EOR Exam Flashcards
(231 cards)
1
Q
Male child presents with facial and lower extremity edema, abd pain and diarrhea. Urine shows 3-4 plus proteinuria. Creatinine wmnl.
A
Nephrotic syndrome
2
Q
What usually precedes nephrotic syndrome?
A
illness
- infections
- allergic reactions
3
Q
What is the treatment for nephrotic syndrome?
A
- corticosteroids
- diuretics (if generalized edema)
4
Q
What is the most common cause of nephrotic syndrome?
A
Minimal change disease
5
Q
How do you treat minimal change disease?
A
corticosteroids
6
Q
What is minimal change disease?
A
glomeruli appear normal, on biopsy
7
Q
When should you get a renal biopsy in a child with nephrotic syndrome?
A
- Under 1yo
- Proteinuria persists over 8weeks
8
Q
What is considered SECONDARY nephrotic syndrome?
A
- over 8yo
- HTN
- persisting hematuria
- renal dysfunction
- rash
- arthralgia
9
Q
What is congenital nephrotic syndrome?
A
- diagnosed w/n first 3 months of life
- In utero findings- proteinuria, large placenta, edema
10
Q
Child presents with fever, arthralgias, rash, rising Cr, fatigue and weight loss. NO hematuria/proteinuria and while cells and hylaline casts. He had strep throat 2 weeks ago and was prescribed PCN.
A
acute interstitial nephritis
11
Q
What usually precedes acute interstitial nephritis by 2 weeks?
A
- Medications (PCN, sulfa, glouroquinolones, NSAIDS, diuretics)
- Infections (strep, pyleo, HBV, EBV, HIV, adeno)
- sarcoid
- SLE
12
Q
How do you treat acute interstital nephritis?
A
-supportive
13
Q
8yo girl presents with SUDDEN onset hematuria, edema and HTN. She had strep throat 2 weeks ago.
A
Post-strep glomerulonephritis
14
Q
In post-strep glomerulonephritis, what lab is elevated after throat infection?
A
anti-streptolysin O titer
15
Q
In post-strep glomerulonephritis, what lab is elevated after skin infection?
A
Deoxyribonuclease B anti-strep
16
Q
How do you treat post-strep glomerulonephritis?
A
Tx aimed at controlling effects of renal failure and HTN (Na restriction, ACE, CCB, vasodilators)
17
Q
What type of glomerulonephritis is associated with deafness and vision problems?
A
alport syndrome
18
Q
What is the most common cause of acute renal failure in kids?
A
Hemolytic Uremic Syndrome
19
Q
What characterizes HUS?
A
- hemolytic anemia
- uremia (toxic levels of nitrogen in blood)
20
Q
What is seen on CBC with HUS?
A
- helmet cells
- burr cells
- decreased HgG (5-9)
- fragmented RBC
21
Q
How do you treat hemolytic uremic syndrome?
A
supportive (nutrition, fluids)
22
Q
When should routine BP screenings start in kids?
A
3yo
23
Q
Patient presents with HTN and recurrent UTIs
A
vesicourectal reflex
24
Q
What is vesicourectal reflex?
A
retrograde flow of urine from bladder to ureter and renal pelvis
-causes urine to back up leading to infection, inflammation, scarring
25
What is the leading cause of HTN in children?
vesicourectal reflex
26
When should toilet training begin?
2-3 yo
27
When should eneuresis stop?
5yo
28
When should pharm therapy for eneuresis begin to be considered?
7yo
29
What is pharm therapy for eneruresis?
desmopressin (synthetic ADH)
imipramine (TCA)
30
What is it called when the urethral opening is located on ventral surface of penis?
hypospadius
31
What do you want to avoid if a child has hypospadius?
circumcision!
32
What is phimosis?
inability to retract foreskin
33
What is treatment for phimosis?
topical steroid TID for 3 weeks
circumcision is definitive tx
34
What is paraphimosis?
foreskin retracted beyond gland penis, cannot be pulled forward again
(EMERGENCY!)
35
What is tx for paraphimosis?
lubrication to help push glans back through phomotic ring
36
What are risk factors for hip dysplasia? (4)
- first child
- girls
- breech position
- family hx
37
What is clinical presentation of hip dysplasia?
- asymmetry of skin folds
- loss of ABduction
- decreased leg length
- limp
38
What is Barlows test?
dislocation of hip
39
What is Ortolani test?
relocation of hip
40
What is galazzei test?
hold legs together and bent at 90degrees at the knee and look for knee height difference
41
How do you dx hip dysplasia?
xray (AP view of pelvis)
42
What should be done for female babies who were breech?
US at 6 weeks
43
How do you tx hip dysplasia?
- Braces/harness (Pavlik)-- best used under 6 months old, brace for 8-12 weeks (until stable)
- casting (for over 6 months old)-- spica cast x8-12 weeks
- surgical reduction is over 2yo
44
A 10yo thin, active boy presents unilateral pain and limping that is worse with activity. He has decreased ABduction and internal rotation. You get an xray and see hyperdensity w/n femoral head (cresent sign)
legg-calve perthes disease
45
What is legg-calve perthes disease?
Idiopathic osteonecrosis of femoral head
46
How do you treat legg-calve perth disease?
- observation (femoral head re-vascularizes usually)
- restrict vigorous activity
- NSAIDs, crutches
47
An obese 14yo boy presents with sudden a sudden onset of a limp and hip and knee pain
Slipped capital femoral epithysis (SCFE)
48
How do you dx slipped capital femoral epithysis?
xray (AP and frog lateral)-- fuzzy irregularities on physis, appears the epiphysis has slipped/rotated
49
How do you treat slipped capital femoral epiphysis?
surgery (WILL progress if left untreated)
50
3yo boy presents with acute onset limp and pain in groin/thigh and a swollen hip. He is AFEBRILE
transient synovitis of hip (toxic synovitis)
51
How do you treat transient synovitis?
rest, monitor temperature
fullr esolution in 3-14 days
52
8yo boy active boy presents with gradual onset of bilateral knee pain that is worse with jumping/running/kneeling
osgood-schlatter
53
What is Osgood Schlatter?
inflammation of tibial tubercle
54
Hhow do you treat osgood-schaltter?
- symptomatic (ice/heat, NSAIDs, active rest, knee pads)
| - reassurance (may take several months to heal)
55
What is a talipes equinovarus?
club foot
56
What are the components of a club foot?
- plantar flexion of ankle
- adduction of heel
- high arch
- adduction of forefoot
57
What is treatment for club foot?
IMMEDIATE casting (serial casting q1-2 weeks x2-4 months
58
What is the clinical definition of scoliosis?
lateral curvature of spine over 10 degrees
59
What are common etiologies of scoliosis?
- idiopatic
- congenital
- neuromuscular (CP, MD)
- vertebral dz (tumor, infection)
60
What are risks of progression of scoliosis?
- girl
- young age of onset
- initial curvature over 11 degrees
61
What is treatment for scoloiosis of 20-40 degrees?
brace (won't reverse)
62
What is treatment of over 50 degrees curvature?
surgical intervention (fusion, rodding)
63
5 week old baby presents with "cock robbin" position and decreased cervical motion
torticolis
64
What is torticolis?
unilateral contraction of sternocleidomastoid (SCM) muscle
65
What is treatment for torticolis?
- passive stretching (performed by parents)
- usually resolves in 1 year
- surgical release of SCM if lasts over 18 months
66
What are etiologies of torticolis?
- intrauterine positioning
| - stretch of musculature during delivery
67
3yo presents with arm held in extension at her side after being swung by her arms by her parents
Nursemaids elbow
68
How do you treat nursemaids elbow?
forcefully flex/supine arm
immobilization not necessary
69
What is a Salter-Harris fracture?
growth plate (physis) injury/fracture
70
Type 1 salter-harris fracture?
through physis
71
Type 2 salter harris-fracture?
through physis, into metaphysis
72
Type 3 salter-harris fracture?
physis into epiphysis
73
Type 6 salter-harris fracture?
compression/crush
74
What is the most common type of salter-harris fracture?
Type 2
75
What is tx of salter-harris fractures?
same as other fractures
76
What do you need to avoid with salter-harris fractures?
Must protect physis from early closure
77
Patient presents with short stature, blue scerla, decreased hearing, lax ligaments and poor dentition
osteogenesis imperfecta
78
What is posteogenesis imperfecta?
defect in Type 1 collagen
79
What do you see on xray with osteogenesis imperfecta?
osteopenia, bowed long bones
80
How do you treat osteogenesis imperfecta?
- symptomatic
- tx fractures routinely
- modify activity to lessen risk
81
1 yo presents with 88 O2 sat, a seal/bark cough and inspiratory stridor
Croup
82
What causes Croup?
parainfluenza
83
What is Croup?
parainfluenza causes subeglottic edema, airfow obstruction
84
How do you treat croup?
- single dose decadron
| - mod/severe: racemic epinephrine, oxygen, IV fluids
85
6yo presents with high fever, stridor, drooling, difficulty swallowing and is in tripod position
Epiglottitis
86
What is the pathogen behing epiglottitis?
H. influenza
87
How do you dx epiglotittis?
- DO NOT visualize airwau
| - xray (lateral soft tissue neck)
88
What do you expect to see on an xray of someone with epiglottitis?
thumb sign
89
How do you treat epiglottitis?
- IV abx (rocephin)
| - secure airway (may need to intubate)
90
When do you want to start ostelmavir (tamiflu)
w/n 48 hrs
91
6month old had URI recently and presents today with fever, poor feeding, "junky" sounding lungs, low O2sat and tachypnea
RSV (bronchiolitis)
92
What is the pathology behind RSV?
inflamed bronchial tubes from RSV virus cause air-trapping
93
How do you dx RSV?
- RSV nasal swab
| - hyperinflation on cxr
94
How to you tx RSV?
- supportive (self-limited)
| - close monitoring
95
When do you admit someone with RSV?
- premature
- under 6 months old
- chronic lung disease
- immunocompromised
96
What are the 3 stages of pertussis?
1. catarrhal stage
2. paroxsymal stage
3. convalescent stage
97
What is the most infectious stage of pertussis?
catarrhal stage
98
What is the catarrhal stage?
- first 1-2 weeks
| - URI sxs
99
What is the paroxsymal stage?
- 1-6 weeks
- post-tussive vomiting
- inspiratory whoop
100
What is the convalescent stage?
- recovery 2-3 weeks
| - cough lessens
101
How do you dx pertussis?
PCR nasal swab
102
How do you treat pertussis?
- macrolides (azithro, clarithro)
| - treat all family members!!!
103
What is the most common pneumonia pathogen in kid?
S. pneumoniae
104
What is first line abx for pneumonia in children?
Amoxicillin BID
105
What are second line abx for pna in children?
macrolides
106
What would make you think it was a viral pna?
- gradual UTI sxs
| - non-toxic appearing
107
- failure to pass meconium at birth
- recurrent resp. infections
- greasy, fowel-smwelling stools that float
- clubbing of fingers
Cystic Fibrosis
108
What is cystic fibrosis?
abnormality in CF transmembrane conductance regulator (cl channel found in cells lining lungs, intestines, sweat glands)
109
What organs are generally dysfunctioning with CF?
- pancreas (caloric malabsorption_
| - lungs (cycle of mucus retention, inflammation)
110
How do you dx cystic fibrosis?
- positive sweat test (over 60)
| - positive newborn screen (elevated IRT)
111
How do you tx CF?
- mucus thinners
- inhalers
- frequent abx
- supplemental enzymes
- airway clearance (oscillatory vest)
112
Patient presents with episodic dry cough, wheexing and resp. distress, especially when active
asthma
113
How do you dx asthma?
PFT
114
What PFT finding suggests asthma?
Decreased FEV1/FVC ratio with post-bronchial inprovment of at least 12-percent
115
What is the rescue inhaler in asthma?
B2-agonist (albuterol)
116
What is the maintenace inhaler for asthma?
inhaled steroids (fluticasone)
117
What would classify as an intermittent asthmatic?
- sxs less than 2 days/week
- no night awakenings
- normal FEV1 between exacerbations
118
What would classify as mild persistent asthma?
-Sxs more than 2 days/week
-1-2x/month night awakenings
-
119
What would classify moderate persistent asthma?
- daily use B2
| - 3-4/month night awakenings
120
What would classify as severe persistent asthma?
- sxs throughout day
- at least 1/week night awakening
- B2 several times/day
- FEV1 under 60 percent
- FEV1/FVC under 75 percent
121
What is SIDS?
Under 1 yo child dies during SLEEP
122
When does SIDS risk peak?
2-4 months old
123
What are risk factors for SIDS?
- cigarette smoking
- mather under 20yo
- premature, low birth weight
- prone sleep position
- soft bedding
- overheating
- bed sharing
- siblings of SID victims
124
What are ways of reducing risk of SIDS?
- room sharing
- breastfeeding
- use pacifier during sleep
- place infant on back to sleep
125
An infant is born at 35 weeks and a few hours after birth starts to become cyanotic and hypoxemic
hyaline membrane disease
126
What is hyaline membrane disease?
Deficiency in surfactant leads to atelectasis
| surfactant maintains alveoli stability and inflation
127
How do you treat hyaline membrane disease?
- corticosteroids-- induces formation of surfactact (give during labor 22-36 weeks)
- give surfactant
128
When should the first stool be passed by a newborn?
w/n 72 hrs
129
Whats the most common cause of diarrhea in children?
rotavirus
130
What are common causes of bloody diarrhea?
- salmonella
- hemolytic uremic syndrome (E. coli)
- intussecption
131
A newborn has not passed meconium in 72 hours and then has a squirt sign with DRE. Also it vomiting and has a fever.
Hirschsprungs Disease
132
What is hirschsprungs disease?
congenital absence of ganglion cells in distal rectum and colon-- leads to obstruction
133
How do you dx Hirschsprung disease?
rectal biopsy
134
How do you tx Hirschsprung disease?
surgery-- resect affected bowel segment, bring normal ganglionic bowel down close to anus and preserve sphincter function
135
What does the rule of 2s apply to?
Meckels diverticulum
136
What is Meckels diverticulum?
Incomplete obliteration of vitelline duct-- leading to true diverticulum of small intestine
137
What is the rule of 2s?
- 2 percent of population
- male (2) : female (1)
- w/n 2 feet of illocecal valve
- 2in long
- present before age 2
138
How do you dx Meckels diverticulum?
- Meckels scan (nuclear medicine)
- mesenteric arteriography
- abd exploration
139
How do you treat Meckels diverticulum?
resection (not elective if found incidentally)
140
3yo presents with sudden onset of intermittient severe abd pain. Patient is draawing legs/knees towards abdomen. On PE you feel a sausage-shaped abd mass.
Intussesception
141
What other PE finding do you expect with intussesception?
currant jelly stools
142
What is intussesception?
Invagination of part of intestine into itself. Causes bowel obstruction and ischemia
143
How do you dx intusseception?
US
144
What do you expect to see on US with intussception?
target sign/bulls eye
145
How do you treat intusseception?
- barium air-enema (dx and tx)
| - surgery for unstable patient or perforation
146
13yo presents with diarrhea, steatorrhea, and weight loss
celiac disease
147
How do you dx celiac disease?
serum celiac-antigen testing
--if positive-- endoscopy for duodenal biopsy
148
How do you dx lactose intolerance?
- lactose breath hydrogen test
| - lactose absorption test
149
Patient presents with ongoing joint pain and uveitis?
Juvenile rheumatoid arthritis
150
Patient presents with arthralgia od wrists/knees/ankles for over 6 weeks and quotidian fever for 2 weeks, and a macular salmon-pink rash associated with fever/heat on axillaw and wrists
Systemic arthritis (stills disease)
151
Patient presents with palpable purpura from waist down, edema, arthritis, abd pain/craming
henoch sholia purpura
152
How do you dx Henoch Sholia Purpura?
Need 2 of 4:
- purpura
- bowel angina
- biopsy
- peds group
(platelets wnl-- non-thrombocytpenic purpura)
153
How do you dx SLE?
need 4 of 11 criteria
154
What are the 11 possible criteria of SLE?
- malar rash (butterfly rash)
- photosensitivity
- discoid rash
- renal signs (esp. peds population-- hematuria, proteinuria, nephrotic syndrome, acute renal failure)
- raynauds
- mucosal sores
- arthritis
- neuro d/o (seizures)
155
How do you monitor SLE treatment?
complement (C3, C4)
156
newborn has loud harsh holosystolic murmur along LSB
Ventricular septal defect
157
Are most ventricular septal defects small or large?
small
158
How do you treat a small ventricular septal defect?
close f/u, periodic echo-- most will close on own by 18 months- 10yrs
159
How do you treat a large ventral septal defect?
surgery (treat HF first)
160
a 21yo presents with fatigue, dyspnea and decreased stamina. On PE there is a lift, S1 is accentuated and S2 is widely splitthrough inspiration/expiration. A midsystolic cresendo-decresendo murmur is heard
atrial septal defect
161
How do you treat atrial septal defect?
sxs present- surgery/catheter
no sxs- surgery if pHTN present
162
Patient has systolic thrill and suprasternal notch and prominent RV impulse and upper LSB. There is an early systolic CLICK and a loud harsh cresendo-decreasendo murmur that radiates to the clavicles
pulmonic stenosis
163
How do you tx pulmonic stenosis?
balloon valvuloplasty
164
a pre-term infant who's mother was exposed to rubella has a systolic thrill and a continuous machinery murmur
patent ductus arteriosus (PDA)
165
When does the PDA normally close?
w/n 2-3 days after birth
166
How do you treat pre-term infants with patent ductus arteriousus?
indomethacin (constriction of ductus)
surgery id ductus remains open
167
Patient presents with differential BP between arms and legs over 10mmHg systolic
coarction of aorta
168
What does coarction do?
causes obstruction to outflow to lower half of body (starts just below subclavian artery)
169
What xray finding do you fin d with aortic coarction?
rib notchin due to prominent collateral circulation to lower body via internal mammary and subcostal arteries
170
Patient presents with strawberry tongye, rash on inguinal area and chest, conjunctivitis, high fever, dry/cracked mucosa
Kawasaki diease
171
What is the major danger of kawasaki disease?
aneurysm formation in small-medium arteries
172
How do you dx kawasaki disease?
Need 4/5:
- conjunctivitis
- mucous membranes (cracked lips, strawberry tongue)
- swollen extremities
- rash
- adenopathy
173
What is crucial to get in someone with kawasaki disease?
ECHO to check for aneurysms
174
What do you want to get after cute phase has passes?
angiography
175
How do you tx kawasaki disease?
IV Ig
ASA during acute phase
176
What is first line treatment for acute seizure?
BENZOS
177
a 4 month old has a generalized seizure that lasts under 5 mins and does not have a CNS infection
febrile seizure
178
How do you treat febrile seuzre?
reassurance!
179
What is status epilepticus?
seizure lasting over 15mins or series of seizures w/o complete recovery for over 30 min
180
What are etiologies of cerebral palsy?
- premature birth (MOST COMMON)
- IUGR
- perinatal hypoxia
- intrauterine infection
- antepartum hemorrhage
181
What is clinical definition of microcephaly?
2 SD below mean
182
What is clinical definition of macrocephaly?
2 SD above mean
183
What are s/s of macrocephaly?
transillumination of skull
184
How often do you have to measure a newborns head circumference?
At every visit for first 36 months
185
When should the posterior fontanelle close?
2 months
186
When does the anterior fontanelle close?
10-24 months
187
What are common causes of premature closure of fontanelles?
- microcephaly
- cranciosyntysis (ridging of suture lines)
- hyperthyroidism
188
What are common causes of DELAYED closure of anterior fontanelle?
- HYPOthyroidism
- incraesed intracrancial pressure
- down syndrome
- Ricketts
189
What are risk factors for strabismus?
- family hx
- decreased birth weight
- prematurity
190
How do you confirm strabismus?
- corneal light reflex
| - cover/uncover test
191
What is red reflex sign of strabismus?
red reflex MORE INTENSE in deviated eye
192
What is the most common cause of colds?
rhinovirus
193
What are common pathogens of otitis media? (3)
- S. pneumoniae
- H. influenza
- M. catarrhalis
194
What are risk factors for otitis media?
- family hx
- daycare
- lack of breast-feeding
- tobacco exposure
195
Who needs OM treated?
- under 2yo
| - bilteral disease or otorrhea
196
What is first line treatment for AOM?
HD amoxicillin (x10days under 5yo, 5-7 days for 0ver 6yo)
197
What is second line for AOM?
amox/clav acid
198
Who should get treatment with amox/clav for AOM?
- patients treated w/abx in last month
- pts w/otitis/conjunctivitis
- pts on daily amox for chemoprophylaxis
199
How do you treat OM w/effusion?
NOT WITH ABX
self limited
200
How do you treat sinusitis?
amox-clav
201
Patient presents with fever, oral vesicles and tender lesions on hands, feet and butt
hand, foot and mouth disease
202
What is pathogen behind hand, foot and mouth disease?
Group A Coxsackie Virus
203
1 yo patient presents with high fever (over 104) and a diffuse maculopapular rash as fever ends. LAD and nagasma spots (uvulopataloglossal macules/ulcers)
roseola
204
How do you treat roseola?
supportive
205
What is pathogen of roseola?
Herpesvirus 6
206
8yo presents with "slapped cheek" rash, low-grade fever, and HA
Fifths disease
207
What is pathogen behind fifths disease?
Parvovirus B19
208
What is first line treatment of GAS pharyngitis?
Penicillin V TID x10days
Amoxicillin BID/TID x10days
209
Why do you want to make sure to treat pharyngitis?
tx decreases risk of peritonsillar abcesses, mastoiditis, rheumatic fever
210
11yo who had pharyngitis 3 weeks ago presents with migratory arthritis, pancreatitis, subcuntaneous nodules, fever and prolonged PR interval
rheumatic fever
211
Patient presents with "hot potato" voice, drooling, trismus (tetanus) fatigue
peritonsillar abscess
212
How do you treat peritonsillar abscess?
- drainage
| - abx-- amox-clav
213
16yo presents with exudative tonsils, pharyngitis, jaundice, fever, HA, malaise?
EBV
214
What lymph nodes would you expect to be swollen with EBV?
posterior cervical adenopathy
215
What are risks with EBV?
- splenic rupture
- airway obstruction (tx with steroids)
- rash following admin of ampicillin
216
When is the peak incidence of bacterial meningitis?
under 2 months old
217
What is the most common pathogens of bacterial meningitis for 1-3 month olds?
GBS, gram neg bacilli (e. coli)
218
What is the most common pathogens of bacterial meningitis of 3-10yo?
S. pneumoniae, N. meningitis
219
Patient presents with fever, conjunctivitis, coryza (stuffy nose), and maculopapular rash beginning on face and spreading to body (sparing palms and soles)?
measles
220
What is so dangerous about mealses?
highly contagious (5 days prior and 4 days after rash)
221
How are measles spread?
spread via droplets (person to person contact not necessary)
222
What are immediate complications of mealses?
- death (resp. complications)
- pulm complications (pneumonia, bronchitis)
- encephalitis
- acute disseminated encephalomyelitis (2 weeks after rash)
- keratitis (common cause of blindness)
223
How do you treat measles?
- post-exposure vaccine w/n 72 hrs
| - after 72 hrs-- IM ig
224
Patient presents with low-grade fever, fatigue, parotitis, weythema and nelargement of stenses duct
mumps
225
What are complications of mumps?
- orchitis (testicular pain, scrotal swelling)
- deafness
- Guillance barre
- myocarditis (dilated cardiomyopathy)
226
How do you treat mumps?
supportive
227
When is varicella most infectious?
2 days prior to rash
228
What are complications of varicella?
- soft tissue infection with GAS
- encephalitis
- acute cerebellar ataxia
- reye syndrome
- pneumonia
- hepatitis
229
Patient presents with maculopapular rash on face and spreads to trunks/extermities w/n 24 hrs, low-grade fever, LAD, forcheimer spots (exanthema of soft palate), and arthritis
Rubella (German measles)
230
What are complications of congenital rubella syndrome?
- blueberry muffin lesions
- hearing loss
- cataracts
- cardiac defects (PDA, VSD)
- IUGR
- hemolytic anemia
- growth deficiency
231
What is congenital adrenal hyperplasia?
- autosomal recessive d/o
- deficiency of enzyme that produces cortisol/aldosterone
- Increased ACTH because no negative feedback w/lack of cortisol/aldosterone causes hyper-production of estradiol/testosterone
