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Flashcards in Med Ed Videos Deck (80):
1

Transient tachypnea of newborn

self-limiting
seen after c-section in healthy babies

-DX: CXR --> hyperexpanded lungs, wet

2

pathophys, DX of IVH, and TX

vascular lining of ventricles bleed --> bleeding and increased ICP

cranial dopplers
TX - decrease ICP (VP shunts, drains)

3

NEC

dead gut --> bloody bowel movement

DX: XR --> air in wall of bowel

TX: NPO + abx (can use TPN for feeding)
--> surgery (f/u short gut)

4

Causes of failure to pass meconium

1) imperforate anus
2) meconium ileus
3) Hirschbrungs

5

Imperforate anus

associated with VACTERL

DX: crosstable XR + f/u on VACTERL abnormalities with U/S sacrum, echo, catheter

TX: mild --> fix now, severe --> colostomy now, fix later

6

Meconium ileus

CF --> decreased H2O in bowel lumen
DX: XR --> transition point with gas filled plug
TX: Water enema
f/u sweat chloride test + ADEK, pancreatic enzymes + pulm tests

7

Enterobius verbicularis (pinworm)

perianal pruritis, especially at night
-vulvovaginal sx may be presenting sx in prepubertal girls

DX: tape test
TX: albendazole or pyrantel pamoate

8

Complete AV septal defect (CAVSD)

most common congenital heart defect in patients with down sydome

--> failure of endocardial cushions to merge --> ASD + VSD

SX: diaphoresis/dyspnea with feeds
-loud S2 due to pulmonary HTN
-systolic ejection murmur (increased flow across pulm valve from ASD)
-holosystolic murmur of VSD

9

Etiologies of pediatric stroke

-sickle cell disease ** Most common
-prehtrombotic disorders
-congenital cardiac disease
-bacterial meningitis
-Vasculitis
-Focal cerebral arteriopathy
-Head/neck trauma

10

Diamond-Blackfan Syndrome (DBS)

aka congenital hypoplastic anemia

-MACROcytic anemia, low retic count (NO hypersegmented neutrophils like you would see in B12)
-congenital anomalies

-defect of erythroid progenitor cells which results in increased apoptosis

11

Wiskott-Aldrich syndrome

X linked disorder characterized by eczema, thrombocytopenia, and hypogammaglobulinemia

12

Fanconi's anemia

AR defect in DNA chromosomal break repair

1) Aplastic anemia + progressive BM failure
2) Short stature, microcephaly, abnormal thumbs, hypogonadism
3) hypopigmented / hyperpigmented areas + cafe au lait spots and large freckles
4) strabismus, low set ears, middle ear problems (Deafness)
5) predisposition to developing cancer

13

Choanal atresia

suspected with newborn cyanosis aggravated by feeding, relieved by crying

*congenital nasal malformation caused by failure of nasal passage to cannalize

CHARGE syndrome - Coloboma, Heart Defects, Atresia choanae, Retardation of growth/development, GU anomalies, Ear abnormalities (deafness)

14

Nephrotic syndromes (4)

1) Minimal change disease (peds)

2) FSGS
3) Membranous nephropathy
4) Membranoproliferative glomerulonephritis

15

Nephritic syndrome

1) Post strep glomerulonephritis (peds)
2) Hemolytic uremic syndrome (peds)

3) IgA nephropathy
4) Mebranoproliferative glomerulonephritis
5) crescentic glomerulonephritis

TX: hematopoietic stem cell transplantation

16

Hirschbrung's

DX?
SX?
TX?

failure of migration of inhibitory neurons --> auerbach/meissner's plexus of DISTAL colon

DX:
-XR (normal colon distended)
-bx --> no plexus
-contrast enema or anometral manometry also works
SX: failure to pass meconium in 48hrs w/explosive stool on DRE

TX: surgical resection

17

Voluntary holding

pain, embarrassment causes kid to hold in stool
-voluntary holding --> overflow incontinence

DX: clinical
TX: behavioral, stool softeners, disimpaction

18

Causes of bilious emesis (4)

1) Malrotation
2) Duodenal atresia
3) Annular pancreas
4) Intestinal atresia

19

Causes of non-bilious emesis (2)

1) tracheoesophageal fistula
2) pyloric stenosis

20

Malrotation

failure of rotation with an otherwise normal uterine course (no polyhydramnios, no DS)

DX: XR (UGI series) --> DOUBLE BUBBLE, nml gas pattern beyond

TX: NG tube --> decompress bowel, and then surgery

f/u: volvulus

21

Duodenal atresia

failure of duodenum to recanalize

associated with DS

DX: XR with DOUBLE BUBBLE + NO gas distally

TX: surgery

22

Annular pancreas

failure of apoptosis of pancreas
associated with DS

DX: XR with DOUBLE BUBBLE + no gas distally

23

Intestinal atresia

vascular accidents in utero
DX: XR with double bubble and multiple air fluid levels
TX: surgery
f/u: short gut

24

Tracheoesophageal fistula

blind pouch +/- fistula

Day 1 presents with nonbiliary emesis

DX: NG tube coild on XR
TX: parenteral nutrition and surgery

25

Pyloric stenosis

hypertrophy of pyloris --> gastric outlet obstruction
presents in males around 2-8wks

SX:
-PROJECTILE, nonbilious vomit
-olive like mass
-visible peristaltic waves

DX: US --> "donut sign"

TX: pyloromyotomy

f/u: metabolic abnormalities: hypochloremic, hypokalemic, metabolic acidosis 2/2 vomiting

*give fluids before surgery

26

Direct bilirubin (conjugated)

charged, water soluble
excreted/trapped in urine --> DARK URINE
CANNOT cross BBB or cell membranes, and thus CANNOT get kernicterus

27

Indirect bilirubin (unconjugated)

fat soluble
NOT excreted in urine --> no dark urine
crosses BBB --> KERNICTERUS

28

Name the cause of the hyperbili:
1) + coombs
2) - coombs, low hgb
3) - coombs, high hgb
4) - coombs, nml hgb, increased retic count
5) - coombs, nml hgb, nml retic

1) + coombs = isoimmunization

2) - coombs, low hgb = hemorrhage (cephalohematoma)

3) - coombs, high hgb = transfusion (twin-twin, delayed clamping, maternal)

4) - coombs, nml hgb, increased retic count = hemolysis (G6PD, pyruvate kinase deficiency, HgbSS)

5) - coombs, nml hgb, nml retic = problem with reabsorption (breast milk jaundice vs. breast feeding jaundice)

29

breast milk jaundice

can present many months later
-breast milk component inhibits conjugation of bilirubin
--> use hydrolyzed formula

30

breast feeding jaundice

presents in first day of life
-also have sx of dehydration

problem with quantity of breast milk --> decreased bowel function and increased absorption of bili

31

Causes of unconjugated hyper bili

hemolysis or hemorrhage

32

causes of mixed hyper bili

Crigler Najar, Gilberts --> problem with uptake
Dubin Johnson, Rotors --> problem with excretion
Hepatitis

33

causes of conjugated hyper bili

biliary atresia
sepsis
metabolic

34

Diaphragmatic hernia

hole in the diaphragm --> bowel in chest, lung hypoplastic

SX:
-scaphoid abdomen
-bowel sounds in chest
-on L>R side and post>lat

DX: XR
TX: surgical + steroids for lung development

35

Gastroschisis/omphaloscele

gastroschisis = uncovered, to R of midline
omphalocele = covered, midline

36

extrophy of bladder (appearance?)

midline defect, shiny, red, wet w/urine

37

biliary atresia

worsening jaundice @7-14 days
-DIRECT hyperbili

DX: US --> no ducts
HIDA after 5-7 days of phenobarbital

TX: surgery

38

common causes of failure to thrive

failure to thrive = loss of weight --> loss of height --> then HC

1) genetic dz
2) heart dz
3) pyloric stenosis
4) GERD
5) CF

39

Developmental milestones:
2 months
4 months
6 months
1 yr

2 months - lift head, social smile, noise
4 months - roll over, ----, noise
6 months - sit up, stranger anxiety, noise
1 yr - walk, separation anxiety, 1 word

40

Developmental milestones:
2 yrs
3 yrs
4 yrs
5 yrs

2 yrs - steps, 2 words
3 yrs - tricycle, 3 words, circle
4 yrs - hop, 4 words, cross
5 yrs - skip, 5 words, triangle

41

Epidural hematoma

LENS
LUCID interval
middle meningeal artery
+ LOC

"walk, talk, die"
sports, skiing

42

Subdural hematoma

+ LOC, CESCENT shaped
ped vs. car, MVA, abuse

43

Severity of concussion:
Mild

Severe

Mild - no FND, <60 sec LOC, no HA or improving, no amnesia --> NO TX, go home

Severe - + FND, > 60 sec LOC, + HA or worsening, + retrograde/anterograde amnesia --> CT SCAN, even if negative, admit for obsurvation

44

Parkland burn formula

%BSA x4 x kg body weight = total fluids in first 24 hrs

give 50% in first 8 hrs, and 50% in next 16 hrs

45

Erythema infectiousum

SX
F/u?
TX?

Parvovirus B19
"slapped cheek"

Fever + rash at SAME time (on cheeks(

TX supportive

f/u: aplastic crisis (sickle cell)
hydrops fetalis

46

Measles

SX
F/u?
TX?

parvomixovirus

prodrome (cough, coryza, conjunctivitis, Koplick spots (white dots in mouth))
--> Fever + Rash

BEGIN ON FACE --> trunk/arms, spares hands and soles

TX: supportive

ppx: MMR vaccine

f/u: subacute sclerosing panencephalitis

47

Rubella

German measles

rash starts on FACE --> trunk/extremities
+Fever and rash

PRODROME = generalized tender lymphadenopathy

TX: supportive

48

Roseola

HHV-6

Prodrome: very high spiking fever (104) --> THEN RASH

rash starts on TRUNK --> expands out

f/u febrile seizures

49

Varicella-Zoster

rash w/o fever

diffuse rash, vessicles on erythematous base in different stages of healing

f/u shingles

50

mumps

pubertal males
parotid swelling, orchitis

f/u infertility

51

hand-foot-mouth disease

cocksackie A

looks like varicella, but on hands, feet, and mouth

52

TX of meningitis

if < 30d --> vanc + cefotaxime + ampicillin +/- steroids

> 30d --> vanc + CTX +/- steroids

53

Tx for scabies and lice

permethrin

54

causes of acute otitis media

strep pneumo, moraxella, h. flu

55

SX, DX, TX of AOM

pain relieved by pulling inner ear
NO light reflex
Erythematous, fluid, pnuematic insufflation --> NO TM movement

TX: amoxicillin vs. augmentin (amox/clav) for a recurrence

IF >3x/6months or 4x/12 months, then consider tympanoplasty

IF penicillin allergic use cefdinir or azithro

56

Otitis externa

swimmers ear, digital trauma --> staph

unilateral ear pain, worse w/ear pulling

TX: abx (cipro) drops +/- steroid drops

57

Mastoiditis

increased risk with otitis media and externa or tympanoplasty

swelling behind ear + ear rotated forward

tX: surgical

58

Sinusitis

URI bugs (strep)

SX: BL purulent discharge --> f/u foreign body if recurrent
DX: no imaging - f/u ct scan if recurrent
TX: supportive vs. amox-clav

59

Centaur criteria

NO cough +1
exudates +1
nodes +1
temp > 38 +1
< 14 yrs +1, >44 -1

IF < 1 , do nothing
IF 2-3, test for strep
IF > 4, TX w/abx

60

Laryngotracheobronchitis

croup

parainfluenza
usually in 3 month-3yrs of age

VIRAL PRODROME + barking "seal like" cough + stridor

DX: XR --> steeple sign (subglottinc narrowing)
Racemic epi --> improves

TX:
mild --> mist
mod --> racemic epi + steroids + O2
severe --> admit

61

Howell-Jolly bodies

nuclear remnants of RBCs that are removed by a functional spleen

if asplenic or functionally asplenic (sickle cell)

62

Bacterial Tracheitis

caused by staph aureus

sx: croup that does not improve --> + fever, increased WBC (toxic appearing)
-does NOT improve with racemic epi

TX: IV ABX

63

Epiglotitis

bug?
sx?
dx?
tx?

path: H. Flu

sx:
-3-7yr old, SAS, rapid onset, high spiking fever, drooling, tripod +muffled voice + accessory muscle us

DX:
-thumbprint sign on XR
-cherry red epiglottis

TX:
-secure airway in OR

64

Retropharyngeal abscess

bug?
sx?
dx?
tx?

path: oral flora
sx: SAS, rapid onset, high fever, drooling, neck extended, stiffness, muffled voice

DX:
-anterior chain, tender lymphandenopathy
-tender mass (abscess)
-CT scan

TX: I+D and IV abx

65

Peritonsilar abscess

bug?
sx?
tx?

path: oral flora

sx: >10yrs, muffled voice, drooling, sore throat
**UVULA DEVIATED**

TX: drain + abx

66

Foreign body airway obstruction

sx: < 3yo left unattended w/sudden onset SOB

DX:
-extrathoracic = INSPIRATORY stridor
-Intrathoracic = EXPIRATORY wheeze
-XR --> coin sign

TX: abx
-rigid bronch if in lungs
-endoscope if in GI
-laryngoscope if ENT

67

What is the coin sign?

coin sign
-> nml AP, seen on lateral = object in TRACHEA
--> seen on AP --> NOT in trachea

68

Intussusception

SX

ABRUPT COLICKY abd pain
-knee-chest relief
-CURRANT-JELLY stool/diarrhea
-sausage shaped pass in RUQ
-age 3 months - 3yrs

69

Intussusception

DX/TX

DX:
-US
-XR KUB --> r/o perforation/obstruction
-AIR ENEMA = dx and tx

TX:
-air enema
-surgery if peritonitits, perf, failure of air enema

70

VSD

common in DS
-often dx <1yr, asx murmur with severe cases can have FTT or CHF

DX: echo
TX: asx --> wait 1 yr, CHF --> repair

71

in what settings can you get congenital cataracts?

1) TORCHES infections
2) galactoremia - develop quickly after birth

72

Posterior urethral valves

SX: can't get urine out of bladder due to redundant tissue --> hydronephrosis, oligohydramnios, decreased or no UOP, distended bladder

TX: catheter + surgery

73

X-linked agammaglobulinemia

no Ig's
mostly boys
decreased B cells
sinopulmonray infections at 6 months old

DX: quant Igs (shows none) and flow cytometroy shows no B cells

due to mutation in BTK gene

TX: schedule IgG transfusions

74

CVID

onsent in teens, mild XLA

nml CBC with decreased in quantitative Igs (2/3 of Igs lower)

75

IgA deficiency

decreaed IgA --> decreased mucosal immunity

sinopulmonary infections
GI bugs
anaphylaxis with transfusions

76

Wiscott Aldrich

atopic dermatitis, eczema
decreased platelets

DX: low WBC, low plts, increased IgM and IgG

77

Leukocyte adhesion deficiency (LAD)

WBC can't get out of vessels
pt has increased fever, increased WBCs WITHOUT PUS

delayed cord seperation

TX: BMT

78

SCID

no immune defense, no B or T cells

adenosine deaminase deficiency

bubble babies, BM transplant

79

Chediak Higashi

giant granules in neutrophils

associated with albinism, neuopathy, neutropenia

80

Chronic granulomatous disease (CGD)

no respiratory burst so neutrophils can't kill gram + organisms

--> staph abscesses

DX: nitro blue, increased WBCs, increased IgM and IgG