Pediatrics Flashcards
(92 cards)
1
Q
A 12-year-old boy presented to your office one week ago with complaints of sore throat, bilateral knee pain, and chest pain. Treatment with penicillin was initiated and he has now returned for follow-up. Which of the following laboratory tests is most appropriate to monitor progress of his disease?
A
C-reactive protein
Acute rheumatic fever (ARF) is an inflammatory, autoimmune response that develops after infection with Group A Streptococci (GAS)
2
Q
A
3
Q
UGI series= “string sign”
A
Pyloric stenosis
4
Q
flu-like symptoms
heart failure
tachycardia out of proportion to fever
Elevated troponin
A
myocarditis
gold standard= endomyocardial biopsy
most common cause= enterovirus (coxsackie group B)
ACE Inhibitors
complication=dilated cardiomyopathy
5
Q
(hips)
ABducted
w/ hips and knees flexed to 90 degrees
A
ORTOLANI (first 3 months of life)
Developmental dysplasia of the hip
Diagnosis is made by ultrasound (< 4 mos of age)
tx: Closed reduction and immobilization in a Pavlik harness
risk: female sex, breech birth position, oligohydramnios, prolonged swaddling, and family history of DDH
6
Q
involuntary repetition or echoing of one’s own words.
A
Palilalia
7
Q
MC organism for otitis externa
A
Pseudomonas aeruginosa
tx: ciprofloxacine/hydrocortisone
8
Q
“rice-water” stool
severe, watery diarrhea flecked with mucus “rice water”
A
Cholera
V. cholerae is a gram-negative curved rod that is highly motile and halophilic
tx: Azithromycin for children
9
Q
“target sign”
A
pyloric stenosis
risk= first born, male sex, prematurity, and macrolide antibiotic use (erythromycin)
10
Q
which vaccine has a Small risk of intussusception after receiving vaccine and contraindicated in infants with a history of intussusception
A
Rotavirus vaccine
11
Q
Tetralogy of Fallot PROVe
A
PROVe::
- Pulmonic stenosis,
- Right ventricular hypertrophy,
- Overriding aorta,
- VSD
12
Q
how do you test for bronchiolitis?
A
bronchiolitis
Respiratory Syncytial Virus (RSV)
dx: Nasopharyngeal swab for fluorescent antibody staining
tx=nasal suctioning/supportive
13
Q
Osteitis+ acute otitis media
A
Acute mastoiditis
mc organism: Streptococcus pneumoniae.
tx: admission and IV abx
14
Q
Type of Hypersensitivity reaction
- Anaphylaxis
- urticaria
- angioedema
- REQUIRES TWO SEPARATE EXPOSURES
A
Type I: Anaphylactic
IgE
15
Q
Most hydroceles are _______ sided
painless
A
Most hydroceles are right sided
16
Q
pectus excavatum, ectopia lentis
A
Marfan
defect in fibrillin-1
Risk of aortic aneurysm
17
Q
double bubble” sign
+
bilious vomiting
Upper GI series: “corkscrew”
A
Midgut volvulus
(intestinal malrotation)
18
Q
ductal-dependent cardiac lesion
A
Coarctation of the aorta
Ductal Dependent Lesions
Transposition of the great vessels (most common cause in newborns)
Tetralogy of Fallot (most common in children >1 year old)
Tricuspid atresia
Interrupted aortic arch
Coarctation of the aorta
Hypoplastic left heart syndrome
19
Q
hypochloremic, metabolic alkalosis
A
pyloric stenosis
20
Q
What is the most common causative organism of meningitis in a 1-week-old child?
A
Group B Streptococci
tx: Cefotaxime + ampicillin or gentamycin + ampicillin
21
Q
What chromosomal abnormality is Hirschsprung disease commonly associated with?
A
Down syndrome (trisomy 21).
22
Q
ekg: Infants less than one month normally have a degree of
A
right ventricular hypertrophy because in utero the newborn heart pumps systemic blood from both the left and the right ventricle (through the ductus arteriosus)
(rightward axis)
23
Q
- fetal connection between the pulmonary artery and aorta remains open, causing a continuous, “machine-like” murmur that is heard in both systole and diastole
- acyanotic
A
Patent ductus arteriosus (PDA)
dx: echo
tx: indomethacin/ ligation
24
Q
“thumb print sign” (x-ray)
A
epiglottitis
MC: Group A streptococcus (GAS)
(enlarged and thickened epiglottis=thumb sign)
25
compulsive use of obscenities
coprolalia
26
Neonatal conjunctivitis: Age 5 days to 5 weeks
* Often the first manifestation is watery discharge, which later becomes mucopurulent.
* Conjunctival chemosis then develops, and the conjunctiva may become so friable that they may bleed.
* Eyelid swelling may also develop.
**_Rule of 5 for Neonatal Conjunctivitis_**
_0-5 Days: N. Gonorrhoeae (tx: ceftriaxone)_
* gonorrheal conjunctivitis occurs almost exclusively in the first few days of life. The discharge of gonococcal conjunctivitis is copious, and the eyelids may be so swollen that the conjunctiva cannot be visualized.
**_5 days to 5 weeks: Chlamydia trachomatis (tx: Oral erythromycin)_**
* **Most common cause of neonatal conjunctivitis**
* **Most common: 5-14 days**
* **Often the first manifestation of the Chlamydial conjunctivitis is watery discharge, which later becomes mucopurulent. Conjunctival chemosis then develops, and the conjunctiva may become so friable that they may bleed. Eyelid swelling may also develop.**
_5 weeks to 5 years: Streptococcus or Haemophilus influenzae (tx: Erythromycin ointment)_
_Otherwise: most common cause of neonatal eye discharge is lacrimal duct obstruction (tx: warm compresses and lacrimal duct massage)_
27
Complex febrile seizures
1. multiple seizures occur during the same febrile illness,
2. seizures are prolonged (\>15 minutes), or
3. the seizures have a focal component
Note: temp \>38C, children 6mos-5yrs
28
involuntary repetition of words or phrases spoken by others
Echolalia
29
speaking elaborate but meaningless speech, or speaking an unknown language
Glossolalia
30
most common finding is a continuous, systolic and diastolic murmur, commonly called a machinery-like murmur
widended pulse pressure
normal skin color
Patent ductus arteriosus
31
The “figure-3” sign, characterized by prestenotic aortic dilation, coarctation indentation and poststenotic aortic dilation.
Aortic coarctation
most commonly around the left subclavian artery
dx=echo
associated with Turner's syndrome
32
“sausage-shaped” abdominal mass palpated
Intussusception
MC location=ileocolic
dx: ultrasound
tx: air/contrast enema
33
Peak Sudden Unexpected Infant Death Syndrome age range
2-4 months
34
Enterobiasis
pinworm
35
rash typically starts on the face and spreads downward
rash generally begins on the head and face and progresses downwards (“showering” rash)
prominent lymphadenopathy (occipital, cervical, postauricular)
Rubella
German measles
36
“toddler’s fracture” or childhood accidental spiral tibial (CAST) fracture
Most common location
DISTAL two thirds of the tibia
undisplaced
spiral pattern
9mos-3 yrs
Requires cast
37
“floppy baby syndrome.”
poor feeding, decreased suckling, loss of facial expression, constipation, and noticeable neck and peripheral weakness
infantile botulism
associated with ingestion of honey, corn syrup, and vacuum or environmental dust
tx:
**_If \>1 year:_** Equine serum heptavalent botulism antitoxin
**_If \<1 year:_** Human-derived botulism immune globulin
Treatment is IV botulism Ig
38
visible dark blue dot present in upper pole of the left testicle
Torsion of the appendix testis
39
Type of Hypersensitivity reaction:
* Autoimmune hemolytic anemia
* Erythroblastalis fetalis
* Goodpasture syndrome
* REQUIRES TWO SEPARATE EXPOSURES TO ANTIGEN
Type II: Cytotoxic
IgG or IgM and resultant complement activation
40
often follows a viral illness with thrombocytopenia
petechiae, purpura, and gingival bleeding
idiopathic thrombocytopenic purpura (ITP)
tx: Corticosteroids and intravenous immunoglobulin
Observation for platelets \>20k
41
* fever and acute parotid gland inflammation and swelling, and the pain often radiates up to the ear. (infectious parotitis)
* It is a systemic disease with low-grade fever, involving other glandular tissue, including the pancreas and testicles.
* elevated serum amylase
Mumps
Paramyxovirus
Acute, self-limited
42
organism for hand, foot mouth?
Coxsackie
43
Gram-positive cocci in chains
Streptococcus
44
"strawberry tongue" (prominent papillae)
Scarlet fever
“Second disease,” is caused by Group A Streptococcus
45
dx for pertussis
Polymerase chain reaction of nasopharyngeal secretions
tx: azithromycin or erythromycin
46
“bag of worms”
Varicocele
47
ADDduct + force posterior
| (hips)
BARLOW (first 3 months of life)
## Footnote
Developmental dysplasia of the hip
Diagnosis is made by ultrasound (\< 4 mos of age)
tx: Closed reduction and immobilization in a Pavlik harness
risk: female sex, breech birth position, oligohydramnios, prolonged swaddling, and family history of DDH
48
Type of Hypersensitivity Reaction
* Contact dermatitis (poison ivy/oak)
* TB skin test
* Transplant rejection
Type IV: Cell-mediated (delayed)
Activated T cells against surface bound antigens
49
In addition, an uncorrected left-to-right shunt, such as a ventricular septal defect, atrial septal defect, or patent ductus arteriosus, can eventually become a right-to-left shunt, a phenomenon known as _**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**_\_. This occurs when increased pulmonary blood flow from a left-to-right shunt leads to pulmonary hypertension and compensatory right ventricular hypertrophy, and, over time, right ventricular pressures surpass left ventricular pressures, resulting in a change in direction of the shunt.
**_Eisenmenger’s syndrome_**
50
Which type of fracture of the leg would be concerning for child abuse?
Mid-shaft fracture.
51
The rash typically starts at the hairline, with formation of macules which progress to fluid-filled vesicles (dew drops on a rose pedal).
Varicella
tx: If age \> 12; acyclovir
otherwise, supportive
52
major cause of perinatal bacterial infection+ maternal UTI
Streptococcus agalactiae (Group B Strep/GBS)
tx: penicillin/ ampicillin
53
a skin finding in which the top layers of the skin slip away from the lower layers when rubbed
Nikolsky sign
+ for SJS, TEN, and Staph Scalded Skin Syndrome
54
"steeple sign" (x-ray, PA view)
symmetric narrowing of the trachea.
Croup/ laryngotracheitis
parainfluenza virus
55
chest X-ray shows a "boot-shaped" heart
Cyanotic
harsh systolic crescendo decrescendo murmur along the left mid-to-upper sternal border
Tetralogy of Fallot
tet spell tx: cradling them in a knee-chest position
associated w/ chromosome 22 deletions and DiGeorge syndrome
PROVe:: Pulmonic stenosis, Right ventricular hypertrophy, Overriding aorta, VSD
56
anterior cervical lymphadenitis
Staphylococcus aureus and Streptococcus pyogenes
57
Triad:
1. acute renal failure,
2. thrombocytopenia, and
3. microangiopathic hemolytic anemia
hemolytic-uremic syndrome (HUS)
Escherichia coli O157:H7 infection
All patients with HUS should be hospitalized
58
“double-bubble” sign on abdominal radiograph
characteristic sign of duodenal obstruction
59
"olive shaped mass"
pyloric stenosis
risk= first born, male sex, prematurity, and macrolide antibiotic use (erythromycin)
60
draw triangle
age 6
Age 3: circle
Age 4: plus sign
Age 5: square
Age 6: triangle
61
" afferent pupillary defect "
decreased extraocular movement, pain with movement of the eye and proptosis
Orbital cellulitis
tx=cefuroxime and vancomycin
62
draw square
age 5
## Footnote
Age 3: circle
Age 4: plus sign
Age 5: square
Age 6: triangle
63
subglottic narrowing
croup
64
(hips) flexing the infant’s hips and knees showing uneven knee heights
Galeazzi test (after 3 months)
## Footnote
Developmental dysplasia of the hip
Diagnosis is made by ultrasound (\< 4 mos of age)
tx: Closed reduction and immobilization in a Pavlik harness
65
While SJS typically involves _**\_\_\_\_\_\_\_\_**_ of the body surface, TEN involves _**\_\_\_\_\_\_**_ of the body surface.
While SJS typically involves **_less than 10%_** of the body surface, TEN involves **_more than 30%_** of the body surface.
66
“sandpaper” rash
Begins on face and spreads to trunk/extremities
"Pastia's lines" (accentuation of linear erythema in the skin folds)
Scarlet fever
“Second disease,” is caused by Group A Streptococcus
67
Contraindications to the use of air-contrast enema include
hemodynamic instability with shock, free air under the diaphragm, and peritonitis
68
Organism responsible for bronchiolitis
Respiratory Syncytial Virus (RSV)
dx: Nasopharyngeal swab for fluorescent antibody staining
tx=nasal suctioning/supportive
69
"telescope bowel"
Intussusception
MC location=ileocolic
dx: ultrasound
tx: air/contrast enema
70
female athlete triad
eating disorders, amenorrhea, and osteoporosis
71
"currant jelly stool"
Intussusception
MC location=ileocolic
dx: ultrasound
tx: air/contrast enema
72
tx for gonorrhea/chlamydia
Ceftriaxone 250 mg IM X 1 and azithromycin 1,000 mg PO X 1
73
blood pressure is markedly higher in the arms than legs
skin color is normal
Aortic coarctation
most commonly around the left subclavian artery
dx=echo
associated with Turner's syndrome
74
Type of Hypersensitivity reaction:
* Serum sickness
* SLE
* RA
Type III: Immune complex
IgG and complement activation
75
High fever prodrome --\>erythematous papular rash on his trunk that extends to his extremities, but spares his face and palms. Began on abdomen and spread to arms and legs
## Footnote
***rash that started after the fever went away***
Roseola infantum
(HHV-6) (Human herpes virus 6)
sixth disease
tx: self-limited; supportive
affects CD4 lymphocytes.
76
Reed-Sternberg cells
Hodgkin lymphoma
77
Neonatal conjunctivitis: Age 5 weeks to 5 years
**_Rule of 5 for Neonatal Conjunctivitis_**
_0-5 Days: N. Gonorrhoeae (tx: ceftriaxone)_
* gonorrheal conjunctivitis occurs almost exclusively in the first few days of life. The discharge of gonococcal conjunctivitis is copious, and the eyelids may be so swollen that the conjunctiva cannot be visualized.
_5 days to 5 weeks: Chlamydia trachomatis (tx: Oral erythromycin)_
* Most common cause of neonatal conjunctivitis
* Most common: 5-14 days
* Often the first manifestation of the Chlamydial conjunctivitis is watery discharge, which later becomes mucopurulent. Conjunctival chemosis then develops, and the conjunctiva may become so friable that they may bleed. Eyelid swelling may also develop.
**_5 weeks to 5 years: Streptococcus or Haemophilus influenzae (tx: Erythromycin ointment)_**
_Otherwise: most common cause of neonatal eye discharge is lacrimal duct obstruction (tx: warm compresses and lacrimal duct massage)_
78
coughing and see a period of peri-oral cyanosis
"whooping cough"
posttussive emesis
pertussis
dx; Polymerase chain reaction of nasopharyngeal secretions
tx: azithromycin or erythromycin
79
bright-red “slapped cheek” appearance followed by lacy rash that waxes and wanes over three weeks
Erythema infectiosum
(fifth disease)
Human parvovirus B19
80
draw circle
age 3
## Footnote
Age 3: circle
Age 4: plus sign
Age 5: square
Age 6: triangle
81
A patent ductus arteriosus is actually beneficial in infants with which other congenital heart diseases?
Ductal dependent lesions include transposition of the great vessels, Tetralogy of Fallot, tricuspid atresia, hypoplastic left heart and severe coarctation of the aorta.
82
Neonatal conjunctivitis: Age 0 to 5 days
* discharge is copious, and the eyelids may be so swollen that the conjunctiva cannot be visualized.
**_Rule of 5 for Neonatal Conjunctivitis_**
**_0-5 Days: N. Gonorrhoeae (tx: ceftriaxone)_**
* **gonorrheal conjunctivitis occurs almost exclusively in the first few days of life. The discharge of gonococcal conjunctivitis is copious, and the eyelids may be so swollen that the conjunctiva cannot be visualized.**
_5 days to 5 weeks: Chlamydia trachomatis (tx: Oral erythromycin)_
* Most common cause of neonatal conjunctivitis
* Most common: 5-14 days
* Often the first manifestation of the Chlamydial conjunctivitis is watery discharge, which later becomes mucopurulent. Conjunctival chemosis then develops, and the conjunctiva may become so friable that they may bleed. Eyelid swelling may also develop.
_5 weeks to 5 years: Streptococcus or Haemophilus influenzae (tx: Erythromycin ointment)_
_Otherwise: most common cause of neonatal eye discharge is lacrimal duct obstruction (tx: warm compresses and lacrimal duct massage)_
83
A 2-month-old girl is found to have positive Barlow and Ortolani signs. Which of the follow is the most appropriate diagnostic study?
Ultrasound
84
Which of the following congenital heart diseases would benefit from palivizumab administration?
prevent respiratory syncytial virus (RSV) infections
Cyanotic congential heart disease
(Children with congenital heart disease (CHD))
85
prodrome of fever cough, coryza and conjunctivitis. Followed by a rash that begins on the face and spreads downward and **Koplik spots (**pinpoint grayish spots with surrounding red inflammation found on the lateral buccal mucosa)
Rubeola
Measles
Koplik spots, pinpoint grayish spots with surrounding red inflammation found on the lateral buccal mucosa, can be found at this point in the illness and are pathognomonic for measles.
86
Rib notching(inferior aspect of the rib) is the classic radiographic finding in
Aortic coarctation
most commonly around the left subclavian artery
dx=echo
associated with Turner's syndrome
87
draw plus sign
age 4
## Footnote
Age 3: circle
Age 4: plus sign
Age 5: square
Age 6: triangle
88
The classic finding on X-ray is a “sunburst” pattern
osteosarcoma
89
body mass index (BMI) between 85th and 94th percentile
1. Lipid panel
2. ALT
3. AST
4. fasting glucose
5. CBC
90
A newborn is being evaluated for cyanosis. Physical examination shows a prominent right ventricular impulse and a systolic thrill. A crescendo-decrescendo murmur with a harsh systolic ejection quality is heard along the left upper sternal border. Based on these findings, which of the following is the most likely diagnosis?
Tetralogy of Fallot
91
* Current recommendations to reduce the incidence of and mortality from GBS include screening with vaginal and rectal cultures at the end of the second trimester and between _**\_\_\_\_\_\_\_\_\_**_ weeks of gestation.
* Those women with positive cultures or a GBS urinary tract infection or GBS bacteria should receive intrapartum antimicrobial prophylaxis with intravenous ampicillin.
35 and 37 weeks of gestation
92
What are the most common medications that trigger Stevens-Johnson syndrome?
Sulfa drugs.
