Pediatric Shelf: Quick Hits

Question 0

Acetaminophen OD

Answer 0

Nausea, vomiting, asx until 24 hours ingestion

No acute hematemesis

Question 1

Iron toxicity

Answer 1

Abdominal pain, vomiting, HEMATEMESIS, diarrhea, hypotensive shock, metabolic acidosis; hepatic necrosis, pyloric stenosis

• Dx*: anion gap metabolic acidosis, RADIOPAQUE
• Tx*: whole bowel irrigation, deferoxamine, supportive care

Question 2

Aspirin OD

Answer 2

Tinnitus, fever, hyperpnea, metabolic acidosis; not radiopaque and would not appear on abdominal Xray

Question 3

Lead OD

Answer 3

Abdominal pain, vomiting, anemia, behavioral problems; radiopaque on X-ray; not corrosive to gastric mucosa

Question 4

Vitamin A OD

Answer 4

nausea, vomiting, bury vision

pseudotumor cerebri; no hematemesis

Question 5

Vitamin B12 OD

Answer 5

Water soluble, large amounts unlikely to cause toxicity

Question 6

Vitamin D OD

Answer 6

Nausea, vomiting, confusion, polyuria, polydipsia, does not erode gastric mucosa or cause hematemesis

Question 7

Vitamin K OD

Answer 7

Hemolytic anemia and hyperbilirubinemia

Question 8

Causes of aplastic anemia

Answer 8

Drugs, toxic chemicals, idiopathic, viral infecitons, immune disorders, thymoma

Question 9

Fanconi anemia

Answer 9

MC congenital cause of aplastic anemia

• Autosomal recessive or X linked, cancer predisposition*
• Pt*: Bone marrow failure, short stature, abnormal thumbs, hypogonadism, hypo/hyperpigmented areas, cafe au late, strabismus, low set ears, middle ear abnormalities
• Dx*: chromosomal breaks on genetic analysis
• Tx*: hematopoietic stem cell transplant

Question 10

G6PD deficiency

Answer 10

RBC enzyme deficiency, oxidant drugs and infection cause hemolysis

Question 11

Benzene

Answer 11

Chemical that causes aplastic anemia

Question 12

Thymic tumors

Answer 12

MC in older women, pure red cell aplasia (ISOLATED)

Question 13

Autoimmune pernicious anemia

Answer 13

Anti intrinsic factor autoantibodies= cobalamin deficiency

Question 14

Sun protection

Answer 14

Apply sunscreen 30 minutes before sun exposure
Remain indoors from 10 to 4
Wear protective clothing
Avoid tanning beds

Question 15

Breastfeeding failure jaundice

Answer 15

First week of life
Lactation resultin gin: decreased bilirubin elimination, increased enterohepatic circulation, unconjugated hyperbilirubimemia
CM: suboptimal breastfeeding, signs of dehydration

Question 16

Breast milk jaundice

Answer 16

3-5 days, peaks at 2 weeks
High level of beta glucuronidase in breast milk deconjugate intestinal bilirubin and increase enterohepatic circulation
CM: adequate breast feeding, normal examination, no signs of dehydration

Question 17

Alloimune hemolytic disease

Answer 17

Hemolysis of RBCs due to ABO or Rh incompatibility

Question 18

Biliary atresia

Answer 18

Conjugated hyperbilirubinemia, in first 2 months of life

Clay colored stools, dark urine, enlarged liver

Question 19

Dubin Johnson

Answer 19

Autosomal recessive, conjugated hyperbilirubinemia, asx except scleral icterus

Question 20

Galactosemia

Answer 20

Conjgated hyperbilirubinemia, Galactose 1 phosphade uridyl transferase deficiecny, vomiting, growth failure, inability to digest breast milk

Question 21

Treatment for breastfeeding failure jaundice

Answer 21

Increase the number of feeds; breastfeed every 15 minutes per side every 2-3 hours

Question 22

Soy formula

Answer 22

Tx for jaundice cause by galactosemia

Question 23

B1 deficiency; thiamine

Answer 23

Beriberi (peripheral neuropathy)

Wernicke Korsakoff

Question 24

B2 deficiency; riboflavin

Answer 24

Angular cheilosis, stomatitis, glossitis Normocytic anemia Seborrheaic dermatitis *No toxic effects because water soluble and excreted in urine

Question 25

B3 deficiency; niacin

Answer 25

Pellagra (dermatitis, diarrhea, delusions, dementia)

Question 26

B6 deficiency; pyridoxine

Answer 26

Cheilosis, stomatitis, glossitis | Irritability, confusion, depression

Question 27

B9 deficiency; folate

Answer 27

Megaloblastic anemia | Neural tube defects

Question 28

B12 deficiency; cobalamin

Answer 28

Megaloblastic anemia | Neurologic deifits

Question 29

C deficiency; ascorbic acid

Answer 29

Scurvy

Question 30

K deficiency

Answer 30

Impaired coagulation; can be in patients with long term abx

Question 31

ADHD

Answer 31

Inattention, impulsivity, hyperactivity in 2 or more settings; academic difficulty, impaired family and peer relationships

Question 32

Myotonic muscular dystrophy

Answer 32

Autosomal dominant Grip myotonia (delayed muscle relaxation), muscle weakness, facial weakness, foot drop, dysphagia, cardiac conduction anomalies, cataracts, testicular atrophy, baldness *Chromosome 19, CTG trinucleotide repeat* Death from respiratory failure

Question 33

Duchenne dystrophy

Answer 33

X linked recessive (deletion of dystrophin on chromosome 21) Onset age 2-3 Gower, pseudohypertrophy, progressive weakness Wheelchair dependence Death by 20-30

Question 34

Becker dystrophy

Answer 34

X linked recessive (deletion of dystrophin on chromosome 21) Onset 5-15y Death by 40-50 from heart failure

Question 35

Fragile X syndrome

Answer 35

X linked dominant; *macroorchidism*, low muscle tone, facial weakness

Question 36

Cri du Chat

Answer 36

Deletion of 5p | Moonlike facies, hypertelorism, bilateral epicanthal folds, high arched palate, wide flat nasal bridge, cat like cry

Question 37

Wolf Hirschorn sndorme

Answer 37

Deletion of 4p | Microcephaly, bilateral epicanthal folds, Greek helmet facies, beaked nose, cardiac malformations

Question 38

13q deletion

Answer 38

Microcephaly, flat wide nasal bridge, LBW, failure to thrive, ocular malformations, syndactyly

Question 39

18q deletion

Answer 39

Hypotonia, froglike legs, depressed midface, protruded mandible, deep set eyes, short upper lip, everted lower lip, prominent anti helix of ears, mental retardation, belligerent personality

Question 40

21q deletion

Answer 40

Hypertonia, downward slanting palpebral fissures, high palate, prominent nasal bridge, large low set ears, micrognathia, mental retardation

Question 41

Interosseous lines

Answer 41

Place when emergency access necessary and peripheral access cannot be obtained