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Flashcards in Pediatrics Deck (51):
1

Is gonnorhea on vag cx of a kid evidence for child abuse?

Is chlamydia?

Gonn - yes
Chlamydia - no. Could have gotten it at birth from mom, it can take up to 3 years to present

2

What type of shunt?

cyanotic congenital heart disease
acyanotic congenital heart disease

cyanotic = R-->L shunt
acyanotic = L-->R shunt (VSDs, ASD's, PDA's)

3

What type of heart defect is associated with:
Rubella?
Turners?
Kawasaki's?
SLE?
Lithium?
maternal DM?

Rubella = PDA
Turners = Coarctation of Aorta
Kawasaki's = Coronary Artery aneurysms
SLE = Congenital heart block
Lithium = Ebsteins anomoly
maternal DM = Asymmetric septal hypertrophy AND transposition of great vessels

4

What is the tx for a PDA?

When do you not treat?

Indomethacin (closes the PDA) - can use up to 6-8 months old

Keep open w/ PGE! Don't close it in case of transposition of great vessels, coarctation of aorta, tetralogy of Fallot, hypoplastic left heart disease, or if indomethacin is contraindicated (intraventricular hemorrhage.)

5

Where does a coarctation of aorta normally occur>?

Just below the subclavian artery (causes HTN in upper extremities and normal BP below the coarctation

Interestingly, more than 2/3 these pts have a bicuspid aortic valve

6

What are the risk factors for transposition of great vessels?

WHat additional abnormalities must these kids have to stay alive?

DM and Digeorge Syndrome

Must have an ASD/VSD and a PDA

7

If kid turns blue after a few years vs few hours?

years = tetralogy of fallot
hours = transposition of vessels

8

What are the risk factor for tetralogy of fallot?

DiGeorge and maternal PKU

9

Infant is asymptomatic until 4 months when he is diaphoretic with feeding and tachypnic

Dx?
Tx?

Tetrology of Fallot

CXR shows Boot Shaped Heart

Tx with PGE (like transposition of great vessels) but will ultimately need surgery.

10

Explain tet spells?

kids squat to increase vascular resistance so that they can breath with tet of fallot. (pulmonary stenosis, overriding aorta, RVH, VSD)

11

What 2 genetic abnormalities can cause down syndrome?

Other issues to worry about in DS?

#1 = meiotic nondisjunction
#2 (4%) = robertsonian translocation

Duodenal atresia, Hirschprung's disease, atrioventricular cushion defects, ALL, hypothyroidism, Alzheimers

12

What genetic abnormality do PKU kids have? Sx?

decreased phenylalanin hydroxylase or decreased THB cofactor.

After a few normal months, the kids present w. MR, fair skin, blonde, eczema, musty urine. Tx w/ tyrosine and low phenylalanine

13

Match disease w/ deficiency:
Fabry's disease
absent galactosylcermidase
Gaucher's disease
absent sphingomyelinase
Tay-Sachs
absent Arylsulfatase A
Hurler's
Absent iduronate sulfatase

Fabry's disease = galactosidase A (telangiectasias, angiokeratomas)
absent galactosylcermidase = Krabbe's disease (CNS issues)
Gaucher's disease = Glucocerebrosidase (crinkled cells, TCP, anemia)
absent sphingomyelinase = Neimann-Pick (cherry spot and HSM)
Tay-Sachs = hexosidase (cherry spot, no HSM)
absent Arylsulfatase A = Metachromatic Leukodystrophy (ataxia)
Hurler's = a-L-iduronidase (corneal cloud, MR, gargoyl)
Absent iduronate sulfatase = Hunter's (no corneal cloud, X-linked)

14

Colicky pain in healthy kid. Flexed knees and vomiting. Current jelly stool w. sausage shaped RUQ mass. Dx? Risk factors? Tx?

Intussusception

Risks = lymphoma, LAD, H.u.S., Meckels Diverticulum

Tx: air contrast barium enema

15

What Abx can be a risk factor for pyloric stenosis?

What abnormal acid state is seen in PS?

Erythromycin

pt will have hypochloremic hypokalemic metabolic alkalosis (persistent emesis of HCl)

16

Healthy kid with sudden, intermittent painless rectal bleeding. Dx?

Meckel's diverticulum, can lead to diverticulitis, volvulus, or intussuss.
FAILURE OF OMPHALOMESENTERIC/VITELLINE DUCT TO DISAPEAR.

Use the 99 scan to check for ectopic gastric tissue

17

What GI disease is associated with MEN type 2?

Hirschprungs Disease

Dx needs rectal bx (will show absence of myenteric (aurbachs) plexus and submucosal (meissners) plexus

18

What is the dx of choice for malrotation (kid shows up with bilious vomiting)

An EGD, although an XR will show a birds beak

19

Newborn with feeding intolerance that has intramural air bubbles in the GI?

Necrotizing Entericolitis (bubbles are made by bacteria)

20

Tx for:
Brutons Agammaglobulinemia
CVID
IgA def
DiGeorge

Brutons Agammaglobulinemia = IVIG (B's are low, tonsils maybe gone)
CVID = IVIG (Low T's and plasma's. B's normal)
IgA def = tx infections (no IVIG as it can cause anti-IgA Abs)
DiGeorge = BM transplants & IVIG (thymic aplasia()

21

Tx for:
Ataxia-Telangiectasia
SCID
Wiskott-Aldrich

Ataxia-Telangiectasia = no specific (DNA repair defect)
SCID = BM transplant, PCP prophylaxis, IVIG (bubble boy)
Wiskott-Aldrich = supportive, die by adults. (infections, purpura, eczema, low IgM, TCP)

22

Tx of:
Chronic Granulomatous Disease
Leukocyte Adhesion Deficiency
Chediak Higashi Syndrome
Job's Syndrome
C1 esterase def (hereditary angioma)
Terminal Complement Def (c5-c9)

-Chronic Granulomatous Disease = nitroblue test, tx: TMPSMX (cat+ infections)
-Leukocyte Adhesion Deficiency: BM transplant. (umbilical cord)
-Chediak Higashi Syndrome: BM Tx (occulo-albinism, neuropathy, neutropenia.)
Job's Syndrome: Abx & IVIG (FATED - facies, abscesses, small teeth, hyper-IgE, dermatologic)
C1 esterase def (hereditary angioma): C1 esterase. (edema)
Terminal Complement Def (c5-c9): mening vaccine & Abx (recurrent N.Men infections.)

23

Kid with painless conjunctivitis and painful unilateral LAD with truncal rash and strawberry tongue w/ desquam of fingertips. Dx? Tx?

Kawasaki Disease
Tx = high dose ASA, IVIG

SCARLET FEVER LOOKS LIKE THIS TOO, BUT HAS NORMAL LIPS AND NO CONJUNCTIVITIS

24

WHAT will labs look like for Juvenile Idiopathic Arthritis?

Tx?

ANA+
RF-

Tx = NSAIDs and strengthening exercises

25

High fever (>102) with HSM and a salmon colored macular rash?

Still's disease (systemic-onset)
RF and ANA negative

26

Young kid comes in tugging on his ears. What bugs? Tx?

S. pneumo
nontypable H flu
Moraxella catarrhalis
Viruses: influenza A, RSV, paraflu

Tx = amox

27

Kid gets sick in the Winter. Dx? Bug? Tx? PPx?

Bronchiolitis!
RSV is most common, other = paraflu, influenza
Tx = supportive, maybe nebs. NO CTSDs. Ribavarin for tx in high risk infants w/ heart/lung dz
PPx = poly/monoclonal antibodies in winter for kids

28

Kid comes in with seal cough. Dx? Bug?

CXR? Tx?

Croup
Paraflu 1
CXR = steeple sign indicating subglottic narrowing
Tx = mild: cool mist, worse: CTSDs, race epi

29

Kid comes in with a fever, dysphagia, and drooling. Dx? Bug? CXR? Tx?

Epiglottitis
If NOT immunized = H.Flu, if immunized = nontypable H.flu, strep
DO NOT EXAMINE THROAT AS IT MAY COLLAPSE, MAY HAVE TO INTUBATE. Look for cherry red epiglotis on fiberoptic
CXR = swollen epiglottis obliterating the valleculae (thumbprint sign)
Tx: secure airway, IV Cef.

30

What is the most common cause of viral meningitis in kids?

Enteroviruses

31

What meningitis medicine do you NOT give to neonates?

Ceftriaxone! It will cause increased biliary sludging and kernicterus. Use cefotaxime or Gent instead

also include Amp and +/- acyclovir for those neonates as well (listeria and herpes)

32

Kid comes in with sore throat and acute onset of HIGH fiver, muffled potato voice. Dx?

What if his uvula was displaced to the opposite side of the pain?

Retropharyngeal abscess

Displaced uvula = Peritonsilar abscess

Bot hare caused by G.A.S. or Staph

33

Kid comes in with paroxysmal cough causing him to vomit b/c he can't breath. Dx? Bug? Tx?

Pertussis. DTap (5) protects against this but by teenage years, the immunity can wane. Infection is mild in adults and kids but can be severe in teens!

Bordella Pertussis. 3 stages, whoop in stage 2, but most contageous in the 1st stage (the catarrhal stage.)

Tx = Erythromycin to pts and contacts for 2 wks

34

Kid comes in with slapped cheek rash that worsens with sun exposure. Dx? Bug? Complications?

Fifths disease (erythema infectiosum)
Parvovirus

Can cause joint pain in kids
If congenital infection, can cause hydrops fetalis and death
Can cause aplastic anemia in Sicklers or H.sperocytosis

35

Keys to differentiating measles from rubella?

Rubella has a lower fever, the rash progresses quicker, and has posterior auricular lymphadenopathy

36

Kid comes in with a really high fever (>104) and then gets a rash on trunk after the fever breaks. The rash spreads to the face and lasts

Roseola Infantum

HHV-6 and 7

37

Kid comes in with oral ulcers, vesicular rash on hands, feet, and butt. Dx? Bug?

hand Foot Mouth

Coxsackie A - self limited disease

38

Juandiced newporn presents with lethargy, poor feeding, and high pitched cry

Kernicterus, result of really high unconjugated bili

39

Direct hyperbilirubinemia is always pathologic. Also, jaundice during the first 24h of life is most likely pathological, not physiological.

Also, can't treat it with phototherapy! Only do this with unconjugated

40

Pathophys of respiratory distress syndrome?

No surfactant leads to poor lung compliance and alveolar collapse and atalectasis. Occurs in 48-72h of life.

CXR = ground glass w/ air bronchograms

41

Imaging of:
1. Transient tachypnea of newborn (amniotic fluid retention)
2. Meconium Aspiration
3. Congenital PNX

1. Perihilar streaking in interlobular fissures. Tx - O2
2. Course, irregular infiltrates w/ hyperexpansion
3. Nonspecific patchy infiltrates, neutropenia

42

What is an intrauterine risk factor for tracheoesophageal fistula?

Polyhydramnios

actually, polyhydramnios is a risk factor for this, gastroschisis, and duodenal atresia

43

Gastroschisis vs Omphalocele

Gastro = intestine only through the wall (no sac)

Omphalocele = herniation of abdominal viscera through the abdominal wall covered by peritoneum and amniotic membrane. Need c-section to prevent sac rupture

44

Kid presents with toe walking, scissor gait, and delayed motor development. Dx?

Cerebral palsy
Pyramidal - spastic paresis of any/all limbs - 75% of cases
Extrapyramidal - damage to extrapyramidal tracts. different subtypes that range in severity of muscle movement disorders

45

Is there a risk of recurrence of febrile seizures?

yes,

46

Kid who refuses to bear weight on his leg and has a green soft-tissue tumor on his skin?

AML

ALL is the most common kid cancer

Tx w/ CXR to rule out lung metz and BM biopsy showing hypercellular w/ increased lymphoblasts

47

Kid with ALL starts chemo but gets hyperkalemia, hyperphos, and hyperuricemia. Dx? Tx?

Dx = Tumor Lysis syndrome

Tx = Hydrate, diuretics, allopurinol, alk the urine, reduce phosphate in diet

STAY AWAY FROM CTSDs as they can cause tumor lysis syndrome

48

What does a neuroblastoma look like on histo?
Where do these originate from?

Small blue tumor cells w/ rosette patterns

Pts will have elvated VMA/HVA

Originate from neural crest cells

49

Wilms tumor vs Neuroblastoma

Both are palpable stomach masses in kids

Wilms = NO IRIS, hemihypertrophy, Mental retardation, and does NOT cross midline

Neuroblastoma = opsoclonus/myocloonus and MAY cross midline

50

When can a kid face forward in the carseat?

Age 2 and weighs more than 40 lbs

51

What tissue do Ewings sarcoma and Osteosarcomas come from?

Ewings = neuroectoderm (sarcoma)

osteosarcoma = mesenchyme (osteoblasts)