PEDS Flashcards
1
Q
Identify possible causes of this rash - 3
A
THE STRAWBERRY TONGUE!
- GASP +/- mononucleosis
- Kawasaki disease
- Toxic Shock Syndrome
2
Q
Dx Criteria for Kawasaki Disease
A
[Burning HIGH Fever x ≥ 5 days] PLUS 4/5 of CRASH:
- Conjunctivitis
- Rash
- Adenopathy unilaterally in cervical region (least likely)
- Strawberry tongue/oral mucosa changes
- Hand/Feet redness or swelling
- THIS IS DX OF EXCLUSION! THERE CAN NOT BE ANOTHER OBVIOUS CAUSE OF PRESENTATION*
3
Q
There are 5 major complications of Kawasaki Disease
In order of greatest to least, list them
A
[Burning HIGH Fever x ≥ 5 days] PLUS 4/5 of CRASH:
CNS ∆(irritability/aseptic meningitis) > CORONARY ARTERY ANEURYSM (within 1-4 wks!) > Liver dysfxn > Arthritis > GallBladder Hydrops
THIS IS DX OF EXCLUSION! THERE CAN NOT BE ANOTHER OBVIOUS CAUSE OF PRESENTATION
4
Q
Tx for Kawasaki disease-2 ; when should this be given?
A
[Burning HIGH Fever x ≥ 5 days] PLUS 4/5 of CRASH:
- [ASA 80-100 mg/kg/day divided into 4 doses] –> [3-5 mg/kg/day as one dose after defervescence] –> DC after 6 wks if no coronary involvement. Cont indefinitely if so.
- [IVIG 2g/kg given over 12 hours]
within 10 days of Burning HIGH FEver
5
Q
Which diseases in kids involve rash involving palms and soles - 4
A
- Kawasaki
- Enteroviruses
- Syphilis
- Rocky Mountain Spotted Fever
6
Q
CBC findings for Kawasaki - 6
A
[Burning HIGH Fever x ≥ 5 days] PLUS 4/5 of CRASH:
- ⬆︎WBC w/neutrophil predominance
- Normocytic Anemia
- ⬆︎⬆︎⬆︎⬆︎ Platelets during 2nd wk of illness–>clots–>coronary artery aneurysm
- +/- ⬆︎LFTs
- low albumin
- ⬆︎ESR that persist after fever subsides
THIS IS DX OF EXCLUSION! THERE CAN NOT BE ANOTHER OBVIOUS CAUSE OF PRESENTATION
7
Q
Which tx for Kawsaki is effective in preventing coronary artery aneurysms?-2 ; when is f/u echo recommended?
A
[Burning HIGH Fever x ≥ 5 days] PLUS 4/5 of CRASH:
[IVIG 2g/kg given over 12 hours] AND [low dose ASA] ; 1-2 weeks since coronary aneursyms develop within 4 wks
HIGH dose ASA is for fever control only
8
Q
3 classic Clinical Manifestations of [Tetralogy of Fallot]
A
A:
- [Systolic Ejection HARSH Murmur @ L Sternal 2/3 ICS] from [RVOO -R Vt Outflow Obstruction]
- Squatting relieves sx (INC afterload–> [DEC amount of R to L shunt]
- [Cyanotic lethal Tet Spells] (tx: Knee chest positioning and inhaled O2)
“VOIR is to have See + Sight & Cry”
9
Q
What is a BRUE ?
A
Brief Resolved Unexplained Event
when there is an IDIOPATHIC sudden, brief and now resolved episode occuring in an infant < 1 yo that included at least:
- cyanosis
- breathing ∆ (absent, ⬇︎, irregular)
- Hyper/hypotonia
- altered LOC
this is a dx of exclusion
10
Q
Violent Infant Shaking —> ________. This is characterized by what 3 things?
B: How is this differentiated from similar conditions?
A
Violent Infant Shaking –> [AHT- Abusive Head Trauma]! =
- Subdural Hemorrhage (from tearing bridging veins between Dura and Arachnoid)
- Retinal Hemorrhages Bilaterally (from congested retinal vein ruptures)
- POSTERIOR rib fractures
B: Usually Accidental Fall is not sufficient for Subdural Hemorrhage OR [BL Retinal Hemorrhage]
AHT is formely known as Shaken Baby Syndrome
11
Q
What’s used to keep the PDA Patent?
A
Prostaglandin E1
12
Q
What should you always suspect in a pediatric pt who recently had a viral illness, now p/w SOB and cardiomegaly?
A
Viral myocarditis (coxsackie B vs adenovirus)
13
Q
2 main sx of Bronchiolitis ; cause?
A
- Wheezing w/respiratory distress
- Fever
RSV
14
Q
Laryngomalacia etx
A
As a neonate, collapse of supraglottic structures during inspiration –> chronic inspiratory stridor worst when supine
15
Q
[T or F] LAD is actually normal in kids and young adults
A
TRUE - AS LONG AS THEY’RE SOFT AND MOBILE
tx = observation
16
Q
Why is cessation of breast feeding in a jaundiced 20 day old pt who is lethargic not necessary?
A
Galactosemia (Conjugated Hyperbilirubenima) is unlikely considering pt is 20 days old. Sepsis should be r/o first with blood cx and px abx
17
Q
What are the 2 major complications of Mumps
A
- Orchitis
- Aseptic Meningitis
18
Q
A child comes in with neonatal conjunctivitis
DDx?-3 ; How do you differentiate each?
A
19
Q
Tx for Neonatal Chlamydia Conjunctivitis?
Tx for Neonatal Gonococcal Conjunctivitis?
A
Topical macrolides are only PX for Gonococcal conjunctivitis
20
Q
What is the most common cause of Chronic renal failure (and urinary tract obstruction) in pediatrics?
A
Posterior Urethral valves (THIS ONLY AFFECTS BOYS-including newborns)
21
Q
All kids with a febrile UTI at age 2mo-2yo should undergo ___ to evaluate for ______
A
Renal US–>[cystourethrogram if recurrent] ; Vesicoureteral reflux
22
Q
Oligohydramnios –> ___ sequence.
Describe this clinical presentation for this Sequence ; Name the 3 most common causes of Oligohydramnios
A
Oligohydraminos –> POTTER Sequence
Pulmonary hypOplasia
Oligohydraminos from renal agenesis/damage (cause)
[Twisted Face & Extremities]
Twisted Skin
Ears set low
Renal Failure
POSTERIOR URETHRAL VALVES are the most common cause of obstruction in newborn boys (which causes renal damage –> oligohydramnios during utero)
23
Q
Minimal change disease is most common cause of nephrOtic syndrome in kids
Tx?
A
Prednisone
24
Q
Minimal change disease is most common cause of nephrOtic syndrome in kids
When is renal biopsy indicated?-2
A
- >10 yo
- Child has NOT responded well to CTS
25
What dx should be suspected in a neonate with painless bloody stools ; mngmt?
Milk/Soy protein proctocolitis ; dairy/soy cessation --\> bleeding stops in 2 wks
## Footnote
*these pts usually also have eczema and regurgitation from Milk/Soy*
26
DDx for neonatal rectal bleeding - 4
1. **\*\*Milk/Soy Proctocolitis\*\* = PAINLESS**
2. Meckel Diverticulum = PAINLESS
3. Volvulus (bloody stool from intestinal ischemia)
4. Intussuception (dx= AIR contrast enema)
27
cp for neonatal Lactose Intolerance - 3
1. crampy abd pain
2. bloating/flatulence
3. **Nonbloddy** diarrhea
28
etx for Choanal atresia in kids ; cp
Congenital falure of posterior nasal passage to canalize --\> bony obstruction instead; cyanotic infant whose cyanosis worsens with feeding and relieves by crying
## Footnote
Dx = inability to pass catheter thorugh nares
29
Demographic for Hypertrophic pyloric stenosis
First Born boys age 3-5 wks
30
Pts with Beckwith-Wiedemann syndrome should be monitored for what 2 CA?
1. Hepatoblastoma
2. Wilms tumor
31
cp for Reye syndrome - 3
1. encephalopathy from ⬆︎ICP --\> seizure & lethargy --\>eventually DEATH
2. liver dysfunction
3. vomiting
32
Dx? ; Mngmt?
Congenital Diaphragmatic Hernia ; Intubation **without any preceding bag mask ventilation**
## Footnote
*Image = Scaphoid concave abdomen with Barrel Chest*
33
Why do pts with this condition often have polyhydramnios?
Hernia of Diaphragm compresses esophagus --\> polyhydramnios
## Footnote
Congenital Diaphragmatic Hernia
*Image = Scaphoid concave abdomen with Barrel Chest*
34
Constipation is common in Toddlers
Why? - 3
1. Transition to solid food and cow's milk
2. toilet training
3. school entry
## Footnote
*Tx = PO Laxatives*
35
When should ingested batteries be emergently and endoscopically removed?
ONLY when the battery is still **IN** the esophagus and not distal to it. If distal --\> obs
## Footnote
*this also includes sharp objects, or multiple magnets*
36
[T or F] Gastroesophageal reflux is common in infants
Why or why not? ;
TRUE
1. More time spent supine
2. Shorter esophagus
37
**Physiological** Gastroesophageal reflux is common in infants
What is the mngmt for this?-2 ; When should you be concerned for GER Disease in infants?-2
Physiologic reflux = **REASSURANCE**, hold infant upright after feeds
GERD =failure to thrive, opisthotonic posturing after feeds. Tx = add oatmeal to thicken feeds + PPI
38
What is the mngmt for an ingested coin? - 3
1. Obs for up to 1 day after ingestion UNLESS
2. Pt is symptomatic = flexible endoscopy
3. Pt has no recollection of ingestion time = flexible endoscopy
39
Zollinger Ellison etx ; cp-2
gastrin producing tumor in pancreas or duodenum --\> ⬆︎⬆︎gastric acid \> 1000 --\>
1. multiple duodenal/jejunal ulcers **REFRACTORY** to PPI
2. steatorrhea from pancreatic enzyme inactivation
*Be sure to screen Zollinger Ellison pts for MEN1 using PTH, Ca+ and Prolactin studies*
40
What is Hepatic Hydrothorax
Liver Disease pts cause damage to R diaphragm --\> small defects that allows R pleural effusions to form
41
[T or F] UNILATERAL cervical lymphadenitis in kids from \_\_(bacteria)\_\_ is uncommon and should be worked further
FALSE! uL cervical lymphadenitis is common
Usually from **Staph** ( \> GASP)!
42
cp for Bronchiolitis in neonates - 3 ; px for this?
1. **Wheezing and/or Crackles**
2. URI sx
3. Respiratory distress eventually --\> APNEA
Px = Palivizumab for kids\<2 yo
43
What does APGAR stand for? ; How is it done? ; How is it used?
**A**ppearance, **P**ulse, **G**rimace(reflex irritability), **A**ctivity(tone), **R**espiration
Performed at **1** and **5** min postpartum, All scaled from 0 to 2 and then added together
[\< 3 = Critical] / [4-6 = fair: PPV] / [7-10 = normal: No intervention]
44
*APGAR is used to assess newborn status immediately postpartum*
Describe the grading system for **R**espiration?
APGA**R**
## Footnote
0 = not breathing
1 = breathing slow/irregular
2 = crying
45
*APGAR is used to assess newborn status immediately postpartum*
Describe the grading system for **P**ulse?
A**P**GAR
## Footnote
0 = No HR
1 = \< 100 bpm
2 = \> 100 bpm
46
*APGAR is used to assess newborn status immediately postpartum*
Describe the grading system for **A**ctivity & tone?
APG**A**R
## Footnote
0 = no motion
1 = arms & legs **flexed** but not active
2 = Active Motion of extremities
47
*APGAR is used to assess newborn status immediately postpartum*
Describe the grading system for **G**rimace & reflex irritability?
AP**G**AR
## Footnote
*Test response to stimulation (i.e. pinch)*
0 = no rxn
1 = grimace
2 = grimace **AND** cough/cry/sneeze
48
*APGAR is used to assess newborn status immediately postpartum*
Describe the grading system for **A**ppearance?
**A**PGAR
## Footnote
0 = entirely blue
1 = pink with blue extremities
2 = entriely pink
49
In a neonate, when should compressions be started?
HR \<60
50
Neonatal Respiratory Distress Syndrome is caused by \_\_\_\_\_
What are the major risk factors?-2
Surfactant Deficiency
1. Prematurity
2. Maternal DM
51
Enuresis (nocturnal urinary incontinence/bed wetting) tx - 3
## Footnote
Dx criteria: occurs ≥2/week AFTER 5 yo
1. LIfestyle change (no fluids at bedtime/void before bedtime/reward system)
2. Enuresis alarm
3. **Rx: DESMOPRESSIN** --\> add Oxybutynin if minimal change
52
Any neonate who presents with Bilious emesis should be worked up for \_\_\_\_\_
Bowel Obstruction!
## Footnote
AbdXray (r/o perf bowel) --\> water-soluble contrast enema
53
A Contrast enema demonstrating microcolon is indicative of what condition? ; etx?
Meconium iLeus 2/2 Cystic Fibrosis
viscous meconium accumulation obstructs terminal iLeum --\> underused colon --\> contracted microcolon
54
In regards to timing, what is the difference between Breastfeeding Failure jaundice and Breast Milk jaundice?
55
In terms of physical exam, what is a difference between Breastfeeding Failure jaundice and Breast Milk jaundice?
In Breast**F**eeding Failure jaundice there will be clinical signs of **F**ailure to thrive/dehydration
## Footnote
*these dehydrated neonates may have brick red urate crystals in their diapers from dehydration*
56
In terms of etiology, what is a difference between Breastfeeding Failure jaundice and Breast Milk jaundice?
B**F**F jaundice within the **F**irst week of life: inadequate feeding --\> inadequate stooling --\> ⬇︎bilirubin elimination --\> ⬆︎Unconjugated bilirbuin recycling with **F**ailure to thrive/dehydration
57
Tx for BreastFeeding Failure jaudice - 3
1. Optimize lactation
2. ⬆︎BreastFeeding frequnecy
3. Supplement with Cow's formula ONLY if mom's milk is inadequate
58
Why is human milk better absorbed than formula?
Protein Whey in human milk is more easily digested than casein which --\> ⬆︎absorption and ⬆︎gastric emptying
59
cp for Physiological Jaundice ; etx?-2
Unconjugated hyperbilirubinemia that appears the **first 24 hours of life** and resolves by the end of that week ; comes from ⬇︎hepatic UGT activity and ⬆︎bilirubin production
60
Describe Metatarsus Adductus
Most common congenital foot deformity in which there is BL medial deviation of the forefoot **usually in 1st born infants**
## Footnote
*Tx = this corrects spontaneously*
61
Atlantoaxial Instability MOD ; Which demographic are at most risk for this?
excessive laxity in the Posterior transverse ligament --\> ⬆︎mobility between C1 atlas and C2 axis --\> spinal cord compression and UMN signs
**Down Syndrome** (remember pts with down syndrome are *usually* hypOtonic but not with Atlantoaxial instability!)
62
What is Osgood Schlatter Disease
**Traction apophysitis of the tibial tubercle** from Self-limited irritation of the growth plate at the tibial tuberosity (front of tibia) possibly --\> hard nodule, relieved with rest/growth spurt
## Footnote
*xray: lifting of tubercle from the shaft*
63
Osgood Schlatter Disease tx -3
1. NSAIDs
2. Ice
3. self-limited (stops with end of growth spurt)
## Footnote
*xray: lifting of the tibial tubercle from the shaft*
64
Tx for Croup-2
1. Mild = Humidified air +/- CTS
2. \> Mild = CTS +/- Racemic Epi nebulized
## Footnote
*Croup = paraflu that --\> subglottic edema and narrowing*
65
Dx for Intussuception
**AIR** contrast enema ultrasound guided
## Footnote
Intussuception age = 3-36 mo
Look for the Target Sign on US!
66
Diagnostic Criteria for Colic - 4 ; tx
Colic = the 3's
excessive crying during first 3 weeks of life that's
≥3hrs/day (usually evenings) for
≥3days / week for
≥3weeks in a healthy infant
Tx = Soothing and feeding techniques
67
Necrotizing Enterocolitis cp - 3 ; X ray finding?
1. Bloody stools
2. feeding intolerance
3. abd distension
X-ray = Pneumotosis Intestinalis
Risk factors= prematurity, congenital heart disease, hypotension
68
Dx
X-ray = Psuemoatosis Intestinalis
Necrotizing Enterocolitis
69
What are the risk factors for Necrotizing Enterocolitis cp - 3
1. Congenital heart disease
2. Prematurity
3. hypotension
X-ray = Psuemoatosis Intestinalis
70
Why should a pediatric pt with fever and rash who received MMR 1 week prior only receive reassurance
small fraction of pts who receive MMR may develop fever and mild rash that are **self-limited**
71
What Mothers are at high risk of having Neonates with [**TGA - *T****ransposition of **G**reat **A**rteries]*?
Diabetic Mothers
72
What is the most common congenital cyanotic heart defect in the neonatal period?
Transposition of Great Vessels
## Footnote
*Look for the **single Loud second heart sound!***
73
A: Clinical Manifestations of **DiGeorge Syndrome** (5)
B: Genetic Cause
"**CATCH 22** & **P**a**3**"
## Footnote
**C**ardiac (*Aortic Arch abnormalitites, Tetralogy of Fallot*)
**A**bnormal face (Bifid Uvula/low set ears)
**T**hymus Aplasia
**C**left Palate
[**H**ypOcalcemia from PTH deficiency] *may*--\> *Carpopedal Spasms*
**22**q.11.2 deletion
**P**haryngeal arch - **3**rd/4th both fail to develop
74
What does Constitutional Short Stature refer to
"late bloomer" but will attain normal adult height later
## Footnote
*pts have normal birth wt and ht but ht velocity slows between 6 mo-3 yo, picks back up after and slows again at adolescence. bone radiographs will show delayed bone age*
75
What is the most common cause of hip pain in kids? ; Dx?
Transient Synovitis; Clinical **but obtain Xray to r/o Legg Calve Perthes**
Tx = NSAID and rest
*may have ⬆︎inflammatory markers but xrays will be normal*
76
Transient Synovitis is the most common cause of hip pain in kids
Tx for Transient Synovitis - 2
**obtain Xray to r/o Legg Calve Perthes**
Tx = NSAID and rest
77
*Cerebral Palsy is a group of clinical syndromes generally characterized as \_\_\_\_\_\_*
How does it present? - 3
Nonprogressive motor dysfunction (Prematurity\>EtOH = RF) ;
## Footnote
Cerebral Palsy is **SAD**
1. BL equinovarus club feet (image)
2. UMN signs LE \>UE
3. Mental Retardation
*Greatest RF = prematurity ( \< 32 wks gestation)*
78
Mangement for Clubfoot - 3
START THIS MNGMT IMMEDIATELY!
## Footnote
1st: Stretch and Manipulate foot --\>
2nd: serial plaster cast, malleable splits or taping
3rd: Surgery beween ages 3-6 mo if refractory to #1-2
79
Langerhans cell histiocytosis cp - 3
1. solitary painful lytic bone lesion in child
2. overlying swelling
3. hypercalcemia
80
Craniopharyngiomas and Pituitary adenomas both can cause bitemporal hemianopsia
How can you differentiate the two? - 2
1. Craniopharyngiomas are calcified (show up white on CT)
2. Craniopharyngiomas results in pituitary hormonal **deficiency** (adenomas result in pituitary hormone ⬆︎)
Craniophyarngiomas are calcified epithelial remnants of Rathke's pouch that reside in the SUPRAsellar region
81
Craniopharyngioma etx
**Calcified** low grade malignancy dervied from epithelial remnants of Rathke pouch within the pituitary stalk and reside in the SUPRAsellar region
82
What is Erythema Toxicum Neonatorum ; tx?
benign neonatal rash with blanching erythematous papules and/or pustules ; self limited to 2 weeks after birth
83
Malrotation and Volvulus are both diagnosed with \_\_\_\_\_\_
Describe how both would look on this diagnostic?
barium swallow Upper GI Series
Malrotation = Ligament of Treitz on the R side of the abd in a **gasless abd**
Volvulus = **corkscrew** image on barium swallow Upper GI series
84
Malrotation and Volvulus are both diagnosed with \_\_\_\_\_\_
What would a Volvulus look like?
barium swallow Upper GI Series
corkscrew pattern
*Try not to use CT scans in kids*
85
cp for Meckel's Diverticulum ; dx
PAINLESS hematochezia ; technetium 99 pertechnetate scan
86
Describe general characteristics of intentional child scald burns - 3
1. uniform depth
2. sparing of flexor surfaces
3. sharp lines of demarcation
87
Strabismus (ocular misalignment) after the age of ____ is abnormal and requires intervention to prevent \_\_\_\_\_
Which intervention is employed for this? - 3
4 mo ; Amblyopia(vision loss from disuse of the deviated eye)
1. CTL eye patch to strengthen deviated eye OR
2. CTL cycloplegic eye drops (blurs normal eye to strengthen deviated eye)
3. Corrective lens
Dx = asymmetric corneal light reflex
88
What is Legg Calve Perthes Disease? ; Demographic? ; mngmt-2?
Avascular necrosis of the Capital Femoral Epiphysis ; [Boys 4-10 yo) ;
1. Self limited but can --\>deformity/degeneration
2. contain femoral head within acetabulum during encounter
89
Slipped Capital Femoral Epiphysis is a complication of childhood obesity
When does this present?; How does this present? ; dx?
puberty (most common hip disorder in fat teens!) ; **Months of vague hip/knee pain** without acute onsets ; plain pelvis XRay
## Footnote
*posterior displaement of capital femoral epiphysis thru cartilage growth plate*
90
Risk factors for Developmental Dysplasia of Hip - 3 ; when should you stop screening for this?
1. **Breech Delivery** - GET HIP IMAGING IF FEMALE AND BREECHED
2. Female - GET HIP IMAGING IF FEMALE AND BREECHED
3. Fam hx
12 months old
91
pediatric pt presents with apparent leg length discrepancy and is diagnosed with \_\_\_\_\_\_
What is the work up for this?-2
Developmental Dysplasia of Hip
hip ultrasound \< 4 mo \< hip xray
92
What is the treatment for Developmental Dysplasia of Hip?
Pavlik Harness tat holds hip in flexion and ABduction
93
Infants with congenital hypothyroidism appear normal because \_\_\_\_\_\_\_
What are s/s of hypothyroidism in peds later on? - 10
protected by maternal thyroid hormone for 6 wks;
1. G: ⬇︎Feeding
2. G: ⬇︎Activity
3. P: Mental retardation (check for Down Syndrome)
4. H: Large Fontannel
5. H: Macroglossia
6. H: Puffy Face
7. **A: Umbilical Hernia**
8. A: Constipation
9. S: Jaundice
10. S: Skin Mottling
*EARLY DETECTION IS KEY, AS NORMALIZING TSH BY 1-2 MONTHS OLD PREVENTS NEURO DAMAGE!*
94
Common characteristics of Down Syndrome pts - 7
the **SHEEPPS** of genetics
1. **S**kin excessive at the nape of the neck = nuchal skin
2. **H**ypOtonia w/ ⬇︎ Startle Moro reflex
3. **E**picanthal folds
4. **E**ars that are small
5. **P**rotruding tongue w/flat face
6. **P**alpebral fissures are upslanted
7. **S**ingle palmar crease
*these pts also have ⬆︎risk for hypothyroidism*
95
cp for Laryngomalacia ; dx? ; tx?
inspiratory stridor that **improves when prone** ; Direct laryngoscopy ; self limited to 18 mo ;
96
tx for Physiological Jaundice
Phototherapy
## Footnote
Unconjugated hyperbilirubinemia that appears the **first 24 hours of life** and resolves by the end of that week
97
What is the most common pediatirc renal cancer?
Wilms tumor
## Footnote
*unilateral abd mass with hematuria*
98
Which pediatric renal tumor crosses the midline and presents in the ____ year of life
Neuroblastoma ; first
99
What is the major (and contraindicating) side effect of the Rotareovirus vaccine?
Intussuception
## Footnote
*Live attenuated vaccine*
100
Both Croup Laryngotracheitis and Epiglottitis can cause inspiratory stridor
How do you discern the two?
Epiglotitis causes **Drooling!**
101
What finding is indicated by the appearance of Pink Stains or Brick Dust in neonatal diapers?
Uric Acid Crystals
102
At what age does Bedwetting start to become pathological for kids?
5
103
Infants that are Small for Gestational Age (SGA) are at risk for developing what complications? - 5
"I'm small, **GOT C**alcium?"
1. low **O**xygen (hypoxia) (which --\> polycythemia)
2. low **G**lucose hypoglycemia
3. low **T**emperature hypothermia
4. low **C**alcium hypocalcemia
5. HIGH RBC COUNT POLYCYTHEMIA
