Pediatric Shelf review University of Texas Flashcards
From lecture on site: http://atsvid.uthscsa.edu/Mediasite/Play/4f425cf23436412c8407d1fc5ede2a21 (272 cards)
0
Q
Immunizations due at 2, 4 and 6 mo
A
HiB (H. influ type B) IPV (inactivated polio vaccine) PCV (pneumococcal conjugated vaccine) hepB Rota DTaP
*its HIP for Babies to Recieve Doses @ 2, 4 and 6mo
1
Q
Immunizations at birth
A
hep B (give HepBIV if mom HbsAg+) *B for Birth
2
Q
Immunization that starts at 6mo and continues yearly thereafter
A
Influenza
3
Q
XXX to flu vaccine
A
egg allergy (also XXX for yellow fever)
4
Q
Immunizations due at 12mo and not before
A
(because live XXX before 12mo)
Varicella
hepA
MMR
*VAM
5
Q
XXX to MMR
A
neomycin/streptomycin (it’s a component of the vaccine)
6
Q
Immunization due before 2yo
A
2nd dose HepA (6mo first dose)
DTaP
*A Dose before 2yo
7
Q
Immunization due before kindergarten
A
IPV
MMR
DTaP
Varicella
*picutre a proud Kindegardener saying, “IM Done w/ my Vaccines for school”
8
Q
Immunization due before 12yo/middle school
A
TdaP booster
Meningococcal vaccine
HPV (girls)
9
Q
systolic , <II/VI, soft, vibratory and musical murmur. Best heard at lower mid-sternum
A
Stills murmur (benign)
10
Q
Murmur best heard at anterior neck, disappears when jugular vein is compressed
A
Venous hum
11
Q
Characteristics of a pathologic murmur
A
Diastolic, >II/VI
GET AN ECHO
12
Q
newborn is cyanotic at birth, O2 does not improve cyanosis.
- MCC in?
- Ass/ murmur?
- Immediate Rx?
A
Transposition of Great Arteries
- infants of diabetic mothers
- NO MURMUR
- PGE1 to keep PDA open
13
Q
2yo child who gets cyanotic and hypernea while playing, squats down.
- ass/ murmur
- Rx?
A
TOF (squat = “tet spell”)
VSD, RA hypertrophy, Overriding aorta, Pulm stenosis
-VSD= systolic ejection
-O2 + knees to chest. Eventually surgery
*basically mimic their “tet spells” by bringing knees up
14
Q
Bipolar mom, gives birth to child w/ holosystic murmur worse on inspiration.
-Ass/ arrhythmia
A
Bipolar…think: Lithium –> Epstein’s anomaly: Tricuspid insuff (right side worse w/ inspiration)
-WPW (delta wave, wide QRS, short PR)
15
Q
“murmur worse on inspiration”, what does this tell us
A
R sided defect
16
Q
Cyanosis @ birth, holosys murmur, depends on VSD or ASD for life. EKG shows LVH
A
Tricuspid atresia
LVH buzzword: b/c w/o tricuspid, blood needs A/VSD to get to L heart
17
Q
Heart defect ass/ w/ DiGeorge. CXR shows increased pulm blood flow and bi-ventricular hypertrophy.
A
Truncus arteriosus
18
Q
1 congenital heart lesion. Harsh holosystolic murmur over LL sternal border, loud P2.
- if II/VI in a 2mo old?
- Gold standard Dx test?
- When is surgery indicated?
- Is louder better or worse?
A
VSD
- wait
- ECHO
- Failure to Thrive, 6-12mo w/ pHTN, >2yrs w/ Qp/Qs > 2:1
- better (smaller defect = louder noise)
19
Q
Loud S1 w/ fixed and split S2. Older child w/ exercise intolerance.
A
ASD Eisenmenger (R to L turns into L to R)
20
Q
most common defect in Down syndrome baby. Fixed + split S2 + Sys Ejection Murmur w/ diastolic rumble.
-Rx?
A
endocardial cushion defect (kinda a combo btw ASD and VSD)
21
Q
- Ass/w/ PDA
- Rx PDA
A
- prematurity, congenital rubella
- indomethicin, if that doesn’t work: surgery
22
Q
most common defect in Turner’s baby. Decreased femoral pulses, “reverse 3 sign”, “notching” @ inf rib border 2/2 increase collateral. May see asymmetry in arm BPs.
A
Coarc of aorta
“reverse 3”= along aorta, narrowing makes the CXR shadow into a 3 shape
23
Q
15yo athlete complains of occasional palpations, angina and dizziness. Last week he fainted.
- Murmur
- Rx
- Restriction
A
Hypertrophic obstructive cardiomyopathy
- Sys ejection murmur (sounds just like aortic stenosis, expect it’s quieter w/ squating, louder when stand because worsens w/ decreased preload)
- Rx: can’t play sports, B-blockers or CCB (no diuretics or dig), can also inject ethanol or surgical myotomy
24
7yo present w/ vague chest pain, pain in several different joints over the past few days and a rash. Her ESR is elevated, EKG shows prolonged PR.
- Rx
- Complications
Rheumatic fever
- should be on PCN prophylatically
- mitral stenosis
25
Cystic Fibrosis
- signs of at birth (how to dx?)
- Signs later
- meconium ileus: dilated loops (dx/rx: gastrograffin enema), "ground glass", <5% wt&ht, bulky stool
- Recurrent respiratory infections, nasal polyps, rectal prolapse (chronic diarrhea)
26
Cystic fibrosis
- Dx
- Rx (4 main areas of Sx)
- sweat test --> 60mEq/L Cl = Dx
1) Thick secretions: mucolytic
2) Pneuo (pseudomonas/B. cepacia): Piperacillin + tobramycin or ceftazidime
3) Panc insuff: Enzy w/ meals + DAKE supp
4) Electrolyte loss: fluids when exercising/hot
27
Asthma: Sx 2x/wk, normal PFTs
| -rX:
mild and intermittent
| -rescue inhalor (albuterol)
28
Asthma: Sx 4x/wk, night cough 2x/month, normal PFTs
| -Rx
mild and persistent
| -add inhaled CS + albuterol
29
Asthma: Sx daily, night cough 2x/wk, FEV1 60-80%
| -rx
FEV1 is low
Moderate
Rx: add long-act B-ag (salmeterol) to CS + albuterol
30
Asthma: Sx daily, night cough 4x/wk, FEV1 <60%
| -Rx
Add oral steriods or LT modifying agent (montelukast) to Salmeterol + inhaled CS + albuterol
31
During asthma exacerbation, PCO2 becomes normal...what do we think?
What should the PCO2 be in a child with an asthma attack?
This is bad!
impending respiratory mm. fatigue ->failure->intubate!
-hypervent --> low PCO2
32
Complication of asthma
allergic bronchopulmonary aspergillus
33
12yo girl presents w/ 2 day history of vomiting. For the last 4 weeks, she has noticed wt loss, polyphagia, polydipsia and polyuria.
Na =130, Cl=90, HCO3=15, Glu=436
-Next best step?
Insulin + IV fluids + K (insulin brings K into cells)
| Monitor w/ anion gap
34
12yo girl presents w/ 2 day history of vomiting. For the last 4 weeks, she has noticed wt loss, polyphagia, polydipsia and polyuria.
Na =130, Cl=90, HCO3=15, Glu=436
-Anion gap?
(anions)-(cations)=
| (Na-Cl)-HCO3= 25
35
12yo girl presents w/ 2 day history of vomiting. For the last 4 weeks, she has noticed wt loss, polyphagia, polydipsia and polyuria.
Na =130, Cl=90, HCO3=15, Glu=436
-Pathophys
Type 1: destruction of panc B cell (need insulin)
36
12yo girl presents w/ 2 day history of vomiting. For the last 4 weeks, she has noticed wt loss, polyphagia, polydipsia and polyuria.
Na =130, Cl=90, HCO3=15, Glu=436
-Dx criteria for diabetes
Type II: any of these three
- Fasting > 126 (twice) + Sx
- any Glu > 200 + Sx
- OGTT (75g): > 200 + Sx
37
What does insulin do to K?
Promotes K uptake into cells
38
2yo fever 105, 3 days later, pink mac-pap rash on trunk, arms and legs
Roseola (HHV-6)
39
2yo w/ a low grade fever, lacy reticular rash on cheeks and upper body (spares palms + soles).
slapped cheek
| parvovirus B19
40
When do we really care about parvovirus.
sickle cell kids- aplastic crisis
| pregnant ladies - hydrops fetalis
41
Fine, mac-pap desquamating rash begins on chest and spreads to neck, trunk and extremities + strawberry tongue. Sore throat 1-2 wks prior.
-Rx
scarlett fever
| -PCN (prevents rheu fever, doesnt help PSglomerulonephritis)
42
Cough, rhinitis, fever, then gets macular rash begins behind ears +spreads down. Gray spots on buccal mucosa.
-Rx
measles
Gray = koplik spots
-Vit A + supportive care
43
Sore throat, jt pain, fever --> pinpoint rash on face the spreads down. Rose spots on palate
-Complications?
Rubella
| -preg--> rubella syndrome
44
Baby w/ poor feeding. Vesicles in the mouth on palsm + soles + rash on buttocks
Coxsackie Hand-foot-mouth dz
45
16yo male w/ swollen parotid glands, fever + HA
| -complications?
Mumps
| -sterility
46
6yo kid from central PA, went camping, had fever
- complications
- Rx
Lyme
- bell's palsy, cardiac issues, meningitis
- Doxy if >8yo, Amoxicillin if <8yo
- if meningitis: IV ceftriaxone (doxcy doesn't penetrate BBB)
47
6yo from coastal NC, went camping, had fever, myalgia, abdominal pain
- Complications?
- Rx?
RMSF
- infections vessels --> gangrene
- ALWAYS DOXCY
48
8yo kid, multiple excoriations on arms. Itchy at night.
| -Rx
Scabies
| -Sulfur (if <3mo), Permethrin for all in house
49
Honey-colored crusted plaque on face
| -Rx
impetigo
| -Topical mupirocin (bactroban)
50
inflamed conjuctive and multiple blisters. Nikolsky's +
| -Rx
SSS
Nikolsky's: epidermis seperates +comes off when Dr runs finger over skin
-IV ABX
51
Meningitis: Most common bug + How to Rx:
| For everyone
S. pneumo
then H. influenza, N. meningitis
52
Meningitis: Most common bug + How to Rx:
| young + immune suppressed
Listeria
53
Meningitis: Most common bug + How to Rx:
| PPl w/ brain surg and instrumentations.
S. aureus
54
Meningitis:
Best first step?
Dx bacterial men?
Roommate of kid in dorms has bacterial meningitis and petechial rash.
start ABX (+steroid if bacterial suspected) --> CT to look for ICP --> LP + gram stain
Dx Bacterial: +Gram strain, >1000WBC, high protein, low glucose
-Rifampin (prophalaxis)
55
Rx for TB meningitis
RIPE + 'roids
56
Rx for Lyme meningitis
IV ceftriaxone
57
2yo w/fever 102, tugging on R ear. Tympanic membrane is red and bulging.
- Most sensitive dx test
- Risk factors?
- rx
- complications
* red + bulging could happen w/ crying
- mobility on insufflationg or air-fluid level is most sensitive
- Native americans, formula fed, tobacco smoke, around kids
- Rx: amoxicillin or azithromycin 10days, if no improvements --> Amox+clav
- Effusions (place tubes), BL effusions >4mo or BL deafness
58
12yo in summer, swim league, has pain when adjusting his google straps behind ear. Thick exudate coming from ear, tender posterior auricular nodes.
- Most likely bug?
- Rx
- Complications
Otitis externa
- Pseudomonas (most likely bug) THEREFORE
- Rx topical ciprofloxacin
- Malig external otitis --> temp bone--> facial paralysis, vertigo (Need CT and IV ABX, may need surgery)
59
7yo w/ exudative pharyngitist w/ tender cervical lymph nodes, fever 102
- Best first test
- If negative?
- rx
- rapid strep
- if neg: culture
- PCN or erythromycin (to prevent rheu fever)
60
child has muffled voice, stridor and refuses to turn their head to the L
- rx
- complications
retropharyngeal abscess (complication of Croup)
- aspiration, I&D abscess and strong ABX
- mediastinitis
61
Child w/ hot potatoe voice, uvula deviated to the right 2/2 bulge
-rx
peritonsillar abscess
| -I&D and strong ABX, tonsillectomy (if strep >5/yr for 2 years or 3/yr for 3 yrs)
62
Older kid, fever, fatigue, gen adenopathy and splenomegaly (ant and post cervical nodes)
- What happens if you give ampicillin or amoxicillin
- Dx test
- Rx
- precautions
Mononucleosis
- Rash!
- mono spot (atypical lymphocytes), +heterophile Ab
- rest, no contact sports until splenomegaly resolves
- splenic hemorrhage or rupture (most in 2nd week)
63
1yo w/ fever 100.5 and barking cough and loud noises on inspiration.
- most common bug
- xray buzzword
- rx
croup
- parainfluenza
- steeple sign
- racemic epi (steroid are second line)
64
2yo fever 104, drooling w/ intercostal retractions and tripod position.
- most common bug in immunized vs not
- xray buzzword
- next best step
- rx
epiglottitis
- S. pyogenes, S. pneumo, Staph, if UNIMM H. flu
- thumb sign
- go to OR and intubate
- Anti-staph + 3rd gen ceph
65
Kid w/ cough, productive of yellow-green sputum, runny nose, T=100.8. Lung exam reveals some rhonchi
-Next best step in Rx
acute bronchitis *benign lung exam
| -Rx w/ supportive care w/ anti-pyretic, tussives, histamines
66
Kid arrives c/o productive of yellow-green sputum, w/ decreased breath sounds + crackles in LLL and WBC= 16k.
- Next best step
- MCC of pneuno in neonates (<28days old)
- MCC 1-3mo old
- specific findings for chlamydia pneumo?
- MCC 4mo-5yo
- MCC >5yo
- CXR
- neonate: LEG (listeria, e.coli, GBS)
- 1-3mo: C. trachomatis, RSV, parainflu, S. pneumo
- C. pneumo: sticcado cough, eosinophilia
- 4mo-5yo: viral (RSV) then S. pneumo
- >5yo: Mycoplasma then S. pneumo
67
9mo infant w/ runny nose, wheezy cough, T=101.5 and RR=60. Retractions are visible and pulse ox 91%.
- Most common bug
- to Dx
- CXR findings?
- Rx
- Who needs vaccine
- RSV bronchiolitus
- confirm w/ swab
- CXR: hyperinflations w/ patchy atelectasis (no consolidation)
- Hospitalize if resp distress, Albuterol nebs. NO STERIODS
- Premature (Palivizumab), heart/lung dz, immune dz
68
9mo infant w/ severe coughing spells w/ loud inspiratory whoops vomiting afterwards. 2 wks ago she had a runny nose and dry cough.
- responsible bug
- lab findings
- treatment
- what do family members/daycare kids get?
Bortella Pertussis
- Lab: high lymphocytes (weird b/c it's a bacterial
- Rx: erythromycin for 14days
- Exposed: SAME THING
* *EXTREMELY CONTAGIOUS
69
UTI in neonate: vague, fever, dehydration, fussy
| *if fever present =
pyelonephritis (cytitis has no fever)
70
UTI more common in?
before age 1: boys, then girls
71
UTI anatomic risk factor
vesicoureteral reflux: NEED ABx prophylaxis
72
How Dx UTI
| -when do u need a US
catheterize to get clean catch for UA
| -when fever/pyelonephritis or suspect abscess or hydronephrosis
73
Rx of UTI (cystitis vs pyelo)
- PO trim-sulfa or nitrofurantoin
| - Pyelo: IV ceftriaxone or amp + Gen 14days
74
UTI
| -follow up
Make sure ABX work and infection has resolved
75
UTI: who needs a VCUG
Girls: if <5yo after first UTI, if >5yo after 2 UTI
boys: after first UTI
ANY pyelo
76
UTI: role of Tc-labeled DMSA scan.
sensitive for renal scarring (not first line)
77
kid w/ a limp: MCC
trauma
78
18mo F w/ asymmetric gluteal folds on exam
- risk factors?
- dx
- rx
hip dyspasia
- female, breech, first child, +fam hx
- barlow, US of hip
- Rx: pavilk harness, surg
79
5yo w/ painless limp now w/ pain in his thigh
Legg-Calve'-Perthes Dz (avascular necrosis)
80
5yo M initially w/ a cold 1wk ago now presents w/ a limp and effusion in hip. Xrays are normal, ESR 35 HIGH, T=99.8, WBC=10K
-next best step
transient synovitis
| -conservative treatment (bedrest for 1 week, NSAIDs)
81
14yo lanky M w/ nagging knee pain and decreased ROM of hip on exam
- Rx
- complications
SCFE (slipped capital femoral epiphysis) (not only in fat kids) ALSO after grow spurt
- Surgery
- if no surgery--> osteonecrosis
82
13yo basketball player has knee pain and swelling of the tibial tubercle.
Osgood-Schlatter: overuse injury from jumping
83
12 yo F w/ 2wk Hx of daily fevers to 102 and a salmon colored evanescent rash on her trunk, thighs and shoulders. her L and R knee are swollen.
- Good prognotic factor
- Bad prognotic factor
- Rx
JRA (juvenile rhue arthritis)
- good: +ANA
- bad: +RF, older age at onset, polyarticular
- 1st= NSAIDs, 2nd = methrotrexate, 3rd= steroids
84
2yo F w/ 2wk Hx of daily fevers to 102 and desquamating rash on perineum. Swollen hands and feet, conjunctivitis and UL swollen cervical lymph node.
- Other lab findings?
- Best 1st test
- Rx
- Most serious sequallae
Kawasaki dz
- increased plts (wk2-3), increased urine WBC, increased LFTs and incrased CSF protein (sterile pyuria)
- ECHO and EKG
- Acute: high dose Aspirin + IVIG, then aspirin + warfarin
- Coronary artery aneurysm
85
<10yo, Bone pain w/ Hx of retinoblastoma or previous radiation. Onion skinning on xray.
-Rx
Ewing Sarcoma
"onion skinning" on xray (layers of periosteal development
-Rx: Rads and/or surgery
86
>10yo, M, "sunburst" and "Codman's triangle on xray".
| -Rx
osteogenic sarcoma
| - chemo and/or surgery
87
Diffuse bone pain in pt w/ petechiae, pallor and increased infections.
leukemia
88
How does leukemia often present in children?
bone pain
89
African American or Mediterranean kid w/ sickle cell: get swollen, painful hands + feet
dactylitis (due to vessel occlusion of arteries feeding hands and feet), 2/2 necrosis of small bones
90
African American or Mediterranean kid w/ sickle cell: w/ excruciating pain in extremeties, ulcers, hip pain
pain crisis. Ischemic damage 2/2 sickling
91
African American or Mediterranean kid w/ sickle cell: w/ point tenderness on femur, fever and malasie.
osteomyelitis (salmonella)
92
sickle cell: things on blood smear
- nucleated RBC
- howel-jolly body (auto splenectomy)
- target cells
93
African American or Mediterranean kid w/ sickle cell: acute drop in HCT with decreased reticulocyte
aplastic crisis from parvovirus B19
94
African American or Mediterranean kid w/ sickle cell: recurrent RUQ pain after meals
cholecystitis (pigment stone)
| do Cholectomy
95
African American or Mediterranean kid w/ sickle cell: respiratory distress and emergent tonsilectomy
Waldyer Ring Hyperplasia
96
Two most common operations in sickle cell patients?
1- Choecystectomy (pigment gall sontes)
| 2- Tonsillectomy (hyperplasia of lymphoid tissue)
97
African American or Mediterranean kid w/ sickle cell: proteinuria and increased Creatinine + recurrent UTI
kidney infarcts due to sickled RBCs
98
Sickle cell:
| MCC of sepsis
strep pneumo
99
Sickle cell:
fever, cough, chest pain, chills and SOB
-Rx
acute chest syndrome (MCC death)
| -exchange transfusion
100
MCC cause of death in sickle cell pt
acute chest syndrome
101
Sickle cell: acute confusoin and focal neurologic deficits
- rx
- assessing risk
stroke
- exchange transfusion (NOT tPA)
- transcranial doppler
102
Sickle cell: vaccination and prophylaxis
H. flu
S. pneumo
Nesseria
PCN prophylaxis until 6yo
103
Sickle cell: fatigue and megaloblastic anemia
| -Rx
folate def
has higher need 2/2 increased reticulocytes
-hydroxyurea to increased fetal Hb
104
In kids: when is anemia not a big deal?
physiologic anemia in first few months of life (fetal RBC die quicker than adults ones are made)
105
What type of anemia? 18mo kid, picky eater, drinks lots of cow's milk.
Labs?
Fe def
| low H+H, MCV 75, Low ferritin, high TIBC
106
What type of anemia?
| 18mo eats varied diet, Mom is Italian
Thalassemia
| low H+H, **(super low) MCV 60, low RDW
107
What the lab give away of thalassemia?
| Rx-
super low MCV ~60
| -deferoxamine + transfusion
108
What type of anemia? irritable, has glossitis, failure to thrive, picky eater, drinks goats milk
-Rx
Folate def
low serums RBC
-Daily folate
109
4mo pale baby, normal plts and WBCs, but Hgb 4. Increased RBC ADA and low reticulocytes. Triphalangeal thumbs
- Rx
- If instead pt was missing thumbs and radius
blackfan diamond anemia
- CS then transfusions and stem cells transplant
- Fanconi
110
18mo baby presents w/ low plts, low WBCs and profound anemia. Cafe-au-lait spots, microcephaly and absent thumbs
- dx
- rx
- complications
Fanconi
- bone marrow shows hypoplasia, cytogenetic studies for chr breaks
- CS, androgens, bone marrow tranplant
- increased risk of CA
111
2yo baby presents with hyperactivity, impaired growth and abdominal pain and constipation
- dx
- rx
- screening?
Lead-poisoning
"basophilic stipiling"
-venous blood sample, check lead level
->45: succimer, if >70 admit + EDTA + dimercaprol
-test blood lead levels btw 12-24 mo if low SES, live in old house (<1960)
112
Thrombocytopenia + 15yo F, recurrent epistaxis, heavy menses + petechiae. low plts only
-rx
ITP
| -IVIG for 1-2days, then prednisone, then splenectomy NO plts!
113
Thrombocytopenia + 15yo F epistaxis, heavy menses, petechiae, normal plts, increased bleeding time and PTT.
-Rx
vWF
| DDAVP for bleeding or pre-op, Replace factor VIII (contains vWf) if bleeding continues
114
Thrombocytopenia + 7yo M recurrent bruising, hematuria + hemarthroses, increased PTT that corrected w/ mixing studies
-rx
Hemophilia
| -if mild w/ DDAVP, otherwise replace factors
115
Thrombocytopenia + 1 wk old, born at home, comes in w/ bleeding from the umbilical stumpe and bleeding diathesis
-rx
Vit K def (low II, VII, IX, X) *also in CF kid w/ malabsorbtion
-FFP acutely + vitK shot
116
Thrombocytopenia + 9yo w/ Wilson's dz and fulminant liver dz
- 1st clotting factor depleted?
- 2 factors not depleted (why)
- VII (so PTT increases first)
| - vWF, VIII (made by endothelial cells)
117
3yo child, petechiae, abd pain, vomiting, lethargy. He had bloody diarrhea 5 days ago after eating hamburgers at family picnic. Shistiocytes
- labs?
- MCC
- Rx
HUS
- thrombocytopenia and increased Cr
- HAMBURGER: e.coli O157H7, Shigella, Salmonella, campylobacter
- NO plts, early peritoneal dialysis. aggressive nutrition TPN
118
Why should you avoid ABX w/ bloody diarrhea?
increases risk of HUS
119
5yo child is brought in purpura on his legs and buttock, abd pain, joint pain, current jelly stool. His smear appears normal, as are his coagulatoin studies and electrolytes. IgA and C3 are deposited in skin.
- MCC
- rx
HSP (henoch-Scholen purpura)
- post URI
- Sx treatment, can use steriord for GI or renal dz
120
New onset seizure, ataxia and HA worse in AM w/ vomiting for a month.
- MCC
- 2nd MCC, worse prognosis
Brain tumor (usually intratentorial)
- Pilocytic Astrocytoma of cerebellum after resection ~90% survive
- Medulloblastoma (small blue cells)
121
Adolescent w/ height in 5% w/ BL hemianopsia, See calcifications in sella turcica.
craniopharyngioma. Suprasellar. Remnant of Rathke's pouch
122
2yo HTN child w/ asymptomatic abd mass
- ass/
- best test
- Rx
Wilm's tumor
- WAGR, aniridia, GU anoms, Hemihypertrophy, Beckwith-Weidemann
- Abd CT, CXR to check lung involvment
- Resect, chemo, rad
123
4yo w/ jerking movements of eyes and legs, bluish skin nodules and a tender abd mass.
-dx test
"dancing eyes and dancing legs"
Neuroblastoma
-increased urine homovanillic or vanillylmandelic acid
124
3 yo girl w/ a limp, left leg pain, T=99.9, petechiae, hepatosplenomegaly, pallor. Cells are CALLA and TdT+.
- best test
- rx
- poor prog factors
ALL (commonly recurs in CNS)
- biopsy bone marrow (look for >30% lymphoblasts)
- chemotherapy + intrathecal methotrexate
- <1 or >10, or if >>WBC
125
14yo boy, large painless, rubbery nodes, drenching fevers and 10% wt loss.
- best test
- and then
- rx
Hodgkin's lymphoma
- excisional biopsy nodes
- staging CT or laparoscopy (determines Rx)
- chemo + rad
126
7yo girl w/ non-productive cough and large anterior mediastinal mass on CXR.
- best test
- Rx
non-hodgkin's lymphoma (often in mediastinum in children)
- biopsy the mass
- excision then radiation
127
How many APGAR points?
| pulse 130
Pulse: 2+ (over 100, full points)
128
How many APGAR points?
| Acrocyanotic
1+
| = hands+feet blue
129
How many APGAR points?
| grimaces to stimulation
1+ (to get full, must withdraw from stimulation)
130
How many APGAR points?
| moving all extremities
2+
131
How many APGAR points?
| crying
2+ for respiration
132
What does APGAR tell us?
What baby looks like at 1min and 5 min:
1min: how baby tolerated labor
5min: how baby tolerates stimulation
133
What does APGAR does NOT tell us?
not predictive of illnesses or direct treatment
134
position in Erb's
| -persists to 3-6months
C5-6, medially rotated, extended
| -neurosurgery
135
newborn edema that crosses suture lines
caput succedaneum
136
newborn edema does not cross, "fluctuant" when palpated
cephalohematoma
137
Newborn: blue, slate gray, macula on back or thigh.
- what is it?
- what are spots made of?
mongolian spot
| melanocytes
138
Newborn: w/ pale pink vascular macules on nuchal/face (face tend to disappear)
salmon patch (nevus simplex)
139
Newborn: firm white papules, DOL 1, filled with keratin
| -If 1-2wk old
Milia
| -neonatal acne
140
Newborn: firm yellow-white pustles and papules on erytematous base, DOL 2
-if took biopsy, what cells are in there?
erythema toxicum
| -eosinophils
141
Newborn: bright red, sharply demarcated, palpable, lesion, first couple months of life
strawberry hemangioma
142
Baby w/ area of alopecia, skin is oranged colored and nodulars.
-Rx
nevus sebaceous
| -remove, risk of malig degeneration
143
Baby w/ thick yellow/white oily scale on an inflammatory base
-rx
seborrheic dermatitis
| -antifungal topical/shampoo
144
two disorders screened for in every state because they are disastrous if not caught early (and happen to be contraindicated to breast feeding)
PKU
| Galactosemia
145
PKU
- def of
- Sx
- Signs
- Rx
- Phe hydrolxalase
- MR, vomiting, athetosis, seizures, developmental delay over first few months
- Signs: fair hair, eyes, skin, musty smell
- Low Phe diet
146
Galactosemia
- def of
- Sxs-
- predisposed to
- rx
- G1P-uridyl-transferase (G1P accululates and damages kidney, liver and brain)
- MR direct bili and jaundice, low glc, cataracts, seizures
- predisposed to E.Coli sepsis
- NO LACTOSE
147
Does PKU or Galactosemia show ssx at birth? why?
galactosemia, because galactose can cross the placenta
148
Yellow babies:
3 DOL bili at 10, direct is 0.5, eating + pooping well
-mechanism
physiologic (gone by 5 DOL)
| -Liver isn't mature enough to fully conjugate all bili it takes in
149
Yellow babies:
7 DOL, bili at 12, direct 0.5, mucous mem dry, not gaining wt
-mechanism
(lack of) Breast feeding
| -low feeding = dehydration = retain meconium + absorb decong bili
150
Yellow babies:
| 14 DOL, bili 12, direct 0.5, baby regained birth wt, otherwise healthy
breast MILK jaundice:
| -breast milk has glucuronidase (which decong bili in infants GI tract)
151
```
Yellow babies:
1 DOL, bili 14, direct 0.5
-are you worried?
-next best test
- if positive?
-if negative
```
YES because DOL 1
- Coomb's test: are there Ab on baby's RBC
- positive = incompadibility
- neg: twin-twin transfusion meternal-fetal transfusion, spherocytosis, G6PD def, etc
152
Pathologic jaundice
- on 1 DOL
- bili>12
- d-bili>2
- rate of rise >5/day
153
```
Yellow babies:
7 DOL
dark urine
stool pale
bili 12, direct 8
LFT elevated
-mechanism
-rx
```
classic biliary atresia
- bile ducts cannot drain bile
- causes liver failure, need surgery
154
With a direct hyperbilirubinemia, must always suspect
SEPSIS, galactosemia, hypothyroid, choledochal cyst, CF
155
Inherited causes of indirect hyperbili (2)?
Gilbert's- decrease glycoroyl transferase lvl
| Criggler-Najjar- absence (type 1)
156
Inherited causes of direct hyperbili (2)?
Dubin-Johnson- black liver
| Rotor
157
Why do we care about hyperbili in babies?
indirect bili can cross BBB, deposit in BG and brainstem nuclei causing kernicterus (ESPECIALLY when bili >20)
158
How does phototherapy work?
isomerizes indirect bili, which makes is more soluble and excreted (NO CONJUGATION)
159
if bili >20 rx?
| if not so severe?
>20= exchange transfusion
| not as severe: phototherapy
160
baby born w/ resp distress, scaphoid abdomen and bowels in chest on CXR
- biggest concern
- best treatment
diaphragmatic hernia
- pulm hypoplasia (this is what kills if not treated)
- Surgery DOL 3-4 @ palce w/ ECMO (extracorporeal membrane oxygenation)
161
baby born w/ resp distress w/ excess drooling
- best dx test?
- what else do you look for?
esophageal atresia or TEF
- place feeding tube, take Xray, see it coiled in thorax
- VACTER (renal U/S, skeletal survey)- vert, anal atresia, cardiac, radial, renal
162
1 wk old baby becomes cyanotic when feeding but pinks up when crying.
-what else do you look for?
Choanal atresia
| -CHARGE: coloboma, heart, retarded growth, GU anomalies and deafness
163
32 wk premie has dyspnea, RR of 80 w/ nasal flaring
- prenatal dx
- pathophys
- rx
RDS
- before delivery, L:S will be < 2
- decreased surfactant, can't keep alveoli open
- bethamethasone, O2
164
38wk LGA infant born by C/S to an type II-GDM dyspnea/grunting
- pathophys
- prognosis
- risk factor?
Transient Tachypnea of the newborn -(buzzwords: "perihilar streaking due to retained fluids in fissures)
- GREAT! BEST Lung dz to have as a newborn
- C-section (don't get same pressure --> lung expulsion of fluid)
165
41 wk AGA (appropriate for gestational age) infant was born after ROM yielded greenish-brown fluid
- next best step
- complications
meconium aspiration syndrome (kinda looks like aspiration pneumo "pathy infiltrates")
- BEFORE stimulation, intubate +suction
- pneumonia pneumonitis, pulm art HTN (cuz blood can't flow through)
166
defect lateral (usually R) of midline, no sac
- ass/w/ other disorders
- complications
gastroschesis
- usually not
- may be atretic or necrotic require removal. Short gut syndrome
167
defect in midline, covered by sac
| -ass/w/ other disorders
omphalocele
| -Beckwith Wiedemann (big baby w/ big tongue, low glc, ear pits)
168
Big baby with big tongue...two things you think of, how to distinguish?
Hypothyroidism- umbilical hernia
| Beckwith-Wiedemann: omphalocele, ear pits, low glc
169
defect midline. no bowel present
- ass/w/ other disoders
- rx
umbilical hernia
- hypothyroidism (big tongue)
- persists to 2-3yo: surgical repair
170
4wk old infant w/ nonbileous vomiting and palpable olive
- metabolic comp
- rx
pyloric stenosis
- hypochloremic (vomit HCl) meta alk
- pyloromyotomy
171
2wk old infant w/ bilious vomiting. Pregnancy was complication by polyhydramnios
-ass/w/
atresia (duo = double bubble) or annular pancreas
| -down (*duo)
172
1wk old baby w/ bilious vomiting, draws up legs, has abd distension
-pathophys
malrotation and volvulus
* Ladd's bands can kink the duo (pieces of peritoneum that kink and cause volvulus)
- didn't have 270 CCW around SMA
173
3DOL has no passed meconium
| -DDX (2)
- CF
| - Hirschsprungs
174
suspect CF when
| -dx
~3DOL has no passed meconium
| -+Fam Hx
175
3DOL has no passed meconium w/ CF Rx
-Dx+Rx: gastrograffin enema
176
Hirschsprung DRE -->
explosion of poo
177
5DOL former 33 weeker, develops bloody diarrhea
- what do u see on xray
- rx
- risk factors
Necrotizing enterocolitis
- "pneumocystis intestinalis"=air in wall
- conservative: NPO, TPN, AbX if necrotic = resection
- PREMATURITY, some say feeding too soon (especially w/ premature gut)
178
2mo w/ colicky abd pain, currant jelly stool w/ sausage shapend mass in RUQ.
- Dx
- rx
intussespection
| -Dx +rx = barium enema
179
newborn male w/ no palpable testes
- ass/w/
- where are they
- next best step
- when to do surgery, why?
cryptorchidism
- prune belly (basically no ab mm)
- inguinal canal
- abd U/S
- by 1yo if not distended- Decreased risk of NOT DISCOVERING CA
180
why is prune belly called that?
failure of ventral musculare, therefore see peristalsis
| as/w/ cryptorchidism
181
newborn male w/ urethral opening on ventral surface of penis
| -what do you NOT do?
hypospadias
| -circumsize (foreskin is used for repair later in life)
182
newborn child w/ ambiguous genitalia. One month later has vomiting and low Na high K and acidosis
- MC cause
- definitive test
- rx
- when should u increase this dose?
CAH
- 21 alpha=hydroxylase def
- 17-OH progesterone before and after ACTH bolus
- since they don't make Cortisol or Aldo: therefore RX: hydrocortisone and fludrocortisone (aldo) **increase doses in times of stress
183
Important things to control during pregnancy in mothers w/ pre-existing diabetes (esp type 1)
- control glucose in first trimester
| - 4mg folate/day
184
midline mass within first few DOL w/ anuria
| -rx
posterior urethral valve
- mass = distended bladder
- catheterize then surgery
185
Risks during pregnancy in mothers w/ pre-existing diabetes (esp type 1)
placental insufficiency/IUGR, congential heart dz, NTD, caudal regression syndrome, small L colon syndrome
186
Mothers w/ gestational diabetes:
| LGA- complications
increases risk of birth trauma (clavicle, Erbs)
| C/S --> transient tachypnea of newborn
187
Mothers w/ gestational diabetes:
babies are typically hypoglycemia, why?
-complications
-rx
fetal hyperinsulinemia because maternal's glucose crosses placenta
- seizure
- if <40 feed freq, if <20 give IV dextrose
188
Mothers w/ gestational diabetes:
babies are typically hypocalcemic
-complications
neonatal seizure
189
Mothers w/ gestational diabetes:
babies can be polycythemic, why?
-comp
LGA, big baby needs more O2, hypoxemia --> increased EPO
| -clot!
190
Mothers w/ gestational diabetes:
| babies can be jaundiced, why?
more RBCs --> bili --> kernicterus
191
Mothers w/ gestational diabetes:
| babies can get RDS, why?
insulin prevents normal surge of cortisol prior to birth (which works to stimulate lung maturation)
CHECK L:S ratio should be > 2
192
if a baby <28 days has a fever > 100.4 and don't look sick =
sepsis until PROVEN OTHERWISE
193
What tests do u order for sepsis work up?
```
CBC w/ dif
CXR
blood cultures
urine cultures (use catheter)
LP
```
194
risk factors for neonatal sepsis
chorio (prolonged rupture(18+hrs), mom GBS+)
intrapartum fever
prematurity
maternal leukocytosis
195
Most common bugs for neonatal sepsis
How rx?
-if suspect meningitis how rx?
LEG
listeria, e coli, GBS
-ampicillin + gentimycin until 38hr cultures are negative
-Meningitis: cefotaxime + Amp
196
Maculopap rash on palms and soles, snuffles and periostitis
Sphyillus TORCH
| -PCN
197
hydrocephalus, intracranial Ca and chorioretinitis
| -rx?
toxoplasmosis TORCH
| -sulfadizine and leucovorin
198
Cataracts, deafness and heart defects (PDA, VSD), extramedullary hematopoiesis
-rx
"blueberry muffin babies"
Rubella
-vaccinate (no good treatment)
199
Microcephaly, periventricular Ca, deafness, thrombocytopenia and petechiae
-rx
CMV
| -ganciclovier, but won't prevent MR
200
limb hypoplasia, cutaneous scars, cataracts, chorioretinitis, cortical atrophy
-rx
congenital varicella **if mom infected 1 or 2 trimester.
| IF mom is exposed, 5 days before and 2 days after delivery GIVE BABY VZIG
201
DOL 1-3, red conjuctiva and tearing
chemical (not that common anymore b/c we use erythromycin)
202
DOL 3-5, BL purulent conjunctivitis can cause corneal ulceration
Gonococcal conjunctivitis
| -topical erythromycin and IV 3rd gen ceph
203
DOL 7-14, red conjunctiva w/ mucoid discharge and lid swelling
- rx
- comp (ssx)
chlamydia conjunctivitis
- oral erythromycin
- chlamydia pneumo (scattered Crackles, nasal discharge, nasal drainage, BL infiltrates on CXR)
204
Purulent =
| mucopurulent =
```
Purulent = gono
mucopurulent = chlamydia
```
205
newborn baby has decreased tone, oblique palpebral fissures, simian crease, big tongue, white spots on his iris
- What will his expected IQ?
- Heart
- GI
- Endocrine
- Msk
- neuro
- CA
Downs
- decreased IQ
- endocardial cushion
- duo atresia, hirschsprung, imperf anus
- hypothyroidism
- AA instability (*pre-op do C-spine film)
- early onset Alzheimer's (amyloid precursor protein on Chr 21)
- ALL
206
omphalocele, rocker bottom feet, hammer toe, microcephaly and clenched hand, multiple other defects
edwards (trisomy 18)
207
holoprosencephaly, severe MR and microceph, cleft lip/palate, multiple others
patau's (trisomey 13)
208
14yo girl w/ no breast dev, short stature and high FSH
- ass/ anomalies (3)
- Rx
Turner's syndrome
- coarc of aorta, horseshoe kidney, bicupsid aortic valve
- estrogen
209
18yo lanky boy w/ mild MR, gynecomastia and hypogonadism
| -increased risk of
Kleinfelter's
| -gonadal malignancy
210
Cafe-au-lait spots, seizures, large head, auto Dom
Neurofibromatosis
211
mandibular hypoplasia, glossoptosis, cleft soft palat, w/ FAS or edwards
pierre robin sequence
212
broad, square face, short stature, self-injurious behavior, deletion of chr17
smith magenis
213
hypotonia, hypogonadism, hyperphagia, skin picking, agression, del of paternal chr15
prader-willi
214
seizures, strabismus, sociable w/ episodic laughter. Deletion on maternal Chr15
Angelman's
215
Elfin-appearance, friendly, increased empathy and verbal reasoning ability, del of Chr7
William
216
IUGR, hypertonia, distinctive facies, limb malformation, self-injurious behavior, hyperactive
Cornelia de Lange
217
microcephaly, smooth philtrum, thin upper lip, ADHD-like behavior, MCC of MR
fetal alc syn
218
most common MR in boys, CGG repeats on X-Chr w. anticipation. Macroceph, macro-orchidism, large ears
Fragile X
219
auto dom, ass/ w/ advanced paternal age, short palpebral fissures, while forelock and deafness
Wardenburg syndrome
220
2yo M w/ multiple ear infections, diarrheal episodes and pneumonias. no tonsils
-labs?
```
no tonsils = B cell problem
Bruton Agammaglobulinemia (x-linked)
infections start around 6-9mo
-no B cells on flow cytometry, low levels of all Igs
```
221
17yo F w/ decreased IgG, IgM, IgE and IgA but normal numbers of B cells.
-comp
combined variable immune def
| -lymphoma
222
Most common B-cell defect, recurrent URIs, diarrhea.
| -comp
IgA def
| -anaphylaxsis if given blood with IgA in it
223
3wk old M w/ seizures, truncus arteriosus, micrognathia
- genetic defect?
- what types of infections in childhood?
annnddd no thymus
DiGeorge
-chr22
-fungus, virus, things that T cells take care of
224
infant w/ severe infections, no thymus or tonsils, severe lymphopenia
- inferitance
- rx
SCID
- bacterial, viral and opportunistic
- usually X-linked (also auto r)
- BONE MARROW TRANSPLANT ITS A PEDS EMERGENCY
225
3yo M w/ recurrent swollen, infected lymph nodes in groin and staph aureus skin abscesses
- inheritance
- how to dx
chronic granulomatous dz
- X linked rec
- Nitrotetrazolium blue (yellow means they have dz) *new test is flow cytometry w/ DHR-123
226
18mo M baby w/ severe ezcema, petechiae and recurrent ear infections
-Ig make up?
Wiskott-Aldrich
- LOW: IgG+M
- HIGH: IgE+A
227
Wisckott-aldrich often present with
prolonged bleeding after circumcision
228
newborns lose 10% of birth weight in first week.
| -why?
fluid loss (pee)
229
newborns should regain birth weight by?
2 wks
230
newborns should double birth weight by?
6 months
231
newborns should triple weight by?
1 yr
232
newborns should increase length by 50% by?
1 yr
233
newborns should double length by?
4-5yrs
234
XXX breast feeding
```
HIV
active Herpes lesions
Alc, drug use
Galatosemia + PKU
TB
Radioactive iodine
```
*Hep C IS OKAY
235
Breast milk
what is the predominant protein? FA?
What does it have more of (compared to formula? What does it have less of?
Breast: whey, long-chain
MORE: two above + lactose
LESS: Fe (but better absorbed, so it's a wash)
236
14yo M, always been below 5% in height, parents are tall and were "late bloomers"
-bone vs real age
constitutional growth delay
- bone < real
- child will likely be normal height
237
14yo M, always been below 5% in height, father 5'2'' and mom 4'10''
familial short stature
| bone = real
238
14yo boy, 50% height, 97% weight
| -bone vs real age (why?)
obesity
bone > age
-high estrogen mature bones, close epi plate sooner --> advanced bone age
239
what are some causes of advanced bone age
precocious puberty,
| CAH, hyperthyroidism
240
14yo boy starts in 50% for height, then in past 2 yrs has dropped to 5-10%
-DDX
pathologic short stature
- craniopharyngioma (vision, check CT)
- hypothyroidism (check TFTs)
- hypopituitarism (check IgF1)
- Turners (check karyotype)
241
Reflex:
normal moro
-age range
when head is E
arms and legs both F
-birth-4/6mo
242
Reflex:
normal Grasp
-age range
place finger in palm
Flexes hand
-birth-4/6mo
243
Reflex:
normal Rooting
-age range
rub cheek
turns head IL side
-birth-4/6mo
244
Reflex:
normal Stepping/Placing
-age range
stim dorsum of foot
steps up
-birth-4/6mo
245
Reflex:
normal fencing
-age range
Turn neck
CL arm F, IL arm E
-
246
Reflex:
normal Parachute
-age range
*kinda the opposite of moro
simulate Fall
arms E
-6/8mo-->
247
Which primitive relfex never goes away?
Parachute (arms E when fall is simulated)
248
CNS origin of primitive reflexes
brain stem and vestibular nuclei
249
Developmental Milestones:
| roll over
6 mo
250
Developmental Milestones:
| skips and copies a triangle
5yr
251
What can baby do at 6 mo?
roll over
sit w/ support
creep/crawl
stranger anxiety
252
Developmental Milestones:
| walk alone
15mo
253
Developmental Milestones:
| walk upstairs with alternating feet
30 months ~2.5yo
254
Developmental Milestones:
| copy cross and square
48months ~4 yr
255
Developmental Milestones:
| pincer grasp
9mo
256
Developmental Milestones:
| walks down stairs and can copy a circle
26months ~3yr
257
Developmental Milestones:
| half speech is comphrehensible
2yr
258
Developmental Milestones:
social smile
-starts to?
2 mo
| -coo
259
Milestones at 15mo
walk alone
| build 3 cube tower
260
Milestones at 30mo
walk upstairs w/ alternating feet
knows name
refers to self as "I"
261
Milestones: Can draw person w/ 8-10 parts
5yo
262
Milestones at 4 yrs
hops on 1 foot
Toilet trained (poop)
group play
263
Milestones at 9mo
pincer grasp
sits unsupported
peak-a-boo
264
Milestones at 3yr
Knows age and sex
| counts to 3
265
Milestones at 2yr
1/2 speech comprehensible
speak w/ 2-3 sentences
can undress
hold spoon
266
Milestones at 2 mo
social smile
| some vowel sounds
267
urinary continence should be attained by?
| When should fecal continence be attained?
5yr
| 4yr
268
Primary vs secondary incontinence
```
Primary = never achieved
secondary = after 6mo of dryness
```
269
urinary continence, medical causes to r/o?
MCC of enuresis = UTI (UA)
| -also constipation (disimpact) or diabetes (check glucose)
270
Rx enuresis
First = behavioral- reward system, pee before bed, bell-alarm pad
Second- DDAVP (desmopressin) or imipramine
271
MCC of fecal incontinence
- rx
- behavioral modification
constipation
| -disimpact, stool softeners, high fiber diet
