High Yield Flashcards
(165 cards)
1
Q
Epiglottitis clinical symptoms
A
Drooling, neck, hyperextension, toxic, appearing, fever, hypoxia, retractions
2
Q
EpiGlottitis treatment
A
Intubation, antibiotics, steroids
3
Q
When do you see steeple sign on X-ray?
A
Croup
4
Q
Croup treatment
A
Nebulized epi, systemic steroids, intubation if needed
5
Q
Preceding upper respiratory infection and evidence of cervical lymphadenitis. Treatment?
A
Reassurance
6
Q
Best way to diagnose retro pharyngeal abscess
A
CT w IV contrast
7
Q
Causes of retropharyngeal abscess
A
Strep or staph species usually
Sometimes anaerobes
Fusobacterium necroforum in teens-high fever, dec ROM, respirator distress, Lemieres syndrome (jugular venous thrombosis)
8
Q
Treatment for orbital cellulitis
A
ENT consultation
IV or IM antibiotics: ceftriaxone, cephalexin, Pip/tazo
Metronidazole in case of brain abscess
9
Q
What is Potts puffy tumor?
A
Pott puffy tumor is a forehead swelling due to frontal bone osteomyelitis with associated subperiosteal abscess. PPT is a rare complication of sinusitis, but can also occur due to trauma. PPT is most commonly seen in the pediatric and young adolescent populations due to the pneumatization process and venous drainage.
10
Q
Patient with cheek pain, fever, swelling, and erythema of overlying skin, pain increased with oral intake
A
Parotitis
Usually viral-mumps paramyx
Treatment is pain control, warm, compress, IV clindamycin, or vancomycin
11
Q
What is a known complication of parotitis?
A
Facial nerve palsy
12
Q
Most common cause of mastoiditis
A
Strep pneumonia
13
Q
Treatment of mastoiditis
A
Broad spectrum IV. Antibiotics and surgical IND.
14
Q
Causes of microcytic anemia
A
Iron deficiency versus thalassemia
15
Q
Macrocytic anemia causes
A
B12/folate def, hypothyroidism
16
Q
Normalcy anemia causes
A
Blood loss, hemolysis, lead, chronic disease
17
Q
Mutation in beta globin gene
A
Sickle cell disease
18
Q
How to treat acute chest syndrome
A
Strep pneumonia and mycoplasma coverage
19
Q
What is the most common cause of osteomyelitis in sickle cell disease?
A
Salmonella
20
Q
How does hydroxy urea help sickle cell disease patients?
A
Increases fetal hemoglobin concentration
21
Q
How does folic acid help sickle cell patients
A
Supports red blood cell turnover
22
Q
What is for virchows triad?
A
Stasis, endothelial injury, hypercoagulability
23
Q
How do you diagnose pulmonary embolus?
A
CT angiogram
24
Q
How do you treat thrombosis in kids with sickle Cell?
A
Anticoagulation: enoxaparin is the standard. Usually three months for provoked DVT/PE or 6 to 12 months for unprovoked. Then transition to oral rivaroxaban
25
Hemarthrosis, easy bruising, epistaxis, bleeding with circumcision would make you worry for what?
Hemophilia
Suspect this with an isolated elevated PTT
26
Management of hemophilia
Desmopressin and aminocaproic acid for preventing clot breakdown
Factor infusion or FFP for low factor levels
27
Patient presents with mucosal bleeding, bruising, menorrhagia
Von Willebrand disease (platelet adhesion factor)
28
Genetic causes of thrombocytopenia
Fanconi disease, gaucher, Wiskott-Aldrich, TAR syndrome
29
Baby presents with absent radius. What diagnostic modality would be our next step?
CBC to look for thrombocytopenia.
Tar syndrome
30
Treatment for ITP
Usually supportive care but short course of steroids if needed
31
Treatment for HUS (fever, anemia, thrombocytopenia, renal dysfunction)
Early hydration improves outcomes.
Eculizimab is helpful for some sub types
32
Fever and neutropenia that waxes and wanes every 3 to 6 weeks
Cyclic neutropenia
Treat w G-CSF
33
Pancreatic insufficiency, bone marrow dysfunction, skeletal abnormalities and short stature
Schwachman diamond syndrome
34
And what is the most common cause of child maltreatment?
Neglect
35
If you suspect abuse or neglect, are you compelled to report the family even if you’re not sure?
Yes, we are mandated reporters
36
What is the most common presentation of physical abuse?
Skin injuries
37
Is bruising normal in an infant?
Bruising is rare in preambulatory infants
38
What is the most common location for accidental bruising?
Over bony prominences
If location is on the butt, genitals, cheeks, etc. that is less likely to be accidental
39
What do abusive patterns of bruises look like?
More bruises, clusters of bruises, imprint of object
40
Children and infants presenting with excessive bruising, what workup should we do?
CBC, PT/PTT, VWf ag/activity, factor 8 and 9 levels for hemophilia
41
What is TEN4-FACESp
Infant/children with bruises in these areas should raise your concern
TEN: torso, ears, neck.
4: children less than four years of age and infants less than four months of age.
FACES: frenulum, angle of the jaw, cheek, eyelid, sclera.
P: patterned injury
42
What type of fractures are highly associated with the abuse?
Infants and toddlers with midshaft, humorous or femur fractures.
Non-mobile infants with fractures.
High specificity fractures: rib, scapula, classic metaphyseal lesions, vertebrae, sternum
43
What labs to workup fractures in kids you suspect abuse in?
Ca, Phos, Alk phos, Mg, PTH, 25-hydroxyvitamin D
44
Indications for skeletal survey
• Bruises, burns or other skin injuries in non-ambulatory infants
• Oral injuries in non-ambulatory infants
• Burns concerning for abuse in children < 2
• Fractures concerning for abuse in children < 2
• Unexplained intracranial injuries (hemorrhage and hypoxic-ischemic injury)
• Unexplained, unexpected sudden death
Infants and siblings < 2 years and household contacts of an abi child **Twins!!)
45
recommended occult workup for abdominal injury in children less than five years old?
AST/ALT, lipase
If AST/ALT is > 80 or lipase > 100 get a CT of the abdomen with contrast or if there’s any external evidence of abdominal injury
46
What is the leading cause of child abuse related fatality?
Abusive head trauma
47
Initial screening for abusive head trauma
Head CT not head ultrasound
48
If head CT shows intracranial injury or hemorrhage in a suspected child abuse case, what should be your next step?
MRI brain and spine
Dilated opthalmalogic exam
49
How do you calculate prevalence?
Total number of people with the condition divided by population at risk
50
How do you calculate sensitivity in the 2 x 2 table?
A/A +C or true positive/everyone with the disease
SNOUT rules out
51
Is sensitivity dependent on incidence?
No it’s just dependent on characteristics of the test itself
52
What does specificity indicate in plain terms?
If a patient does not have the disease what is the likelihood the test will be negative
53
How do you calculate specificity?
True negative/everyone without disease
D/B+D
SPIN rules in
54
In plain terms, what is positive predictive value and negative predictive value?
PPV: what is the likelihood I have the disease if I test positive?
NPV: what is the likelihood I don’t have the disease if I test negative?
55
What is a graph that shows the trade-off between sensitivity and specificity called?
Receiver operating characteristic curve
56
If someone has screened positive for a disease like positive PPD…What is the most important characteristic of a confirmatory test?
That it is highly specific.
If you hear screening think specificity
57
Screening for a disease like screening for ebola amongst travelers. What is the most important statistic?
Sensitivity
58
Screening for a disease like screening for ebola amongst travelers. What is the most important statistic?
Sensitivity
59
What would be the most important statistical test if you are deciding to omit urine culture in a febrile infant with negative urinalysis?
NPV
60
What statistical test is most important if you’re interpreting a positive rheumatoid factor in a patient with no signs or symptoms of auto immunity
PPV
61
What is a case control study?
Retrospective; compares cases (with disease) to controls (without) to identify past exposures
62
What is a case control study?
Retrospective; compares cases (with disease) to controls (without) to identify past exposures
63
What is a cohort study?
Prospective or retrospective; follows a group over time to assess the effect of exposures on outcomes
64
What is a cross-sectional study?
Snapshot; examines the relationship between variables and outcomes in a population at one point in time
65
What is a randomized controlled trial?
Prospective; participants are randomly assigned to groups to test the effect of an intervention
66
Informed consent components
Capacity to consent
Disclosure of options
Voluntariness
67
Areas were adolescence can legally give consent
Mental health
Sexual health
Substance abuse
Emancipation or mature minor
68
Symptoms of episodic tachycardia, hypertension, hyperthermia, diaphoresis, posturing/dystonia, agitation, and discomfort
Dysautonomia
69
Treatment for dysautonomia
Beta blockers like propanolol, alpha 2 Agonist like clonidine, dopamine, like bromocriptine, gabapentin
70
Medication management for bladder dysfunction/neurogenic, bladder, resulting from peripheral or central nervous system injury
clean intermittent catheterization
Alpha blocker like tamsulosin or doxazosin
Anticholinergics like oxybutynin
Botox in detrusor
71
What is the major side effect of Dantrolene?
Black box warning for hepatotoxicity
72
What is the major side effect of Dantrolene?
Black box warning for hepatotoxicity
73
Which class of drugs has the greatest negative impact on cognitive function and patients with brain injury?
Benzodiazepines
74
If a patient needs to self administer a drug (hospital doesn’t have it) the hospital must:
Ensure an order allowing self administration of the drug is written
75
What is the cutoff for hypoglycemia per the AAP and pediatric endocrine society for the first four hours of life?
AAP less than 40
PES less than 50 (for first 24 hours)
76
What is the cutoff for hypoglycemia per the AAP and pediatric endocrine society for the first four hours of life?
AAP less than 40
PES less than 50
77
What is the cutoff for hypoglycemia per the AAP and pediatric endocrine society for 4-24 hours of life?
AAP less than 45
PES less than 60 (24-48 hours)
78
What is a syndrome that can cause hypoglycemia? What are the features?
Beckwith Wideman syndrome.
Everything is big: big tongue, eyes, macrosomia, umbilical,hernia, cryptochordism, posterior ear pit or anterior lobe crease
79
Contraindication for PTX
Porphyria
80
What to consider with a baby that has a direct hyperbilirubinemia
Galactosemia
Hypothyroidism
Sepsis.
Biliary atresia and other causes of cholestasis
81
How does a kid with Biliary atresia present?
Acholic stools
Persistent jaundice 3 to 5 weeks.
Hepatomegaly.
82
How do you work up a child suspected of having biliary atresia?
Ultrasound.
Hida scan
Liver biopsy.
Gold standard: intraoperative cholangiogram
83
What is the definitive treatment for biliary atresia?
Kasai procedure less than 60 days is the best outcome
84
What is a syndrome that would present with direct hyperbilirubinemia that is autosomal dominant, kid has a triangle shaped face with a broad forehead and deep, set eyes, pointed chin, elongated nose with a bulbous tip. Bike duct, paucity, stasis, cardiac PPS, butterfly vertebrae, CNS vasculopathy
Alagille syndrome
85
What respiratory distress cause will have decreased lung markings?
PPHN
86
What chest x-ray finding will be seen with meconium aspiration syndrome and what infection can mimic this syndrome?
Patchy infiltrates.
Listeria pneumonia can mimic
87
What is neonatal hyperviscosity syndrome?
Small baby who is plethoric with high hematocrit and is grunting/in respiratory distress, hypoglycemic
Blood cells are eating up the glucose
88
Newborn presents with maternal history of flu like symptoms and ingestion of unpasteurized milk/cheese/undercooked poultry. Newborn has a patchy chest x-ray resembling MAS and also had meconium stained fluid. Baby has a nodular skin rash is stressed.
Listeria.
Fetus is stressed, which is why they end up with meconium
Modular skin rash is called granulomatosis infantisepticum
89
Newborn with chlamydia pneumonia…treatment?
Azithromycin for 3 days or erythromycin for 14 days
90
Is it ok to breastfeed if Hep C positive?
Yes
91
Not moving arm/hand. Claw hand
Klumpke
C8/T1
92
What does VACTERL stand for
Vertebrae
Imperfect anus.
Cardiac.
TEF
Renal
Limb
93
Which congenital anomaly includes extra fingers and toes, as well as heart, renal, brain, eye, cleft lip palate, IUGR?
Trisomy 13
94
Which congenital anomaly has overlapping fingers, club feet, low set ears, and lots of other stuff
Trisomy 18
95
Baby with conotruncal CHD-TOF, hypoplastic thymus (low T cells), parathyroid hypoplasia (calcium)
DiGeorge 22q11
96
Mom 16 weeks pregnant and has increased alpha fetoprotein
Anencephaly
97
Contraindications for BF
Galactosemia
HIV
Untreated brucellosis
Active herpes/TB
Suspected/confirmed Ebola
Opioids/PCP/cocaine
Radioactive isotope therapy
98
Baby with jaundice, CATARACTS, vomiting, helatomegaly, poor feeding, diarrhea, and E. COLI SEPSIS in the first few days of life
GALT or galactosemia
99
Doe infant ingestions: One pill can kill (name them)
Clonidine
Fentanyl
Beta blockers
Ca Channel blockers
100
During which period of time after an ingestion can you use activated charcoal?
60-90 min
101
Which substances can you not use activated charcoal for an ingestion?
Corrosive substances
Will not work with rapidly absorbed liquids or elements on the periodic table (iron, lead, potassium, calcium, lithium, cyanide)
102
What is the antidote for ingestion of organophosphates?
Atropine
Pralidoxime
103
What is the antidote for ingestion of toxic alcohol’s like methanol or ethylene glycol?
Bicarbonate, Fomepizole for both
Also Folate for methanol and pyridoxine for ethylene glycol
104
If the question stem states that they have altered mental status, and everything is up (increased heart rate, blood pressure, respiratory rate, temperature), agitated. What to ingestion categories are you going to distinguish between?
Anticholinergic vs sympathomimetic
105
Signs of an anticholinergic ingestion versus cholinergic
Anticholinergic: red, dry, blind, mad, hot. MYDRIASIS
Cholinergic: salvation, lacrimation, urination, diarrhea, bronchorrhea, fasciculations MIOSIS
106
When comparing an anticholinergic versus a sympathetic ingestion, all of the vital signs will be increased in the pupil sizes will both be dilated. What is one way to distinguish between the two of them?
Sympathomimetic will have diaphoresis (also tremor and seizure)
107
Tx for anticholinergic ingestion
Physostigmine
108
If everything is going down, decreased heart rate, blood pressure, respiratory rate, temperature, depressed, mental status think about which ingestions
Opioids, sedative hypnotics, ethanol
109
Question includes information on a Tylenol ingestion, but the labs were obtained prior to the four hour mark. If the lab is below treatment level, what do you do next?
Repeat at four hour mark
110
When do you give N-acetylcysteine, other than when the level is above the treatment line?
If a Tylenol ingestion exceeds 150 mg/kg or over 7.5 g
Unknown time of ingestion and Tylenol level is over 10 µg per milliliter.
Patient with known Tylenol ingestion with abnormal AST/ALT, PT/INR
111
Pit viper bite management versus coral snake bites.
Pit viper bites (rattlesnakes, copperheads, cottonmouth) cause hemotoxic/derma, toxic issues and bleeding disorders so you have to check PTT/PT/INR, D dimer, fibrinogen
112
Patient with symptoms of opsoclonus (rapid disconjugate eye movements) of acute onset along with other neuromuscular signs. What bite or sting?
Scorpions
113
Usually after a bite they do not recommend early primary closure, except for which part of the body…
Face and neck
114
What indicates a poor prognosis in drowning?
Submersion more than five minutes.
No early basic life support.
Development of ARDS
115
Heat stroke is a temp of greater than what?
>104/F40C
AMS
116
Hypothermia versus hyperthermia: in which one do you use IV fluids to correct the temperature?
Hypothermia-warmed IVF w dextrose
Contraindicated in hyperthermia
117
Radiographic modality to work up, abdominal trauma in pediatrics?
CT with IV contrast
118
When you’re working up a burn, is superficial thickness or a first-degree burn included in the calculation of total body surface area included?
No
119
When does a patient need a burn center referral?
Partial thickness burns greater than 10% TBSA
BURNS THAT INVOLVE FACE, HANDS, FEET, GENITALIA, PERINEUM, MAJOR JOINTS
Any third-degree burns
Electrical burns/Chemical burns/Inhalation injury
Burns in complicated pts
120
What are the only two FDA approved treatments for children and teens with depression?
Fluoxetine (children and teens)
Escitalopram (teens only)
121
What is the mainstay of treatment for kids with somatic disorders?
CBT
122
Clues in the question stem that should lead you towards diabetes insipidus
Central: mentions trauma, cns infections, hypothalamic or pituitary defect
Nephrogenic : meds-lithium especially, chronic renal failure, sjogrens, sickle cell disease, polycystic kidney disease
123
What does the lab look like in diabetes and insipidus?
Increase serum osmolality, decreased urine osmolality.
Decreased urine spec gravity, increased serum sodium, increased urine volume
124
How does primary polydipsia differ from diabetes insipidus on labs?
In primary polydipsia, the serum osmolality is low as compared to diabetes insipidus where it is high
Serum sodium will be normal in primary polydipsia
125
Next step after dx of central diabetes insipidus
Brain MRI
Tx w PO DDAVP
Correct free water deficit
126
Tx for nephrogenic diabetes insipidus
Thiazide diuretics or indomethacin
127
Pt w hyponatremia and some other condition like pneumonia, a neurological infection, or medication‘s, like carbamazepime NSAIDS, etc.
Think about SIADH
128
Differences between SIADH and diabetes insipidus
SIADH is freewater excess, hyponatremia serum hypo osmolality with inappropriate urine hyperosmolality (concentration)
Diabetes inipidus is free water loss, hypernatremia with polydipsia/polyuria/dilute urine
129
What can affect absorption of levothyroxine in the treatment of congenital hypothyroidism?
Soy containing foods/formulas.
Meds such as iron.
Calcium
130
Newborn screening is likely to miss which type of hypothyroidism?
Central hypothyroidism
131
Which lab value will be different for Hashimoto’s versus congenital hypothyroidism
Both of them have low free T4 and high TSH, but Hashimoto’s is positive for anti-thyroid antibodies
132
In hyperthyroidism or Graves’ disease, what labs do you get and what is the mechanism?
You’ll see low TSH, high T4 and T3
TSH receptor activating or stimulating antibodies… TSI or TAHR-Ab
133
Treatment of hyperthyroidism
Methimazole
Can cause agranulocytosis so get baseline anc
134
Patient with numbness around the mouth with tingling and fingers and toes and maybe some muscle cramps.
Hypocalcemia
Probably won’t mention but maybe Chvostek sign, trousseau’s sign (BP cuff induced tetany), seizures
135
Vitamin D deficiency vs hypoparathyroidism
Vitamin D/ calcium, and phosphorus will start off normal.
Hypoparathyroidism: calcium is low and phosphorus is high
136
Bones, stones, groans, and psychiatric overtones
Hypercalcemia (>12-14)
137
Classic presentation for adrenal insufficiency
Fatigue, orthostatic hypotension, hyponatremia, hyperkalemia, hypoglycemia
138
What lab findings would suggest Addison’s disease?
Low cortisol (if low or drawn at wrong time move to ACTH stimulating test)
High ACTH
Positive adrenal auto immune antibodies
139
Treatment for primary adrenal insufficiency
Correct, hypotension and dehydration, hypoglycemia, electrolyte imbalance
Correct cortisol deficiency
Glucocorticoid stress dosing if sick sick
Fludricortisone
140
What studies to order for critical sample of glucose less than 50 mg/L?
Stat glucose level
Insulin
C-peptide
Cortisol
Growth hormone.
Beta hydroxybutyrate
Lactate and free fatty acids.
Comprehensive metabolic panel
141
Work up for an infant with recurrent I hypoglycemia
Exocrine profile.
Free insulin
Ammonia
Plasma amino acids
Urine Organic acid
142
What is the criteria for medical management of appendicitis and what antibiotics do you use?
Over seven years old.
Normal white blood cell count (less than 18,000)
Less than 48 hours of pain
Confirmed on imaging
No preggers or super sick
Ceftriaxone and metronidazole
143
What is the criteria for medical management of appendicitis and what antibiotics do you use?
Less than seven years old.
Normal white blood cell count (less than 18,000)
Less than 48 hours of pain
Confirmed on imaging
No preggers or super sick
Ceftriaxone and metronidazole
144
If a kid presents with bilious vomiting, hemodynamic instability and distention, tenderness, peritonitis and hematochezia. What is the work up and treatment?
Malrotation.
Diagnosed with upper G.I.
Treat with the Ladds procedure
145
What does duodenal atresia look like on x-ray and what congenital anomaly is associated with?
Double bubble
Trisomy 21
146
How to distinguish Crohn’s disease from ulcerative colitis
Crohn’s: patchy, mouth to anus, full thickness, perianal fistula, erythema nodosum and pyoderma gangrenosum, cobblestoning, non-caseating granulomas
Ulcerative colitis: colon only, mucosal layer only, toxic megacolon, crypt abscess
147
Who should you image if they have AMS?
Trauma, edema, bleeding, shunt malfunction, mass effects.
If you’re worried about empyema or abscess, do it with contrast
148
What three infections have high rates of febrile seizures?
Salmonella, shigella, roseola
149
Seizures: who to treat
After second unprovoked seizure, those presenting in status, known neurological disease with expected recurrence of seizures
150
Acute management of seizures:
benzodiazepines.
If that fails, levetiracetam, valproic, fosphenytoin, phenobarbital loads
151
Child with fever, headache, photophobia, and cochlear implants is at risk for what infection
Meningitis
152
Which infection causing meningitis has a really high opening pressure?
Lyme
153
What is a major cause of chronic headaches?
Medication overuse
154
What are some risk factors for pseudotumor cerebri?
Vitamin A in excess
Tetracycline
Sleep apnea
Lupus
155
Treatment of botulism
Under one-year-old: human derived botulism immunoglobulin
Over one year-old: equine serum botulism antitoxin
156
Lumbar puncture that shows cytogenic dissociation (100–150 protein, less than 10 white blood cells)
Guillan Barre
157
Patient newly diagnosed with Duchene muscular dystrophy…what is the next best step?
ECHO
158
Lab finding in Kawasaki disease
Anemia for age
Thrombocytosis
Hypoalbuminemia
Elevated ALT
Leukocytosis
Sterile pyuria
159
Patient with alopecia, diarrhea, dermatitis with erythematous plaques on the cheeks and buttocks
Acrodermatitis enteropathica
Inherited defect in zinc absorption
160
Port wine stains in a distribution of the ophthalmic division of the trigeminal nerve are associated with what condition
Sturge-Weber syndrome
161
What is DRESS?
Drug rash with eosinophilia and systemic symptoms
Etiology: phenytoin, phenobarbital, carbamazepine, lamotrigine, sulfonamides, trimethoprim
Patients are sick appearing with lymphadenopathy, rash, organ dysfunction, most commonly hepatitis.
Starts one to six weeks after the exposure
162
How is dress diagnosed and treated?
Labs will show eos, atypical lymphocytosis, pancytopenia, elevated AST ALT.
Get skin biopsy if uncertain.
Treatment is removal of offending agent.
High dose corticosteroids
163
What is Brutons agammaglobulinemia?
Absence of B cells
Presents after 6 mos
Severe infections
No tonsils
Need monthly IVIG
164
What is common variable immune deficiency?
Acquired disorder of antibody production.
Presents after 2yo
Low IgA, IgG, IgM
Lymphoma, autoimmune disease
Monthly IVIG
165
What are the characteristics of DiGeorge?
CATCH 22
Cleft palate
Abnormal faces.
Thymic plasia leading to T cell deficiency.
Congenital heart defects.
Hypocalcemia
Chromosome 22 microdeletions
