Pediatrics Flashcards
(409 cards)
1
Q
Treatment for tinea capitus
A
- 1st Line: Oral griseofulvin
- topical therapy of 2.5% selenium sulfide or ketoconazole shampoo twice weekly suppresses viable spores
2
Q
Tinea pedis
- mc org
A
Trichophyton rubrum
3
Q
Tinea pedis
- treatment
A
Topical antifungals
4
Q
Tinea corporis
- mc org
A
Trichophyton rubrum
5
Q
Tinea corporis
- treatment
A
- Topical azole antifungals (1% clotrimazole, 2% ketoconazole)
- 1% terbinafine cream applied twice daily for 2–4 weeks
6
Q
Tinea versicolor
- org
A
Malassezia furfur
7
Q
Tinea versicolor
- treatment
A
selenium sulfide 2.5% applied to affected skin for 10 minutes.
8
Q
Do hives blanch?
A
Yes
9
Q
Darier’s Sign
A
localized urticaria appearing where the skin is rubbed
10
Q
Darier’s Sign
A
localized urticaria appearing where the skin is rubbed
11
Q
Epinephrine treatment of anaphylaxis
- Dose adults
- Dose peds
- IM dilution
- IV dilution
A
- Adults 0.3–0.5 mg
- Peds 0.01 mg/kg SC/IV
- IM is 1:1,000 dilution
- IV is 1:10,000
12
Q
Name for genital warts
A
Condyloma acuminatum
13
Q
Name for genital warts
A
Condyloma acuminatum
14
Q
Acute vs. chronic otitis media
A
- acute < 3 weeks
- chronic > 3 months
15
Q
Definition of recurrent otitis media
A
3 episodes in 6 months
or
4 episodes in 12 months
with clearing between episodes
16
Q
Chronic OM
A
- Clear serous fluid in the middle ear without signs or symptoms of ear infection.
- May have hearing loss, may be asymptomatic, does not require antibiotics.
- pseudomonas, s. aureus
17
Q
Acute otitis media
- treatment
A
- First line: Amoxicillin x 10-14 days
- Cefixime in children
- Augmentin is 2nd line
- If PCN allergic give Azithromycin, Erythromycin or Bactrim
18
Q
MCC epiglottitis
A
H. influenzae type B (Hib)
19
Q
MCC epiglottitis
A
H. influenzae type B (Hib)
20
Q
Epiglottitis
- xray sign
A
thumbprint sign
21
Q
Epiglottitis
- treatment
A
- Secure airway: anesthesiology and prepare to establish airway, transfer to OR to perform exam, tracheostomy if necessary to maintain airway
- Admit for observation, humidified O2, IV antibiotics (ceftriaxone + clindamycin), and IV corticosteroids
22
Q
Epistaxis: anterior bleed
- MC location
A
Kiesselbach’s Plexus
23
Q
Epistaxis: posterior bleed
- MC location
A
- Woodruff’s Plexus: sphenopalatine artery
24
Q
Epistaxis: anterior bleed
- treatment
A
- Direct pressure at least 10-15 minutes, seated leaning forward
- Short-acting topical decongestants: oxymetazoline/Afrin, phenylephrine, cocaine
- Anterior nasal packing + antibiotics
25
Epistaxis: posterior bleed
| - treatment
- Posterior balloon
| - Must be admitted to the hospital and prompt consultation with an otolaryngologist is indicated
26
Recurrent epistaxis
| - workup
Must rule out hypertension or hypercoagulable disorder
27
Antiviral for influenza
zanamivir and oseltamivir
28
Treatment for pinworms
mebendazole, albendazole, pyrantel
- single dose, repeat 2-4 weeks
- hand washing
- wash bedsheets
29
Erythema infectiosum
| - causative org
parvovirus B19
30
hand foot and mouth
| - causative org
coxsackie virus
31
Roseola
| - causative org
HHV 6 or 7
32
Roseola
| - clinical presentation
- fever, resolves before rash appears
| - pink, macular rash, blanchable
33
Pneumonia MCC
<1
<2
young adults/college
- RSV
- parainfluenza virus
- mycoplasma pneumoniae, chlamydia pneumoniae
34
What respiratory condition should bulbous myringitis make you think of?
mycoplasma pneumoniae pnuemonia
35
outpatient CAP treatment
- macrolide (clarithromycin or azithromycin)
| - doxycycline
36
bronchiolitis
| - management
- supportive: ensure oxygenation and hydration
- RSV: consider hospitalization and admin of ribavirin, esp if high risk pt (premie, underlying conditions, severely ill)
- nebulizer albuterol, IV fluids, antipyretics, chest physiotherapy, humidified O2
37
croup
| - aka
laryngotracheobronchitis
38
croup
| - MCC causative orgs
- parainfluenza types 1 and 2
- RSV
- adenovirus
- influenza
- rhinovirus
39
croup
| - clinical findings
- harsh, barking, seal-like cough
- inspiratory stridor
- hoarseness
- aphonia
- low-grade fever
- rhinorrhea
40
croup
| - treatment
Mild: hydration, cool humidified air, dexamethasone
Moderate: IM/PO dexamethasone, supportive, +/- nebulized epinephrine
Severe: dexamethasone, nebulized epinephrine, hospitalize (O2 < 92%)
41
how should asthma spirometry respond to albulterol
FEV1 or FVC increase > 12%
42
Asthma
- CXR
- ABG
- hyperinflation
| - hypocarbia: have increased respiratory rate. If normal or high, may be sign of impending respiratory failure
43
Intermittent Asthma
- daytime sx / SABA use
- nighttime sx
- interference with activities
- FEV1
- ≤ 2 days/week
- ≤ 2 times a month
- no interference
- FEV1 >80% predicted
44
Mild persistent asthma
- daytime sx / SABA use
- nighttime sx
- interference with activities
- FEV1
- > 2 days/week, not daily
- 3-4 times a month
- minor
- FEV1 >80% predicted
45
moderate persistent asthma
- daytime sx / SABA use
- nighttime sx
- interference with activities
- FEV1
- Daily
- > once a week, not nightly
- Some interference
- FEV1 60-80% predicted
46
severe persistent asthma
- daytime sx / SABA use
- nighttime sx
- interference with activities
- FEV1
- multiple times daily
- daily
- extremely limited
- FEV1 < 60% predicted
47
Asthma therapy steps
Step 1: SABA
*steps 2-6 SABA plus...
Step 2: Low dose ICS
Step 3: medium dose ICS OR low dose ICS + LABA/montelukast/theophylline
Step 4: medium dose ICS + LABA/montelukast/theophylline
Step 5: high dose ICS + LABA +/- omelizumab
Step 6: high dose ICS + LABA + oral steroid =/- omelizumab
48
Cystic fibrosis
- genetics
- overview
- autosomal recessive
| - abnl production of mucus by almost all exocrine glands = obstruction
49
Cystic fibrosis
| - clinical
- chronic lung dz, bronchiectasis, pancreatitis, infertility
- sx: cough, sputum, dec exercise tolerance, sinus pain, purulent nasal dc, steatorrhea, diarrhea, abd pain
- signs: clubbing of fingers, anteroposterior chest diameter inc, apical crackles
50
Cystic fibrosis
| - dx studies
- ABG: hypoxemia and possible compensated respiratory acidosis
- PFT: mixed obstructive and restrictive
- CXR: hyperinflation, peribronchial cuffing, mucous plugging, bronchiectasis, inc insterstitial markings, etc.
- GS: sweat chloride test (>60 mEq/L) on two diff days, then DNA testing for definitive evidence
51
Hyaline membrane disease
| - aka
respiratory distress syndrome, RDS
52
hyaline membrane disease/RDS
| - general
- MC cause resp distress in preterm infant
| - deficiency of surfactant
53
hyaline membrane disease/RDS
| - dx
- CXR: air bronchograms, diffuse bilateral atelectasis causing a ground-glass appearance, doming of the diaphragm
54
hyaline membrane disease/RDS
| - management
- synchronized intermittent ventilation
| - exogenous surfactants
55
Cyanotic heart defect
right-to-left shunt (skipping the lungs)
56
Four cyanotic heart defects
1. Tetralogy of Fallot
2. Pulmonary atresia
3. Hypoplastic left heart
4. Transposition of the great arteries
57
Tetralogy of fallot
| - define anomoly
- ventricular septal defect
- aortic origination over defect (aortic override)
- right ventricular outflow obstruction
- right ventricular hypertrophy
58
Tetralogy of fallot
| - murmur
crescendo-decrescendo
holosytolic
LSB
radiates to back
59
Tetralogy of fallot
| - physical findings
cyanosis
clubbing
increased RV impulse at LLSB
Loud S2
60
Tetralogy of fallot
| - clinical information
- polycythemia usually present
| - tet spells: extreme cyanosis, hyperpnea, agitation (medical emergency)
61
noncyanotic congenital heart anomalies (5)
1. atrial septal defect
2. ventricular septal defect
3. atrioventricular septal defect
4. patient ductus arteriosus
5. coarctation of the aorta
62
Atrial septal defect
| - MC subtype
osmium secundum
63
Atrial septal defect
| - murmur
- systolic ejection murmur at 2nd LICS
| - early to middle systolic rumble
64
Atrial septal defect
| - physical findings
- failure to thrive
- fatigue
- RV heave
- wide fixed split S2
65
Ventricular septal defect
| - three types
- perimembranous (MC)
- muscular
- outlet openings btwn ventricles
66
Ventricular septal defect
| - murmur
systolic murmur at LLSB
67
Ventricular septal defect
| - physical findings
asx to signs of CHF
68
Patent Ductus Arteriosus
| - describe
- failed or delayed closure of ductus arteriosus between pulmonary artery and aorta - allows placental gas exchange during fetal state, bypasses the lungs
- sx treatment generally not indicated
69
Patent Ductus Arteriosus
| - treatment
IV indomethacin (reduction of prostaglandins)
70
Patent Ductus Arteriosus
| - murmur
continuous (machine like) murmur
71
Patent Ductus Arteriosus
| - physical findings
- wide pulse pressure
| - hyper dynamic apical pulse
72
Coarctation of the aorta
| - describe
narrowed proximal thoracic aorta
73
Coarctation of the aorta
| - murmur
- systolic, LUSB/left intrascapular area
| - may be continuous
74
Coarctation of the aorta
| - physical findings
- infants: CHF
- older: systolic hypertension or underdeveloped lower extremities
- difference between UE and LE blood pressure is pathognomonic
75
Treatment for cyanotic defects prior to surgical correction
- if PDA: prostaglandins to maintain
76
Hypertrophic cardiomyopathy
| - presentation
- dyspnea and angina
- syncope and arrhythmias common
- asx to sudden death
77
Hypertrophic cardiomyopathy
| - dx
- EKG: nonspecific ST- T-wave changes, exaggerated septal Q wave, LVH
- Echo: key to dx. LVH, asymmetric septal hypertrophy, small LV, diastolic dysfunction
78
Hypertrophic cardiomyopathy
| - management
- BB or CCB, disopyramide
- sx or nonsx ablation of hypertrophic septum
- dual-chamber pacing, implantable defibrillators, mitral valve replacement
79
Rheumatic fever
| - describe
2-3 weeks following beta-hemolytic strep pharyngitis
- ages 5-15 MC
- self-limited to progressive valve deformity
80
Rheumatic fever
| - valves affected
- MC: mitral valve
| - also aortic valve
81
Rheumatic fever
| - Jones criteria
2 major
or
1 major + 2 minor
82
Rheumatic fever
| - Major jones criteria
- carditis
- erythema marginatum
- subcutaneous nodules
- chorea
- polyarthritis
83
Rheumatic fever
| - minor jones criteria
- fever
- polyarthralgias
- reversible prolonged PR interval
- rapid ESR
- CRP
84
Rheumatic fever
| - management
- bed rest
- IM penicillin (erythromycin if PCN allergic)
- antipyretics and steroids to reduce joint sx
85
Rheumatic fever
| - prevention
early tx of strep pharyngitis
86
Kawasaki dz
- aka
- etiology
- aka mucocutaneous lymph node syndrome
| - etiology unknown, suspect virus
87
Kawasaki dz
| - presentation
- fever > 5 D
AND 1+:
- conjunctivitis
- lip crack/fissure, strawberry tongue, inflammation oral mucosa
- cervical lymphadenopathy
- polymorphous exanthem
- red/swelling of hands and feet, subsequent desquamation
88
Kawasaki dz
| - cardiac involvment
- worrisome
| - myocarditis, pericarditis, valvular heart disease, coronary arteritis, aneurysms all possible
89
Kawasaki dz
| - Testing for all pts
- 2D echo or angiography to r/o heart involvement
90
Kawasaki dz
| - treatment
- IV immunoglobulin, high dose ASA
- early treatment -> lower chance cardiac involvement
- cardiac involvement: long term ASA and annual f/u
91
Cause of intussusception
- child
- adult
- follows URI
- neoplasm
(proximal goes into distal portion)
92
Intussusception
| - dx
barium or air enema
- diagnostic and therapeutic
- if not, then surgery
93
Vitamin A deficiency
- function
- s/sx
- vision, epithelial cell maturity, infection resistance, antioxidant
- night blindness, dry skin, squamous metaplasia*, bitot's spots*
94
Vitamin C deficiency
- function
- s/sx
- collagen synthesis, hormone function, nt synthesis
| - scurvy: hyperkeratosis, hemorrhage, hematologic (3 Hs)
95
Vitamin D deficiency
- function
- s/sx
- calcium regulation, cell differentiation
| - rickets, osteomalacia
96
Niacin deficiency
- function
- s/sx
- energy, fat metabolism
| - Pellagra: diarrhea, dementia, dermatitis (3 Ds)
97
eosinophilic esophagitis
- associated with what
- clinical
- atopic disease
| - dysphagia, +- reflux or feeding difficulties in children
98
eosinophilic esophagitis
- dx
- management
- endoscopy: normal +- multiple corrugated rings +- white exudate
- remove foods that incite allergic response, inhaled topical corticosteroids
99
Crigler-Najjar syndrome
| - Type 1
no UGT activity = no conversion of indirect to direct bilirubin
- neonatal jaundice with severe progression in the 2nd week, leads to kernicterus
- normal LFTs, indirect bilirubin 20-50 mg/dL
- Tx: phototherapy, plasmapheresis, liver transplant
100
Duodenal atresia
- clinical
- XR findings
- polyhydramnios in pregnancy, inc risk in Downs
- intestinal obstruction shortly after birth, abd distention, bilious vomiting
- double-bubble sign
101
Duodenal atresia
| - management
- decompression fo GI tract
- electrolyte and fluid replacement
- duodenoduodenostomy: repair or anastomosis
102
what is the only childhood exanthem that starts on the trunk?
roseola
103
when do annual blood pressure readings start (age)
3 yo
104
when should intermittent alternating strabismus stop (age)?
6 months
105
when does the rooting reflex stop?
2-3 months
106
by what age should posterior fontanelle close?
2 months (usually closed at birth)
107
What drug is used to treat Lyme disease in kid <8 yo
amoxicillin
108
What level of bilirubin is suspicious for kernicterus?
20-25 mg/dL
| ** encephalopathy
109
Hyperbilirubinemia
< 24 hours old
>24 hours old
< 24 is more worriesome for non-physiologic causes (ABO, Rh isoimmunization, etc.)
110
What maternal blood types can lead to hyperbilirubinemia in the infant?
- O
| - Rh neg
111
Down syndrome
| - dx sx
- hypotonia
- poor Moro reflex
- hypermobility of joints
- flattened facies and occiput
- excess posterior neck skin
- anomalous auricles
- upward-slanting palpebral fissures
- pelvic dysplasia
- dysplasia of middle phalanx of 5th finger
- Simian crease
112
Down syndrome
| - common congenital defect
ASD
113
what should always be considered in neonate presenting with fever
herpes simplex infection
114
herpes simplex meningitis neuro signs
seizures
lethargy
poor feedings
115
Test of choice to confirm CNS herpes simplex
PCR of cerebrospinal fluid
116
Four signs of neonatal herpes simplex infection
1. keratoconjunctivitis
2. vesicular skin rash
3. seizure meningitis
4. sepsis
117
Duodenal atresia
- s/sx
- xray findings
- management
- associated with what
- bilious vomiting w/o abd distention within first days of life
- double bubble sign on XR
- NG or OG decompression, IVF until surgery
- Down's syndrome
118
What RA finding is rarely found in juvenile idiopathic arthritis
rheumatoid factors
119
What are the three types of juvenile idiopathic arthritis?
1. systemic juvenile idiopathic arthritis
2. Oligoarticular juvenile arthritis
3. Polyarticular juvenile arthritis
120
Major clinical manifestation of juvenile idiopathic arthritis
persistent joint swelling that may lead to deformity
121
What is the age range for febrile seizures
6 months to 5 years
122
Definition of simple febrile seizure
- tonic clonic
- less <15 min
- only once w/in a febrile episode
123
Simple febrile seizure RF
- elevated fever
- viral infection
- + fam hx
- recent immunization
124
Treatment for recurrent febrile seizures
- if >5 min, diazepam gel or suppository (one dose)
125
Presentation of CF
- chronic sinopulmonary disease: persistent infection with CF pathogens, chronic cough/sputum, chest xr abnl, airway obstruction, nasal polyps, digital clubbing
- GI and nutritional abnl: meconium ileum, distal GI obstruction, rectal prolapse, pancreatic insufficiency, DM, chronic hepatic dz, FTT, etc.
- salt loss syndromes
- male urogenital abnl
126
CF
| - management
- meds to clear resp secretions (DNase and inhaled hypertonic saline)
- chest physiotherapy
- anti-inflammatories
- nutritional optimization
- exercise as tolerated
- *anti-pseudomonal abx when indicated
127
what two sugars form lactose
glucose
| galactose
128
Prolonged QT syndrome
| - common presentation
syncope
| presyncope, torsades de pointes, sudden cardiac death
129
Prolonged QT syndrome
| - QT interval
>440 milliseconds
130
Prolonged QT syndrome
| - 1st line treatment
beta blockers - blunt paradoxical effects of catecholamine on QT interval
131
concerning sign for pathologic murmur
widely split and fixed S2
132
mastoiditis
| - s/sx
- anteverted ear
| - pain with palp of post auricular area
133
Mastoiditis
| - dx
CT - coalescence of air cells, subperiosteal abscess
134
Mastoiditis
| - management
- sx
- prolonged abx (initial vanc and ceftriaxone)
- possible tympanostomy tubes
135
Effects of fetal coarctation of the aorta in utero
blood flow through PDA bypasses the coarctation, resulting in hemodynamic stability
136
what electrolyte disorder is commonly seen in hyperparathyroidism
hypercalcemia
137
What two meds are known to exacerbate hypercalcemia
- thiazide diuretics
| - lithium
138
Lead testing
- screening
- definitive test
- capillary blood for screening: easier to get but easily contaminated yielding false positives
- venous blood: confirms dx and guides management based on levels
139
common lead poisoning sx
- HA
- joint pain
- constipation
140
Lead poisoning
| - management
- education
- remove lead
- oral succimer
- IV EDTA
* * >45 mcg/dL = chelation
141
CF dx
- test of choice
- another test
- Sweat chloride test
| - Fecal elastase - elevated: indicates malfunction of exocrine pancreas
142
Perforated TM
| - management
* * min hearing loss, no vestibular sx
- ofloxacin drops
- keep ear dr
- f/u primary care in 4 weeks: audiometry to assess hearing loss and healing of TM
143
what type of ear drops are ototoxic
gentamicin - only use if positive TM is not perforated
144
f/u for breech baby with unremarkable exam and no family hx of developmental hip dysplasia
- US of hips at 4-6 weeks
145
developmental hip dysplasia
| - RF
- female
- breech> 34 weeks
- fam history
- tight lower extremity swaddling
146
developmental hip dysplasia
| - testing
- Barlow and Ortolani: subluxation = hip laxity or mild instability
- Galeazzi: unequal height of legs or asymmetrical skin folds
147
developmental hip dysplasia
| - tx for <6 mo
Pavlik harness
148
Hereditary spherocytosis
| - RBCs
biconcave shape
| Howell-jolly bodies
149
Hereditary spherocytosis
| - heredity
autosomal dominant
150
Hereditary spherocytosis
| - PE findings
- splenomegaly
- jaundice
- scleral icterus
- microcytic/normocytic anemia
- reticulocytosis
- ** increased MCHC
- Coombs negative
151
What is cryptorchidism associated with?
low birth weight
| prematurity
152
When do undescended testes usually descend
- by three or four months
- after 6 months, rare to descend further
-
153
Management of undescended testes after four months
surgical orchiopex
154
Complications associated with cryptorchidism
testicular torsion
infertility
malignancy
155
Croup
| - Clinical
- URI sx
- barking, seal cough
- stridor
- sx worse at night
- hypoxia UNCOMMON
156
Croup
| - management
- cool, humidified air
- racemic epinephrine
- corticosteroids (dexamethasone)
157
Acute otitis media
| - abx algorithm
1st line: amoxicillin
2nd line: amox-clavulanate (Augmentin)
3rd line: Cefixime, Cefaclor
4th line: Ceftriaxone
158
Acute otitis media + conjunctivitis
| - mc org
H. influenza
159
Acute otitis media + conjunctivitis
| - abx
Augmentin
160
Non-accidental Trauma
| - suspicious fracture (6)
1. metaphysical fracture (pathognomonic)
2. Rib fx
3. skull fx
4. scapular fx
5. sternal fx
6. transverse long bone fx
161
Injuries suggestive of non-accidental trauma
- bruises and fractures in various stages of healing
- retinal hemorrhage
- cigarette burns
- glove-and-stocking pattern burns
162
Comedonal acne
| - treatment
- topical retinoid
| - azelaic acid/salicylic acid
163
Mild papulopustular and mixed acne
| - treatment
- topical antimicrobial (benzoyl peroxide/abx) and topical retinoid
OR
- benzoyl peroxide and topical abx
164
moderate papulopustular and mixed acne
- topical retinoid
- oral abx
- topical benzoyl peroxide
(all)
165
Severe acne
- topical retinoid AND oral abx AND topical benzoyl peroxide
| - isotretinoin monotherapy
166
Best acne option for pregnant woman
oral erythromycin
167
what test is recommended for children who present with hearing loss
ophthalmology exam - often seen together
168
Medication given as pretreatment for chemo (dt non-hodgkin lymphoma)
benzodiazepines help with n/v
169
Management for child with mild strabismus but no other vision deficits
- observation
| - f/u with ophthalmologist q 6 months
170
Four types of strabismsu
- Esotropia (looks medial)
- Exotropia (looks lateral)
- hypertropia (up)
- hypotropia (down)
171
Tropia vs. phoria
Tropia: manifest strabismus, evident with both eyes uncovered
Phoria: latent strabismus, evident when one eye is covered
172
Physiologic anemia
- MC anemia in young infants 6-9 weeks
- decrease in erythropoiesis dt increased tissue oxygenation
- hgb drops from 14 g/dL newborn to 11 g/dL
173
At what age are hemoglobinopathies generally discovered?
3 and 6 months
| - sickle cell and thalassemia
174
What age is iron deficient anemia usually first seen
not before 6 months
175
Pertussis
| - org
bordetella pertussis
176
Pertussis
| - stages
1. catarrhal: coryza, cough, low energy, lacrimation (1-2 weeks). Most contagious
2. paroxysmal: paroxysms of cough, inspiratory stridor, associated with cyanosis, apnea, emesis. up to 2 months
3. Convalescent phase: sx gradually subside
177
Pertussis
| - infants <4 mo
higher risk of severe illness, mortality
178
Pertussis
| - management
- Azithromycin first line (macrolide)
| - Bactrim second line
179
How to remove insect from ear
1. Kill insect: mineral oil, lidocaine, ethanol
| 2. remove via syringe or alligator forceps
180
Fanconi anemia
- inheritance
- presentation
- autosomal recessive
- pancytopenia and congenital anomalies (hyper or hypo pigmented skin, cafe-au-lait spots, short stature, upper limb abnl, hypogonadism, skeletal abnl, renal malformations, etc.)
181
Fanconi anemia
| - management
- supportive care
- transfusions and abx for infection
- stem cell transplantation
182
Nutritional vitamin D deficiency
- phosphate
- calcium
- PTH
- hyperphosphatemia
- hypocalcemia
- elevated PTH
(due to low calcium levels)
183
Rickets
| - MC cause
Vit D deficiency
| - inadequate mineralization = widened epiphyseal regions, softening bones = bend
184
Rickets
| - clincial
- softened cranial bones
- widened costochondral junctions
- growth plate widening in wrists and ankles
- FTT
- Weakness
- Seizure
185
Meckel's Diverticulum
| - describe
- persistence of omphalomesenteric duct beyond fetal development
- contains all layers of small bowel
186
Meckel's Diverticulum
| - rules of two
- M:F 2:1
- 2% of population
- within 2 feet of ileocecal valve
- 2" in length
- complications usu before age 2
187
Meckel's Diverticulum
| - Complications
painless GI bleeding or obstruction
188
Meckel's Diverticulum
| - dx
nuclear medicine scan: 99m technetium pertechnetate
189
Fetal lung surfactant
- starts production 20 weeks
- gradual increase to 33-36 weeks
- 36+ lrg increase in production
190
Respiratory Distress Syndrome
| - RF
- DM mother
- C-section
- birth asphyxia
191
Respiratory Distress Syndrome
| - decreased risk
- prolonged rupture of membranes
| - prenatally admin steroids
192
Respiratory Distress Syndrome
| - clinical features
- tachypnea
- nasal flaring
- exp grunting
- retractions
193
Respiratory Distress Syndrome
| - management
- mechanical ventilation
| - exogenous surfactant
194
Respiratory Distress Syndrome
| - prolonged ventilator support at risk for?
bronchopulmonary dysplasia
195
Acute cystitis peds
- MC pathogen
- Abx
- e. coli
- cephalosporins, augmentin
- bactrim if PCN allergic
196
Perioral dermatitis
| - management
- 1st line: topical metronidazole and erythromycin
- oral tetracycline
* * avoid steroids!!
197
Treatment for neonatal conjunctivitis
| - gonorrhea
IV aqueous PCN G
198
Treatment for neonatal conjunctivitis
| - chlamydia
PO erythromycin
199
Oral candidiasis
| - tx
- nystatin
- clovtrimazole troches
- po fluconazole
200
RSV is what family of virus
paramyxoviridae
201
Pneumonia
- MCC org neonates (<28 d)
- tx
S. aureus
| - ampicillin + gentamicin or ampicillin + cefotaxime
202
Pneumonia
- MCC org 2wk - 4 mo
- tx
C. trachomatis
| - erythromycin, azithromycin, cefotaxime
203
Pneumonia
- MCC org >6 weeks lobar
- tx
S. pneumoniae
- 1st: amox, clindamycin
- 2nd: ceftriaxone, cefotaxime
204
Pneumonia
- MCC org atypical 6W to 4Y
- tx
- B. pertussis
| - macrolide or clarithromycin
205
Pneumonia
- MCC org atypical >4Y
- tx
- mycoplasma or chlamydia, influenza
| - macrolide, doxy
206
Pneumonia prevention
vaccination with hib and pneumococcal
207
What sx is most sensitive and specific to pneumonia in kids? Rate by age group
tachypnea
- <2 months >60
- 2-12 months >50
- 12 mo - 5 Y >40
- >5 Y >20
208
Pertussis
| - dx
mostly clinical
| - Culture and PCR assays
209
Pertussis
| - tx
- supportive care: bronchodilators, steroids, antihistamines, anti-tussive agents
- Macrolide, bactrim 2nd line
210
SSRIs
| - list
```
Paroxetine
Sertraline
Fluoxetine
citalopram
escitalopram
```
211
SNRI
| - list
duloxetine
| venlofaxine
212
Two SSRI recommended <18 yo
Fluoxetine
| Paroxetine
213
First line med for ADHD
- stimulant: ritalin
214
Psych treatment for <6 yo
behavioral therapy
215
Best medication for bulimia purging
fluoxetine (but watch for cardio ADR)
216
what med has ADR of gingival hyperplasia
phenytoin
217
US findings in torsion of testicular appendage
blue dot sign
218
Marfan findings
- pectus excavatum
- wrist and thumb signs (stretchy)
- aortic root dilation and dissection
219
Ehlers Danlos
| - findings that differentiate from Marfan
- skin laxity
- contractures
- skin nodules
- Easy bruising
220
Other name for mongolian spot
Dermal melanosis
221
Henoch-Schonlein purpura
| - overview
generalized vasculitis of skin, GI, joints, kidney
222
Henoch-Schonlein purpura
| - findings
- palpable purpura: LE and buttocks
- normal platelet count
- colicky abd pain
- intussusception
- heme + stool
- microscopic hematuria, proteinuria, elevated BUN/Cr
- peri-articular disease of knee and ankle
* * Most cases resolve within 6 to 8 weeks, with a recurrence rate of up to 33%.
223
how to confirm dx of appendicitis in pediatrics?
ultrasound: noncompressible, dilated appendix, aperistalsis, target appearance, etc.
224
Erythroblastosis fetalis
transplacental passage of maternal antibody active against paternal RBC antigens of the infant and is characterized by an increased rate of RBC destruction that leads to anemia and jaundice in newborn infants
225
First line treatment for urticaria
Second generation antihistamines: cetirizine, loratadine, fexofenadine
226
necrotizing enterocolitis
- MC neonatal GI emergency
- abdominal XR to dx
- RF: premature
- abd distention, bloody stool, vomiting
- tx: IVF, abx, sx
227
Shigella
| - common complication kids
seizures and high fever
228
Still's murmur
- heard with bell at apex or LLSB
- systolic, ejection, soft/vibratory
- grade 1-2/6
- louder supine
- decreased sitting, standing, inspiration
229
chlamydia trachomatis infant
| - two MCC presentation
- conjunctivitis
| - pneumonia
230
chlamydia trachomatis infant
| - presentation
- 3-16 weeks of age
- nontoxic and is afebrile, but is tachypneic with a prominent staccato cough
- diffuse rales with few wheezes
- CXR: hyperinflation and diffuse interstitial or patchy infiltrates
- Labs: eosinophilia
- Tx: Azithromycin
231
Tx for mod to severe croup
steroids
232
Lyme disease
| - two abx used in children
- amoxicillin
| - doxy
233
Acute epiglottis
| - MC orgs
- h. flu (non immunized)
| - Group A Strep - more common now due to immunization for h. flu
234
Sickle cell with osteomyelitis
| - MCC org
Salmonella spp
| ** overall increased risk of osteomyelitis
235
Burn % of body
- head/neck 9%
- upper limbs 9% ea
- trunk 36%
- lower limbs 18% ea
- genitalia 1%
236
Burn management
- wash with mild soap and water
- cool compress
- water over chemical burn X 20 min
- Acetaminophen, NSAIDs, opioids
- Silver sulfadiazine (silvadine) but not on face
237
When is silvadine CI
sulfa allergy
| pregnant
238
Parkland formula for burn IVF
(% burn)(4 mL)(kg)
| 1/2 first 8 hours, 1/2 next 16 hours
239
Type I allergic reaction
- IgE
- urticaria and angioedema
- immediate
240
Type II allergic reaction
- cytotoxic
- Ab-mediated
- drug+cytotocix antibody = cell lysis
241
Type III allergic reaction
- Ab-Ag complex
- vasculitis, serum sickness
- IgG and IgM
242
Type IV allergic reaction
- delayed, cell mediated
- morbiliform
- erythema multiform
243
Drug eruption
| - management
- Dc drug
- antihistamine oral
- systemic steroids
- IM epinephrine if warranted
244
Erythema Multiforme
| - overview
- Type IV reaction
- MC 20-40 yo
- HSV MC cause, also mycoplasma in children
245
Erythema Multiforme
| - clincal
- target, dull red, vesicle/bullae in middle with pale rim, red halo
- often febrile
246
Impetigo
- MC org
- 2nd MC org
- staph aureus
| - GABHS
247
Mumps
- org
- clinical
- paramyxovirus
| - low grade fever, myalgia, HA --> parotiditis
248
Mumps
| - complications
- orchitis (unilateral)
- oophoritis
- encephalitis
- meningitis
* * MCC pancreatitis in children
249
MMR vaccine
12-15 months and 4-6 years
250
measles
| - org
paramyxovirus
| - rubeola
251
Measles
| - complications
- diarrhea
- otitis media
- pneumonia
- encephalitis
252
Rubella
| - org
Togavirus
253
Rubella
| - clinical
"three day rash"
- low grade fever, cough, anorexia, lymphedema
- pink/light-red spotted maculopapular rash on face -> extremities. More rapid spread vs. measles
- transient photosensitivity and joint pain
254
Rubella
| - congenital defects
- sensorineural deafness
- cataracts
- TTP (blueberry rash)
- Mitral regorge
(part of TORCH)
255
What exanthema is associated with ___ complication in sickle cell / G6PD?
- erythema infectious (Parvovirus B19)
| - aplastic crisis risk
256
Lice
| - treatment
- permethrin topical
- head for 10 min
- pubis and corporis 8-10 hours
- only >2 yo
257
Lichen Planes
- RF
- describe
- Hep C
- purple, polygonal, planar, pruritic papules
- fine scale and irregular borders
258
Lichen Planes
| - management
- topical steroids
- antihistamines
- 2nd line: oral steroids, UVB light, retinoids
259
Scabies
| - management
- permethrin topical neck to feet 8-14 hours, repeat in 1 week
260
Conjunctivitis: Viral
- MCC
- presentation
- tx
- adenovirus (pool MC source)
- red, itchy
- preauricular lymphadenopathy
- watery discharge
- scanty mucoid discharge
- usu bilateral
- slit lamp: punctate staining
- Tx: supportive, antihistamine
261
Conjunctivitis: allergic
- presentation
- tx
- cobblestone mucosa
- itching, red, tearing
- stringy dc
+/- chemises
- topical antihistamines (H1 blockers), olopatadine, pheniramine/naphazoline
262
Conjunctivitis: bacterial
- MC org
- presentation
- MC staph aureus, strep pneumo, h. flu
- purulent dc, lid crusting
- no visual change or ciliary injection
263
Conjunctivitis: bacterial
| - tx
- erythromycin, fluoroquinolone, aminoglycoside topical abx
| - contacts: FQ/aminoglycoside to cover pseudomonas
264
MCC org for neonatal conjunctivitis by time
- day 1: chemical from silver nitrate
- day 2-5: gonococcal
- day 5-7: chlamydia
- Day 7-11 HSV
265
orbital cellulitis
- dx
- tx
- CT (MRI)
| - IV abx (vancomycin, clindamycin, cefotaxime)
266
otitis externa
| - tx
- cipro +/- dexamethasone (ok with TM perf)
| - neomycin/polytrim +/- steroid (not ok with TM perf)
267
AOM
| - MC org
- S. pneumonia (MC)
- m. cat
- h. flu
268
AOM with bullae = ?
mycoplasma pneumonia
269
Weber
- sensorineural
- conductive
- lateralizes to normal ear
| - lateralizes to affected ear
270
Rinne
- sensorineural
- conductive
- AC > BC
| - BC > AC
271
Way to memorize sensorineural
sensoriNeural lateralizes to Normal ear and Normal Rinne
272
peritonsillar abscess
| - progression
tonsillitis > cellulitis > abscess
273
peritonsillar abscess
| - mc org
GABHS, s. aureus, polymicrobial
274
peritonsillar abscess
| - dx
- CT to differentiation from cellulitis
275
peritonsillar abscess
| - management
- abx (ampicillin, clindamycin, PCN, metro)
| - aspiration / I&D
276
Herpes Simplex
| - dx
- PCR most sensitive and specific
| - Tzanck smear
277
Pinworms
| - tx
- albendazole
| - mebendazole
278
Varicella zoster
| - org
HHV-3
279
Varicella
| - presentation
- fever, malaise
- vesicles on an erythematous base (dew drops on a rose petal) in crops
- face and trunk -> extremities
280
Pertussis
| - dx
- PCR nasopharyngeal swab within first 3 weeks of sx (gold standard)
281
Bronchiolitis
| - presentation
- fever
- URI
- progresses to respiratory distress (wheezing, tachypnea, nasal flaring, cyanosis, retractions, +/- rales)
282
Bronchiolitis
| - CXR findings
hyperinflation
| peribronchial cuffing
283
Reye syndrome
- ASA + viral illness
| - rash, vomiting, liver damage, encephalopathy
284
Acute hepatitis AST and ALT
both >500, if viral ALT > AST
285
Hirschsprung dz congenital RF
Down Syndrome
286
Hirschsprung
| - presentation
- meconium ileus ( no meconium in >48 hrs)
- bilious vomiting
- abd distention
- FTT
- toxic megacolon
287
Duodenal atresia
- congenital condition RF
- associated with what
- Down syndrome
| - polyhydramnios
288
Jaundice
| - physiologic timing
- rises day 3-5
| - falls during first week
289
Jaundice
| - indications of pathologic cause
- present within first 24 hours
- persistent 10-14 days
- direct >2
- total >12
290
Jaundice
| - what level is worrisome for kernicterus
>20
291
Jaundice
| - causes of increased indirect
- premature baby
- breast feeding jaundice
- diseases
292
Jaundice
| - causes of increased direct
- infection
- Dubin-Johnson
- Rotor syndrome
293
hypertrophic cardiomyopathy
| - overview
1. hypertrophied septum
| 2. systolic anterior motion of mitral valve and papillary muscle displacement
294
hypertrophic cardiomyopathy
| - murmur
- harsh, systolic crescendo-decrescendo LLSB
- decreases with increased venous return (preserves outflow)
- increase with decreased venous return (valsalva, sit to stand)
295
hypertrophic cardiomyopathy
| - mgmt
- ICD
- avoid dehydration and exertion
- BB (caution with digoxin, nitrates, diuretics)
296
VSD
| - location
- MC perimembranous
- muscular (swiss cheese)
L to R shunt
297
VSD
| - clinical
- small: asx or mild sx
- moderate: sweating/fatigue, esp during feeding (inc SNS dt reduced CO)
- large: severe sx
* restrictive: retained pressure between ventricles (small)
* non-restrictive: pressure equal between ventricles
298
VSD
| - murmur
- loud, harsh holosystolic LLSB
- signs of CHF
- +/- thrill and diastolic rumble at mitral valve due to increased flow
-
299
ASD
| - mc location
- osmium secundum MC
300
ASD
| - clinical
- usu asx until > 30
- recurrent infections
- dyspnea
- FTT
- fatigue
301
ASD
| - murmur
- systolic ejection crescendo-decrescendo at pulmonic
| - wide, split, fixed S2
302
PDA
| - location
descending aorta and pulmonary artery
303
PDA
| - murmur
- continuous machinery murmur at pulmonic
- wide pulse pressure
- bounding peripheral pulse
304
PDA
- to keep open
- to close
- open: prostaglandin (E2)
| - close: indomethacin
305
Coarctation of the aorta
| - location
descending aorta
| ** associated with bicuspid aortic valve
306
Coarctation of the aorta
| - clinical
- 2 HTN
- bilateral claudication
- FTT
- poor feeding
- incr BP UE
- delayed or weak femoral pulse
307
Coarctation of the aorta
| - murmur
- systolic
| - radiates to back/scapula/chest
308
Coarctation of the aorta
- CXR
- GS dx
- rib notching dt increased collateral circulation
- 3 sign
- GS: angiogram
309
Coarctation of the aorta
| - mgmt
- sx
- balloon angio and stent
- prostaglandins pre-op
310
Tetralogy of Fallot
| - shunt type
MC R to L shunt
311
Tetralogy of Fallot
| - four components
1. RV outflow obstruction
2. RVH
3. VSD (lrg, unrestrictive)
4. overriding aorta
312
Tetralogy of Fallot
| - murmur
- harsh, systolic LUSB
| - RV heave
313
Tetralogy of Fallot
| - CXR
boot shaped heart
314
Turner Syndrome
| - clinical
- 1 amenorrhea
- early ovulation failure
- delayed 2nd sex characteristics
- short, webbed neck, edema, low hairline, low-set ears, widely spaced nipples
315
Turner Syndrome
| - assoc with what congenital defect
coarctation of the aorta
316
Simple partial seizure
focal sensory, autonomic, motor sx
| - no LOC
317
complex partial seizure
- aura (sensory, autonomic, motor)
- lip smacking, picking, patting, etc
- yes LOC
318
Absense seizure
MC childhood seizure
| - ethosuximide
319
Febrile seizure
| - simple
- <15 min, tonic-clonic, once in 24 hours
- fever >38
- antipyretics will not prevent
- no anti convulsive tx
- may reoccur
320
Febrile seizure
| - complex
>38 degrees
>15 min or focal or recurs within 24 hours
- phenobarbital, valproic acid
321
Hep B vaccine schedule
0, 2, 4 months
322
what vaccines are given at 2, 4, 6 months
- rotavirus
- DTap
- PCV
- Hib
- Polio
323
when is DTap given
2, 4, 6, 15-18 months
4-6 years
12 years
324
what vaccines are given 12-15 months and 4-6 years
MMR and varicella
325
Hep A vaccine schedule
between 12-23 months
| 6-18 months apart
326
HPV vaccine schedule
11-26 years for F
| 11-21 years for M
327
Meningococcal vaccine schedule
11-12 years
328
MC org meningitis
- neonate
- older
- listeria
| - strep pneumonia, h flu, N. meningitis
329
LP findings in bacterial meningitis
neutrophils
cell # >1000
dec glucose
inc protein
330
bacterial meningitis
| - tx
IV abx
- ampicillin
+/- cefotaxime
+/- vanc
331
LP findings ascetic meningitis
- lymphocytes
- cell # <1000
- nl glucose
- inc protein
332
Panic disorder
| - 3 components
- concern for future panic attack
- concern about implication of panic attacks
- change in behavior to avoid panic attacks
+/- agoraphobia
333
Panic disorder
| - mgmt
- SSRI
- CBT
- benzo for acute management
334
GAD
| - define
- anxiety/worry majority of days about various aspects of life
- > 6 months
- not episodic or focal
335
GAD
| - mgmg
- SSRI
- buspirone
- benzo (ST only)
- CBT
336
MC offender in sexual abuse
- male who knows the victim
337
MC offender in physical abuse
primary female caregiver
| ** hyphema and retinal hemorrhage shaken baby
338
Neglect
- failure to provide the basic needs
| - malnutrition, withdrawal, poor hygiene, FTT
339
Obesity
| - BMI
>30 or body weight >= 20% ideal weight
340
Obesity management
- behavioral mod: exercise, diet, therapy
- SSRI if depression
- Orlistat (dec fat digestion), Lorcaserin (5HT agonist)
- bariatric surgery
341
Anorexia nervosa
| - types
- Restrictive: reduce kcal intake, diet pills
| - purging: vomit, diuretic, laxative, enema
342
Anorexia nervosa
| - BMI
<17.5
| weight <85% ideal weight
343
when to hospitalize anorexia nervosa
- <75% ideal weight
| - medical complications
344
Bulimia nervosa
| - weight
- normal or overweight
345
management for AN and bulimia
- CBT
- SSRI (fluoxetine)
- +/- atypical antipsychotics for AN
346
autism
| - describe
- social interaction difficulties (emotional discomfort, detachment)
- impaired communication
- restricted, repetitive, stereotyped behavior
347
Autism
| - screening
M-CHAT
348
Oppositional defiant disorder
| - overview
- pattern of negative, hostile, defiant behavior to adults
- 6 months or more
1. angry/irritable
2. argumentative/defiant behavior
3. vindictiveness
349
Oppositional defiant disorder
- mgmt
- may progress to what
- CBT
| - conduct disorder
350
Conduct disorder
| - overview
- persistent behavior that deviates from age-appropriate norms and violate the rights of others
- social and academic difficulty
- 40% become antisocial personality
351
Conduct disorder
| - 4 components
1. serious violates of law
2. aggressive, cruel to animals
3. deceitful
4. destruction of property
352
ADHD
| - 3 components
1. inattentiveness
2. hyperactivity
3. impulse control
353
ADHD
- required for dx
- screening test
- must have sx < 12 yo
- must be in 2+ settings (home, school, etc.)
- must occur >6 months
- Vanderbilt to screen
354
ADHD
| - mgmt
- behavioral modification
- sympathomimetic meds (stimulants)
- non stimulants
355
ADHD
| - stimulants
- methylphenidate (Ritalin)
- amphetamine/dextroamphetamine (Adderall)
- MoA: blocks NE and dopamine reuptake
- S/E: anxiety, HTN, tachycardia, weight loss, growth delay, addiction
356
ADHD
| - nonstimulant
- atomoxetine
357
#1 predictive factor for suicide
previous attempt or threat
| ask directly if they have a plan
358
Major depressive disorder
| - define
```
- decreased mood and/or anhedonia for 2+ weeks
and >5 of:
- fatigue
- insomnia
- guilt, etc.
SIGECAPS
```
359
Major depressive disorder
| - mgmt
- CBT
- SSRI min 3-6 weeks
- Add on burporpion or mirtazapine
- 3rd line: TCA, MAO
- Electroconvulsive therapy
360
Legg-Calve-Perthes
- avascular necrosis of femoral head
- MC 4-10 male
- painless limping, worse with activity, end of day
- lose abduction and internal rotation
- XR: Crescent sign
- observation, activity restriction, pelvic ostomy
361
Slipped Capital femoral Epiphysis
- femoral head is posterior and inferior
- hip, knee pain with limp
- external rotation of leg
- Mgmg: ORIF and non weight bearing
362
Osgood Schalter disease
- osteochondritis of patellar tendon at tibial tuberosity
- dt overuse
- MC 10-15 yo active male with growth spurt
- RICE, NSAIDs, quad stretching
363
Scoliosis
- lateral curve >10
- MC F 8-10 onset
- 20-40: brace
- >40 surgery
364
Osteosarcoma
- 90% on metaphysis of long bone (femur, tibia, humerus)
- MC mets to lung
- bone pain, joint swelling
- XR: hair on end/sunburst
- mgmt: sx and chemo
365
Ewing Sarcoma
- giant cell tumor
- MC 5-25
- femur MC, then pelvis
- bone pain, mass, joint swelling
- MC mets to other bone
- XR: layered periosteal layers "onion skin"
- mgmt: sx, chemo, radiation
366
Osteochondroma
- mc benign tumor
- 10-20 male
- pedunculate, grows away from physics
- observation, resection if painful or in pelvis
367
congenital hip dysplasia
| - RF
- fam hx
- breech
- female
- first born
368
congenital hip dysplasia
| - clinical
- unequal thigh folds
- short leg
- painless limp
- ortolani and barlow
- Galeazzi - unequal knee length
- Trendelenburg
369
congenital hip dysplasia
- dx
- mgmt
- PE at birth and WCC until walking
- limited hip adduction when knees at 90 flexion
- Ultrasound
- observation for spontaneous resolution, Pavlik harness, closed reduction
370
Juvenile RA
| - 3 kinds
- Paci-articular
- systemic/acute febrile
- polyarticular
371
Juvenile RA
| - paci-articular
- 50%
- <5 joints
- MC large joints like knee and ankle
- type I assoc with iridocyclitis / anterior uveitis
- Type II assoc with ankylosing spondylitis
372
Juvenile RA
| - systemic/acute febrile
- 20%
- daily arthritis
- diurnal fever
- large and small joints
- salmon/pink rash
373
Juvenile RA
| - polyarticular
30%
- >= 5 small joints
- most similar to adult RA
- risk iridocyclitis
374
Juvenile RA
- dx
- mgmg
- ESR, CRP, ANA (RF only 15%)
- NSAIDs, steroids, methotrexate, leflunomide
- eye exams
375
Insulin
- rapid acting
- short acting
- intermediate acting
- long acting
- Humalog and Novolog
- Regular
- NPH
- Levemir and lantus
376
hypercalcemia
| - lab findings
- increased ca
- increased PTH
- decreased phosphate
377
hypercalcemia
| - clinical
- stones, bones, groans, psych overtones
| - decreased DTR
378
Hyperthyroid
- MCC graves
- TSH receptor antibodies increase thyroid hormone synthesis
- sign: pretibial myxedema
- dx: thyroid-stimulating ab, red TSH, inc T4
- RAIU increased uptake
379
hyperthyroid
| - mgmt
- radioactive iodine
- methimazole/PTU
- BB for sx
- thyroidectomy
380
Cretinism
| - cause
- congenital hypothyroid
| - dt maternal hypothyroid or infant hypopituitarism
381
Cretinism
| - clinical
- macroglossia
- hoarse cry
- coarse facial features
- umbilical hernia
- weight gain
- mental development issues
* levothyroxine to treat
382
Anemia
| - lab
- dec ferritin
- inc TIBC
- dec serum iron
- dec transferrin saturation
383
Anemia
| - lead poisoning
- sideroblastic anemia
- basophilic stippling
- increased serum lead and iron
- XR: lead lines at metaphyseal plates
- screen 9-12 mo and 24 months
384
Thalassemia
| - overview
- reduced production of globin chains
- normal or increased iron
- suspect if anemia doesn't respond to iron treatment
385
Thalassemia
| - alpha overview
- decreased alpha globin production
- Asian
Alleles affected:
1: asx
2: mild microcytic anemia
3: similar to beta-thalassemia
4: hydrops fettles, still birth
386
Thalassemia
| - alpha dx
folate, avoid oxidative stress, no Fe supplements
387
Thalassemia
| - beta overview
- reduced beta chains, increased alpha chains
- B-thal. trait (minor): usu asx, mild ot mod anemia
- B-thal major (Cooleys): asx at birth, sx start about 6 months
388
Thalassemia
| - beta major clinical
- frontal bossing and maxillary overgrowth dt extra medullary hematopoeisis
- hepatosplenomegaly
- severe hemolytic anemia
389
Beta Thalassemia
| - dx
- electrophoresis
Minor: increased HgbF, decreased HgbA
Major: major inc HgbF, little to no HgbA
390
Thalassemia
| - mgmt
- blood transfusions
- vitamin C and folate supplementation
- iron chelation
391
Sickle Cell
| - signs
- dactylitis (digital swelling)
- osteomyelitis (salmonella**)
- functional asplenia
392
Sickle cell
| - dx
- sickled RBC
| - Howell-jolly bodies
393
Sickle cell
| - mgmg
- pain: O2 and IVF
- folic acid
- immunizations: SHiN (s. pneumo, Hib, influenza, N. meningitis)
394
Hemophilia A
- Factor 8
- MC, almost only males
- Intrinsic pathway (PTT)- normal platelets but increased PTT
- hemarthrosis, hemorrhage
- Factor 8 infusion, DDAVP
395
Hemophilia B
- Factor 9
- clinically similar to A
- Factor 9 infusion, DDAVP not used
396
Hodgkin lymphoma
Bimodal: peak at 20 and >50
- Epstein-barr virus association
- upper body lymph nodes
- painless lymphadenopathy
- Reed-Sternberg cells
- mediastinal lymphadenopathy
397
Non-hodgkin lymphoma
- peripheral lymph nodes
| - usually older people
398
Acute lymphocytic leukemia
- malignancy of lymphoid stem cells in bone marrow
- peak age 3-7
- RF down syndrome
- Clinical: pancytopenia (fever MC)
- CNS sx: HA, vision change, etc.
- Dx: bone marrow hyper cellular with >20% blasts
- chemo
399
Brain tumor
60% infratentorial
- pilocytic astrocytoma MC overall: benign
- medulloblastoma MC malignant
400
Cystitis
| - mgmt
- nitrofurantoin
- bactrim
- <2 : cefixime
401
Cystitis
| - RF
- vesicourethral reflux
- DM
- catheter
- UA: pyuria, leukocyte esterase, nitrites
402
Enuresis
- def
- mgmt
- bedwetting > 5 w/o infection
| - behavioral (motivation, bladder training, fluid restriction), enuresis alarm, desmopressin, TCA last resort
403
Hypospadias
| - mgmt
- do not circumsize
- bilateral US to eval for ascending pathology
- pediatric urologist referral
404
Vesicourethral reflux
- mislocated or incompetent uterovesical valves
- RF: recurrent UTI, weakness of trigone
- F>M
- bedwetting, renal insufficiency, HTN, proteinuria
- Dx: VCUG, renal US
- magma: spont resolution common, ACE/Arb HTN, abx prophylaxis for UTI
405
Post streptococcal glomerulonephritis
| - 3 sx
- hypertension
- hematuria
- peri-orbital edema
406
Bacterial tracheitis
| - mcc org
staph aureus
407
how long can an ingested blunt object be observed before must be removed?
24 hours
408
Breast milk jaundice vs. breastfeeding jaundice
- Breastmilk: factor in milk increases enterohepatic recirculation of bilirubin. Onset later half first week of life, peak bilirubin about 2 weeks. Baby feeds, voids, grows, normal development
- Breastfeeding jaundice: Suboptimal milk intake by baby. Decreased urine output, excessive weight loss, sleepiness, and decreased skin turgor, prolonged duration of meconium,
409
When should infant regain birth weight
2 weeks
