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Pediatrics Flashcards

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1
Q

Type I HSR

A

IgE mediated

anaphylaxis

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2
Q

type II HSR

A

cytotoxic, antibody mediated

HA

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3
Q

type III HSR

A

serum sickness

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4
Q

type IV HSR

A

delayed T cell mediated rxn

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5
Q

conjunctivitis timeline of newborn

A

immediate - chemical
2-7 days - gonoccal
7-14 days chlamydia

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6
Q

tx of gonoccocal conjuctovitis

A

ceftriaxone

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7
Q

tx of chlamydia conjuctivitis

A

oral erythromycin

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8
Q

Necrotizing fascitis

A

symptoms that are out of proportion compared to the PE

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9
Q

PKU

A

AR
deficiency in phenylalinine hydroxylase
mental retardation

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10
Q

CF

A 
AR 
thick mucous 
nasal polyps 
pseudomonas 
recurrent URIs
pancreatic insufficiency
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11
Q

MC skull fractures

A

linear - depression can cause further cortical damage

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12
Q

caput succedaneum

A

crosses the midline

swelling of the soft tissues of the scalp

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13
Q

cephalohematoma

A

subperiosteal hemorrhage

does NOT CROSS the suture lines

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14
Q

causes of polyhydramnios

A

werdig hoffman syndrome - cant swallow

intestinal atresias (dbl bubble)

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15
Q

diaphragmatic hernia

A

bowel sounds in the chest
air fluid lvels are seen on CXR
concave abd
barrel shaped chest

associated with polyhydramnios

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16
Q

ophalocele

A

link to edwards trisomy 18
intestines with sac covering
increased AFP on screening

due to the failure of the GI sac to retreat at 10-12 wks gestation

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17
Q

umbilical hernia

A

associated with congenital hypothyroidism
weakness of rectus abdominus
allows protrusion of vessels and bowel

most spontaneously resolve

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18
Q

gastroschisis

A

intestines outside abdomen without sac
usually lateral to midline

tx- sx intervention - aggressive reintroduction of bowels –> infarction of bowel

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19
Q

causes of elevated AFP

A

neural tube defects
abdominal wall defects

MCC - incorrect dating

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20
Q

nephroblastoma

wilms tumor

A

large palpable abdominal mass
aniridia - absence of iris
hemihypertrophy of 1 kidney due to increased vascular demand

tx chemo

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21
Q

WAGR syndrome

A

chromsome 1 deletion

wilms tumor
aniridia
genitourinary malformations
retardation

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22
Q

neuroblastoma

A

MC of cancer in infancy
extracranial solid malignancy
blue spots in eyes

cross midline
CT calcification

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23
Q

dx of neuroblastoma

A

increased VMA
increased Metanephrines
(similar to pheochromocytoma)

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24
Q

hydrocele

A

painless swollen fluid filled sac
transluminates
remnant of tunica vaginalis

self resolving typically

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25
varicocele
bag of worms swelling of pampiniform plexus heaviness in scrotum
26
cryptochordism
absence of 1 testicle usually found in inguinal canal | must be removed to prevent cancer risk (after 1yr)
27
hypospadies
urethra found on ventral surface of penis (bottom) associated with inguinal hernias and cryptochordism Circumcision = C/I
28
epispadies
opening of urethra dorsal (top) | associated with urinary incontinence and bladder exstrophy
29
TOF
``` chromosome 22 deletion pulmonary stenosis rvh overriding aorta vsd ```
30
tet spells
TOF - kids squat to increase preload - increases svr - decreases R>L shunting - increases pulmonary blood flow - which increases blood O2 saturation.
31
types of holosystolic murmurs
mitral regurgitation vsd tricuspid regurgitatioin pda
32
transposition of great vessels
maternal DM kids MC cyanotic lesion during neonatal period aorta and pulmonary artery switched requires PDA to stay alive - prostaglandin E1 to keep it open
33
CXR of transposition of great vessels and auscultation
egg on a string | s2 heard
34
causes of otitis media
viral - adenovirus | bacterial - strep pneumonia, h influenza , m catarrhalis
35
child received 5% dextrose in water for a prolonged period of time and has seizure, whats the cause
hyperosmotic hyponatremia
36
point tenderness of a joint increased uptake by bone scan increased ESR dx = ?
osteomyeletis
37
lens shaped cranial hemorrhage
epidural hematoma
38
BUN to creatine ratio greater then 15:1
acute renal failure
39
pt with abdominal cramps relieved by BMs and arthritis
Ulcerative Colitis - manifests with GI and arthritic symptoms
40
reducing substance in urine jaundice poor weight gain neonatal period dx = ?
galactosemia
41
anemia target cells MCV <70 asian dx = ?
thalessemia decreased synthesis of globulin chains
42
DKA TX
IVF first then insulin
43
antibodies to proteus vulgaris = what test
weil felix test which is for ricketssia
44
borrelia = what type of organism
spirochete
45
``` atelectasis hyperinflation recurrent resp problems infancy hyperexpanded chest clubbing ``` dx = ?
cystic fibrosis
46
digital clubbing differential
cystic fibrosis malignancy R>L Shunt
47
brown urine after a cold 1-2 days after
IgA nephropathy
48
features of cor pulmonale
``` peripheral edema raised jvp loud S2 right sided heave pulsatile liver hepatomegaly ```
49
absence of cremasteric reflex | unilateral testicular pain
testicular torsion
50
young boy recurrent bacterial infections from encapsulated organisms (otitis media, sinusitis, pneumonias) small lymphoid tissue
brutons | XLA
51
felt syndrome
rheumatoid arthritis splenomegaly neutropenia anemia of chronic disease
52
diarrhea causes what metabolic disorder
metabolic acidosis - losing bicarb
53
gait ataxia bilateral papilledemea abducens palsy in a kid dx = ?
medullobastoma majority occur in the cerebellar vermis - truncal ataxia block 4th ventricle - > hydrocephalus
54
oropharyngeal candidiasis tx
nystatin invasive fungal tx intestinal candidiasis tx
55
topical mupirocin treats
impetigo
56
MCC of hypothyrodisim in infants
thyroid dysgenesis - appear normal at birth but gradually develop apthy, weakness hypotonia and large tongue
57
mechanisms behind hashimotos
lymphocytic thyroiditis
58
large dense consolidation and fixed effusion on cxr - what bug
description = abscess caused by old pna now staph causing abscess plus new pna
59
tricuspid atresia
``` left ventricular hypoplasia LAD mitral valve atresia absent pulses with a single s2 increased RV impulse gray cyanosis ```
60
truncus arteriousus
``` 1st few days of life severe dyspnea early and frequent infections single S2 heard systolic ejection murmur bounding peripheral pulses ```
61
CXR of truncus arteriosus
cardiomegaly with increased pulmonary markings
62
VSD
dyspnea with resp distress loud pulmonic S2 high pitched holosystolic murmur over the L sternal border apical diastolic rumble - increased flow across mitral valve
63
CXR of VSD
increased vascular markings
64
complications of VSD
pulmonary HTN | CHF
65
ASD
Fixed wide splitting of S2 | systolic ejection murmur at Left upper sternal border
66
complications of ASD
dysrhythmias | perodoxical emboli from DVT
67
PDA
machine like murmur wide pulse pressure bounding bulses
68
complications of PDA
recurrent resp infections and infective endocardatitis (MC complication)
69
EKG presentation of a PDA
LVH secondary to increased systemic resistance
70
presentation of coarctation of the aorta
severe CHF and resp distress within first few months of life | LE and UE pulses vary
71
presentation of prolonged QT syndrome
hearing loss syncope normal vital signs normal PE
72
Tx of prolonged QT syndrome
metoprolol
73
Rheumatic heart disease
complication of rheumatic fever | mitral stenosis - MC
74
major criteria for rheumatic fever
``` migratory polyarthritis carditis erythema marginatum subcutaneous nodule chorea ```
75
minor criteria for rheumatic fever
``` fever antecedent strep infection arthralgias elevated ESR prolonged PR Interval heat block on EKG ```
76
criteria needed to dx rheumatic fever
2 major or 1 major and 2 minor
77
when is hyperbilirubinemia pathologic
day 1 of life increase of 5mg/day above 19.5 in term child direct bili above 2mg at ANY time
78
complications of hyperbilirubinemia
``` kernicterus - hypotonia seizures hearing loss choreoarthritis ```
79
choanal atresia
blue when feeding pink when crying resp distress caused by the: buccopharyngeal membrane - between the nostrils and pharyngeal space
80
esophageal atresia
esophagus ends in blind pouch recurrent ASPIRATION PNA early on vomiting with 1st feed choking/coughing cyanosis
81
dx of esophageal atresia
coiling of the NG tube gastric air bubble esophageal air bubble
82
pyloric stenosis
1-6 month old BOY typically NONbilious PROJECTILE vomit hypochloremic hypokalemic metabolic ALKALOSIS
83
dx of pyloric stenosis
olive sign - palpable mass epigastric | abd US - string sign (barium leaking thru)
84
tx of pyloric stenosis
1) IVF and electrolytes 2) NGT decompress the bowel 3) Sx
85
best initial step for choanal atresia
pass the NGT tube then secure airway
86
CHARGE accroynm
``` coloboma of eye, CNS heart defects atresia of choanae retardation genital and lower urinary tract issues ear anomalies ```
87
duodenal atresia
down syndrome double bubble on CXR no resp distress BILIOUS VOMITING
88
best first step for duodenal atresia
IVF
89
hirschsprung disease basics
congenital lack of innervation of distal bowl by the auerbach plexus constant contracture of muscle tone
90
hirschsprung disease presentation
DOES NOT pass meconium within 48 hrs large bowel obstruction tight rectal sphincter + squirt sign if older child - hx of constipation and poor weight gain
91
dx of hirschsprung dz
X-Ray - distended bowel loops with lack of air in the rectum biopsy with lack of ganglion cells
92
VACTERL
``` Vertebral anomalies Anal atresia Cardiovascular abnormalies TEF Esophageal atresia Renal anomalies Limb anomalies ```
93
volvulus
bowel obstruction leading to loop of bowel twisted on itself vomiting + colicky abd pain complications sepsis/necrosis
94
dx of volvulus
Upper GI series - multiple air fluid levels
95
intussusception definition and causes
telescoping of bowel into another causes: polyps, hard stool, lymphoma, virus, rotavirus vaccine, HENOCH SCHLOEN PURPURA
96
odd complication of henoch schloen purpura
intussusception
97
presentation of intussusception
colicky abd pain INTERMITTENT bilious vomiting RQ sausage shaped mass currant jelly stools
98
dx of intussusception
US - dough sign or target sign (concentric alternating mucosa and submucosa bands) Barium Enema or air Enema are both dx and tx
99
tx steps for intussusception
1) IVF 2) NGT decompress bowel 3) Barium or air Enema 4) Sx if needed
100
meckel diverticulum
only true diverticulum vitelline duct persists in small intestine tract
101
presentation of meckel diverticulum
painless rectal bleeding 2y/o M typically (rule of 2's) - bleeding is from gastric acid secretion from ectopic tissue
102
dx of meckel diverticulum
techenium 99 scan
103
Rotavirus diarrhea
``` MC winter months Fever, emesis, NO BLOOD < 7 days viral prodrome ```
104
adenovirus diarrhea
``` year round fever emesis NO BLOOD <7 days viral prodrome ```
105
norwalk virus diarrhea
epidemic EXPLOSIVE diarrhea cramping pain short lived = 1-2 days
106
timeline of Fever and Rash in measles and rubella
Measles = fever + rash Rubella = fever ---> --> Rash
107
Necrotizing enterocolitis
premie infants who have blood in stool low birth weight vomiting and abd distension bacteria invade intestinal wall
108
dx of NEC
ABD x-ray - pneumatosis intestinalis or AIR in the bowel air in the portal vein on CT
109
tx of NEC
1) Feedings stopped - REST BOWELS 2) IV fluids 3) NGT for bowel decompression 4) sx if needed
110
antidote to methhemoglobin
methylene blue - acts as an electron acceptor for NADPH and is reduced to a substance that then in turn --> reduces methemoglobin back to hemoglobin
111
``` new born with large posterior fontanelle large tongue hypotonia nml agpar scores nml pregnancy and delivery ``` cause = ?
thyroid dysfunction
112
tx of afib in a newborn
ice pack to chest then adenosine
113
``` fresh newborn hours old with cyanosis of arms and legs feeding well no distress cap refill time delayed low body temp bradycardia ``` ``` dx = ? tx = ? ```
neonatal hypothermia place under warming lights
114
scaly puritic rash on flexor surfaces in a kid occurs during episodes of resp distress and wheezing ``` dx = ? tx = ? ```
atopic dermatitis (eczema) tx: emolients (petrolatum or aquaphor) topical steroids triamcinolone betamethasone valerate
115
what type of shunting do you see in a PDA
left --> right shunt allows blood from systemic circulation to the pulmonary circulation pulmonary blood flow is excessive prominent apical impulse
116
at what age do you start worrying about puberty in female and male
15 years old
117
serous otitis media
middle ear effusion without the evidence of acute infection dull (blueish grey) TM that is hypo mobile
118
MOA of post strep glomerulonephritis
type III HSR | antigen antibody immune commplexes
119
Timeline if IgA nephropathy h
1-2 days after URI
120
Volvulus dx
corkscrew appearance on KUB
121
C diff presentation
s/p abx use and occasionally can be bloody (rare) fever abd pain
122
BUN: Cr greater than 20:1
prerenal injury | - decreased renal perfusion
123
direct hyperbilirubinemia
>20% of total bili decreased excretion of bilirubin
124
indirect hyperbilirubinemia
decreased conjugation of bilirubin hepatic enzyme deficiency increased production of bilirubin
125
pale stools are caused by
obstructive jaundice | increased direct bilirubin
126
``` 4 month old with increased BP right > left pronounced S2 precordial heave hepatomegaly RVH RAD wheezing occasionally heard ``` dx = ?
bronchopulmonary dysplasia leads to pulmonary HTN - hepatomegaly - edema RVH
127
dx of PSGN
elevated ASO abs decreased C3 concentration in plasma pedal edema
128
Sequela of PSGN
nothing full recovery without any complications
129
VSD on PE
4/6 holosytolic murmur with thrill heard along the left sternal boarder P2 is accentuated 2/6 mid diastolic murmur is heard at the apex
130
tx of chemical ingestion
stabilize airway fiberoptic endoscopy (see damage)
131
17 alpha hydroxylase def
increased aldosterone and cortisol decreased K+ decreased sex hormones HTN nml girls boys - pseudohermaphrodism
132
21 hydroxylase def
decreased cortisol and aldosterone increased K+ increased sex hormones girls - virilized boys - nml
133
legg calve perthes dz
avascular necrosis of the femoral head painless limp 2-8 y/o nml weight
134
dx and tx of legg calve perthes
dx - x-ray joint effusion and widening tx - NSAIDS and rest
135
slipped capital femoral epiphysis and risk
adolecents 10-15 OBESE painful limp externally rotated
136
tx of slipped capital femoral
internal fixation with pinning
137
2 sources of milk that are low on Vit D
goats milk and breast milk
138
lead poisoning
vomiting, abd pain fatigue loss of appetitie decreased sleep
139
path behind Osgood Schlatter
repeated knee extensions leading to microalvusions of the tibial tubercle
140
ewing sarcoma
onion skinning - lytic lesions causing laminar peristeal elevation midshaft systemic symptoms local pain and swelling
141
osteosarcoma
sunburst pattern - sclerotic destruction metaphysis of long bones increased alk phos local pain and swelling
142
osteoid osteoma
round central lucency with a sclerotic margin adolescent boy proximal femur site - worst at night unrelated to activity NSAIDS will spontaneously resolve
143
tx for neonatal sepsis order
IVF cultures ampicillin and gentamicin
144
causes of early neonatal sepsis
e coli | listeria
145
causes of late neonatal sepsis
e coli | GBS
146
presentation of toxoplasmosis
chorioretinitis hydrocephalus multiple ring enhancing lesions
147
dx and tx of toxoplasmosis
dx - (initial) increased IgM to toxo , PCR (most accurate) tx - pyrimethamine and sulfadiazine
148
syphilis presentation of a neonate
desquamation of the palms and soles frontal bossing sniffles
149
rubella presentation
fever --> --> rash sensoneuronal deafness PDA cataracts hepatomegaly blueberry muffin rash hyperbilirubunemia thrombocytopenia
150
CMV presentation
periventricular calcifications with microcephaly chorioretinitis petechiae
151
varicella presentation
vesicles on an erythematous base START on face possible fever and malaise
152
rubeola (measles) presentation
4'Cs - cough, conjuctivities, coryza (stuffy/running nose), C(k)oplik spots (buccal surface) cephalocaudal spread
153
5th dz or erythema infectiosum presentation
parvob19 fever and URI --> --> slapped cheek rash
154
complication of 5th disease
aplastic anemia
155
Herpes 6 roseola presentation
HIGH fever --> goes away --> diffuse lacy rash
156
mumps presentation
fever that precedes parotid gland swelling
157
complications of mumps
orchitis | aseptic meningitis
158
scarlet fever presentation 3-6 days
``` fever pharyngitis SANDPAPER rash strawberry tongue cervical lympadenopathy ```
159
kawasakis disease presentation
``` FEVER >5 days mucositis conjuctivitis rash edema of hands and feet cervical lympadenopathy ```
160
complication of kawasakis dz and tx
complication - coronary artery aneursym tx - IV Ig and aspirin
161
malignant otitis externa
exquisite otalgia and otorrhea
162
retropharyngeal abscess
decreased ROM of neck and jaw muffled voice younger kid 4years old fever dysphagia lateral neck soft tissue x-ray - widened prevertebral space
163
croup presentation parainfleunza virus
``` barking cough inspiratory stridor difficulty breathing while lying flat signs of hypoxia hoarse voice ```
164
tx of croup
mild .- steroids | mod-severe = racemic epinephrine
165
epiglottis
due to H influenza type B (unvaccinated kid) fever QUICK ONSET muffled voice/ drooling TRIPOD position/refusal to lie flat - hyperextended neck
166
whooping cough - bordetella pertussis
catarrhal stage - severe congestion and rhinorrhea (14 days) paroxysmal stage - severe coughing episodes with vomiting, gasp for air, inspiratory wheeze (14-30 days) convalescent stage - decrease freq of coughing (14 days)
167
tx of pertussusis for pt and close contacts
macrolide for close contacts erythromycin or azithrymycin during catarrhal stage or with kids IV Ig
168
pharyngitis presentation
cervical adenopathy petechiae fever >104
169
Diptheria
membranous inflammation of the pharynx gray highly vascular pseudomembranous plaques on a pharyngeal wall DO NOT SCRAPE
170
tx of diptheria
antitoxin
171
riboflavin vit b2 def
``` anuglar cheilosis stomatitis glossitis normocytic anemia seborrhic dermatitis ```
172
vit b6 pyridoxine def
peripheral neuropathy
173
vit D toxicity
increased Ca2+ polyuria polydipsia
174
von gierkes dz
glucose 6 phosphatase deficiency liver hepatomegaly ketotic hypoglycemia ketones increased TGLs and Uric Acid Doll Face adn thin extremeties
175
tay sachs
``` hexosaminidase A def increased gangliosides cherry red macula mental retardation seizures ``` lysosome onion whorled membrane
176
gaucher dz
beta glucoererbrosidase def hepatosplenomegaly aseptic necrosis of femur head
177
fabry dz
alpha galactosidase A def x-linked peripheral neuropathy
178
nieman pick dz
cherry red macula neurodegeneration hepatosplenomegaly increased sphingomyelin
179
metachromatic leukodystrophy
arysulfatase A def | dymelination with ataxia and dementia
180
patient with subcutaneous emphysema secondary to severe coughing paraxysms what is the first test done
CXR in order to rule out pneumothorax
181
what can cause methemoglobuniemia
exposure to oxidizing substances dapsone nitrites (meats) local/topical anesthetic
182
presentations of methemoglobunemia
cyanosis pulse Ox 85% dark chocolate blood saturation gap between pulse ox and PaO2 >5% on ABG decrease O2 delivery to peripheral tissues - supp O2 does not help
183
blue green discoloration of blood and mucocutaneous surfaces cause = ?
sulfhemoglobinemia - exposure to sulfur meds such as: sumatriptan sulfasalazine
184
antidotes for lead poisoning
dimercaprol | EDTA
185
tx of ethylene glycol or methanol ingestion
fomepizole - inhibits alcohol dehydrogenase - preventing the metabolism of these alcohols to their toxic metabolites
186
antidote for beta blockers
glucagon - activates adenylate cyclase -> increased Ca2+ --> improves cardiac contractility
187
antidote for acetominephen toxicity
N-acetylcysteine
188
cause of Howell Jolly bodies
asplenic pts nuclear remnants within the RBCs that are typically removed via the spleen
189
chylothorax
milky white fluid | increased TGLs
190
galactose 1 phosphate uridyl transferase def
``` failure to thrive bilateral cataracts jaundice hypoglycemia vomiting hepatomegaly mental retardation ``` increased risk for neonatal sepsis via E coli
191
galactokinase def
cataracts only
192
complication of hereditary spherocytosis
cholelithiasis
193
initial test for asthma
spirometry if not available methemacholine test
194
other symptoms associated with juvenile idiopathic arthritis
anterior uveitis so perform a slit lamp examination dx of JIA - elevated ESR,ANA ab, pain in AM
195
testicular torsion PE
absence of cremasteric reflex epididymitis will have a nml cremasteric reflex
196
precocious puberty ages
Males <9 Females <8
197
croup edema location
subglottic edema which improves with the vasoconstriction effects of cold air
198
lethargy complexion darkening height weight nml decreased BP dx test ?
plasma cortison - since this is a decreased of ACTH
199
young boy with GBS infection HIB infection leukocytosis and low lymphoctes dx = ?
agammaglobulinemia - infec form encapsulated bugs that normal ppl are immune too tx - abx and IV Ig
200
fat kid bowing legs dx = ?
tibia vara
201
neurofibromatosis type 1
cafe au lait spots seizures skin tags (lisch nodules) clustered freckles nerve sheath tumors optic gliomas
202
prophylactic tx of TB
Isoniazid
203
sudden onset of constipation, bilious vomiting, squirt sign neg and blood in stool in 1 month
shows its below the level of duodenum this dx = volvulus until proven otherwise
204
neuroblastoma presentation
``` young kid racoon eyes (blue underneath eyes) ``` HTN fatigue posterior mass weight loss mets to the bone
205
sinusitis presentation
long term fever, ha, yellow green nasal discharge posterior pharyngeal wall is erythematous and covered with gray mucus
206
aspirin ABG findings
mixed metabolic acidosis and respiratory alkalosis
207
hyperglycemia causes osmotic shifts of water from intracellular to the extracellular space leading to
dilutional hyponatremia
208
low BMI and no periods put you at risk for what?
osteoperosis
209
biliary cyst
extrahepatic mass --> dilation of the bile duct scerlal icterus palpable abd mass abd pain dark urine
210
conjugated bili = | unconjugated bili =
conj = direct unconj = indirect
211
breast feeding jaundice
``` 1st week of life SUB OPTIMAL FEEDING decreased bili elimination increased enteroheptic circulation signs of dehydration ``` tx = increase feedings
212
Heavy irregular mentsrual bleeding in a young teenager cause = ?
immature hypothalamic pituitary axis - causing anovulation tx = high dose OCPs - stabilize endometrium
213
complication of repeated otits media
conductive hearing loss
214
tx of strabismus
cover up the good eye to strengthen the bad eye
215
presentation of neonatal herpes
temporal lobe hemorrhage/ edeme mucucutaneous vesicles keratoconjuctivitis seizures fever, lethargy
216
guillane barre syndorme
follows URI ascending paralysis - concerned about resp compromise so perform spirometry to check
217
chronic sickle cell hemolysis can lead to what def
folate deficiency | papillry necrosis
218
pathological murmur
diaphoretic fatigue with feeding or exercise poor growth , dizzy poor weight gain harsh holosystolic, diastolic increased intensity on standing and valsalva manuever strong family hx
219
acute causes of hemiplegia in kids
seizures - todd paralysis intracranial hemorrhage - vomit, brady hemiplegic migraine - family Hx
220
Measles Virus precautions
airborne transmission vitamin A for hospitalized patients
221
causes of impetigo
staph auerus | strep pyogenes
222
causes of vit K def
``` malnutrition CF IBD Biliary atresia celiac dz frequent abx use ```
223
homocystinuria
marfanoid habitus intellectual disability megaloblastic anemia thrombosis lens dislocation joint hyperlaxity skin hyperelasticity scoliolisis
224
generalized seizure presentation
LOC post ictal state tongue laceration +/- preceding aura
225
vasovagal syncope
preceding lightheadnes pallor diaphoretic IMMEDIATE return to baseline mental status
226
cardiogenic syncope
sudden LOC without prodrome | IMMEDIATE return to base line mental status
227
dissemenitaed gonoccal infection
fever rash - vesiculopustular (no facial involvement) polyarthritis
228
rocky mountain spotted fever
febrile prodrome --> --> erythematous macular rash that STARTS on the wrists and ankles and spreads centrally
229
selective IgA def
recurrent sinupulmonary and GI infections associated with celiac and atopy anaphylaxis during transfusion
230
milk or soy induced colitis
FmHx of eczema, allergies, asthma 2-8wks old regurgitation or vomiting can have painless blood stools tx = resolves in one year - hydrolyzed formula
231
Chronic Granulomatis disease x-linked
recurrent pulmonary and cutaneous infections susceptibility to CATALASE + organisms (staph, serratia, brukholeria) dx = nitroblue tetrolium, dihydrodium test defect in intraccellular killing due to impaired resp burst
232
beckwith wiedeman syndrome
deregulation of imprinted gene expresssion on chr 15 fetal macrosmia hemihypertrophy rapid growth until late childhood umbilicated hernia
233
complications of Vesicoureteral reflux
pyelonephritis --> parenchymal scarring, HTN and renal insufficiency
234
pediatric causes of stroke
``` sickle cell dz prethrombotic disorders congenital cardiac dz bacterial meningitis vasculitis head/neck trauma ```
235
Werdnig hoffamn syndrome
degeneration of anterior horn cells and cranial nerve motor nuclei other cause of floppy baby syndrome and associated with polyhydramnios (due to inability to swallow)
236
myotonic congential myopathy
muscle weakness and atrophy (distal muscles of UE and LE) testicular atrophy baldness hand grip myotonia dysphagia
237
atopic dermatitis
itchy red scaly crusted lesions extensor and flexor surfaces (lichenified plaques) risks with low humidity tx - emollients and topical steroids
238
complications of atopic dermatitis
eczema herpeticum cellulitis abscesses
239
septic arthritis presetnation
acute onset of fever and joint pain fatigue and refusal to bear weight erythema, warmth, swelling and pain with ROM increased WBCs, ESR, c-react synovial fluid = wbcs >50,000
240
retinal hemorrhage seen on a baby =
shaking baby syndrome - acceleration deceleration injury
241
bronchiolitis presentations in a small children
low grade fever rhinorrhea/congestion cough/ wheezing + respiratory symptoms RSV cause tx = supplemental O2
242
vit A toxicity can lead to
Increased cranial pressure uric acid stones headaches
243
what type of PNA bug do HIV patients get
pneumocystis jerovecii
244
patients of diabetic mothers that have prolonged QT and then seizures due to
hypocalcemia due to suppressed PTH
245
tuberosclerosis presentation
``` ash leaf spots (hypopigmentation) pariventricular masses sare sub ependymal nodules seizures forehead plaques mental impairment renal angiomyolipoma (benign) ```
246
young girl with peristent diarrhea multiple episodes of oral thrush failure to thrive viral infections and heart murmur dx = ?
SCID T lymphocyte def
247
SCID basics
Fungal infection Viral Infection Bacterial Infection T lymphocyte deficiency failure to thrive chronic diarrhea
248
culprit for salmonella diarrhea
uncooked bbq chicken
249
how to prevent rotavirus outbreak
strict hand washing protocol
250
palpable suprapubic mass
distended bladder
251
CVID
susceptible to encapsulated organisms due to impairment of the humoral system so gets infected with strep pnumo and Hib while nml ppl are protected with the vaccines
252
serum glucose --> decrease plasma osmolarity --> fluid goes back into cells -->
cerebreal edema
253
shunt reversal of VSD leads to
pulmonary artery HTN leading to polycythemia
254
tx for septecemia in neoneate
cefotaxime
255
fundoplication can tx
stage 4 GERD
256
shigellosis presentation
``` bloody stool young child tonic clonic seizure high fever dehydration ```
257
adam strokes attack presentation
attack occurs without warning leading to sudden LOC and generalized tonic clonic seizure activity
258
what causes a J wave on an EKG
hypothermia <90degrees F hypercalcemia brain injury v fib
259
chemical ingestion presentation in a kid
drooling ulcers involving the lips annd the tongue vomiting
260
newborn male not urinated since birth and abdomen is distended with a midline mass dx = ?
posterior urethral valves midline mass = bladder from not urinating
261
hodgkin lymphoma presentation
painless lymphadenopathy - usually cervical, axillary or inguinal - rubbery mediastinal mass on CXR teenagers
262
hematocrit 50-60% in a neonate = ?
normal in a neonate
263
test for addisons
measurement of morning serum fasting cortisol concentration
264
HIV presentation in infancy
failure to thrive lymphadenopathy opportunistic infections severe thrush selective loss of CD4 cells
265
thalessemia minor presentation
microcytic anemia normal red cell distribution width increased reticulocyte count
266
hereditary spherocytosis
jaundice, splenomegaly increased reticulocyte count increased Mean corpuscular Hgb concentration increased osmotic fragility on acidifed glycerol lysis test nml MCV, nml RDW
267
tx of erythema migrans
< 8/o = amoxicillin > 8 y/o = doxycycline > stage 1 = ceftriaxione
268
hypertrophic cardiomyopathy physio behind increasing murmurs and decreasing murmurs
manuevers that increased preload or afterload (squatting, leg raise, hand grip) will increased LV cavity size and decreased Lv outflow obstruction --> decreasing murmur intensity things that decreased preload will increase murmur intensity (standing up)
269
causes and tx of otitis externa
pseudomonas and staph auereus ototopical abx - fluoroquinolone +/- glucocorticoid
270
aplastic crisis in a sickle cell patient
decreased reticulocytes - due to a transient arrest of erythopoesis secondary to infection (parvo b19)
271
splenic sequestration crisis
increased reticulocytes splenic vaso-occlusion --> rapidly enlarging spleen occurs in children prior to autosplenectomy (sicklers)
272
aplastic anemia lab values
thrombocytopenia leukopenia anemia
273
viral meningitis causes and basics
majority caused by enteroviruses - coxsackie b spread by fecal oral transmission
274
pathogenesis of refeeding syndrome
starvation -> decreasd insulin increased glucagon increased cortisol -> decreased ketone bodies in muscles + increased ketones in brain -> increased glycogenlysis incresde lipolysis increased protein catabolsm -> depleted fat and protein start refeeding -> increased insulin -> increased glycogen synthesis, increased protein synthesis, -> decreased thiamine, decreased K+ , decreased PO4, decreased Mg -> seizures, CHF
275
causes of QT prolongation
decreased Ca, K , Mg macrolides, fluoroquinolones antipsychotics, TCAs, SSRIs opiods (methadone, oxycodone) antimetics (zofran) quinidine, procainamide, flecanamide, amiodarone, sotalol
276
complications of prolonged QT syndrome
torsades de pointes
277
Wiskott aldrich syndrome | x-linked
imparied cytoskeleton changes in leukocytes, platelets eczema microthrombocytopenia recurrent infections
278
ataxia telengectiasias
T- cell def associated with a defect in DNA repair progressive cerebellar degeneration
279
congenital clubfoot
rigid positioning medial/upward deviation of forefoot and hindfoot hyper plantar flexion of the foot
280
MC complication of a patient with sickle cell trait
painless hematuria
281
FB aspiration
MC -infants and toddlers acute onset of inspiratory stridor +/- wheezing without infectious symptoms perform an endoscopy or bronchoscopy
282
laryngolamalacia presentation
inspiratory stridor most prominent in infants stridor is worse when supine stidor improves when prone
283
vascular ring presentation
infants | biphasic stridor that improves with neck extension
284
primary nocturnal enuresis age and tx
> 5 y/o tx - alarms, routine adjustment, and then desmopressin therapy if needed
285
levonorgestrel pill > OCPs for what use
emergency contraception (plan B)
286
risk factor for henoch schonlein purpura
intussussception risk
287
erythema toxicum neonatorum def and tx
asymptomatic scattered erythematous macules, papules, pustules throughout the body tx - reassurance
288
neonatal HSV presentation and tx
vesicular clusters on skin, eyes, mucous membranes CNS infections fulminant, disseminated multi organ disease tx = acyclovir
289
tx of neonatal varicella
acyclovir
290
staph scalded syndorme
fever, irritability diffuse erythema followed by blistering and exfoliation + nikolsky's sign tx = naficillin, oxacillin or vanco
291
friedrich ataxia
neurodegenerative disease - presents with progressive ataxia and loss of positional and vibratory senses genetic test - excessive # of tri nucleotide repeats
292
cerebral palsy risk factors
prematurity (that leads to hypoxia induced damage) | low birth weight
293
cerebral palsy clinical features
``` delayed motor milestones abnormal tone hyperreflexia comorbid seizures intellectual disability ```
294
craniopharyngioma
calcified intracranial tumors that occur in the suprasellar region
295
craniopharygioma presentation
bitemporal hemaniopsia | pituitary hormonal deficiencies (DI, GH def)
296
pityriasis rosea clinical features
+/- viral prodrome annular pink herald patch on trunk oval lesions in x-mas tree pattern pruritus tx = reassurance and antihistamines for pruritus
297
acrocynasosis
typically normal during newborn period
298
MC pathogen associated with kids with CF
staph aureus - while pseudomonas is more associated with adults with CF
299
cystic hygromas
congenital malformation of the lymphatic system - located in the posterior triangle of the neck fluctulant mass that transuluminates with light associated with turners syndrome
300
clavicle fx presentation in a newborn
crepitus swelling decreased ROM of UE (ipsy)
301
congenital muscular torticollis
posterior neck deformity SCM mass ispy head tilt contra chin deviation
302
presentation of viral conjunctivitis
unilateral/ bilateral 1-2 wks watery/mucoid viral prodrome
303
presentation of bacterial conjunctivitis
uni/bilateral 1-2wks unremitting ocular discharge purulent
304
allergic conjunctivitis
ocular pruritus* always bilateral <30min or annually (certain time of year)
305
asian babies have what def
decreased UGT activity --> increased total Bili and increased unconjugated bili
306
sturge weber syndrome
mutations in GNaq gene ``` port wine stain leptomenengial capillary venous malformations seizures +/- hemiparesis intellectual disability visual field defeceits glaucoma ```
307
ALL
``` MC childhood cancer, 2-5 y/o, M>F bone pain lymphadenopathy hepatosplenomegaly pallor petechiae ```
308
Common Variable immunodefeciency
recurrent resp infections (sinusitis, pna, otitis) reccurent gi infections (salmonella, campylobacter ``` autoimmune diseases (RA, thyroid dz) chronic lung disease (bronchiectesis) GI disorders (chronic diarrhea,) ```
309
dx of CVID
decreased IgG decreased IgA/IgM no response to vaccinations
310
tx of CVID
Ig replacement therapy
311
antifungal and antiviral prophylaxis is important for what patients
CGD SCID transplant patients
312
rett syndrome
girls - loss of speech and purposeful hand use gait disturbance stereotypical hand movements seizures
313
landon klefer syndrome
regression of language skills due to severe epileptic attacks 3-6 years old
314
presentation of reactive arthritis
injected conjuctivae with mucopurulent discharge pain swelling and rash over a joint
315
otitis media with effusion physical exam
observable air fluid levels (which may be vertically oriented) serous middle ear fluid translucent membrane with diminished mobility
316
otitis media without effusion
bulging erythematous purulent discharge limited mobility
317
tinea capitis
MC in black children transmission via direct contact or from fomites scaly erythematous patch with hair loss on scalp
318
tx of tinea capitis
oral grisefulvin or terbinafine
319
langerhans cell histiocytosis
``` lytic bone lesions (skull, femur, jaw) skin lesions (purpleish papules, eczematous rash) lymphadenopathy hepatosplenomegaly pulmonary cysts/ nodules ``` central DI
320
elevated glutamyl transpeptidase
alcoholics
321
wilson disease
copper accumulation - > leak from damaged hepatocytes -> deposits in tissues (basal ganglia, cornea) acute liver failure, chronic hepatitis, cirrhosis neuro - parkinsonisms, gait disturbances, dysarthria psych - depression, personality changes, pyschosis
322
tx of wilsons disease
chelators - D penicillamine zinc (messes with copper absorption)
323
preseptal orbital cellulitis
PAIN to palpation eyelid swelling No pain with EOM
324
postseptal orbital cellulitis
PAIN with palpation eyelid swelling PAINFUL and difficulty with EOMs
325
minimal change disease
MCC of nephrotic syndrome in children <10 y/o | T cell mediated injury to podocytes caused by increase molecular permeability to albumin
326
minimal change disease presentation
edema fatigue NO hematurial proteinuria >3g
327
tx of minimal change disease
corticosteroids
328
leukocyte adhesion deficiency
recurrent skin and mucosal bacterial infections No PUS - lack of neutrophils at the inflammation site delayed umbical cord separation marked peripheral leukocytosis with neutrophilia
329
steps for precious puberty workup in a female
bone age - if >2yrs --> Baseline LH --> if elevated = central precocioys puberty --> MRI
330
lab values for iron def anemia
low -MCV low - Fe low -ferritin low - transferrin high - TIBC
331
lab values for thalessemia
low low - MCV low - TIBC high - ferritin high - transferrin
332
lab values for anemia of chronic disease
mcv - normal low - Fe low - TIBC
333
presentation of juvenille idopathic arthtritis
subacute/chronic - pain that is worse in the am but able to bear weight long standing fever arthritisi > 1 joint pick macular rash increased WBCs, thrombocytosis, high ESR
334
antidote to protect from cardiac damage in hyperkalemia
calcium gluconate
335
hypertrophy of peyers patches is a risk for
intussception
336
MC type of CNS tumor in kids
astrocytoma
337
complications of otitis media
facial nerve palsy | mastoiditis
338
dx test of choice for DMD
genetic testing
339
presentation of HSP
IgA mediated leukocytoclastic vasculitis palpable purpura arthitis/ arthalgias abd pain/ intussecpetion renal disease - IgA nephropathy
340
reactive attachment disorder
pattern of emotional and social withdrawal lack of positive response to. attempts to comfort
341
disinhibited social engagment disorder
overfamiliarity and an unhesistant approach to unfamiliar adults outcome of early neglect
342
MCC of proteinuria in kids
transient proteinuria - make sure to obtain at least 2 dipsticks to r/o whether its a more serious cause of proteinuria
343
PKU presentation highlights
fair complexion | musty odor
344
mcCune albright syndrome
cafe au lait spots precocoious puberty fibrous dysplaisa of the bone
345
tx of bullous impetigo | tx of non bullous impetigo
tx of bullous = cephalexin, dicloxicillin, clindamycin tx of non bullous = mupirocin
346
mastoiditis
complication of AOM strep pneumo fever otalgia inflammationof mastoid deviation of ear needs CT or MRI
347
dactylitis
earliest manifestion of a vasoocclusive crisis in sicke cell patient symmetrical swelling of the hands and feet caused by: mcrovascular occlusion
348
compliactions of bacterial meningitis
intellectual/behavioral disablity hearing loss cerebral palsy epilespy
349
complications of. prematurity
resp distress syndrome/ PNA bronchopulmonary dysplasia intraventricular hemorrhage NEC retinopathy of prematurity
350
what accumulates in a 21 hydroxylase def
17 hydroxy progesterone
351
avascular necrosis - risks
``` steroid use alcohol abuse SLE - antiphospholipid syndrome sickle cell dz infections decompression sickenss ```
352
presentation of avascular necrosis
groin pain on weight bearing pain on hib abduction and internal rotation no erythema, swelling or point tenderness NML - WBCs, ESR, CRP
353
meconium ileus
ileum obstruction meconium inspissated negative squirt sign associated with CF
354
congenital lymphedema
occurs due to dysgenesis of the lymphatic system and presents at birth with non pitting carpal and pedal edema eventually leads to the webbed neck - seen in turners syndrome
355
immune thrombocytopenia
platelet autoantibodies preceding viral infection petechia, ecchymosis mucosal bleeding tx- observe
356
serous OM vs AOM
lack of inflammatory signs = serous
357
absence seizures on EEG
3hz spike and wave pattern
358
juvenille myoclonic epilepsy
generalized seziures during adolescence myoclonic jerks that are more prominent in the first hour after awakening
359
alport syndrome
recurrent episodes of hematuria sensorineural deafness and family hx of renal failure
360
first line tx for ADHD non stimulant
atomoxetine
361
neonatal sepsis
``` temp instability poor feeding jaundice CNS signs abnormal WBCs left shift ```
362
choleostoma
peripheral granulation and severe skin debris visualized in the ear
363
spondylolisthesis
``` forward slip of vertebrae MC - L5 over the S1 preadolescent children back pain neurological deficit ```
364
viral myocarditis
cosackie B virus Adenovirus ``` prodrome HF resp distress murmur hepatosplenomegaly ```
365
dx of viral myocarditis
CXR - cardiomegaly, pulmonary edema ECG - sinus tachy Echo - decreased Ejection Fraction
366
suspicious burns
buttocks and back of legs sparing of the flexor surfaces sharp lines of demarcation uniform burn depth delayed medical treatment seeking
367
growing pains
primarily occurs at night and resolves by morning affects the LE bilaterally Normal PE and activity level tx = reassurance and NSAIDs
368
hemophilia knee joint microscopic exam
hemosiderin deposition and fibrosis
369
transient tachypnea of the newborn
resp distress and fluid in the intralobular fissures from a neonate that has been delivered via C-section
370
path behind coarctation of the aorta
thickening of the tunica media of aortic arch near the ductus arteriosus
371
hyposthenuria
inability of the kidney to concentrate urine and can occur in pats with sickle cell trait polyuria decrease urine specific gravity nml serum Na
372
central Diabetes insipidus
polyuria | increased Na in serum
373
primary pyschogenic polydipsia
decreased Na due to dilutional
374
brain abscesses
HA vomiting fever focal neuro deficits (stroke like) riing enhancing lesions on CT
375
Congenital heart defect increases risk for NEC due to
decreased mesenteric perfusion
376
pneumatosis
extravasation of bowel gas into the damaged bowel
377
breath holding spell
cyanosis LOC nml pe
378
risks for hip dysplasia
breech position Fhx excessive tight swaddleing
379
graves dz
transplacental TSH receptor antibody tachy weight loss jittery poor feeding
380
atlantoaxial instability
pts with down syndrome who present with upper motor neuron findings excessive laxity in the posterior transverse ligament causing increased mobility between C1 and C2
381
fanconis anemia
dna repair defect Bone marrow failure short stature hypo/hyper pigmented macules GU malformations
382
lab avlues in fanconis anemia
low WBCs low RBCSs low platelets
383
benzene exposure leads to
chromosomal breakage | aplastic anemia
384
scabies
spread by direct perosn to person contact extremely pruritic small erythematous papules rash located on interdigital web spaces, felxor wrists, extensor elbows, axillae, ubilicus, genitals
385
tx of scabies
topical 5% permethrin or oral ivermectin
386
midgut volvulus
neonates with bilious vomiting and abdominal distension dx - upper GI study
387
HUS
``` shigella toxin (serotype O157H7) vascular damage and microthrombi formation ```
388
HUS clinical features
hemolytic anemia (schistocytes increased bili) thrombocytopenia acute kidney injury (Increased BUN and creatine)
389
tx of perinatal hep B
HBV and HB Ig
390
symptoms of. bacterial sinusitis
nasal congestion drainage and cough that are all persistent most common predisposing factor = viral URI
391
comorbidites that go along with tourrette synrome
OCD and ADHD
392
parinaud syndrome
pineal gland tumor limited upward gaze upper eyelid retraction pupils non reactive to light pupils reactive to accommodation
393
subdural hemorrhage neonates
``` convulsions period of apnea resp depression altered muscle tone fontanelles may be tense and bulging ```
394
eczema herpicum
complication of atopic dermatitis painful vesicles - punched out erosions hemorrhagic crusting along with fever lymphadenopathy
395
membranous nephropathy
edema proteinuria hypoalbuminemia in adolescents and adults active hep B infections - important risk factor
396
pneumococcal vaccine
conjugate capsular polysacharride
397
antibodies to dsDNA
SLE
398
hydroxyurea ADR
myelosuppresion
399
Serum sickness like rxn
caused by beta lactams and sulfa drugs Ic formation acute hep B infection 1-2 weeks after exposure
400
myotonic muscular dystrophy
``` grip myotonia delayed muscle relaxation facial weaness foot drop dsyphagia ```
401
tx of tourrettes
antidopaminergic medication
402
pinworm
school aged children nocturnal perianal pruritus spread by itching to other areas helminth infection
403
celiac disease
autoimmune disorders increase the risk abd pain, bloating, diarrhea failure to thrive/short stature dermatitis herpitiformis Iron deficiency
404
vitamin d deficiency
``` increased skin pigmentation delayed fontanelle closure enlarged skull frontal bossing enlarged costochondrial joints long bone joints ``` genu varum
405
language disorder
common and characterized by persistent difficulties in the acquisition and use of language due to defects in comprehension and/or production limited vocab sentence structure and functional use of language
406
iron toxicity
radioopaque pills abd pain vomiting hematemesis metabolic acidosis
407
aspirin poisoning
``` tinnitus resp alkalosis and metabolic acidosis fever hyperapnea pills not RADIOOPAQUE ```
408
anemia of prematurity
usually asymptomatic tachy poor weight gain apnea normocytic, normochromic low reticulocyte count low hgb and low hct
409
premature adrenarche
early activation of adrenal androgens obese children precocious puberty development of pubic and axillary hair, acnes and body odor in a child with normal bone age
410
eosinophilic esophagitis
chronic immune mediated inflammation ``` dysphagia chest pain/ epigastric pain reflux, vomiting food impaction associated atopy ```
411
sickle cell provides decrease morbidity when it comes to what disease
malaria
412
MCC of lymphadenitis in kids
staph aureus followed by group A strep
413
lab values of turners sydndrome
increased FSH and LH | due to negative feedback of estrogen
414
renal tubular acidosis
``` poor hydrogen secretion into urine urine pH > 5.5 serum K low high Cl low HCO3 ``` nml anion gap + failure to thrive
415
lactic aidosis metabolic panel
high anion gap metabolic aidosis
416
DKA
polyuria/ nocturia, polydipsia, polyphagia vomiting, abd pain, weight loss fatigue, dehydration kaussmaul respirations gucose > 200 bicarb < 15 pH < 7.3 anion gap >14 urine ketones increased FFAs falsely normal K - due to decreased insulin --> K. shift to ECF
417
reye syndrome biopsy
microvesicular fatty steatosis
418
complication of friedreich ataxia
cardiac dsyfunction - hypertrophic cardiomyopathy
419
seborrheic dermatitis
peaks in infancy and adulthood erythematous plaques and/or yellow greasy scales located on scalp face eye area, posterior ears umbilicus/ diaper area
420
tx of seborrheic dermatitis
emollient then topical antifungals or low potency glucocorticoids
421
infant botulism
ingestion of botulinum spores from environmental spores
422
ringworm
tinea corporus tx - topical clotrimazole
423
jejunum atresia
risk factors = vasoconstrictive meds, cocaine use in mom dx - triple bubble sign and gasless colon
424
risks seen in a small for gestational age infant under 10%
``` hypoxia polcythemia hypoglycemia hypothermia hypocalcemia ```
425
MCC of conductive hearing loss
repeated OTITIs media infections
426
congenital torticollis can lead to
positional plagiocephaly
427
MCC of childhood bloody diarrhea
entamoeba histolyticum
428
dx of ALL via
bone marrow biopsy
429
central DI labs
increased Na
430
recommendation for diabetic athletes
lower there dose of insulin 10 to 15% on practice days
431
ADR of ceftriaxone
hyperbilirubenmia
432
tx for neonatal meningitis i kids < 30 days
ampicillin steroids cefotaxime
433
testing for HIV in baby <18months
DNA PCR
434
testing for HIV in baby > 18months
ELISA
435
CD4 count diseases <200 <100 <50
``` <200 = PCP - tx - TMP-SMX +/- dapsone <100 = toxoplasmosis - tx - TMP-SMX +/- atovaquone <50 = mycobacterium avium - tx - azithromycin ```
436
tx for kid with latent TB
INH + vitamin b6
437
TB test for kid <5 and > 5
< 5 = PPD | > 5 = quantiferon
438
Peritonsilar abscess
approx 10 years old displaced uvula to one side sore throat, muffled hot potatoe voice drooling
439
tx of angioedema
FFP
440
tx of scabies
topical permethrin
441
``` urine pH >5.5 + metabolic acidosis = dx? ```
renal tubular acidosis
442
physio of transient tachypneic of the newborn
delayed resorption and clearance of aleolar fluid
443
diamond blackfan anemia
weird tripharyngeal thumbs craniofacial abnormalities increased risk of malignancy macrocytic anemia reticulocytopenia normal platelets, white tx corticosteroids
444
erythematous plaques and yellow, greasy scales located on scalp, nasolabial folds
seborrheic dermatitis tx - emollients
445
difference between angioedema and anaphylaxis
anaphylaxis has hypotension angioedema does not and you treat with securing airway vs anaphlyaxis you give IM epi if c1 eserase def tx with FFP
446
tx of allergic rhinitis
avoid allergen + intranasal steroids
447
presence of gamma tetramers (hemoglobin barts ) should make you suspicious for
alpha thalassemia - associated with hydrops fetalis elevated reticuloctye count low MCV target cells seen on peripheral smear
448
heavy regular bleeding in menses in an adolescent with normal cogulation profile =
Von WIllebrand disease
449
hemophilia A patient develops increased bleeding frequency or has become refractory to treatment =
inhibitor development - body recognizes factor 8 being infused as foreign and rejects it
450
fever, irritability generalized erythema, blisters epidermal shedding (nikolsky sign)
staph scalded skin syndrome tx - nafcillin, vancomycin
451
neruoblastoma can be associated with what disorders
neurofibromatosis | hirchsprung disease
452
nurse maids elbow
radial head subluxation tx - reduction
453
supracondylar humerus fracture
MC pedaitric elbow fx 5-8 yrs old increased risk of volkmann contracture - due to compartment syndrome beware of brachial artery entrapment - check radial pulse
454
compication of scolioiss
restrictive lung disease
455
what live attenuated vaccine can HIV patients take
MMRV
456
male in fant with a distended palpable bladder and low urine output
posterior urethral valves - MC congenital urethral obstruction
457
dx step of croup
give raecmic epi and they get better
458
croup that does not improve slightly more toxicity raecemic epi doesnt help
bacterial tracheitis - caused by staph aureus do a tracheal culture tx - iv abx
459
unilateral anterior chain lymphadenopathy mass drooling
peritonsillar abscess
460
VSD can lead to what
RVH
461
CXR of ASD
increased vascular markings and cardiomegaly
462
complications of ASD
dysrhythmias | paradoxical emboli and DVTs
463
pear shaped heart
pericardial effusion
464
jug handle appearance
primary pulmonary artery HTN
465
adverse rxn of working with plastics
hydrogen cyanide poisoning - ha, confusion, sudden LOC, metabolic acidosis
466
diluting formula leads to
hyponatremia --> seizures
467
nevus flammeus = nevus simplex salmon patch
flat vascular lesions that occuri n the beck/base of scalp appear more prominnent during cyring or exerise
468
pustular melanois
benign self limited newborn dz more common in blacks 1-2mm pustules that result in hyperpigmented lesions encircles by scale
469
sebacceous nevi
small sharply demarcated lesions that occur more commonly on the head and neck of infants yellow -orange in. color slightly elevated hairless
470
cold panniculitis
destruction of fate cells caused by expposure to cold weather or cold object self resolving
471
tx for aspirin overdose
sodium bicarbonate
472
teratogeneic effects of ACE-I
oligohydramniosis | renal dysgenesis
473
tx of inflammed lesions in seborrheic dermatitis
topical corticosteroids
474
neonatal SLE exposure can lead to
heart block --> heart failure
475
testing for digeorge syndrome
intradermal skin test using candida albicans NO RESPONSE in patients with T cell defect
476
fecal occult blood test + in a newborn
meckels diverticulum dx - meckels scan = technium 99 or if a teenager = ct scan
477
baby swallows moms blood what test
apt test
478
Ulcerative colitis basics
bloody diarrhea surgery is curative continous damge in the colon
479
crohns basics
skip lesions watery diarrhea medications - tx weight loss
480
kid with fever and bloody BM what is the next step
stool culture
481
milk protein allergy tx
hydroylzed formula
482
metabolic acidosis effects on bilirubin
reduces its binding similiar to. sulfa drugs
483
phenobarbital has what effect on bili pathway
kickstarts gluconuryl transferease
484
neonatal sepsis has what effect for bili
interrupts the BBB incresing risk for kernicterus
485
hyperalbuminemia has what effect on bili
will aid in reducing excess bili by binding to it
486
what drugs are C/I in breast feeding
``` amphetamines lithium cyclosproin drugs bromocrptine ```
487
what symptoms follow in a newborn delivered by maternal diabetes mom that has finally got insulin and glucose under control
hypocalcemia --> tetany hypomagensia
488
smaller for dates infants have a higher incidence of
major congenital anomalies and at increased risk for future growth retardation
489
in premature infants apnea is thought to be secondary to
an incompletely developed respiratory center
490
early tx of galactosemia =
soy formula feeding
491
polycythemia in a newborn can lead to what complication
seizures
492
goats milk is deficient in
vit d | folate
493
newborns with cleft lip and cleft palate are at greater risk for
recurrent otitis media and hearing loss speech issues
494
``` 2 week old newborn with: enlarged fontanelles jaundice lethargic feeding difficulties edema of extremities and gentials bradycardia ``` dx =
congenital hypothyroidism
495
cxr of transient tachypnea of the newborn
increased pulmonary vascular markings
496
most common type of PNA in kids , 5 y/o
viral
497
1 day old infant fronto occipital head circumference that is 2cm larger than it was initially several hours ago and the scalp is no squishy and the infant is now tachy
subgaleal hemorrhage subaponeurotic hemorrhage
498
intraventricularhemorrhage (germinal matrix hemorrhage)
small premature infants can lead to hydrocephalus --> tx = vp shunt
499
caput succedaneum
soft tissue swelling - presenting in the delivery portion of the head can CROSS suture line edema may be. pitting resolves in the first few days
500
tx of SVT in infant
carotid massage complicaitons = hydrops fetalis
501
pulsus parodoxus in a kid cna be seen in what autoimmune disease
JIA muffled heart sounds increase pulsus parodoxus spindle shaped swelling of finger joins
502
tricupsid atresia
RVH LAD LVH
503
unilateral nasal obstruction with foul smelling discharge in young kid
FB
504
complication of staph and other types of pna - signs - acute worsening over minutes markedly increased work of breathing increased O2 requirements hypotension
tension pneumothroax - tx - needle aspiration
505
tx and management of bacterial tracheitis
maintain airway
506
lens shaped hemorrhage
epidural
507
crescent shaped hemorrhage
subdural
508
punctate hemorrhages seen on a head CT
concussion
509
car safety
car seat - rear facing 0-2yrs old booster seat until 4'9''
510
hypertrophied tonsils and adenoids lead to what metbaolic condition
respiratory acidosis with metabolic compensation - due to chronic upper airway obstruction
511
cause of. mono
ebv
512
dx of lactose intolerance can be made via
hydrogen breath test
513
first teeth to form in a newborn are
mandibular central incisors
514
prolonged bottly use in an infant can lead to
tooth decay
515
other lab values that can occur during nephrotic syndrome
incerased cholesterol and TGLs
516
complication of spina bifida
recurrent UTIs hypotnia o LE muscle atrphy of LE
517
FB and expiratory wheeze
intrathroacic airways - bronchioles since they collapse when breathing out
518
FB and inspritory wheeze
extrathroacic airways since the air has to push to get around object
519
+ coin sign on lateral x-ray FB is located
in the trachea
520
Athsma taper tx
1) SABA + rescue inhaler (RI) 2) above + inhaled corticosteroid (ICS) 3) above + leukotriene antagonist 4) above + increased dose of. ICS 5) above + LABA 6) above + oral steroid
521
tx of RSV
supportive care O2 IVF
522
complete lack of acid beta galactosidase actvity
niemman pick
523
B cell def diseases
XLA CVID IgA DEF hyper IgM
524
T cell def
dieorge syndrome | HIV
525
Combined b cell and t. cell def diseases
Wiskott aldreich ataxia telengectasias SCID (mega aids)
526
phagocytosis diseases
LAD CGD chediak higashi
527
XLA - LAB VALUES
CBC -. NORMAL NO IgG No B. cells no RTK gene
528
CVID lab values
mild form of XLA teenager normal CBC decreased 2/3 of Igs's
529
diegorge syndorme
22q11.2 - 3rd pharyn pouch wide spaced eyes, low set ears, small face absent thymic shadow fungi + PCP infection
530
digeorge lab values
CBC = decreased absolute lymphocytes | decreased Ca
531
wiskott aldrich lab values
CBC = decreased WBCs, decreased platelets increased IgM increased IgG
532
SCID lab values
CBC = decreased WBCs | decreased IgG, IgM, IgA
533
CGD lab values
CBC = increased WBCs increased IgM, IgG recurrent staph abscesses
534
LAD lab values
CBC = increased WBCs Increased temp no pus delayed cord separation
535
tx of c1-esterase def
FFP
536
rubeola =
measles
537
test for scoliosis
adams test
538
signs of botulism
``` constipation poor feeding absent gag reflex ptosis hypotonia descending paralysis ```
539
when is chelation therapy needed
> 45 lead levels
540
tx of diabetes insipidus
desmopressin
541
excessive milk intake can lead to
iron def anemia microcytosis increased red cell distribution width
542
langerhan histiosytosis
lytic bone lesions skin lesions lyphadenopathy pulmonary cyst/nodules tx - vinblastine + prednisone
543
neuroblastoma can also present with
spinal cord compression from epidural invasion
544
serous otitis media basics
non bulging
545
biliary atresia
direct bili increased 7-14 days after birth US- no ducts HIDA scan 7 days after phenobarbital is given
546
dysmorphic RBC casts in urine =
glomerular damage = nephritic syndromes
547
ectopic ureter presenttion
young girl who is never dry
548
tx of ringworm
topical clotrimazole
549
migraine HA presentation in predtriacs
mcc of acute and recurrent hAs unilateral or bilateral photophobia n/v
550
biphasic stridor that improves with neck extension
vascular ring
551
rickets labs
low Po4 and normal Ca
552
osteogenesis imperfect
normal PO4 | normal Ca
553
medulloblastoma
2nd mcc tumor of brain cerebellar vermis - ataxia ha n/v
554
simple seizures in newborns
require no workup - less than 15min only 1 in 24hr gnerlaized
555
risk factor for RDs
maternal diabetes
556
non classical congenital adrenal hyperplasia
premature secondary se characteristics accerlaerated growth and bone age low/normal LH levels
557
periventricular calcifications in newborn
CMV
558
intracerebeal calcifcations | chorioretinitis
toxoplasmosis
559
fredriech ataxia
``` mri cervical spinal cord atrophy loss of position sense and decreased vibratory sense progressive weakness in LEs wide based gait kyphoscoliosis ``` complications - hypertrophic cardiomyopathy
560
tx of acute bacterial rhinosinusitis
amoxicillin +/- clavulanuate
561
premature adrenarche
caused by early activation of adrenal androgens more common in obese children nml bone age
562
primary cause of toxo
undercooked food
563
cxr of transient tachypnea
lung hyperexpanded wet increased pulmonary vascular markings
564
viral myocarditis
can be caused by coxsackie b and adenovirus ``` viral prodrome heart failure resp distress murmur hepatosplenomegly ```
565
dx workup of precocious puberty
advance bone age --> LH test if low --> gnrh stimulation test if high --> MRI - central precocious puberty
566
shigellosis
bloody diarrhea seizures fever dehydration
567
s3 gallop hypotension recent URI
myocarditis
568
ADR of TMPSMX
neutropenia
569
+ ppd - cxr dx =
latent TB - tx - INH + B6

Step 2 Rotation Cards (14 decks)

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