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USMLE Rapid Review > Pediatric > Flashcards

Flashcards in Pediatric Deck (97)
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1
Q

most common type of tracheoesophageal fistula

A

esophageal atresia w/ distal TEF - unable to pass NG tube

2
Q

things that are not contraindications to vaccination

A

mild illness and/or low grade fever, current abx therapy, and prematurity

3
Q

tests to r/o shake baby syndrome

A

ophthalmologic exam, CT, and MRI

4
Q

neonate has meconium ileus

A

cystic fibrosis

5
Q

bilious emesis w/in hours after the first feeding

A

duodenal atresia

6
Q

2 month old baby w/ non-bilious projectile emesis. Dx? Lab abnormality? Tx?

A

pyloric stenosis; hypocholermic, hypokalemic metabolic alkalosis; surgical correction - pyloromyotomy

7
Q

most common primary immunodeficiency

A

selective IgA def

8
Q

infant w/ high fever and onset of rash as fever breaks

A

roseola infantum (risk for febrile seizure)

9
Q

chronic respiratory infections w/ - nitroblue tetrazolium test

A

chronic gramulomatosis dz

10
Q

male child w/ eczema, thrombocytopenia (purpura/bleeding), and recurrent infections (otitis media). pts have high levels of IgA/IgE and decreased IgM

A

wiskott-aldrich syndrome (x-linked recessive only in males)

11
Q

acute-phase tx of kawasaki dz

A

high-dose ASA for inflammation and fever and IVIG to prevent coronary artery aneurysms

12
Q

tx for mild and severe unconjugated hyperbilirubinemia

A

phototherapy (mild) or exchange transfusions (severe)

13
Q

sudden onset of mental status changes, emesis, and liver dysfunction after ASA intake

A

reye syndrome

14
Q

child has loss of red light reflex (white pupil). Dx? child has increased risk of what cancer?

A

suspect retinoblastoma. increased risk of osteosarcoma

15
Q

vaccinations at a 6 month well child visit

A

HBV, DTaP, Hibb, IPV, PCV, rotavirus

16
Q

infection of small airways w/ epidemics in winter and spring

A

RSV bronchiolitis

17
Q

cause of neonatal RDS? risk factors?

A

surfactant deficiency. risk factors include prematurity and maternal DM

18
Q

condition associated w/ red “currant-jelly” stools, colicky abdominal pain, bilious vomiting, and a sausage-shaped mass in the RUQ

A

intussusception

19
Q

congenital heart dz that causes secondary HTN

A

coarctation of the aorta (find decreases femoral pulses)

20
Q

first line tx for otitis media

A

amoxicillin x 10 days

21
Q

most common pathogen causing croup

A

parainfluenza virus type I

22
Q

defect in x-linked syndrome w/ mental retardation, gout, self-mutilation, and choreoathetosis

A

lesch-nyhan syndrome (purine salvage problem w/ HGPRTase def)

23
Q

newborn girl has continuous machine like murmur

A

PDA

24
Q

tx to close PDA

A

indomethacin

25
Q

newborn w/ posterior neck mass and swelling of the hands

A

turner’s syndrome

26
Q

non-tender abdominal mass associated w/ elevated VMA and HVA

A

neuroblastoma

27
Q

fixed, widely split S2

A

ASD

28
Q

digeorge syndrome - CATCH 22

A
CATCH 22
cardiac abnormalities (transposition)
abnormal facies
thymic aplasia
cleft palate
hypocalcemia
22q11 deletion
29
Q

trisomy ? - MR, flat face, upslanted eyes w/ epicanthal folds, simian crease, general hypotonia, atlantoaxial instabiligy, duodenal atresia, hirschsprung’s dz, and congenital heart defects

A

trisomy 21 (downs syndrome)

30
Q

trisomy ? - rocker-bottom feet, low set ears, micrognthia (undersized chin), clenched hands (overlapping 4-5 digits)

A

trisomy 18 (edwards syndrome)

31
Q

trisomy ? - microphthalmia, microcephaly, polydactyly

A

trisomy 13 (pataus syndrome)

32
Q

male pt w/ testicular atrophy, eunuchoid body shape, tall stature, long extremities, gynecomastia, and female hair distribution. dx? tx?

A

klinefelter’s syndrome (47 XXY). tx w/ testosterone (prevents gynecomastia; improves secondary sexual characteristics)

33
Q

second most common cause of MR (first is downs) + large jaw, testes and ears + autistic behaviors

A

fragile x syndrome (x-linked dominant)

34
Q

cherry-red spot w/ hepatosplenomegaly. Dx? Path?

A

niemann-pick dz. due to def of sphingomyelinase

35
Q

cherry-red spot but no hepatosplenomegaly. Dx? Path?

A

tay-sachs disease. due to absence of hexosaminidase

36
Q

meckel’s rules of 2

A

2 yrs or less; 2 x more in males; 2 types of tissue (pancreatic and gastric); 2 in long; 2 feet from ileocecal valve; 2% of population

37
Q

pneumatosis intestinalis on plain film is pathognomonic for…

A

NEC in neonates

38
Q

b-cells make immunoglobulins and are responsible for immunity against?

A

extracellular bacteria

39
Q

t-cells are responsible for immunity against?

A

intracellular bacteria, viruses, and fungi

40
Q

features of kawasaki dz

A

fever greater than 104 for 5 days + 4 more criteria: conjunctivitis, rash, adenopathy (unilateral), strawberry tongue, erythema of hands and feet

41
Q

most common cause of bronchiolitis

A

RSV

42
Q

most common cause of croup

A

parainfluenza

43
Q
x-ray findings:
1. double-bubble...
2. triple-bubble...
3. dilated loops of bowel...
4. pneumatosis intestinalis...
dx for each?
A
  1. duodenal atresia (stomach + doudenum)
  2. jejunal atresia (stomach + duodenum + jejunum)
  3. hirschsprung dz
  4. NEC
44
Q

classic findings in congenital rubella syndrome

A

classic triad of cataracts, PDA, and sensorineural hearing loss. may also have IUGR and purpura

45
Q

differentiate neonatal gonococcal vs chlamydia conjunctivitis

A
gonococcal = copious purulent ocular drainage and eyelid swelling in 2-5 days post birth
chlamydia = milder symptoms in 5-14 days post birth
46
Q

young child w/ increased intracranial pressure (ie. HA, vomiting), bitemporal hemianopsia, and a calcified lesion above the sella. dcx?

A

craniopharyngioma

47
Q

tx for pt w/ B-cell def (pts that present after 6 months w/ recurrent sinopulmonary, GI, and urinary tract infections w/ encapsulated organsisms (SHiN - Strep, H. influ, Neisseria)?

A

IVIG (except for selective IgA def, as can lead to the production of anti-IgA antibodies)

48
Q

x-linked recessive B-cell def found only in boys. symptoms begin after 6 months when maternal IgG (transferred across placenta) is no longer present. pt may have absent tonsils or other lymphoid tissue

A

bruton’s congential agammaglobinemia

49
Q

pt w/ combined B and T-cell def. normal B-cell numbers w/ decreased plasma cells –> usually all Ig levels are low and symptoms usually present later in life (15-30 yo)

A

common variable immunodef (CVID)

50
Q

tx for DiGeorge?

A

treat w/ BM transplant and IVIG for antibody def

51
Q

pt w/ progressive cerebellar ataxia and oculocutaneous telangiectasias caused by DNA repair defect

A

ataxia-telangiectasia

52
Q

severe lack of B and T-cells due to defect in stem cell maturation and decreased adenosine deaminase

A

severe combined immunodef (SCID)

53
Q

x-linked or autosomal recessive dz w/ anemia, lymphadenopathy, hypergammaglobulinemia, and + nitrobule tetrazolium test

A

chronic granulomatous disease (def of superoxide production by PMNs and macrophages)

54
Q

pt w/ recurrent skin, mucosal, and pulmonary infections. infant w/ delayed separation of the umbilical cord. no pus w/ minimal inflammation in wounds

A

leukocyte adhesion def (defect in chemotaxis of leukocytes)

55
Q

autosomal recessive disorder that leads to defect in neutrophil chemotaxis/microtubule polymerization –> partial oculocutaneous albinism, peripheral neuropathy, and neutropenia. may have giant granules in neutrophils. dx?

A

chediak-higashi syndrome

56
Q

defect in neutrophil chemotaxis –> FATED: coarse Faces, Abscesses, retained primary Teeth, hyper-igE, Dermatologic (severe eczema)

A

job’s syndrome

57
Q

autosomal dominant disorder w/ recurrent episodes of angioedema lasting 2-72 hrs and provoked by stress or trauma

A

C1 esterase def (hereditary angioedema)

58
Q

inability to form membrane attack complexes (MAC) due to terminal complement def (C5-C9) leads to recurrent infections of?

A

neisseria infections

59
Q

pedi cancer - differentiate wilms tumor vs neuroblastoma

A

wilms tumor - unilateral mass w/ hematuria that is otherwise asymptomatic, and occurs in older children
neuroblastoma - mass that crosses the mildline, has systemic symptoms, and occurs in younger children

60
Q

association of anomalies in newborns - VACTERL

A

vertebral, anal atresia, cardiac, tacheoesophageal fistula, renal, and limb

61
Q

obese adolescent (11-14 yo) boy has pain in the left anterior thigh for 2 months. typically have painful limp. may have inability to bear weight. limited passive flexion and internal rotation of hip. x-ray w/ frog leg view reveals posterior/inferior displacement of femoral head. dx? tx?

A

SCFE (separation of proximal femoral epiphysis through the growth plate leading to inferior/posterior displacement of the femoral head to femoral neck). tx is surgery.

62
Q

4-10 yo boy presents w/ hip pain and/or knee pain. has painless limp, has limited abduction or internal rotation of the hip. dx? tx?

A

legg-calve-perthes disease (idiopathic AVN of the femoral head). tx is observation, if severe may need to brace

63
Q

16 yo boy complains of R knee pain. exam shows signficant tenderness and swelling over the tibial tuberosity. otherwise healthy. dx? tx?

A

osgood-schlatter dz (due to chronic microtrauma to the tibial tuberosity secondary to overuse of the quads). tx is rest, restriction of activities, and/or brace

64
Q

pt w/ recurrent fx, blue sclera, hearing loss. dx? cause?

A

osteogenesis imperfecta. caused by a mutation in type 1 collagen (m/c autosomal dominant)

65
Q

pt w/ leukocoria. dx?

A

retinoblastoma until proven otherwise. emergent to ophthalmology

66
Q

pt w/ combo of neurologic (ataxia, dysarthria), skeletal (scoliosis, feet deformities), and cardiac (concentric hypertropic cardiomyopathy). dx?

A

friedreich ataxia (most common cause of death is cardiomyopathy and respiratory complications)

67
Q

3 P’s of mccune albright syndrome (defect in G-protein cAMP-kinase function)

A
  1. precocious puberty
  2. pigmentation (cafe au lait spots)
  3. polyostotic fibrous dysplasia
68
Q

rheumatic fever is a preventable complication of strep pharyngitis. what is non-preventive complication.?

A

post-strep glomerulonephritis

69
Q

rheumatic fever - clinical diagnosis based off of JONES criteria

A

joints (migratory), heart (carditis), nodules (subQ), erythema marginatum, sydenham chorea

70
Q

child w/ fever, oral vesicles on the bucca mucosa, tongue, and small, tender cutaneous lesions on the palms and soles. dx? cause? tx?

A

hand, foot, mouth dz. caused by coxsackie. self-limiting, therefore supportive care

71
Q

effects of epi given during anaphylactic rxn?

A

epi = beta2 and alpha 1 receptor agonists –> bronchial smooth muscle relaxation and constriction

72
Q

young infant w/ upper respiratory symptoms, wheezing/crackles, and respiratory distress. dx?

A

bronchiolitis most commonly 2/2 RSV

73
Q

pt w/ rapid-onset edema of the face, acral extremities, genitals, trachea, and abdominal organs w/o urticara. dx? cause?

A

hereditary angioedema. due to def or dysfunction of C1 inhibitor –> elevated levels of the edema producing factors C2b and bradykinin

74
Q

pt w/ inspiratory stridor that worsens in the supine position and w/ crying that peaks around 4-8 months. dx? workup to confirm dx? tx?

A

larynogomalacia. confirm w/ flex laryngoscopy, which shows collapse of the supraglottic structures during inspiration. tx is none, as usually resolves by 18 months

75
Q

abx of choice for tx and post-exposure prophylaxis of pertussis

A

macrolide abx

76
Q

infant w/ lateral traction on neck during delivery –> abduction of army, lateral rotation, and flexion, supination. dx? risk factor? injured nerve roots?

A

erb palsy w/ increased risk due to fetal macrosomia - injury at C5-C6 roots

77
Q

infant w/ upward force on army during delivery –> total claw hand deformity. dx? injured nerve roots?

A

klumpke palsy - injury at C8-T1

78
Q

neonatal in first few days of life presents w/ irritability, high-pitched cry, poor sleep, tremors, seizures, sweating, sneezing, tachypnea, poor feeding, vomiting, and diarrhea. dx? cause?

A

neonatal abstinence syndrome caused by infant withdrawal from opiates (morphine, heroin, etc)

79
Q

contraindications to breast feeding due to mother? due to baby?

A

mother - active, untreated TB, HIV, and active illicit drug use (hep B and C are not considered contraindications)
baby - galactosemia

80
Q

ddx of solitary, painful, lytic bone lesions w/o overlying swelling and hyperCa in a child

A

langerhans cell histiocytosis and neoplasms

81
Q

pt w/ palpable purpura on the LE, arthralgias, abdominal pain, and renal dz. dx? cause?

A

HSP. caused by IgA mediated vasculitis

82
Q

well appearing infant w/ intermittent cyanosis and distress during feeding that is relieved by crying. dx? confirm dx?

A

choanal atresia. failure to pass a catheter through the nose into the oropharynx is suggestive of the diagnosis and CT shows narrowing at the level of the pterygoid plate in the posterior nasal cavity

83
Q

maternal imprinting - deletion of paternal copy of chromo 15. dx? features?

A

prader-willi - features include hyperphagia, obesity, intellectual disability, hypogonadism, and hypotonia

84
Q

paternal imprinting - deletion of maternal copy of chromo 15. dx? features?

A

angelman syndrome - features include inappropriate laughter/smiling, seizures, ataxia, severe intellectual disability

85
Q

pt w/ macrocytic pure red aplasia + several congential anomalies such as short stature, webbed neck, cleft lip, shielded chest, and triphalangeal thumbs. dx?

A

diamond-blackfan syndrome

86
Q

associated cardiovascular co-morbidities w/ turner syndrome

A

bicuspid aortic valve, coarctation of the aorta, and aortic root dilation

87
Q

early cyanosis - blue babies are R–>L shunts (5 T’s)?

A
  1. truncus arteriosus
  2. transposition
  3. tricupsid atresia
  4. tetralogy of fallot
  5. TAPVR
88
Q

4 features of tetralogy of fallot?

A
  1. pulmonary stenosis
  2. RVH
  3. overriding aorta
  4. VSD
89
Q

late cyanosis - blue kids are L–>R shunts (3)

A
  1. VSD
  2. ASD
  3. PDA
90
Q

pt w/ bounding peripheral pulses, wide pulse pressure, and continuous machine like murmur. dx?

A

PDA

91
Q

most common early cyanotic congenital heart condition in newborns? risk factors? CXR finding? tx?

A

transposition of great vessels. risk factors include maternal DM and DiGeorge syndrome. CXR finding is an “egg-shaped silhouette.” tx includes IV PGE to maintain PDA and surgery

92
Q

most common early cyanotic congential heart condition in childhood? key PE finding? CXR finding? tx?

A

tetralogy of fallot. key PE finding is children will squat for relief during hypoxemic episodes (tet spell) –> increased SVR. CXR finding is a “boot-shaped heart” tx includes IV PGE to keep PDA open and surgery

93
Q

pt w/ FTT, easy fatigue, and heart failure w/ pansystolic murmur heard loudest at the L LSB and a diastolic rumble at the apex due to increased flow across the mitral valve

A

large VSD

94
Q

pt w/ EKG that shows shortened PR interval, delta wave, and widened QRS complex

A

wolff-parkinson-white syndrome

95
Q

allergic contact derm is what type of HSR

A

HSR type IV - delayed type - T-cell mediated

96
Q

pt w/ self-mutation, neuro features, gouty arthritis, and tophus formation. dx? cause?

A

lesch-nyhan syndrome. caused by def in HGPRT (hypoxanthine-guanine phosphoribosyl transferase)

97
Q

pt w/ nocturnal vulvar itching. dx? confirm dx? tx?

A

pinworms. confirm by scotch tape test. tx w/ mebendazole