Peds 2 Flashcards
(120 cards)
1
Q
What is the most common of all childhood malignancies?
A
ALL
2
Q
What are the typical s/sx of childhood leukemias?
A
- B symptoms
- Bone pain or limp/refusal to bear weight
- Anemia
- Ecchymoses/petechiae
- HSM
3
Q
What is a chloroma, and what does it signify?
A
Greenish soft tissue tumor on the skin or spinal cord
4
Q
What are the relative WBC levels in leukemia?
A
Can be high, low or normal
5
Q
What is the definitive diagnostic test for acute leukemia?
A
Bone marrow bx
6
Q
What is the role of a CXR in diagnosing ALL?
A
r/o a mediastinal mass
7
Q
What is the major complication associated with chemotherapy induction in leukemias?
A
Tumor lysis syndrome
8
Q
What are the electrolyte changes that occur with tumor lysis syndrome?
A
Hyperkalemia
Hyperphosphatemia
Hypocalcemia
Hyperuricemia
9
Q
What is the treatment for tumor lysis syndrome? (3)
A
IVFs
Diuretics
Allopurinol
10
Q
What medications, besides chemotherapy, classically precipitates tumor lysis syndrome?
A
Corticosteroids
11
Q
What diseases are associated with neuroblastomas?
A
Neurofibromatosis
Hirschsprung’s disease
12
Q
What are the symptoms of neuroblastomas?
A
Nontender abdominal mass
Horner syndrome
HTN
Cord compression
13
Q
What are the classic PE findings of a neuroblastoma, besides an abdominal mass?
A
Opsoclonus/myoclonus
14
Q
What is opsoclonus?
A
Random, multi vectorial eye movement, commonly seen with neuroblastomas
15
Q
How are neuroblastomas diagnosed? (2)
A
- FNA of tumor revealing small round blue cells
- Elevated 24 hours urinary catecholamines
16
Q
How are neuroblastomas staged?
A
CT scan
17
Q
What is the treatment for a neuroblastoma?
A
Surgical resection and/or XRT
18
Q
What are the skin manifestations of neuroblastomas?
A
Multiple SQ nodules
19
Q
What ages do Wilms tumors commonly occur in?
A
2-5 years
20
Q
What syndromes are Wilm tumors commonly associated with?
A
- Beckwith-Wiedemann syndrome
- Neurofibromatosis
- WAGR syndrome
21
Q
What are the components of WAGR syndrome?
A
- Wilms tumor
- Aniridia
- GU abnormalities
- Retardation
22
Q
What are the s/sx of Wilms tumor, besides unilateral abdominal mass?
A
- Abdominal pain
- Fever
- HTN
- microscopic/gross hematuria
23
Q
How are Wilms tumors diagnosed?
A
- FNA
- Abdominal US
- CT scan
24
Q
What is the treatment for a Wilms tumor?
A
Local resection and nephrectomy with postsurgical chem and XRT if there are mets
25
What germ cell layer do Ewing sarcomas arise from?
Neuroectoderm
26
What germ cell layer do osteosarcomas arise from?
Osteoblasts (mesenchymal)
27
Who classically gets Ewing's sarcoma? Osteosarcomas?
```
Ewing's = white male adolescents
Osteosarcomas = Male adolescents
```
28
What are the s/sx of Ewing's sarcoma?
- Local pain and swelling
| - Systemic symptoms, e.g. fever, anorexia, fatigue
29
What are the s/sx of osteosarcomas?
Local pain and swelling
| *systemic symptoms are rare*
30
Where anatomically are Ewing sarcomas commonly located?
Midshaft of long bones
31
Where anatomically are osteosarcomas commonly located?
Metaphyses of long bones
32
What lab abnormalities are common to Ewing's sarcoma?
Leukocytosis
| Increased ESR
33
What lab abnormalities are common to osteosarcoma?
Increased alkphos
34
What is the classic x-ray findings for Ewing's sarcoma?
Onion skinning lytic bone lesion
35
What is the classic x-ray findings for osteosarcoma?
Sunburst lytic bone lesions
36
Sunburst lytic bone lesions on x-ray = ?
Osteosarcoma
37
Onion skinning lytic bone lesion on x-ray = ?
Ewing's sarcoma
38
What is the treatment for Ewing sarcoma?
Local excision, chemo, and XRT
39
What is the treatment for osteosarcoma?
Local excision, chemo
40
What is the treatment for a clavicular fracture?
Sling
41
What is a Greenstick fracture, and what is the treatment?
- Incomplete fracture involving the cortex of only 1 side (tension/trauma) side of the bone
- Reduction with casting.
42
What is a torus fracture? Treatment?
- Buckling of the compression side of the cortex 2/2 trauma
| - Cast immobilization for 3-5 weeks
43
What is a supracondylar humeral fracture, and what is the treatment?
- Humeral fracture just above the condyle
| - Cast immobilization
44
What are the complications associated with a supracondylar humeral fracture?
- Volkmann contraction (results from compartment syndrome of the forearm)
- Brachial artery entrapment
45
What is the treatment for Osgood-Schlatter disease?
Decreased activity for 2-3 months or until asymptomatic
46
What are the components of the SALTER mnemonic for salter-harris classifications?
```
Straight across
Above
Lower
Through
Erasure of the physis
cRushed
```
47
What is the treatment for a salter-harris fracture?
Closed or open reduction, followed by immobilization
48
What is the inheritance pattern of Duchenne's muscular dystrophy? What protein is deficient?
XLR
| Dystrophin
49
Which muscles are more prominently affected with Duchenne muscular dystrophy: proximal or distal? Axial or peripheral?
axial and Proximal
50
What are the presenting symptoms of Duchenne muscular dystrophy?
Clumsiness, fatigability
51
What is the diagnostic test for Duchennes? What will this show?
- Muscle bx
| - Necrotic muscle fibers, and negative dystrophin stain
52
What lab is elevated with Duchennes muscular dystrophy?
CK
53
What will EMG show with Duchennes?
Polyphasic potential and increased recruitment
54
What is the treatment for Duchenne muscular dystrophy?
Physical therapy to maintain ambulation and to prevent contractures
55
What causes the high-output cardiac failure in Duchenne muscular dystrophy?
Cardiac fibrosis
56
What is developmental dysplasia of the hip?
a congenital or developmental deformation or misalignment of the hip joint. It does not typically produce symptoms in children less than a year old
57
Who usually develops congenital hip dysplasia?
Firstborn girls in breech position
58
What are the maneuvers that are used to screen/diagnose developmental hip dysplasia?
Ortolani and barlow maneuver
59
What is the Allis (Galeazzi) sign?
Test for developmental dysplasia of the hip--The knees are at unequal heights when the hips and knees are flexed (the dislocated side is lower).
60
What is characteristic about the inguinal area in kids with hip dysplasia?
Asymmetric skin folds that extend beyond the anus and limited abduction of the affected hip
61
When does DMD and becker's begin?
```
DMD = 3-5 years
Becker's = 5-15 years
```
62
What is the life expectancy for DMD and beckers?
```
DMD = teens
Becker's = 30s-40s
```
63
Which more commonly has MR: DMD or beckers?
DMD
64
What is the difference in dystrophin in DMD vs beckers?
DMD is absent
| BEckers has normal levels, but the protein is abnormal
65
How is developmental hip dysplasia diagnosed?
- US prior to 6 months given lack of ossification
| - Radiographs after 6 months
66
What is the treatment for developmental dysplasia of the hip (before 6 months, 6-15 months, and 15-24 months)?
- Less than 6 months: Splint with a Pavlik harness (maintains hip flexed and abducted)
- 6-15 months: spica cast
- 15-24 months = Open reduction followed by spica cast
67
What are the major complications associated with developmental dysplasia of the hip?
AVN of the femoral head
68
What is Legg-calve-perthes disease?
Idiopathic AVN and osteonecrosis of the femoral head
69
In whom is Legg-calve-perthes disease most common in?
Boys 4-10 years
70
What are the s/sx of Legg-calve-perthes disease?
painless limp, antalgic gait, and thigh muscle atrophy
71
If pain is present with Legg-calve-perthes disease where is it usually found?
Groin, anterior thigh, or may be referred to the knee
72
What PE finding is classic for Legg-calve-perthes disease?
Limited abduction and internal rotation
73
How is Legg-calve-perthes disease diagnosed?
Radiography
74
What is the treatment for Legg-calve-perthes disease?
■ Observation sufficient if limited femoral head involvement or if full ROM is present.
■ If extensive or ↓ ROM, consider bracing, hip abduction with a Petrie cast, or an osteotomy.
75
What is the prognosis for Legg-calve-perthes disease?
The prognosis is good if the patient is < 6 years of age and has full ROM, ↓ femoral head involvement, and a stable joint.
76
What are the components of the STARTSS HOTT mnemonic for the ddx for pediatric limp?
```
Septic joint
Tumor
AVN
RA/ JRA
TB
Sickle cell
SCFE
HSP
Osteomyelitis
Trauma
Toxic synovitis
```
77
What is slipped capital femoral epiphysis?
Displacement of the femoral head from the femoral neck through the growth place.
78
In whom are SCFEs common in?
Obese children
79
What are the presenting s/sx of a SCFE?
- Insidious onset of hip pain, or referred knee pain
| - *painful* limp
80
How do you diagnose a SCFE? What will these show?
- Radiographs of both hips in AP and frog-leg lateral views
| - Reveals posterior and inferior displacement of the femoral head
81
What is the treatment for a SCFE?
■ Immediate surgical screw fixation to reduce risk of AVN.
| ■ No weight bearing should be allowed until the defect is surgically stabilized.
82
What is the technical definition of scoliosis?
Lateral curvature of the spine more than 10 degrees.
83
What is the treatment for scoliosis (less than 20 degrees, 20-50 degrees, 50+ degrees)?
■ Close observation for < 20 degrees of curvature.
■ Spinal bracing for 20–49 degrees of curvature in patients with remaining growth. Curvature may progress even with bracing.
■ Surgical correction for > 50 degrees of curvature.
84
How should babies sleep to reduce the risk of SIDS?
On their backs
85
How hot should the water heated be allowed to get with children in the house?
Less than 120 F
86
How long should children be rear facing in the car?
Until 2 years, and/or weighs over 40 pounds
87
When can solid foods be introduced to an infant diet?
After 6 months
88
When should cow's milk be introduced into an infant diet?
No sooner than 12 months
89
When is objective hearing screens indicated for children if not done routinely at discharge?
h/o TORCHES infections
90
How long is strabismus considered normal?
Until 3 months of age
91
What is strabismus?
Misalignment of eyes
92
What is amblyopia?
Suppression of retinal imaged in a misaligned eye
93
What two pathologies are indicated with leukocoria?
- Retinoblastoma
| - Retinopathy of prematurity
94
Patients who have a severe allergy to eggs should not receive which vaccine?
MMR
95
True or false; HIV patients should not be given any live attenuated vaccines
False-can get MMR and varicella
96
What are NOT contraindications to vaccinations?
- Mild illness and/or low grade fever
- Current abx use
- Prematurity
97
When is screening for Pb poisoning indicated?
at 12 and 24 months in high risk areas only (not universal)
98
What are the s/sx of Pb poisoning? (3)
- Intermittent abdominal pain
- Peripheral neuropathy (wrist or foot drop)
- Acute encephalopathy if severe
99
What will a PBS show with Pb poisoning?
Microcytic, hypochromic anemia with basophilic stippling.
| Sideroblasts may also be present
100
What is the treatment for Pb poisoning (less than 45 micrograms, 45-70, 70+)?
■ < 45 μg/dL and asymptomatic: Retest at 1–3 months; remove sources of lead exposure.
■ 45–69 μg/dL: Chelation therapy (inpatient EDTA or outpatient oral succimer [DMSA]).
■ ≥ 70 μg/dL: Chelation therapy (inpatient EDTA + BAL [IM dimercaprol]).
101
What is the most common cause of urethral obstruction?
Posterior urethral valves
102
What is vesicoureteral reflux?
Retrograde projection of urine from the bladder to the ureters and kidneys
103
What is mild (grade I) vesicoureteral reflux?
No ureteral or renal pelvic dilation. Often resolves spontaneously
104
What is moderate (grade II) vesicoureteral reflux?
Ureteral dilation with associated caliceal blunting in severe cases
105
What is the typical presentation of vesicoureteral reflux?
Recurrent UTIs, typically in childhood
106
How is vesicoureteral reflux diagnosed?
Voiding cystourethrogram
107
What is the treatment of vesicoureteral reflux?
- treat infx aggressively
- mild with daily prophylaxis
- surgery for grade III+
108
What is the common complication to untreated vesicoureteral reflux?
Renal scarring
109
What is the major risk factor for cryptorchidism?
Low birth weight
110
What is a major complication of untreated cryptorchidism?
Infertility and increased risk of testicular malignancy
111
What is the treatment for cryptorchidism?
Orchiopexy
112
What organs are affected by maternal hyperglycemia?
- Heart
- Liver
- muscle
113
What organs are *not* affected by maternal hyperglycemia?
Brain
| Kidneys
114
What causes breastfeeding jaundice?
Insufficient breast milk in the first week increases enterohepatic circulation of bili. Beta-glucuronidase present in meconium conjugates bili, and causes it to be reabsorbed
115
What is/causes breast milk jaundice? When does it present, and how long does it last?
- Jaundice on day 4-7, and can persist for up to 12 weeks
| - beta-glucuronidase in milk causes deconjugation of bili and increased enterohepatic circulation
116
What are the s/sx of biliary atresia?
- Acholic stools
- Dark urine
- Jaundice
117
What is the normal color for infant stools? Are they usually odorous?
Yellow
| Breast fed infant stools are usually odorless
118
What is the treatment for breast discomfort 2/2 engorgement?
- Increased feedings
- Warm compresses
- Manual/mechanical expression of milk
119
What vitamin supplements should a baby receive if exclusively breast fed?
Vit D (through mother)
120
What visual problem can arise with NF1?
Optic pathway glioma
