From questions Flashcards
1
Q
Improvement or no improvement in hypoxemia test in cyanotic heart disease
A
no
2
Q
Improvement or no improvement in hypoxemia test in meconium aspiration syndrome
A
yes
3
Q
Improvement or no improvement in hypoxemia test in persistent pulmonary hypertension
A
yes
4
Q
Improvement or no improvement in hypoxemia test in pneumonia
A
yes
5
Q
Improvement or no improvement in hypoxemia test in retained fetal lung liquid
A
yes
6
Q
Causes of superior vena cava syndrome
A
1) Extrinsic compression - mediastinal mass or tumor
2) Intrinsic compression - surgical anastomotic sites, baffle stenosis, thrombosis, cardiac tumors
3) Increased right atrial pressure
7
Q
Pattern: infant 4 weeks of age, fatigues with feeding and now takes twice as long to complete his feeding as he did 1 week ago. Also breathes fast during his feedings and stops frequently to “catch his breath”
A
congestive heart failure
8
Q
Regurgitation of mitral valve produces what murmur
A
holosystolic
9
Q
Regurgitation of aortic valve produces what murmur
A
diastolic
10
Q
Most common two organisms for infective endocarditis
A
Viridans streptococci
Staphylococcus aureus
11
Q
If patient with suspected infectious endocarditis is looks acutely ill how do you manage?
A
Get blood culture than treat with abx
12
Q
If patient with suspected infection endocarditis has chronic symptoms how you manage?
A
Get ECHO to confirm
13
Q
Infective endocarditis can cause hematuria how?
A
Through deposition of immune complexes
14
Q
Cases when microalbuminuria are useful.
A
Diabetes and HTN
15
Q
Casesw when 24-hour urine testing for proteinuria helpful?
A
risk factors for nephrolithiasis/urolithiasis or to screen for catecholamine metabolites in children suspected of neural crest tumors (neuroblastoma or pheochromocytom)
16
Q
Pattern: AR disorder, chornic tubulointerstitial disease (azotemia, ESRD), polyuria, polydipsia, tubular wasting leading to hyponatremia and salt cravings, acidosis, anemia, azotemia, associated with Senior-Loken syndrome with tapetoretinal degeneration, retinitis pigmentosa
A
Juvenile nephroopththisis
17
Q
What are all the eye findings in Senior-Loken?
A
1) tapetoretinal degneration, retinitis pigmentosa, blindness, nystagmus, coloboma, cataracts
18
Q
Pattern: aplasia of cerebellar vermis causing ataxia and retinal coloboma/retinitis pigmentosa
A
Joubert
19
Q
Gene: nephronophthisis
A
NPHP1 gene, chromosome 2q12.3 (nephrocystin 1) NPHP2 and NPHP3 encode for proteins for infantile and adolescent
20
Q
Eye finding in Alport
A
Anterior lenticonus and catarcts
21
Q
Pattern: X-linked FAnconi (glycosuria, met acid, aminoaciduria, hypophosphatemia) MR, and congenital cataracts
A
Lowe syndrome
22
Q
Pattern: AR, Fanconi, FTT, cystine crystal deposition within the cornea, severe photophobia
A
Nephropathic cystinosis
23
Q
Any treatment from narrowed urethra in child with h/o of UTI
A
no, normal variant
24
Q
What are some extrarenal structural causes for hematuri?
A
ruptured cyst of cystic kidney (polycystic kidney), renal mass (Wilms tumor), renal stone, renal vein thrombosis, papillary necrosis or hypercalciuria, hemorrhagic cystitis, bladder clculi, hemangioma, rhabdomyosarcoma of the bladder
25
Definition o hematuria
>5 RBC/HPF
26
DDx of red urine
hematuria, hemoglobiunuria, myoglobinuria, porphyrinuria
27
Dipstick is sensitive to what?
free hemoglobin, myoglobin, intact red blood cells
28
Definition of persistent microscopic hematuria
blood on UA detected on repeat samples over a 1-month period
29
Pattern: Fever in setting of UTI in infant and neonates
pyelonephritis
30
Neonates and infants, UTI no fever
Lower tract
31
90% of UTIs are caused y what?
E. coli
32
What is best initial treatment of cystitis?
TMP-SMX
33
If recurrent UTI, history of resistance or allergy to TMP-SMX, what second line abx?
cephalexin, defixime, or ciprofloxacin
34
First-linefor steroid-resistant nephrotic?
cyclosporine and then tacrolimus
35
What is the chance of relapse in minimal change?
50-70%
36
What are labs associated with hemolysis?
elevated lactate dehydrogenase and low haptoglobin values
37
What is reticulocytosis sometimes not elevated in HUS?
impaired Epo production
38
What are two endocrine problems associated with chronic kidney disease?
Increased IGF1 and PTH as compensation
39
Most common types of renal stones?
calcium oxalate, calcium phosphate, mixd, struvite, cystine, and uric acid
40
Promoters of kidney stone formation
calcium, oxalate, uric acid, cystine
41
Inhibitors of stone formation
magnesium and citrate
42
What first test to do for evaluation of kidney stones
urinary calcium excretion
43
What organism is associated with struvite stone
proteus, produces urease
44
Pattern: hypercalciuria and renal stones
RTA
45
Pattern: midface hypoplasia, ocular hypertelorism, nail hypoplasia, cleft lip +/- cleft palate, and heart defects, developmental delay, pre and postnatal growth failure
Phenobarbital toxicity
46
Pattern: newborn with cyanosis, hypotonia, abnormalities of cardiac rhythm, goiter, hypothyroidism, and nephrogenic diabetes insipidus, mom has bipolar
Lithium toxicity
47
Pattern: newborn with tremulousness, increased irritability and abnormal visual response to light stimulus, what did the mother smoke/ingest prenatally
marijuana
48
LSD and birth defects Y/N?
No
49
Is there an increase in congenital anomalies wtih metamphetamine?
No
50
Describe general picture of polycythemia and hyperviscosity.
Lots of organs can be affected. some signs, hypotonia, sleepiness, irritability, hypoglycemia, jaundice, hypocal, plethora, cardiomegaly, increased pulmonary resistance, decreased cardiac output, Nec
51
Pattern: in newborn, IUGR, jaundice, heptaospelnomegaly, hepatitis, thrombocytopenia with petechiae and purpura, microcephaly, intracerebral calcifications, chorioretinitis, sensorineural hearing loss
CMV
52
Estimated MAP for new borns
should not be less than gestational age
53
Pattern: meat impaction, dysphagia
EE
54
Pattern: heartburn, dysphagia, odynophagia, hoarseness, chronic cough, exacerbation of asthma, apnea and aspiration pneumonia
GER
55
Difference b/w findings from GER versus EE
GER- ulceration and injury limited to the distal 5cm of esophagus; EE characterized by inflammation of the proximal, middle and distal esophagus with large number of eosinophils seen on biopsy
56
GI symptoms associated with Down syndrome
Hirschsprung, duodenal atresia
57
Most commonly injured intra-abdominal organs
liver and spleen
58
What are complications of long-term H pylori infection?
Gastric and duodenal ulcers, gastric lymphoma, and atrophic gastritis
59
What is gold standard test for H pylori?
upper GI endoscopy with biopsy of gastric antrum
60
What are non invasive tests for H pylori?
IgG serology, fecal sample for H pylori antigen, C13 urea breath test
61
Rx for H pylori
2 antibiotics and PPI
62
What is follow-up after H pylori treatment?
documentation of eradication, negative fecal antigen studies or endoscopy
63
What is the ratio of L:S typically achieved by 35 weeks' gestation
2
64
Is PG or PI used as indicator of pulmonary surfactant maturity?
PG
65
What should be used as test for fetal lung maturity in setting of maternal diabetes?
surfactant
66
Pattern: bilateral microtia, depressed nasal bridge, ocular hypertelorism, cleft palate, macrocephaly, truncus arteriosus, dilated ventricles with hydrocephalus
isotretinon
67
Pattern: neonate with IUGR, ocular hypertelorism, midface hypoplasia, celft lip+/- cleft palate and heart defects
phenobarbital and phenytoin
68
Shortened AP dimension. Which suture close early?
Coronal
69
Pattern: coronal suture synostosis, large thumbs or great toes
FGFR dominant mutation
70
Trigonocephaly "keel-shaped" skull. Which suture close early?
metopic
71
Scaphocephalic (long in AP dimension and narrow in biparietal dimension) Which suture close early?
sagittal
72
Posterior plagiocephaly (flattening of one or both sides of the occiput) Which suture close early?
lambdoid suture
73
When should you start helmet for positional plagiocephaly?
9 months
74
When infant sees a mirror, smiles and vocalizes
4 mo
75
When infant sees a mirror, reaches for it and pats the image
6 mo
76
When infant sees a mirror, offers it a toy
12mo
77
Letter reversal is normal up to what age?
7yrs
78
Why is MCT used in children with distal ileal resection for nec?
It can be absorbed directly across the tnerocyte and does not require intraluminal digestion by bile acids.
LCFA require bile acids for digestion and might cause diarrhea in a child with cholestasis and ileal resection
79
Pattern: cardiac disease (PS), vertebral anomalies, ocular anomalies (posterior embryotoxon), facial dysmorphism (triangular facies, macrocephaly, large ears) and paucity of the intrahepatic bile ducts
Alagille syndrome
80
Vitamin deficiency: hypotonia and apnea
Magnesium
81
Vitamin deficiency: hypotonia and seizures
Vitamin B6
82
Vitamin deficiency: hypotonia, DD, seizures, steely hair
Cooper
83
Vitamin deficiency: pallor, poor feeding, hypochromic anemia, neutropenia, and skeletal changes Metaphyseal fraying and osteoporosis
Cooper
84
Vitamin deficiency: hemolysis and peripheral neuropathy, hyporeflexia, tremors
Vit E
85
Differential for children with small hands and feet, hypogonadism, learning disabilities, MR
Prader-Willi and Bardet-Biedl syndromes
86
What infections is absolute contraindication for breast feeding?
HIV, untreated TB, active herpes lesion
87
What maternal medications preclude breastfeeding?
Chemo, immunosuppressants, lithium and readiopharmaceutical
88
Is candida contraI for breastfeeding?
No, but mother and baby should be treated
89
Difference between foodborne and infant botulism
Foodborne ingestion of food that is contaminated with spores - honey
Infant results from ingestion of C bot spores that germinat and produce the toxin
90
Pattern: nausea, dry mouth and diarrhea --> cranial nerve dysfunction, most commonly diplopia, blurry vision, descending to include dysphagia, upper extremity weakness, respiratory dysfunction, and lower extremity weakness
Foodborne botulism - hours incubation time
91
Pattern: Injury 4 to 14 days prior to symptoms of cranial nerve dysfunction, diplopia, blurry vision, descending to include dysphagia, upper extremity weakness, respiratory dysfunction and lower extremity
Wound botulism
92
Pattern: 3 to 30 days from ingestion of spores, constipation, feeding difficulties, hypotonia, incrased drooling, weak cry, diminished gag reflex, truncal weakness, cranial nerve palsies, and generalized weakness
Infant botulism
93
Toxin type for infant and wound botulism
A and B
94
Rx for wound and foodborne
Equine trivalent antitoxin
95
Rx for infant botulism
BIGIV
96
Pattern: paralysis ascending beginning in the lower extremities and ascending symmetrically to involve trunk, upper extremities and head within a few hours
tick paralysis
97
Three infections that cause oculoglandular disease
Bartonella, tularemia, H influ
98
Pattern: fever, diarrhea, blood mucous, neutrophils in stool, seizures
Shigella
99
Pattern: tenosynovitis, dermatitis, polyarthralgias
Dissemniated gonococcal infection
100
What can cause disseminated syndrome, neonatal conjunctivitis, urethritis, salpingitis, PID
N. gonorrhoeae
101
Complications associated with varicella
superinfection of skin lesions, pneumonia, cerebellar ataxia, encephalitis, thrombocytopenia, glomerulonephritis, arthritis, and hepatitis
102
Rx for immunocompetent hosts at increased risk for moderate to severe varicella
oral acyclovir
103
Persons at increased risk for moderate to severe varicella
?12yo, chornic cutaneous or pulm disorders, persons receiving long-term salicylate therapy, people receiving short, intermittent or aerosolized courses of croticosteroids and secondary household cases
104
Rx for immunocompromised patients who have varicellas and who have been treated with chronic corticosteroids
IV antiviral
105
Rx for varicella in HIV with normal CD4, leukemic patient in whom careful follow-up is guaranteed
High dose oral
106
Which antibiotics should you not take with dairy products?
tetracycline, doxycycline, ciprofloxacin
107
Which antibiotics should you not take with food?
ampicillin - acid ability
108
Which antibiotics should you take with food to reduce stomach upset?
erythromycin and metronidazole
109
Liquid restrictions pre-sedation
Milk or food 6 hours
Human milk 4 hours
Clear juices 2 hours
110
Treatment for HSV
400mg acyclovir 3x/day for 7 to 10 days
111
After antihistamine, what is next therapy for allergic rhinitis
intranasal corticosteroid
112
What % of COHgb concentration is indicative of exposure
>3 to 5% sometimes 100%
113
Rx for carbon monoxide poisoning
100% nonrebreather decreases half life from 300 minutes to 90 minutes and should be continued until COHgb concentration is less than 5%
114
When should you suspect bacterial cause of rhinitis?
URI persisting longer than 7 to 10 days
115
Most common cause?
H influ
116
Rx for acute bacterial rhinosinusitis
high dose amoxicillin, augmentin, cefdinir, defpodoxime proxetil, cefuroxime axetil
117
List complications of chronic renal failure
1. poor appetites
2. impaired growth --> FTT, short stature
3. Increased IGF-BP so bioavailability of IGF is lower
4. Decreased urine output with impaired excretion of sodium and water
5. Hypertension
6. P, K, Mg accumulate
7. 25-hydroxyVitD3 exiting liver cannot be activated to 1,25-dihydroxyD3 because of low 1-alpha hydroxylase activity
8. Low bioactive forms of VitD3 acompanied by phosphorus retention and secondary hyperPTH lead to renal astodystrophy (renal rickets)
8. Anemia
118
Pattern: dry mucous membrane, can be aroused, dry mucous membranes, and pupillary constriction
clonidine overdose
119
In 1/3 to 1/2 of males with Hemophilia A, no family history, what percentage of those mothers could be carriers
80%, she could have denovo or germline mosaicism
120
Exercise limitations for mild aortic stenosis and moderate
Mild- no restrictions
| Moderate - self-limited aerobic activities and avoid isometric activities
121
Drugs that cause hemolysis with G6PD
Sulfonamides, antimalarials, aspirin, vit K analogs
122
Rx for corneal abrasion
oral pain killers
123
When to refer to ophthalmology after corneal abrasion
if complete healing isn't seen in 2 to 3 days
124
Rx for sulfonylurea overdoses
octreotide
125
Pattern: salivation, lacrimation, urination, diarrhea, and gastic emesis
cholinergic poisoning via inhibition of acetylcholinesterase inhibitor
126
Pattern: failure to gain weight, jaundice, and hepatomegaly and elevated urine reducing substances
galactosemia
127
Adult complications of galactosemia
learning disabilities, verbal dyspraxia, neurologic disorders and ovarian failure
128
Name pro-epileptic drugs
isoniazid, theophylline, cocaine, burproprion, insulin, cyclosporine
129
HOCM genetics
AD
130
Pattern: 16yo boy with family with HCM. Treatment/consult
Cardiology should follow
131
How long does oral iron have to be taken for in anemic patient?
2 months to replenish iron stores
132
Pattern: bump on neck located laterally along the anterior border of SCM, nonmobile
Branchial cleft cysts
133
Pattern: soft midline neck mass that moves vertically when the child swallows or protrudes the tongue, drainage onto the skin
Thyroglossal duct cyst
134
What is a cystic hygroma
lymphangioma, a soft mass of dilated lymph vessels
135
Pattern: on xray, patchy area of diffuse atelectasis, focal areas of air-trapping, and increased lung volume
Meconium stained amniotic fluid
136
Pattern: on xray, air bronchograms, diffusely hazy lung fields, and low lung volume
surfactant deficiency-related respiratory distress syndrome
137
Pattern: Diaphoresis, tachycardia, tremulousness, pallor irritability, somnolence, and coma
hypoglycemia
138
What are some poisons that cause hypoglycemia
oral hypoglycemic agents, insulin, beta-blockers, saicylates, and ethanol
139
What is the RAST method
radioallergosorbent test to measure IgE
140
What needs to be discontinued before skin testing
Anti-histamine 1 week prior to skin testing
141
Can you anaphylax during skin testing?
Yes
142
First-line medication for steroid-resistant nephrotic syndrome
cyclosporine
143
Age when most kids are toilet trained
98% by 3 years
144
Pleural liquic concentration of protein and LDH for transudate and exudate
Transudate protein <3g/dL
| LDH <200 IU/L
145
Which metabolic problem can lead to E. coli sepsis
galactosemia
146
Iron deficiency can lead to what?
impaired cognitive abilities
147
Name the types of fractures that are concerning for NAT
metaphyseal chip fractures, metaphyseal bucket handle fractures, fracture of posterior ribs, scapula, spinous process, sternum, multiple fractures, fractures of different ages, femor fractures younger than 1 year of age, complex skull fractures
148
When would you need to use antivenom in spider bite?
Indicated only when autonomic symptoms or pain cannot be managed with usual measures
149
Pattern: severe muscular cramping, tremors and autonomic symptoms such as drooling and sweating
similar to cholinergic crisis, but can be black widow spider bites
150
Congenital scoliosis is associated with abnormalities in what other organs?
Heart, kidneys and spinal cord
151
Management for child with congenital scoliosis
serial PA and lateral spine radiographs at birth; after 1 year, spine xray should be taken with child standing and the pelvis maintained in a level position, CT with thin slices and 3D reconstruction may be helpful,especially if malformations are multiple or complex; MRI with cratilate is recommended to determine growth potential
152
Which salter should you reduce and which to cast to immobilize?
Reduce Salter III and IV; cast and immobilize V
153
Which Salter sets you up for significant risk for deformity
Salter IV and V
154
Endocrine causes of myositis
hypo/hyperTH, hypercortisolism, hypo/hyperPTH, hypoca/hypoK
155
Drugs that cause myositis
colchicine, lipid-lowering, cyclosporine
156
Metabolic conditions that cause myositis
myhosphorylase deficiency, acid maltase deficiency, lipid storage disease
