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Flashcards in Pediatrics UWorld Deck (71):
1

what is dx in pt who refuses to speak in specific social situations but engages in normal communication when he/she feels comfortable >= 1 month

selective mutism

2

why is selective mutism not considered normal shyness

refusal to speak at school can impair both academic and social development and should not be considered normal shyness

3

what is dx in pt where social situations are avoided or endured with great distress due to fears of negative evaluation

social anxiety disorder

4

what is dx in pt who demonstrates impairments in social reciprocity and restricted or repetitive patterns of behavior during early development

children with autism spectrum disorder

5

when is stranger anxiety normal

usually begins in children 6-9 months old and generally subsides by 3yo

involves anxiety and distress when encountering unfamiliar people, even in the presence of a parent.

6

what is dx in pt who develops fever, urticaria, polyarthralgias, and lymphadenopathy ~1 week after penicillin therapy

serum sickness-like reaction

7

what type of hypersensitivity is serum sickness-like rxn

it's a type 3 hypersensitivity rxn that occurs 1-2 weeks after admin of beta-lactams (penicillin, amoxicillin, cefaclor) or trimethoprim-sulfamethoxazole

8

what is management of serum-like sickness

removal of offending agent (penicillin d/c) resolves symptoms within 48 hrs

more severe cases may require glucocorticoid therapy

9

what is dx in systemic IgA-mediated vasculitis occurring after an URI
presents with fever, arthralgia, and palpable purpuric rash of buttocks and lower extremities

Henoch-Schonlein Purpura

10

what develops if mononucleosis is treated with amino penicillin

morbilliform rash on the trunk

rash typically spares the extremities (no arthralgias either)

11

what is dx in pt with fever and sandpaper rash following strep pharyngitis

scarlet fever

12

what is dx in pt who starts a medication then gets acute high fever, vesicular or bulls lesions, and painful hemorrhagic oral erosions

Stevens-Johnson syndrome

13

what is dx in infant who presents with easy bleeding/bruising born without prenatal care and/or at-home delivery

Vitamin K deficiency

14

what will labs look like in infant with Vitamin K deficiency

normal platelets

prolonged PT

prolonged PTT (possibly normal if mild deficiency)

15

what are 4 reasons infants are born Vitamin K deficient

poor placental transfer

absent gut flora

immature liver function

inadequate levels in breast milk

16

what is the most common inherited bleeding disorder

impaired synthesis of Von Willebrand factor

17

what is the most common congenital foot deformity, characterized by medial deviation of forefoot with normal/neutral position of the hind foot; usually bilateral

metatarsus adductus

18

what dx is characterized by flexible feet that overcorrect both passively and actively into lateral deviation (abduction)

metatarsus adductus

19

what is management for metatarsus adductus

reassurance

most forms of metatarsus adductus correct spontaneously

20

what is dx in infant with rigid medial and upward deviation of both forefoot and hind foot with hyper-plantar flexion of foot

congenital clubfoot

21

what is the management for congenital clubfoot

karyotyping should be considered due to risk of chromosomal abnormalities

requires ortho evaluation, and
serial manipulation and casting soon after birth

22

what should you be concerned with in a newborn with meconium ileus

cystic fibrosis

23

what is dx in infant with gradual growth failure and recurrent sinopulmonary infections with greasy stools

cystic fibrosis

24

how do CF pts develop pancreatic insufficiency?

pancreatic duct obstruction and distention due to viscous mucus and subsequent inflammation develop in utero, and
eventually lead to fibrosis

25

what will a CF baby's growth chart reveal

normal birth measurements

deceleration in weight
followed by declaration in length

26

what is dx in pt who presents with decelerated velocity of height growth in infancy
normalization of height growth rate after age 2-3 but have short stature and delayed puberty; and catch-up growth after puberty

constitutional growth delay

27

for a thalassemia, what is:
MCV
RDW
total RBC

low MCV (microcytic)
RDW normal
total RBC count is normal or high

28

what is Mentzer Index, and when is it low vs high

Mentor index = MCV/RBC

<13 typically occurs in a thalassemia (small cells but nl/high RBC count)

> 13 in iron deficiency (due to decline in total RBC count)

29

what are contraindications to a rotavirus vaccine

anaphylaxis to vaccine ingredients

history of intussusception

history of uncorrected congenital malformation of GI tract (ex Meckel's diverticulum)

SCID

30

what is most common cause of gastroenteritis in infants and young children worldwide

rotavirus

31

when is rotavirus vaccine administered

age 2-6 months

32

what type of vaccine is rotavirus vaccine

live attenuated virus vaccine

33

what is a risk when giving the rotavirus vaccine

intussusception

34

which is the only type of vaccines that should be administered 4 weeks apart due to possible interference of immune response

live -virus vaccines

35

what 2 types of injuries typically go along with shaken baby syndrome

shearing of dural veins and vitreoretinal traction (retinal hemorrhages)

36

what is the most common heart defect with Down Syndrome

complete atrioventricular septal defect

37

how does a complete AtrioVentricular septal defect present

heart failure in early infancy

systolic ejection murmur due to increased pulmonary flow form the ASD

holosystolic murmur due to the VSD

38

what causes a complete atrioventricular septal defect

failure of endocardial cushions to merge

39

what is coarctation of aorta associated with

Turner syndrome

40

what causes Ebstein anomaly

severe tricuspid regurgitation

41

what does auscultation reveal in Ebstein anomaly

"triple or quadruple gallop"
(widely split S1 and S2 sounds plus a loud S3 and/or S4

and

holosystolic or early systolic murmur at the LLSB

42

which murmur presents as continuous machine-like murmur

Patent ductus arteriosus

43

what is PDA strongly associated with

congenital rubella syndrome

44

what 2 heart defects are strongly associated with DiGeorge syndrome

Truncus arteriosus

transposition of the great arteries (TGA)

45

which vaccine is associated with a decreased risk in developing hepatocellular carcinoma, esp in regions of Asia and Africa

Hepatitis B vaccine

46

what is the initial tx for hypernatremia

initial goal is to stabilize with fluid resuscitation
--only isotonic solutions such as 0.9% NS or LR should be used to slowly lower the Na levels

47

what type of solutions are 0.45% NS and 5% dextrose

hypotonic solutions

48

what is the classic triad for brain abscess

fever
severe headaches (nocturnal or morning)
focal neurologic changes

49

what should you give for treatment and post-exposure prophylaxis for pertussis

Macrolides (azithromycin, clarithromycin, erythromycin)

all close contacts should be given the Abx regardless of age, immunization status, or symptoms
--Pertussis is highly contagious

50

what are the doses of each macrolide for pertussis treatment and Post-exposure prophylaxis

< 1 mo: Azithromycin x 5 days

all others:
Azithromycin x 5 days
OR
Clarithromycin x 7 days
OR
Erythromycin x 14 days

51

what should you suspect in pt with dermatitis herpetiformis and/or T1DM

Celiac disease

52

what does the work-up of Celiac disease involve

a high tissue transglutaminase (TTG) IgA antibody

intestinal biopsy (villous atrophy)

53

what age is bedwetting normal up to

bedwetting is normal before age 5

54

what two options might help a pt with nocturnal enuresis >5yo?

enuresis alarm
or
desmopressin therapy

55

what is dx in pt who presents with persistent symptoms of nasal drainage, congestion, and cough, lasting 10-30 days without improvement; pt appears ill, high fevers, and purulent nasal drainage for at least 3 days

bacterial sinusitis

56

what is the most common predisposing factor for acute bacterial sinusitis

viral upper respiratory infection

57

why does a viral URI predispose a pt to bacterial sinusitis

contaminating bacteria cannot be cleared by mucociliary clearance due to mucosal inflammation from viral infection,
leading to secondary bacterial infection

58

what is first-line treatment for acute bacterial sinusitis

amoxicillin plus clavulanic acid

59

what is dx in pt with rapid onset of:
noninflammatory edema of the face, limbs, and genitalia
laryngeal edema (could be life-threatening)
edema of the intestines, resulting in colicky abdominal pain
no evidence of urticaria

usually follows an infection, dental procedure, or trauma

angioedema (hereditary)

60

what is pathogenesis of hereditary angioedema

C1 inhibitor deficiency, dysfunction, or destruction

low C1 inhibitor leads to elevated levels of edema-producing factors C2b and bradykinin

61

what's the most common cause of acquired isolated angioedema

ACE inhibitor use, which results in elevated levels of bradykinin

62

what are C1q and C4 levels in hereditary vs acquired forms of angioedema

C1q is normal in hereditary

C1q is low in acquired

C4 levels are depressed in all forms of angioedema

63

what is the best way to dx phenylketonuria

quantitative amino acid analysis
--elevated phenylalanine

64

what is the deficiency in PKU

phenylalanine hydroxylase
--inability to metabolize phenylalanine into tyrosine
--accumulation in phenylalanine and its neurotoxic byproducts

65

what is the mutation in Marfan syndrome

auto dominant disorder that results from mutations in the fibrillin-1 gene

66

what is dx in pt with tall stature, long/thin extremities; arachnodactyly; joint hyper mobility; upward lens dislocation; aortic root dilation

Marfan syndrome
fibrillin-1 gene mutation

67

what is management of newborn with hydrocele

most will disappear spontaneously by 12 months
--observation

hydroceles that do not resolve spontaneously should be removed surgically due to risk of inguinal hernia

68

what is the most common type of brain tumor in children

astrocytoma

69

what is dx in young pt with recurrent, severe viral, fungal, or opportunistic (Pneumocystitis) infections, failure to thrive, and chronic diarrhea

SCID

70

what is etiology of SCID

gene defect leading to failure of T cell development

B cell dysfunction due to absent T cells

71

what is treatment of SCID

stem cell transplant ASAP