Complex febrile seizure have what characteristics?
Focal, > 15min duration, recurrent
Unconjugated bilirubinemia w/- Coombs test, normal Hgb, and + retic count means what?
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?
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?
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?
Technicium-99 radionucleotide scan
What are the most effective treatments for allergic rhinitis?
When is Palivizumab used?
RSV prevention in premature infant
What is the treatment for bacterial tracheitis?
F/u with what?
Pt that has bloody diarrhea plus fever indicates what?
Shigella, salmonella, E. Coil, Yersenia
Stool culture, hydration, electrolyte management
What bugs MC cause OE?
Scoliosis suspected, 1st step in diagnosis?
Bracing or surgery for severe cases
When does Legg-Calve-Perthe Disease occur?
Can suffer what?
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?
Absent ganglion migration of Meissner and Auerbach plexus
What causes TGA?
Needs what to survive?
What will the Haptoglobin content be in a sickle cell pt?
What causes HFMD?
Vesicle on erythematous base, can involve buttocks
What is an osteochondrosis aka traction apophysitis?
Pt with fungal or PCP infection most likely has what?
CBC shows what?
What presents in a premature infant w/acidosis, HoTN, bloody diarrhea?
What flu vaccine is the MC?
What is MC given to kids?
Live attenuated intranasal
Multi physic or to and fro heart lesion is called what?
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
Supplemental oxygen use in a premature infant indicates what?
What is the pathology behind it?
Decreased surfactant and alveoli
What are the indications for Exchange transfusion in sickle cell crisis?
Noncardiogenic pulmonary edema
Syndrome w/interictal EEG showing hypsarrhythmia is what?
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?
When do kids need to be admitted to the burn ward for fluid replacement?
> 10% BSA
1 year old what can you do?
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?
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?
Begins on trunk, spreads to face
Cataracts in newborn, think what?
If later on but still early life?
What is an atretic or anatomically stenosis connection between the nose and mouth called?
What describes a complex partial seizure?
Focal, (+) LOC
Total body, (+) LOC
What is the treatment for tetanus if sx have already started?
What presents as a sunburst pattern on distal femur?
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?
Breast milk jaundice is what kind of issue?
What is elevated?
Quality aka enzymes (at 6-14 days), mom’s milk inhibits conjugation
Temporarily substitute formula
What is TTN?
Seen in what?
How does the infant present?
CXR shows what?
Delayed clearance of fetal lung fluid
Grunting and tachyons
Hyperexpanded and wet
Febrile illness w/joint pain points to what?
Xray, then joint aspiration w//gram stain and Cx
Osteomyelitis due to a dog bite, what organism?
Inheritance of CF?
How do these kids present?
Management focused on what?
FTT, meconium ileus, frequent respiratory infections
Lungs (pseudomonas) and pancreas
How does duodenal atresia present?
Polyhydramnios, X-ray shows double-bubble w/NO distal air
What causes chemical conjunctivitis in newborns?
If assessing for kidney stones bc of hematuria, what test to image it?
Pt w/sickle cell crisis has what lab values?
What high electrolytes can cause FTPM?
Albinism, neuropathy, neutropenia w/giant granules, wither recurrent stap aureus infections is what?
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?
WBC VERY high
When is the median age of onset for neuroblastoma?
How to tell it apart from Wilms tumor?
It crosses midline
Pharyngitis plus rash on palms/soles is what Dx?
How does annular pancreas present?
Double-bubble with or w/out distal air
What presents as sudden onset dyspnea in a young child?
Foreign body aspiration
Pt that is persistently hypoxic that does not improve w/oxygenation has what?
How do you know?
None of the inspired oxygen is getting into the systemic circulation
PGE1, then surgery
CMP in baby w/pyloric stenosis shows what?
6 mo old baby w/FTT after feeding most likely has what?
Milk-soy protein allergy
What are some Non-organic causes of FTT?
Premature infant what are the 4 diseases to consider?
Pt w/X-ray showing air fluid levels with a gas filled plug has what?
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?
Mild Concussion describe the following:
< 60 seconds
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?
Croup but they are more ill-appearing
Adolescent w/hot potato voice and uvula displaced to one side indicates what?
GAS, S. Aureus, anaerobes
What kind of virus is measles?
Cough, coryza, conjunctivitis, Koplik spots
Premature infant w/blood bowel movement must r/o what first?
Sickle cell pts have what other than sickled cells on blood smear?
What describes a loss of consciousness and the CT shows punctuate intracerebral hemorrhages?
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?
Premature baby and bloody diarrhea = what?
NPO, TPN, IV Abx
Arthrocentesis that shows wbc > 50,000 means what?
What is a good first test for immunodeficiency?
QIGs and CBC w/diff
What does the X-ray show in a Hirschsprung’s pt?
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?
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?
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?
Pt with CGD has what kind of NBT test?
Bactria, itraconazole, bone marrow transplant
Tx for Hyper-IgM syndrome?
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?
All Igs are LOW. —> A, G, E, M
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?
Female pt w/constant leak that has never been dry has what?
US, VCUG, radionuclide scan
How do you treat active pertussis?
What is an inspiratory sound of the upper airway that indicates a partial obstruction near the trachea or larynx?
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?
Rh or ABO incapability
A pulse between 60-100 requires what in newborn?
If no improvement upon treatment do what?
Chest compressions at 3:1 ratio
Epinephrine via umbilical vein catheter
What presents as a harsh holosystolic murmur at the left sternal border?
FTT, HF, Down syndrome
Severe Concussion describe the following:
> 60 seconds
Present or worsening
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?
Immediate IVF for rehydration
US showing donut sign
Pnematosis intestinalis means what else?
Seen in what condition?
Air in the wall of the bowel
What is the biggest issue of cleft lip/palate?
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?
Mid to late childhood
2/3 Igs will be low - A, G, M
How to prevent SIDS?
Sleep on back
Don’t share beds
What causes croup?
MC age group?
AP film shows what?
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?
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?
What are some organic causes of FTT?
Genetic (CF) Cardiac disease Pyloric stenosis GERD Hyperthyroid
What causes ROP?
High oxygen delivery
What medications can cause FTPM?
Newborn male that presents w/low or no urine output and a palpable bladder has what?
May be PMHx of what?
Posterior urethral valve
What is the definitive way to treat biliary atresia?
Kasai procedure - hepatoportoenterostomy
What gives away HSV encephalitis?
Mention to hippocampus
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?
How to treat PNA when it is a typical pathogen?
When should congenital esotropia be corrected?
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?
Onion skin, moth eaten
What is a Mongolian spot?
Seen in whom?
Mistaken for what?
Latin America and east Asia
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
Describe features of simple febrile seizure
< 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?
What is the SE of Ceftriaxone if used in kids < 30 days old?
What to use instead?
What kind of vomiting means there is an obstruction distal to ampulla of Vater?
1st step in workup?
X-ray —> gas patterns
RDS can cause what?
Infant presents how?
CXR shows what?
Surfactant deficiency causing atelectasis
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?
US plus LFTs
HIDA after phenobarbital
Liver biopsy —> intraoperative cholangiogram
What makes a high-risk BRUE?
Hx suggestive of Dz
Physical suggestive of dz
What is the cut off for failure to pass meconium?
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?
IV pain meds
Abx if infection present
Breast feeding jaundice is what kind of issue?
What is elevated?
Quantity (newborn < 7 days), bowel moves too slow
Increase # of feeds
How to treat apnea of prematurity?
What is the MC SE for the HPV vaccine?
Recommended in what age groups?
How do you treat shingles outbreak?
Colicky ABD pain w/abrupt onset in kids 3mo - 3 years indicates what?
Air-contrast barium enema, if it fails, then surgery
What is characterized as low glucose?
How to treat SYMPTOMATIC hypoglycemia?
If it is persistent?
2mL/kg of D10W
What presents w/double-bubble but Normal gas pattern?
Upper GI series, contrast enema
Unconjugated bilirubinemia w/- Coombs test but high Hgb means what?
Twin-twin, maternal-baby, delayed cord clamping
What is right of midline and without a membrane congenital defect?
Retinal hemorrhages in a baby indicate what?
Shaken baby syndrome
How do you treat scabies?
Permethrin or lindane
Newborn w/clicky hip has what?
US in 4-6 weeks
Bleeding with pattern of dysmorphic urinary rbcs, rbc casts, and coca-colored urine points to what cause?
Chediak-Higashi is what inheritance?
Job syndrome is what?
Cold abscesses (Staph, H.flu, Strep pneumo0
Fungal or PCP infections with underlying heart defect in newborn think what?
Prophylaxis w/Bactrim and scheduled IVIG
What is the MC heart defect in kid > 1 y/o
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?
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?
A2B2 with Valine substitution
What can Parvo virus cause in adults?
How to treat TTN?
O2 and CPAP/intubation aka PPV
Femoral or skull fracture in a kid indicates what?
What is the MC primary immunodeficiency?
How do they present?
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?
Draw bilirubin level
Bowel sounds over the lungs w/scaphoid abdomen in a dyspneic baby means what?
Congenital diaphragmatic hernia
Babygram - xray
What is an exanthem?
Rash on the skin
What is the treatment for Toxo/PJP?
If can’t use alternate?
What are the 2nd gen H1 antihistamines used to treat urticaria?
What presents w/high fever w/rapid onset, pt will be drooling and tripoding?
AP film shows what?
What presents w/a fixed, wide split S2?
How to close?
Catheter-directed device closure
What are the features of ToF?
See what on xray?
Due to defect in what?
Pulmonic stenosis, RVH, overriding aorta, VSD
Down syndrome, DiGeorge
Baby w/HTN, claudication (refuses to walk) most likely has what?
Coarctation of the aorta
BP on arms and legs, Echo next
What presents w/synovial inflammation up to 4 weeks after uri or GI viral illness?
Unilateral conjunctivitis most likely due to what?
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?
What does urology pelvic US look at?
Can tell you what?
Hydronephrosis (obstruction) is or NOT
Baby that has bubbling and gurgling w/respirations has what?
Meckel’s diverticulum is remnant of what?
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 ?
Double bubble w/no distal gas pattern indicates what?
Duodenal atresia or annular pancreas
Posthepatic jaundice has what pathology?
What shape can you make as a 3 year old? What gross motor?
4? G motor?
5? G motor?
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?
Is rotavirus vaccine live or killed? Given how?
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?
Pt w/sinopulmnary infections and absent IgA with poor DNA repair has what?
Conjugated bilirubin is always ________ as it is indicative of problems w/________?
Unconjugated bilirubinemia w/- Coombs test, normal Hgb, and - retic count means what?
Hemorrhage, breast feeding jaundice, breast milk jaundice
How long should children be in a rear-facing car seat in the back of the car?
SCFE occurs in whom?
Obese teen or one in a growth spurt
What kind of pts are more susceptible to voluntary constipation?