Pediatrics Flashcards
(137 cards)
1
Q
Persistent pulmonary HTN can be suspected in what group - preterm, term, postterm
What does the Xray look like?
A
Term and Post-term neonates with cyanosis
XRay: Clear lungs with decreased pulmonary vasculature
2
Q
Transient Tachypnea of the Newborn can be suspected in what group - preterm, term, postterm
What does the Xray look like?
A
Term
XRay: Bilateral perihilar linear streaking
3
Q
Premature infants with grunting, flaring, retractions, central cyanosis immediately after birth =
Treatment?
A
Respiratory Distress Syndrome
Treatment = continuous positive air pressure ventilation
4
Q
Acrocyanosis =
A
Blue extremities + Pink body
- common
- benign
- may last for 1-2 days
5
Q
severe coughing paroxysms + apparent subcutaneous emphysema -> need to rule out _
A
Pneumothorax
- it can also cause other things but a pneumothorax would be the most emergent
- get a chest xray to rule out
subcutaneous emphysema = gas or air under the skin that usually comes from the chest, feels like rice crispies
6
Q
How is RSV different in smaller kids vs older kids
A
Can present with URI symptoms (rhinorrhea, nasal congestion) + lower tract symptoms (wheezing, crackles, respiratory distress)
Older kids only get the URI symptoms
Main risks:
- apnea
- respiratory failure
- recurrent wheezing throughout childhood
RSV -> bronchiolitis
7
Q
Treatment for Epiglottitis
A
First priority is to secure the airway
- keep child calm
- endotrachial intubation in the OR
- if that doesn’t work, emergency trachyotomy
8
Q
What is epinephrine’s mechanism?
A
Beta-2 agonist = bronchodilation, decreases systemic release of inflammatory mediators
Alpha-1 agonist = vasoconstriction
9
Q
neonate with scaphoid abdomen (concave), barrel chest, polyhydramnios in utero, no breath sounds on L,, hypoxia on room air =
Management =
A
Congenital Diaphragmatic Hernia
First step in management = endotrachial intubation
Second step = gastric tube - decompresses the stomach and bowel
10
Q
Are men with CF fertile?
A
No - due to obstructive azoospermia
- insipissated mucus in the fetal genital tract obstructs the developing vas deferens -> congenital bilateral absence
- spermatogenesis is normal but the sperm cannot be ejaculated
11
Q
Genetics of CF?
A
AR
12
Q
SGA complications for the baby:
A
- Hypoxia
- Perinatal asphyxia
- Meconium aspiration
- Hypothermia
- Hypoglycemia
- Hypocalcemia - caused by decrease Ca transfer across the placenta
- Polycythemia - caused by increased Epo secretion in response to hypoxia
13
Q
Pills/tablets that are radio-opaque on XRay
A
-Iron
14
Q
What to do if parents refuse life-saving treatment for their child?
A
Obtain court order to mandate treatment
15
Q
Contraindications to rotavirus vaccine: (4)
A
- Anaphylaxis
- Hx of intussusception
- Hx of uncorrected congenital GI malformation
- SCID
note: Do no give rotavirus older than 8 months 0 days old
16
Q
Chronic Granulomatous Disease prophylaxis (2)
A
- TMP/SMX
- Itraconazole
17
Q
- Rapid onset of facial edema following infection, trauma, dental procedure without a rash
- Normal C1q level
- Depressed C4 level
A
Hereditary angioedema
-C1q levels are depressed in acquired
18
Q
For stable preterm infants, vaccines should be given based on (chronological/gestational) age.
One exception:
A
Given based on chronological age
Exception: weight should be >2 kg (4 lbs 6 oz) before first vaccine (Hep B)
19
Q
EKG changes are indicative of what process in a teenager:
- Tall R wave in aVL + Deep S wave in V3
- Inverted T waves in I, aVL, V4, V5, V6
A
Hypertrophic cardiomyopathy
Prevalence 1/500
20
Q
Commotio cordis
A
Development of a fatal V fib after sudden blunt chest wall trauma
- often seen in basketball
- occurs in athletes with no prior cardiac disease
21
Q
On EKG, infants have physiologic findings
-L/R axis deviation?
A
R axis deviation is physiologic
-infants have a larger R ventricle due to the PDA shunting the blood away from the lungs, thus the R ventricle being responsible for pushing blood to the systemic circuit
22
Q
Tricuspid Valve Atresia requires 2 other structural defects to survive
A
- ASD: results in increased blood flow to RA -> RA enlargement -> peaked P waves
- VSD: results in holosystolic murmur loudest at the L lower sternal border
23
Q
What happens to the Right Ventricle and R sided circulation in Tricuspid Valve Atresia?
A
Lack of blood flow from RA->RV results in a hypoplastic RV and consequently underdevelopment of the pulmonary valve and artery
Will see decreased pulmonary markings on CXR
24
Q
EKG of a 1 week old
- L axis deviation
- small/absent R waves in V1-V3
A
Tricuspid Valve Atresia
25
"Boot shaped heart" on CXR
Tetralogy of Fallot
26
4 characteristics of Tetralogy of Fallot
1) RV Outflow Tract Obstruction - Plumonary stenosis or atresia
2) RV hypertrophy
3) Overriding aorta
4) VSD
27
Jervell-Lange-Neilsen Syndome
Inherited cause of Long QT syndrome
- molecular defect in K channel
- AR
- associated with sensorineurial deafness
28
3 electrolyte derangements that can cause Long QT Syndrome
- Hypocalcemia
- Hypokalemia
- Hypomagnesemia
29
Romano-Ward Syndrome
Inherited cause of Long QT syndrome
- molecular defect
- AD
- NOT associated with deafness
30
Kawasaki Disease treatment
Usually self-limited but treatment is used to prevent cardiac complications
-Aspirin + IVIG
31
Sandpaper rash that spares the palms and soles =
Rash of scarlet fever
32
Most common cause of secondary hypertension in children =
Fibromuscular dysplasia
- R renal artery worse than L renal artery
- hum/bruit heard at the costovertebral angle due to well developed collaterals
- string of beads appearance on angiography
33
DiGeorge Syndrome clinical features (5)
CATCH-22
- C = conotruncal cardiac defects
- A = abnormal facies
- T = thymic aplasia/hypoplasia
- C = cleft palate
- H = hypocalcemia
- 22 = chromosome 22q11.2 deletion
34
Loud first heart sound + Mid diastolic rumble =
Mitral stenosis
| -almost always due to Rheumatic Fever
35
Causes of pediatric viral myocarditis (2)
- Coxsackie B
- Adenovirus
Viral prodrome -> Heart failure
36
What effect do these things have on preload?
- Valsalva
- Abrupt standing
- Nitroglycerine
Decreases preload
37
At what grade murmur do you need to do a work up?
Grade I-II = no workup needed
| Grade III+ = workup
38
LH and FSH levels in central vs peripheral precocious puberty
Central: early GnRH activation -> elevated LH/FSH
Peripheral: gonadal or adrenal release of excess sex hormones -> low GnRH, low LH/FHS
39
Treatment for idiopathic precocious puberty
GnRH agonist therapy
| -goal is to increase adult height
40
15 yo had a URI last week and now is presenting with metabolic acidosis, polyuria, decreased level of consciousness, dehydration, diffuse abdominal pain
DKA -> increased release of catecholamines, cortisol, glucagon -> hyperglycemia, ketonemia, osmotic diuresis -> net renal loss of K and K body stores depleted
41
Isolated premature adrenarche is a risk factor for the development of what 3 syndromes =
- PCOS
- T2DM
- Metabolic Sydrome
42
Virilazation of female infants + Salt Wasting =
21 hydroxylase deficiency
| -build up of 17 hydroxyprogesterone
43
```
swollen + fluctuant tonsil
uvula deviated to the opposite side
"hot potato" voice
trismus
drooling
```
Peritonsillar abscess
44
Growth failure + recurrent respiratory infections + steatorrhea =
Cystic Fibrosis
| -GI manifestation - pancreatic insufficiency - leads to inability to absorb fats and vitamins DEAK
45
Down Syndrome associated GI defects (3)
- Duodenal atresia
- Hirschprung disease
- Imperforate anus
46
CF associated GI defects (1)
Meconium ileus
| -usually occurs at terminal ileum
47
What should be used for IV bolus rehydration in children?
20 mL/kg normal saline IV (isotonic fluid)
-add dextrose to maintenance fluid
48
Patients with Beckwith Weidmann Syndrome are at increased risk for what 2 complications?
- Hepatoblastoma
- Wilms Tumor
Screening abdominal ultrasounds and alpha-fetoprotein levels are routinely monitored
49
```
Macrosomia
Macroglossia
Hemihyperplasia
Umbilical Hernia/Omphalocele
Hypoglycemia
```
Beckwith-Weidmann syndrome
- chr 11p15
- encodes insulin-like growth factor
50
Are women with CF infertile?
Only 20% of CF women have fertility problems
| -secondary amenorrhea from malnutrition + thick cervical mucus obstructing sperm pathway
51
Describe the dermatitis of pellagra:
looks like a sunburn and occurs in sun exposed areas
52
GI complaints + Glossitis + Watery diarrhea + rash = what vitamin deficiency?
Niacin (Vit B3) - Pellagra
- diarrhea
- dermatitis
- dementia
- death
53
How to distinguish milk-protein allergy in an infant? (4)
Treatment?
- regurgitation
- eczema
- poor weight gain
- painless bloody stools
Treatment: switched to hydrolyzed formula OR mom should eliminate all dairy and soy from her diet
-NOTE: most formulas are cow milk protein based
54
What is the only absolute infant contraindication to breastfeeding?
Galactosemia
55
Liver biopsy of Reye Syndrome?
Lab findings?
Microvesicular fatty infiltration
Increased AST, ALT, PT, INR, PTT, ammonia
56
Metabolic derangements of pyloric stenosis
Hypochloremic, hypokalemic metabolic alkalosis
Before surgical treatment it is important to rehydrate and fix electrolyte abnormalities
57
Intussusception causes:
- less than 2 yo
- greater than 2 yo
less than 2 yo: most likely idiopathic
greater than 2 yo: most likely a pathological lead point - Meckles diverticulum
if patient had a preceding viral infection (gastroenteritis), inflamed peyer's patches may serve as lead point
58
Triple bubble sign + gasless abdomen on X Ray =
Jejunal atresia
- occurs often due to vascular accident in utero (ex: cocaine)
- bilious vomiting
- abdominal distension
59
pneumatosis intestinalis on Xray
extravasation of bowel gas into the damaged bowel wall
- occurs in Necrotizing Enterocolitis (NEC)
- may lead to pneumoperitoneum, strictures, short bowel syndrome or death
60
Children with Cyclic Vomiting Syndrome usually have a family history of _
migraines
Therapy with anti-emetics and anti-migraine medications (sumitriptan) is often helpful
61
VACTERL
```
Vertebral anomalies
Anal atresia
Cardiac anomalies
Tracheo-Esophageal fistulas
Renal anomalies
Limb malformation
```
62
3 risk factors for constipation in children
- dietary changes - solid foods, cow's milk
- toilet training
- school/daycare entry
63
Cause and location of gastroschisis
```
cause = vascular insult resulting in bowel herniation
location = lateral to umbilical cord
```
will see elevated maternal serum alpha-fetoprotein
64
CHARGE
```
Coloboma
Heart defects
Atresia choanae
Retardation of growth/development
Gentio-urinary anomalies
Ear abnormalities/deafness
```
65
Treatment for and cause of unilateral uncomplicated acute lymphadenitis
Most common cause of unilateral is Staph aureus or Strep pyogenes
Treatment is clindamycin
66
Treatment of localized Lyme disease in a 5 year old (rash only)
Oral amoxicillin or cefuroxime
Doxycycline is contraindicated in children
67
3 main causes of acute bacterial sinusitis
First line treatment
- Strep pneumoniae
- Nontypable H flu
- Moraxella catarrhalis
Treatment = Amoxicillin/Clavulanate
68
neonate who develops rhinorrhea and a desquamating maculopapular rash on buttocks/feet in the first 48 hours has what congenital infection?
Congenial syphilis
- transplacental transmission
- snuffles (rhinorrhea)
- maculopapular rash that may involve palms and soles that desquamates or becomes bullous
- abnormal long bone radiographs (metaphyseal lucencies)
Treatment: penicillin - curative and prevents late manifestations
69
At what size should you be worried about a lymph node?
>2cm
70
antibiotic prophylaxis for a cat bite
Amoxicillin/Clavulanate
| -covers for Pasturella multiocida and oral anaerobes
71
Most common cause of CF-related pneumonia by age
less than 20 yo =
20+ yo =
less than 20 yo - Staph aureus
| 20+ yo - Pseudomonas
72
Patients with sickle cell disease are at risk for sepsis from what 3 bacteria?
- Strep pneumo
- H flu
- N meningiditis
73
Acute onset high grade fever and respiratory distress (impaired inspiration)
Drooling
Muffled voice
Keeping neck hyperextended provides some relief
Epiglottitis
- "hot potato" voice
- hyperextention of the neck increases airway diameter
- obstruction is the most concerning complication
- may require nasotrachial intubation
74
Infant with chlamydial conjunctivitis
- timing
- treatment
```
timing = 5-14 days
treatment = oral erythromycin
```
note: oral erythromycin in infants increases the risk of pyloric stenosis. this is also the treatment for chlamydial pneumonia (develops at 4-12 weeks).
75
Infant with gonococcal conjunctivitis
- timing
- treatment
```
timing = 2-5 days
treatment = IM or IV ceftriaxone or cefotaxime
```
76
The erythromycin ointment put on infants eyes within 1 hour of birth is to prevent _
Gonococcal conjunctivitis
77
Most common leukemia in children?
ALL
78
Most common primary bone tumor in children and young adults?
Osteosarcoma
- Codmann's triangle - periosteal elevation
- Sunburst pattern
- Elevated alk phos and lactate dehydrogenase
79
What bone lesion?
Sclerotic lesion in the cortex of a long bone
Pain worse at night
Pain is relieved with NSAIDs
Osteoid osteoma
80
What is the organ most affected by people with sickle cell trait?
Kidney
- painless hematuria
- isothenuria (nocturia or polyuria - impaired concentrating ability)
- splenic infarction at high altitudes
81
macrocytic anemia + low reticulocyte count + congenital anomalies (short stature, webbed neck, triphalangial thumbs) + elevated fetal Hb levels + pallor in neonatal period =
Diamond-Blackfan Syndrome
- intrinsic defect in erythroid progenitor cells which results in increased apoptosis
- therapy = corticosteroids
82
pancytopenia + macrocytosis + cafe au lait spots + absent thumbs + short stature + horseshoe kidney =
Fanconi anemia
- AR
- caused by chromosomal breaks
- dx by age 8 yo
83
Treatment of stroke like symptoms in a sickle cell patient
exchange transfusion
-it does not reverse the initial sickling/vascular event but it reduces the number of sickled cells in circulation therefore reducing the likelihood of another event
84
neonatal polycythemia is defined by
hematocrit greater than 65% in term infants
caused by:
-intrauterine hypoxia
-erythrocyte transfusion
85
Eosin-5-maleimide test (flow cytometry) and Acidified glycerol lysis test are used to dx what?
Hereditary Spherocytosis
86
Pharmacotherapy for monosymptomatic enuresis
- first line
- second line
First line = desmopressin
| Second line = TCAs
87
What renal disease is associated with HBV?
- Membranous nephropathy (nephrotic)
| - Membranoproliferative glomerulonephritis (nephrotic or nephritic)
88
What renal disease is associated with HIV?
Focal Segmental Glomerulosclerosis (nephrotic)
89
5 Kawasaki Disease diagnostic criteria
Need 4/5 for dx
- fever for at least 5 days
- bilateral conujunctivits - spares limbus, nonexudative
- rash
- extremity changes - erythema, edema, desquamation
- oral mucosa changes - strawberry tongue, fissured lips, erythema
- cervical lymphadenopathy - greater than 1.5 cm, unilateral
90
child with back pain + progressive neurological dysfunction (new urinary incontinence) + palpable step off at the lumbosacral area
Spondylolisthesis
- forward slip of the vertebrae
- usually at L5 over S1
91
Down syndrome child who presents with upper motor neuron findings
Atlantoaxial instability = excessive laxity in the posterior transverse ligament of the spine which results in increased mobility between the atlas (c1) and the axis (c2)
92
Macrocephaly + feeding problems since birth + numerous café au lait spots + short stature + learning disabilities
Neurofibromatosis 1
| -Chr 17 = NF1 tumor suppressor gene = protineruofibromin
93
Greatest risk factor for CP
Premature birth before 32 weeks gestation
| -results in spastic diplegia
94
Teenager who was adopted + myotonia + facial weakness + foot drop + dysphagia + testicular atrophy =
Myotonic dystrophy
- AD
- CTG repeat in DMPK gene on chr 19
95
Child presenting with sudden onset hemiplegia + hemianesthesia + neck pain. Earlier in the day while brushing his teeth he fell and the toothbrush hit the back of his throat.
Traumatic carotid injury resulting in internal carotid artery dissection
- Internal carotid arteries are located directly posterior and lateral to the tonsillar pillars
- Caused by minor oropharyngeal trauma, neck strain/manipulation, penetrating trauma
- Dx confirmed with CT or MR angiography
96
Fever + severe nocturnal or morning headaches + focal neurological changes = classic triad of _
brain abscess
97
Medulloblastoma symptoms
- obstructive hydrocephalus = morning/night headaches, night vomiting
- cerebellar dysfunction = truncal ataxia, incoordination
Medulloblastoma is a posterior fossa tumor. Most often occuring in the cerebellar vermis.
98
T wave inversion ddx: (5)
- Myocardial infarction
- Myocarditis
- Old pericarditis
- Myocardial contusion
- Digoxin toxicity
99
First line OCD treatment
First line = cognitive behavior therapy + high dose SSRI
If resistant to SSRI treatment, then antipsychotic
100
First line Tourette's treatment
First line = second generation antipsychotic (Risperidone)
| Second line = alpha adrenergic receptor agonist (Clonadine, Guanfacine)
101
Electrolyte disturbances in anorexia nervosa (2)
- Hypokalemia
| - Hypophosphatemia
102
TM with peripheral granulation + skin debris. That same ear has been draining for an extended period of time despite antibiotics.
Choleosteatoma = abnormal growth of squamous epithelium in the middle ear
- congenital
- acquired - caused secondary to chronic middle ear infections
103
Acute Otitis Media causes (3)
Treatment (2)
Causes:
- Strep pneumo
- H flu nontyepable
- Moraxella
Treatment: 10 days
- oral Amoxicillin
- oral Amoxicillin/Clavulanate
104
Adolescent boy + nasal obstruction symptoms + nasal mass + frequent nosebleeds + erosion of nasal bone on CT =
juvenile angiofibroma
- composed of many blood vessels that can easily bleed
- benign but locally invasive
- needs a specialist
105
infant who has inspiratory stridor only when supine
Laryngomalacia
- chronic stridor in infants
- caused by floppy supraglotting structures that collapse during inspiration
- spontaneous resolution by 18 months
- dx via clinical + flexible laryngoscopy
106
follicular conjunctivitis + pannus (neovascularization) in the cornea
Trachoma
- C. trachomatus serotype A-C
- major cause of blindness worldwide
- concurrent infection of nasopharynx leading to nasal discharge
- treatment: topical
107
Most common predisposing factor for orbital cellulitis is _
bacterial sinusitis
108
3 pill emergency contraception options
- Levonorgestrel oral = progestin, delays ovulation [first option]
- Ulipristal oral = antiprogestin, delays follicular rupture and impairs implantation
- Combined OCP = progestin, delays ovulation, not as effective
109
moderate to severe bleeding from acute abnormal uterine bleeding (AUB) caused by ovulation dysfunction in an adolescent is treated with
high dose IV or oral estrogen
| -promotes regrowth of the endometrium over the denuded epithelium
110
cause of a young girl's irregular menstrual cycles
- immaturity of the hypothalamic-pituitary-gonadal axis
| - not enough hormones to induce correct ovulation (too low GnRH)
111
marfanoid habitus + mental retardation + downward lens dislocation + fair complexion + thromboembolic events =
Homocystinuria
- AR
- deficiency of cystathionine synthase
112
marfanoid habitus + heart issues (aortic root dilation) + upward lens dislocation =
Marfan syndrome
- AD
- mutation in fibrillin-1 gene
113
Turner syndrome patients are at risk for developing _
Osteoporosis - perhaps due to the low E levels from gonadal dysgenesis
114
Gold standard for dx Muscular Dystrophy
Genetic testing
- X linked R
- deletion of dystrophin gene (Xp21)
115
Kallmann Syndrome genetics
Xlinked R
| -46 XY
116
How to prevent the spread of salmonella?
Cook meats thoroughly
117
Click/clunk of hips in a newborn 2 causes, 4 risk factors
- shallow, poorly developed acetabulum
- laxity of supporting ligaments
risks:
- female
- first born
- breech
- family hx of developmental dysplasia of the hip (DDH)
118
mental status changes that occur during ketoacidosis is caused by _
cerebral edema
119
J wave on an ekg =
hypothermia
120
3yo comes in for rapid breathing and can't catch his breath. pulse = 100, RR = 30, BP=120/80. lungs clear. slight hyperresonance on right chest. decreased breath sounds on right. x-ray shows slight overexpansion of right lung compared with left. no infiltrates or effusions.
What has happened?
aspiration
do a bronchoscopy to evaluate
121
newborn with HIV+ test - what is the treatment?
6 weeks of AZT started within 12 hours of delivery
122
age group for legg-calve-perth disease
| age group for slipped capital femoral epiphysis
4-10 yo
| 9-14 yo
123
Apt test
Distinguishes maternal blood from fetal blood via hemoglobin
124
Treatment for seborrheic dermatitis
topical steroids + special shampoo
125
subglotting edema in a child who is having trouble breathing =
croup
126
A child has ingested a caustic liquid.
| What is the next step after stabilizing airway?
fiberoptic endoscopy and nothing NPO
127
testicular swelling + absent cremasteric reflex + scrotal or abdominal pain
testicular torsion
treatment: surgery ASAP
128
microscopy of Hashimoto thyroiditis
lymphocytic infiltrate
129
child with + PPD skin test + negative CXR + appears well
| treatment?
Isoniazid only
130
acute otitis media VS otitis media with effusion
acute otitis media occurs more rapidly with signs and symptoms of inflammation
otitis media with effusion has no signs or symptoms of acute inflammation, generally asymptomatic
131
blood under the periostium
cephalohematoma
132
blood under the galea aponeurotica
subgaleal hemorrhage
133
when does infantile colic subside?
4 months
134
RBC casts
glomerulonephritis
135
MCV less than 80 + anemia + target cells in periphery
thalassemia
136
First step in management for a kid in DKA?
1) replace fluids and potassium
| 2) insulin
137
What keeps a PDA open?
Prostaglandin E1
