Pediatrics Flashcards
(248 cards)
1
Q
Do you suction the nose first or do the cord ABG?
A
Suction
2
Q
How many weeks defines a term neonate?
A
38
3
Q
How many weeks defines late preterm?
A
34-37
4
Q
What’s a normal RR in a neonate?
A
40-60 breaths/min
5
Q
What’s a normal HR in a neonate?
A
120-160 beats per minute
6
Q
T/F: a low score on the Apgar is not associated with future cerebral palsy?
A
True
7
Q
What are the 5 criteria of the apgar scoring?
A
- Appearance
- Pulse
- Grimace
- Activity
- Respiration
8
Q
What’s the most likely cause of conjunctivitis at 1 day after birth?
A
Chemical irritation
9
Q
What’s the most likely cause of conjunctivitis at 2-7 days after birth?
A
Neisseria gonorrhoeae
10
Q
What’s the most likely cause of conjunctivitis at 7+ days after birth?
A
Chlamydia trachomatis
11
Q
What’s the most likely cause of conjunctivitis at 3+ weeks?
A
Herpes
12
Q
What’s the mnemonic to remember the causes of newborn conjunctivitis by time after birth?
A
My chemical romance is gone with the track, herpes
13
Q
What’s a cause of intracranial bleeding 1 week after birth?
A
Vit K deficiency (if didn’t receive the shot at birth)
14
Q
What’s the most common intraocular malignancy of childhood?
A
Retinoblastoma
15
Q
Is Rb a tumor suppressor?
A
Yes
16
Q
Which chromosome is Rb on?
A
Chromosome 13
17
Q
How does retinoblastoma present?
A
White reflex in a child under age 3
18
Q
What will show up on dilated opthalmologic exam in retinoblastoma?
A
White retinal mass with friable consistency
19
Q
Do you biopsy retinoblastoma?
A
No, there is risk of seeding
20
Q
How do anesthetics affect the neonate?
A
Respiratory and CNS depression
21
Q
How do barbiturates affect the neonate?
A
Respiratory and CNS depression, dilated pupils
22
Q
How does magnesium sulfate affect the neonate?
A
Respiratory depression
23
Q
How do sulfonamides affect the neonate?
A
Displaces bilirubin from albumin
24
Q
How do NSAIDs affect the neonate?
A
Premature closure of the PDA
25
How does warfarin affect the neonate?
Facial dysmorphism and chondrodysplasia
26
How does isotretinoin affect the neonate?
Facial and ear anomalies, congenital heart disease
27
How does phenytoin affect the neonate?
Hypoplastic nails, IUGR
28
How does DES affect the neonate?
Clear-cell adenocarcinoma of the vagina or cervix
29
How does tetracycline affect the neonate?
Enamel hypoplasia, discolored teeth
30
How does valproate/carbamazapine affect the neonate?
Intellectual disability, neural tube defects
31
How do ACE inhibitors affect the neonate?
Craniofacial abnormalities
32
What bacteria normally helps make vitamin K and clotting factors?
E coli
33
What's the inheritance pattern of G6PD deficiency?
XLR
34
What's the inheritance pattern of PKU?
AR
35
What's the treatment of PKU?
Special diet low in phenylalanine
36
What's the treatment of galactosemia?
Cutting out all lactose-containing products
37
What's the inheritance pattern of CAH?
AR
38
What are the 3 main infectious contraindications to breastfeeding?
1. HIV
2. TB
3. Herpes of the nipple
39
Is splenomegaly a normal finding in newbors?
Yes
40
What dx presents with tachypnea within a couple hours of delivery, resolves within 1-5 days?
TTN
41
What dx presents with tachypnea in preterm infants?
RDS
42
If tachypnea in a newborn lasts more than 4 hours, what should be tested?
Blood and urine cultures
43
Is an egg allergy a contraindication to MMR, yellow fever, or influenza vaccine?
No
44
Is a reaction to a previous DPT with fever, or a FH of seizures or SIDS contraindication to vaccinations?
No
45
What's the diff between caput succedaneum and cephalohematoma?
Caput is not caput (it crosses suture lines)
46
Which spinal cord level is Erb palsy?
C5-C6
47
Which spinal cord level is claw hand?
C7-C8 +/- T1
48
Can claw hand also have Horner's syndrome?
Yes
49
What are the 2 causes of polyhydramnios?
1. Werdnig-Hoffman
| 2. Intestinal atresia
50
What are the 2 main causes of oligohydramnios?
1. Renal agenesis/Potter sequence
| 2. Prune belly (lack of abdominal muscles)
51
What neonatal syndrome causes airway obstruction and appears as patchy infiltrates and flattening of diaphragm on CXR?
Meconium aspiration syndrome
52
Which neonatal dx occurs in premies and presents with abdominal distension, bilious vomiting, rectal bleeding, and diarrhea, with crepitus?
Necrotizing enterocolitis
53
What's the tx for necrotizing enterocolitis?
NG tube, broad spectrum abx, surgery if needed
54
T/F: diaphragmatic hernia can cause respiratory distress in premies?
True, it's different from a hiatal hernia in adults
55
What dx is a defect in which intestines and organs form beyond the abdominal wall with a sac covering?
Omphalocele
56
What syndrome is omphalocele associated with?
Edwards (trisomy 18)
57
What 2 things does elevated AFP mean?
1. Neural tube defects
| 2. Abdominal wall defects
58
T/F: 90% of umbilical hernias close by age 3?
True; if not, surgery is needed
59
What dx is a wall defect lateral to midline with intestines and organs forming beyond the abdominal wall but without any sac covering?
Gastroschisis
"Gasp that's bad"
60
What dx is a large, palpable abdominal mass due to hemihypertrophy of one kidney?
Wilms tumor
61
What's the most common abdominal mass in children?
Wilms tumor
62
What's the best initial study for Wilms tumor?
US
63
What's the tx for Wilms tumor?
Total nephrectomy with chemo and radiation
64
What dx is an adrenal medulla tumor similar to pheochromocytoma but with fewer cardiac presentations, with increased vanillyl mandelic acid and metanephrines on urine?
Neuroblastoma
65
What congenital dx is characterized by overriding aorta, pulmonary stenosis, RVH, and VSD?
Tetralogy of Fallot
66
What murmur is present in Tetralogy of Fallot?
Holosystolic murmur at LLS border
67
What does a CXR show in Tetralogy?
Boot shaped heart
68
How does squatting help in Tetralogy?
Increased preload and increased SVR (decreased R to L sunt and decreased pulmonary resistance)
69
Which 3 trisomies commonly have VSD?
1. Trisomy 21
2. Trisomy 13
3. Trisomy 18
70
There are only 3 holosystolic murmurs:
1. Mitral regurgitation
2. Tricuspid regurgitation
3. VSD
71
What dx presents with early, severe cyanosis, single S2, and egg on a string on CXR?
Transposition of the Great Vessels
72
How do you treat Transposition of the Great Vessels?
PG E1 to keep ductus open and 2 surgeries
73
What's the prognosis for Transposition of the Great Vessels?
Poor, only 1 in 4 will survive the surgeries
74
What does pulsus alternans signify?
LV systolic dysfunction
75
Which dx presents with gray cyanosis (rather than blue), single S2, hyperdynamic precordium, and a globular shaped heart with pulmonary edema?
Hypoplastic L Heart Syndrome
76
What's the tx for Hypoplastic L Heart Syndrome?
3 surgeries or a heart transplant
77
What dx occurs when a single trunk emerges from both L and R ventricles and gives rise to all major circulations?
Truncus arteriosus
78
What dx presents with severe dyspnea after birth and early and frequent respiratory infex, as well as single S2 and a systolic ejection murmur?
Truncus arteriosus
79
What's the tx for truncus arteriosus?
Surgery
80
What will happen if surgery is not performed in truncus arteriosus?
Pulmonary HTN
81
What dx causes no venous return between pulmonary veins and the L atrium, and oxygenated blood instead returns to the SVC, dx with echocardiogram and tx with surgery?
Total anomalous pulmonary venous return
82
What dx presents with severe cyanosis in a newborn with CXR showing decreased pulmonary flow and EKG showing L axis deviation?
Tricuspid valve atresia
83
What's the tx for tricuspid valve atresia?
PG E1, surgical aortopulmonary shunt
84
What type of hypertrophy occurs due to VSD?
RV hypertrophy
85
Is pansystolic the same as holocystolic?
Yes
86
Do VSD's usually close?
Yes within 1-2 years
87
If it doesn't close, do VSD's need surgery?
Yes
88
What defect can clots pass through in the heart and cause stroke?
ASD
89
Do ASD's need to be fixed?
Yes if symptomatic but most close on their own
90
How do you close a PDA?
Indomethacin
91
What does a pear shaped heart on CXR indicate?
Pericardial effusion
92
What does a boot-shaped heart on CXR indicate?
Tetralogy of Fallot
"Tetra is a boot maker"
93
What does a jug handle appearance on CXR indicate?
Primary pulmonary artery HTN
"Bring a jug of PAH to the lab?
94
What does a "3"-like appearance or rib notching on CXR indicate?
Coarctation of the aorta
'3 Coarctee"
95
What genetic condition often includes a coarctation of the aorta?
Turner's syndrome
96
What syndrome presents with cardiac problems and hearing loss?
Congenital long QT syndrome
97
What's the best medication for long QT syndrome?
B-blocker
98
What condition presents with some of the following: migratory polyarthritis, carditis, erythema marginatum, chorea, fever, elevated ESR?
Rheumatic fever
99
What congenital heart defect has a downwardly displaced tricuspid valve into the R ventricle and is associated with maternal lithium use?
Ebstein anomaly
100
Why does the Ebstein anomaly have a holosystolic murmur?
Tricuspid regurgitation
101
What dx presents with respiratory sx that improve with neck extension including biphasic stridor, and a statement from parents that their child is a noisy breather?
Vascular ring
102
Do vascular rings need surgical correction?
Yes
103
When is newborn hyperbilirubinemia considered pathological?
1. Appears on first day of life
2. Rises >5/day
3. Rises above 19.5 in a term child
4. Direct bili rises above 2 at any time
5. Persists after 2nd week of life
104
What structure in the brain is involved with deposits of bilirubin in untreated hyperbilirubinemia, causing kernicterus?
Basal ganglia
105
Does kernicterus cause seizures and hearing loss?
Yes
106
```
Conjugated or unconjugated bili:?
UTI
Gilbert
Crigler-Najjar
Hemolysis
Spherocytosis
G6PD deficiency
```
Unconjugated (indirect)
107
Conjugated or unconjugated bili:?
| Cholestasis
Conjugated (direct)
108
What's the tx for infants with bilirubin encephalopathy or failure of phototherapy?
Exchange transfusion
109
What type of gaze palsy is associated with kernicterus?
Upward gaze palsy
110
What dx is caused by the Uridine diphosphoglucoronic glucoronosyltaransferase 1A1 gene?
Gilbert syndrome
111
What's the most common complication of esophageal atresia with tracheoesophageal fistula?
Aspiration pneumonia
112
What dx presents with vomiting with first feeding, or choking/coughing and cyanosis?
Esophageal atresia
113
What's the best test to diagnose esophageal atresia?
CXR
114
What's the tx for esophageal atresia
2-step surgical repair
115
What dx presents with infant projectile vomiting and palpable abdominal mass?
Pyloric stenosis
116
What dx will reveal a succession splash on auscultation of the stomach?
Pyloric stenosis
117
What is low chloride and low potassium metabolic alkalosis usually caused by?
Vomiting
118
What dx has string sign on upper GI series?
Pyloric stenosis
119
What dx has donut sign?
Intussusception
120
What dx has bird's beak sign?
Achalasia or volvulus
121
What dx has steeple sign?
Croup
122
What is olive sign?
A palpable mass in pyloric stenosis
"Mike Stennis loves olives"
123
What's the best initial test for pyloric stenosis?
US
124
Does pyloric stenosis require surgical myotomy?
Yes
125
What dx presents with a child turning blue during feeding and pink when crying?
Choanal atresia
126
What syndrome often goes along with choanal atresia?
CHARGE syndrome
127
How is choanal atresia treated?
Surgery to perforate the membrane between the pharynx and the nostrils
128
What does CHARGE stand for?
```
Coloboma of the eye
Heart defects
Atresia of the choanae
Retardation of growth
Genital urinary defects
Ear anomalies
```
129
What dx is a congenital lack of innervation of the distal bowel by the Auerbach plexus?
Hirschsprung disease
130
The lack of innervation of the distal bowel in Hirschsprung disease causes a constant _________ of muscle tone?
Contracture
131
How does Hirschprung normally present?
No passing of meconium for >48 hours or full failure to pass it (usually it happens within 24 hours)
132
What will x-rays show in Hirschprung?
Distended bowel loops with lack of air in rectum
133
What will manometry show in Hirschprung?
High pressures in the anal sphincter
134
What will full thickness biopsy show in Hirschprung?
Lack of ganglionic cells in the submucosa
135
What's the tx for Hirschprung disease?
3 step surgery
136
What anal condition has a high association with Down syndrome?
Imperforate anus
137
What dx has a double bubble on CXR?
Duodenal atresia
138
What dx presents with onset of biliary vomiting within the first 12 hours of birth?
Duodenal atresia
139
What's the tx of duodenal atresia?
Surgical duodenostomy
140
What area of the intestine does volvulus normally occur?
Ileum
"That volvo is ill"
141
What 2 risk factors is intussusception associated with?
1. Rotavirus vaccine
| 2. HSP
142
What type of stool is associated with intusussception?
Currant jelly
143
T/F: a sausage-shaped mass can be palpated in the upper R quadrant in intussusception?
True
144
What's the best initial test for intusussception?
US
145
What are the most important initial steps for any GI issue?
Fluid resuscitation and balancing electrolytes if needed
146
What's the best tx for intusussception?
Air or barium enema
147
What dx presents with massive painless bright red blood per rectum in a male child under age 2?
Meckel diverticulum
148
What's the most accurate test for Meckel diverticulum?
Tech99m scan
"Meck 9"
149
What 3 conditions cause bilious vomiting in the infant?
1. Duodenal atresia
2. Volvulus
3. Intussusception
150
Meckel diverticulum contains _____ layers of the bowel?
All
151
How do you differentiate between Rotavirus, Adenovirus, and Norwalk diarrhea?
Rotavirus occurs in the winter and is the most common type; Adenovirus is year-roun, both of those two are <7 days and have fever and emesis; Norwalk is explosive with cramping pain and short-lived (1-2 days)
152
What does air in the bowel wall often mean?
Necrotizing enterocolitis
153
If necrotizing enterocolitis is suspected, what's the best first treatment?
Vancomycin, metronidazole, or gentamicin
154
T/F: infants of diabetic mothers can be born with hypoglycemia?
True; remember that the answer is not insulin!
155
What 5 findings can be present in infants with diabetic mothers?
1. Macrosomia
2. Small L colon
3. Cardiac problems
4. Renal vein thrombosis
5. Metabolic findings and effects
156
What are the 3 forms of CAH?
1. 21-hydroxylase
2. 17-a-hydroxylase
3. 11-beta-hydroxylase
157
What dx presents with a hypotensive or hypertensive child with severe electrolyte abnormalities?
CAH
158
What are the effects of CAH on genitals of males and females?
Females: ambiguous
Males: Normal
159
What's the tx for CAH?
Fluid and electrolyte replacement plus lifelong steroids
160
Which CAH has hypotension?
21
"When you're 21 you drink and pass out and you get low BP"
161
Which CAH has elevated aldosterone?
17-a-hydroxylase
| "17-aldosterone-hydroxylase"
162
Which CAH's have decreased cortisol?
All 3
163
Which CAH has decreased hormone levels?
17-a-hydroxylase
| "When you're 17 your hormones start decreasing"
164
Which 2 CAH's have virilized female sex characteristics at birth and normal male?
11 and 21
165
Which CAH has normal female sex characteristics at birth and pseudo-hermaphrodite male?
17
166
Which dx has beading of the ribs on CXR and bowing of tibia?
Rickets
167
Which pediatric MSK disease has click or clunk in the Ortolani and Barlow maneuver?
Congenital hip dysplasia
168
What's the tx for congenital hip dysplasia?
Pavlik harness
169
Which pediatric MSK disease has a painful limp and x-rays show joint effusions and widening?
Legg-Calve Perthes disease (avascular necrosis of femoral head)
170
What's the tx for Legg-Calve Perthes?
NSAIDS and bilateral surgery
171
Which pediatric MSK disease has an externally rotated leg and x-ray shows widening of the joint space?
Slipped capital femoral epiphysis
172
What's the tx for slipped capital femoral epiphysis?
Internal fixation with pinning
173
What dx presents in a child with recent loss of appetite, intermittent abdominal pain, decreased sleep at night, learning disabilities, and behavioral problems?
Lead poisoning
174
What's the best initial test for lead poisoning?
Capillary blood finger-stick
175
At what level is intervention needed for lead poisoning?
>10
176
What's the treatment for severe lead poisoning (>70)?
IV dimercaprol/BAL
177
What's the treatment for moderate lead poisoning (45-69)?
Oral succimer as inpatient
178
What's the treatment for mild lead poisoning (<45)?
Lifestyle change and outpatient follow-up
179
What dx presents in a young athlete with chronic pain over the tibial tubercle, caused by repeated knee extension?
Osgood-Schlatter Disease
180
What's the prognosis for Osgood-Schlatter?
Usually resolves in 1-2 years with PT
181
What dx presents with repeated fractures, blue sclerae, and early deafness?
Osteogenesis Imperfecta
182
What's the most accurate test for osteogenesis imperfecta?
Skin biopsy analyzed for collagen synthesis
183
Is there a cure for osteogenesis imperfecta?
No
184
What type of bone cancer shows up on x-ray as an onionskin pattern due to lytic lesions, is tested for a t(11;22) translocation, and treated with a multidrug chemotherapy/radiation?
Ewing sarcoma
185
What type of bone cancer shows up as sclerotic destruction causing a sunburst appearance on x-ray and treatment includes chemo/surgery?
Osteogenic sarcoma
186
What type of bone condition shows up on x-ray as round central lucency with a sclerotic margin, treated with NSAIDS for pain because it will resolve on its own?
Osteoid osteoma
187
What type of JIA causes a fever for 2+ weeks along with inflammation in one or more joints?
Systemic-onset JIA
188
What type of JIA spares the hip and causes uveitis, especially if ANA is positive, and requires an eye exam every 3 mos if ANA+?
Oligoarticular JIA
"Oligo sounds like eye"
189
Which chromosome is Marfan syndrome on?
15
190
What's the inheritance pattern of Marfan syndrome?
AD
191
What should be done at the time of diagnosis of Marfan's and then again 6 months later?
Transthoracic echocardiogram
192
What dx presents with the following 5 criteria:?
1. Rash
2. Mucositis
3. Edema or erythema of hands/feet
4. Cervical LAD
5. Limbic-sparing bilateral conjunctivitis
Kawasaki disease
193
What's the tx for Kawasaki?
IVIg and aspirin
194
Do you give steroids for Kawasaki?
No, they increase aneurysm formation
195
What are the two most common causes of neonatal sepsis?
1. Pneumonia
| 2. Meningitis
196
What are the 4 most common organisms causing neonatal sepsis?
1. GBS
2. E. coli
3. S. aureus
4. Listeria monocytogenes
197
What 2 abx treat neonatal sepsis?
1. Ampicillin
2. Gentamicin
"Kids get amped so you need to treat them gently"
198
What are the TORCHes infections?
```
Toxoplasmosis
Other infex such as Syphilis
Rubella
CMV
Herpes simplex virus
```
199
Which torch infex presents with chorioretinitis, hydrocephalus, and multiple ring-enhancing lesions on CT?
Toxoplasmosis
200
What's the tx for toxoplasmosis?
Pyrimethamine & sulfadiazine
201
Which torch infex presents with a rash on the palms and soles, snuffles, frontal bossing, Hutchinson 8th nerve palsy, and saddle nose?
Syphilis
202
What's the tx for syphilis?
Penicillin
203
Which torch infex presents with PDA, cataracts, deafness, hepatosplenomegaly, thrombocytopenia, blueberry muffin rash, and hyperbilirubinemia?
Rubella
204
What's the tx for Rubella?
Supportive care
205
Which torch infex presents with periventricular calcifications with microencephaly, chorioretinitis, hearing loss, and petechiae?
CMV
206
What's the best tx for CMV?
Ganciclovir with signs of end organ damage
207
Which torch infex presents with the following pattern of sx:?
Week 1: shock and DIC
Week 2: vesicular skin lesions
Week 3: encephalitis
Herpes
208
What's the best tx for Herpes?
Acyclovir
209
Which red rash of childhood presents with multiple highly priuritic vesicles starting on the trunk and progressing to face, possible fever, an is dx by Tzanck smear showing multinucleated giant cells?
Varicella (VZV)
210
Which red rash of childhood presents with cough, stuffy nose, and grayish spot on buccal surface; begins on head and moves down?
Measles (rubeola; paramyxovirus)
211
Which red rash of childhood starts with fever and URI and progresses to rash with slapped cheek appearance?
Fifth disease (erythema infectiosum; parvovirus B19)
212
Which red rash of childhood starts with fever and URI and progresses to diffuse rash?
Roseola (HSV 6 & 7)
213
Which red rash of childhood starts with fever and progresses to parotid gland swelling with possible orchitis?
Mumps (paramyxovirus)
214
What's the tx for all red rashes of childhood?
Supportive care
215
Which 2 main conditions can cause strawberry tongue?
1. Kawasaki
| 2. Scarlet fever
216
What organism is scarlet fever caused by?
Strep pyogenes
217
Does the rash of scarlet fever blanch easily?
Yes
218
Which red rash of childhood presents with pink macules and papules that begin at head and move down, followed by desquamating trunk rash and postauricular LAD?
Rubella
219
Which 2 red rashes of childhood start on the face and move down?
1. Measles
| 2. Rubella
220
Which 1 red rash of childhood starts on the trunk?
Varicella
221
Which 2 rashes have vesicles on the palms and soles?
1. Syphilis
| 2. Hand-foot-mouth
222
Which red rash of childhood has oval shaped vesicles on palms and soles and ulcers in oral mucosa?
Hand-foot-mouth (Coxsackie A)
223
What are the 3 most common organisms causing meningitis in the newborn 0-6 mos?
GBS
E coli
Listeria
"Newborn brains are like GEL"
224
What are the 4 most common organisms causing meningitis in children 6 mos-6 years?
S pneumo
H influe
Enteroviruses
N meningitidis
"SHEN"
225
What are the 4 most common organisms causing meningitis in people age 6 years-60 years?
S pneumo
HSV
Enteroviruses
N meningitidis (teens)
"SHEN with a different H because now that they are older they have herpes"
226
What are the 3 most common organisms causing meningitis in older adults age 60+?
Gram negative rods
S pneumo
Listeria
"Gramma is negative in her old age and SL"
227
What dx presents with muffled voice, deviated uvula, and decreased or painful ROM of neck/jaw?
Retropharyngeal abscess
228
Which dx presents with a seal-like barking cough and a steeple sign?
Croup
"The old-fashioned kids with croup go to the church"
229
What's the way to dx croup?
Clinically; you don't need to do an x-ray
230
How do you differentiate croup from epiglottitis?
Croup has hypoxia
231
What's the tx for mild croup?
Steroids
232
What's the tx for moderate and severe croup?
Racemic epinephrine
233
What dx presents with a fever, hot potato voice, drooling in the tripod position, and refusal to lie flat, and x-rays reveal a thumbprint sign?
Epiglottitis
234
What vaccine prevents epiglottitis?
HiB
235
What dx presents with 14 days of severe congestion, followed by severe coughing episodes with an inspiratory whoop followed by vomiting, and then 14 more days of a decreased frequency of cough, with a butterfly pattern on CXR?
Whooping cough (Bordatella pertussis)
236
What's the best tx for whooping cough?
Erythromycin or azithromycin in the first 14 days, afterward it doesn't help
237
Which dx presents with gray highly vascular pseudomembranous plaques on the pharyngeal wall?
Diptheria
238
What's the tx for diptheria?
Antitoxin
239
What's the immediate tx for acute pediatric seizure?
Lorazepam or diazepam
240
What's the tx for absence seizure?
Ethosuximide
241
What's the tx for seizures presenting with jerky movements in the morning with irregular spike and wave pattern?
Valproic acid
242
What dx presents with infantile spasms during the first year of life?
West syndrome
243
What's the tx for West syndrome?
ACTH
244
What's the tx for a partial seizure?
Carbamazepine
"Only eat part of your carbs"
245
What's the tx for a generalized seizure?
Valproic acid
246
Which vitamin deficiency presents with Wernicke's and Beriberi?
B1 (Th1amine)
247
Which vitamin is folate?
B9
248
What vitamin deficiency presents with diarrhea, dermatitis, dementia, and death?
Vitamin B3
