\general pediatrics Flashcards
(129 cards)
1
Q
A
measles
3c and 1 K
coryza, cough, conjunctivitis,
coryza= inflammation of membrane int he nose
Kooplik spots ( white spots that occur inside cheeks)
2
Q
p
person with sickle cell disease, history of acute chest syndrome with worsening chest tightness at night and dry cough most likely has
what would you do to diagnose?
A
asthma
spirometry
vs PE would see persistent chest pain and cough.
3
Q
4A preterm baby with rapidly increasing head circumference, seizures, lethargy, hypotonia most likely has
A
Intraventricular hemorrhage
4
Q
acute chest syndrome
A
vascoocculustion of pulmonary vasculature
common in SCD
5
Q
acute onset of pain over the anterior surface of the neck, worsens with swallowing or sticking out tongue + fever and chills is?
A
infected thyroglossal cyst
6
Q
acute post streptococcal glomerulonephritis
what lab should you draw for diagnosis?
A
complement since it lowers complement 3
antigen form IgG ang IgM immune complexes to kidney cells
- will see lower complement 3 , hematuria, and proteinuria
vs IgA nephropathy ( IgA complexes in mesangium)/ Henoch Schonlein purpura
- IgA does not fix complements so will see normal complements
7
Q
angelman syndrome
A
happy puppet syndrome
- unusual gait, unprovoked outbursts of laughter, seizures, microcephaly, speech impairment, hyperactivity, fascination with water, poor sleeping
- deletion of chromosome 15q11-13 from maternal side
8
Q
anorexia induced ammenorrhea labs
A
FSH and LH are low
9
Q
antibiotic pcp px is indicated for
A
Severe Combined Immunodeficiency,
chronic granulomatous disease
10
Q
asymmteric red reflex is a sign of ______ ,
can be in someone with a________
diagnostic test?
A
strabismus, retinoblastoma
dilated funduscopic exam
11
Q
Ataxia telangiectasia
A
autosomal recessive disorder that causes defective DNA repair => tumors and immunodeficiency
B and T cell dysfunction
4 A’s:
ATM gene mutation, Ataxia, spider Angioma, IgA deficiency,
ataxia- gait abnormality, movement abnormality, strabismus
12
Q
bacterial meningitis
A
few days of fever and progresses to CNS symptoms ( HA, lethargy, irritability)
13
Q
bacterial vs viral rhinosinusitis
A
*Bacterial more intense
fever more that 3 days,
symptoms 10 days or more
new or recurrent fever after improvement
14
Q
Beckman Wiedmann Syndrome
What is is, now to monitor, tx?
A
gene disorder
Big Becky likes to get Big
-macrosomia -big head, macroglossia- big tongue
-organomegaly (big organs)
—-> big pancreas produces too much insulin =>hypoglycemia
—-> omphalocele: organs protrude from belly button cus too
likes to get big unevenly
- tumors: nephroblastoma, hepatoblastoma
- hemihypertrophy
Assessment
-abdominal US q3 months until 8 yo
-Alpha-fetoprotein q3 months until 4 yo
Tx. Frequent feedings, resection of tumor
15
Q
biliary atresia
A
absence of extrahepatic biliary tree, commonly common bile duct
- billirubin can;t be excreted and builds up => Jaundice, scleral icterus
16
Q
Blount Disease
A
bowlegs
-abnormality in medial aspect of proximal tibial epiphysis
17
Q
Brudzinki sign
A
sigen for meningitis, knees flex when neck is flexed
18
Q
Bun:Cr ratio in
pre-renal azotemia
intrinsic renal failure
A
> 20 (pre-renal)
<15 (“I” ntrinsic) I looks like 1
19
Q
cause of viral meningitis in unvaccinated child
CSF values
A
mumps, elevated WBC & protein, low glucose
rubella can’t cause meningitis
20
Q
Causes of membranous nephropathy
A
Infection ( Hep B, Hep C, Syphillis)
Malignancy
Autoimmune (Lupus, thyroiditis)
Drugs ( NSAIDS)
21
Q
Chediak Higashi syndrome
A
phagocytic deficiency
oculocutaneous albinism, peripheral neuropathy, progresssive neurological dysfxn
CHEDIA-k
CNS abnormality
HEmorrhage
Decreased Immunity
Albinism
22
Q
Child most with a hoarse voice, most likely had a mother who
A
had an active HPV infection,
lesion affected kid’s vocal cords
23
Q
Chlamydia trachomatis pneumonia onset
A
4-12 weeks
typically afebrile and mild
24
Q
cholesteatoma
A
keratinizing squamous epithelium grows from tympanic membrane or auditory canal to the middle ear mucosa or mastoid air cells
form of chronic otitis media
- foul smelling discharge from ear, conductive hearing loss
-otoscope findings
1)retraction pocket that appears as a brown irregular man
2) pearly white mass behind tympanic membrane
Xray of mastoid process, CT of temporal bone
Tx: surgery
25
Chronic granulomatous disease
defectiveNADPH oxidase,
-susceptible to catalase positive organisms( s. aureus, nocardia, E Coli, candied, klebsielle, pseudomonas, aspergillus, serrait)
26
clinical features of congenital cytomegalovirus in utero
managment
fetal growth resticition, enlarged liver with multiple intrahepatic calcifications, bilateral periventricular intracranial calcifications
management is expectant or pregnancy termination
27
Common variable immunodeficiency
- abnormal differentiation of B cells into plasma cells causes decreased immune globulin production ( no response to vaccinations, normal B cells)
=B cell defect
- will see lots of infections, Giardia, PNA
- TX: immunoglobulin replacement therapy
28
congenital rubella classic triad
CDC
-Cataract,
- sensorineual Deafness,
-Cardiac disease ( patent ductus arteriosis and pulmonary artery stenosis)
Other: fetal growth restriction, hepatomegaly
29
Congenital syphillis
Early <2 yo
hepatomegaly with jaundice,
Snuffles: Rhinorrhea with white or bloody discharge
pemphigus symphiliticus: bullous rash on palms and soles
skeletal abnormality
generalized lymph adepnopathy
Late> 2yoL
- saddle nose, frontal bossing, short maxilla
- hutchinson teeth, mulberry molar, syphillic keratitis, hearing loss
- saber shin ( bowing)
- CN 8 palsy, deafness, intellectual disability
other: PNA, hemolytic anemia, blueberry muffin spots
30
contraindications to breastfeeding
Baby Gotta HAV CASH TU
**Baby** **G**alactosemia
**H**IV
**A**ctive Varicella
**C**hemo or radiation therapy
**A** ctive Substance disorder
**H**erpestic Breast Untreated
active TB Untreated,
31
cornelia de lange syndrome
Bushy Syndrome
long curly eyelashes, hirsutism, short stature, microcephaly, VSD, undescended testes, confluent eyebrow(uni-brow)
intrauterine growth restriction, intellectual disability
32
cri du chat syndrome
cause and core symptoms
mutation of short arm of chromosome 5
think cat-chat: cries like a cat,
high pitched cry
microcephaly, intellectual disability
cardiac VSD
33
dactylitis is_________
sign of _______
symmetric swelling of hands and feet, can see low grade fever, soft tissue swelling on x-ray fo rearly stages
vaso-occlusion in sickle cell disease
34
Delayed separation of umbiilical cord is when
___, caused by?
umbilicial cord remains more than 1 month post partum
leukocyte adhesion deficiency type 1: genetic condition where defect in leukocytic chemotaxis results in decreased phagocytic activity
- leukocytosis, but decreased neutrophils
35
Di Georges syndrome
Classic triad? symptoms
chromosome** 22**q11 microdeletion
Defective development of 3rd and 4th pharyngeal pouch
22 yr old George was a CATCH
**C**left Palate
**A**nomalous face: Micrognathia, dysplastic ears, hypoplastic wing of nose
**T**hymic Aplasia: T-cell deficiency
**C**ardiac Abnormalities (truncus arteriosus, Tetralogy of fallot)
**H**ypoparathyroidism, hypocalcemia with tetany
| classic triad: loss of parathyroid, loss of thymus, congenital heart def
36
dialectal behavior therapy is for
treating emotional dysregulation and self-harm behaviors in borderline personality disorder
37
Digeorge Syndrome
cause
chromosome 22q11 microdeletion
Defective development of 3rd and 4th pharyngeal pouch
Catch 22
CATCH -22
Cleft Palate
Abnormal facies
Thymic Aplasia
Cardiac Abnormalities (truncus arteriosus, Tetralogy of fallot)
Hypocalcemia (no parathyroid)
38
diphtheria
features,
Physical exam finding
prodromal: fever malaise, sore throat (2-5 days)
Systemic: myocarditis, arrhythmmia, septic arthritis
Can be fatal
unique physical finding: grayish white pseudomembrane over posterior pharyngeal wall and/or tonsils
39
excess androgens, virilization, advanced bone age
adrenal tumor
40
Fanconi Anemia
What is it
clinical findings?
increases risk for?
Inherited DNA defect think
Fanconi: Diet Cafe with Abnormal TEA shrinks testes and kidneys
Deafness
Cafe Au lait
mAcrocytic or normocytic Anemia
Thumbs and Ears Abnormal
Atrophy of Testes and Kidneys
inc risk for AML and MDS
41
Febrile seizure age
6 months- 5 years
42
forward best test that shows asymmetric thoracic lumbar prominence is most likely _____
further evaluated via, and managed?
adolescent idiopathic scoliosis (AIS) , x-ray of spine
Cobb angle determines treatment
0-30: monitor
30 or greater: thoracolumbar spinal brace
40-50: surgical fixation
43
fragile x syndrome
X-tra large face, ears, testes
- learning disability
- joint hypermobility
large face with prominent ears, macrocephaly
Flat feet or pes planus
Regurgitation at mitral valve
Autism
Genitals giant after puberty
IQ low
Large face, head circumference
Ears protruding
X sensible joints
44
Friedrich ataxia
autosomal recessive disorder that causes degenerations of spinal tracts: spinocerebellar, posterior columns
FrieD Hassh: Friedrish
Symptoms:
Dysarthria( imparted speech),
Hypercardiotrophic myopathy
Ataxia(impaired gait),
loss of Sense of vibration/propioception,
Skeletal deformity: scoliosis
high arches
45
gastroschisis
46
Gaucher disease
Gaudy GiRl HaS Painted A Bone Meticulously on a Crumpled Tissue Paper
Glucocerebrosidase accumulation in leukocytees and fibroblasts
HepatoSplenomegaly
Pancytopenia
Avascular necrosis of femur
Bone Crisis
Macrophage inclusions that resemble crumpled tissue paper
47
gram diplococci contact precaution
neisseria meningitis
- droplet
48
Hemolytic Uremic Syndrome
hematuria, low C3, acute kidney injury , Hg<8
49
Henoch Schloein purpura
IgA vasculitis
abodominal pain (intusseption)
pupura ( petechal rash on butt & leggs)
Arthralgia following URI
50
hereditary angioedema characterized by
cause and test?
cutaneous swelling , no urticaria or pruritis
abdominal pain, vomitting diarrhea
C1 inhibitor deficiecny will causes decreased levels of C4
51
how do you diagnose bacterial pharyngitis?
1) rapid step antigen
2) If negative, throat culture
causative organism Group A step
**don't use antistreptolysin O antibody cuz it takes too long
52
how should a biliary cyst be managed?
surgical resection to decrease risk of malignancy
53
HSV encephalitis
Triad:
-Focal neuro deficit (aphasia, memory loss, ataxia, altered smell)
-seizure
-altered mental status (confusion)
CSF: inc. lymphocytes, mild inc in protein normal glucose
54
Bruton agammaglobulinemia
- low levels of everything IgG, IgM, IgA, and B lymphocytes
-recurrent sinopulmonary infections
55
Hyper IgM Syndrome or Cd40 ligand deficiency4
recurrent sinopulmomary infections, frequent viral infection, inc risk for opportunistic infection
56
hyperthermia sx and treatment
symptoms: dry hot skin, mental status changes, athletes may continue to sweat profusely
tx: agreesive cooling ie cold immersion therapy
57
Idiopathic intracranial hemorrhage
signs
medications
meds: retinoids, tetracycline, growth hormone
signs: papilledema, headache, bilateral vision changes
vs cluster headache- no papilledema
vs optic neuritis: unilateral, no headache or vomiting
58
In children with an open, full fontanelle and concerns of meningitis-- would you image first or go straight to LP?
LP, no concern of elevated ICP rinse it's open
59
infants born to mothers with __________ are risk for thrombocytopenia
preeclampsia
60
ITP management
Observe
- Children: if cutaneous symptoms only
- Adults: cutaneous symptoms and platelet greater than or equal to 30k
Glucocorticoids, IVIG, and anti-D
-Children: bleeding
-Adults: bleeding or platelet less than 30k
***If all tx given and still symptomatic splenectomy ( spleen recycles platelets and removal sometimes improves low platelet count)
61
laryngomalacia
stridor worsens with feeding, crying and supine position
stridor improves with prone position since tongue moves anteriorly and relieves obstruction
62
lead poisoning management
diagnosis and when to start therapy?
need 2 tests: capillary and venous
start chelations therapy if lead greater than or equal to 45 microgram/dl
63
legs-calves perthes
vascular necrosis of femoral head
-presents as painless limp
onset2-12 yo
64
manamgedment of pediatic patient older than 4 with anogenitial warts
sexual abuse assessment
65
4manifestations of lupus
consitutitional: feverfstigue, wt loss
symmetric: migratory arthritis
Skin: butterfly rash, photosensitivity
serositisL pericarditis
thromboembolic events
neurologic: psychosis, seizures
Hemolytic anemia,
low c3, c4
AB: Anti dsDNA, Anti0Smith, ANA
renal involvement
66
mass that forms in quadricep after trauma is most likely
myositis ossification or heteroscopic ossification
67
McCune Allbirght Syndrome 3 P's
1. precocious puberty
2. polyostotic fibrous dysplasia (normal tissue is replaced. by fibrous tissue causing x-ray changes)
3. pigmentation Café-au-lait spots
68
medicaitons that can casue serum sickness-like reaction
PCN, cefaclor, bactrim
69
milia vs seborrheic dermatitis (SD) vs HSV
milia: unpoppable keratin plugs
- (SD) weepy rash of face and scalp
HSV: child is usually ill
70
moa for drug-induce hemolysis
drug binds to RBS creating hapten for IgG attachment/ hemolysis
71
neonatal teeth mangement
remove if its lose or interferes with feeding, if not just leave it (normal)
72
Neonstal resuscitation whne to just to skin to skin
-term gestation, good, tone, breathing/cryin
- what to do if one of thsoe are not met
1) warmth airway, stimulate
2) If HR <100, initite positve pressure
3) If still bradycardia, CPR advanced resuscitation)
73
nephrItic syndromes
I for Injury to kidney- blood and protein in urine,
drinking IPA beers kills kidney despite seeing DR
- IgA nephropathy, Post strep glomerulonephritis , Alport Syndrome
- Diffuse proliferative and Rapidly progressive glomerulonephritis
74
Nephrotic syndrome
FM DAMM- keeps the peace so no blood seen
-Focal segmental glomerulonephritis, Membrane proliferative glomenrulonephritis
-Diabetes, Amyloidosis, Minimal Change Disease, Membranous Nephropathy
-
75
Neurofibromatosis Type 1
Neurofibromas collect on skin, eyes, bones
CAFESPOT
Cafe Au lait spots
Axillary Freckles
Eye nodules
Skeletal Abonormalties
Pressure high
Optic Tumor
S short
76
newborn how becomes rapidly ill with hypothermia tachycardia, tachypnea, hypotension, and respiratory distress most likely has
CXR: diffuse bilateral granulates
GBS PNA
77
Niemann pick Disease
No Man Pictures the Sphinx PruNing HouSe Cherries
Niemann Pick Dx
Spingomyelinase deficinecy
Progressive neurodegeneration
Hepatosplenomegaly/ Areflexia (difference form tay sachs)
Cherry spots on macula
78
osgood schlatter
overuse causes swelling of tibial tubercles
79
osteogenesis Imperfecta
dec synthesis of collagen type causing brittle bones and hones hyperlaxity
can't BITE only Juice
- Bones (reccurent fracture),
-I ("eye"= blue sclera),
-Teeth Abnormality (opalescent teeth)
-Ears (Hearing loss from faulty ossicles )
Joint Hypermobility
80
otitis media with effusion features
when to plave tympasnostomy tubes?
mild discomfort (ear pulling)
air fluid levels posterior to TM, and poor TM mobility
tympanostomy tubesL OME> 3 months + hearing loss
81
oxidative burst test is used to diagnose
chronic granulomatous disease
82
papilledema
optic disc swelling secondary to elevated intracranial pressure
83
patietn cystic fibrosis with PNA, that does not respond to antibiotics after 1 week, and a high IgE level most liekley has
allergic bronchopulmonary aspergillosis
84
peritonsillar abscess features
large tonsil swelling with deviation of the uvula
- muffled voice
85
pneumococcal-23 is given for
kids with high risk conditions ie sickle cell disease, immune deficiency, congenital heart disease
86
prader wili syndrome
hypotonia, feeding difficulty (need NG tubein infancy(
-GU abnormality ( males, undescended testes)
-small hands or feet, short stature
-adolescence or adulthood: excessive eating and obese
deletion of 15q 11-134 on paternal side
87
primary amenorrhea
no sex chracteristics and no menses AGE 13 OR OLDER
-sex chracteristics but no menses age 15 or older
88
Primary amenorrhea, breast present, but uterus absent
1. mullerian agenesis ( 46,xx) mullerian structures just don't form, normal testosterone 2. Androgen insensitivity syndrome (46, xy) male but no androgen receptor so will see no pubic hair
89
primary amenorrhea: no breasts, no uterus
17 alpha hydroxylase 46,XY
90
primary amenorrhea: no breasts, uterus present
1. no ovarian follicle top produce sex steroid, estrogen ( FSH high) GT17 Gonadal Dysgenesis, Turner Syndrome 17alpha-Hydroxylase deficiency 46(,XX) 2. HPA Axis disorder, low (FSH from lack of GnRh secretion) Kallman Syndrome, lesion in brain
91
patient with no iris
hypospadias, one undescended testes is a riskfor?
willms tumor: delestion f of chromosome 11p13
WAGR Syndrome
wilms tumor
aniridia
genitourinary abnormality
mental Retardation
92
pubertal gynecomastia
features, management
- occurs in tanner stage 304 due to imbalance of estrogen
-features: small < 4cm, firm
- no pathologic features: nipple discharge, axillary lymphadenopathy, systemic illness
management: reassurance and observation, should resolve in a yr
93
rett Syndrome
x-linked dominant ret Reggresses
MECP2 gene mutation, deceleration of brain growth
Lost of speech, gait abnormality, hand wringling, microcephaly
94
Risk Factors for Scoliosis Progression
CSAFE
cob angle greater than or equal to 25 degree
skeletal immaturity
Age< 12 yo
female
early prepubertal status, premenarchal
95
scalp hands and feet
what is this?
crusted scabies
96
septic arthritis symptoms and treatment
ill appearing, acute hip pain, fever, inability to bear weight
-vancomycin
97
child with fever, rash(below), arthralgia (pain in joints most likely has?
Serum sickness-like reaction or Serum sickness reaction
98
side effect with lithium use in pregnancy
Epstein Anomaly: malformed tricuspid valves that are displaced into the RV with subsequent
**TV regurgitation **and **right heart enlargement**
99
side of retinoid derivatives in pregnancy
-microtia (underdevelopment of pinna in ear leads to hearing impairment)
-congenital CNS effects: hydrocephalus, microcephaly, cortical blindness
-congenital heart disease: vessel anomalies
100
SLE lab values
decreeased complement 1q, 2, 3,4, CH50
increased cr
101
slipped cap femoral epiphysis
obese child with a limp
limited internal rotation of hip with waddling gait
femoral head is separated from neck and femur moves anteriorly
102
spastic diplegia vs tethered cord vs transverse myelititis
tethered cord has. lower extremity motor neuron signs ( hyporeflexia, weakness), foot deformity
spastic diplegia: upper motor neuron sign hyperreflexia
transverse myelitis: weakness, bladder dysfunction but no foot deformity
103
strength training can be done in children who are
8 years and older
cognitively mature
104
Tay Sachs Disease
After they hexed tay;;s Sax he becasem deficent
hexosaminidase A deficiency
Developmental delay, hypotonia,
hyperreflexia seizure
cherry red spot on macula
105
TB meningitis lasts
6months- 4yrs of life
- week 1-2: irritable, listless, anorectic
- second stage: seizure, lethary, hypertonicity, hydrocephalus, focal neuro signs
-3rd stage: coma, hypertension, posturing, decompensation, death
diagnostic : increase adenosine deaminase (ADA) activity
106
transient synovitis feeatures
vs. SCFE
vs SCFE affects younger age 3-8yo
107
Transfusion associated circulatory overload
TACO
when blood is transfused in someone who has underlying anemia causes volumes overload
- will see respiratory distress, volume overload,
-s3 gallop, JVD, hypertension pulmonary edema
management : diuresis, oxygenation
108
transfusion related acute lung injury
TRALI
prior to transfusion, host has neutrophils in lungs => donor blood activates those cells , pro-inflmmatory markers released, pulmonary edema
-hypotension, fever, leukopenia, thrombocytopenia
management: aggressive supportive care, ventilator, pressers
NO S3 gallop
109
treatment for OCD
SSRI and cognitive behavioral therapy
110
treatment of anal pinworn
pyrantel pamoate, albendazole
111
trisomy 13
failure to thrive, cleft lip, aseizures, palate , congenital heart disease
low survival
112
Turner Syndrome Symptoms
Horse CLOWNS
Horseshoe kidney
Cardiac abnormality: aortic coarctation or bicuspid aorta
Lymph adenopathy
Ovary nonexistent
W ebbed neck
Nipples wides spaced and Nails dysplastic
Short stature
113
Turner syndrome karyotype
45,xo - partial deletion of x chromosome results in gonadal dysgenesis
-short stature,
-FSH ,and LH high
114
VATER
or VACTERL, normal intelligence
3of the following:
Vertebral defect,
Anal atresia/ imperforate anus
Cardiac defect
TracheoEsophageal fistula
Renal/radial defect
Limb abnormalities ( fusion of fingers, too little or too many fingers, long bones)
115
vesicoureteral reflux- what is it?
- complications
-presentation
retrograde flow of urine through ureter
-febrile UTI
-if untreated can renal scarring, CKD, and recurrent pyelonephritis
116
44Vin Hippel Lindau Diisease symtoms
mutation of VHL - tumro suppresoors
-cerebellar & retinal hemiangioblastoma
-phreochromocytoma
-renal cell carcinoma (clear cell)
117
what is congenital dacryostenosis
nasolacrimal duct obstruction
- duct fails to form resulting in blocked tear flow
-fluorescein testL dye persists and flows down cheek vs abrasion where ther would only be disrete staining
118
what is this and mangemnt?
molluscum contagious
just watch it, shoudl self resolve
119
what is this?
Right upper lobe atelectasis
linera density with associated shooting of mediastinum towards collapsed lung
120
what is this?
clasisc scabies
121
what is this?
impetigo
122
what is this?
Kawasaki disease
unknown cause: genetic or infectious
-cervical lymphadenopathy unilateral
CRASH and BURN
Conjuntivitis, Rash, Adenopathy, Strawberry tongue Hands and feet swelling
BURN (fever for at least 5 days)
123
what is this?
psoriasis
124
4what is this? mangement?
neurofibromatosis type 1
NF1 genetic test to confirm
125
what's marked not he chest x ray?
sail sign; thymus
- could be absent in Di George Syndrome
126
clinical features of developmental hip dysplasia
Red flags: + ortolani test, dislocated hip, limited hip abduction
supportive: limb-length discrepancy, asymmetric gluteal inguinal/thigh creases
treatment pavlik harness
127
which blood pressure measurement method is the most accurate?
auscultation or oscillometric?
ausculation
128
why would someone with sickle cell disease have Howell-jolly bodies?
episodes if vasoocculusive pain crisis leads to autoinfarction of the sleep and functional asplenia
- spleen no longer remove nuclear remnants of RBC (Howell-jolly body)
129
Wiskott Aldrich Syndrome
bleeding due to microthrombocytopenia, recurrent infections, and eczema
- low platelet count
