Pediatrics 2 Flashcards
(216 cards)
1
Q
Treatment of herpes simplex conjuntivitis?
A
systemic acyclovir and topical vidarabine
2
Q
if tachypnea in a newborn lasts >4 hours it is considered _____ and must be evaluated with _____ tests?
A
sepsis, blood and urine culture
3
Q
most fatal infant skull fracture?
A
basilar
4
Q
most common infant skull fracture?
A
linear
5
Q
Caput succedaneum
A
swelling of soft tissues of scalp that do cross suture lines (edema)
6
Q
Cephalohematoma
A
subperiosteal hemorrhage (does NOT cross suture lines)
7
Q
Duchenne-Erb Paralysis: C5-C6 presents as
A
“Waiter’s tip” appearance. secondary to shoulder dystocia
8
Q
Klumpke paralysis C7-C8/T1
A
Claw hand due to lack of grasp reflex (paralyzed hand with horner syndrome- ptosis, miosis, anhydrosis)
9
Q
Forcep delivery can cause damage to?
A
facial nerve- facial nerve palsy.
10
Q
Werdnig-Hoffman
A
spinal musclar atrophy in infant
11
Q
Causes of polyhydramnios?
A
Werdnig-Hoffman (infant cant swallow), Intestinal atresias
12
Q
Causes of oligohydramnios?
A
Prune belly (no abdominal wall muscles so unable to bear down and urinate) Renel agenesis (potter syndrome)
13
Q
Omphalocele is associated iwth what chromosomal abnormality?
A
trisomy 18
14
Q
Aniridia is?
A
absence of iris
15
Q
aniridia is most valuable clue to what diagnosis?
A
Wilms Tumor
16
Q
Most common abdominal mass in children?
A
Wilms Tumor
17
Q
Best initial study to diagnose Wilms tumor? Most accurate study to diagnose wilms tumor?
A
Ultrasound
Contrast-enhanced CT
18
Q
Wilms tumor, GU malformations, mental retardation, aniridia is known as what syndrome? what chromosome?
A
WAGR - chrom 11
19
Q
Most common extracranial solid malignancy?
A
neuroblastoma
20
Q
most common cancer in infancy?
A
neuroblastoma
21
Q
Hypsarrythmia on EEG and opsomyoclonus are hallmark findings of?
A
neuroblastoma
22
Q
How do you diagnose neuroblastoma?
A
Increased VMA and metanephrines on urine collection
23
Q
hydrocele
A
remnant of tunica vaginalis
painless, swollen, fluid filled, transilluminates on inspection
24
Q
If you see varicocele on one side…?
A
always ultrasound the other side
25
Does surgical correction of cryptorchidism reduce cancer risk?
no (associated with malignancy regardless of surgical intervention)
26
hypospadias has a high association with ?
cryptorchidism and inguinal hernias
27
epispadias is associated with?
urinary incontinence, bladder extrophy
28
4 characteristic traits of tetralogy of fallot
overriding aorta
pulmonary stenosis
RVH
VSD
29
Cxray showing boot shaped heart and decreased pulm vascular marking is suggestive of?
Tet of Fallot
30
Name the 3 holosytolic murmurs
mitral regurg
tricuspid regurg
VSD
31
most common congenital heart defect in Down Syndrome?
endocardial cushion defect of AV canal
32
A single S2 is heard in this congenital heart defect?
transposition of great vessels
33
most common cyanotic condition in kids ?
Tet of Fallot
34
most common cyanotic condition in neonatal period?
TOGV
35
pulsus paradoxus suggests?
cardiac tamponade and tension pneumo
36
pulsus bisferiens?
aortic regurg; (double peaked pulse)
37
pulsus bigeminus?
sign of HOCM;
38
pulsus alternans
left ventricular systolic dysfunction
39
Gray rather than blue cyanosis, absent pulses, single S2, increased RV impulse?
hypoplastic left heart syndrome
40
most severe sequela of truncus arteriosus?
pulmonary hypertension
41
total anomalous pulm venous return?
no venous return between pulmonary veins and left atrium. oxygenated blood returns to the SVC
42
before surgery for VSD what are some medical treatments?
Diuretics and Digoxin
43
PDA is a normal finding in the first ____ hours of life. It is considered pathologic after the first ____ hours
12, 24
44
Best initial test for murmurs? most accurate?
Echo, cardiac cath
45
Pear-shaped cardiac x-ray?
pericardial effusion
46
jug handle cardiac xray?
primary pulm artery htn
47
hearing loss, syncope, normal vitals and exam and a fam history of sudden cardiac death =
long QT syndrome
48
when is hyperbilirubinemia considered pathological?
- appears on first day of life
- bilirubin rises >5mg/dL/day
- bii > 19.5 in term child
- direct bili > 2 anytime
- hyperbili persisting into 2nd week of life
49
string sign is seen with?
pyloric stenosis
50
best initial test to diagnose pyloric stenosis? most accurate test?
ultrasound
| upper GI series
51
first step in management of choanal atresia?
secure airway
52
how will an infant with choanal atresia present?
difficulty with feeds- cyanosis during feeds. membrane between nostrils and pharyngeal space
53
choanal atresia is associated with?
CHARGE syndrome
54
CHARGE syndrome?
```
C: coloboma of eye (hole), CNS anomalies
H: heart defect
A: atresia of nasal concha
R: retardation of growth/deelopment
G: genital/urinary defects
E: ear anomlie/deaf
```
55
how do you confirm a clinical diagnosis of choanal atresia?
CT scan
56
imperforate anus has a high association with?
down syndrome
57
VACTERL syndrome?
```
V: vertebral anomalie
A: anal atresia
C: cardio anomalie
T: TE fistula
E: esoph atresia
R: renal
L:limb
```
58
diagnosis of imperforate anus?
complete failure to pass meconium and physical exam. (do NOT perform barium study or rectal manometry)
59
Duodenal atresia is associated with?
annular pancreas and down syndrome
60
Intussusception is associated with?
previously used rotavirus vaccine and HSP
61
best initial test for intussusception?
ultrasound- doughnut sign or target sign
62
what is both diagnostic and therapeutic for intussuception?
barium enema
63
when should you not perform a barium enema in case of intussusception?
peritonitis, shock, perforation
64
Best initial test for duodenal atresia and volvulus?
AXR
65
Rotavirus is most commonly seen in what season?
Winter
66
antibiotics of choice in nec enterocolitis?
vanc, gent, metronidazole
67
first step in management when nec enterocolitis is diagnosed?
antibiotics
68
small left colon syndrome is found in?
infants born to moms with DM (can be diagnosed by barium study. can cause distension from constipation)
69
90% or more cases of CAH are due to?
21-hydroxylase deficiency
70
hypotensive child with severe electrolyte abnmlites?
CAH
71
In CAH describe common genitalia findings in girls/boys?
ambiguous in girls. boys typically normal- but can lose defining sex features as they age.
72
most common organisms causing neonatal sepsis?
GBS
E.coli
S. aureus
Listeria monocytogenes
73
treatment for neonatal sepsis
ampicillin, gentamicin
74
treatment for Toxo?
pyrimethamine and sulfadiazine
75
Roseola is caused by? presents as?
herpes virus 6+7. fever and URI progressing to diffuse rash.
76
Mumps presents as?
fever, parotid swelling, orchitis
77
Initial management of patietn with Croup who presents in respiratory distress?
racemic epinephrine to decrease swelling
78
croup is caused by?
parainfluenza types 1 and 2
79
how can you differentiate croup from epiglottitis?
croup- hypoxia on presentation
| epiglottitis- hypoxia imminent
80
first step in management of epiglottitis?
intubation
81
management of epiglottitis?
1. inubate in OR incase you need a tracheostomy
2. ceftriaxone 7-10 days
3. rifampin to all close contacts
82
severe coughing followed by vomiting is suggestive of?
paroxysmal stage of whooping cough (bordetella pertussis)
83
erythromycin and azithromycin are beneficial for whooping cough when?
only during catarrhal stage (first 14 days of runny nose and congestion)
84
treatment for diptheria?
antitoxin. abx dont work.
85
management for legg calve perthes disease?
rest and nsaids
| eventual surgery on both hips
86
painful hip and externally rotated leg?
SCFE
87
calcified intracranial tumors in the suprasellar region?
craniopharyngioma
88
how can you differentiate pituitary adenoma from craniopharyngioma?
pituitary adenoma not calcified
89
Todd paralysis
transient, focal neuro deficit (hemiparesis) that occurs after a seizure
90
onset of hemiplegic migraines?
adolescence often with positive family history
91
Children < 2 with first febrile UTI should have what done?
1-2 weaks abx
| renal and bladder US
92
when is a VCUG indicated after a UTI in babies?
if hydro/scarring is seen on US
| newborns < 1 month, children < 2 with recurrent UTIs or UTI with organism other than e.coli
93
most common predisposing factor for orbital cellulitis?
bacterial sinusitis
94
most common cause of neonatal sepsis?
GBS
95
does GBS screening and prophylaxis decrease GBS sepsis risk after 7 days?
no
96
most common cause of pediatric stroke?
sickle cell disease
97
only absolute contraindication to breastfeeding?
galactosemia
98
breastfeeding reduces the risk of which types of cancer?
ovarian and breast
99
painful vesicles with punches out erosions and hemorrhagic crusting along with fever and lymphadenopathy =?
eczema herpeticum
100
eczema herpeticum is associated with?
atopic dermatitis
101
Diamond-Blackfan syndrome (congenital hypoplastic anemia)
macrocytic anemia, low retic count, congen anomolies
102
syndrome with eczema, thrombocytopenia, hypogammaglobulinemia?
Wiskott-Aldrich
103
pellagra
niacin (B3) deficiency: diarrhea, dermatitis, dementia
104
Fetal macrosomia, rapid growth, omphalocele or umbiical hernia, macroglossia, hemihyperplasia?
Beckwith-Wiedemann syndrome
105
patients with beckwith-wiedemann are at sig increased risk for?
hepatoblastoma and wilms tumor
106
what tests should occur every 3 months in kids with beckwith-wiedemann?
abd ultrasound and AFP levels
107
clinical trials have shown that what 3 drugs have equivalent efficacy for lyme disease?
doxy, amoxicillin, cefuroxime
108
Treatment for chlamydia conjunctivitis?
PO macrolide!! (not topical)
109
neonatal sepsis often presents as?
fever or hypothermia, poor feeding, decreased activity
110
severely low T cells and hypogamaglobulinemia with recurrent infections, absence of lymphoid tissue suggests
SCID
111
normal T cells, absence of B cells, hypogammaglobulinemia- absence of lymphoid tissue
Bruton's
112
recurrent skin and soft tissue infections with normal lymphocyte and immunoglobulin concentrations?
chronic granulomatous disease
113
presents at a later age with normal T and B cell counts and hypogammaglobulinemia?
CVID
114
bleeding post circumcision, bleeding from umbilical stump, eczema- should make you think of?
Wiskott-Aldrich
115
All close contacts of a patient with Bodetella Pertussis should be given?
macrolide antibiotics
116
Treatment for pertussis if <1 month?
Treatment for pertussis if > 1 month?
1. Azithro X 5 days
| 2. Azithro X 5, Clarithro X 7, Erythro X 14
117
erythromycin use in infants < 1 month is associated with?
pyloric stenosis
118
how do you confirm diagnosis of duchenne muscular dystrophy?
absent dystrophin gene on genetic testing. undetectable dystrophin protein on muscle biopsy
119
myotonic discharges on electromyography is indicative of?
Myotonic dystrophy
120
in addition to elevation in inflammatory markers, what is also seen in juvenile idiopathic arthritis?
anemia (elevated hepcidin decreases iron abs across small intesting and decreases release of iron)
121
contrast aplastic anemia with aplastic crisis?
aplastic anemia = pancytopenia due to bone marrow failure
122
Patient with SS with acute anemia, low retic count, no splenomegaly?
aplastic crisis
123
rotavirus is contraindicated in patients with a history of?
intussusception
124
ovarian tumor that secretes LDH and B-hcg?
dysgerminoma
125
most common benign ovarian neoplasm
serous cystadenoma
126
when does visual acuity testing begin?
Age 3
127
gold standard diagnostic test for malrotation with midgut volvulus?
upper GI contrast study
128
finding of ligament of treitz on right side of abdomen reflects what? what do you see with volvulus?
- malrotation
| - Volvulus: corkscrew pattern on barium swallow
129
differentiate pyloric stenosis from volvulus?
pyloric stenosis is not billious
130
cataracts, PDA, sensorineural hearing loss?
congenital rubella
131
fever, rash with cephalocaudal spread and post auricular and occipital lymphadenopathy and arthralgias?
rubella
132
how to differentiate measles from rubella?
koplik spots, higher fever (>104), cervical rather than post-aur lymphadenopathy, rash spreads over multiple days, no arthralgias in measles
133
Treatment for kids with previous history of rheumatic fever?
benzathine penicillin G every 4 weeks to prevent recurrent infection with GAS (which they are at risk for)
134
Sphingomyelinase deficiecny?
Niemann-Pick disease
135
Difference between Tay-Sachs and Niemann-Pick?
No hepatosplenomegaly or areflexia in Tay-Sachs
| Hyperreflexia in tay-sachs
136
B-hexosaminidase deficiency
Tay-Sachs
137
Mentzer index?
MCV/RBC
138
Mentzer index in thalassemia? MCV/RBC < ?
13
139
Mentzer index in iron deficiency anemia?
MCV/RBC > 13 (due to decline in RBC count)
140
Complications of cryptorchidism and orchiopexy?
Inguinal hernia
testicular torsion
subfertility
testicular cancer
141
patients with cryptorchidism are at greatest risk for developing?
subfertility
142
rapid diagnosis and treatment for intussuseption is done with?
ultrasound guided air contrast enema
143
should centor criteria be used for children (preadolescent) ?
no
144
why is a knee to chest position helpful in the case of tetrology of fallot?
increases systemic vasc resistance, increases pulmonary blood flow, improves hypoxia
145
what determines the severity and clinical presentation of Tet of Fallot?
Degree of RVOT obstruction
146
sterile pyuria and elevated ESR, c-RP can be supportive evidence if presentation of this illness in child is not convincing enough?
Kawasaki
147
Treatment for kawasaki
aspirin and IVIG
148
major protein source in breast milk and major protein source in formula and the difference between the 2?
breast: whey
formula: casein
whey is more easily digested and helps to improve gastric emptying
149
a patient with history of sore throat, writhing and jerking of arms and hands and subcu nodules has ______ caused by _____?
acute rheumatic fever caused by strep pyogenes
150
JONES criteria for myocarditis?
```
J: joints (mig arthritis)
O: carditis
N: nodules
E: erythema marginatum
S: sydenham chorea
```
151
most common cause of sepsis in SCD patients
s. pneumo
152
maintenance for SCD patients?
vaccination, penicillin (until age 5), folic acid
153
how does HSP increase risk for intussusception?
small bowel hematoma from autoimmune vasculitis
154
describe potter sequence
urine tract anomaly (commonly posterior uretheral valve) -> anuria, oliguria -> oligohydramnios -> pulm hypoplasia, flat facies, limb deformities
155
what abnormality in Turner's syndrome might lead to edema?
abnormal development of the lymphatic system
156
lymphadema is generally pitting or non-pitting?
non-pitting
157
pain in a 6 year old boys legs - bilaterally, mostly at night, without systemic symptoms?
growing pains
158
In a patient with down syndrome who presents with upper motor neuron findings- suspect?
atlantoaxial instability
159
most common presenting symptom of cerebral palsy?
delayed motor development
160
hand preference before 1 year of age is a red flag for?
cerebral palsy
161
define complex seizure
long duration > 15. or focal. or multiple seizures in 24 hour period. or not returning to neuro baseline.
162
Infants less than 6 months of age need _____ for febrile seizures? do kids > 18 moa need a work up for first time feb seizure?
sepsis work up ; no
163
Work up for complex febrile seizure?
full seizure work up. MRI, EEG, electrolytes.
164
most common childhood malignancy in white boys 2-5?
ALL
165
most common childhood malignancy in black boys throughout childhood?
AML
166
young child with bone pain, refusal to bear weight, anemia, ecchymoses, petechia, hepatosplenomegaly?
think leukemia
167
greenish soft tissue tumor on skin or spinal cord can be odd presentation of?
AML
168
What imaging study do you need after diagnosis of ALL is made?
Cxray
169
neuroblastoma is associated with?
neurofibromatosis, hirschsprung, n-myc oncogene
170
Differentiate Ewing and Osteosarcoma
Ewing: systemic symptoms common
Osteosarcoma: systemic symptoms rare
E: midshaft of long bones
O: Metaphysis of long bones (mets to lungs 20%)
E: lytic lesion with "onion skin" and increase ESR
O: increase alk phos, sunburst lytic lesions
171
cxray for RDS
air bronchograms, ground glass
172
cxray TTN
perihilar streaking
173
meconium aspiration
coarse, irregular infiltrates, lung hyperextension, pneumothorax
174
congenital pneumonia
nonspecific patchy infiltrates
175
chorioretinitis, hydrocephalus, intracranial calcification?
toxoplasma
176
PDA, cataracts, deafness
Rubella
177
hearing loss, seizure, periventricular calcification, petechial rash?
CMV
178
leukocoria can indicate what 3 things?
retinoblastoma, congenital cataracts, retinopathy of prematurity
179
Patients who have life threatening allergies to eggs may not receive what vaccine?
MMR
180
Treatment for lead poison < 45 and asymptomatic?
retest at 1-3 months, remove sources of lead
181
Treatment of lead 45-69?
chelation with EDTA (inpatient) or outpatient (oral succimer- DMSA)
182
Treatment of lead >70?
inpatient EDTA and BAL (IM dimercaprol)
183
3 P's of McCune-Albright syndrome?
precocious puberty, pigmentation (cafe au lait spots), polyostotic fibrous dysplasia ( bone defects)
184
Treatment for HUS?
fluid and electrolyte managment
blood transfusions
dialysis
185
most common type of brain tumor in kids?
pilocytic astrocytoma
186
A patient with primary amenorrhea and no pubic hair, breast development is found to have a uterus. what is next test?
FSH
187
Isolated amenorrhea with well developed sex characteristics can be considered normal up to age?
16
188
If amenorrhea is determined to be of peripheral origin (with measurement of high FSH) what is next study?
karyotype
XX- likely abnormal mullerian development
XY- likely androgen insensitivity
189
primary dysmenorrhea is caused by?
prostaglandin release from endometrial sloughing
190
bulky, globular, tender uterus that may cause dysmenorrhea and bleeding?
adenomyosis
191
vitamin deficiency in malnourished patient with angular chelitis, stomatitis, glossitis anemia, seborrheic dermatitis
B2 riboflavin
192
petechia, bleeding gums, hyperkeratosis, coiled hair?
Vitamin C deficiency
193
patients with androgen insensitivity syndrome should have gonadectomy done when?
electively after puberty so that they may reach adult height potential
194
eosin-5-maleimide binding test and the acidified glycerol lysis test are gold standard for?
spherocytosis
195
treatment for HS?
folic acid, blood transfusion, splenectomy
196
most common pathogen of otitis externa? 2nd most?
Pseudomonas aeruginosa
| staph aureus
197
kartagener syndrome
primary ciliary dyskinesia, with triad of situs inversus, recurrent sinusitis, bronchiectasis
198
limited upward gaze, upper eyelid retraction (collier sign), pupils non-reactive to light, reactive to accomodation is characterisric of what type of tumor?
Pineal
| Perinaud syndrome
199
when are varicella vaccines given?
1+4
200
most common pathogen isolated from infants and young children until about age 20?
staph aureus
201
most common cause of CF related pneumonia in adults?
pseudomonas
202
The treatment for clubfoot should be started _______
immediately
203
new onset hearing loss or chronic ear drainage despite abx therapy with skin debri and granulation tissue are typical presenting symptoms of?
cholesteomas
204
children with HSP are at an increased risk for?
ileo-ileal intussusception
205
palpable purpura, arthritis, abd pain, intussusception, renal disease (IgA), scrotal swelling?
HSP
206
FTT, bilateral cataracts, jaundice, hypoglycemia, hepatosplenomegaly, mental retardation, jerking?
Galactosemia
207
why does maternal diabetes increase risk of RDS?
high levels of circulating insulin antagonize cortisol and block maturation of sphingomyelinase (component of surfactant)
208
abnormal uterine bleeding in adolescents who have just started their periods might be due to?
immature HPGA (most cycles are anovulatory and present as painless, irregular, heavy bleeding)
209
Treatment of AUB due to immature HPGA axis?
progestin only or combo OCP
210
a fall with object in mouth (toothbrush/pencil) can cause traumatic?
carotid injury
211
radioopaque tablets in stomach of child with abd pain, hematemasis? cause? treat with?
lead poisioning
deferoxamine
212
management of hydrocele?
most can be observed as they often dissapear spontaneously by the age of 12 months
213
how do you manage battery stuck in esophagus? distal to esophagus?
remove immediately under endoscopic guidance to prevent mucosal damage.
batteries distal to esophagus pass uneventfully in most cases and are observed with stool exam / follow up x-ray
214
orthostatic hypotension is a common side effect of?
amitriptyline
215
Beckwith-Wiedemann syndrome
```
fetal macrosomia, rapid growth until late childhood
omphalocele, umbilical hernia
macroglossia
hemihyperplasia
wilms tumor
hepatoblastoma
```
216
how do you monitor beckwith-wiedeman?
US, AFP
