Falcon Review Pediatrics 3 Flashcards Preview

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Flashcards in Falcon Review Pediatrics 3 Deck (242):
1

A patient presents with a history of sweating while feeding, what pathology does this suggest

Suggestive of cardiac disease

2

What physical exam findings are suggestive of cardiac disease pediatrics

Poor growth or failure to thrive
Abnormal heart rate blood pressure
Crackles suggest of left-sided failure
Hepatomegaly suggestive of right-sided failure
Cyanosis or clubbing
Murmur

3

What is the best diagnostic test for pediatric cardiovascular disorders

Echocardiography

Other studies are helpful such as chest x-ray EKG MRI and cardiac catheterization

4

Generally speaking define innocent murmurs

Usually soft
Never just diastolic
Never associated with a thrill or a click

Do not require additional work up

5

Name the four major types of innocent murmurs

Stills
Pulmonary flow murmur
Pulmonary ejection murmur
Venus hum

6

Describe a stills murmur

3 to 6 years old
Soft vibratory or musical systolic ejection murmur heard at left lower to mid sternal border

7

Describe a pulmonary flow murmur

0 - 6 months of age
High-pitched blowing systolic murmur at upper left sternal border due to turbulent flow at the origin of the right and left pulmonary arteries
Transmits to back and axilla

8

Define pulmonary ejection murmur

Similar to pulmonary flow murmur
8 to 14 years of age
Blowing early systolic murmur at upper left sternal border due to increased flow over the pulmonary valve

9

Define a Venus hum

Not a true murmur
3 to 6 years of age
Continuous (starts in systole and spills into diastole) murmur
Heard in supraclavicular or infraclavicular areas, disappears with compression of jugular vein Institute and supine position

10

What other concerns should you have for a patient with a congenital heart disease

30% of patients will have other anatomic abnormalities

11

What are the common causes of cyanosis

Cardiac
Pulmonary
Hematologic
Neurologic

12

What is the best test isolates the cause of cyanosis

Hyperoxia test

13

What are the expected results for cardiac disease causing cyanosis on the hyperoxia test

Before oxygenation less than 40 PaO2
after oxygenation less than 50 PaO2.

With complete mixing before you have 50 PaO2 after oxygenation you'll have less than 150 PaO2

14

What valves open with systole

Aortic and pulmonic

15

What valves close with systole

Tricuspid and mitral

16

What is the most common congenital heart malformation

VSD
Ventricular septal defect

17

Will a large or small ventricular septal defect have a soft murmur

large

18

What are the symptoms of a large ventricular septal defect

Congestive heart failure
Active precordium
Hepatomegaly
Crackles
BVH or LVH

19

What is Eisenmenger's physiology

Initially there is a left to right shunt
Then right ventricular hypertrophy and increased pulmonary vascular resistance
Then a right to left shunt develops
Blood is bypassing lungs and leads to cyanosis

20

What murmur is highly suggestive of a the ventricular septal defect

Holosystolic murmur (Harsh or soft) at lower left sternal border

21

What is the prognosis of a ventricular septal defect

30 to 50% of cases will close spontaneously by two years
Surgical closure for failure to close and large defects

22

What is the normal cardiac to rib cage ratio

Less than 0.5

23

When does pulmonary vascular resistance reached its nadir in pediatrics

Eight weeks
You will begin to get an increase in left to right shunting

24

What is the most common type of ASD

Ostium secundum type

25

Most patients with ASD or asymptomatic until when

Third decade of life

26

What murmur is suggestive of an atrial septal defect

Systolic ejection murmur and left mid and upper sternal border,

Wide fixed split S2 due to an increased blood in the right atrium and ventricle being pushed through the pulmonic valve

27

Discuss normal physiology of a split S2

With inspiration the pulmonic valve closes a little later

28

What many seen on X-ray with an atrial septal defect

An enlarged right atrium in ventricle

29

What is the biggest risk factor for endocardial cushion defect

Trisomy 21

30

What murmur is associated with endocardial cushion defect

Holosystolic murmur heard at apex (AV valve insufficiency)

31

What is a PDA

Patent ductus arteriosus
Failure of closure of ductus resulting in blood flow from aorta to pulmonary artery
Common in prematurity

32

What symptoms are associated with a large PDA

Pulmonary overload
Wide pulse pressure
Bounding arterial pulses

33

In infants what may be used to help close the PDA

Indomethacin
prostaglandin inhibitor

34

What cardiac malformation is highly associated with Turner's syndrome

Coarctation of the aorta

35

What murmur is associated with coarctation of aorta

Short systolic murmur at the left upper sternal border with radiation to left back

36

What chest x-ray findings are associated with coarctation of the aorta

Marked cardiac enlargement
Increased pulmonary vascular markings
Rib notching (from enlarged collaterals)

37

What congenital malformations are associated with cyanotic heart disease

The five T's

Truncus arteriosus
Transposition of the great arteries
Tricuspid atresia
Tetrology of Fallot
Total anomalous pulmonary venous return

Pulmonary atresia
Large VSD

The last two or associated with cyanotic heart disease after Eisenmenger's physiology

38

What's the most common cause of congenital cyanotic heart disease

Tetralogy of Fallot

39

What are the findings associated with tetralogy of Fallot

Ventricular septal defect
Pulmonary stenosis
Hypertrophy of right ventricle
Overriding aorta

40

What determines the cyanotic yet spells associated with Tetralogy of Fallot

Ventricular pressure determines the direction of bloodflow

Acyanotic tetralogy is associated with sufficient pulmonary bloodflow shunting across the VSD is balanced

Paroxysmal cyanosis tet spells occur when systemic resistance drops or pulmonary resistance increases

41

What will reverse the paroxysmal cyanosis associated with pathology of Fallot

Increasing the left side pressures will reverse the right to left shunt such as bringing the knees to the chest or squatting

42

What are the murmurs associated with tetralogy of Fallot

VSD over the lower left sternal border
Pulmonic Stenosis

43

What chest x-ray finding do you expect to have with tetralogy of fallot

Boot shaped heart

44

What is the transposition of great vessels

Aorta arises from right ventricle, pulmonary artery arises from left ventricle resulting in a parallel circulation
Must be some communication atrial, septal or ductal levels to be compatible with wife

45

What is the most common cause of extreme cyanosis within the first 24 hours of life

Transposition of the great vessels

46

Will the cyanosis correct with oxygenation for a transposition of the great vessels

No

47

What is the treatment for transposition of the great vessels

Prostaglandin to maintain ductus open is life-saving used PGE
Surgical correction is definitive

48

What do you expect to find with pulmonary atresia on EKG

Tall spiked P waves suggestive of right atrial enlargement, right ventricular hypertrophy

49

What is the treatment for pulmonary atresia

Maintain ductus open until surgery

50

What murmur is associated with pulmonary stenosis

Harsh systolic ejection murmur with ejection click at left upper sternal border

51

What findings suggestive of tricuspid atresia

Cyanosis at birth
Systolic murmur along left sternal border
Single S2
Left axis deviation in the infant

52

What findings on X-ray are suggestive of a total anomalous pulmonary venous return

The snowman or figure 8 with cardiomegaly

53

What murmur is associated with total anomalous pulmonary venous return

Systolic murmur at left upper sternal border
S2 fixed and widely split

54

Increase flow over the pulmonic valve will cause what heart sound

Split S2

55

What is truncus arteriosus

Single vessel arises from the ventricles supplying systemic/pulmonary/coronary circulation

56

What the complications of a hypoplastic left heart

Inadequate systemic circulation and pulmonary venous hypertension
Small aorta

57

What is the most common cause of myocarditis

Viral etiology is most common enterovirus (coxsackie) virus and adenovirus

58

What are the causes of a dilated cardiomyopathy in infants

Often idiopathic
Maybe associated with neuromuscular disease, drug toxicity, and chemotherapy (including doxorubicin)

59

What is the diagnostic study for cardiomyopathies

Echocardiogram

60

What causes acute rheumatic fever

GABHS
1 to 3 weeks after preceding streptococcal infection is commonly in 5 to 15-year-olds

61

What is required to diagnose acute rheumatic fever

The Jones criteria
- Must have two major criteria or one major and two minor criteria plus evidence of preceding strep infection

62

What are the Major Jones criteria

Carditis
Arthritis
Erythema marginatum
Chorea
Subcutaneous nodules

63

What are the minor Jones criteria

Fever
arthralgia
elevated acute phase reactants
Prolonged ER
Previous rheumatic fever

64

What is the treatment for acute rheumatic fever

Treat streptococcal infection and monthly penicillin prophylaxis
Salicylates to decrease myocardial inflammation
Steroids for carditis

65

What is a complication of acute rheumatic fever

Valvular heart disease

66

What are the most common organisms that cause endocarditis

Staff aureus
Streptococcus Viridans

67

What are the signs and symptoms of endocarditis

Acute or insidious onset
Persistent fever, chills, arthralgias, new murmur, petechiae
Oslers nodes (painful)
Janeway lesions (painless) splinter hemorrhages

68

How is endocarditis diagnosed

Echocardiogram

69

What preventative measures must be taking with endocarditis

Prophylactic antibiotics prior to dental visits

70

How is hypertension diagnosed in pediatrics

What pressure above 95% for age 3 review measurements

71

What is the most common cause for pediatric hypertension

Most commonly secondary
Renal is 75 to 80%

72

What are the risk factors for pediatric arrhythmias

Congenital, acquired or functional heart disease
Electrolyte abnormalities
Drug toxicity
Poisoning
Collagen vascular disease

73

What are some causes of sinus bradycardia pediatrics

Increased vagal tone
hypothyroidism
increased intracranial pressure
anorexia nervosa

Most commonly a normal finding in healthy athletic children

74

What is the difference between a Mobitz type I and a Mobitz type II heart Block

Type one will have a prolongation of PR then a drop a QRS
Type II will just drop the QRS

75

What maternal diseases associated with a third degree heart block in infancy

Maternal lupus

76

What are the causes of sinus tachycardia

Hypovolemia
Shock
Anemia
Fever
Sepsis
Pulmonary embolism
Medications

77

What do you expect to see on an EKG for supraventricular tachycardia

A runn of three or more premature supraventricular beats a greater than 230 beats permitted
Abnormal or absent P waves

Key association with WPW syndrome

78

What is WPW syndrome

Anomalous conduction pathway to ventricles bypassing the AV node which leads to premature and prolonged depolarization of ventricles
Predisposes to SVT

On the EKG: shortened PR, Delta wave, wide QRS

79

What is the treatment for long QT syndrome

Beta blocker

80

What is apnea of prematurity

Premature infants less than 36 weeks of gestation holding their breath for periods of less than 15 seconds

81

What is the treatment of apnea prematurity

Theophylline/caffeine as central stimulant

82

What is the obstructive sleep apnea

Prolonged partial airway obstruction intermittent cessation of breathing disrupting sleep and breathing

83

What are the pediatric risk factors for obstructive sleep apnea

Adenotonsillar hypertrophy
trisomy 21
Anatomical abnormalities

84

What is used to diagnose obstructive sleep apnea

Polysomnography

85

What are the complications of obstructive sleep apnea

Cor pulmonale
Poor growth
Poor school performance

86

What is cyanotic breath holding

Breath holding spells between the ages of one and three years old usually associated with temper tantrums or angry outbursts

It's self-limited and very benign

87

What is Pallad Breath holding

Associated with fright
Patient becomes pale and hold breath
loses consciousness

88

What is the most commonly aspirated food

Peanuts
Popcorn, grapes, hot dogs are also common

89

What are the signs and symptoms of a foreign body aspiration

Cough, Strider, shortness of breath, cyanosis
Localized wheezing or new onset wheezing

90

How will a chest x-ray demonstrate foreign body aspiration

With an expiratory expiratory film. The effected side is the same appearance for both inspiration and expiration

Ball valve mechanism

91

What is the treatment for foreign body aspiration

Bronchoscopy

92

What is the pneumothorax

Intrapleural accumulation of air, maybe spontaneous or traumatic

93

What are the causes of the pneumothorax

CF, congenital lobar emphysema, asthma, pertussis,
Due to excessive cough

94

What is croup

Laryngotracheobronchitis

95

What are the most common causes of croup

Parainfluenza is the most common
Adenovirus, RSV, influenza

Most common three months to five years of age

96

What is the expected x-ray finding for croup

Staple sign
Suggestive of subglottic swelling

97

What is the treatment for croup

Humidified air in mild cases such as the steam from a shower
For ill children you can use corticosteroids

98

What is spasmodic croup

episodic and recurrent stridor associated with croup without the associated viral symptoms

99

What is the most common cause of bacterial tracheitis

Staph aureus

100

What are the signs and symptoms of bacterial tracheitis

Strider, respiratory distress, toxic appearance, "Brassy" cough, purulent airway secretions

101

What is epiglottitis

Acute inflammation of the epiglottis

Most commonly H influenza type B, can be strep pneumo-, nontypeable H. influenzae

Most common 2 to 7 years of age

102

What are the signs and symptoms of epiglottitis

Sudden onset of high fever, dysphasia, drooling, muffled voice, respiratory distress, tripod position, neck hyperextension

103

What is the main concerns with epiglottitis

The number one priority is securing the airway

TONGUE BLADE EXAM SHOULD NOT BE DONE OR ANY AGITATION PROCEDURE

104

What is bronchiolitis

Lower respiratory tract infection caused by inflammatory obstruction of the small airways
Usually less than two years of age
RSV is most common

105

What are the signs and symptoms of bronchiolitis

URI, rhinorrhea, fever, may progress to respiratory distress and poor feeding

Tachypnea, wheezing, crackles, retraction, cyanosis

106

What is pneumonia

Inflammation of pulmonary tissue associated with consolidation of alveolar spaces
Most commonly viral

107

What are the signs and symptoms of pneumonia

Fever
Tachypnea
Cough

108

What are the likely causes of pneumonia in neonates

Gram-negative rods
E. coli
Lysterria
Enterococcus
Klebsiella

109

What are the most likely causes of pneumonia in preschool age children

Strep pneumonia
Staph aureus
Viral is the most common

110

What is the most likely causes of pneumonia and school-age and up

Mycoplasma/chlamydia
Strep pneumonia
Staph aureus
Viral most common

111

What will viral pneumonia show on a chest x-ray

Streaky infiltrates, peribronchial coughing
No consolidation

112

What will a bacterial pneumonia show on a chest x-ray

Lobar consolidation

113

What is the treatment for mycoplasma pneumonia

Macrolides or quinolones
Most commonly azithromycin

114

Who is most likely to get chlamydia trachomatis pneumonia

Six weeks to six month olds

115

What type of cough is associated with chlamydia trachomatis pneumonia

Staccato cough

116

What is the treatment for chlamydia trachomatis pneumonia

Erythromycin

117

What is the treatment needed for aspiration pneumonia

Anaerobic coverage such as clindamycin in addition to usual bacterial coverage

118

What is asthma

Reversible obstructive airway disease affecting small and large airways

119

What are the components of asthma such as clinical findings

Bronchospasm
Mucus production
Airway inflammation

120

What are the triggers to asthma

Infection
Exercise
Cold
Allergens
Smoke

121

What can be used for serious acute exacerbations of asthma

Magnesium sulfate
Terbutaline confusion

122

What is mild intermittent asthma

Daytime symptoms less than two times per week
Nocturnal symptoms less than two times per month

123

What is mild persistent asthma

Daytime symptoms greater than two times per week but less than one times per day

Nocturnal symptoms greater than two times per month

124

What is moderate persistent asthma

Daily symptoms
Nocturnal symptoms greater than one time per week

125

What is the severe persistent asthma

Continuous symptoms
Frequent nocturnal symptoms

126

What is the treatment for mild intermittent asthma

No daily medication
Short acting bronchodilator as needed

127

What is the treatment for mild persistent asthma

One daily medication- low dose inhaled corticosteroid
Short acting bronchodilator as needed

128

What is the treatment for moderate persistent asthma

One daily medication-medium acting inhaled corticosteroid and a long acting bronchodilator
Short acting bronchodilator as needed

129

What is the mutation associated with cystic fibrosis

Deletion
Most common mutations Delta 508

130

What is the major problem associated with cystic fibrosis

Abnormality of the chloride transport
Thick mucus and impaired pancreatic secretions

Average age is 30 years

131

What are the signs and symptoms of cystic fibrosis

Meconium illeus, rectal prolapse, failure to pass meconium in first 24 hours
Recurrent respiratory infections
Stearrhea
Vitamin deficiency A,D,E and K
Nasal polyps
Diabetes mellitus
Delayed sexual development

132

What is the gold standard to diagnose cystic fibrosis

Sweat chloride test

133

What is the treatment for cystic fibrosis

1. clear secretions
- VEST, Chest PT, inhalation therapy, DNAse

2. nutrition therapy
- Pancreatic enzyme replacement, Vitamins

3.treat infection aggressively

134

What is a duodenal atresia

Obstruction resulting from failure to re-canalize the duodenal lumen

135

What are the risk factors for duodenal atresia

Trisomy 21

136

What are the signs and symptoms of duodenal atresia

Bilious vomiting, often on the first day of life
Usually no abdominal distention

137

What's will an x-ray show for a duodenal atresia

Double bubble

First bubble is air in the stomach
Second bubble is air in proximal duodenum
No air in the rest of the intestines

138

What is Hirschsprung's disease

Absence of ganglion cells of bowel wall

139

What are signs and symptoms of Hirschsprung disease

Failure to pass meconium in 24 hours
Obstruction leads to bowel dilation

140

What is the treatment for Hirschsprung disease

Surgical resection

141

What is meconium ileus

Abnormally thick meconium can cause in utero or neonatal blockage
Volvulus and bowel infarction can occur

142

What is the risk factors for meconium ileus

Cystic fibrosis
90% of patients with meconium ileum have cystic fibrosis

143

What is appendicitis

Blockage of appendiceal lumen
Most commonly caused by lymphoid hyperplasia, feoclith

144

What are the causes of gastroesophageal reflux

Inappropriate LES relaxation, hiatal hernia, delayed gastric emptying

Common in all

145

When is gastroesophageal reflux considered pathological

Infants not gaining weight
Pain and discomfort
Aspiration

146

What are the signs and symptoms of gastroesophageal reflux

Vomiting, chronic cough, wheezing, apnea, failure to thrive, substernal chest pain

147

What is the treatment for gastroesophageal reflux

Head elevation
Thickening of seeds (rice, bananas)

Medical managements: H2-blockers, proton pump inhibitors, prokinetic's

Surgical correction: Nissen fundoplication

148

What are the risk factors for pyloric stenosis

Firstborn males

149

What are the signs and symptoms of pyloric stenosis

Nonbileus projectile vomiting usually beginning of 3 to 4 weeks of age

Happy vomiter

150

What happens with excessive vomiting

Hypokalemic, hypochloremic, metabolic alkalosis

With vomiting you lose hydrogen which leads to alkalosis. Also vomiting chloride which leads to hypochloremia.
Because you are alkolotic, your kidneys begin excreting potassium instead of hydrogen to maintain the hydrogen which leads to hypokalemia

151

What will ultrasound demonstrates for pyloric stenosis

Thickened elongated pylorus

152

What is the treatment for pyloric stenosis

REHYDRATION AND ELECTROLYTE CORRECTION FIRST

Then surgical correction

153

What is colic

Rules of three

1. Usually seen three weeks to three months of age
2. Crying for greater than three hours per day
3. More than three times per week for no other reason

154

What are the signs and symptoms of small bowel instruction

Bilious vomiting

155

What are the two classifications of diarrhea

Infectious
Malabsorptive

156

One of the two mechanisms of diarrhea

Osmotic
- stool volume depends on diet and decreases with fasting

Secretary
- Stool volume is increased and does not increase with diet

157

What is the most common cause of infectious diarrhea

Viral is most common: rotavirus

Bacterial
Parasitic

158

What are the features of rotavirus

Watery diarrhea for 7 to 10 days
Maybe associated with vomiting

159

What is associated with enteropathogenic E. coli

Nurseries and daycare

160

What are the features of enterotoxigenic E. coli

hemorrhagic colitis
Associated with hemolytic uremic syndrome

161

What are the features of Yersinia associated diarrhea

Transmitted by pest, contaminated food
Maybe associated with arthritis and rash
Often confused with IBD
Pseudo-appendicitis

162

What is the onset of time for staph aureus toxin mediated associated diarrhea

Within 12 hours of ingestion
Other food toxins will take closer to 24 hours before symptoms manifest

163

What is the treatment for diarrhea

Ensure adequate hydration

164

What is the most common cause of constipation

Functional (voluntary withholding)

Other causes include: meconium ileus (CF) Hirschsprung disease, botulism, hypothyroidism

165

What is encopresis

Fecal incontinence after age 4 years

166

What are the signs and symptoms of encopresis

Leakage of loose stool around obstruction

167

What is hematemesis

Blood stained vomitus
Usually indicates bleeding proximal to the ligament of Treitz
(Dividing line between duoden and jejunum)

168

What is allergic proctocolitis

Streaks of blood in stool
Typically not ill appearing with history of milk use or exposure

Hematochezia in infancy one day to three months of age is typical

169

What is the treatment for allergic proctocolitis

Partially hydrolyzed formula
Hypoallergenic formula

170

What is Meckel's diverticulum

Known as the happy bleeder
Most common congenital G.I. anomaly

Vestigial remnant of the omphalomesenteric

Disease of 2's
2% infants, two years, 2 cm, 2 feet from ileocecal valve

171

What are the signs and symptoms of Meckel's diverticulum

Painless rectal bleeding

172

What will hard stools induce

Anal fissures

173

What is an intussusception

Portion of G.I. tract telescopes into portion Distal to it; most are ileocolic

6-24 months

Associated with lympoid hyperplasia (peyer's patches), Meckel diverticulum

174

What are the signs and symptoms of intussusception

Acute onset of cramping intermittent pain, lethargic, currant jelly stool, soft sausage shaped mass on rectal exam

175

What is both diagnostic and therapeutic for intussusception

Barium enema

Surgical intervention needed if failed reduction with enema twice

176

What are the signs and symptoms of Crohn's

Weight loss
Fever
Abdominal pain
Growth failure
Diarrhea
Perianal disease or mouth ulcers

177

What does a colonoscopy and biopsy demonstrate for Crohn's disease

Skip lesions
Transmural inflammation
Noncaseating granuloma's

178

What is the treatment for Crohn's disease

Steroids
Immunosuppression

179

What are the signs and symptoms of ulcerative colitis

Involves only the colon
Bloody diarrhea with mucus
Abdominal pain symptoms

must be present for at least 3 to 4 weeks to make a diagnosis of exclusion

180

What is the complication of ulcerative colitis

colon cancer

181

How is a obesity determined in pediatrics

BMI greater than 95% for age/sex
BMI greater than 30 in adolescence

182

What are signs and symptoms of obesity in pediatrics

Striate
Pseudogynecomastia
Early puberty

183

What are the causes of obesity in pediatrics

Endocrine (cushion, hypothyroidism, Prader-Willi)

Genetic (turner)

Most commonly lifestyle

184

What is celiac disease

Gluten sensitive enteropathy
Develop when gluten containing foods (wheat, rye, barley) introduced 6 to 12 months, depending on preference leading to failure to thrive

185

What is the pathophysiology of celiac disease

Intraepithelial lymphocytes in villi causing villous blunting

Associated with dermatitis herpetiformis

186

What is the dermatitis herpetiformis

Erythematous vesicles distributed symmetrically over elbows and knees

187

What are the rest factors for celiac disease

Down syndrome
Type I diabetes mellitus
Autoimmune disease

188

What testing is available for celiac disease

Tissue transglutiminase
Anti-enodmysial antibody

Must obtain an IgA level at the same time to prevent a false negative

189

What's will biopsy demonstrate for celiac disease

Villus blunting and second biopsy following gluten-free diet with normalization of architecture

190

What is failure to thrive

Failure to gain weight or deceleration of weight growth
Less than 10 percentile
Crosses two or more percentile marks for growth curve

191

What are the causes for failure to thrive

Nonorganic (deprivation, neglect, abuse) is the most common cause

Malnutrition
Mal absorption
Allergies
Immune deficiency states
Chronic disease

192

What is the first thing to notice with caloric deprivation failure to thrive

Weight

193

What is affected more for failure to thrive due to hyporthyroidism and growth hormone deficiency

Height

194

What is constitutional growth delay

The child will follow the growth curves and will ultimately reach adulthood with a delayed growth spurt

195

What is familial short stature

Adult height will be below the growth curve

Normal curve throughout, just below the normal percentages

196

How do you tell the difference between a constitutional growth delay and familial short stature

By using a bone age
-If bone age is less than chronological age then the diagnosis constitutional growth delay
-If bone age equals chronological age, then diagnosis is from familial short stature

197

What is the symptoms of vitamin A deficiency

Ocular lesions (xerosis)
Night blindness
Dry skin

198

What are the symptoms of a thiamine (B1) sufficiency

Beriberi neuritis
Heart failure
Encephalopathy

199

What are the symptoms of the niacin deficiency

Pellagra

Diarrhea
Dermatitis,
Dementia

200

The symptoms of a pyridoxine (B6) deficiency

Seizures
Neuritis
Dermatitis
Anemia

201

What are the symptoms of a vitamin C deficiency

Scurvy
Pseudoparalysis
Mucous membrane hemorrhages

202

What are the symptoms of vitamin D deficiency

Rickets

Craniotabes
Rachitic rosary
Bowlegs tetany

203

What are the symptoms of vitamin E deficiency

Creatinuria
Muscle weakness
Anemia

204

What are the symptoms of vitamin K deficiency

Hyporprothrombinemia
Bleeding

205

What are the symptoms are riboflavin (B2) deficiency

Seborrheic dermatitis
Anemia
chelitis/bursitis/stomatitis
Photophobia
Sore throat
edmatous oropharyngeal mucosa

206

What is the problem with adolescent pregnancy

Higher rates of illness and death from both mother and infant

207

What is pelvic inflammatory disease

Ascending spread of organisms from lower genital tract to cervix, endometrium and fallopian tubes

208

What is the most common calls of pelvic inflammatory disease

Chlamydia and gonorrhea

209

What are the signs and symptoms of pelvic inflammatory disease

Abdominal pain, cervical motion tenderness, adnexal tenderness;
May have fever, leukocytosis

210

What is the treatment for pelvic inflammatory disease

Gonorrhea: IM ceftriaxone
Chlamydia: 14 days of doxycycline

211

What is the reason we treat for pelvic inflammatory disease

To prevent complications such as
Tubo-ovarian abscess
Increase risk for ectopic pregnancy in the future
Decreased fertility
Fitzhugh Curtis syndrome

212

What is Fitzhugh Curtis syndrome

Perihepatitis
PID plus right upper quadrant pain in transaminase elevation

213

What are the signs and symptoms of gonorrhea

Purulent vaginal discharge, dysuria, abdominal pain, arthritis (large joints)

214

What is the treatment for gonorrhea

Cefiximine for anything less than PID
Ceftriaxone for PID

Treat concurrently for chlamydia
Emperic testing for comorbid STDs

215

What complication is associated with gonorrhea

Fitzhugh Curtis-perihepatitis

216

What is chlamydia

Intracellular obligate parasites
Most common STD

217

What is gonorrhea

Gram-negative intracellular diplococci

218

What are the signs and symptoms of chlamydia

They are often asymptomatic; use a routine screen
Urethritis, cervicitis, PID

219

What is the treatment for chlamydia

Azithromycin or seven days doxycycline for urethritis/cervicitis

14 days doxycycline for PID

220

Legally how are adolescents affected by reproductive health

There considers emancipated minors

221

Herpes simplex virus type I most often affects what region

Make calls genital disease but usually oral and CNS infections

222

Herpes simplex virus type II soft effects what region

More common causes genital infection

223

Where the signs and symptoms of herpes

Fever, regional adenopathy, dysuria, painful vesicles and ulcers

224

How's herpes diagnosed

Most often clinical but may use a tzanck smear

225

What is the treatment for herpes

Acyclovir for outbreaks-early in the course (within a day)
If genital disease, evaluate for other STDs

226

What is Trichomonas vaginalis

Mobile flagellated protozoan

227

What are the signs and symptoms of trichomonas vaginalis

Malodorous, frothy, yellow-green discharge and vaginal itching

228

How is trichomonas vainalis diagnosed, what technique

What prep to look for leukocytes and Mobile trichomonads

229

What is the treatment for trichomonas vaginalis

Metronidazole

230

What causes bacterial vaginosis

Gardnerella vaginalis,
Mycoplasma hominis

231

What are the signs and symptoms of bacterial vaginosis

Send, white, foul-smelling discharge that smells "fishy" when mixed with KOH

Vaginal pH > 4.5

232

What will a wet prep demonstrate for bacterial vaginosis

Clue cells

233

What is the treatment for bacterial vaginosis

Metronidazole

234

What are the signs and symptoms of vaginal candidiasis

Thick, white, vaginal discharge with vaginal itching and burning

235

What will a wet prep demonstrate for vaginal candidiasis

KOH prep to look for yeast and pseudohyphae

236

What are the causes for amenorrhea in pediatrics

Primary: chromosomal (turner syndrome) or congenital (imperforate hymen)

Secondary: malnutrition (anorexia), endocrine disorders/hypothalamic

237

What are the steps to diagnose amenorrhea

Evaluate for pregnancy and presents/absence of virilization
Progesterone challenge test: withdrawal bleeding will occur with normal endometrium tract presents
Check FSH, LH (elevated level suggest primary gonadal failure), TSH and prolactin

238

What are the causes of dysmenorrhea

Primary: absence of pelvic condition and related to prostaglandin production
Secondary: structural abnormality, endometriosis

239

What is the treatment for dysmenorrhea

Consider NSAIDs, OCP

240

What is polycystic ovarian syndrome

Excessive levels of LH resulting and increased ovarian androgen production
Associated with peripheral insulin resistance

241

One of the signs and symptoms of polycystic ovarian syndrome

Multicystic ovaries, hirsutism, menstrual irregularities

242

What is the treatment for polycystic ovarian syndrome

Consider OCP's