Case Files 2 Flashcards by Robby Skinner

Most commonly used stool softener in young children

Oral polyethylene glycol - odorless and flavorless powder

How well did you know this?

Not at all

Perfectly

Mickey diverticulum remnant of

Omphalomesenteric duct

How well did you know this?

Not at all

Perfectly

Lower GI bleeding most often presents with

Hematochezia (bright red)

How well did you know this?

Not at all

Perfectly

2 diff dx of painless rectal bleeding with hx of normal stopping and no associated symptoms

Juvenile polyp or Meckel diverticulum

How well did you know this?

Not at all

Perfectly

3 things that would indicated coagulopathy is underlying cause of rectal bleeding

Hepatosplenomegaly, petechiae, or purpura

How well did you know this?

Not at all

Perfectly

Anal fissures bleed enough to cause anemia?

Nah

How well did you know this?

Not at all

Perfectly

If constipation resolves but an anal fissure recurs, what could be the cause

Look into possible chron disease

How well did you know this?

Not at all

Perfectly

MCC of hematochezia in children

Anal fissures

How well did you know this?

Not at all

Perfectly

First indication that bleeding is causing anemia

Tachycardia

How well did you know this?

Not at all

Perfectly

3 otitis media bugs

S pneumo, H flu, moraxella

How well did you know this?

Not at all

Perfectly

Acute OM tx

Amoxicillin - 80-90 mg/kg/d for 7-10 days

Add b-lactamase inhibitor if no change after 3 days

How well did you know this?

Not at all

Perfectly

AOM with ear lobe pushed superiorly and laterally

Mastoiditis

How well did you know this?

Not at all

Perfectly

Irritability and lethargy in 1 year old

Admit for sepsis workup

How well did you know this?

Not at all

Perfectly

MC childhood movement disorder? What is also seen

Cerebral palsy

1/3 have seizures and 60% have MR

How well did you know this?

Not at all

Perfectly

Most likely cause of CP

Antenatal insults, and subsequent difficulties during the pregnancy

How well did you know this?

Not at all

Perfectly

What is hemiplegia? diplegia?

Hemiplegia: single lateral side of body w/ greater def in upper
Diplegia: four limp involve with greater impairment in LE

How well did you know this?

Not at all

Perfectly

What is the motor quotient

divide normal milestone by time CP child starts milestone to asses impairment

How well did you know this?

Not at all

Perfectly

2 MCC of bronchiectasis

Asthma and infections

CF MCC of chronic

How well did you know this?

Not at all

Perfectly

Metabolic state in CF? Unique bug to worry about?

Hyponatremic, hypochloremic alkalosis

pseudomonas unique

How well did you know this?

Not at all

Perfectly

CF dx requires?

Two positive sweat tests in conjunction with any of the other features

How well did you know this?

Not at all

Perfectly

ALL peak incidence? 2 genetic syndromes that increase risk?

2-4 year old boys

Down’s and fanconis increase risk*
Dont let WBC count

How well did you know this?

Not at all

Perfectly

Blast level to confirm ALL in marrow biopsy

At least 25%

less than 5% normal

How well did you know this?

Not at all

Perfectly

Suspected ALL workup

CBC w/ diff and platelets, LP, CXR to look for mediastinal mass

How well did you know this?

Not at all

Perfectly

What patients are likely to develop asthma

RSV bronchiolitis

How well did you know this?

Not at all

Perfectly

Why inc wheezing sometimes after asthma treatment

Increased airflow over areas that were previously closed

Long term asthma drugs

Mast cell stabilizers (cromyln) and leukotriene modifiers (montileukast)

What is a late phase reaction in asthma

Typically occurs 2-4 hours after initial wheezing episode, caused by accumulation of inflammatory cells in airway Responsible for chronic inflammation seen in asthma

Peak SIDS

2-4 month AA or native american boys

3 odd things that seem to reduce SIDS

Breast feeding, immunizations, and pacifier use

Investigation for SIDS

History, post-mortem exam, and death scene investigation

VSD murmur

Holosytolic at LL sternal border

ASD murmur

Fixed, wild split S2

Coarctation of aorta murmer

Systolic murmur in the left axilla

Majority of cyanotic lesions result in change in

Volume load (left to right shunt)

Most common heart lesions in children? Features of a large one

VSD | Dyspnea, feeding diff, growth failure, profuse perspiration

3 things a large ASD can cause

Growth failure, frequent URIs, exercise intolerance

Diff needed to to dx shunt across ductus

3-5% diff above and below ductus

Single S2 can be heard with

Pulmonary valve atresia or truncus arteriosis

3 CHD that decreased pulmonary vascularity can be seen with

Atretric tricuspid valve, atretic pulmonary valve, or TOF

"egg-on-a-strin" or narrow mediastinum seen with

Transposition of great artery

"Snowman" appearance seen in

Total anomalous pulmonary venous return (supra cardiac shadow caused by anomalous pulmonary veins entering the innominate vein and persistent left superior vena cava)

Seizures, neurologic changes, and abdominal complaints in child? what else can you see?

Lead poisoning | May also see hyperirritiability, altered sleep patterns, and loss of play

Next step in kid with lead level of 15-19

Lead education and follow up BLL 3 months later

What lead level to start chelation therapy

> 45

Infants exposed to in utero methyl mercury ay display?

Low birth weight, microcephaly, and seizures

Top 3 neonatal meningitis bugs

GBS, E. coli, listeria

Top 2 causes of bacterial meningitis in older children

S pneumonia and Neisseria

Recommendation for bacterial meningitis tx? In neonates?

3rd gen cef + vanc | In neonates: amp + 3rd gent ceph

Most common long term complication of meningitis

Hearing loss

Nuchal rigidity is not a reliable finding in meningitis until

12-18 months old

CSF findings of bacterial meningitis

Elevated protein, reduced glucose, lots of wbc's

Salmonella features

Gram neg bacilli (non motile facultative anaerobic)

When is salmonella more common

Warmer months

Two infections that can cause SJS in kids? SJS risk factors?

Mycoplasma and Herpes viridae | Risk factors include HIV and underlying genetic disorder (Slow N-acetyltransferase)

How long for SJS to manifest after drug? What if 2nd exposure?

2 weeks for skin lesions, 48 hours if around 2nd exposure

Most common mucocutaneous finding in SJS

Ocular -> risk of corneal abrasion and eventual blindness (consult optho**)

4 antiepileptis known to cause SJS

Carbamazepine, phenytoin, lamotrigine, phenobarbital | *SJS needs mucosal involvement in 2 or more areas*

SJS SCORTEN risks

Age > 40, ass malignancy, HR > 120, BUN >27, >10% body surface, Bicarb 250

Cardinal features of salmonella gastroenteritis

N/v, watery diarrhea, fever w/in 8-72 hours

Why is shigella easily transmitted

Less susceptible to acid than other bacteria

CBC in shigella infection

Wbc's usually normal but left shift with lots of bands seen

Why ab for shigella

Shortens illness and decreases duration that organisms are spread

MCC of acute childhood renal failure

HUS from 0157:H7

Brain injury most common with

Subdural | Seizures seen more commonly with them

Features of subdurals in kids under 1

One third have associated fracture | 75% are bilateral, seizures in up to 90%

Subdural hematomas by timing

Acute: symptoms in 48 hours Subacute: 3-21 days Chronic: after 21 days (more common in older children)

Schedule for athletes returning from concussion

Graduated return to play schedule that begins with light, non impact activity

Best test to asses subdural hematoma

MRI - can determine the age of the insult

Age for febrile seizures

6 months - 6 years

Simple vs complex febrile seizures

Simple: generalized lasting no more than 15 minutes, no post-ictal state, and no recurrence in 24 hours (80% of febrile seizures)

Positive Brudzimki sign

While supine, passive neck flexion results in involuntary hip and knee flexion)

Associated mutation with febrile seizures

SCN1A sodium channels

Ongoing seizures with no response to benzos can be treated with

Fosphenytoin

All children with seizures must have what on differential unless proven otherwise

Meningitis (esp under 1 year when exam is unreliable)

Case Files 2 Flashcards

(74 cards)