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Clinical Medicine LAB - Professor Sample > Peds > Flashcards

Peds Flashcards

1
Q

Metabolic Disorders ?

A

Proprionic acidemia

Methylmalonic acidemia

Isovaleric acidemia

3-Methylcrotonyl- CoA-
carboxylase deficiency

3-Hydroxy-3-methyglutaric aciduria

Holocarboxylase synthase deficiency

Beta-ketothiolase deficiency

Glutaric acidemia type I

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2
Q

Fatty Acid Oxidation Disorders ?

A

Carnitine uptake defect/carnitine transport defect

Medium- chain acyl-CoA dehydrogenase deficiency

Very long-chain acyl-CoA dehydrogenase deficiency

Long-chain L-3 hydroxylacyl-CoA dehydrogenase deficinecy

Trifunctional protein deficiency

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3
Q

Amino Acid Disorders ?

A

Argininosuccinic aciduria

Citrullinemia, type I

Maple syrup urine disease

Homocystinuria

Classic phenylketonuria

Tyrosinemia, type I

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4
Q

Endocrine Disorders ?

A

Congenital adrenal hyperplasia

Primary congenital hypothyroidism

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5
Q

Hemoglobinopathies ?

A

Sickle cell anemia

Beta-thalassemia

S,C disease

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6
Q

Other tests ?

A

Biotinidase deficiency

Critical congenital heart disease

Cystic fibrosis

Classic galactosemia

Glycogen storage disease, type II

Hearing loss

Severe combined immunodeficiencies

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7
Q

Recommended in infants ?

A

Born to mothers with gestational diabetes or DM

Large infants (>3969 g)

Small infants (<2608 g)

Premature (<37 weeks)

Smaller twin (sizes are discordant)

Polycythemia (>70% Hct)

Hypothermia

Low apgar scores (<5 at one min, <6 at five minutes)

Stress (sepsis, RDS)

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8
Q

Lead: CDC recommends universal lead screening despite risk factors for children ages _______ and targeted screening for older children at risk.

A

1 and 2

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9
Q

High levels of lead can cause ?

A

seizures or coma

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10
Q

Lead: Even blood levels less than __ have been correlated with lower intelligence quotients

A

10

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11
Q

Lead: < 10 ?

A

stunt bone growth as a consequence of decreased vit. D metabolsim

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12
Q

Lead: >10 ?

A

slow cognitive and behavioral development

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13
Q

Lead: >20 ?

A

delayed nerve conduction

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14
Q

Lead: > 40 ?

A

decrease hemoglobin synthesis

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15
Q

Lead: > 70 ?

A

anemia with acute poisoning

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16
Q

Lead: 100-150 ?

A

encephalopathy

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17
Q

Lead: >380 ?

A

convulsions, coma, death

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18
Q

Lead Poisoning: ____ mcg/dL is elevated and should be prompt for repeat screening

A

> 5

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19
Q

Lead Poisoning: >45 mcg/dL = ?

A

chelation therapy indicated

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20
Q

Lead Poisoning: > 70 mcg/dL = ?

A

immediate emergent treatment

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21
Q

Most common nutritional deficiency in the US ?

A

Iron Deficiency Anemia

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22
Q

Iron Deficiency Anemia severe causes ?

A

Anemia

Behavioral problems

Cognitive effects

Abnormal sleep cycles

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23
Q

Risk factors for IDA ?

A

Low birth weight
Pregnancy with multiples

IDA in the mother

Use of cow’s milk before 12 months of age

Low iron diet

Chronic illness
Restricted diets

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24
Q

IDA: Universal Screening at __ months by Hgb or Hct

A

12

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25
If child is anemic, further tests may be needed like what ?
CBC Iron studies Hgb electrophoresis Etc…..
26
TB: Screening with TST for high-risk patients include ?
Born outside of US? (TST for Africa, Asia, Latin America, or Eastern Europe) Traveled outside the US greater than one week and staying with friends and family. Exposed to active TB? Close contact with a person with postive TST?
27
HepB: Vaccine - composition ?
Inactive subunit of Hep B virus
28
HepB: Vaccine - immunity life ?
Usually for life Occasionally needs a booster
29
HepB: Vaccine - contraindications ?
none
30
HepB: Vaccine - Major adverse reactions ?
erythema multiforme erythema nodosum Stevens-Johnson syndrome
31
HepB: Vaccine - Common reactions ?
Irritability fever diarrhea
32
HepB: Vaccine - Dosing ?
Begins at birth 3-4 shots over 6 months (Recombivax, Engerix)
33
Central elements to reducing Hep B burden in the US ?
Immunizations of all infants beginning at birth Routine screening of pregnant women HBIG to all infants born of infected mothers Vaccination
34
Rotavirus - vaccine: composition ?
live, oral, attenuated rotavirus
35
Rotavirus - vaccine: immunity life ?
No clear data on immunity life For first year after vaccination 85%-98% protective against severe rotavirus disease 74%-87% protective against rotavirus disease of any severity
36
Rotavirus - vaccine: contrindications ?
Acute diarrhea Severe immunodeficiency
37
Rotavirus - vaccine: major adverse reactions ?
intussusception Kawasaki dz ITP
38
Rotavirus - vaccine: common reactions ?
vomiting irritability diarrhea flatulence
39
Rotavirus - vaccine: dosing ?
(Rotateq, Rotarix) 2 months AND 4 months
40
Rotavirus - vaccine: considerations ?
Viral antigens can be detected in stool CBC usually shows normal WBC count Patients may be hypernatremic May develop a metabolic acidosis Urine can show ketones
41
DTaP, Tdap - vaccine: composition ?
Diphtheria toxoid Tetanus toxoid Acellular pertussis
42
DTaP, Tdap - vaccine: immunity life ?
10 years
43
DTaP, Tdap - vaccine: contraindications ?
neurologic disorder, progressive infantile spasms uncontrolled epilepsy
44
DTaP, Tdap - vaccine: major adverse reactions ?
Seizures hypotonic-hyporesponsive episode Guillain-Barre syndrome
45
DTaP, Tdap - vaccine: common reactions ?
irritability | drowsiness
46
DTaP - vaccine: dosing ?
(higher dose diphtheria and pertussis) [Pediarix, TriHIBit) 5 shots ``` 2 months 4 months 6 months 15-18 months 4-6 years ```
47
Tdap - vaccine: dosing ?
Tdap (Boostrix) Booster every 10 years Tetanus needs booster every 5 with dirty wounds
48
Diptheria acute infections with ?
Corynebacterium diptheriae: gram + club shaped rods
49
Diptheria facts ?
Hemolytic anemia can occur Thrombocytopenia is frequently associated. Diagnosis is clinical Cultures are difficult to grow and require specialized media
50
Tetanus caused by ?
Clostridium tetani
51
Clostridium tetani | shape ?
Drumstick-shaped gram + bacilli
52
Tetanus dx. ?
clinical Anaerobic culture and microscopic examination can be helpful but are often difficult
53
Pertussis considerations ?
Elevated WBC count ~20-30,000 with 70-80% lymphocytes Identification by culture or PCR from nasal swab is the definitive diagnosis Culture requires specific media PCR is more commonly used ELISA for detection of antibodies (may be unreliable in previously immunized patients)
54
Hib - vaccine: composition ?
Hib polysaccharide protein
55
Hib - vaccine: immunity life ?
usually for life
56
Hib - vaccine: contraindications ?
Children under six weeks Hypersensitivity to tetanus toxoid
57
Hib - vaccine: major adverse reactions ?
angioedema seizures hypotonic-hyporesponsive episode
58
Hib - vaccine: common reactions ?
fever | fussiness
59
Hib - vaccine: dosing ?
(PedVaxHib) 3-4 doses 2 months 4 months (6 months depending on formulation) 12-15 months
60
Haemophilus influenza B lab findings ?
WBC count = elevated with +/- left shift Blood culture is frequently positive Culture of aspirated pus or fluid from involved site (ie; septic arthritis) CSF smear may show pleomorphic gram (-) rods
61
PCV13 (Pneumococcal) - vaccine: composition ?
conjugaated pneumococcal polysaccharides 13 strains of polysaccharides (was 7)
62
PCV13 (Pneumococcal) - vaccine: immunity life ?
Until 18 years old Also given to adults: Over 19 and immunocompromised OR Over 65 and have not had PCV13
63
PCV13 (Pneumococcal) - vaccine: contraindications ?
none
64
PCV13 (Pneumococcal) - vaccine: major adverse reactions ?
anaphylaxis/anaphylactoid rxn angioedema erythema multiforme
65
PCV13 (Pneumococcal) - vaccine: common reactions ?
irritability altered sleep patterns fatigue
66
A 23 strain version (PPSV23) is not used in ________.
children
67
PCV13 (Pneumococcal) - vaccine: also given to adults if ?
Over 19 and immunocompromised OR Over 65 and have not had PCV13
68
PCV13 (Pneumococcal) - vaccine: dosing ?
At least 4 doses 2 months 4 months 6 months 12-15 months (>24 months depends on previous formulation administered and risk factors)
69
Inactivated poliovirus (IPV) - vaccine: composition ?
Polio antigens
70
Inactivated poliovirus (IPV) - vaccine: immunity life ?
Usually life
71
Inactivated poliovirus (IPV) - vaccine: contraindications ?
Febrile illness
72
Inactivated poliovirus (IPV) - vaccine: major adverse reactions ?
seizures
73
Inactivated poliovirus (IPV) - vaccine: common reactions ?
irritability fatigue
74
Inactivated poliovirus (IPV) - vaccine: dosing ?
4 doses 2m 4m 6-18m 4-6y
75
Influenza - vaccine: composition ?
Usually trivalent grown in eggs, purified surface antigens Usually contains A and B
76
Influenza - vaccine: immunity life ?
1 year
77
Influenza - vaccine: contraindications ?
Egg allergy Guillan Barre (caution)
78
Influenza - vaccine: major adverse reactions ?
anaphylaxis bronchospasm Stevens-Johnson syndrome neurologic disorders Guillain-Barre syndrome
79
Influenza - vaccine: common reactions ?
myalgia fatigue irritability
80
Influenza - vaccine: dosing ?
Once yearly
81
Influenza CXR ?
Nonspecific findings Peribronchial thickening Diffuse interstitial infiltrates hyperaeration
82
Influenza Lab tests ?
Rapid flu antigen from nasal swab
83
Influenza virus can be found by ?
DFA antibody staining of NP epithelial cells ELISA PCR Culture
84
MMR - vaccine: composition ?
lyophilized virus grown in chicken embryos
85
MMR - vaccine: immunity life ?
life
86
MMR - vaccine: contraindications ?
hypersens. to gelatin anaphylactic anaphylactoid rxn to neomycin immunocompromised pts tuberculosis, active untreated
87
MMR - vaccine: major adverse reactions ?
erythema multiforme Stevens-Johnson syndrome atypical measles
88
MMR - vaccine: common reactions ?
arthralgia/arthritis fever urticaria rash, measles-like
89
MMR - vaccine: dosing ?
2 doses 12-15m 4-6 yrs
90
Measles hx. ?
Lymphopenia/Leukopenia high fever 104 runny nose, cough, red watery eyes
91
Measles DS ?
Measles IgM drawn 3 days after the onset of rash Fluorescent antibody staining of NP cells for direct detection of antigen PCR of oropharyngeal secretions or urine can show positive results up to 5 days before symptoms begin.
92
Mumps DS ?
Viral culture or PCR of saliva, throat, urine, or CSF may be positive for one week after onset of symptoms Single positive IgM is definitive diagnosis
93
Rubella DS ?
Leukopenia common Thrombocytopenia common 4 fold rise in antibody titer in serum drawn 1-2 weeks apart Positive IgM titers indicate acute infection
94
Rubella congenital infection is associated with ?
Low platelets Abnl LFTs CSF pleocytosis Hemolytic anemia
95
Varicella - vaccine: composition ?
live attenuated varicella virus
96
Varicella - vaccine: immunity life ?
life
97
Varicella - vaccine: contraindication ?
hypersens. to gelatin anaphylactic or anaphylactoid rxn to neomycin immunocompromised pts tuberculosis, active untreated pregnancy or planned pregnancy w/in 4wk
98
Varicella - vaccine: major adverse reactions ?
Stevens-Johnson syndrome erythema multiforme Henoch-Schonlein purpura herpes zoster (shingles)
99
Varicella - vaccine: common reactions ?
fever rash, varicella-like URI sx
100
Varicella - vaccine: dosing ?
2 doses 12-15 months 4-6 years
101
Varicella lab tests ?
Leukocyte decrease Fluorescent antibody tests of a lesion smear PCR is definitive
102
HepA - vaccine: composition ?
Hep A antigens
103
HepA - vaccine: immunity life ?
life
104
HepA - vaccine: contraindications ?
Neomycin hypersensitivity
105
HepA - vaccine: major adverse reactions ?
angioedema erythema multiforme hepatotoxicity thrombocytopenia neurotoxicity
106
HepA - vaccine: common reactions ?
irritability anorexia fatigue
107
HepA - vaccine: dosing ?
2 doses 12-24 months
108
Hepatitis A lab findings ?
Bilirubin is elevated LFTs are elevated +/- prolongation of the PT Definitive diagnosis made by positive anti-HAV IgM (anti-HAV IgG persists after infection resolves)
109
Meningococcal - vaccine: composition ?
4 conjugated polysaccharides
110
Meningococcal - vaccine: dosing ?
2 doses 11-12 years 16-18
111
Meningococcal lab findings ?
WBC count low or elevated Thrombocytopenia +/- DIC CSF cloudy with >1,000 WBC with many PMNs Gram (-) intracellular diplococci
112
HPV - vaccine: composition ?
quadrivalent polysaccharides 6, 11 16, 18
113
HPV - vaccine: dosing ?
3 dose series 11-12 years
114
Newborn Screening ?
Blood samples collected by heelstick before hospital discharge State-to-state variations in testing have diminished since 2010 Secretary Advisory Committee on Heritable Disorders in Newborns and Children set 30 core recommendations.

Clinical Medicine LAB - Professor Sample (36 decks)

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