OME/Book Flashcards
(106 cards)
1
Q
how to dx developmental dysplasia of hip
A
get click on ortolani/barlow,
return in 4 weeks to get U/S if it doesn’t resolve
2
Q
how to rx ddh
A
harness
3
Q
6 year old, insidious onset of antalgic gait
dx and rx
A
Leg Calve Perthes (avascular necrosis)
rx with cast
4
Q
teenage boy, obese,/growth spurt, non traumatic joint pain (dx, rx)
A
slipped capital femoral epiphysis
dx frog leg xray
rx surgery
5
Q
hip pain in kid after viral illness, inability to bear weight, no fever or leukocytosis
A
transient synovitis
if patient has fever, leukocytosis, ESR/CRP elevation, ARTHROCENTESIS to r/o septic arthritis
6
Q
teenage athelete, knee pain and tibial swelling/pinpoint tenderness on tibia
dx and rx
A
osgood schlatter’s disease/osteochondrosis
due to traction apophysitis of tibial tuberosity
rx: wait it out, work through it
7
Q
bad complication of scolosis
A
dyspnea (ribs can’t come together)
8
Q
dx scoliosis
rx
A
Adams test, xray
brace to slow progression and avoid surgery, or surgery if bad enough, surgical rods
9
Q
translocation 11,22
A
ewing’s sarcoma
10
Q
onion skin, MID SHAFT
A
ewing’s
11
Q
distal femur bone tumor
A
osteosarcoma
12
Q
location of osteosarcoma and xray finding
A
sunburst pattern
distal femur
13
Q
rx transient synovitis
A
supportive
NSAIDs, follow up in 2 days
14
Q
kid with fracture of growth plate
A
TAKE TO OR!
15
Q
high yield association osteosarcoma
A
retinoblastoma
16
Q
conservative and major interventions within 1st minute of new born
A
stimulate and get baby breathing
suction (o2 sat60-65% nml), baby may need intubation/ positive pressure ventilation (bagging)
17
Q
HR goal for new born
A
greater than 100
if less baby may need positive pressure ventilation
18
Q
long term complication of respiratory distress syndrome?
A
bronchopulmonary dysplasia
decreased surfactant, can’t expand alveoli, leads to scarring
19
Q
ground glass opacities in neonate with increased o2 requirements
A
BPD
20
Q
rx BPD
A
SURFACTANT! to child post delivery (NOT VENTILATION….you’ll just be blowing air into closed alveoli and make things worse)
antenatal corticosteroids to mom before birth
21
Q
pathophys of retinopathy of prematurity
A
neoangiogenesis in retina due to increased 02 requirement
22
Q
rx ROP
A
laser ablation to prevent early GLAUCOMA
23
Q
bulging fontanelles, seizure, coma in premature infant
A
IVH
dx with cranial doppler
rx with decreasing ICP via surgery (VP shunt/drain)
24
Q
bloody BM in premie
diagnostic finding and
A
NEC
dx with xray
rx NPO, IV Abx, TPN, surgery (short gut syndrome)
25
air in the wall of bowel, pneumatosis coli on xray
NEC
26
complications IVH
seizure disorder, hydrocephalus, CVA, intellectual disability/MR, cerebral palsy
27
most neonates will pass meconium in how many hours
48 (anything greater is abnormal)
28
imperforate anus seen, screen for?
VACTERL
```
vertebrae defects
anal atresia
cardiac defects
tracheo-esophageal fistula
renal abnormalities
limb anomalies
```
get imaging for all of this (echo, catheter, xray etc)
29
GI complication CF
meconium ileus
30
rx meconium ileus
no water so can't pass stool
give water enema to dissolve plug
confirm diagnosis with sweat chloride test (if positive give vit ADEK and pancreatic enzymes, pulmonary toilet)
31
failure of migration of inhibitory neurons in aurback/meisnner plexus with failure to innervate distal colon (muscle can't relax)
hirschsprung's
32
palpable colon, explosive diarrhea on digital rectal exam
hirshsprung's
33
how to dx hirshsprung's (best test)
suction rectal biopsy for missing neurons
| can also do contrast enema
34
effect of thyrotoxicosis on heart
hyperdynamic circulation from increased myocardial contractility and HR leads to systolic HTN
35
how can blood transfusion cause hypocalcemia
chelation!
| in blood there is citrate, EDTA, or foscarnet which can chelate Ca esp in patients with bad liver function
36
female with hirsuitism, weight gain, bone loss, has proximal muscle weakness
glucocorticoid induced myopathy (Cushing myopathy)
37
painful red subcutanoues nodules most commonly on anterior lower legs + arthrlagia and malaise
erythema nodosum
| do chest xray to rule out sarcoid
38
central face erythema, flushing, telangiectasias, burning within a few minutes of going outside or drinking alcohol,
rosasea
39
microscopy demonstrates linear IgG and C3 deposits along basement membrane, elderly patient with prodroem of urticaria/eczema
dx and rx
```
bullous pemmphigoid (autoimmoune)
rx with high potency glucocorticoid
```
40
non tender firm hyperpigmented nodules <1cm, central dimpling when pinched
dermatofibroma
41
pearly nodule with small telangiectasia in sun exposed area, no dimpling, delderly patients
basal cell carcinoma
| MCC skin cancer
42
firm scaly papules or plaques in sun exposed area
squamous cell carcinoma
| 2nd most common skin cancer
43
inheritance mode g6pd deficiency
x linked recessive
44
limited upward gaze, upper eye lid retraction, pupils non-reactive to light but can accomodate
parniaud syndrome (n=pineal mass)
45
how to evaluate for possible fibroadenoma
follow up after next menses
46
patient with precocious puberty with advanced bone age has high LH, what to do next
central precocious puberty
| MRI brain then treat with GnRH
47
how to dx CGD
dihoydordorhoamine 123 or nitroblue tetrazolium test
48
rx Lyme disease in child<8 or pregnant woman
amoxicillin
NOT DOXY
49
rx for gonorrheal/chlamydial conjunctivitis in neonate
gonorrhea - appears 1st week; IM dose 3rd gen cephalosporin
| chlamydia - appears 2nd week, PO macrolide
50
```
double bubble with normal gas pattern on xray
normal pregnancy (no cocaine, no polyhydramnios, no down syndrome)
```
malrotation
51
rx malrotation
NG tube, decompress, then surgery if volvulus
52
bilious emesis, hx of polyhydramnios, down syndrome, double bubble on xray + no gas beyond
```
duodenal atresia (failure of duodenum to recannalize)
rx with surgery
```
53
bilious emesis, polyhydramnios, bililous emesis, down syndrome, x ray shows double bubble with no gas beyond
```
annular pancreas (failure of apoptosis of parts of pancreas)
rx with surgery
```
similar presentation to duodenal atresia
54
bilious emesis, hx of cocaine in mom, possible polyhydramnios, no down's, double bubble + multiple air fluid levels
```
intestinal atresia (failure of ventral bud to rotate with duodenum)
rx with surgery but can get short gut syndrome
```
55
1st day of life, nonbilious emesis, gurgling+bubbling, rx and how to diagnose?
tracheoesophageal fistula
dx with NG TUBE that coils
rx with TPN and surgery
56
non bilious emesis (projectile), olive shaped mass, visible peristaltic waves, what to do next?
check CMP correct!!!
(hypochloremic/hypokalemic metabolic alkalosis) FIX THESE with IVF and electrolytes
U/S -> elongated pylorus
rx with pyloromyotomy
57
characteristics of ILD
decreased lung volumes (low total lung capacity, functional residual capacity, residual volume), preserved FVC1/FVC, INCREASED A-A GRADIENT, reduced diffusion capacity of CO
58
SHOULDER PAIN, horner syndrome, weakness/pain/paresthesia of hand
pancoast tumor (superior pulmonary sulcus)
59
cyanosis with feeding, secretions
TEF (blind pouch proximally and fistula between brochus and distal esophagus)
60
rectal prolapse, meconium ileus, esophageal varices, recurrent pulmonary infections
CF
61
low glucose in pleural effusion indicates....
infection (increased WBC)
| exudate
62
noenate with direct hyperbilirubienami
biliary atresia
sepsis
metabolic
63
two genetic disorders that can cause child with indirect bilirubinemia
Gilbert
| Crigler Najar
64
two genetic disorders that cause child with direct bili
dubin johnson
| rotors
65
which bili can cause kernicterus?
indirect (non water soluble , fat soluble and can cross BBB) can't excrete in urine
66
dark colored urine in noenate
water soluble so this is direct bili
67
jaundice after 72 hours, resolves in 1-2 weeks, unconj bilirubin, slow rise
physiologic
68
jaundice within 1st day, takes longer to resolve, conjugated bili, quick rise
pathologic
69
how to work up unconjugated bili
coombs (isoimmunization), Hgb (twin twin transfusion, cephalohematoma, delayed clamping), retic count (G6PD, sickle cell, pyruvate kinase deficiency), if all negative
then breast milk vs breast feeding jaundice
70
decreased bowel function, dehydration day 1-7, unconj jaundice
breast feeding failure jaundice
71
unconj bili, after day 7 of breast feeding,
| dx and rx
breast milk jaundice (due to mom's milk having high quantities of b-glucourinidase)
feed hydrolyzed formula
72
how to treat unconj bili
1. phototherapy more common
| 2. exchange transfusion for rapidly rising
73
blue child with low O@ sat, supplemental oxygen fails to increase pulse ox
methemoglobienima )exposure to oxidasing agent), decreased o2 to peripheral tissues, normal PaO2, saturation gap between pulse ox and ABG)
74
erythematous patches and plaques with yellow oily scales on scalp, face, and umilicus
```
seborrhic dermatitis ("cradle cap")
(rx with emolients, non med shampoos,)
```
75
trianglur sail, pediatric chest xray
thymus
76
respiratory distress in neonate with suspected CDH
| what to do?
1. endotracheal intubation
| 2. orogastric tube to decompress bowel and improve respiration
77
absoption of breast milk vs formula
breast milk protein absorbed better and improves gastric emptying
78
how to prevent SIDS
1. lay infant on back while sleeping (watch for flattened occiput and alternate head)
2. don't share bed
3. smoking cessation
79
benzo overdose vs opoid intoxication
benzos only cause mild respiratory depression and normal pupils while opoids can cause severe respiratory depression and constricted pupils
80
dry mouth, eye blurriness, urinary retention, fever, decreased bowel sounds
dx and rx
anticholinergic/antihistamine toxicity rx with ache inhibitor
to increase ach...physiostigmine
81
tinnitus, fever, nausea, vomoiting
ASA toxicity
82
ingestion, abdominal pain, vomiting, diarrhea, hypotensive shock, metabolic acidosis (anioin gap), hematemasis
iron toxicity
| rx with whole bowel irrigation, deferoxamine
83
wet with urine, shiny red abdominal protrusion
extrophy of bladder
| can be mistaken with omphalocele
84
neonate with worsening direct hyperbili @ 2 weeks, no ducts on U/S, then confirm with HIDA after phenobarb (induces biliary tree to secrete bile)
biliary atresia
85
traumatic delivery, mother develops waddling, painful ambulation postpartum day 1, dx and rx
pubic symmphisis diastasis (widening)
86
for IUFD, when to DnC vs induce labor
DNC<24 weeks
| induce>24 weeks
87
fetal complications pre-eclampsia (3)
IUGR, small for GA, oligohydramnios
all 2/2 uteroplacental insufficiency
88
baby sac in back, CSF but no nerve fibers
meningocele
89
babcy sac in back, nerve fibers and CSF in sac
meningomyelocele`
90
asthma + nasal polyps/sinusitis
ASA sensitive asthma
stop ASA and NSAIDS!
91
how to differentiate anaphylaxis for just regular allergic reaction
HYPOTENSION
92
allergic condition associated with angioedema
c1 esterase deficiency
| rx with FFP
93
polyps with cobblestoning
| pale boggy mucosa
allergic rhinitis
| rx INTRANASAL STEROIDS
94
baby, nausea, vomiting, diarrhea, failure to thrive despite feeding adequate amounts
milk protein allergy
try another formula (not SOY)
i.e. breast milk/hydrolyzed
95
targetoid lesion on knees, palms, face, fingers...
erythema multiforme (SYPHILIS/LYME DISEASE)
also HSV
rx with topical steroids
96
skin sloughing off, +nikolsky sign, person looking poorl, involvement of basal layer, dusky, <10% total body surface area
SJS
STOP ALL MEDS including steroids
97
skin sloughing off, +nikolsky
| FULL THICKNESS, >70%
toxic epidermal necrolysis (like a burn)
98
what drugs can cause SJS/ toxic epidermal necrolysis
sulfa
PCN
anti retrovirals
anti convulsants
99
attack of desmosomes, infant with febrile illness, sloughing of skin @ skin folds
staph scalded skin syndrome
rx nafcillin (not PCN)
100
dietary recommendations to prevent calcium stones
1. NML Ca intake
2. decreased Na
3. increase fluid intake
101
what order to get if you suspect malignancy, compression fracture, ankylosing spondylitis
xray (initially...then do MRI)
102
what to order if you suspect cauda equina, epidural abscess?
MRI
if patient can't tolerate DO BONE SCAN
103
numbness pain between 3rd/4th toes, clicking when palpating space between 3rd and 4th joints
morton neuroma
104
burning, numbness, aching of distal plantar surface of toes
tarsal tunnel syndrome (compression of tibial nerve at ankle)
105
pulmonary complication rheumatoid arthritis
exudative pleural effusion with low glucose
can also be bacterial infxn or TB
106
reproductive age woman, adnexal mass, regular menses, hyperechoic, calcifications
dermoid cyst
watch out for ovarian torsion later on!
