Pediatrics Flashcards
1
Q
Most frequently diagnosed neoplasm in infants
A
Neuroblastoma
2
Q
2nd most common abdominal tumour in kids
A
Wilm’s Tumour (aka nephroblastoma)
3
Q
Anaphylaxis definition
A
- Need any ONE of the following
- Acute onset (min-hrs) involving skin/mucosa and at least 1 of respiratory compromise and/or drop in blood pressure
- 2 or more organ systems – skin/mucosa, respiratory, CVS, or GI rapidly after exposure
- Drop in BP after exposure to a known allergen
4
Q
Age limit of asthma dx
A
18 months (not enough smooth muscle yet to cause airway constriction)
5
Q
Common bacteria for meningitis in newborns
A
K-LEG GBS E. Coli L. monocytogenes Klebsiella
6
Q
Common bacteria for meningitis in toddlers
A
SN-EG S. pneumo N. meningitidis E. Coli GBS
7
Q
Bacterial meningitis LP findings
A
Low glucose High protein Very high WBC Nitrites Positive or neg gram stain
8
Q
Viral meningitis LP findings
A
Normal glucose Normal or slightly elevated protein High WBC Lymphocytes Neg gram stain
9
Q
Pyruria definition
A
> 5 WBCs/hpf in centrifuged urine
10
Q
Gram neg bacteria that cause nitrites
A
E. Coli
Klebsiella
proteus
11
Q
Most common organism causing pyelonephritis
A
E.coli
12
Q
Follow-up study for first episode of pyelo
A
Kidney and bladder U/S
13
Q
Third generation cephalosporins good for broad spectrum antibiotic treatment
A
Cefiixime
Cefotaxime
Ceftriaxone
14
Q
Epiglottitis typically caused by
A
H. influenza type B
15
Q
Croup most commonly caused by
A
Parainfluenza Type 1
16
Q
Most common cause of bronchiolitis
A
RSV
17
Q
Top 2 most common bacterial causes of otitis media
A
- Strep pneumo
2. Haemophilus influenza
18
Q
Buccal mucosa lesions in initial stage of measles
A
Koplik spots (red lesions with bluish white spots in centre)
19
Q
Another name for 5th disease
A
Erythema infectiosum
20
Q
Cause of 5th disease
A
Parvovirus B19
21
Q
Causes of strawberry tongue (3)
A
Strep pharyngitis
Kawasaki
Toxic shock syndrome
22
Q
Most common type of congenital diaphragmatic hernia
A
Bochdalek
23
Q
Insulin sensitive organs
A
Heart, liver, muscle
24
Q
Most common cause of respiratory distress in premature infants
A
Respiratory distress syndrome
25
Respiratory distress syndrome
♣ Deficiency of lung surfactant and delayed lung maturation
♣ Can occur as late as 37 weeks’ gestation
♣ Increased risk in infants of diabetic mothers
26
Transient tachypnea of newborn
♣ Result of delayed clearance of fluid from lungs following birth
♣ Much more common in infants born to diabetic mothers and in infants born by c-section
27
CXR findings in RDS
Diffuse reticulogranular appearance of lung fields (ground glass) and air bronchograms
28
CXR findings in TTN
Wet looking lungs, no consolidation, no air bronchograms
29
TORCH infections
```
Toxoplasmosis
Other (syphillis, varicella, parvo)
Rubella
CMV
Herpes
```
30
X-ray finding for croup
Steeple sign (tapering of upper trachea)
31
X-ray finding for epiglottis
Thumb-print sign
32
Treatment for severe dehydration
Lactated Ringer's solution or normal saline (isotonic) in 20 mL/kg boluses until urine output is established and mental status improves, then 100 mL/kg oral rehydration solutions over next 4 hours. ntravenous hydration with 5% dextrose ½ normal saline at twice maintenance fluid rates may be substituted for the oral rehydration solution if the child is not tolerating PO intake. To replace ongoing losses, the CDC recommends 60-120mL of oral rehydration solution per diarrheal/emetic episode (through a nasogastric tube, if necessary).
33
Cushing's triad
Symptoms related to increased ICP
1. Increased BP
2. Low HR
3. Irregular respirations (Cheyne-Stokes)
34
Most likely pathogens in sepsis <4wk old
Streptococcus agalactieae (GBS)
E. coli
Listeria monocytogenes
HSV
35
First choice abx for sepsis in <4 weeks
Ampicillin + Gentamicin or Cefotaxime +/- Acyclovir
36
Most likely pathogens in sepsis >/= 4 wk old
Neisseria meningitides
Strep pneumo
H. influenzae
37
First choice abx for sepsis in <4 wk old
Amp + Gent +/- Acyclovir
38
Most likely pathogens for meningitis in <4 wk old
Streptococcus agalactiae (GBS)
E. coli
Listeria monocytogenes
HSV
39
First choice abx for meningitis in <4wk old
Ampicillin + Cefotaxime + Acyclovir
40
First choice abx for meningitis in >/= 4 wk old
Cefotaxime +Vancomycin +/- Acyclovir
41
Most likely pathogens for meningitis in >4wk old
N. meningitides
Strep penumo
H. influenza
42
Most likely pathogen for encephalitis
HSV
43
Abx for strep pharyngitis/tonsillitis
Penicillin V PO
or Amoxicillin PO
or Penicillin G
44
Bacterial acute otitis media common pathogens
H. influenza
Strep pneumo
Moraxella catarrhalis
45
Bacterial acute otitis media first line tx
Amoxicillin 80-90mg/kg/d PO
| or Amox-Clav PO
46
Sinusitis common pathogens
```
H. influenzae
Strep pneumo
Moraxella catarrhalis
Staph aureus
GAS
Anaerobic organisms
```
47
Sinusitis first line tx
Amox PO
| Amox-clav PO
48
Community-acquired PNA <1mo most likely pathogens
GBS
E. coli
Listeria monocytogenes
49
Community acquired PNA <1mo first line tx
Ampicillin + Gentamicin or Cefotaxime
50
Community-acquired pneumonia (1-3 mo) first line tx
Cefotaxime +/- Vanco +/- Clarithomycin PO
51
Obstructive lung disease spirometry
Low FEV1/FVC ratio d/t reduction in FEV1
52
Restrictive lung disease spirometry
Normal FEV1/FVC ratio d/t proportionate reduction in FEV1 and FVC
53
Most commonly heard innocent murmur
Still's murmur, best heard at LLSB in supine position
54
Most likely pathogen for UTI
E. coli
55
First line empiric abx for <2mo UTI
Amp + Gentamicin
56
First line empiric abx for >/=2mo mild UTI
Cephalexin PO
57
First line empiric abx for >/=2mo severe UTI
Cefotaxime OR Gentamicin
58
Requirements for renal U/S in UTI
```
<2yo first febrile UTI
Any age with recurrent UTI
Any age with fam hx of renal dz
Any age with poor growth, HTN
Any age with no response to abx
```
59
Requirements for voiding cystourethrogram in UTI
Any age with >/= 2 febrile UTI
Any age with first febrile UTI and abnormal U/S
Any age with >/= 39C and pathogen other than E. Coli
Any age with poor growth, HTN
60
Vesicoureteral reflux grades
Grade 1: Half way up ureter
Grade 2: All the way up ureter
Grade 3: Up ureter and some dilation of ureter & calyces
Grade 4: Marked dilation of ureter and calyces
Grade 5: Massive reflux, dilated ureter, calyces dilation and loss of renal cortex
61
VUR grade tx
Grade 1/2 - spontaneous resolution (2-5yrs), follow by GP
| Grade 3/5 - referred to urologist
62
Roseola
HHV6
Fever 3-5d --> maculopapular rash that starts on trunk and spreads to face/extremities
Tx = Reassurance
63
Asthma X-ray findings
Hyperinflation
Increased interstitial markings
Patchy atelectasis
64
Pertussis stages
Catarrhal (1-2wks) - URTI symptoms
Paroxysmal (4-6wks) - whooping cough
Convalescent - decrease in severity/freq of cough
65
Pertussis treatment
Azithromycin
Clarithromycin
Erythromycin
66
Turner syndrome
45XO
67
Klinefelter Syndrome
47 XXY
68
Trisomy 13
AKA Patau Syndrome
69
Trisomy 18
Edward Syndrome
70
Fragile X syndrome
Expansion of CGG repeats on FMR1 gene on X chromosome
71
Febrile seizures simple vs complex
```
Simple:
- More common
- <15min
- Generalized
- Once in 24h period
Complex:
- Less common
- >15min
- Focal
- More than once in 24h period
```
72
Recurrence rate of febrile seizures
<12mo: 50%
| >12mo: 30%
73
Risk of epilepsy after febrile seizure
Slightly increased above 0.5-1% baseline population risk
74
Most common cause of recurrent headache in children
Migraine without aura (more common than classic with aura)
75
Tx for headaches in children
TCAs for migraine
| NSAIDs for tension
76
Dx criteria for idiopathic intracranial HTN
1. Increased ICP with associated symptoms
2. Normal brain anatomy
3. Normal CSF
77
Infratentorial brain tumour findings
Cerebellar signs and increased ICP
78
Cerebellar brain tumour findings
Change in muscle tone, deep tendon reflexes = hypotonia, hypOreflexia
79
Supratentorial brain tumour findings
Focal motor and sensory abnormalities on side OPPOSITE to lesion
80
Brain stem brain tumour findings
CN and gaze palsies
81
Most common location for brain tumour
Posterior fossa
82
Most common brain tumours in peds
Medulloblastoma, juvenile pilocytic astrocytoma
83
Measles rash
Maculopapular, starts on neck/face then spreads down to feet in 2-3d
Initial Koplik spots in buccal mucosa
Tx: supportive
84
Rocky mountain spotted fever
Tick-borne bacterial infection
Rash on ankles and wrists --> spreads centraly and to palms and soles
Maculopapular --> petechial
85
Cat scratch disease
Bartonella henselae
Axilla > cervical, submandibular, inguinal areas
Subacute/chronic unilateral lymphadenitis
Self-limited
Start empiric abx if suspected coverage for S. aureus and GAS (cephalexin, clinda, septra, amox-clav, etc.) + coverage for cat scratch (azithromycin, rifampin, septra, doxy)
86
Bacterial cervical adenines most common causes
```
Staph aureus
Strep pyogenes (GAS)
```
87
Kawasaki disease dx
Fever >5d
4/5 of the following:
- Conjunctivitis (bilateral, non purulent)
- Rash
- Extremity changes (redness/swelling)
- Adenopathy (unilateral cervical lymphadenopathy)
- Mucosa (strawberry tongue)
88
Kawasaki stages
Acute Onset-10d (fever, clinical findings, serologic evidence of inflamm)
Subacute 10d-3wk (Fever resolves and clinical findings subside, ongoing serologic evidence) *coronary artery aneurysm formation*
Convalescent 3wk - 6-8wk (clinical findings resolved, cont serologic evidence of inflammation)
89
Drug to avoid in kawasaki
Ibuprofen
90
Use corrected age in premature babes until age...
2yo
91
Developmental screening tests recommended at...
9, 18 and 30 months
92
Common risk factors for developmental delay in premature infant
- Chronic lung dz
- Periventricular leukomalacia (damage/necrosis to white matter around ventricles)
- Retinopathy of prematurity
- Hyperbilirubinemia
93
Babinski reflex gone by...
Time child is walking
| Up to 2yrs
94
Types of cerebral palsy
```
Spastic hemiplegia
Spastic diplegia
Spastic quadriplegia
Ataxic
Dyskinetic
```
95
Spastic hemiplegia CP
Leg and arm on one side
Etiology - unilateral UMN abnormalities
Clinical - stroke
96
Spastic diplegia CP
Most common
Legs > arms
Etiology - periventricular white matter abnormality
Clinical - premature
97
Spastic quadriplegia CP
Whole body
| Etiology - global brain involvement
98
Dyskinetic CP
AKA Athetoid dystonic
Variable, often entire body
Basal ganglia, cerebellum and/or thalamus
Clinical - perinatal asphyxia, kernicterus
99
Ataxic CP
Entire body
Etiology - Cerebellum
Clinical - Cerebellar hypoplasia, pontocerebllar hypoplasia
100
Screening tool for ASD
M-CHAT
101
Language milestone at 2yo
```
50+ words
2 word phrases
50% intelligible
Follows 2-3 commands
Points to pictures when asked
```
102
Language milestone at 3yo
200+ words
3 word phrases
75% intelligible
Knows age and gender
103
Language milestone at 4yo
Tells stories, 100% intelligible
400-1500 words
Numbers 1-4
Knows full name
104
Language milestone at 9-10mo
Single words "mama" "dada"
105
Language milestone at 18mo
10-25 words
Names body parts
Follows 1 step commands
106
Risk factor for speech delay
Sex (boys > girls)
107
Fencing reflex
Should be gone by 6mo
| Most common primitive reflex that persists in CP
108
Dx of Trisomy 21
Lymphocyte karyotype
109
Most common familial cause of intellectual disability
Fragile X syndrome
110
Turner syndrome
45XO
Physical differences at birth
Webbed neck, edema of hands/feet, low ears, shield chest with wide nipples, coarctation of the aorta
Most have NORMAL IQ
111
Klinefelter Syndrome
47 XXY (male)
Normal at birth
Infertility, gynecomastia, small testicles
Other less obvious symptoms: weaker muscles, greater height, poor coordination, less body hair, decreased libido (most noticeable at puberty)
Typical random mutation
IQ low-normal range
112
Fragile X clinical
Females - asymptomatic (ID, behavioural), may suffer from infertility
Males - large testes, flat feet, long face with large mandible, high-arched palate, hypotonia, connective tissue abnormalities (joint laxity, pectus excavatum)
~1/3 have features of autism (co-occur), usually fertile
Hyperactivity common
Normal-severe IQ
113
Normal weight gain in newborn
20-30g/d average weight gain during first 4mo of life
114
Weight should double by...
| Weight should triple by...
4mo of age
| 1 yo
115
FTT definition
Weight <3rd percentile
Weight for height/length <3rd percentile
Rate of weight gain slows compared with previous growth, crossing 2 more major percentiles in downward direction
116
Child CPR
```
100-120 compressions/minute
1/3 AP diameter
Infants = 1.5inches
Children = 2inches
Teens = 5cm (adult recommendation)
```
117
Neimann-Pick disease
Neurodegenerative disorder
6mo-2yrs
GDD, milestone regression, hepatosplenomegaly, interstitial lung dz, macular cherry red spot
118
Palmar grasp persists until
2-3mo
119
Plantar grasp persists until
8mo
120
Fencing reflex persists until
6mo
| AKA asymmetric tonic neck reflex
121
Babinski reflex persists until
1-2yrs
122
Moro reflex persists until
4mo
123
Vitamin D recommendations
400IU per day within days of birth to 6 months if child is exclusively breasted or not receiving at least 1L via D fortified formula daily
124
Birth weight doubles by age...
4-5mo
125
Birth weight triples by age...
12mo
126
Birth length doubles by age...
4yo
127
New food may be added to the diet...
every 5-7 days
128
Wilms tumour often associated with this syndrome
Beckwith-Weidemann syndrome = genetic overgrowth (omphalocele, hemihypertrophy, hypoglycaemia, large for GA)
129
Neuroblastoma lab findings
Elevated Urine or serum VMA/HVA (measures metabolites of catecholamines)
Possible anemia/other cytopenias
130
Target glucose screen in neonate prior to feeds
2.6mmol/L
131
Preterm definitions
Extremely preterm <28wks
Very preterm 28-32 wks
Moderate preterm 32-34 wks
Late preterm 34-36wks
132
Replacement of losses for dehydration
<10kg: 60-120mL ORS to each diarrheal stool or vomiting episode
>10kg: 120-140mL ORS for each diarrheal stool or vomiting episode
133
Rehydration therapy for mild-moderate dehydration
ORS 50-100mL/kg over 3-4h
134
Rehydration therapy for severe dehydration
Lactate Ringer's solution or NS in 20mL/kg until mental status improves THEN 100mL/kg body weight ORS over 4h or D5 1/2 NS IV at twice maintenance fluid rates
135
Replacement therapy for severe dehydation
D5 1/4 NS with 20mEq/L KCl
136
Surgical abdomen that has bilious vomiting
Malrotation with volvulus
137
Surgical abdomen that has projectile, non-bilious vomiting
Pyloric stenosis
138
Hallmark electrolytes in pyloric stenosis
Hypochloremic, hypokalemic metabolic alkalosis with dehydration
139
Radiological sign of pyloric stenosis via upper GI contrast study
String sign (narrow pyloric channel)
140
Intussusception symptoms
Bilious emesis and red current jelly stools
141
Duodenal intestinal atresia associated with...
Trisomy 21
| Congenital heart disease
142
Xray imaging sign for duodenal intestinal atresia
Double bubble
143
Symptoms of intestinal atresia
Abdo distention
Bilious emesis
Hyperbilirubin --> jaundice
Possible polyhydramnios in utero
144
IV fluid bolus
Isotonic (0.9%) NS at 20mL/kg over 60min
145
DKA definition
Random glucose >11.1mmol/L AND
pH < 7.3 or bicarb <15mmol/L AND
Moderate or large ketonuria or ketonemia
146
Diagnosing DM in peds
Symptoms of diabetes (polyuria, polydipsia, unexplained weight loss) + random glucose >11.1 OR
Fasting glucose >7 OR
2h post-Oral glucose challenge >11.1
HbA1c not usually used in peds but >/= 6.5% in adult
147
Isotonic/isonatremic dehydration - time period for fluid replacement
Over 12h
148
Hypotonic/hyponatremic - time period for fluid replacement
Over 24h
Risk of central pontine myelinolysis
(ie. patient consumes diluted fluids/water when dehydrated)
149
Hypertonic/hypernatremic - time period for fluid replacement
Over 48h
Risk of cerebral edema
(ie. DKA)
150
Add dextrose to fluid maintenance once glucose levels drop below
16.7mmol/L
151
Cushing's triad of increased ICP
High BP
Low HR
Irregular respiration
152
Most common AI diseases associated with DKA
AI thyroid disease
| Celiac disease
153
Traditional regimen 2/3, 1/3 insulin
2/3 in AM - 1/3 rapid and 2/3 intermediate acting
| 1/3 in PM - 1/6 rapid with dinner, 1/6 intermediate acting at bedtime
154
Basal bolus regimen for T1DM
Half of total given at bedtime in long-acting form (insulin glargine)
other half split up into 3 doses with meals (rapid)
155
T2DM screening guidelines in peds
Screen all overweight children (BMI >85th percentile) PLUS any 2 of :
- Maternal hx of diabetes or GDD
- Fam hx of T2DM in 1st or 2nd degree relative
- Race/ethnicity
- Signs of insulin resistance (acanthosis nigricans, HTN, dyslipidemia, PCOS)
Screen by fasting plasma glucose starting at 10yo onset of puberty and 13yrs
156
T2DM treatment
Start treating right away if random glucose >13.9mmol/L or HbA1c >9%
157
Name of enzyme that conjugates bilirubin in liver
Glucuronsyl transferase
158
Kernicterus
Pathological consequence of elevated unconjugated bill --> bill staining the basal ganglia and CN nuclei
159
Physiologic jaundice
Total bili = 257umol/L in full term infants who are otherwise healthy
Seen in 2-3 d of life, peaks at 3-4d
160
Breastfeeding jaundice
Early in first week of life
Low breast milk --> slow gut motility --> beta glucuronidase in meconium
2nd most common cause of neonatal jaundice
161
Breastmilk jaundice
Presents after 1st week of life, can persist up to 12 wks
| Beta-glucuronidase in breastmilk
162
2 diseases that are antibody negative hemolytic cause of anemia due to RBC enzyme deficiency
1. G6PD deficiency
| 2. Pyruvate kinase deficiency
163
Crigler-Najjar Syndrome
Auto-recessive
Causes unconjungated hyperbili
Type 1 - glucuronosyl transferase absence (more severe)
--> Tx = lifelong phototherapy
Type 2 - glucuronosyl transfersation dysfunction
--> Tx = Phenobarbital
164
Gilbert Syndrom
Not as severe, usually presents in adolescence
| Dysfunction of glucuronosyl transferase
165
Biliary atresia
Jaundice, dark urine and pale stools presenting at 3-6wks of age
Tx - Kasai procedure
166
Caput succadaneum
Swelling commonly from SVD in vertex position
Serum, crosses suture lines
Does not cause hyperbili
167
Cephalohematoma
Subperiosteal hemorrhage
Blood, does NOT cross suture lines
Causes hyperbili
168
Photherapy
For unconjugated hyperbili
Expect 30-40% decline in first 24h
If no decline, consider HEMOLYSIS as cause
169
MEC should no longer appear in stool by day...
3
170
Conjugated hyperbili
```
If >20% of TSB is conjugated
Think obstruction (cholestasis), hepatitis or AI diseases
```
171
CPR in child
100-120 compressionsmin
| Depress chest at least 1/3 AP diameter
172
Infant Colic
Crying for more than 3h/d, for at least 3 days/wk for 3wks
| Typically starts after 2wks of age, peaks at 6 wks, lessens by 3-4mo
173
Brief resolved unexplained event (BRUE)
Occurs in infan <1yo when observer reports sudden, brief, now resolved episode that includes on or more of the following:
Cyanosis or pallor
Absent, irregular or decreased breathing
Marked change in tone (hyper or hypo)
Altered level of responsiveness
174
Distinguishing between restrictive and obstructive lung disease
```
Restrictive = normal FEV1/FVC ratio (both decrease)
Obstructive = lower FEV1/FVC ratio
```
175
Spirometry finding for asthma dx
FEV1/FVC < 80% with 12% improvement in FEV1 after SABA
176
Scoring system used to assess severity of acute asthma exacerbation
```
PRAM Score
O2 sat
Suprasternal retractions
Scale muscle contractions
Air entry
Wheezing
```
177
Mild acute asthma exacerbation
PRAM score of 0-3
| Salbutamol q20min x 1-2 doses in first hour
178
Moderate acute asthma exacerbation
PRAM score of 4-7
Salbutamol q20min x 3 doses AND
Ipratropium q20min x 3 doses in first hour
179
Mild persistent asthma
Symptoms >2d/wk but not daily
PM awakenings 1-2x/mo if <4yrs, 3-4x/month if >/= 5mo
SABA use >2d/k but not daily and not more than 1x/day
Minimal limitation of normal activity
FEV1 >80%
FEV1/FVC 80%
180
Moderate persistent asthma
```
Symptoms daily
PM awakenings 3-4x/mo if <4yrs, >1x/wk but not nightly if >/= 5yrs
SABA use daily
Some limitation of normal activity
FEV1 60-80%
FEV1/FVC 75-80%
```
181
Severe asthma
```
Symptoms daily
PM awakenings >1x/wk if <4 yrs, >7x/wk if >/=5yrs
SABA use several times per day
Extreme limitation of normal activity
FEV1 <60%
FEV1/FVC <75%
```
182
Mild persistent asthma tx
Daily low dose ICS
| SABA reliever med as needed
183
Mod persistent asthma tx
Daily med dose ICS
If >12yrs, add LABA (affair, symbicort, salmeterol)
SABA reliever med as needed
184
Severe asthma tx
Refer to specialist
| AND/OR Leukotriene receptor antagonist or LABA in combo with med dose inhaled steroids
185
Vitamin K given to newborns to prevent
Hemorrhagic disease of the newborn
186
Erythromycin eye ointment given to newborns to prevent
Ophthalmia neonatarum caused by N. gonorrhoea
Causes globe rupture and blindness
No protection against chlamydia trachoma's conjunctivitis which is more common
187
Hearing screen
Should be done before 1mo of age (usually as newborn before d/c)
if failed, then repeat at 3mo
If failed twice then needs more formal assessment
Repeat at 4yo
188
Tx for congenital hypothyroid
Levothyroxine ASAP 10-15mcg/kg/d
189
Juvenile idiopathic arthritis
<16yo, arthritis in at least 1 joint for >6wks
Fleeting salmon-coloured rash of discrete macule on trunk and extremities
A/W Iridocyclitis
190
Oligoarthritis
Typically affects knee, onset of arthritis is acute a/w asymptomatic iridocyclitis
Affects = 4 joints for >/= 6 weeks
191
Slipped capital femoral epiphysis
Most common hip d/o in adolescents (boys > girls)
Affected leg is shortened and externally rotated
Months of vague hip or knee symptoms and limp
Tx: Internal reduction of femoral head
192
Legg-Calve-Perthes Disease
Most commonly affects boys btwn 4-10
Avascular necrosis of femoral head
Typically self-resolving, casting and crutches to keep joint ABducted and internally rotated to keep head in acetabulum
Complications - femoral head deformity, degenerative arthritis
193
Developmental dysplasia of the hip
Infants where femoral head is not properly aligned with acetabulum
Common in females born by breech with fam hx of DDH
Tx: Newborn wears pavlik harness --> closed reduction and spica cast at 6mo-2yrs
194
Ortolani maneuver
Assesses for dislocated hip by abduction of flexed hip with gentle anterior force
195
Barlow maneuver
Assesses for dislocatable hip by adduction of flexed hip with gentle posterior force
196
Holosystolic murmur ddx
VSD (starting with S1, blowing)
Mitral insufficiency
Tricuspid insufficiency
197
Continuous murmur
Patent ductus arteriosus
198
Most common murmur
Still's murmur
3-7 yo
Musical or vibratory
Best heard at LLSB in supine position
199
Atrial septal defect murmur
First detected at age 3-5
Systolic murmur caused by increased flow through pulmonic valve
Widely split, fixed S2
Best heard at ULSB
200
Coarctation of the aorta
Systolic murmur with loud S2 bet heard at ULSB, L axilla and L unterscapular area
Presents in infancy
Check BPs
201
Ventricular septal defect murmur
Most common in infancy
Holosystolic murmur with possible wide split S2
Best heard at LLSB
202
Meds for CHF due to VSD
Furosemide
Digoxin
Enalapril (ACEi causes after load reduction --> more bloodflow out to systemic vasculature than through VSD)
203
Eisenmenger syndrome
Pulmonary HTN gets so severe that pulmonary pressure > systemic pressure --> R to L shunting --> RV hypertrophy --> cyanosis --> polycythemia --> HF --> death
204
Aortic stenosis murmur
Systolic ejection murmur followed by early diastolic murmur of aortic insufficiency
205
Pulmonic stenosis
Prominent systolic ejection click just after S1
206
Tetralogy of Fallot
R --> L shunt
1. VSD
2. RV out flow tract obstruction
3. Overriding aorta
4. RVH
207
Henoch-Schonlein Purpurs (HSP)
NON-thrombocytopenic purpura
Self-limited, IgA-mediated small vessel vasculitis that typically involves tetrad of RASH, ARTHRALGIAS, ABDO PAIN, RENAL INVOLVEMENT
A/W hematuria (possible progression to renal failure), arthralgias, colicky abdomen pain, intestinal bleeding with FOBT, possible intussusception
Tx: supportive management, steroids controversial
208
Most common cause of isolated thrombocytopenia in otherwise healthy child
idiopathic thrombocytopenic purpura
209
Idiopathic thrombocytopenic purpura
Most cases follow non-specific viral illness
NOT a/w splenomegaly and hepatomegaly
Isolated thrombocytopenia with normal plt morphology
Tx depends on severity
Ranges from watchful waiting to methylprednisilone (1st line), IVIG (2nd line) and platelet transfusions
210
HEEADSSS
```
Home
Education
Eating
Activities
Drugs
Sexuality
Safety
Suicide
```
211
First and most subtle sign of possible inadequate perfusion
Tachycardia
212
Pediatric sepsis treatment
20cc/kg NS boluses over 5-20 min to a max of 60cc/kg
Give bolus even in its with relative C/I to receiving large amounts of fluids (ie. meningitis, SIADH)
Once reached max and pt's perfusion still inadequate, give inotropic support (epinephrine, norepinephrine, dopamine)
213
Leading cause of bacterial meningitis in children
Neisseria meningitides
214
Definitive tx for meningococcal disease
Pen-G
215
Tx for carrier status of meningococcal disease
Adults: Ciprofloxacin
Peds: Ceftriaxone, azithromycin or rifampin
216
Antibiotic choice for Rocky Mountain Spotted Fever
Doxy
217
Toddler fracture
Subtle, non-displaced oblique fracture of distal tibia in young walking children (9mo-3yrs)
218
Tests to order post-strep
Anti-streptolysin-O (ASO)
| Low C3
219
Causes or primary nephrotic syndrome from most to least common
Minimal change disease
Focal segmental glomerulonephritis
Membranoproliferative glomerulonephritis
220
Most frequent infectious complication associated with nephrotic syndrome
Spontaneous peritonitis
221
HTN defined as
Systolic OR diastolic >95th percentile measured on 3 or more occasions, preferably several weeks apart
222
Urine protein:creatinine ratio
<0.2 = normal in children >2yo
< 0.5 = normal in children <2yo
>1 = suspicious for nephrotic syndrome
>2.5 = dx for nephrotic syndrome
223
Streptococcal infection rash
```
Scarlet fever rash
Erythematous, sand-paper rash
Accentuated at skin creases
Starts on face/neck --> trunk, arms, legs
Blanchable
```
224
Erythema multiforme
`Symmetrical rash that starts as dusky macule and forms target lesions
Often triggered by infections (HSV)
1-3 wks
Conservative maanagement
225
Erythema migrant
A/W early localized Lyme disease
226
Head lice
AKA pediculosis capitis
| Tx: 1% permethrin lotion, 2-3 repeated applications in weekly intervals
227
Scabies
5-10mm curvilinear thread-like lesion (burrow)
| TxL 2 applications of permethrin 5% cream, 1 wk apart
228
Tinea capitis treatment
Systemic therapy required
| Griseofulvin (oral anti fungal )
229
Diaper rash common causes
Irritant dermatitis
Diaper candidiasis
Bacterial infection (perianal GAS)
230
Irritant dermatitis diaper rash
Most common cause of diaper rash
Typically spares intertriginous creases
Tx: Barrier cream with Zinc-oxide
231
Diaper candidiasis
Erythematous papule that become confluent plaques with satellite lesions
Tx: Antifungal nystatin, imidazole antifungals (miconazole, ketoconazole)
232
Bacterial infection causing diaper rash tx
Oral abx
233
Neonatal acne associated with...
Malassezia species
234
Erythema toxicum
Idiopathic benign self-limiting cutaneous eruption of full-term newborns
Blotchy, macular erythema
Progresses to 1-3mm yellow/white papule and pustules
Day 2-10 of life
No tx needed
235
Neurofibromatosis Type 1
Need at least 2 of 7:
1. Cafe au last spots (>/=6, 0.5cm if pre-puberty and >1.5cm if post-puberty)
2. Axillary/groin freckling
3. Auto dominant (first-degree relative affected)
4. Neurofibromas present
5. 2 or more Lisch nodules (iris hamartomas) - no clinical significance --> seen later in dz
6. Optic nerve gliomas
7. Patognomonic skeletal dysplasia
236
Risk associated with tobacco use during pregnancy
Low birth weight
237
SGA
Diagnosed at birth
| <3rd or <5th percentile
238
IUGR
Dx during pregnancy
Height and weight <2SD mean for GA
Usually catch-up
239
Symmetric IUGR
Growth pattern in which head, length, weight are decreased proportionately
Can be caused by congenital infections
Early pregnancy
240
Asymmetric IUGR
Growth pattern in which decrease in size of length and/or weight without affecting head circumference
Can be caused by poor fetal nutrition (i.e. maternal smoking), placental insufficiency
More favourable than symmetric
241
Risk factors for early onset GBS
Prolonged rupture of membranes
Prematurity
Intrapartum fever
Previous delivery of infant with GBS disease
242
Prophylaxis against GBS administered if ONE of the following is present and mother is in labour with ruptured membranes
Prev infant with GBS dx
GBS bacteriuria during any trimester of current pregnancy
+ve GBS vag-rectal screening culture in late gestation
Unknown GBS status and any of the following:
- <37 wks GA
- Amniotic membrane rupture >/= 18h
- Intrapartum temp >/= 38C
- Intrapartum NAAT +ve for GBS
243
Rubella
Prodrome of low grade fever, headache, mild pink eye, myalgia, swollen/enlarged lymph nodes, cough, runny nose
Rash on face that spreads to rest of body, lasts ~3d
244
Caloric requirements for term infant
100-120 cal/kg/d
245
Caloric requirements for pre-term infant
115-130cal/kg/d
246
Caloric requirements for very low birth weight infant
Up to 150cal/kg/d
247
First line imaging for abdo mass
U/S
248
Preventing dental caries
No bottle use by the time child is 12-15mo
| Supplement with fluoride
249
Intoeing in toddlers
Caused by tibial torsion
| Resolves by ~4yo
250
Intoeing in school-aged children
Caused by femoral ante version
| Resolves by 8-12yo
251
Common cause of normocytic anemia in children
Transient erythoblastopenia of childhood
| Post-viral in school-aged children, recovers in 2mo
252
Vision screening begins at
3yo
253
Psych condition with highest comorbidity rate with ADHD
Oppositional defiant disorder
254
Empiric abx of choice for UTI
Cephalexin (Keflex)
255
Antibiotic to be avoided in neonates
Ceftriaxone (knocks off bill from Albumin --> risk of kernicterus; also avoid in pregnant women 48h before delivery)
Tetracycline avoid <8yo (teeth staining)
Nitrofuratnoin (hemolytic anemia)
Septra <2mo (risk of G6PD)
256
Abx choice for PNA PO step-down
Cefprozil
257
Only cephalosporin with pseudomonas activity
Ceftazidime
258
PNA treatment in >3mo (mild)
Amoxicillin
259
PNA treatment in >3mo (moderate)
Amp +/- Clarithromycin +/- Oseltmavir
260
PNA treatment in >3mo (severe)
Cefotax +/- Vanco +/- Clarithro PO +/- Oseltmavir PO
261
GBS treatment
Penicillin G mono therapy
262
Most likely pathogens for cervical lymphadenitis
```
Staph aureus
Strep pyogenes (GAS)
```
263
Most likely pathogens for preseptal cellulitis
Strep pneumo
| Staph aureus
264
Most likely pathogens for orbital cellulitis
Staph aureus
Strep pneumo
Other strep spp
Haemophilus influenza
265
Most likely pathogens for community acquired pneumonia in 1-3 months
```
Strep pneumo
Strep agalactiae (GBS)
Staph aureus
E. coli
Chlamydia trachoma's
```
266
Most likely pathogens for community acquired pneumonia >3mo
```
Viruses
Strep pneumo
Haemophilus influenza
Staph aureus
Strep pyogenes
Mycoplasma pneumonia
Chlamydia pneumonia
```
267
Most likely pathogens for infective endocarditis
Viridans strep
| Staph aureus
268
Most likely pathogens for PID
Neisseria gonorrhoea
CHlamydia trachoma's
Anaerobic organisms
269
PID tx
Cefixime PO Or ceftriaxone IM
+ Doxycycline PO or Azithro PO
+/- Metronidazole PO
270
Most likely pathogens for bacterial gastroenteritis
```
Salmonella
Shigella
Campylobacter
E. coli
Plesiomonas shigelloides
Aeromonas hydrophily
```
271
Tx for bacterial gastroenteritis
Not routinely required
| If severe then tx according to susceptibilities
272
Most likely pathogens for cellulitis
GAS
| Staph aureus
273
Tx for mild cellulitis
Cephelexin PO or Septra PO
274
Tx for severe cellulitis
Cefazolin or Vancouver (if MRSA)
275
Dog/cat/human bites most likely pathogens
```
Staph aureus
Strep spp
Eikenella corrodens (human)
Pasteurella spp (dog/cat)
Capnocytophaga cynodegmi (dog/cat)
Anaerobic organisms
Usually polymicrobial
```
276
Dog/cat/human bites tx for mild and severe cases
Mild: Amox-clav PO
Severe: Pip-Tazo
277
OM or septic arthritis tx
Cefazolin or Vanco
278
Gross motor milestone at 4mo
Rolls prone to supine
Able to lie prone and push up onto elbows
Moro reflex may/maynot be present
279
Gross motor milestone at 6mo
Sits unsupported
| Fencing reflex should disappear
280
Gross motor milestone at 5mo
Rolls supine to prone
281
Gross motor milestone at 8mo
Crawling
282
Gross motor milestone at 9-10mo
Cruising
283
Gross motor milestone at 12mo
Walks
Extensor plantar response seen until 12mo
Drinks from a cup
284
Gross motor milestone at 15mo
Runs
285
Gross motor milestone at 18 mo
Goes up stairs holding adult's hand
| Feeds self
286
Gross motor milestone at 3yo
Rides tricycle
| Goes up and down stairs with alternating feet
287
Gross motor milestone at 4yo
Hops on one foot
| Balances on one foot
288
Gross motor milestone at 5yo
Skips with alternating feet
Rides 2 wheeler
Plays games with rules
balances for 10s on one foot
289
Fine motor milestone at 1 mo
Visual fixation
290
Fine motor milestone at 3mo
Brings hands to midline
291
Fine motor milestone at 6mo
Puts toys in mouth
| Transfers objects hand to hand
292
Ability to follow object visually at age
3mo
293
Fine motor milestone at 8mo
Pincer grasp
294
Fine motor milestone at 6mo
Trying to get things that are out of reach
295
Fine motor milestone at 12mo
Copy gestures such as clapping
296
Fine motor milestone at 18mo
Handing things to others as play
Stacks 3-4 cubes
Emergence of hand preference
Kicks ball, throws ball
297
Fine motor milestone at 2 yrs
Copies a line
| Stacks 6 cubes
298
Fine motor milestone at 3yo
Buttons and zippers
| Copies a circle
299
Fine motor milestone at 4yo
Copies a square, uses scissors, chopsticks, brush teeth
300
Fine motor milestone at 5yo
Copies a triangle, prints first name, starts tying shoelaces, mature tripod grasp of pencil, cuts along line, copies triangle
301
Fine motor milestone at 6yo
Draws man with fingers, 2D arms and legs
| Ties shoelaces
302
Cognitive milestone at 4mo
Out of sight, out of mind
303
Cognitive milestone at 8mo
Aware that if object is out of sight, may still exist and have fallen to ground
304
Cognitive milestone at 12mo
Child will search for completely hidden object
305
Toilet training
Start at 18mo
| Most are toilet-rained by 3yo
306
Independent with ADLs by age
5yo
307
Social milestone at 1mo
Social smile
308
Social milestone at 5mo
Clear preference for primary caretakers
309
Social milestone at 9mo
Stranger anxiety develops
310
Social milestone at 18-20mo
Starts to pretend
311
Galactogogues
Metoclopramide, Domperidone
| = DA antagonists
312
Lactational mastitis
Most common in first 6wks postpartum
Tx: Cold compresses, anti-inflammatories, good breastfeeding techniques
Abx : No MRSA --> Cephalexin, MRSA risk --> Septra or Clinda
313
Tx for low risk febrile neutropenia
```
IV mono therapy:
Ceftriaxone
Pip-Tazo
Cefepime
Carbapenems
```
314
Tx for high risk febrile neutropenia
Pip-Tazo, add gentamicin if unstable
315
Tx for septic shock febrile neutropenia
Vanco + Gentamicin + Meropenem
316
Meds that requires therapeutic drug levels
Gentamicin, Vancomycin
Anticonvulsants
Immunosuppresants (tac, cyclosporine)
317
Drugs to avoid with EBV
Amoxicillin, Ampicillin
| Can cause nonallergic morbilliform rash
318
Oral thrush
Most commonly caused by Candida albicans
Pseudomembranous oropharyngeal candidiasis
Tx: Nystatin suspension
319
All pulses poor
Myocardial problem
320
Palpable paradoxus
Pericardial effusion
321
Bounding pulses
PDA, truncus arteriosus, AI, AVM, sepsis
322
Femorals < brachial
Coarctation
323
Right racial only pulse palpable
Interrupted aortic arch
324
Medication used to keep ductus arterioles open
Prostin 0.05mcg/kg/min
325
Transposition of the great arteries
Most common heart defect presenting with cyanosis in newborn
Aorta comes off RV, Pulmonry artery comes off LV
Requires ASD, VSD, PDA to survive
Needs intervention right away
326
Features of innocent murmur
```
Never a/w thrill
Normal hx
Normal peripheral exam
Never in diastole
normal S2
Usually low-pitched ejection
Changes with position
```
327
Common ECG finding in new born
Right Axis Deviation
328
Trisomy 21 with LAD
AVSD
329
Syndromal look with LAD
Noonan's
330
Normal child with LAD and cyanosis
TGA
331
Tricuspid atresia ECG finding
LAD (no right AV connection --> uses ASD to send blood to left side and VSD to send blood to pulmonary arteries = LV has to pump blood to pulmonary and systemic systems --> LV hypertrophy --> LAD)
332
Familial short stature
Appropriate for mid-parental height
Bone age = chronological age
normal growth velocity
333
Constitutional growth delay
Delay at 18mo-3yrs
After 3yrs grow at normal rate --> catch up
May have delayed puberty
334
Clue to chondrodystrophies causing abnormalities of cartilage or bone dz
Height:arm span ratio (should be within 3cm of each other)
335
GH and IGF1 levels in malnutrition cases
GH levels vary
| IGF1 levels low (esp in protein shortage diets)
336
Tx for boys with constitutional growth delay
Testosterone 1x/month for 3 months --> induces puberty and increases growth rate --> primes pituitary gland to take over once completed
Does NOT affect end adult height
No tx for girls
337
Tx for child with hypothyroid (ie. Hashimoto's Thyroiditis)
Adolescent/older child --> start low and go slow, if you correct too fast can cause hyperthyroid
Neonate --> load first then work down to maintenance (thyroid hormone necessary for brain myelination)
338
Febrile seizure management
Benzo at 5min, 10min
If still seizing, then give phenobarbital at 15min over 20min
If still seizing, call ICU and secure airway
339
Goal SBP
(2 x age in years) + 70
340
Inotrope for warm shock
Norepinephrine
341
Inotrope for cold shock
Epinephrine
342
Parkland formula for burn rehydration
Volume of Ringer's Lactate = 4mL x %BSA x weight (kg) --> half in first 8 h, then half in next 16h
343
IV tx for hypoglycaemia in newborn
10% dextrose in 80mg/kg/d
Adjust pen to keep glucose >2.6mmol/L
IDM/LGA --> stop testing glucose when >/- 2.6mmol/L for 12h
Preterm/SGA --> stop testing when >36h of stable glucose and intake achieved
344
Bucket handle fracture
Metaphyseal fracture/corner fracture
Caused by torsional/shearing force on limb or violent shaking
Pathognomic for abuse
345
Most common form of child maltreatment
Neglect
346
TEN-4
Bruising clinical decision rule
TEN = Torso, Ears, Neck (bruising in TEN region?)
Child <4mo?
If yes to one of these, workup for child abuse unless clear accidental cause of bruise
347
Humerus fracture
Always concerning for abuse, esp in young infant
348
Rib fracture
If abuse, usually in posterior at transverse process articulation (levering from shaking baby)
349
Pittsburg Infant Brain Injury Score
Any skin abnormality --> 2pts
Age >/= 3mo --> 1pt
Head circumference >85th percentile --> 1pt
Hemoglobin <112 -->1pt
350
Cyanotic baby ddx
```
1,2,3,4,5
Truncus arteriosus
TGA
Tricuspid atresia, pulmonary atresia
Tetralogy of ballot
Total anomalous pulmonary venous return
```
351
Poor pulses and LVH
Aortic stenosis
352
Poor femoral and RVH
Coarctation of the aorta
353
Normal ECG with cyanotic babe
TGA
354
Ebstein's anomaly
Tricuspid valve sits low and leaflets displaced towards apex of RV --> RA hypertrophy
355
5 features that make it an epileptic event
```
o Post-ictal
o Not suppressible
o Reproducible
o Stereotyped
o Eyes open
```
356
Tx for idiopathic intracranial HTN
Acetazolamide
Optic nerve sheath fenestration
Therapeutic LP
357
Ability to follow object at age
3mo
358
Orbital cellulitis features not seen in periorbital cellulitis
```
Pain with eye movements
Diplopia
Proptosis
Vision impairment
Chemosis
```
359
Orbital cellulitis treatment
IV ceftriaxone + Vanco
OR Cefotaxime
OR Amp-sulbactam
OR Pip-Tazo
Switch to PO once afebrile and symptoms resolved (3-5d)
PO tx: Clindamycin mono, OR Clindamycin or Septra + amox or amox-clav (continue for 2-3 more wks)
360
Periorbital cellulitis treatment
Oral output abx - clinda mono OR septa +amox or amox-clav
| Tx for 5-7d
361
Serious ddx to rule out for conjunctivitis
Acute angle glaucoma
Iritis
Keratitis
362
Nocturnal enuresis
Episodes of urinary incontinence in children >/= 5yo
363
Phimosis
Inability to retract foreskin
364
Balanopothitis/Balantis
Inflammation of glans penis and foreskin vs Inflammation of glans penis only
365
Phimosis tx
Physiological - no tx needed
Pathological (non retractable secondary to distal scarring) --> stretching exercises (gentle retraction), topical corticosteroids (betamethasone), circumcision
366
Balanopothitis tx
Proper hygiene
Abx ointment (polysporin, bactrian)
Should resolve in 3-5d
367
Vulvovaginitis abx tx if needed
10d amox PO or amox-clav
OR topical metronidazole
OR topical clindamycin
368
Benefits of circumcision
Lower rates of STIs, penile cancer, UTI
369
Major complication in circumcised males
Meatal stenosis (urine from wet diaper irritates meatus --> chemical dermatitis --> scarring)
370
Most common CFTR gene mutation a/w Cystic Fibrosis
Delta F508
371
Physiologic anemia
Mean hemoglobin in healthy 2mo = 112g/L
Marrow only stimulated to make new RBCs once 110g/L at 7-9wks of age
Fetal RBCs have short half life --> physiological nadir
372
GERD
Peak onset at 1-4mo
| Usually resolves by 1yo (more upright)
373
Test to rule out malrotation
Barium swallow
374
Major gene a/w celiac disease
HLA-DQ2
375
Major complication of untreated celiac disease
Osteoporosis secondary to poor calcium and vitamin D absorption
376
Intussusception classic triad
Inconsolable pain
Red currant jelly stool
Sausage on palpation
377
Intussusception treatment
Barium or air enema
| Surgery if failed
378
Antibiotic associated with diarrhea
Erythromycin (promotability)
379
Osmotic diarrhea
High stool osmolality compared to serum
Problem with absorption
Responds to NPO
380
Secretory diarrhea
Stool osmolality equal to serum
Problem with secretion
Does not respond to NPO
Think Cholera
381
Crohn's disease
Regional enteritis - SI, LI, or both
Less likely to cause bloody stool
More likely to cause FTT
Dx: Upper and lower GI endoscopy with biopsy
Tx: Corticosteroids for acute, immunomodulators for maintenance (thiopurines, MTX, anti-TNF), surgery
382
Ulcerative colitis
```
Colon only
Diarrhea usually bloody
FTT less common
Dx: MRI of SI, fecal calprotectin
Tx: Corticosteroids for acute, immunomodulators for maintenance (thiopurines, MTX, anti-TNF), surgery
```
383
Ulcerative colitis antibody marker
ANCA
384
Crohn's disease antibody marker
ASCA
385
Stool assay for IBD protein marker
Fecal calprotectin
386
Derm condition a/w IBD
Erythema nodosum
387
Most common cause of anemia in childhood
Fe-deficiency anemia
| Low Fe, low retics, high iron binding capacity
388
HTN, oliguria, AKI, edema indicates
Acute Nephritic syndrome
389
HTN med choice for child with HTN and edema secondary to acute nephritic syndrome
Diuretic (ie. high dose lasix 1mg/kg TID and titrate up)
390
Nephritic vs nephrotic a/w HTN
Nephritic
391
Hematuria definition
>/= 5 RBCs/hpf on urine microscopy
392
Non-glomerular causes of hematuria
Hypercalciuria, stones, sickle cell, cystic disease
393
Glomerular causes of hematuria
Post-infectious glomerulonephritis, IgA nephropathy, HSP, HUS, SLE, Familial thin basement membrane dz, Alports
394
Nephrotic syndrome definition
Proteinuria (>50mg/kg/d)
Hypoalbuminemia (<25g/L)
Hyperlipidemia
Edema
395
Proteinuria definition
>100mg/m2/d or >22g protein/mol creatinine
396
Treatment for nephrotic syndrome
Most likely minimal change disease which responds to steroids
Oral prednisone 2mg/kg to max 60-80mg for 6 wks, then alternate day dosing a 1mg/kg --> wean off over 6mo
na+ restrict
If edema, treat with IV lasix and 25% albumin
397
Seborrheic dermatitis
AKA cradle cap
Older patients caused by Malassezia fungus
Tx:
Baby oil and small brush
Frequent shampooing with baby shampoo, if resistant get rx shampoo with ketoconazole or pyrithione zinc
Low potency topical steroid (hydro)
Ketoconazole cream in older children
398
Parvo B19 rash
```
Stage 1 (2-3d after prodrome): Fiery red facial eruption
Stage 2 (1-4d after facial rash): Lacy reticulated eruption on extremities and trunk
Stage 3: intermittent waxing and waning of reticular rash
Not infectious anymore once rash develops
```
399
Complication of Parvovirus B19
In pregnant women can cause fetal hydrous
400
Test solution for nickel
Dimethylglyoxime in 10% aqueous solution of ammonia
401
Sturge-Webber Syndrome
Port-wine stain on face
| Neuro symptoms - seizures, glaucoma
402
Newborn milia
Resolves within 3-4 wks
| No tx needed
403
Tuberosclerosis
```
Hypopigmented macule (ash-leaf) spots
Angiofibromas often in malaria region
Cardiac rhabdomyoma
Renal angiomyolipomas --> HTN, CKD
Seizures
```
404
Pityriasis alba
Asymptomatic hypo pigmented scaly patches
Commonly in atopic dermatitis patients
Esp noticeable after summer b/c don't tan as well
Supportive tx
405
Ataxia telangiectasia
Truncal ataxia --> axial ataxia in infancy
Conjunctival telangiectasias
Immunodeficiencies
Predisposition to malignancy
406
Phenylketonuria (PKU)
Auto recessive disorder of AA metabolism caused by deficiency in phenylalanine hydroxylase
Detected by newborn screen
Vomiting, hypotonia, musty odor, developmental delay, decreased pigmentation of hair/eyes
Tx: Phenylalanine-restricted diet
407
Sleep through the night by age
4-6mo
408
5-2-1-0 Rule
5 servings of fruits/veggies per day
= 2h screen time/d (no screen time <2yo)
>/= 1h of physical activity per day
0 sugar sweetened drinks per day
409
ADHD subtypes
Inattention
Hyperactive/Impulsive
Combined
410
ADHD Screening Test
Vanderbilt Assessment Scale
411
von Willebrand disease treatment
Intranasal or IV desmopressin
412
Female puberty stages by age
```
Puberty during 8-13yo
10-11: breast buds, pubic hair
12: growth spurt
12-13: periods begin
15: adult height
```
413
Male puberty staged by age
```
Puberty during 10-15yo
12: testicles grow, pubic hair
13-14: Growth of penis/scrotum, first ejaculations
14: Growth spurt
17: Adult height
```
414
Sleep stage GHRH is released during
Stage 4
415
Thyroid hormones role in growth
Direct effect on growth of epiphyseal cartilage
Needed to release GH from pituitary
Needed for post-natal growth only
416
Sex steroids role in growth
Augments GH pulsatility
| Does NOT play a role prior to puberty
417
Growth inhibitory peptides
Cytokines (ie. TNF) regulate programmed cell death
418
Cortisol affect on growth
High levels act on epiphyses to inhibit growth
| Affect levels of GH, IGF-1, IGFBP3
419
In utero growth most dependent on
Nutrition
Insulin
IGF-2
420
Height deficiency but okay weight gain, think of...
Endocrinopathy
421
Graves' disease
Anti TSHr
422
Hashimoto's disease
Anti-TPO (Thyroperoxidase)
423
Thyroiditis
Anti-Thyroglobulin (Anti Tg)/Anti-TPO
424
Cortisol testing
If suspecting Cushing's: Dexa suppresion
| If suspecting deficiency: AM cortisol
425
Hypopituitarism tx order
CORTISOL FIRST > Thyroid > GH
426
Diabetes insipidus test
Water deprivation
| Deprive water for 8h --> >3% weight loss, serum osmolality increase and UO < 600mosm/kg = DI
427
Nephrogenic vs central diabetes insipidus
ddAVP (synthetic ADH) --> if urine osm does NOT increase by much = nephrotic, if urine osm increases to >700mosm/kg = central DI
428
False results from heel stick blood test
Hb higher and platelets lower
429
Fe-def treatment
3-6mg/kg elemental iron daily for 3 months
430
Fe-def anemia lab work restyle
```
Low Fe
Low ferritin
Hb <110
Low MCV
High TIBC
High RDW
Low relic count
High transferrin
```
431
RDW to distinguish thalassemia from Fe-def
```
Thalassemia = small RDW
Fe-deficiaency = High RDW
```
432
Diagnosing Fe-deficiency
6-24mo: Fe supplement trial
| Older children: Bloodwork
433
Blast smear
Leukemia
434
Microcytic hypo chromic smear
Fe-deficiency
435
Spherocytes on smear
HS or AIHA
436
Schistocytes on smear
HUS, TTP, MAHA
437
Blister cells on smear
G6PD
438
Transient erythroblastopenia of childhood
Post-viral in school-aged children
Otherwise healthy
Recover in 2mo
439
Diamond blackfan
Bone marrow disorder where it fails to make enough RBCs
440
Bloodwork supporting hemolysis
```
Normocytic anemia
High LDH
High indirect bili
Plasma free Hb
Reduced haptoglobin
```
441
Hereditary spherocytosis
Inherited erythrocyte membrane defect that causes lifespan to be 10-30d instead of 120d
Anemia, jaundice, splenomegaly
Dx: Peripheral blood smear --> spherocytosis
Tx: Supportive, folic acid, possible splenectomy
442
HUS
Bloody diarrhea, thrombocytopenia, and microangiopathic hemolytic anemia, AKI
Shiga toxin, Strep pneumo
Tx: Support care
443
MAHA
TTP - Thrombotic thrombocytopenia purpura (severely reduced activity of vWF cleaving protease ADAMTS13)
DIC - Activation of coag system from sepsis, trauma, malignancy
Tx - PLEX if feeling unwell, severe anemia, thrombocytopenia, fragmented RBCs, renal failure; anti-complement, transfusion of RBCs/plts
444
Hemophilia A
Factor VIII deficiency
445
Hemophilia B
Factory IX deficiency
446
Hemophilia C
Factor XI deficiency
447
Anticonvulsants during pregnancy can lead to
```
Cardiac defects
Dysmorphic cranial features
Hypoplastic nails
IUGR
Microcephaly
Mental retardation
```
448
Chorioretinitis of the newborn may be due to
Congenital toxoplasmosis and CMV infections
449
Cocaine use during pregnancy
Not typically a/w withdrawal symptoms
| Linked to subtle deficits later in childhood - cognitive performance, attention
450
Fetal alcohol syndrome characteristic facial features
Thin upper lip
Smooth philtrum
Small palpebral fissures
451
Congenital rubella presentation
Sensorineural deafness
Eye abnormalities
PDA
452
Congenital CMV presentation
Microcephaly
Jaundice
Low birth weight
Petechiae
453
PKU
Auto recessive
Mutation in phenylalanine hydroxyls
Vomiting, hypotonia, musty odor, developmental delay, decrease pigmentation of hair and eyes
454
General ADHD dx requirements
6 or more symptoms in 2 or more settings for at least 6 months, several symptoms presenting before age 12
455
Overweight vs obesity definitions
```
Overweight = BMI 85-95th percentile
Obese = BMI >95th percentile
```
456
Treatment for vWF disease
Desmopressin
457
Female puberty stages
Breast bud > pubic hair > growth spurt > menarche
458
Male puberty stages
Testicular enlargement > pubic hair appearance > growth of penis and scrotum > first ejaculations > growth spurt
459
Congenital hypothyroidism
Clinically evident at 6wks
Circulating maternal thyroid hormone transmitted from placenta
Feeding problems, large fontanels, hypotonia, large tongue, coarse cry, umbilical hernia
Picked up on neonatal screening
Most often due to aplasia or hypoplasia of thyroid gland
460
Congenital adrenal hyperplasia
```
Abnormal genitalia (females)
Poor feeding
Vomiting
Dehydration
Electrolyte changes
Low Na, High K, low cortisol, low aldosterone
Elevated 17-OH progesterone
Presents at 1-2wks
```
461
Ornithine transcarbamylase (OTC) deficiency
Most common urea cycle d/o
Hyperammonemia
Elevated urine orotic acid
X-linked
462
Factors that decrease insensible losses
CHF
Renal failure
ADH release
Mechanical ventilation
463
NPO orders for children
* No solids after midnight
* May have formula until 2AM
* May have breastmilk until 4AM
* May have clear fluids until 6AM, complete NPO after
* Start IV fluids at 6AM
464
NPO orders for neonates
* Higher fluid requirements
* Term: 60cc/kg/d
* Pre-term: 80cc/kg/d
* Increase 20cc/kg/d until day 7 (150ml/kg/d)
* Ex. For 3kg newborn
* Day 1 - 180cc/24h = 7.5cc/h
* Day 4 - 60 —> 80 —> 100 —> 120: 120cc/kg/d x 3d = 360ml/24h = 15cc/h
465
Reasons to NOT add K+ to IV fluids
Hyperkalemic
Not voiding
Starting to tolerate PO
IV rate TKVO
466
Symptomatic hyponatremia treatment
3% NS at 2cc/kg bolus
467
ECG findings for hyperkalemia
* Peaked T-waves
* Short QT int
* Depressed ST segment
* Wide QRS
468
Hyperkalemia treatment
* Fluids
* Calcium gluconate to protect cardiac membranes
* Ventolin neb
* Beta-agonist role… not really sure how this works
* Always check K+ if pt is on ventolin!
* Insulin
* Bicarb
* Kayexalate
469
Encapsulated organisms
Strep pneumo
H. influenzae type B
N. meningitides
470
Pneumococcal vaccine
13-valent pneumococcal conjugate vaccine given in first year of life provides protection against 13 serotypes (all children)
23-valent pneumococcal polysaccharide vaccine given to sickle cell children at 2 and 5yo
471
Vaccines required in sickle cell children
H. influenza type b conjugate vaccine at 2, 4, 6 and mo
13-valent pneumo at 2, 4, and 6mo
23 valent pneumo at 2 and 5yo
Meningococcal vaccine at 2yo if functionally/anatomically splenic
Yearly flu shot
472
Esophagus begins at which spinal level
C4
473
Lateral neck X-ray rule
Pre-vertebral soft tissue should never be more than the AP diameter of the vertebrae behind them
474
Possible complications of retropharyngeal abscess
Mediastinitis
| Jugular vein thrombosis
475
Most common congenital anomaly of nasal cavity
Bilateral choanal atresia
| Most are BONY and BILATERAL
476
How to diagnose choanal atresia
CT
477
Most common lesion in young child at subglottic region of trachea
Hemangioma
478
Bronchial wall thickening with hyperinflation
<2yo: Bronchiolitis
| >2yo: Reactive airway disease
