Final FINAL-Table 1 Flashcards
1
Q
What are 2 important diagnostic tests for anemia?
A
Reticulocyte count, Hgb
2
Q
What does a high retic count with high bilirubin indicate?
A
Bone marrow is working!
Most likely d/t destruction or loss of RBCs (hemolytic)
3
Q
(acute/chronic) anemias are well tolerated in children
A
Chronic
4
Q
Anemic disorder characterized by bone marrow aplasia
A
Diamond Blackfan anemia
5
Q
Diamond Blackfan anemia responds to ____treatment, and is cured by ____
A
Steroids
Bone Marrow Transplant (BMT)
6
Q
3 yo pt with cc of lethargy x3 days. Pt is pale, jaundiced, w/ palpable spleen. CBC shows low Hb, High retic count, and increased LDH. What do you suspect?
A
Hemolytic anemia
7
Q
In the case above, which findings were indicative of hemolysis?
A
Jaundice
Splenomegaly
8
Q
___ hemolysis can be due to Hereditary spherocytosis, G6PD deficiency, and hemoglobinopaties
A
Intrinsic
9
Q
____ hemolysis can be due to AIHA, DIC, or IV hemolysis
A
Extrinsic
10
Q
What common virus can produce a low retic count and red cell aplasia?
A
Parvovirus B19
11
Q
Your patient presents with anemia + Petechiae. You suspect:
A
Leukemia or HUS
12
Q
Which lab would show you the presence of spherocytes?
A
Peripheral blood smear
13
Q
When does Fe deficiency anemia first appear?
A
After the first 4-5 mo of life
14
Q
What should you check if a pt presents with neutropenia or thrombocytopenia?
A
Bone marrow fxn
15
Q
Name the iron studies for Fe Deficient anemia
A
Serum ferritin (low) Serum iron (low) Total Fe binding capacity (inc) Transferrin saturation (low)
16
Q
Children who drink cow’s milk are at risk for developing__ deficiency
A
Iron
17
Q
Kids who drink goat’s milk are at risk for developing__ deficiency
A
Folate
18
Q
Age range for kids with Diamond Black-fan anemia
A
Birth-1 year
19
Q
B-12 deficiency is a common finding in this GI disorder
A
Crohn’s
20
Q
Smooth beefy red tongue may indicate
A
B-12 deficiency
21
Q
Fanconi and Diamond-Blackfan anemias are ____ forms of normocytic anemia
A
Congenital
22
Q
Age range for Fanconi anemia
A
2-10 years
23
Q
What is TAR and what condition is it found in?
A
Thrombocytopenia with absent radius. Fanconi anemia
24
Q
____anemias are characterized by Anemia, Jaundice, Splenomegaly
A
Hemolytic
25
Longstanding spherocytosis and sickle cell disease can cause _____
Gallstones
26
What is the most common inherited enzyme defect?
```
G6PD deficiency
(2nd is Pyruvate Kinase Deficiency)
```
27
G6PD manifests as _____ cells on peripheral blood smear
Blister cells
28
G6PD commonly presents with this finding
Hyperbilirubinemia
29
B12/folate deficiency presents as _____ RBCs on peripheral blood smear
Macrocytic
30
This hemoglobinopathy is found in carriers only
Thalassemia trait
31
Hemophilias, vitamin K deficiency, and DIC are all disorders of _____
Coagulation
32
Intrinsic clotting pathway is measured by a
PTT
33
Extrinsic pathway measured with a
PT
34
A pt who is bleeding into their joints should be worked up for
Hemophilia
35
More common mechanism of thrombocytopenia
Increased consumption/ breakdown of RBCs
36
Kasabach-merritt syndrome is associated with sepsis and ____
Thrombocytopenia
37
DIC, Liver disease, and HSP are all _____ types of bleeding disorder
Acquired
38
____ is a type of thrombocytopenia associated with severe illness or shock
DIC
39
Most common bleeding disorder of CHILDhood
ITP (idiopathic thrombocytopenia purpura)
40
ITP usually shows up after____
A viral infection
41
Treatment for ITP includes
```
Steroids
IV Ig (in severe cases)
```
42
Factor ___- and Von Willebrand work together
VIII
43
Hemophilia B, aka _____, is x-linked and are assoc w/ factor IX deficiency
Christmas Disease
44
_____ is the most common INHERITED bleeding disorder among Caucasians (though it can be acquired…)
Von Willebrand disease
45
VW disease can be treated with _________, which releases vWF from endothelial stores
Desmopressin
46
FFP contains____
All coag factors
47
If you have abnormal PT/PTT, you would give
FFP
48
If you have normal PT/PTT values, you would give
Cryoprecipitate
49
In ___ syndrome, bilirubin is elevated in times of stress, causing jaundice
Gilbert’s Syndrome
50
Most common death by disease in children
Cancer
51
___ has inc. incidence of Trisomy 21, NF type 1, and fanconi’s anemia
ALL
52
First labs for a CA workup
CBC w/ diff
| Peripheral blood smear
53
ALL occurs most commonly in kids aged _____-______
2-10 (peak at 4)
54
Most common CA treatment for kids
Chemo
55
Philadelphia chromosome is associated with ____
CML (Chronic Myelogenous Leukemia)
56
Pt presents with firm, non-tender lymph node and hx cough. What do you order?
CBC
CXR
Lymph biopsy
57
What are you looking for on x-ray for a kid with suspected ALL?
Mediastinal widening/ mass
58
This type of lymphoma peaks in adolescence and again after age 50
Hodgkins Disease
59
Biopsy for suspected hodgkin’s disease would show this type of cell:
Reed-Sternberg cells
60
Hodgkin’s is characterized by ______ adenopathy
Painless cervical
61
Mediastinal lymphadenopathy or mass can present with: __ or ___
Cough, dyspnea
62
Most common type of solid tumor in kids:
Brain tumor
63
Classic triad of brain tumors
Papilledema
Morning headache
Vomiting (w/o nausea)
64
Most common tumor of childhood
Astrocytoma
65
Young children most often get ______ brain tumors
Infratentorial
66
Older children more often get ____ brain tumors (which are WORSE)
Supratentorial
67
Abdominal mass that crosses midline
Neuroblastoma
68
Painless abdominal mass that does NOT cross the midline
Wilms Tumor (nephroblastoma)
69
Most common solid neoplasm OUTSIDE the CNS
Neuroblastoma
70
This type of tumor is common in Beckwith-Widemann syndrome
Wilms tumor
71
Most common sign of a retinoblastoma
White pupillary reflex
72
How do you diagnose retinoblastoma
MRI
73
Most common soft tissue sarcoma in childhood
Rhabdomyosarcoma
74
3 types of Rhabdomyosarcoma
Orbital, nasal, bladder
75
____ is a definitive test for osteosarcomas
Tissue biopsy
76
____ present with a painful, palpable mass and lytic lesions with calcifications on x-ray
Osteosarcoma
77
___ commonly presents with femur and pelvic pain, fever, and wt loss.
Ewing sarcoma
78
Most important diagnostic tools in ortho
PE and Radiographic imaging
79
Hip dysplasia (is/is not) a disease of dislocation
Is NOT
80
____ is the abnormal relationship between the prox femur & acetabulum
Hip Dysplasia
81
Hip dysplasia can be diagnosed using these techniques
Barlow’s and Ortolani’s
82
______ are indicative (not diagnostic) of hip dysplasia, occurring in up to 40% of cases
Asymmetric Skin folds
83
If diagnosed in the first 4-6 mo of life, hip dysplasia can be treated with __
Pavlik harness
84
You find a palpable mass in your patient’s neck, and note that their head is twisted to the side. X-ray reveals no cervical deformities. What is your ddx?
Torticollis
85
Children with this congenital connective tissue disorder can have subluxed ocular lenses, thoracic aortic aneurysms.
Marfan syndrome
86
This disorder is characterized by in-utero fractures and blue sclera
Osteogenesis imperfecta
87
_____ show promise for decreasing incidence of fractures in OI
Bisphosphonates
88
The most common form of short-limbed dwarfism:
Achondroplasia
89
Patients with achondroplasia have a greater risk for ___
Scoliosis
90
Your patient has a 20˚ scoliosis curvature. Your next step is:
No tx required
91
Name 4 types of congenital vertebrae abnormalities
Wedge vertebra
Hemivertibra
Congenital bar
Block vertebra
92
Most common cause of limping and hip pain for kids in the US:
Transient Synovitis
93
Most common organism implicated in septic arthritis of the hip
Staph aureus
94
Treatment course for septic arthritis
ABX then surgery if needed
95
Your 7 year old male patient presents with an atraumatic painless limp and decreased internal rotation. You suspect:
Legg-Calve-Perthes Dz
96
Treatment for Perths disease includes
Protecting the joint w/o limiting mobility
97
3 x-ray views for diagnosing Perths disease
AP, Lateral, Frog-leg
98
____ is an orthopedic emergency, characterized by pain in hip, medial knee, and anterior thigh.
SCFE
99
Radial head subluxation is also known as
Nursemaid’s Elbow
100
Typical posture associated with radial head subluxation
“my arm” posture
101
SCFE is most common in this age group
Adolescents 10-16
102
Genu ____ is normal between infancy and 2 years
Varum
103
Genu ____ is normal between 2-8 years
Valgum
104
___ is the abnormal growth of the medial aspect of the proximal tibial epiphysis, resulting in a progressive varus deformity
Blout’s
105
Most common cause of in-toeing in kids under the age of 2
Tibial torsion
106
The recommended treatment for W-sitters
Bicycle/skating
107
Patellofemoral Pain Syndrome presents with _______pain, worse with activity, stairs, prolonged sitting
Anterior knee pain
108
___ can cause microfractures to the tibial tuberosity bone overgrowth
Osgood-Schlatter Disease
109
_______ is a MSS problem of intrauterine positioning and will resolve spontaneously
Calcaneovalgus
110
What should you look for on physical exam if the patient also presents with metatarsus varus?
Check for hip dysplasia
111
Most ___ is caused by congenital hypoplastic tarsal bones (esp the Talus)
Talipes Equinovarus
112
Torus fractures are also known as
Buckle fracture
113
Torus fractures affect these bones
Radius/ulnar
114
___ is an oblique fracture of the distal tibia without a fibula fracture
Toddler’s Fracture
115
Salter Harris classification describes ______ fractures
Epiphyseal
116
A type _____ S-H fracture through a portion of the physis and epiphysis into the joint that may result in complication because of intra-articular component and because of disruption of the growing or hypertrophic zone of the physis.
Type III
117
A type ____ S-H fracture presents as a crush injury to the physis with a poor functional prognosis (aka the WORST)
Type V
118
This type of S-H fracture has joint involvement
Type III
119
Types _&__ are a closed reduction and are treated with a cast
Types I & II
120
Osteosarcomas most commonly occur in ______ bones
Long bones
121
Most common bone tumor in children (benign)
Osteochondroma
122
Most common malignant bone tumor in children
Osteosarcoma
123
____ can present like an osteomyelitis with fever and leukocytosis, but shows lytic lesions on x-ray
Ewing Sarcoma
124
Anterior thigh and knee pain may be presentations of a ___ problem
Hip
125
Joint pain can be an early presentation of ___-
Crohns Disease
126
____ is the inflammation at the insertion of a ligament to a bone
Enthesitis
127
Pleuritis, pericarditis, or peritonitis are all types of _____
Serositis
128
Most common chronic Rheumatic Disease of children is ___
JIA/JRA
129
Young girls with ____ JRA and a positive ANA are at highest risk of uveitis
Pauciarticualr
130
You order an ANA on your patient. It comes back positive. What should be on your differential?
Lupus
131
Most common site of pauciarticular arthritis
Knee
132
___ often presents with a cyclic fever, salmon pink macular rash, and HSM
Systemic Form of JRA
133
The 3 P’s of systemic JRA
Polyserositis
Pleuritis
Pericarditis
134
____ in kids usually affects males >10 yrs, and typically presents with a positive HLA-B27, elevated ESR, and CRP
Spondyloarthropathy
135
1st & 2nd line tx for JRA
1 – NSAIDs
| 2 – Methotrexate
136
First lab to order for suspected SLE
ANA
137
Mainstay treatment for SLE
Steroids
- methylprednisolone/ prednisone
- hydroxychloroquin
- NSAIDs
138
Leading cause of death from SLE
Renal disease (diffuse proliferative nephritis)
139
Most common vasculitis in childhood
Henoch Schonelien Purpura
140
___is a rare inflammatory disease of muscles and skin that presents w/ fatigue, malaise, progressive muscle weakness, w/ low grade fever & rash
Dermatomyositis
141
Most likely cause of HA in kids
Migraine or tension HA
142
Secondary gain is common in this type of headache
Chronic Tension Headache
143
Migraines are usually (unilateral/bilateral)
Unilateral
144
1st line treatment for migraines in kids
Ibuprofen/APAP
145
Cluster headaches are best treated with ____
100% oxygen
146
Define epilepsy:
2 or more unprovoked seizures
147
___ epilepsy is a benign condition w/ unilateral focal seizures and speech abnormalities
Rolandic epilepsy
148
Typical age range for febrile seizures
6mo – 6 yrs
149
___ seizures are associated with GI or upper respiratory infections
Febrile seizures
150
Most common type of seizure in childhood
Partial/focal (40-60%)
151
Role of an EEG in diagnosing seizures
Adjunct test (hx is most important)
152
The majority of febrile seizures are ______
Generalized
153
Treatment for febrile seizures includes
Phenobarbital, Valproic Acid
| Rectal Diazepam
154
The majority of epileptic seizures are ______
Partial/focal
155
Type of impairment of consciousness in simple focal seizures
NO impairment
156
Type of impairment of consciousness in complex focal seizures
Impairment = staring
157
Type of impaired consciousness in secondary generalized focal seizures
Generalized convusion
158
____ = no impairment of consciousness
Simple
159
____= impairment of consciousness (staring)
Complex
160
____= simple or complex partial seizure that ends in a generalized convulsion
Secondary Generalized
161
____ can be mistaken for colic, reflux, or startle
Infantile spasms
| West Syndrome
162
Infantile spasms are associated with _____, which presents with ash leaf spots on the skin
Tuberous Sclerosis
163
Treatment for Status Epilepticus includes:
ABCs then IV benzos
| Diazepam or lorazepam
164
The AAP recommends ____ for obtaining LP
Low threshold
165
The majority of febrile seizures are (simple/complex)
Simple
166
Febrile seizures that are focal, prolonged, or multiple are:
Complex
167
Treatment (if any) for febrile seizures
Rectal diazepam
168
Sleep disorders, migraine variants, benign breath-holding spells, syncope, movement disorders, and pseudoseizures are all_______
Spells that mimic seizures
169
An infant pt presents with lethargy and vomiting. Upon PE you find that his fontanelles are bulging. What is the cause?
Increased Intracranial Pressure
170
Sign visible in the eyes of younger children that indicates ICP
“Setting sun sign”
171
An obese teenage girl presents to your clinic with a complaint of HA, tinnitus, and loss of vision. You perform an MRI to exclude hydrocephalus and intracranial mass. What do you suspect?
Pseudotumor Cerebri
172
Most common cause of stroke in children
Cyanotic heart disease
| +sickle cell anemia, meningitis, hypercoagulable states
173
Most common cause of concussion in kids
Falls
174
Management for children with amnesia or who were unconscious
ER Evaluation
175
HA, dizziness, forgetfulness, inability to concentrate, slowing of response time, mood swings, and irritability after a concussion is known as:
Post-concussive Syndrome
176
Meningomyelocele are usually identified using this screening tool
Ultrasound (+ high AFP)
177
Arnold Chiari types I and II are types of ______
NTDs
178
Arnold Chiari III defect is also known as
Anencephaly
179
Migrational disorder associated with severe delay and seizures, with a “smooth brain” on MRI
LIssencephaly
180
The premature closure of sutures
Craniosynostosis
181
You notice ash leaf spots on your patient. Which neurocutaneous disorder do you suspect?
Tuberous Sclerosis
182
____ is an autosomal dominant disorder characterized by café au lait spots, axillary freckling, and learning disabilities
Neurofibromatosis
183
Characterized by benign tumors in vital organs (brain, eyes, kidneys, heart, skin) and can often cause infantile spasms
Tuberous Sclerosis
184
This neurocutaneous disease presents with a unilateral port wine stain over the upper face
Sturge-Weber syndrome
185
Up to 90% of Sturge Weber patients have this vascular anomaly
Leptomeningeal Vascular Anomaly
186
2 common causes of ataxia in children
Post-infectious
| Drug intoxication
187
A neuromuscular disorder of the Anterior Horn
| progressive weakness, wasting of skeletal muscle resp failure
SMA (Spinal Muscular Atrophy)
188
A neuromuscular disorder of the Peripheral Nerve
| ascending symmetrical weakness, post-infectious
Guillian Barre
189
A neuromuscular disorder of Neuromuscular Transmission
| ptosis, loss of facial expression
Myasthenia Gravis
190
A neuromuscular disorder of Muscle Tissue
| X-linked, proximal muscle wasting, pseudohypertrophic calf
Muscular Dystrophy
191
Pelvic weakness seen in Duchenne Muscular Dystrophy results in a positive _____ sign on physical exam
Gower Sign
192
Most common type of cerebral palsy
Spastic
193
5 types of cerebral palsy
Spastic, athetoid, rigidity, tremor, ataxic
194
Most common nutritional disorder affecting children and adolescents in the developed world?
Obesity
195
No other source of protein is needed in the 1st 6 mo of life except ___
Breastmilk
196
Who needs more kcal/kg….a 2 year old or a 10 year old?
2 year old (102 vs 70)
197
RDA for protein ranges for 2.2g/kg/day for 0-6 mo, to ____g/kg/day for adolescents
1 g
198
Breast milk provides about ___% calories from fats
50%
199
During the first year, weight increases ____% and brain size ____
200%, doubles
200
The last measurement to change in a child with malnutrition is _____
Head circumference
201
The American Academy of Pediatrics recommends human milk as the sole source of nutrition for______, with continued intake for the first year and as long as desired thereafter
the first 6 mo of life
202
A new mom comes in and asks if she can breastfeed while on methadone treatment. What do you say?
YES!
203
SIDS is more common in this type of household:
Smoking
204
Is breastfeeding recommended in mothers infected with HIV?
No, unless water source for formula is unsafe
205
How do you assess adequacy of milk intake in an infant?
rate of wt gain is most objective indicator of adequate intake
206
Breast milk stools typically look ____
Seedy
207
A well-hydrated infant voids ___-___ times per day
6-8
208
Standard formulas contain ____cal/oz (same as breast milk)
20
209
You should use special formulas (soy, lactose free) for infants with:
Malabsorption, gastroschesis,
210
What kind of TERM infant might need extra calories
Heart disease
211
What vitamin does breast milk lack?
Vitamin D (supplement 200IU/day)
212
At what point do full term breast-fed babies need supplemental iron?
4-6 mo of age (1mg/kg/day)
213
Formula fed infants should get Fe fortified formula for ______
1st year of life
214
When can you start solid foods in infants?
6 mo
215
What is the max amount of cow’s milk per day that is recommended?
Not >24 oz/day (over 1 yr old)
216
At what point should bottle feeding be discontinued?
12-18 mo
217
Most common form of malnutrition in children living in poverty?
Iron deficiency anemia
218
Brain growth triples by age ___
6
219
____ is a leading cause of death in children under 5 years of age
Protein-energy malnutrition
220
Less than 5% of failure to thrive is due to ____ causes
Organic
221
This type of adolescent may be especially vulnerable to IDA
Student athletes
222
Best indicator that baby is getting enough calories
Growth rate in length, weight, and FOC
223
11yo children who are overweight are more than ___x as likely to remain overweight at age 15 than 7yo children.
2 times
224
SCFE, Pseudomotor Cerebri, DM Type II, HTN, and low self esteem are all consequences of ____
Childhood obesity
225
Bacteria that causes cavities
Strep Mutans
226
```
CRITICAL CARE
Bites/Stings
Hyperthermia/hypothermia
Burns
Shock
Respiratory Failure (status asthmaticus, ARDS)
```
```
NORMAL ABG VALUES
pH 7.35-7.45
CO2 35 – 45
O2 70 –100
O2 sat 93-98 %
HCO3 22 – 26
```
227
3 important differences in the pediatric patient
- Greater body surface area
- Internal organs are more anterior, protected by less fat
- Airway structural differences
228
A child’s BP may be maintained with up to _____% acute blood loss
30%
229
1st step in assessing the seriously ill child:
ABCDE’s
| Rapid clinical assessment
230
What does the term “exposure” refer to?
Hypo/hyperthermia and also
| Exposing the patient to assess for injuries
231
Dehydration d/t gastroenteritis is an example of something that can cause _______ shock in a child
Hypovolemic
232
Epiglottitis is an (upper/lower) airway disorder leading to resp distress
Upper
233
_____ presents as the main compensatory mechanism for blood loss
Tachycardia
234
A goal of resuscitation is to identify and restore abnormalities of __ and __
Oxygenation, Perfusion
235
Most children with shock have ______causes
Non-cardiac
236
____ is most common cause of hypovolemic shock in kids
Dehydration
237
Kid showing up in 1st week of life in shock…you suspect a ___ cause
Sepsis, Cardiac, Or metabolic
238
Hypoxic injury to the ___may cause seizures, cerebral edema, infarction.
Brain
239
Hypoxic injury to the ___may cause ATN, ARF
Kidney
240
____ is the most common cause of unplanned hospitalization in kidd 3-12yr
Asthma
241
____ is due to severe bronchospasm, excessive mucus secretions, or inflammation/edema of airways, causing airway obstruction that may progress to respiratory failure
Status Asthmaticus
242
Labs to order for suspected status Asthmaticus
O2sat, ABG, CXR
243
Therapy for Status Asthmaticus
Humidified O2
B2 agonist (nebulized or bolus)
IV corticosteroids
244
___ is the most common precipitant of ARDS
Infection
245
Appropriate labs to order for your peds patient with ARDS
ABGs, daily CXR, CBC (infection surveillance)
246
Loss of acid occurs with ____/_____
Vomiting/ NG suctioning
247
Bicarb loss occurs with ____
Diarrhea
248
Treatment of DKA includes
NS
Insulin, then D5
Na given via NS
*NO bicarb given!
249
Airway obstruction, pneumonia, ARDS, PE, trauma, and respiratory depression can all lead to_____
Respiratory Acidosis
250
H+ loss and bicarb gain can lead to____
Metabolic acidosis
251
Anxiety, pain, altitude, excessive ventilation, PE, asthma, edema, or salicylate overdose can lead to ____
Respiratory Alkalosis
252
Lactic acidosis, ketoacidosis, and exogenous acid consumption are all types of metabolic acidosis with a ______ anion gap
Increased
253
Septic, anaphylactic, and spinal shock are all ____ types of shock
Distributive
254
Type of shock where organ perfusion is maintained
Compensated
255
Most common cause of shock in children
Hypovolemic shock
256
This syndrome occurs in response to distributive shock, with fever, tachycardia, tachypnea, and abnormal WBC counts
SIRS (systemic inflammatory response syndrome)
257
Gram (+ /- ) organisms use endotoxins which cause release of cytokines which can lead to septic shock
Gram Negative
258
Gram (+ /- ) organisms use pyrotoxic superantigens, which cause massive lymphocyte activation and release of T-cell cytokines, leading to cellular injury, organ failure, and shock
Gram Positive
259
Which are more painful, 2nd or 3rd degree burns?
2nd degree
260
Burns > ____cm need grafting
1 cm
261
___ is a life threatening failure of thermoregulation, characterized by high fever, CNS dysfunction, and incoherence
Heat Stroke
262
___ in children is defined as core body temp
Hypothermia
263
Most common cause of burns in children
Scalding
264
A 5 y/o presents with a deep, white and dry burn on his arm. The skin blanches when you touch it. What degree burn is this and how long should it take to heal?
Partial thickness 2nd Degree
| Could take a month or more
265
What types of findings on PE would make you suspect an inhalation injury?
Facial burns, singed hair, carbonaceous sputum
266
Labs/vitals to order/monitor for a burn patient
Urine output, CBC, electrolytes, renal function, urinalysis, tetanus prophylaxis
267
What is the time limit for using activated charcoal for poison tx?
w/in 1 hour
268
Most common poisoning in kiddos
Acetaminophen
269
Treatment for carbon monoxide poisoning w/ cerebral edema
100% O2
270
Your 4 year old patient comes in with a bite on his hand after sticking it into a hole in the woods. You don’t know what bit him, but you should do this for all bites.
Irrigation
271
1. What congenital orthopedic/skeletal problem is characterized by blue sclera?
Osteogenesis imperfect
| (also see broken bones pre and post natal – if you see it in US, it is almost pathopneumonic
272
2. What meds are used to treat OI?
bisphosphonate
273
3. Most common form of short-limb dwarfism?
Achondroplasia
274
4. A patient is diagnosed with achondroplasia. What long-term orthopedic problem are they at increased risk for?
Scoliosis
275
5. A mother brings her 6 y/o son in with complaints that he has been limping. He denies any trauma, and says it doesn’t hurt. On PE you note poor internal rotation and abduction. What is your suspicion?
Legg-Calf-Perthes disease
276
6. What exams would you order and what would you expect to find?
XRAY: Necrotic bone (avascular necrosis of hip)
LABS: CBC, ESR
TX: protect joint, limit movement.
277
7. Toxic synovitis is usually an autoimmune response following:
An infection, esp URI
278
8. Clinical features distinguishing L-C-P dz and septic arthritis of the hip include:
- + fever in septic arthritis
| - + pain in septic arthritis (LCP = PAINLESS)
279
9. What is “nursemaid’s elbow” and how is it treated.
Subluxation of the radial head
| TX: Flex the FA, supinate the elbow
280
10. This type of fx is described as “oblique fx of the distal tibia without fibular involvement” and usually manifests in children ages 1-3 without hx of significant trauma, and with only minimal pain/swelling.
Toddler’s Fx
281
11. A common fracture of the forearm, usually about 1/3 way up the radius, is a ____
Buckle fracture (aka Taurus Fx)
282
12. Describe the various Salter-Harris classifications.
Which is worst?
Class V = worst (crushed growth plate, likely to arrest growth)
(III and IV bad too, b/c go into joint space)
283
13. Describe distinguishing factors of a limp caused by SCFE
Slipped Capital Femoral Epiphysis
- Adolescents 10-16
- especially very active or obese males
- Vague syptoms: + limp, +pain knee/med thigh/ hip
- limited internal rotation
* SURGICAL EMERGENCY
284
14. Congenital deformity of the foot, characterized by inward deviation with angulation at the base of the 5th metatarsal.
Metatarsus varus
285
15. ID Causes of #14. Differentiate from club foot
Intrauterine positioning
| MV can be passively moved to midline, club foot is a rigid skeletal abnormality.
286
16. An infant born with metatarsus varus is at increased risk of what OTHER ortho finding?
Hip dysplasia (2-10%)
287
17. 14/F presents with lump on knee. She is an active soccer player and says it hurts every now and then, but usually doesn’t bother her. She appears very thin but well –nourished. The lump is visible and makes her nervous. You note a 3-4cm hard, palpable mass on the medial side of the knee. You suspect?
Ostechondroma (most common bone neoplasm)
TX: typically benign, you can leave it there, or surgically remove if problematic
288
18. What is the most common malignant bone tumor in kids? Where are they typically found?
- Osteosarcomas
| - Typical in long bones
289
19. What is the first treatment done for osteosarcoma?
```
- Chemotherapy
THEN Excision (excision = curative)
```
290
20. 6 y/o Female presents with pain in L arm, especially if you touch it. Pain worsens day by day. She also presents with fever. What are your differentials?
- Ewing’s sarcoma vs. Osteomyelitis
- Do Labs + XRay to ID. Fever + lytic lesion in bone = osteomyelitis
- Fever, Inc WBC also osteomyelitis
291
21. An infant is diagnosed with hip dysplasia. You want to apply an orthopedic splint called ____
- Pavlik Harness
292
22. A 4 year old presents in status epilepticus. What is your first-line treatment?
- Diazepam (Valium)
293
23. EEG’s _____ (can/not) be used to diagnose epilepsy
They are NOT used
294
24. What is the most common type (manifestation) of childhood epilepsy?
- partial seizures (usually due to genetics)
295
25. A form of epilepsy characterized by very brief spasms, severe EEG, and poor prognosis is called:
- Infantile spasms
296
27. Describe facts associated with febrile seizures. When would you work them up?
- Typically ages 6m – 6y
- Usually do not progress to epilepsy
- If resolves quickly and returns to normal, no workup need. If difficult to arouse or vomiting after seizure, work up neuro
297
28. Patient presents for 2m check up. Home birth with educated midwife. NB Screen and vaccines done by midwife. Mom’s concern – baby not eating in last week or so, separated sutures and bulging fontanelle. What do you think of?
- Increased ICP – mass? Hydrocephalus?
298
29. What symptoms would you expect to see in a child with increased ICP?
- HA (may be worse in AM, worsens with cough, vagal, or bending over)
- Strabismus, diplopia, wandering eye
- Vomiting WITHOUT nausea
299
30. 13/F overweight, presents with complaint of HA. Mother states she complains a lot, but recently also complains of tinnitus and vision being off. What is your concern?
*most commonly= idiopathic cause
300
31. Most common causes of childhood stroke?
- cyanotic heart disease
- sickle cell disease
- meningitis
- hypercoagulable state
* Sxs: similar to adult: u/l flaccidity, facial droop
301
32. Neurofibromatosis, Tubosclerosis, and Sturge-Webber are all associated with what finding?
Seizures
302
33. 5 y/o presents with concerned grandparents due to him “not like other kids”, has to climb to stand. What do you suspect? What is this finding called?
- Suspect Muscular dystrophe
| - Gower sign
303
34. What pathopneumonic finding would further heighten suspicion of MD?
- calves appear full (hypertrophic)
304
35. Match diseases to their pathologies:
a) Muscular dystrophy
b) Guillan-Barre
c) Myesthenia gravis
d) Spinal Muscular Atrophy (SMA)
a) Muscle fiber
b) nerve
c) Neuromuscular junction
d) Anterior horn
305
36. 15y/o mom brings him in in a panic because hisfeet felt numb, by lunch he felt weird standing up. He can talk but he feels like he’s getting weaker in his upper legs. Hx significant for URI this week. You suspect? How do you treat?
- Suspect Guillan-Barre
- Tx: supportive care, ADMIT
- May need ventilator support
306
37. A 12 y/o presents with purpuric rash 1 week following a URI. She also has a blood-shot eye and red colored urine. You suspect?
- Henloch Schenlein pupura (autoimmune against blood vessels)
307
38. Describe tx for meningomyeloceles.
- Surgery
| - * be sure to assess for paralysis at birth (active & symmetric movement? Incontinence? )
308
39. Compare and contrast Henoch-Shonlein vs Idiopathic Thrombocytic Purpura
BOTH: Autoimmune, Purpuric rashes, Hx URI (or infection).
HSP = autoimmune a/g blood vessels
ITP = autoimmune a/g platelets
309
40. 18m/f brought in for pallor. Family think something’s wrong because she’s getting pale and they’re dark Hispanic. Nml diet, no PMH. Normal vitals… You only note pallor. No hepatosplenomegaly, lymphadenopathy, no bruising. What do you consider?
- consistent with anemia
| - Order: CBC, Iron studies
310
41. What lab would you order in #40 to ID whether this is an acute or chronic anemia and how the body is compensating?
- Order reticulocyte count. High reticulocyte count = enough time AND able to make new cells.
- Low retic = acute onset OR aplastic/hypoplastic (use hx!)
311
42. 3 y/o female in ER presents with jaundice, fatigue x 3 days, Low hgb, high retic. She also has organomegaly. You want to consider what?
- Hemolytic/destructive anemias (organs large from processing broken cells/ bilirubin excess):
- sickle -G6PD
- spherocytosis - thalassemias
312
43.T/F heart murmurs are commonly associated with anemia.
TRUE
313
44. Diamond Black-fan is a _____ anemia that can be treated by ____ and cured by ___
1. Congenital hypo/aplastic anemia
2. tx by steroids
3. cured by bone marrow transplant
314
45. Diamond black-fan has __ (more/less) association with other anomalies than it’s cousin Fanconi’s anemia
Less: 30% dbf, 50% Fanconi
315
46. How is Fanconi’s managed?
- steroids or IVIG, BM trasfusion
| - 20% self-limited auto-immune and often grow out of it.
316
47. Differentiate Fanconis vs DBF:
DBF: onset @ birth-1yr, short stature, autosomal recessive,
| Fanconis” onset 2-10 yrs, higher rate congenital problems, autosomal recessive
317
48. 4 y/o male with pallor, fatigue x 2 months. You order a CBC and find low RBC, WBC, AND platelets. What do you think?
- 2+ depressed cell lines think leukemia
| - age 4, boy, most common leukemia in kids = ALL
318
49. What lab finding would be consistent with your differential in #48?
- high lymphoblast numbers (overgrow the BM so the BM can’t work)
319
50. Most common cancer in teens?
Lymphomas (3rd most common cancer of all: #1- ALL, #2-brain tumors #3-lymphoma)
320
51. What are the two types of lymphoma? Which is worse?
- Hodgkin vs non-Hodgkin lymphoma
| - non-Hodge = worse (also less common)
321
52. What clinical findings would you find in a pt with Hodgekin lymphoma? What would you use to confirm?
- Findings: PAINLESS lymphadenopathy without illness, splenomegaly, nml CBC
- Do CXR to confirm: look for mediastinal widening/mass, enlarged thymus
322
53. What characteristic finding will differentiate between Hodgekin and non-Hodgekin lymphoma?
- Reed Steinberg cells in Hodgekin lymphoma
| - hodgekin = cervical lymph most common
323
54. A patient presents with a triad of symptoms including papilledema, HA worse in AM, and vomiting. You recognize this as alarming for ___
Increased ICP
324
55. What is the most common brain tumor in kids?
Astrocytoma
325
56. A brain tumor where allows for the best prognosis?
SUPRAtentorial
326
57. Definitive tx for a brain tumor includes:
Surgical removal (successful in 50-60% of all CA)
327
58. A 3y/o presents with poor feeding, abd distention, and refuses to walk. When you pick him up, he cries loudly. He also appears pale and miserable. On exam you note a large, palpable abdominal mass and HTN. What do you consider?
-Diff dx: HTN=renal?, mass = neuro/nephroblastoma
328
49. Differentiate between neuroblastoma and nephroblastoma. Which is called Willm’s tumor?
- Neuroblastoma can cross midline
| - Nephrobllastoma (Willms) does not cross midline
329
50. The most common sign of retinoblastoma is:
- absence of red reflex (white reflex)
| - Strabismus
330
51. Tx for retinoblastoma includes:
radiation (mainstay)surgery if ineffective.
| − monitor for metastisization (fatal if mets)
331
52. The soft tissue tumor aka most common sarcoma of childhood is called:
-Rhabdomyosarcoma
332
53. Differentiate presentation of rhabdomyosarcoma by age.
- Young – head, neck, GU
| - Older kids: extremities, trunk
333
54. A patient presents with jaundice. It is determined that they do not posess the enzyme that metabolizes and conjugates bilirubin. This diagnosis is called ___
Guilbert’s (specifically elevation in unconjugated bilirubin d/t deficiency of conjugating enzyme.
334
55. ID types of congjugating enzyme deficiencies.
- No enzyme AT ALL = Kraigler Najar. (requires tx or fatal; tx = phenobarbiotol)…)
- Diminished activity (Guilberr’s) (usually benign, but keep a close eye out. Often don’t require tx)
335
56. Protein C deficiency, antitrombin 3 deficiency, and protein S deficiency all result in what?
- Hypercoagulation state (clotting problems)
336
57. A pt presents with septic shock. You also note hematuria, bleeding gums, etc. What labs should you order?
What is the most likely diagnosis?
What is the treatment?
- CBC, PTT, PT, fibrinogen, INR
- DIC highly associated with sepsis
Tx: FFP (contains a lot of clotting factors)
337
58. How can you treat severe thrombocytopenia?
- transfusion of platelets
338
59. A 14 y/o presents with heavy periods and occasional nose bleeds. She denies any spontaneous bruising though. What problem might you check for?
- VonWillebrands
339
60. Define whether each problem is due to a problem with production, consumption, or abnormal function:
a) ITP
b) Leukemia
c) Sickle cell (in crisis)
a) Destruction (auto immune)
b) production
c) function
340
61. ID and differentiate between most common childhood leukemias.
ALL (acute lymphoblastic leukemia (most common = 75%
AML (15-20%)
CML (
