Pediatrics Flashcards
(332 cards)
1
Q
Essential SIDS safety to educate the parents on?
A
Sleep on back, don’t share beds, stop smoking
2
Q
When is there a social smile?
A
2 months
3
Q
When can a kid hop on one foot?
A
4 years
4
Q
At about what age should a kid be able to walk?
A
1 year
5
Q
When can a kid skip?
A
5 years
6
Q
What type of child behavior is indicative of abuse (in regards of child to hospital staff)?
A
Seeking comfort from you rather than parents
7
Q
When is there separation anxiety?
A
6-12 months (stranger at 6, separation at 12)
8
Q
Talk about the speech relative to age
A
1:1 (add one word to the sentence for every year)
9
Q
When is there stranger anxiety?
A
6-12 months (stranger at 6, separation at 12)
10
Q
Dirty wound with unknown tetanus status. What do you do?
A
vaccine and tetanus immunoglobulin
11
Q
Dirty wound. Tetanus booster greater than 5 years ago but received full series. What do you do?
A
Booster only
12
Q
Child has uncontrollable coughing spells with inspiratory “whoop” sound between coughs. What’s the dx?
A
Pertussis
13
Q
How many doses of MMRV do you need?
A
Two - one at 12-15 months and one at 4-6 years
14
Q
A child received two doses of the hep B vaccine but then hasn’t been seen in 2 years. Do you need to restart the series?
A
No - finish the series with one time dose (need total of 3)
15
Q
Dyspnea, dysphagia, grey pseudomembrane, what’s the dx?
A
Diptheria
16
Q
How do you treat diphtheria (3 A’s)?
A
Airway, antibiotics, antitoxin
17
Q
What is an absolute contraindication to giving another dose of the DTaP vaccine?
A
encephalopathy within 7 days of a previous dose
18
Q
Which vaccines are live attenuated?
A
Intranasal flu, MMRV
19
Q
What group shouldn’t get live-attenuated vaccines?
A
Immunocompromised (or pregnant!)
20
Q
What are the 3 types of flu vaccines? Name them and their individual contraindication
A
1) Inactivated IM injection: severe egg allergy (though not anymore); 2) live intranasal - immunocompromised; 3) recombinant - anaphylaxis to its components
21
Q
Vaccines associated with egg allergy?
A
Yellow fever (influenza and MMR ok to use)
22
Q
Can you give HPV vaccine to a sexually active teen?
A
Yes - it will provide immunity as long as they’re not already infected (start as early as 9)
23
Q
Post-exposure interventions for varicella. Who gets what?
A
varicella vaccine for all children; VZIG for immunocompromised pts
24
Q
Difference btwn DTaP and Tdap?
A
DTaP is for kids (big D for big dose)
Tdap is for adults
25
Mom has hep B and is delivering baby, what do you do?
Hep B immunoglobuline and vaccine for baby
26
Dirty wound, greater than 3 lifetime doses, less than 5 years since the less one - what do you do?
Send home
27
Mom has unknown Hep B status and is delivering baby, what do you do?
Hep B vaccine for baby now; check mom's status; give HBIG to any if cannot obtain in timely fashion
28
Ill-appearing child with croup that does not respond to racemic epinephrine. What is your likely alternative diagnosis?
Bacterial tracheitis
29
How can you prevent epiglottitis?
Hib vaccine
30
Barking cough, severe dyspnea improved by arrival, organism that causes it?
Parainfluenza virus (croup)
31
If you seen an abscess (retropharyngeal or peritonsilar), what should you do?
Incision and drainage (it actually doesn't matter that it's an ENT abscess - same tx) + antibiotics
32
Drooling, tripoding, high fever, very sick looking - what is it and what do you do?
Epiglottitis, intubate before anything else
33
Unvaccinated child with toxic-appearance, drooling, and stridor. Dx? Causative organism?
Epiglottitis; Hib (haemophilus influenza)
34
What does the X-ray show for bacterial tracheitis?
steeple sign (sublottic narrowing) - see the same thing in parainfluenza (croup)
35
Barking cough, severe dyspnea improved by arrival; dx?
croup
36
Hot potato voice (nasal sounding) and you can see the tonsils shifted to the side, dx?
peritonsillar abscess
37
Hot potato voice (nasal sounding) and you can't see anything in the mouth but neck is swollen and tender - dx?
retropharyngeal abscess
38
How do you make the dx of asthma?
PFTs, bronchodilator reversibility, methacholine inducibility
39
What's the most common virus responsible for bronchiolitis?
RSV (NOT parainfluenza)
40
How do you treat an acute asthma exacerbation?
Albuterol/ipratropium and steroids (maybe Magnesium, maybe subQ epi); get peak flow rates before and after
41
Immigrant child without any prenatal testing has salty sweat and failure to thrive, what's the diagnosis?
Cystic fibrosis
42
Child has sudden onset dyspnea after being left alone for "just a few minutes" - what do you do?
CXR AP and lateral (foreign body airway obstruction)
43
What are some things you can tell parents to help their kids with asthma?
remove pets, carpets, parental smoking
44
Cystic fibrosis kids get respiratory infections and there are two big causative pathogens. What are they?
Pseudomonas (trending down) and staph aureus (trending up)
45
How do you diagnose cystic fibrosis?
sweat chloride test (gt 40 for neonates, gt 60 for older)
46
What's the first step in treating asthma?
SABA (albuterol)
47
What do you add on after a SABA in chronic asthma tx?
SABA + ICS (inhaled corticosteroid)
48
What do you add on after a SABA and ICS in chronic asthma tx?
SABA, increase ICS, then can add LABA
49
A ___ should not be used without an inhaled corticosteroid in asthma prevention, or else asthma related death increases
LABA
50
How do you diagnose BRUE (age, duration, and 4 things)?
(brief resolved unexplained event) - combination of change in color, breathing, tone, or responsiveness. Less than 1 year of age. Less than 1 minute. No other causes on H&P.
51
BRUE age cut off?
1 year of age
52
What's the difference btwn ALTE and BRUE?
ALTE relies on caregiver concern, BRUE relies on timing and duration
53
Features of ALTE (apparent life threatening events)?
combination of change in respiration (choking, gagging, apnea), color change (red, blue, pale), and muscle tone change (hyper or hypotonic); also need parental concern
54
SIDS isn't associated with BRUE. What ahs it been associated with?
Maternal smoking
55
Got a BRUE. What is the next step?
stratify in to high or low risk
56
Define a lower risk BRUE (4)
Pt older than 60 days (or 45 wks post conception for premie), first occurrence without multiple episodes, no CPR, no concerning findings on H and P
57
Suspected BRUE except the kid has a confirmed infection?
It's an infection not a BRUE
58
What can be done to prevent SIDS (3)?
place on back for sleep, don't share a bed, parental smoking cessation
59
When MUST you report child abuse?
Always - even if suspected, confirmation not needed
60
Name some child risk factors that may promote abuse (3)
premature birth, cognitive defect, physical disability
61
Name some care-giver risk factors that may promote abuse (4)
hx of being abused, young/single parent, non biologic care giver, poor
62
When is an abused child hospitalized (2)?
When injuries warrant admission or when no safe alternatives exist
63
Bilateral burns on the buttocks are?
dunk burns (kid picks up legs to escape hot water, buttocks hit first)
64
Bilateral burns to the feet to the ankles are?
Dunk burn
65
Child from an Asian family with circular burns on the back. They're associated with?
Coining, NOT cigarettes, and should NOT be considered abuse
66
If you see small circular burns, suspect?
cigarette burns
67
What are some signs of abuse as the child interacts with the caregiver (3)
1) not crying around parents despite obviously painful injury; 2) running FROM caretaker; 3) comfort from health care workers
68
Failing to provide food, shelter, love, and nourishment to a child is classified as?
Neglect
69
Sexually transmitted infection in a child should prompt suspicion for?
sexual abuse
70
Non-purulent rhinorrhea, congestion, no cough, no fever: dx an tx?
Common cold - supportive care! (no abx!)
71
When do you get a CT scan for sinusitis?
Recurrent or refractory - looking for anatomic defects or foreign body
72
Antibiotic management for acute otitis media?
Amoxicillin first line, cephalosporin if pen allergic (cefdinir) without anaphylaxis, amoxicillin-clavulanate if recent abx use
73
Pain when pulling on the pinna, child swimmer. What is it and how to treat?
Otitis externa; tx with aural antibiotics (cipro) and aural steroids
74
Best diagnostic test for otitis media?
pneumatic insufflation
75
Strep pneumo, H flu, and Moraxela can cause which ENT infections?
Otitis media and sinusitis (differentiate by ear pain)
76
Catheter fails to pass through the nose of a young infant, dx?
Choanal atresia
77
Suspected pharyngitis in a 3 year old - first step?
rapid group A strep testing (Centor not helpful in preadolescent crowd)
78
Otitis media symptoms but there's a bulge behind the ear + it's rotated forward. Dx and tx?
mastoiditis - get a surgeon (and continue with abx)
79
Purulent rhinorrhea, fever, congestion, facial tenderness, greater than 10 days of symptoms: diagnosis and mgmt?
bacterial sinusitis. Amoxicillin-clavulanate 1st line, levofloxacin if pen allergic (it is atypical to use a fluoroquinolone in kids)
80
Childhood snoring, pink while crying, blue while feeding, dx?
choanal atresia
81
Pharyngitis + enlarged spleen = ? Do what?
Mono. Get a monospot test to confirm (EBV ELISA)
82
3 year old girl with anterior cervical nodes, no cough, tonsillar exudates, and a temp of 40C. Next step?
Rapid strep testing (Centor not helpful in preadolescent crowd)
83
Epistaxis doesn't stop. Anterior bleed suspected. Tx?
cauterize anterior bleeds; pack posterior
84
What are the CENTOR criteria and how do they work
```
Cough (absent) + 1
Exudates +1
Nodes (adenopathy) +1
Temp gt 38C +1
OR: age lt 14 +1 OR age gt 44 -1
lt 1: supportive; 2-3: rapid strep (cx or tx); 4 or gt: tx as strep
```
85
Penicillin in group A strep prevents __ but not __.
rheumatic fever; post-strep glomerulonephritis
86
What is a sequelae of Measles?
subacute sclerosing panencephalitis
87
Dx if there are vesicles on an erythematous base across a single dermatome?
Shingles (varicella zoster)
88
Cough, coryza, conjunctivitis, koplik spots are symptoms of ?
Measles prodrome
89
What are vesicles on an erythematous base in various stages of healing indicative of?
Varicella (chicken pox)
90
Baby gets parvovirus B19; what are you worried about?
Aplastic anemia in baby (hemoglobinopathies); Hydrops fetalis in utero if mom is pregnant. Isolate mom
91
Vesicles on an erythematous base on hands, feet, and buccal mucosa - dx?
Hand-foot and mouth (coxsackie A)
92
What virus can cause bilateral facial swelling + orchitis?
Mumps
93
Separate measles from rubella clinically
Prodrome of cough, coryza, conjunctivitis, koplik spots (measles) vs generalized tender lymph nodes (rubella) - both have rash and fever (rubella has fever before rash, but not different enough)
94
What pathogen has a rash that starts on the face, spreads to the toes, then clears the same way?
Measles (and rubella?)
95
REALLY high fever, starts on trunk spreads outward - what's the virus?
HHV-6 (roseola)
96
Empiric antibiotic therapy for meningitis in a 2 year old?
vancomycin + ceftriaxone
97
Empiric antibiotic therapy for meningitis in a baby less than 30 days old?
vanc + cefotaxime + ampicillin
98
Empiric antibiotic therapy for meningitis in a baby 30 days - 2 years?
vanc + cefotaxime
99
When can you trust an ELISA for HIV in a baby?
around 6 months when maternal antibodies have worn off
100
Pruritic rash in fingers, axilla, and multiple family members. Diagnosis and treatment?
scabies - permethrin (or lindane)
101
You see knits in hair, you think and treat with?
Lice, treat with permethrin
102
Itchy butt, positive tape test (there are worms) gets?
albendazole
103
Red hot tender joint in a child gets?
Arthrocentesis (the fact that its a child doesn't change management)
104
PJP prophylaxis CD4 cutoff? Tx and alternate?
CD4 < 200; use TMP/SMX; Dapsone as alternative
105
Febrile infant with fussiness and bulging fontanelle. Diagnosis?
Meningitis
106
What is the FAILS criteria and how do you use it?
Focal neurologic deficit; Altered mental status; Immunocompromised; Lesions over the site of LP; Seizures
If any of FAILS is met, abx first, then CT, then LP
If NOT fails, LP first then abx
107
Treatment for primary apnea of newborn?
Stimulation with towels (rub back, tap feet)
108
What does APGAR stand for, and what is considered good?
Appearance, Pulse (gt 100), Grimace, Activity, Respiration; 7-10 is good
109
What do you do with a neonate who has hypoglycemia on its first check?
Give glucose - recheck; give IV if symptomatic (jitteriness, tremor, lethargy); feed if not symptomatic
110
What gets 0 points for each component of APGAR?
A: blue pale baby; P: pulse absent; G: grimace absent; A: activity absent; R: respirations absent
111
What gets 1 point for each component of APGAR?
A: Acrocyanosis; P: lt 100; G: with lots of tim; A: flexion; R: irregular
112
What gets 2 points for each component of APGAR?
A: pink; P: gt 100; G: with stim; A: resists extension; R: strong
113
What do you suction in a neonatal resuscitation and in what order?
Mouth then nose
114
What do you do if a neonate's heart rate drops below 60 in the first ten minutes after birth (3)?
Positive pressure ventilation and CPR (3:1 with breaths), epinephrine via umbilical vein if not improving
115
Neonate in the delivery room with respiratory distress, hyper expanded lungs, and a "wet" chest XR. Dx and tx?
Transient tachypnea of the newborn. Treatment is oxygen (if needed) and occasionally CPAP
116
Neonate in the delivery room with respiratory distress, under expanded, and with atelectasis. Dx and tx?
Respiratory distress syndrome; may need surfactant and mechanical ventilation
117
Baby comes out of mom and isn't breathing on its own. What's that called?
Primary apnea
118
Bronchopulmonary dysplasia is caused by RDS due to decreased surfactant production. ___ is required for the diagnose. Xray shows __. How do you tx?
FiO2 required greater than 28 days; ground glass opacities; post birth tx with surfactant, pre birth give steroids to mom
119
Retinopathy of prematurity is caused by ___. It is worsened by __. How do you tx?
Oxygen toxicity (neoangiogenesis gone awry). increased FiO2 requirements; tx with laser
120
Intraventricular hemorrhage is seen in premies due to ___, which causes susceptibility to changes in blood pressure and therefore bleeds. How do you diagnose? Tx? What may result later on?
highly vascular ventricles; Cranial doppler (may see bulging fontanelles); Tx by decreasing ICP (shunts, drains); intellectual disability, seizures
121
Necrotizing enterocolitis is __. Seen in premies as __. Diagnose? Tx?
dead gut; bloody BM; XR (see pneumatosis intestinalis); NPO, IV abx, TPN (may need surgery)
122
What is mechanism of Hirschsprung's?
Failure of neuron to migrate to distal colon
123
In Hirschsprung's there is normal looking colon and dilated colon, which do you remove?
Normal looking colon (normal is bad - good colon should dilate)
124
If there is no anal opening on the first day of life...
imperforate anus: assess severity with cross table X-ray, consider VACTERL
125
What is VACTERL and how do you analyze each one?
Vertebra (U/S sacrum), Anus (xray), Cardiac (echo), TE fistula and Esophagel atresia (XR w/coiled tube), Renal (VCUG), Limb (XR) (things to rule out if there is no anal opening on the first day of life)
126
Treat a meconium ileus with?
Water-contrast enema
127
A diagnosis of meconium ileum means what other diagnosis?
Cystic fibrosis
128
Kids at risk for functional constipation?
school age or toilet age children
129
How does the dx of Hirschsprung differ in children and neonates (how it presents and what you do)?
Neonates: failure to pass meconium, contrast enema
Children: overflow incontinence or encopresis, anorectal manometry
You will still obtain rectal suction biopsy in both
130
Xray of Hirschsprung shows ___?
dilated proximal colon (normal colon) and normal looking distal colon (bad colon)
131
Tx when voluntary holding becomes involuntary constipation?
behavioral modification and bowel regimen
132
Explosive bowel movement on DRE in a child = ?
Hirschsprung's (you are unblocking the obstruction)
133
Male baby, visible peristalsis, projectile vomiting, metabolic alkalosis - what's the dx?
Pyloric stenosis
134
You diagnose pyloric stenosis, what do you do next?
assess for electrolyte abnormalities and fix those; then surgery to fix pylorus (pyloromyotomy)
135
Double-bubble sign and no distal air, polyhydramnios in utero - what's the dx (2)?
Duodenal atresia or annular pancreas
136
Double bubble sign and normal gas patter beyond it; what's the dx?
Malrotation
137
The pt obviously has pyloric stenosis. How do you make the diagnosis?
Donut sign on US (may also see olive shaped mass and visible peristaltic waves)
138
Multiple loops of bowel with air fluid levels - what's the dx?
Intestinal atresia
139
Multiple loops of bowel with air fluid levels - how did that happen?
Mom did cocaine with baby in utero (vascular compromise) = intestinal atresia
140
The pt obviously has pyloric stenosis. What's the next step?
BMP to look for (and correct) electrolyte abnormalities
141
What is an olive-shaped mass, visible peristalsis in a baby?
pyloric stenosis (also see non-bilious projectile vomiting)
142
Diagnose esophageal atresia with?
Xray with an NG tube in place - tube will be coiled
143
Baby has bubbling or gurgling with breathing, dx?
TE fistula
144
A baby looks to be yellow in the nursery - what's the first step?
Check bilirubin - transcutaneous (sensor = screen) vs serum (diagnostic)
145
In the workup of a jaundiced neonate, what does a positive Coombs test mean?
Rh or ABO incompatibility
146
How do you diagnose biliary atresia?
US
| If equivocal, HIDA scan after 1 wk of phenobarbital
147
Baby has an elevated unconjugated bilirubin at day 10 that wasn't present at birth. Dx and tx? What is the cause?
breast milk jaundice - can temporarily interrupt breast feeding and supplement with formula or continue breast feeding - phototherapy if needed; Enzyme inhibition by mother's milk causes insufficient conjugation
148
In the workup of a jaundiced neonate, what dose a high hemoglobin mean (2 causes)?
baby has too much blood - twin twin transfusion or delayed clamping of the cord
149
Persistent conjugated hyperbilirubinemia after aggressive measures to fix - what's the dx?
biliary atresia
150
Baby has an elevated unconjugated bilirubin at day 4 that wasn't present at birth. Dx and tx?
Breast feeding jaundice (not enough feeding, gut slows, increased bili reabsorption) - advice mom how to feed and how often
151
Kernicterus comes from which kind of bilirubin?
Unconjugated (lipid soluble so can cross BBB!)
152
How do you confirm an elevated transcutaneous bilirubin?
Get a serum bilirubin level
153
A mention of "black liver" in the vignette - what's the dx?
Dubin-Johnson
154
Name 3 causes of increased conjugated bilirubinemia in a neonate
1) biliary atresia; 2) sepsis; 3) metabolic (Rotor, Dubin Johnson)
155
Name 4 causes of increased unconjugated bilirubinemia in a neonate
1) hemolysis (G6PD, pyruvate kinase defic, sickle cell); 2) hemorrhage (cephalo-hematoma); 3) Transfusion (twin-twin or delayed cord clamping); 4) Reabsorption (breast feeding vs breast milk jaundice)
156
Name 4 findings due to maternal estrogen effects in newborns
1) breast hypertrophy (boys and girls); 2) swollen labia; 3) physiologic leukorrhea (whitish vaginal discharge); 4) uterine withdrawal bleeding
157
Bilious vomiting in vignette, a double-bubble with multiple air fluid levels on XR image
Intestinal atresia
158
If you find imperforate anus in a newborn, what do you do next?
Up-side-down baby gram (Xray)
159
Coiled NG tube in an esophagus in a newborn?
Esophageal atresia (look for VACTERL)
160
Intestines are out of baby, in the midline, and are contained in sac. What is the dx and what do you do next?
Omphalocele; give a silo
161
Intestines are out of baby, they are to the right of midline and have no membrane. What is the dx and what do you do next?
Gastroschisis; give a silo
162
Premature neonate develops bloody diarrhea, what's the dx? Next step?
Necrotizing enterocolitis; get an XR
163
Scaphoid abdomen and bowel sounds in the chest in a newborn, what's the dx? Next step?
Diaphragmatic hernia; XR
164
How do you treat congenital diaphragmatic hernia?
give pulmonary surfactant and surgical repair
165
Failure to pass meconium, XR shows dilated proximal colon and distal normal colon. What's the dx and how do you treat it?
Hirschsprung's; remove the normal looking colon
166
Biliary atresia presents with persistent or worsening jaundice at what age? How do you diagnose it?
2 weeks; US shows absence of ducts and HIDA scan after phenobarbital shows no contrast in GI
167
Neural tube defects are caused by what (2)? What would you see in prenatal screen (2)?
Folate deficiency and genetic syndromes; visible on US in utero and positive AFP screen
168
Myelomeningocele is associated with ___.
chiari type II
169
Cleft lip/palate can be caused by failure of __ or __.
growth or fusion of underlying structures
170
Floaties aren't sufficient for pool safety; why?
they hold up arms, not the head (child can still drown)
171
Football player gets knocked out after a big tackle but remembers everything, what does he have?
Concussion
172
How do you prevent drowning in pools?
supervision, life jackets
173
A teen is involved in a MVA, isn't wearing his seatbelt, flies through the windshield and suffers LOC with a single lucid interval then LOC. Test and suspicion of dx?
CT scan; epidural hematoma
174
A three year old comes in with bruises form her toes to knees, dx?
Abuse
175
Football player takes a big hit, wobbles, comes out, but quickly shakes it off and appears ok. Next step and why?
Don't allow return to play - 1) cognitive deficits may not show up immediately; 2) higher incidence of second impact syndrome
176
What is the most effective way to prevent trauma from guns?
Eliminate them from the home
177
What are the 4 criteria for deciding mild vs severe concussion? What do you do if it is mild vs severe?
FND (none vs positive); LOC (lt vs gt 60 seconds); Headache (none/improving vs present/worsening); Amnesia (none vs retrograde/anterograde);
For mild no CT, d/c home; for severe CT scan to r/o bleed and observe. Both step wise return to play
178
What is the parkland formula for pediatric burns and how do you calculate %BSA?
```
%BSA x Kg x 4 (2nd and 3rd degree burns only)
Head: 9+9 = 18
Front thorax is 9+9 = 18
Back thorax is 9+9 = 18
Arms are left = 9 and right = 9 = 18
Legs are 9+9+9 = 27
```
179
Timing of fluids in burn patients?
50% of fluid in 8hrs and the second 50% of fluid in the next 16
180
Concussion symptoms (4)?
- Physical (photophobia, nausea, headache)
- cognitive (memory issues)
- emotional (moody, depression)
- sleep problems
181
Infant is in a coma, subdural on CT, dx?
shaken baby syndrome, abuse
182
Rear facing car seat for baby until what age?
2 years old
183
Kids need a booster seat until?
4'9", 8-12 years old
184
Bee sting with a red wheal around the site. What do you do?
Supportive care. You can use antihistamines
185
Young child develops an itchy rash on their face, what's the first thing to do?
Evaluate/withdraw recently added foods to diet
186
Vomiting, bloody diarrhea, failure to thrive in infant on formula - dx and tx?
milk-soy protein allergy; switch to hydrolyzed formula
187
A child has rhinorrhea and allergic shiners. How do you evaluate?
Take history for triggers and remove them (no skin testing or RAST)
188
What's the first line treatment for seasonal allergies?
H1 blockers (loratidine = fexofenadine = cetirizine)
189
Bee sting with red wheals, hypotension, and wheezing. What is the immediate treatment?
IM Epi 1:1000
190
When should you do skin testing for allergies?
In the case of severe or refractory disease
191
What can you tell mom and dad about allergens when it comes to household safety for baby?
Remove carpets, clean regularly (dust mites), and stop smoking
192
Name the findings associated with allergic rhinitis in children (6)
Allergic shiners, allergic salute, pale mucosa, boggy mucosa, polyps, cobblestoning
193
What is the best tx (after avoiding triggers) for allergic rhinitis?
Intra nasal steroids!! (anti-histamines are not as good!)
194
A child has ADHD but the question is about seizures - dx? Tx?
Absence; Ethosuximide (valproate as back up)
195
What makes a febrile seizure complex (3)? Why does it matter?
complex if: 1) not generalized, 2) gt 15 mins, 3) multiple episodes in 24hrs. Simple seizures do not require any additional workup
196
What do you NEVER give to a febrile seizure? What do you give to tx it?
Aspirin (reyes syndrome); tx underlying cause (acetaminophen does not tx or prevent recurrence of febrile seizures)
197
Less than 6 months old, bilateral jerking of head and extremeties - dx? How do you treat? What is seen on interictal EEG?
Infantile spasms (West syndrome); ACTH; hypsarrhythmia
198
Seizure, ash leaf spot on wood's lamp - dx? What's the next step?
Tuberous sclerosis; CT head or MRI brain (looking for brain tubers)
199
When do you use bentos to treat a febrile seizure?
ANY seizure lasting more than 5 minutes (abortive bentos)
200
What do you do about an anal fissure in a child?
Treat constipation if present; check for IBD if older child
201
You're worried about a GI bleed in a premature neonate - what do you get? What would you see on X-ray?
Xray for necrotizing enterocolitis; pneumatosis intestinalis (air in the wall of the bowel)
202
Currant jelly diarrhea in a child, pain relieved by knee to chest position. What's the dx?
Intussusception
203
Sausage shaped mass and currant jelly diarrhea - dx?
Intussusception
204
What are the 3 other things you should look for in a pt with necrotizing enterocolitis?
1) intraventricular hemorrhage (US w/doppler); 2) retinopathy of prematurity (optho exam); 3) Bronchopulmonary dysplasia
205
What test do you do to investigate intussusception?
Air enema (best test and often curative); can also do X-ray (to look for perf or obstruction) and US which would show target sign (aka donut)
206
What is the tx for intussusception? What is the back up and when do you do it?
Air enema (surgery if that doesn't work or if pt has peritonitis, perforation)
207
Diagnostic step for a meckel's diverticulum?
Technetium-99 scan
208
What do you get if you're worried about a GI bleed in a healthy term neonate right after delivery?
Apt test (differentiates fetal from maternal blood - aka alkali test) - baby might have swallowed mom's blood
209
Warm upper extremities, cool lower extremities in a child, what's the diagnosis?
Coarctation of the aorta
210
You want to keep the patent ductus arteriosus open, what do you give? What do you give to close it?
Prostaglandin; indomethacin (anti-prostaglandin)
211
Fixed split at S2?
Atrial septal defect
212
What are indications to surgically repair a VSD (4)?
right sided hypertrophy, increased R sided pressures, failure to thrive, and heart failure (amongst others)
213
Holosystolic murmur in a neonate - what's the dx? What's the dx in an adult?
VSD; mitral regurg
214
Cyanotic congenital heart disease at age 3 - what's the diagnosis?
Tetralogy (all others are immediate at birth)
215
Mom has diabetes and the question asks about congenital heart disease
Transposition of the great vessels (not gestational diabetes!)
216
Down syndrome baby and a question about congenital heart disease = ?
atrioventricular septal defect
217
In most cases how do you diagnose a congenital heart disease?
Echo
218
Name 3 associations with VSD, 1 with ASD, and 1 with AV septal defect
VSD: Fetal Alcohol Syndrome, Downs, VACTERL
ASD: Downs
AV Septal Defect: Downs
219
Name 1 association each with PDA, coarctation, transposition of the great vessels, tetralogy of fallot, and truncus arteriosus.
```
PDA: Congenital Rubella
Coarctation: Turners
Transposition: Maternal Diabetes
Tetralogy: DiGeorge
Truncus: DiGeorge
```
220
Children with tetralogy of fallot can relieve their cyanosis by ___. How does this work?
squatting (tet spells) - this increases both venous return and systemic vascular resistance, forcing blood in to the pulmonary artery instead of the aorta
221
Sandpaper rash in a child with fever?
Scarlet fever (also will see pharyngitis, tonsillar erythema & exudates, strawberry tongue, tender anterior cervical nodes)
222
Legg-Calve-Perthes disease is idiopathic __ of the __. Classically presents in young children (age __ to __) with progressive __ and/or a __. Physical exam shows these two findings.
osteonecrosis; femoral epiphysis; 3-12 (peak 5-7); leg pain; limp; 1) decreased hip range of motion; 2) thigh muscle atrophy
(XR shows flattened and fragmented femoral head)
223
What is the most common heart defect with Down syndrome?
Complete atrioventricular septal defect
224
Name 3 features of leukocyte adhesion deficiency
1) recurrent skin and mucosal bacterial infxns (omphalitis, periodontitis) (no pus, poor wound healing); 2) delayed umbilical cord separation (gt 21 days); 3) marked peripheral leukocytosis with neutrophilia
225
Fracture in kids that DOES NOT involve the growth plate and is closed. What's the next step? What if it does involve the growth plate?
Cast; Open reduction and internal fixation (ORIF)
226
Teenage athlete, knee pain, nodule on the tibia, diagnosis?
Osgood-Schlatter
227
Clicky hip in a newborn in the newborn nursery - dx? What do you do next?
Potential developmental dysplasia of the hip - reassess in 4 wks, and if still there US to confirm, then harness
228
Obese teenager with non traumatic hip pain. Test and diagnosis?
Xray - slipped capital femoral epiphysis
229
How do you make the diagnosis of scoliosis?
Adam's test (have the child lean forward and see asymmetry)
230
Describe the XR pattern of osteogenic sarcoma?
Sunburst pattern in distal bone (often femur)
231
6 year old child with an insidious onset antalgic gait - dx?
Legg-Calve-Perthes disease (avascular necrosis) - antalgic = abnormal gait to help avoid pain
232
A girl has retinoblastoma at birth; what cancer should be monitored for?
Osteosarcoma
233
A young kid with fever and pain of any joint - most serious diagnosis?
Septic arthritis
234
Hip pain in a child after a viral illness - dx?
Transient synovitis - can be confused for septic arthritis (may need arthocentesis to rule out)
235
What diagnostic test do you do for slipped capital femoral epiphysis?
Frog-leg Xray (XR "plain film" isn't enough)
236
Fever, swelling, joint pain in a teen - next step?
Arthrocentesis (fever + joint swelling = tap)
237
What is the translocation in Ewing's sarcoma? What is the pattern on XR?
t(11:12); onion skin patter on mid shaft
238
What's the one thing you'll check for in a long bone fracture in a child?
Growth plate involvement (if positive, go straight to surgery)
239
What are the 4 Kocher criteria and what are they used for?
Used to detect septic arthritis: +1 for any positives
| non-weight bearing, temp gt 38.5/101.3, ESR gt 40, WBC gt 12
240
Other than involving the growth plate, name 4 other considerations for pediatric bone fractures that would make you choose ORIF.
Comminuted (fracture in which the bone has broken into several pieces), angular, displaced, open
241
How do you definitively diagnosis a child with sickle cell disease?
Hemoglobin electrophoresis
242
How do you treat iron overload in sickle cell disease?
Deferoxamine
243
What's the genetic problem in sickle cell disease?
Valine for glutamine in the 6th position on the beta global gene cluster on chromosome 11
244
What medication can help prevent sickle pain crises? How does it work?
Hydroxyurea; increased HgbF (which can't sickle); hydration also helps!
245
How do you treat an acute vaso-occlusive crisis?
IVFs, oxygen, and pain control (abx if suspect an infxn)
246
If there is acute chest, what is the treatment? Name 2 other conditions that require the same tx.
Exchange transfusion; priapism, stroke
247
Inability to ambulate, hip pain, and in sickle cell pt. What is the diagnosis and diagnostic step?
Avascular necrosis of the hip, take an XR
248
Kids with sickle cell auto infarct their spleens - what do you do for them?
Vaccinate against encapsulated organisms and give prophylactic penicillin until age 5
249
How can you tell if someone is in a sickle cell crisis (3)?
Sickled cells on smear, bili is up from baseline, reticulocytes are up from baseline
250
If you see salmonella osteomyelitis, what disease should you think of?
sickle cell
251
What type of anemia are kids with sickle cell likely to get if they aren't cared for?
Folate deficiency (they are actually at risk of iron overload because of transfusions)
252
Treat avascular necrosis in a newly diagnosed pt with?
NSAIDs and rest (casting and surgery are also options but will vary based on severity)
253
The most common cause of osteomyelitis in pts with sickle cell?
Staph aureus (NOT salmonella - though if you have salmonella osteo you likely have sickle cell)
254
Name 4 B cell immunodeficiencies and 1 T cell.
1) Bruton's X-linked agammaglobulinemia
2) Common variable immunodeficiency
3) IgA deficiency
4) Hyper IgM
1) DiGeorge
255
Name 3 Phagocyte immunodeficiencies
1) Leukocyte adhesion deficiency
2) Chronic granulomatous disease
3) Chediak Higashi
256
Name 3 combined immunodeficiencies
1) Wiskott-Aldrich (xlinked)
2) Ataxia telangiectasia
3) Severe combined immunodeficiency (SCID)
257
Which set of immunodeficiencies all have normal CBCs?
B-cell deficiencies
258
Small chin, small mouth, low-set ears, wide spaced eyes, and ___. What's the diagnosis?
absent thymic shadow; DiGeorge
259
Anaphylactic reaction to a blood transfusion - dx?
IgA deficiency
260
When does X linked agammaglobulinemia usually appear and when does common variable immunodeficiency? How do you treat both?
6 months; late childhood or early teens
(CVID is less severe - missing about 2 out of 3 Ig's (A, G, M) instead of all); with both you can give scheduled IgG but to cure they need BM transplant
261
Boys with lots of recurrent infection btwn ages 1-2, dx?
Bruton's X-linked agammaglobulinemia
262
What is the diagnosis if you see low IgA, low IgG, and high IgM?
hyper IgM syndrome
263
Boys, eczema, thrombocytopenia with infections. What's the diagnosis?
Wiskott-Aldrich (problem with antigen presentation)
264
What will an immunoglobulin panel look like in Brutons?
All down - low IgA, IgG, IgM, IgE
265
Recurrent Neisseria infections, what's the diagnosis?
terminal complement deficiency C5-C9 Mac attack
266
What's a cause for severe combined immunodeficiency?
adenosine deaminase deficiency (causes an autosomal recessive pattern)
267
How do you confirm an XLA diagnosis?
Type the BTK gene
268
Delayed separation of cord, dx? Name another symptom
Leukocyte adhesion deficiency; toxic but no pus! (WBCs can't leave blood)
269
Recurrent staph abscesses are seen in what immunodeficiency? How do you diagnose?
chronic granulomatous disease (no respiratory burst - will eat bugs but cannot kill catalase + organisms); Nitro blue test will fail to turn blue
270
Disruption of complement pathway that causes angioedema but not associated with immunodeficiency - dx?
C1 esterase deficiency
271
Obviously syndromic physical appearance and immunodeficiency - dx? How do you treat these pts (3)? What else should you look out for in these pts.
DiGeorge syndrome; TMP-SMX ppx, IVIg bridge to thymic transplant; decreased calcium 2/2 PTH deficiency (3rd pharyngeal pouch absent)
272
Severe immunodeficiency involving both T and B cells. Abscesses and mucosal infxns - dx? How do you treat (3)?
SCID; TMP-SMX against PCP, isolate!, BM transplant is curative (no risk of GVHD)
273
Name 3 conditions that qualify you to receive palivizumab for RSV prevention
1) preterm birth (lt 29 wks gestation); 2) chronic lung disease of prematurity; 3) hemodynamically significant congenital heart disease
274
Name 3 clinical manifestations of Kartagener's (primary ciliary dyskinesia)
1) recurrent sinopulmonary infxns and 2) bronchiectasis - both due to immotile cilia leading to poor mucociliary clearance; 3) +/- situs inversus (Kartagener's!)
275
Name 4 clinical manifestations of HSP (Henoch-Schonlein purpura). How do you tx?
1) palpable purpura; 2) arthritis/arthralgia; 3) abdominal pain, intussusception; 4) renal disease similar to IgA nephropathy; supportive tx (hydration and NSAIDs) - in severe cases can hospitalize and give systemic glucocorticoids
276
The most common predisposing factor for acute bacterial sinusitis is ____.
a viral URI
277
Mucopurulent discharge from one eye 5-14 days into life - dx? Tx? What would the gram stain show?
Chlamydia; erythromycin PO; nothing
278
Purulent disharge, bilateral, 2-7 days into life - what would the gram stain show? Tx?
gram negative diplococci (gonorrhea) - ceftriaxone IM
279
Unilateral mucopurlent discharge from one eye 5-14 days into life - what should you have used for ppx?
Nothing (there is no ppx for baby against chlamydia)
280
Red light reflex shows a bright white thing, dx? Tx?
Retinoblastoma; surgery (NEVER radiation)
281
What do you do about congenital cataracts? What are they usually caused by?
Remove them before amblyopia sets in; TORCH infections
282
Purulent disharge, bilateral, 2-7 days into life - what should you have used for ppx?
Topical erythromycin
283
A baby with cataracts not present at birth is likely caused by?
Galactosemia
284
In retinopathy of prematurity how do you diagnose and tx?
Diagnose with optho exam showing growth on retina; laser ablation
285
If baby has retinopathy of prematurity, name 3 other conditions you should consider
1) necrotizing enterocolitis; 2) bronchopulmonary dysplasia; 3) intraventricular hemorrhage
286
What is the one thing you NEVER do with hypo or epispadias?
Circumcision - use the foreskin to reconstruct the penis
287
Intense colicky pain after a teenager first experiments with alcohol, what's the dx?
Ureteropelvic junction obstruction (works at normal urinary flow - problems at increased flow)
288
You want to dx vesicoureteral reflux - what test do you get?
voiding cystourethrogram (VCUG)
289
Any UTI in an infant should prompt investigation for what? How do you check it?
vesicoureteral reflux; first U/S, the VCUG if abnormal
290
You want the confirmative diagnostic step of a bladder mass, what test do you get?
cystoscopy
291
A testicle could not be palpated, what do you do (plan out the boys life)
Give it a year (6 mo?) to descend on its own, then bring it down yourself. Take it out after puberty
292
Dysmorphic red blood cells in a child with microscopic hematuria. What is the general name for this condition?
Glomerulonephritis
293
A girl who is able to void, is toilet trained, but leaks constantly anyway - dx? Tx?
Ectopic ureter (aka low implantation of the ureter); reimplant
294
You're thinking hydronephrosis or hydroureter, what test do you get?
U/S
295
Oligohydramnios in male infant, no urine output on first day of life with palpable bladder. Dx? Tx?
Posterior urethral valves; catheter to relieve obstruction and surgery to resolve problem
296
In a pt with posterior urethral valves, what would you see on ultrasound?
Hydronephrosis
297
Hearing loss, ocular abnormalities, and renal disease - dx? pathogenesis?
Alport syndrome; basement membrane thinning (and splitting) due to abnormality of type IV collagen (hereditary nephritis)
298
In lead chelation, ___ is typically used when lead levels are 45-69. __ plus __ is used on an emergency basis for levels greater than 70 or acute encephalitis
Dimercaptosuccinc acid (DMSA, Succimer); Dimercaprol (british anti-lewisite) plus calcium disodium edetate (EDTA)
299
Name 5 clinical features of DiGeorge syndrome (pneumonic!)
CATCH: Conotruncal cardiac defects (truncus arteriosus, tetrology of Fallot, interrupted aortic arch, septal defects); Abnormal facies; Thymic aplasia/hypoplasia; Cleft palate; Hypocalcemia
300
Name 3 clinical features of McCune-Albright syndrome
1) peripheral precocious puberty; 2) irregular cafe-au-lait macules; 3) polyostotic fibrous dysplasia (recurrent fractures)
(caused by mutation in GNAS gene leading to over production of pituitary hormones)
301
What is the most common cause of pediatric stroke
Sickle cell disease
302
___ is a macrocytic pure red aplasia associated with several congenital anomalies such as short stature, webbed neck, cleft lip, shielded chest, and triphalangeal thumbs
Diamond-Blackfan syndrome (DBS)
303
A child has many outbursts in class, is started on stimulants for ADHD, the outbursts get worse - dx? Tx?
Tic disorder; dopamine antagonists (fluphenazine, tetrabenazine)
304
A child misbehaves at school, appears easily distracted. They're able to sit quietly at home and watch TV - dx?
Troublemaker (not ADHD)
305
Tx: child is fidgety, interrupts theres, is easily distracted, has poor grades, and can't follow instructions at home
Stimulant med (methylphenidate)
306
Child has impaired speech, poor social function, repetitive behaviors, and rocks back and forth - dx?
Autism spectrum disorder
307
Child acquired risk factors for intellectual disability disorders (3)
lead poisoning, trauma, cerebral palsy
308
Maternal acquired risk factors for child's intellectual disability
Hypothyroid while pregnant, alcohol while pregnant
309
How do you grade an intellectual disability?
Based on their adaptive functioning (aka ability to take care of themselves/socialize) - NOT IQ
310
What does an IQ less than 70 mean?
Person is 3 SDs below the mean
311
A 6 month old girl has normal developmental progress, but then regresses - dx?
Rett syndrome
312
What are the two main symptoms of Autism spectrum disorder?
Impaired social communication and Repetitive behaviors
313
Chromosomal causes of intellectual disability (3)
Down syndrome, Fragile X, Cri-Du-Chat
314
Lying, cheating, hurts animals, less than 18 yo, dx?
Conduct disorder
315
Child yells, talks back to teachers and parents, but isn't aggressive with peers or animals - dx?
Oppositional defiant disorder
316
Older than 7 yo, still bed wetting, frequently cries from embarrassment - tx (5)?
Positive reinforcement, alarm blankets, water restriction; medication tx = DDAVP, TCAs are okay
317
Kawasaki disease (aka mucocutaneous lymph node syndrome) is a vasculitis characterized by fever greater than ___ days in addition to gt/= 4 of these 5 findings
5 days; 1) conjunctivitis (nonexudative); 2) oral mucosal changes (strawberry tongue, fissured lips); 3) Rash; 4) extremity changes (desquamation of hands and feet); 5) cervical lymphadenopathy (gt 1.5 cm node)
318
How do you treat Kawasaki?
IVIg and aspirin!
319
The first step in the evaluation of primary amenorrhea is ___ to determine __.
pelvic exam; whether the ovaries, uterus, and vagina are present or absent. Ultrasound is the preferred imaging modality
320
___ is increased laxity of supraglottic structures, which presents as __ that worsens when __. How do you diagnose? What is the peak age?
Laryngomalacia; inspiratory stridor; supine; Clinical dx or flexible laryngoscopy; 4-8 months
321
Newborn with bilious emesis - next 4 steps?
stop enteral feeds, NG tube decompression, IV fluids, abdominal Xray (to rule out pneumoperitoneum from intestinal perf)
322
Name 4 causes of bilious emesis
1) meconium ileus (CF); 2) Hirschsprung disease; 3) Malrotation (volvulus); 4) Duodenal atresia
323
Newborn with bilious emesis, X-ray shows dilated loops of bowel - what's the next test to determine cause
contrast enema - will either show microcolon (meconium ileus = CF) or rectosigmoid transition zone (Hirschsprung)
324
Diagnosis of ___ can be confirmed with eosin-5-maleimide binding test and ___ test.
Hereditary spherocytosis; acidified glycerol lysis test
| look for triad of combo's negative hemolytic anemia, jaundice, splenomegaly - and of course spherocytes
325
Causes of meningitis in children less than 3 months of age (4); 3 months - 10 years (2); greater than 11 years (1)
Group B strep, E coli (and other gram negs), Listeria, Herpes; Neisseria meningitidis and strep pneumo; N meningitidis
326
Painless hematochezia in a young toddler is most likely due to __. Diagnosis is confirmed with __.
Meckel's diverticulum (if it has ectopic gastric tissue, it secretes HCl, causing mucosal ulceration of surrounding small bowel); technetium-99m pertechnetate scanning
327
Septic arthritis in birth-3months: what organisms (3) and what abx (2/3)
staphylococcus, group B strep and gram neg bacilli; antistaph agent (nafcillin or vancomycin) PLUS gentamicin or cefotaxime
328
Septic arthritis in pt older than 3 months: what organisms (3) and what abx (4)
staph, group A strep, and strep pneumoniae; nafcillin, clindamycin, cefazolin, or vancomycin
329
Patient has channel atresia - may be isolated or part of this syndrome (name the 6 parts)
CHARGE syndrome: Coloboma, Heart defects, Atresia choanae, Retardation of growth/development, Genito-urinary anomalies, Ear abnormalities/deafness
330
___ is characterized by macrosomia, macroglossia, umbilical hernia/omphalocele, hemihyperplasia, and hypoglycemia. Children must be closely monitored for development of these two tumors
Beckwith-Wiedmann syndrome; Wilms tumor or hepatoblastoma
331
In pts with primary amenorrhea with confirmed uterus present, the next step is to order ___. If it is increased, do ___. If it is decreased, do __.
FSH; karyotyping (peripheral origin); pituitary MRI (look for a lesion in the sella turcica)
332
Pt with combination of neurologic (ataxia, dysarthria), skeletal (scoliosis, feet deformities), and cardiac (concentric hypertrophic cardiomyopathy) manifestations has __.
Friedreich ataxia (most common type of spinocerebellar ataxias)
