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Peds > Emma Holliday part 2 > Flashcards

Emma Holliday part 2 Flashcards

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1
Q

why rectal prolapse with cystic fibrosis?

A

chronic diarrhea

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2
Q

treat CF pt with pneumonia

A

must cover pseudomonas and b cepacia

pipearacillin + tobramycin
or
ceftazidime

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3
Q

what makes mild vs moderate asthma?

intermittent vs persistent?

A

PFTs normal vs abnormal
for mild vs moderate/severe

freq of sx for intermittent (v2&2 2 days/wk 2night/mo) vs
persistent
(2-6 days, daily, throughout the day… weekly nights)

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4
Q

infectious complication of chronic asthma….

A

allergic bronchopulmonary aspergillus

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5
Q

why add K+ to IVMF for T1 diabetic hospitalized kid with hyperglycemia and hypochloremic anion gap metabolic alkalosis from puking

A

because you are going to give insulin and that drives K+ into cells, don’t want serum to get hypokalemic

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6
Q

diagnostic criteria for diabetes

A

fasting gluc ^125 (twice)
any gluc ^200 with sx
2hr OFTT (75g) ^200

(any of the above I think..)

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7
Q

High fever, Then rash maculopapular erythematous on trunk

dx
bug

A

roseola

HHV6 human herpes virus 6

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8
Q

when do we worry about erythema infectiousum, slapped cheek, parvovirus B19

A

sickle cell kids - can cause aplastic crisis

pregnant women - fetus can get hydrops fetalis

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9
Q

2yo low grade fever, lacy reticular rash on cheeks and upper body that spares palms/soles

dx
who to worry about

A

erythema infectiousum, slapped cheek, parvovirus B19

worry about
sickle cell kids - can cause aplastic crisis
pregnant women - fetus can get hydrops fetalis

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10
Q

fine maculopapular desquamating rash begins on chest and spreads to neck, trunk, extremities
strawberry tongue
sore throat 1-2 weeks prior

dx
tx

A

scarlet fever

penicillin to prevent rheumatic fever (won’t prevent PSGN post strep glomerulonephritis)

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11
Q

how and why treat scarlet fever

A

penicillin to prevent rheumatic fever (won’t prevent PSGN post strep glomerulonephritis)

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12
Q

cough runny nose fever.. macular rash begins behind ears and spreads down, gray spots on buccal mucosa

dx
bug
tx

A

measles

paramyxovirus

vitamin A

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13
Q

sore throat, joint pain, fever… pinpoint rash on face spreads down, rose spots on palate

dx
bug

A

rubella

paramyxovirus

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14
Q

complications of lyme

A

arthritis, heart block, meningitis, bell’s palsy

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15
Q

treat lyme

A

doxy ^8yo
amox v8yo

iv ceftriaxone to penetrate csf if complicated by meningitis

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16
Q

tf

treatment of lyme and rocky mountain spotted fever is age dependent

A

lyme is age dependent
doxy ^8yo
amox v8yo
iv ceftriaxone to penetrate csf if complicated by meningitis

RMS is not age dependent
everyone gets doxy

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17
Q

kid went camping, got fever, myalgias, abdominal pain

dx
bug
tx
compx

A

rocky mountain spotted fever

rickettsia rickettsii

doxy for everyone every age

can be complicated by gangrene via vascular infection

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18
Q

treat impetigo

A

topical mupiricin

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19
Q

inflamed conjunctiva and multiple nikolsky positive blisters

dx
path
tx

A

staph scalded skin syndrome
from exfoliative toxin

iv abx

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20
Q

meningitis bug that gets young and immunosuppressed

tx

A

listeria

ampicillin

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21
Q

meningitis bug that gets brain surgery patients

A

staph aureus

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22
Q

tf

TB can cause meningitis

A

T

treat with RIPE and ‘roids

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23
Q

what to give dorm roommate of college kid who got bacterial meningitis and petechial rash

A

rifampin

for nisseria meningitidis ppx

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24
Q

most sensitive finding for otitis media

A

limited mobility on insufflation, or air-fluid level visualized

(may be erythematous and angry just from kid crying)

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25
when to consider ear tube
bilateral effusion ^4mos or bilateral hearing loss
26
treat otitis externa | what bug to cover
topical ciprofloxacin | cover pseudomonas
27
complications of otitis media vs otitis externa
media - deafness, so place ear tubes if bilateral effusion ^4mos or bilateral hearing loss externa - malignant external otitis - can invade temporal bone - facial paralysis, vertigo... so get CT and IV abx if concerned, surgery may be needed
28
muffled voice, stridor, stiff painful neck dx tx bugs compx
retropharyngeal abscess IandD for culturs and sensitivities 3rd gen cephalosporin + amp or clinda... to cover GAS and anaerobes mediastinitis
29
treat peritonsilar abscess
aspiration or IandD + abx tonsillectomy if recurrent
30
indications for tonsillectomy
recurrent peritonsilar abscess recurrent step throat ^5 strep/year for 2 years ^3 strep/year for 3 years
31
what happens if you give mono kid amp or amox, | why
maculopapular rash | immune mediated vasculitic
32
dx mono
blood smear with atypical lymphocytosis heterophile antibody (monospot) test
33
treat mono
rest | no contact sports till splenomegaly resolved
34
most common epiglottitis bugs in vaccinated child
ga strep pyogenes strep pneumo staph aureus
35
epiglottitis next step next step
intubate IN THE OR (very sensitive airway, manipulation may inflame and cut off acutely) anti-staph abx + 3rd gen cephalosporin
36
acute bronchitis | get cxr?
no
37
``` suspect pneumonia next step most common bugs in v1mo most common bugs in 1-3mo specific finding for chlamydia pna? most common bugs in 4mo-5yo most common bugs in ^5yo ```
cxr v1mo GBS Ecoli Lysteria (same as meningitis) 1-3mo strep pneumo, chlaymidia trachomatis, RSV, paraflu chlamydia pna staccato cough, eosinophilia 4mo-5yo VIRAL (RSV) then strep pneumo (the only age that viral is most common) ^5yo mycoplasma and strep pneumo like adults
38
cxr findings in rsv bronchiolitis
hyperinflation with patchy atelectasis
39
who needs rsv vaccine
palivizumab for premies, congenital heart disease, lung disease (CF), immune disease
40
lab finding in pertussis
high lymphocytes | weird because it is a bacteria
41
treat family members and kids in daycare of pt with pertussis?
yes with erythromycin, just like pt (very contagious)
42
tf | cystitis can have fever
f | febrile uti is PYELONEPHRITIS
43
prophylactic tx for child with vsicoureteral reflux
ppx abx for recurrent uti risk
44
when get ultrasound for UTI
anytime uti is febrile for anatomy, abscess, hydronephrosis
45
treat UTI | treat pyelo
uti - po tmpsmx or nitrofurantoin pyelo - 14 days IV ceftriaxone or amp + gent
46
who needs VCUG in setting of UTI
any male at first UTI any female v5yo any female ^5yo with 2nd uti any pyelo
47
best test for scarring in setting of pyelonephritis
Tc-labeled DMSA scan...
48
most common cause of limp in child
just trauma not transient synovitis, septic joint, ddh, legg-calve perthes, scfe, just trauma, ouchie, booboo
49
5yo boy with painless limp now has pain in thigh
legg calve perthes | AVN of hip
50
preteen female with 2wk hx daily fevers, random rash, joint pain and swelling dx good prognostic factor bad prognostic factor tx
JRA juvenile rheumatoid arthritis +ANA actually good prognostic factor +RF bad prognostic factor, also older age, multiple joints 1st line tx NSAID 2nd MTX 3rd steroids
51
best 1st test when kawasaki's diagnosed
echo and ekg | for scary coronary artery aneurysms
52
treat kawasaki
high dose aspirin IVIG then aspirin and warfarin
53
treat kawasaki with high or low dose aspirin?
high dose aspirin IVIG then aspirin and warfarin
54
diffuse bone pain in peds pt w petechiae, pallor, and increased infections top dx
leukemia
55
sickle cell pt w point tenderness over femur, fever, and malaise top dx
osteomyelitis | salmonella
56
howell jolly bodies in sickle cell pt tells you...
autosplenectomy has occured
57
sickle cell pt, acute drop in HCT, with decreased retics
aplastic crisis | suspect parvovirus B19 slapped cheek erythema infectiousum
58
recurrent RUQ pain after meals in sickle cell pt think...
cholecystitis from pigment gallstones, do cholecystectomy
59
sickle cell pt in respiratory distress without fever cough chest pain chills think..
hyperplastic tonsils (waldeyer ring) get tonsillectomy if fever cough chest pain chills sob think acute chest syndrome (pulmonary infarct) - get exchange transfuion to rid sickle cells
60
most common surgical procedures for sickle cellpatients
cholecystecomy for cholecystitis from pigment gallstones tonsillectomy for waldeyer ring (hyperplastic lymphoid tissue... respiratory distress)
61
proteinuria and increased Cr and recurrent UTIs in sickle cell pt think..
kidney infarcts
62
most common cause of sepsis in sickle cell pt
strep pneumo (not salmonella!) because...encapsulated? post-autosplenectomy?
63
sickle cell pt in respiratory distress with fever cough chest pain chills think.. tx...
acute chest syndrome (pulmonary infarct) get exchange transfuion to rid sickle cells
64
most common cause of death in sickle cell patient
acute chest syndrome (pulmonary infarct) sickle cell pt in respiratory distress with fever cough chest pain chills
65
acute confusion and fnds in sickle cell pt think. .. tx. ..
stroke | exchange transfusion to rid sickle cells not tPA!
66
can increase HbF in sickle cell baby with
hydroxyurea
67
vaccinations and ppx for sickle cell pt
strep pneumo h flu nisseria meningitidis (encapsulated organisms, because autosplenectomy) penicillin ppx till age 6...
68
sickle cell pt with fativue and megaloblastic anemia think.. why?
folate deficiency | because more RBC turnover, higher demand
69
treat baby with sickle cell
hydroxyurea to maintain HbF manage pain bone marrow transplant is curative but 10% postop mortality...
70
unconcerning anemia in kids
physiologic HandH drop v3mos old immunosuppresion after viral infection - transient erythroblastopenia 3mos-6yo
71
lab tip for thalassemia
very low MCV (e.g. 60)
72
8mo irritable, glossitis, failure to thrive, drinks goats-milk formula, picky eater top dx tx
folate deficiency | supplement folate
73
pale baby, anemic, low retics, triphalangeal thumbs top dx tx
blackfan-diamond anemia corticosterods, transfusions, stem cell bone marrow transplant
74
anemia no thumbs no radius top dx diagnostic tests tx complications
fanconi anemia bone marrow shows bone marrow hypoplasia, chromosomal breaks on cytogenetic tests corticosteroids, androgens, bone marrow transplant increased cancer risk
75
baby with low WBC, anemia, low plts... cafe-au-lait spots, microcephaly, absent thumbs top dx diagnostic tests tx complications
fanconi anemia bone marrow shows bone marrow hypoplasia, chromosomal breaks on cytogenetic tests corticosteroids, androgens, bone marrow transplant increased cancer risk
76
2yo hyperactivity, impaired growth, abdominal pain, constipation, basophilic stippling of RBCs on peripheral smear top dx dx test tx
lead poisoning led level in venous blood sample - treat level ^45 with oral succimer (sucks to be a kid with lead poisoning) - treat really high level ^70 with admission for EDTA and dimercaprol IV
77
lead poisoning screening
blood lead levels 12-24 mos age 1-2years especially if low SES, old house from 1960s or earlier
78
15yo F recurrent epistaxis heavy menses petechiae, low platelets top dx tx give platelets?
ITP IVIG for 1-2 days predisone splenectomy NO DON"T GIVE PLTS!...
79
15yo F recurrent epistaxis heavy menses petechiae, normal platelets, inc bleeding time and PTT top dx tx
von Willebrand disease (normal number but defective platelets) DDAVP for bleeding or preop replace factor VIII and vWF
80
7yo M with recurrent bruising, hematuria, hemarthroses, inc PTT top dx tx
hemophilia if mild tx w DDAVP otherwise replace factor VIII or IX depending on type of hemophilia
81
diathesis means
tendency to suffer from a particular medical condition
82
1wk newborn born at home now bleeding from umbilical stump and bleeding diathesis (tends to bleed) top dx and pathophys tx
Vitamin K deficiency (dec factors II VIII IX X) give FFP and vit K shot
83
risk factors for vit k deficiency one healthcare related one genetic
born at home without vitamin K shot CF malabsorption
84
peds pt with wilson disease developed fulminant liver disease 1st factor depleted 1st coag abnormality two factors not depleted
factor VII depleted first PTT increased first vWF and factor VIII are normal
85
toddler with petechiae, abdominal pain, vomiting, lethargy. bloody diarrhea 5 days ago after hamburgers at family picnic. labs thrombocytopenia and inc Cr ``` top dx rank most common causes tx give platelets? give abx? ```
HUS hemolytic uremic syndrome ecoli O157H7 shigella salmonella campylobacter aggressive TPN nutrition early peritoneal dialysis *don't give platelets!! can inc HUS *don't give abx to treat bloody diarhea! can inc HUS
86
give abx for bloody diarrhea?
NO! can inc risk of HUS (toddler with petechiae, abdominal pain, vomiting, lethargy. bloody diarrhea 5 days ago after hamburgers at family picnic. labs thrombocytopenia and inc Cr)
87
IgA and __ deposited in skin in HSP
IgA and C3
88
peds new onset seizure, ataxia, headache worse in morning, vomiting, for a month most common, prognosis 2nd most common, prognosis
most common brain tumor of childhood - pilocytic astrocytoma of cerebelllum, resect, 90% survive 2nd most common brain tumor of childhood - medulloblastoma.. very poor prognosis
89
adolescent 5% for height, bitemporal hemianopsia, calcifications in sella turcica top dx pathogenesis
craniopharyngioma remnant of Rathke's poutch
90
2yo hypertensive with asymptomatic abdominal mass noticed while mom bathing him top dx associations best test treatment
Wilm's tumor assoc Wilms tumor with aniridia, GU anomalies, hemihypertrophy, Beckwith-Weidemann syndrome abdominal CT, CXR to check for lung mets resect, chemo, radiation
91
4yo dancing eyes dancing legs bluish skin nodules and tender abdominal mass top dx diagnostic test
neuroblastoma urine HVA and VMA (homovanillic acid and vanillylmandelic acid... catecholamine metabolites... sympathetic chain ganglion / adrenal medulla tumor)
92
CALLA and TDT are markers of
ALL
93
best test for ALL
bone marrow biopsy with ^30% lymphoblasts
94
treat ALL
chemo + intrathecal methotrexate for CNS
95
poor prognostic factors for ALL
v1yo or ^10yo lots of WBCs.. on bone marrow biopsy? ^30% lymphoblasts is diagnostic... a lot more than that means poor prognosis?
96
peds pt with large painless rubbery nodes, drenghing fevers, 10% weight loss, owl eyes on path top dx best test next step tx
Hodgkin lymphoma best test excisional biopsy next step staging CT tx resection chemo radiation
97
peds pt with non-productive cough and large anterior mediastinal mass on cxr top dx best test tx
non-hodkin lymphoma biopsy mass biopsy bone marrow for staging resect if abdominal anti-cd20 if bcell tumor radation for some

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