Complex febrile seizure have what characteristics?
Treatment?
Focal, > 15min duration, recurrent
Anti-epileptic
Unconjugated bilirubinemia w/- Coombs test, normal Hgb, and + retic count means what?
Path?
Hemolysis or hemorrhage
HS, G6PD, pyruvate kinase def OR hematoma/bleed
Rubella is what kind of virus?
How does the rash start?
Prodrome presents how?
Togavirus
Face and spreads down to toes
tender LAD, Forchheimer spots in mouth
Treatment for BPD?
Give O2 and lung protective strategy ventilation
Perinatal surfactant and ante-natal steroids
Brief period where gasping respiration’s start followed by what?
Treatment?
Secondary apnea
Bagging
6 months old what can you do?
Think June summer solstice
Sitting at a picnic and having stranger anxiety with mom’s weird friends raking your face
What is the workup for suspected in meningitis if FAILS (Inc ICP) Positive?
Blood Cx —> Abx —> CT scan —> LP
How do you diagnose Meckel’s?
Treat?
Technicium-99 radionucleotide scan
Surgically
What are the most effective treatments for allergic rhinitis?
Intranasal corticosteroids
When is Palivizumab used?
RSV prevention in premature infant
What is the treatment for bacterial tracheitis?
F/u with what?
IV Abx
Scope
Pt that has bloody diarrhea plus fever indicates what?
Treatment?
Shigella, salmonella, E. Coil, Yersenia
Stool culture, hydration, electrolyte management
What bugs MC cause OE?
Pseudomonas
S. Aureus
Scoliosis suspected, 1st step in diagnosis?
Next?
Treatment?
Adam’s test
Xray
Bracing or surgery for severe cases
When does Legg-Calve-Perthe Disease occur?
Can suffer what?
CFs?
Dx and treat how?
6 years old
AVN of the hip
Insidious knee pain, antalgic gait
Xray, then cast
What is bronchiolitis?
Caused by what?
Inflammatory disorder of the small airways caused by a viral infection
RSV most common
What is Hirschsprung’s?
Always where?
Absent ganglion migration of Meissner and Auerbach plexus
Rectum/distal colon
What causes TGA?
Needs what to survive?
Pregestational diabetes
PDA
What will the Haptoglobin content be in a sickle cell pt?
LDH?
Low
High
What causes HFMD?
Appears how?
Coxsackie A
Vesicle on erythematous base, can involve buttocks
What is an osteochondrosis aka traction apophysitis?
Osgood-Schlatter disease
Pt with fungal or PCP infection most likely has what?
CBC shows what?
DiGeorge syndrome
Dec Lymphocytes
What presents in a premature infant w/acidosis, HoTN, bloody diarrhea?
NEC
What flu vaccine is the MC?
What is MC given to kids?
Inactivated
Live attenuated intranasal
Multi physic or to and fro heart lesion is called what?
PDA
Pts 5-15 have the highest incidence of GAS, so what can you do?
Jump straight to testing if they do not have viral sx (cough, rhinorrhea)
How does choanal atresia present in a baby?
Blue at rest
Pink up while crying
Childhood snoring
Supplemental oxygen use in a premature infant indicates what?
What is the pathology behind it?
BPD
Decreased surfactant and alveoli
What are the indications for Exchange transfusion in sickle cell crisis?
Encephalopathy
FND
Chest pain
Noncardiogenic pulmonary edema
Syndrome w/interictal EEG showing hypsarrhythmia is what?
Treatment?
West syndrome (Infantile spasm)
ACTH aka cosyntropin
Meconium aspiration syndrome causes what complications?
Treatment in infant w/pulse < 100 and poor tone?
Severe pulmonary complications
Endotracheal auctioning w/endotracheal tube
What presents as a bone cancer w/fever, leukocytosis and night sweats?
Ewing Sarcoma
When do kids need to be admitted to the burn ward for fluid replacement?
> 10% BSA
1 year old what can you do?
Think Christmas
Walking over to Santa to grasp and pinch him but getting separation anxiety when leaving him
What is the CENTOR score?
Absent cough = +1 Exudate (tonsillitis) = +1 Nodes (Ant chain LAD) = +1 Temp > 38C = +1 OR: < 14 = + 1 > 44 = -1
Major feature of Tuberous sclerosis?
3+1 other assoc CF?
Intellectual disability
Ash leaf spots, Lisch nodules, angiofibromas
+1 = sebaceous adenoma
How do you diagnose Asthma?
Describe the condition
PFTs showing decreased FEV1/FVC
Reversible bronchoconstriction and inflammation
What starts w/a high fever > 40C that breaks as the rash starts?
What is the pattern of the rash?
Roseola
Begins on trunk, spreads to face
Cataracts in newborn, think what?
If later on but still early life?
TORCH infection
Galactosemia
What is an atretic or anatomically stenosis connection between the nose and mouth called?
Choanal atresia
What describes a complex partial seizure?
Generalized?
Focal, (+) LOC
Total body, (+) LOC
What is the treatment for tetanus if sx have already started?
Sedation+intubation
Muscle relaxers
Metronidazole
What presents as a sunburst pattern on distal femur?
Osteosarcoma
What is the BRUE definition?
< 1 year old + < 1 min duration +
- change in color, tone, respirations or responsiveness
1st step in workup of 3/6 hear murmur in child less than 1 y/o is what?
Echocardiogram
Breast milk jaundice is what kind of issue?
Treat how?
What is elevated?
Quality aka enzymes (at 6-14 days), mom’s milk inhibits conjugation
Temporarily substitute formula
Indirect bili
What is TTN?
Seen in what?
How does the infant present?
CXR shows what?
Delayed clearance of fetal lung fluid
C section
Grunting and tachyons
Hyperexpanded and wet
Febrile illness w/joint pain points to what?
Dx how?
Septic hip
Xray, then joint aspiration w//gram stain and Cx
Osteomyelitis due to a dog bite, what organism?
Sickle cell?
Penetrating injury?
Pasteurella
Salmonella
Coag-negative Staph
Inheritance of CF?
How do these kids present?
Management focused on what?
AR
FTT, meconium ileus, frequent respiratory infections
Lungs (pseudomonas) and pancreas
How does duodenal atresia present?
Assoc w/what?
Polyhydramnios, X-ray shows double-bubble w/NO distal air
Down syndrome
What causes chemical conjunctivitis in newborns?
Occurs when?
Silver nitrate
24 hours
If assessing for kidney stones bc of hematuria, what test to image it?
Non-contrast CT
Pt w/sickle cell crisis has what lab values?
INC bilirubin
INC reticulocyte
DEC platelets
DEC Hgb
What high electrolytes can cause FTPM?
Low ones?
Ca, Mg
hypoglycemia, hypokalemia
Albinism, neuropathy, neutropenia w/giant granules, wither recurrent stap aureus infections is what?
Cheddar Higashi
What to do if febrile seizure lasts more than 5 min?
Abort seizure w/benzos
What do you do in a pt that is older than 3 but younger than a teenager in suspicion of GAS?
Rapid strep test
Delayed separation of the cord most likely has what?
Labs should what?
LAD
WBC VERY high
When is the median age of onset for neuroblastoma?
How to tell it apart from Wilms tumor?
19 months
It crosses midline
Pharyngitis plus rash on palms/soles is what Dx?
Coxsackie
How does annular pancreas present?
Double-bubble with or w/out distal air
What presents as sudden onset dyspnea in a young child?
Do what?
Foreign body aspiration
Chest XRay
Pt that is persistently hypoxic that does not improve w/oxygenation has what?
How do you know?
Treat how?
TGA
None of the inspired oxygen is getting into the systemic circulation
PGE1, then surgery
CMP in baby w/pyloric stenosis shows what?
Hypochloremic
Hypokalemic
Metabolic alkalosis
6 mo old baby w/FTT after feeding most likely has what?
Treat how?
Milk-soy protein allergy
Hydrolyzed formula
What are some Non-organic causes of FTT?
Formula
Feeding
Frequency
Premature infant what are the 4 diseases to consider?
IVH
BPD
ROP
Necrotizing enterocolitis
Pt w/X-ray showing air fluid levels with a gas filled plug has what?
Treatment?
Meconium ileus
Water-soluble contrast enema or surgery
How to treat NEC?
Surgery can cause what?
NPO, IV Abx (against g negs), and TPN
Short guy syndrome
what has a 3 Hx spike on EEG?
Absence seizure
Mild Concussion describe the following:
FND
LOC
HA
Amnesia
CT
None
< 60 seconds
None, improving
None
No CT, go home
What is the response to high pressure in the pulmonary circulation?
RVH and Pulm HTN
What age group does bacterial trancheitis?
What is seen on xray?
Looks like what? But what?
5-7 years
Subglottic narrowing
Croup but they are more ill-appearing
Adolescent w/hot potato voice and uvula displaced to one side indicates what?
MC pathogens?
Peritonsillar abscess
GAS, S. Aureus, anaerobes
What kind of virus is measles?
Sx?
Biggest concern?
Paramyxovirus
Cough, coryza, conjunctivitis, Koplik spots
SSPE
Premature infant w/blood bowel movement must r/o what first?
Necrotizing Enterocolitis
Sickle cell pts have what other than sickled cells on blood smear?
Howell-Jolly bodies
What describes a loss of consciousness and the CT shows punctuate intracerebral hemorrhages?
Cerebral contusion
Coup and contra-coup injuries
For a pt w/3 or more lifetime doses of Tetanus vaccine, what is the treatment for a dirty wound if it has been more than 10 years since the last dose of vaccine?
Less than 10 years?
Tdap
Home
Premature baby and bloody diarrhea = what?
Dx how?
Tx?
NEC
Babygram xray
NPO, TPN, IV Abx
Arthrocentesis that shows wbc > 50,000 means what?
Septic joint
What is a good first test for immunodeficiency?
QIGs and CBC w/diff
What does the X-ray show in a Hirschsprung’s pt?
Treatment?
Dilated proximal colon (normal)
Normal distal colon (ABNORMAL)
Pull-through procedure, colostomy
A teenager with a heart murmur < 3/6 w/no palpable thrill, what is the workup prior to starting sports?
NONE - he can play, yeah i said HE
For a pt w/less than 3 lifetime doses of Tetanus vaccine, what is the treatment for a clean wound?
Dirty?
Tdap
Tdap + TIG
What presents w/altered mental status, no tonic-clonic activity and the pt will have mild confusion after?
Complex partial seizure
What is an absolute contraindication to DTap?
Relative?
Hx of encephalopathy
Fever > 40C w/in 48 hours, shock, persistent crying (3+ hours), seizures w/in 3 days
Pharyngitis plus conjunctivitis in kid, what is it?
Adenovirus
Pt with CGD has what kind of NBT test?
Treat how?
Negative
Bactria, itraconazole, bone marrow transplant
Tx for Hyper-IgM syndrome?
IVIG
What is primary apnea?
Apnea from any perinatal insult, it will quickly respond to stimulation
What presents w/recurrent sinusitis, OM, PNA and shows that there is a B-cell deficiency?
What Ig levels present?
Tx?
Bruton’s Agammaglobulinemia
All Igs are LOW. —> A, G, E, M
IVIG
What is the parkland formula?
Used for what?
%BSA x Kg x 4
2nd and 3rd degree only
What must you check for in the head?
Caput succedaneum (CROSSES sutures) or cephalohematoma
What are peak incidences of IBD?
10-20 and 50-80
Acute OM and swelling behind the ear that is anteriorly rotated indicates what?
What cause?
Mastoiditis
Pseudomonas
Female pt w/constant leak that has never been dry has what?
Dx how?
Tx?
Ectopic ureter
US, VCUG, radionuclide scan
Surgery
How do you treat active pertussis?
Erythromycin
What is an inspiratory sound of the upper airway that indicates a partial obstruction near the trachea or larynx?
Stridor
Bilious vomiting means what?
Obstruction is distal to biliary tree or NO obstruction at all
Direct hyperbilirubinemia requires a workup for what?
Sepsis (wbc, blood Cx) Obstruction (HIDA scan) metabolic diseases (Rotor, Dubin, etc)
Unconjugated bilirubin w/+ Coombs test means what?
Path?
Isoimmunization
Rh or ABO incapability
A pulse between 60-100 requires what in newborn?
< 60?
If no improvement upon treatment do what?
Ongoing ventilation
Chest compressions at 3:1 ratio
Epinephrine via umbilical vein catheter
What presents as a harsh holosystolic murmur at the left sternal border?
Assoc w/what?
VSD
FTT, HF, Down syndrome
Severe Concussion describe the following:
FND
LOC
HA
Amnesia
CT
Positive
> 60 seconds
Present or worsening
Retro/anterograde
Get it to r/o Bleeding
Prophylactic PCN is indicated for kids w/sickle cell in what age?
Def < 5
Probably until Age 18
How do you interpret the CENTOR criteria?
< 1 no further testing
2-3 perform rapid testing
>/= 4 empiric Abx
1st step in pyloric stenosis?
Diagnose how?
Then what?
Immediate IVF for rehydration
US showing donut sign
Pyloromyotomy
Pnematosis intestinalis means what else?
Seen in what condition?
Air in the wall of the bowel
Necrotizing enterocolitis
What is the biggest issue of cleft lip/palate?
Others?
Feeding - FTT
OM, feeding problems, hearing difficulties, speech pathology
How does a pt w/UPJ present?
What is the MC pt population?
Colicky ABD pain
Teenager after binge drinking
When does CVID usually present?
Ig levels will show what?
Thx?
Mid to late childhood
2/3 Igs will be low - A, G, M
IVIG
How to prevent SIDS?
Sleep on back
Don’t share beds
Smoking cessation
What causes croup?
MC age group?
AP film shows what?
Treat how?
Parainfluenza virus
6mo - 3yr
Steeple sign (clear lungs w/subglottic narrowing)
Racemic Epi and steroids
What does derecruitment mean?
Alveoli that get stuck together and fail to open
What is an enanthem?
Rash on the mucous membranes
What presents as double-bubble and multiple air-fluid levels?
What pathology? Due to what?
Intestinal atresia
Vascular accident in utero —> cocaine
Baby w/imperforate anus, what do you want to do first?
Never do what?
Cross table X-ray
Take temp rectally
Baby that has FTT, what is the first thing to go?
Next?
Last?
Weight
Height
Head circumference
What are some organic causes of FTT?
Genetic (CF) Cardiac disease Pyloric stenosis GERD Hyperthyroid
What causes ROP?
Why?
Treat how?
Prematurity
High oxygen delivery
Laser photocoagulation
What medications can cause FTPM?
Magnesium
Opiates
Newborn male that presents w/low or no urine output and a palpable bladder has what?
May be PMHx of what?
Posterior urethral valve
Oligohydramnios
What is the definitive way to treat biliary atresia?
Kasai procedure - hepatoportoenterostomy
What gives away HSV encephalitis?
Mention to hippocampus
Bloody LP
4 months old what can you do?
Think April Fool’s
Rolling over in Laughter
If it is a situation of hereditary angioedema, how do you treat?
FFP
How to treat PNA when it is a typical pathogen?
Atypical?
Amoxicillin
Azithromycin
When should congenital esotropia be corrected?
6 months
What do you use to determine if if blood in stool of newborn is maternal or fetal origin?
What yields a + test?
Apt test (alkali desaturation test)
Fetal blood resistant to denaturation
Ewing sarcoma found what part of bone?
Diagnose how?
Buzz words?
Diaphysis (shaft)
MRI
Onion skin, moth eaten
What is a Mongolian spot?
Seen in whom?
Mistaken for what?
Dermal melanocytosis
Latin America and east Asia
Bruising
What is the definitive test for OM?
Pneumatic insufflation (tense immobile membrane)
Pt w/severe jaundice needs what? Decide how?
If it fails then what?
Phototherapy, look at a nomogram
Exchange transfusion
Describe features of simple febrile seizure
Generalized
< 15 min in duration
1 episode in 24 hours
No underlying neurological problems
Pt w/GAS that is treated appropriately is still at risk for what?
Untreated can lead to what?
PSGN
Rheumatic fever
What is the SE of Ceftriaxone if used in kids < 30 days old?
What to use instead?
Hyperbilirubinemia
Cefotaxime
What kind of vomiting means there is an obstruction distal to ampulla of Vater?
1st step in workup?
Bilious
X-ray —> gas patterns
RDS can cause what?
Infant presents how?
CXR shows what?
Surfactant deficiency causing atelectasis
Premature w/grunting
Low lung volumes w/uniform granular pattern
Pt w/TEF can be diagnosed how?
NG tube coils up, use X-ray
Baby w/biliary atresia what is the 1st step in workup?
Next?
Last?
US plus LFTs
HIDA after phenobarbital
Liver biopsy —> intraoperative cholangiogram
What makes a high-risk BRUE?
Hx suggestive of Dz
Physical suggestive of dz
CPR performed
Multiple, recurring
What is the cut off for failure to pass meconium?
48 hours
But most do so w/in 24 hours
2 months old, what can you do?
Think Valentines Day
Lift your head to Smile
How do you treat acute crisis in sickle cell?
IVF
O2
IV pain meds
Abx if infection present
Breast feeding jaundice is what kind of issue?
Treat how?
What is elevated?
Quantity (newborn < 7 days), bowel moves too slow
Increase # of feeds
Indirect bili
How to treat apnea of prematurity?
Give caffeine
What is the MC SE for the HPV vaccine?
Recommended in what age groups?
Syncope
9-26
How do you treat shingles outbreak?
TCA
Gabapentin
Colicky ABD pain w/abrupt onset in kids 3mo - 3 years indicates what?
Diagnose how?
Treatment?
Intussusception
US
Air-contrast barium enema, if it fails, then surgery
What is characterized as low glucose?
How to treat SYMPTOMATIC hypoglycemia?
If it is persistent?
< 40-45
2mL/kg of D10W
Dextrose infusion
What presents w/double-bubble but Normal gas pattern?
Diagnose how?
Malrotation/volvulus
Upper GI series, contrast enema
Unconjugated bilirubinemia w/- Coombs test but high Hgb means what?
Path?
Blood transfusion
Twin-twin, maternal-baby, delayed cord clamping
What is right of midline and without a membrane congenital defect?
Gastroschisis
Retinal hemorrhages in a baby indicate what?
What else?
Shaken baby syndrome
Subdural hematoma
How do you treat scabies?
Permethrin or lindane
Newborn w/clicky hip has what?
Diagnose how?
Treatment?
DDH
US in 4-6 weeks
Harness
Bleeding with pattern of dysmorphic urinary rbcs, rbc casts, and coca-colored urine points to what cause?
Glomerular
Chediak-Higashi is what inheritance?
CFs?
AR
Neutropenia, necrosyphilis
Job syndrome is what?
Present how?
Hyper IgE
Cold abscesses (Staph, H.flu, Strep pneumo0
Fungal or PCP infections with underlying heart defect in newborn think what?
Treat how?
DiGeorge
Prophylaxis w/Bactrim and scheduled IVIG
What is the MC heart defect in kid > 1 y/o
ASD
Describe how much BSA is in each of the following areas: Head Front thorax Back thorax Arms Legs Genitals
9+9 = 18 9+9 = 18 9+9 = 18 (4.5 per side) L=9, R=9, 18 total 9+9+9 = 27 1
How do you treat lice?
Permethrin or malathion
Paralysis + encephalitis?
West Nile
What will classify anaphylaxis?
2 of the following: HoTN or End-organ damage (syncope) GI sx Skin/mucosa Respiratory sx
What is normal hemoglobin composed of?
Sickle cell?
a2B2
A2B2 with Valine substitution
What can Parvo virus cause in adults?
Arthritis
How to treat TTN?
O2 and CPAP/intubation aka PPV
Femoral or skull fracture in a kid indicates what?
Child abuse
What is the MC primary immunodeficiency?
How do they present?
IgA def
Anaphylaxis after blood transfusion
Baby w/imperforate anus, what else do you want to look for?
Vertebral Anus Cardiac TracheoEsophageal Fistula Esophageal atresia Renal Limb
1st step in workup of yellow baby?
Next?
Transcutaneous sensor
Draw bilirubin level
Bowel sounds over the lungs w/scaphoid abdomen in a dyspneic baby means what?
Diagnose how?
Congenital diaphragmatic hernia
Babygram - xray
What is an exanthem?
Rash on the skin
What is the treatment for Toxo/PJP?
Alternate?
If can’t use alternate?
TMP/SMX
Dapsone
Atovaquone
What are the 2nd gen H1 antihistamines used to treat urticaria?
Cetirizine
Loratadine
Fexofenadine
What presents w/high fever w/rapid onset, pt will be drooling and tripoding?
AP film shows what?
Treat how?
Epiglottis
Thumbprint sign
Controlled intubation
What presents w/a fixed, wide split S2?
How to close?
ASD
Catheter-directed device closure
What are the features of ToF?
See what on xray?
Assoc w/what?
Due to defect in what?
PROV
Pulmonic stenosis, RVH, overriding aorta, VSD
Boot-shaped heart
Down syndrome, DiGeorge
Endocardium cushion
Baby w/HTN, claudication (refuses to walk) most likely has what?
Dx how?
Treat?
Coarctation of the aorta
BP on arms and legs, Echo next
Surgery
What presents w/synovial inflammation up to 4 weeks after uri or GI viral illness?
Septic hip
Unilateral conjunctivitis most likely due to what?
When?
Treat how?
Chlamydia
Day 5-14
Erythromycin PO
For a pt w/3 or more lifetime doses of Tetanus vaccine, what is the treatment for a dirty wound if it has been more than 5 years since the last dose of vaccine?
Less than 5 years?
Tdap
Home
What does urology pelvic US look at?
Can tell you what?
The tubes
Hydronephrosis (obstruction) is or NOT
Baby that has bubbling and gurgling w/respirations has what?
TEF
Meckel’s diverticulum is remnant of what?
Presents how?
Omphalomesenteric (vitelline) duct
FOBT, Fe def anemia, or hematochezia
How long should kids be in booster car seats?
Until 4’9’’ and 8-12 years old
What is the workup for suspected in meningitis if FAILS (Inc ICP) Negative?
LP —> CSF and Blood Cx —> ABx
Pulse < 100 or respiratory difficulties at 30 seconds means what?
Do what ?
Primary apnea
PPV
Double bubble w/no distal gas pattern indicates what?
Duodenal atresia or annular pancreas
Posthepatic jaundice has what pathology?
ASO
Atresia
Sepsis
Obstruction
What shape can you make as a 3 year old? What gross motor?
4? G motor?
5? G motor?
Circle, trike
Cross, hop
Triangle, skip
What are the 5 criteria of APGAR and what does normal mean?
Appearance - pink Pulse - > 100 Grimace - with stimulation Activity - resists extension Respiration - STRONG
Pt w/recurrent pulmonary infections, GI infections w/high fever, and massive leukocytosis. No pus in the infections has what?
LAD - CD18
When does the intraventricular lining involute?
How to screen for it?
What happens?
Treatment?
34 weeks
Cranial US
Increases ICP
VP shunt
Is rotavirus vaccine live or killed? Given how?
Biggest SE?
Live, orally
Intussusception
What presents in a kid w/drooling and a fever w/neck fixed in a sniffing position w/refusal to move and has a muffled voice?
What imaging to get?
What special Clinical Feature?
Retropharyngeal abscess
CT scan
Unilateral LAD
Pt w/sinopulmnary infections and absent IgA with poor DNA repair has what?
Ataxia Telangiectasia
Conjugated bilirubin is always ________ as it is indicative of problems w/________?
Pathologic
Biliary excretion
Unconjugated bilirubinemia w/- Coombs test, normal Hgb, and - retic count means what?
Path?
Reabsorption problem
Hemorrhage, breast feeding jaundice, breast milk jaundice
How long should children be in a rear-facing car seat in the back of the car?
2 y/o
SCFE occurs in whom?
Dx. How?
Obese teen or one in a growth spurt
frog-leg Xray
What kind of pts are more susceptible to voluntary constipation?
Tx?
Retarded kids
Manual disimpaction
