lymphoma

3 y.o. girl with "grape-like masses" growing from her vagina, per mom Suspect?

Rhabdomyosarcoma (botryoid variant)

X-ray:-Sclerotic destruction: "sunburst"

Osteogenic sarcoma

X-ray:-Lytic with laminar periosteal elevation: "onion skin"

Ewing sarcoma

X-ray:-small round central lucency with sclerotic margin

Osteoid osteoma

Cough, cough, coryza, conjunctivitis, high fever, koplik spots, morbilliform rash Diagnosis?

Measles

Complications of measles (4)

Otitis media Pneumonia Encephalitis Subacute sclerosing panencephalitis

Mild constitutional symptoms, forchheimer spots, posterior cervical and auricular nodes, rash spreads from face to trunk and extremities Diagnosis ?

Rubella

Headache, fever, malaise, muscle pain, glandular swelling Complications ?

Encephalitis Orchitis Pancreatitis

Low grade fever, malaise, URI symptoms, crops of papules, vesicles that crusts at the same time, central to peripheral Diagnosis?

Varicella

Low grade fever, malaise, URI symptoms, crops of papules, vesicles that crusts at the same time, central to peripheral Complications?

``` Superinfection Zoster Pneumonia Encephalitis Hepatitis Congenital varicella ```

Mild URI symptoms, slapped cheek -> trunk -> central clearing-lacey Diagnosis?

Erythema infectiosum | Parvovirus B19

Complications of parvovirus B19 infection

Aplastic anemia | Dangerous for pregnant mothers

URI symptoms, abrupt onset, high fever then breaks -> macular rash on trunk and spreads to extremities Diagnosis?

Roseola

Sore throat, exudative pharyngitis, strawberry tongue, fine maculopapular rash (like sandpaper, esp antecubital and in GUI make areas), pastia lines Diagnosis?

Scarlet fever (streptococcal infection)

Complications of scarlet fever

Acute rheumatic fever | Glomerunephritis

Usually absent (maybe fussiness, low-grade fever); oral macule -> vesicle w/halo of erythema; macular, maculopapular or vesicular; hands, feet and buttocks common Diagnosis?

Hand-foot-mouth disease (coxsackie-virus)

Treatment of Lyme disease?

Doxycycline

Treatment of carditis and meningitis complications of Lyme disease ?

Ceftriaxone

7 y.o. w/fever, headache, rash that started on extremities (lives in wooded area of N. Carolina)

Rocky Mountain spotted fever

3 y.o. with honey-colored crusted plaques on face

Impetigo

Treatment for impetigo

Topical mupirocin

10 y.o. male w/ multiple excoriations and linear burrows in webs of fingers, ++pruritis

Scabies

1 week old infant w/ conjunctivitis, blisters on skin, + Nikolsky’s sign

Staphylococcal scalded skin syndrome

2-12 mos; fever lethargy, irritability, anorexia, N/V, meningeal irritation (photophobia, neck & back pain, rigidity, brudzinski, kernig or bulging fontanelle in infant)

Meningitis

6 yo male fromPA returns from camping with fever, headache and rash Most likely diagnosis?

Lyme disease (borrelia burgdorferi)

Treatment for Lyme disease?

Doxycycline

Treatment for Lyme disease in a child < 8y.o.

Amoxicillin

Treatment for carditis or meningitis complication of Lyme disease

Ceftriaxone

New born; cluck on Barlow; Positive ortolani Management?

Pavlik harness (developmental dysplasia of hips)

5 y.o. with progressive limping (initially painless now anterior thigh pain) Management?

Casting or orthoses, rest, exercises, surgery | Legg- Calve- Perthes disease

Obese 14y.o. with knee pain and decrease range of motion of hip Management?

Surgical stabilization | Slipped Capital femoral epiphysis

Complications of slipped capital femoral epiphysis

Osteonecrosis | Chrondolysis

6 y.o. male had URI 2 wks ago, now: limp, pain in groin and knee; non-toxic appearing kid, X-rays of hip and knee WNL, slight increase in ESR Diagnosis?

Transient synovitis

10 y.o. basketball player with knee pain and swelling Most likely ...

Osgood-Schlatter disease

2-12 mos; fever lethargy, irritability, anorexia, N/V, meningeal irritation (photophobia, neck & back pain, rigidity, brudzinski, kernig or bulging fontanelle in infant) Etiologies?

S. pneumonia, N. meningitidis, HiB

Meningitis in 0-2 months most likely organisms

GBS, E.coli, L. monocytogenes

Meningitis in 0-2 months, empirical antibiotics

Ampicillin + cefotaxime

Meningitis in 2-3 months; most likely organisms

GBS, E. coli, L. monocytogenes + Some S. pneumoniae + very little H. influenza type B

Meningitis in 2-3 months; empiric antibiotics

Ampicillin + caefotaxime/ | Ceftriaxone + vancomycin (assume resistant S. pneumoniae)

Meningitis 3 months- 2 years; most likely organisms

S. pneumoniae + N. meningitides

3 months - 2 years with meningitis; empiric antibiotics

Vancomycin + cefotaxime/ ceftriaxone

2-18 years with meningitis; most likely organisms

N. meningitides +

2-18 years with meningitis; empiric antibiotics

Vancomycin + cefotaxime / ceftriaxone

19 y.o. male with roommate at college with bacterial meningitis and a petechial rash. What does this patient need?

Rifampin po x 2days

Treatment for otitis media

Amoxicillin

8 y.o. female with sore throat and fever over 1 day; exam: enlarged, erythematous tonsils with exudate, cervical lymphadenopathy

Acute pharyngitis

Complications of acute streptococcal pharyngitis

- Acute rheumatic fever - Post streptococcal glomerulonephritis - Reactive arthritis

Treatment of acute pharyngitis in a patient with allergy to penicillin

Erythromycin

Sore throat, “hot potato “ muffled voice, trismus, ipsilateral ear pain, uvula displacement Most likely _____

Peritonsillar abscess

16 y.o. with sore throat, fever, fatigue, generalized adenopathy, splenomegaly

Infectious mononucleosis

3 y.o. with barking cough, hoarseness, inspiratory strider

Croup

Management of different severity of croup

Mild- sg dose dexamethasone Mod- nebulized epinephrine + corticosteroid Severe- nebulized epi + corticosteroid + admission

2 y.o. with fever of 102 F, tugging on ear; TM bulging and red Most sensitive test

Pneumatic insufflation | Otitis media

Otitis media treatment in a patient with penicillin allergy

Azithromycin

Most common cause of croup?

Parainfluenza

3 y.o. with fever, tripod position, drooling

Epiglottis

3 y.o. with fever, tripod position, drooling First line management

Intubation

9-mo-old infant w/runny nose, cough, wheezing, ↑work of breathing; RR = 60, + retractions, O2sat = 91% Most common cause

RSV | Bronchiolitis

Prevention of bronchiolitis for premature patients, those with chronic lung disease or congenital heart disease

Palivizumab

6-mo-old infant w/coughing spells (loud inspir whoops) f/b vomiting Confirm diagnosis by ________

Nasopharyngeal cx or PCR | Whooping cough; Bordetella pertussis

Treatment of cystitis in young children

amox, TMP/SMX, nitrofurantoin

Treatment for pyelonephritis in children

3rdgen cephalosporin 10-14 days

2 y.o. male with multiple episodes of otitis media, pneumonia and diarrhea. On exam, no tonsils seen

X-linked (Briton) Agammaglobulinemia (XLA)

17 y.o. female with ↓IgG, IgM, IgE, IgA but normal B cells

Common Variable Immunodeficiency (CVID)

2 y.o. female with giardiasis, PMH: pneumonia and UTI; Anaphylaxis with blood transfusion

IgA deficiency

3-day-old male with hypertelorism, thin upper lip, small mandible, notched ears presents with seizures and cyanosis

DiGeorge syndrome (thymic hypoplasia)

Infant with severe infections, no thymus, no tonsils, severe lymphopenia

Severe Combined Immunodeficiency (SCID)

18-mo-old male with severe eczema, petechiae, recurrent ear infxns.

Wiskott-Aldrich Syndrome

2 y.o. male with 4thepisode of otitis media; mom remembers his umbilical cord stump separated around 2 mos.

Leukocyte Adhesion Deficiency

3 y.o. male, recurrent swollen, infected LNs in groin Test of choice

Dihydrorhodamine 123 | Chronic granulomatous disease

7 y.o. girl w/L wrist and R knee pain (off and on x 3 mos.), pain is worst in morning (improves through day); R knee has effusion and ↓ROM

Juvenile Idiopathic Arthritis (JIA) (synovitis of peripheral joints)

Juvenile Idiopathic Arthritis (JIA) (synovitis of peripheral joints) treatment options

NSAIDs, methotrexate, azathioprine, cyclophosphamide, biologicals, steroids

2 y.o. female w/2-wk h/o fevers to 102°F, conjunctivitis, very red tongue, cracked lips, desquamating rash, swollen hands and feet

Kawasaki disease

Treatment for Kawasaki disease?

IVIG +high dose aspirin

Complication of Kawasaki disease

Aneurysm

feeding difficulty, choking,stridor, apnea, vocal cord paralysis,UE spasticity + spina bifida oculta/ meningocele/ myelomeningocele Next step?

Head Ct : look for Arnold Chiari malformation

Presents: head circum > 95%ile, bulging fontanelle, distended scalp veins, “setting sun” eyes, ↑DTRs, vomiting

Hydrocephalus

↑ing head size, prominent occiput, spasticity, hyperreflexia, ataxia delayed motor development; Diagnosis?

Dandy-Walker malformation (agenesis or hypoplasia of cerebellar vermis, cystic dilation of 4thventricle, enlarged post fossa)

Treatment for simple partial seizures

Phenytoin

18-mo-old male w/first time tonic-clonic seizure lasting 3 mins. He has had a viral illness with temp up to 103.8°F

Febrile seizure

Management for febrile seizure

Acetaminophen

10 y.o. female with falling grades in school and many episodes of ”staring into space” with eye flickering; EEG shows 3 Hz spike

Absence (petit mal )seizure

Management for absence seizure

Ethosuximide *drug of choice) or valproic acid

6-mo-old w/symmetric contractions of neck, trunk and extremities; EEG: hypsarrhythmia (asynchronous, chaotic spike-wave pattern)

Infantile spasm

6-mo-old w/symmetric contractions of neck, trunk and extremities; EEG: hypsarrhythmia (asynchronous, chaotic spike-wave pattern) Treatment?

ACTH, prednisone, +/- anticonvulsant

10 y.o. male w/ataxia, explosive speech that is difficult to understand, kyphoscoliosis

Friedreich ataxia

10 y.o. male w/ataxia, explosive speech that is difficult to understand, kyphoscoliosis Most common cause of death

HOCM—> | CHF, arrhythmia, death

13 y.o. male w/dystonia, tremors, Kayser-Fleischer rings in his eyes, and recent behavioral changes Best test?

Serum ceruloplasmin

13 y.o. male w/dystonia, tremors, Kayser-Fleischer rings in his eyes, and recent behavioral changes Diagnosis

Wilson disease

13 y.o. male w/dystonia, tremors, Kayser-Fleischer rings in his eyes, and recent behavioral changes Treatment?

Chelation with penicillinamine

10-mo-old Jewish male w/seizures, hypotonia, cherry-red macula

Tay-Sachs disease

What is deficient in Tay-Sachs disease

Beta-hexosaminidase A

9 y.o. male w/choreoathetosis and spasticity + h/o renal calculi

Lesch-Nyhan disease

Newborn lying in frog-leg position w/subdiaphragmatic retractions, absent DTRs

Spinal Muscle Atrophy (SMA) (AR degenerative dz of motor units)

11 y.o. male w/clumsiness (dropping items) and frequent falls; LEs are “stork like” + pes cavus

Charcot-Marie-Tooth (HMSN I)

3 y.o. male w/clumsiness and big calves;

Duchenne Muscular Dystrophy

Cause of becoming wheel bound in duchenne muscular dystrophy

Calf pseudohypertrophy (deposits of fat and collagen) + thigh muscle wasting

What is seen on muscle biopsy for Duchenne muscular dystrophy

Abnormal or absent dystrophin

Initial best for diagnosis of duchenne muscular dystrophy

CPK (Increased)

Presents: facial wasting (“inverted V” upper lip, thin cheeks, scalloped temporalis, narrow head, high arched palate) + hypotonia (progressive wasting: distal →proximal) + poor speech, difficulty swallowing, EOM weakness, slow GI emptying + heart block + endocrine probs + half w/intellectual disability

Myotonic dystrophy (CTG trinucleotide expansion)

Disorders that are associated with omphalocele (2)

Beckwidth-Weidemann syndrome, trisomy 18

Pediatrics Flashcards

(261 cards)