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Clerkships-PEDIATRICS Flashcards

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1
Q

1) mongolian spot. comprised of? 2) pale pink vascular macules in nuchal area or face 3) firm yellow-white pustules/papules on an erythematous base, perhaps seen on DOL 2; what would you find on bx? 4) cherry hemangioma

A

1) arrested melanocytes 2) nevus simplex 3) erythema toxicum; eosinophils 4) raised, palpable

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2
Q

2 ddx for papules on the face in neonate 2 distinguishing features

A

baby acne (not present on day 1 of life) milia

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3
Q

Etiology of neonatal acne!

A

Maternal hormones! (not p. acnes)

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4
Q

What is this rash called? How is it characterized? Tx and why?

A

Nevus sebaceous, an area of alopecia with orange colored nodular skin,

tx by removing before adolescence bc of malignant transformation risk

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5
Q

What is the cradle cap? tx and definition (looks like impetigo but it’s not)

A

Seborrheic dermatitis, “thick yellow/white oily scale on an erythematous base.”

tx, clean with shampoo

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6
Q

What two things are mandatory on neonatal screens?

Timing of the px of each?

A

PKU, Galactosemia (can cross placenta!)

PKU longer time to show up, galactosemia present right away.

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7
Q

Days of jaundice, levels; dx? NBS?

1, 14, .5

2-3, 10, .5 (normal stool and feeds)

7, 12, .5 (dry mucous membranes)

14, 12, .4 (otherwise healthy, regained birth weight)

A

1) Hemolytic, DAT- if +
2) physiologic jaundice of newborn, should resolve by day 5
3) breast FEEDING jaundice (def?)
4) breast MILK jaundice (def?)

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8
Q

Other kinds of jaundice:

1) Dark urine, pale stools
2) Rando INHERITED causes of indirect
3) Rando INHERITED causes of direct
4) Random non-inherited cuases of DIRECT

A

1) Cholestatic/biliary atresia
2) Gilbert’s (less enzyme), Criggler Najjar type 1 (abscent enzyme UDP-glucuronyl-tranferase)
3) Rotor’s, Dubin Johnson
4) sepsis, hypothyroidism, galactosemia, CF, choledochal cyst

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9
Q

What is given to sickle patients to prevent encapsulated infxn?

A

Penicillin

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10
Q

Postpericardiotomy syndrome

A

pericardial effusion 2/2 autoimmune response occurring 1-6 weeks postoperatively following surgery for congenital heart disease.

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11
Q

Foreign body in the vagina

A

common in pre-pubertal girls. The foreign body should be removed before CPS is contacted, if warranted.

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12
Q

Wheezing that improves with neck extension and unaffected by bronchodilators. Etiology?

A

Tracheal compression by a vascular right (ex. double aortic arch, right sided aorta, pulmonary sling, etc.)

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13
Q

Night terrors vs nightmares

A

Night terrors: non-REM, crying, screaming, tachycardia, no recollection

Nightmares: REM, no crying, no screaming, no tachy, recollection upon wakening

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14
Q

dx and nbs for baby with bowel loops in thorax

A

pulmonary hypoplasia

deliver baby in a place with ECMO, 3-4 days later correct surgically

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15
Q

Baby is cyanotic but becomes pink when crying.

Other asociated things to look for?

A

Choanal atresia,

CHARGE: coloboma, cognitive, heart defects, retarded growth, ear anomalies, eye anomalies

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16
Q

Gastroschisis vs Omphalocele vs Umbilical Hernia

A

Gastroschisis - lateral, no sac, not assoc. w/ any other anomalies, high AFP

Omphalocele - midline, sac, assoc. w/Beckwith Weidemann syndrome = ear pits, big baby, big tongue, low glucose

UH - HYPOTHYROIDISM, resolves by 2-3 years, if not, surgery

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17
Q

Management of itussusseption vs meconium ileus

A

Barium enema vs gastrograffin enema

(dx and tx)

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18
Q

CF genetics

A

AR!!!!!

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19
Q

cryptorchidism tx

A

if testes don’t descend within 1 year (reduces cancer risk; detection, not prevetion)

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20
Q

Midline suprapubic mass with anuria early in life. dx, tx,

A

(distended bladder is the mass here)

posterior urethral valves

NBS is catheterization for relief

surgery for correction

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21
Q

congenital adrenal hyperplasia (21-hydroxylase def.)

px, path, labs, dx, tx

A
  • ambiguous genitalia at birth
  • 21 hydroxylase deficiency (AR)
  • hyponatremia, hyperkalemia
  • 17 hydroxy-progesterone
  • hydrocortisone (replace cortisol), fludrocortisone (replaces aldosterone)
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22
Q

more medical name for osgood schlaughtters

A

traction apophysitis

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23
Q

IgA def vs Wiskott-Aldrich syndrome vs X-linked bruton’s agammaglobulinemia vs hyper IgM

Transfusion rxn/anaphylaxis?

Recurrent URI?

Giardia?

Serum levels?

A

IgA: yes, yes, yes, obv

WAS: (thrombocytopenia, otitis media, eczema)

Bruton’s: NO, yes, NO, no levels

hyper IgM: NO, yes, yes, high M, low G&A

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24
Q

intussusseption dxx,tx?

A

U/S targetoid mass

tx: air-contrast enema (dx and tx)

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25
Most common symptoms of polycythemia of the newborn
Respiratory distress, cyanosis/tachypnea (decreased pulm perfusion 2/2 increased viscosity of blood), poor feeding, hypoglycemia, hypocalcemia, neurologic (seizures, jitteriness, irritability, lethargy) tx: hydration and exchange transfusion
26
Fever \>101.2 in neonate, \<28 days old
sepsis until proven otherwise, order everything tx. amp/gent GBS, listeria, E coli
27
Gonorrhea vs Chlamidia conjunctivitis neonate
Gonorrhea: DOL 3-5, purulent dcg, tx. ceftriaxone, topical erythromycin Chlamidia: mucopurulent, DOL 7-14, tx oral erythromycin, chlamydial pneumonia concern
28
Most common cause of unilateral lymphadenopathy
Staph aureus
29
Lead posoning screenings?
Do screenings frequently. Try to do it before 5 years of age. If there's more suspicion, do a SERUM lead and go from there.
30
How to potty train if child isn't interested?
Stop potty training attempts for several months and allow the child to become interested. If interested, then use positive reward techniques and regular scheduling.
31
The most common predisposing factor for acute bacterial sinusitis
Viral URI
32
Fluctuant, cervical lymphadenitis/lymphadenopathy 2 most causative agents and tx?
Staph/strep DICLOXACILLIN Cephalexin and clindamycin work as well
33
Congenital syphillis presentation and tx
HSM Jaundice Cutaneous Lesions Anemia Rhinorrhea (metaphyseal dystrophy, periostitis) TREAT: penicillin G
34
Most common causes of viral meningitis?
Echovirus, coxackievirus
35
Child falls on a pencil or a stick in his mouth. What can result? What is the mechanism? Time till onset? vs. postictal condition that usually rapidly improves with restoration of function within 24 hours
Stroke 2/2 Internal carotid artery dissection/thrombosis onset can be up to 24 hours later postictal (Todd's) paralysis
36
Kid with ADD symptoms but also poor eye contact, poor language development
UNDETECTED HEARING DISORDER! DON'T MISS IT! could be absence seizures
37
Most common cause of diarrhea in children? Some others?
Rotavirus (watery) Norwalk (second most common)
38
MSK manifestation of Down's
Atlanto-axial instability
39
Omphalocele, microcephaly, clenched hand, rocker bottom feet, hammertoe Severe mental retardation, holoprosencephaly, microcephaly, cleft lip/palate
Edward's Syndrome 18 Patau's Syndrome 13
40
Breast milk vs formula
Breast milk WHEY is dominant, more LONG-chain fatty acids, less iron but better absorbed, more lactose
41
14 yo boy, always been below 5th percentile for height, both parents are super tall and were late bloomers. dx? bone age vs actual age? prognosis for kid? Same story, but both parents are super short. ??? Comment on bone age in obese ppl. Why?
Constitutional growth delay, bone age less than actual age (bones "have more room to grow), kid can attain height Familial Short Stature, bone age=real age (bones "don't have any more room to grow"), kid is doomed Bone age\>actual age, fat=estrogen
42
Most common leukemia in children? Dx?
ALL (acute lymphoblastic leukemia); +25% lymphoblasts in bone marrow
43
Spondylolisthesis
Developmental disorder in which a vertebrae makes a forward slip (L5 over S1 usually). Palpable "step off" at lumbosacral area. Cauda equina type symptoms
44
Easy bruisability and petechiae usually following a viral infection, px in early childhood
ITP All labs normal except for thrombocytopenia
45
Isolated appearance of axillary hair before the age of six, resulting from premature androgen secretion of the adrenal glands. tx? pubic hair before the age of 8. tx?
premature adrenarche benign, no clinical significance premature pubarche, requires thorough eval, as it may be due to a CNS disorder
46
Which newborn brachial palsy is accompanied by horner's symptoms?
Klumpke's (C7-8, T1)
47
Give 3 contraindications to breastfeeding?
Active drug abuse, TB, HIV
48
1) CLASSIC TRIAD OF TOXOPLASMOSIS 2) SYPHILIS 3) RUBELLA 4) HSV
1) CHORIORETINITIS, HYDROCEPHALUS, INTRACRANIAL CALCIFICATIONS 2) fever, osteitis, osteochondritis, mucocutaneous lesions, lymphadenopathy, hepatomegaly, rhinitis 3) microcephaly, microphthalmia, meningoencephalitis, sensorineural deafness, PDA, ASD, congenital glaucoma/cataract 4) encephalitis, chorioretinitis, NO MICROCEPHALY/MICROPHTALMIA
49
Cri-du-chat syndrome is due to what? Px?
5p deletion microcephaly, hypotonia, short stature, cat-like cry
50
Long term neurologic sequelae of bacterial meningitis (that can prevent kids from reaching developmental milestones, etc.)
hearing loss loss of neurons in dentate gyrus seizures mental retardation spasticity or paresis
51
tx for exacerbation of lung dz 2/2 CF? which organism
penicillin/cephalosporin+aminoglycoside covers pseudomonas (ex. ceftazidime+gentamicin)
52
Gastric residues? Bloody diarrhea with eosinophils, fam hx of atopy
NEC milk protein intolerance
53
Distinguish TTNB from HMD
HMD has fine granularity on CXR
54
To Screen for dystrophies? To confirm dx?
CK levels Muscle biopsy
55
Sturge-Weber (3 characterisstics), (4 more presentations), xray findings, tx (3)
Generalized seizures, mental retardation, portwine (nevus flammeus) along trigeminal [2/2 congenital unilateral cavernous hemangioma] hemianopia, hemiparesis, hemisensory disturbance, ipsilateral glaucoma 2+ years old, xray shows gyriform intracranial calcifications that resemble a tramline tx aimed at reducing intraocular pressure and reducing seizures, lazer therapy to remove skin lesions
56
Treatment for the following: wonder drug (levitiracetam) 1) Absence 2) Trigeminal Neuralgia 3) Myoclonic (helmet), Atonic 4) Febrile Seizures 5) Seizure abortive measure heirarchy (all IV) 6) Wes Syndrome of infantile spasms
levitiracetam 1) ethosuximide 2) carbamazepine 3) valproic acid 4) acetaminophen (tx source) 5) lorazepam, phenytoin, phenobarbital, midazolam+propofol 6) ACTH
57
# Define: Complex vs. Simple Generalized vs Partial Seizures vs Epilepsy
+LOC vs -LOC Whole body vs Specific symptoms (loss of tone?) One episode vs life long with "focus" of neuroconductive abnormality pathway
58
how to distinguish seizures from syncope
SEIZURES WILL HAVE A POST-ICTAL STATE, in which patient slowly regains consciousness
59
Atonic vs myoclonic vs absence seizures loss of tone? loss of conciousness?
atonic and myoclonic both DO NOT have LOC (simple) atonic has LOT while myoclonic is jerky absence has LOC but no LOT
60
Patient has infantile spasms, not febrile, Dx? Tx? Hypopigmented spots shown with what test. what's the name?
interictal EEG showing hypsarrythmia tx ACTH ash leaf spots, dx with woods lamp, seen in tuberous sclerosis. tx is supportive
61
Loud S1, fixed split S2, gets tired in gym class PDA assoc. with what infection
ASD Cogenital rubella syndrome
62
1) Super high fever, 3 days later resolves and now there's a rash on the trunk and legs 2) Fever, Slapped cheeks 3) 2 weeks post sore throat, fine maculo-pap rash that starts on top and spreads down (tx?) 4) cough, fever, runny nose, rash top down, gray spots on the buccal mucosa (tx?) 5) sore throat, joint pain, fever, pinpoint rash on face that moves down, rose spots on palate
1) Roseola (HHV-6) 2) Erythema Infectiosum (Parvovirus B19) 3) Scarlet Fever (group A strep pyogenes) (PCN) 4) Measles (vitamin A) [koplik spots] 5) rubella (paramyxovirus)
63
Scabies tx Impetigo tx
Primethrin topical muciprocin
64
1) Most common meningitis bugs overall? Tx? 2) Young and immune suppressed? Tx? 3) Brain surg w/ instruments? 4) 2 Randos and (tx?)
1) Strep pneumo, H flu, Neisseiria meningitidis (encapsulated). Tx. IV Ceftriaxone + vancomycin + steroids 2) GBS, strep pneumo, Listeria, tx add ampicillin 3) Staph tx vanco 4) TB (ripe+steroids) , lyme (IV ceftriaxone)
65
Retropharyngeal abcess vs Peritonsillar abcess
Can't turn head, can lead to mediastinitis (retropharyngeal space communicates directly with mediastinum). tx I&D, strong abx "hot potato voice", deviated uvula tx I&D, strong abx
66
Croup Epiglottitis Bronchiolitis Pertussis
Parainfluenza, barking cough, steeple sign, racemic epi H Flu, thumb sign, intubate in OR, ceftriaxone/vanc RSV, wheezy cough/runny nose, swab, nebs, NO STEROIDS, rare: pavalizumab Bordatella pertussis, whooping, lymphocytosis, erythromycin for patient and close contacts
67
2 most common surgeries for Sickle cell patients study to assess risk?
Chole Tonsillectomy (hyperplasia happens in sickle) transcranial doppler
68
Blackfan Diamond Fanconi's Anemia Lead Poisoning
Triphalangeal thumbs, pale baby, increased RBC ADA tx. corticosteroid, stem cell transplant, transfusions Absent thumbs, cafe-au-lait, microcephaly tx. corticosteroids, stem cell txpt, androgens Hyper baby, basophilic stippling
69
Brain tumors in kids. Two most common. (infratentorial!)
Pilocytic astrocytoma, resect, good prognosis Medulloblastoma, increased ICP bc it blocks 4th ventricle, vermis, bad prognosis
70
tx ALL? What causes mediastinal mass w/resp distress
chemo + intrathecal mtx non-hodgkins lymphoma. tx surgical excision and radiation
71
Infant born to an HIV-positive mother. NBS?
Course of Zidovudine
72
Metabolic derangement from immobilization?
"immobilization hypercalcemia" from sedentary-ness after a fracture, etc. montior with serum calcium and urine calcium:creatinine ratios (greater than .2 is hypercalciuria) treatment with mobilization, calcitonin in extreme cases
73
Tx of hydrocele?
Observation, usually spontaneously resolve after 1 year of life
74
Encephalofacial angiomatosis
another name for Sturge Weber syndrome leptomeningeal angiomas unilateral port-wine nevus hemiparesis
75
Distinguish calcifications caused by CMV vs toxoplasmosis. Mnemonic
cmV - periVentricular toXoplasmosis - scattered throughout the corteX
76
Infant with hemiparesis looking away from the paralyzed side. Pathophys?
Acute Infantile hemiplegia thomboocclusion of the middle cerebral artery
77
Which "brain bleed" happens with shaken baby syndrome
SubDURAL hematoma (rupture of bridiging veins)
78
Analgesia for circumcision?
Penile block Topical Lidocaine Subcutaneous Ring Block
79
Parinaud Syndrome
Pineocytoma Lid retraction, loss of vertical gaze, loss of pupilary light reflex, and convergence-regtraction nystagmus (eyes jerk back into orbit upon attempted upward gaze)
80
Isoniazid MOA?
Inhibits pyridoxine utilization, therefore consider supplementing Vit B6 in children undergoing tuberculosis treatment. Recall that B6 def. leads to peripheral neuropathy
81
What is prune belly syndrome? Features?
Urinary tract abnormalities, renal malformation, oligohydramnios, pulmonary hypoplasia, club feet, wrinkled abdomen, dilated urinary tract, intra-abdominal testes
82
1) Dolichocephaly 2) Brachycephaly
1) Long, thin head 2) Broad head
83
Acute disseminated encephalomyelitis path? timing? features? imaging? tx?
- autoimmune demyelinating condition seen in children less than 10 years of age - follows viral URI - fever, emesis, weakness, headache - MRI shows disseminated focal white matter lesions - corticosteroids
84
tx for newborn galactosemia?
switch to soy-based or casein-based and avoid galactose
85
Anaphylactoid purpura
Same thing as Henoch-Schonlein Purpura
86
Hartnup disease Path? Features? Treatment?
Intestinal malabsorption of tryptophan and other neutral amino acids Red Scaly rash, emotional lability, episodic cerebellar ataxia, developmental delay Treat with nicotinamide replenishment
87
Cure for salycilate poisoning
NaCO3, acetazolamide, hemodialysis if extreme
88
Which of the following has karytype abnormalities? Gastroschisis or Omphalocele? Which ones?
Omphalocele the three Trisomies
89
Antidote for phenothiazine poisoning? Symptoms of this?
Diphenhydramine Opisthotonus, oculogyric crises, torticollis, tremors, dysphagia
90
What kind of a patient would have an unresponsive intradermal skin test using Candida Albicans. Explain
DiGeorge. T-cell deficiency (don't forget hypocalcemia, heart defects, etc., too). Therefore, you can't mount the intradermal response to something like candida
91
How to test for EHEC?
McConkey Agar
92
hypothalamic harmatoma
preceded by laughter (gelastic seizures) GHrH release leading to acromegaly
93
General example, if you have a negative dipstick, then you'd probably want to do a urine culture.
But obviously if the dipstick was positive, then it's high index of suspticion enough to consider the infection
94
Tanner Stages (review kaplan behavioral video on this?)
Tanner 1 - no pubes? Tanner 2 - sparse, thin, long pubes Tanner 3 - pubes begin to curl Tanner 4 - resembles adult pubes, but incomplete coverage Tanner 5 - resemlbes adult pubes, but extends on thigh
95
Impaired ocular mobility, diplopia, pain greatest on upward gaze, infraorbital hypoesthesia, following blunt force trauma
Orbital Floor Fracture
96
Kid with SVT, NBS?
Adenosine (NOT CAROTID MASSAGE)
97
Distinguish the definitions of primary vs secondary enuresis Nocturnal vs diurnal
Primary - never followed by period of dryness Secondary - enuresis followed by 6 months of dryness Nocturnal - only during the nighttime Diurnal - both night and day
98
Explain the metabolic derangements you'd find and explain the pathophys: 1) 21-hydroxylase def. & addison's disease 2) Conn's Syndrome 3) von-Gierke's disease
1) hypOnatremic hypERkalemia; low aldosterone (low cortisol/glucocorticoids as well) 2) hypERnatremic hypERchloremic hypOkalemic metabolic alkalosis; high aldosterone 3) hypO everything; VGD patients have glucose-6 phosphatase def. which lends hyperlipidemia. this reduces the aqueous volume which in turn "factitiously" reduces electrolyte concentrations in the reading (the machine thinks there's normal volume, but there's actually less) tai
99
Legg-Calve-Perth's Disease SCFE Transient synovitis of the hip
Femoral head necrosis Common in blacks, knee pain referred to hip, early teens Post-infectious condition affecting toddlers
100
Wiskott aldrich new mnemonic
TEA-TIME T-cell dysfunction Hyper IgE, A Thrombocytopenia Infection (otitis media) LOW IgM Eczema
101
hypsarrythmia
multifocal high amplitude spikes and slowing on EEG (characteristic of West's infantile spasm syndrome) tx. ACTH
102
Best treatment to stop carriage of Group A Strep from oropharyngeal secretions
Oral Clindamycin or quinolone
103
Hurler's Syndrome
mucopolysaccridosis type I alpha-L-iduronidase def. leading to deposition of dermatan and heparan sulfate in the skin and excessive excretion in the urine umbilical hernia, kyphoscoliosis, deafness, cloudy cornea, claw hand
104
General triad of storage diseases
HSM Coarse Facies Progressive developmental delay
105
What is ebstein anomaly
Downward displacement of the tricuspid valve
106
WHICH RASH HAS EOSINOPHILS
ERYTHEMA TOXICUM
107
Paraphimosis. path and tx?
Foreskin is retracted over the glans and does not return to its original position. Emergency. NBS: manual reduction of the skin back into place
108
What does ivermectin treat?
cutaneous larva migrans (creeping eruption) caused by dog or cat hookworms

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