Peds Flashcards
(161 cards)
1
Q
Duodenal atresia
A
Failure to reanalyze; polyhydramnios in utero
Bilious vomiting
Double bubble on XR with no distal air
Down Syndrome
2
Q
Annular pancreas
A
Double bubble with or without distal air
Bilious vomiting
3
Q
Malrotation/volvulus
A
Upper GI series: abrupt cutoff of GI tract
Bilious vomiting
Contrast enema: abnormal position of the cecum
Leads to ischemia
4
Q
Intestinal atresia
A
Double bubble with multiple air-fluid levels
Bilious vomiting
Mom had cocaine or tobacco problem
5
Q
Pyloric stenosis
A
Sudden onset projectile non-bilious vomiting; olive shaped mass and visible peristaltic waves
CMP: hypochloremic, hypokalemic, metabolic alkalosis
US: donut sign
6
Q
TE fistula
A
Non-bilious vomiting
NG tube will coil
Bubbling and gurgling with respirations
7
Q
Bilirubin metabolism
A
Unconjugated from heme breakdown (indirect) -> conjugated in the liver (direct; water soluble) -> unconjugated in the colon
8
Q
Dangerous hyperbilirubinemia
A
Indirect/unconjugated can cause kernicterus; >20/25
Direct is more concerning: sepsis/obstruction/metabolic dz
9
Q
Work up for indirect hyperbilirubinemia
A
Coombs: isoimmunization
Hgb, Retic count
10
Q
Work up for direct hyperbilirubinemia
A
HIDA, Hepatic US, sepsis, metabolic eval
11
Q
Breast feeding jaundice
A
Quantity problem -> more frequent feeds
Elevated unconjugated
Presents <7 days old; not feeding well, dehydrated, jaundiced
12
Q
Breast milk jaundice
A
Quality issue (enzyme problem)
Elevated unconjugated
Presents >7 days old; will be feeding normally (just jaundiced)
Temporarily switch to formula
13
Q
Gastroschisis vs omphalocele
A
Gastro: to the right, no membrane, no chromosome abnormalities
Omphalocele: midline, membrane, chromosome abnormalities
14
Q
Biliary atresia
A
Persistant/worsening jaundice after 2 weeks; direct hyperbilirubinemia
US + LFTs -> HIDA scan: 5-7 day phenobarbital sim shoes lack of bile reaching duodenum -> intraopertive cholangiogram
Treat w/ Kasai (hepatoportoenterostomy)
15
Q
NTD
A
Fusion of caudal neural tube
Elevated AFP
16
Q
Managing dirty wound
A
<3 lifetime doses of Tdap: Clean gets tdap/dirty gets tdap + TIG
>3 doses: clean but >10 years tdap, clean <10 home, dirty >5 years tdap, dirty <5 years home
17
Q
Contraindications to Tdap
A
Absolute: encephalopathy <7 days after previous dose
Relative: fever, shock, crying, seizures
18
Q
Epidural hematoma
A
Temple trauma, lucid interval, “lens” on CT
Evacuate
19
Q
Subdural hematoma
A
Trauma/abuse, LOC w/no lucidity, “crescent”
Evacuation and ICP mgmt
20
Q
Cerebral contusion
A
Trauma, LOC, punctate hemorrhage
Manage ICP
21
Q
Car seats
A
Rear-facing: 0-2y
Booster seat: until child is 4’9 (8-12y)
22
Q
Parkland formula
A
%BSA x kg x 4
1/2 in 8 hours, 1/2 in 16
23
Q
Sx of shaken baby
A
Subdural hematoma, retinal hemorrhage
24
Q
Erythema infectiosum
A
Parvovirus B19, slapped cheek, lacy rash
Aplastic crisis, hydrops
25
Measles
4 C's: cough, coryza, conjunctivitis, coplik spots (white centers on bright red buccal mucosa)
Rash starts on face -> body
Fever starts with rash
SSPE is concerning sequelae
26
Rubella (german measles)
Togavirus
Face -> toes spread; macular (fainter and quicker than measles)
Generalized tender lymphadenopathy
Forchheimer spots (red enanthem)
27
Roseola
HHV-6
Prodrome of high fever that breaks when rash starts
Macular rash on trunk -> face
Febrile seizures
28
Varicella
```
Chicken pox
VZV
Rash on trunk/head -> outward spread
Vesicles on an erythematous base in different stages
Contagion ends with final crust
```
29
Varicella zoster
Shingles
Immunocompromised adults w/varicella hx
Painful prodrome and rash in dermatomal distribution; does not cross the midline
Posteherpetic neuralgia treated with TCA or gabapentin
30
Mumps
B/L parotid swelling
| Orchitis
31
HFMD
Coxsackie A
Vague prodrome, often oral pain
Vesicles on erythematous base
Can see herpangina: lesion on soft palate, tonsils, uvula
32
Bulging fontanelle
Meningitis
33
HSV encephalitis
Hippocampus
| Bloody LP
34
West Nile
Paralysis + encephalitis
35
Causes of osteo
Most common: staph
Animal bite: pasturella
Sickle cell: salmonella
36
Pneumonia
Strep pneumo, H. flu, Moraxella
| Neonatal: E. coli, GBS, chlamydia
37
Allergic rhinitis
IgE
Venous congestion under eyes (allergic shiners), transverse nasal crease (allergic salute), pale and boggy nasal mucosa, polyps, posterior cobblestoning
38
First line treatment for otitis media
Amoxicillin
39
Causes of otitis externa
Pseudomonas, S. aureus
40
Croup
Viral prodrome, barking cough, inspiratory stridor, worse at night
Steeple sign on XR
Recepi and steroids
41
Epiglottitis
High fever, rapid onset
Tripoding, drooling, thumb print sign on XR
Straight to OR
42
Bacterial tracheitis
Ill appearing, subglottic narrowing on XR
Presents similar to croup but in older children
Tracheal culture, abx
43
Retropharyngeal abscess
Drooling and fever; neck in sniffing position, muffled voice, unilateral cervical lymphadenopathy, tonsils with gray exudates
Lateral neck XR: widened paravertebral space
CT scan
Consult surgery
44
Peritonsillar abscess
Hot potato voice, muffled, drooling, tonsillar bulge that displaces uvula
Polymicrobial
Abx and surgical drainage
45
Breath sounds heard with extra thoracic obstruction (in a FB aspiration)?
Inspiratory (stridor)
46
Breath sounds heard with intrathoracic obstruction (in a FB aspiration)?
Expiratory (wheezing)
47
Most likely place for FB aspiration?
Right mainstream bronchus
48
Treating pneumonia in kids
Typical: amoxicillin
Atypical: azithromycin
49
Bronchiolitis
Inflammation of small airways by virus; wheezing caused by sloughed epithelial cells
Treat when: O2 <90%, premature, <3m, cardiopulmonary abnormalities or immunodeficiency
50
CF
Meconium ileus, failure to thrive, frequent respiratory infections, salty
Infertile males, malnourished, pseudomonas
Need pancreatic supplementation and ADEK
51
Febrile seizures
Generalized, <15m, single episode in 24 hours, no neuro deficits
No workup needed
52
West Syndrome
```
Infantile spasm
<1yo with symmetric jerking of head, trunk or extremities with NO fever
EEG: hypsarrhythmia
Treat with ACTH
Associated w/ intellectual disability
```
53
Tuberous Sclerosis
Intellectual disability, seizures
| Ash leaf spots on Woods lamp, angiofibromas, cortical tubers
54
NEC
Premature baby and bloody diarrhea
XR: pneumatosis intestinalis
NPO, TPN, IV abx (surgery only if no improvement)
55
Anal fissure
Tear in anal mucosa; hematochezia
Associated w/ constipation
Possible IBD
56
Intussusception
Abrupt, colicky abdominal pain; knee to chest
3m-3yo
Sausage shaped mass, currant jelly diarrhea
Air-contrast barium enema; US to monitor resolution
57
Meckel's diverticulum
Remnant of omphalomesenteric (vitelline) duct; can contain gastric tissue
FOBT+, anemia, or hematochezia
58
IBD
Blood diarrhea for either; lasts >6w
| Seen at 10-20yo
59
Infectious colitis
Bloody diarrhea and fever
| Don't treat unless septic, Shigella or immunosuppressed
60
Mild-protein allergy
Hematochezia and FtT ~6m
| Typically outgrown
61
Apt test
Differentiates swallowed maternal blood from fetal blood
| Fetal blood resistant to denaturation -> workup
62
General features of LtoR shunts
Increased vascular markings on CXR
| Ventricular hypertrophy -> pulmonary HTN (eventual reversal); not cyanotic until reversal
63
ASD
LtoR; fixed wide split S2
64
VSD
LtoR; harsh holosystolic murmur
Most common congenital heart disease
Repair if: right sided hypertrophy, elevated rt pressures, failure to thrive, heart failure
65
PDA
LtoR; continuous machine like murmur
Connection between aorta and pulmonary artery
Indomethacin to close; PGA to keep open
66
General features of RtoL shunts
Cyanotic at birth (the T disease)
67
Transposition of the great vessels
Most common cyanotic defect of a newborn
Risk factor: pregestational diabetes
Fatal with no PDA
68
Tetralogy of Fallot
Most common cyanotic defect of children
Overriding aorta, pulmonary stenosis, RVH, VSD
Tet spells (increases vascular resistance), boot shaped heart
Down and DiGeorge
69
Coarctation of aorta
HTN, claudication, temp difference between arm and legs
| Rib notching
70
Legg-Calve-Perthe Disease
~6y; avascular necrosis of the hip
| Insidious onset knee pain, antalgic gait, pain with abduction & internal rotation
71
Slipped Capital Femoral Epiphysis
Adolescents: obese or growth spurt
Sudden onset of hip or knee pain
Frog leg XR
72
Septic hip
```
Any age (typically a toddler)
Febrile illness and joint pain
XR -> joint aspiration
```
73
Transient Synovitis
Synovial inflammation up to 4 weeks after URI or GI viral illness
No fever, no leukocytosis
74
Osgood-Schlatter Disease
Teenage athlete; painful knee with swelling over tibial tubercle
Stop exercising or play through it; palpable nodule
75
Osteogenic sarcoma
Sunburst onion skin at the distal femur
| Retinoblast
76
Ewing's sarcoma
Midshaft; t(11;22) translocation
77
Strabismus
"Lazy eye"; reflection of light comes from separate locations on each eye
Patching, glasses, surgery
78
Retinoblastoma
Pure white retina instead of red reflex
| Look for osteosarcoma
79
Cataracts
Milky white
| TORCH or galactosemia
80
Posterior urethral valves
Male; low/no urine output and +/- palpable bladder
Redundant tissue in urethra
Hx of oligohydramnios
VCUG
81
Ureteropelvic junction obstruction
UPJ narrow -> colicky pain
| Dx with US; VCUG for reflux
82
Ectopic ureter
Females with have constant leak
83
Vesicoureteral reflux
Retrograde urine flow; UTIs and scarring
| Dx with VCUG
84
Sickle cell substitution
Valine for glutamine at 6th
85
Baseline labs in sickle cell
Bilirubin, LDH and retic elevated
| Haptoglobin low
86
Sickle cell associations
Pigmented gallstones/early cholecystecomy
Splenic autoinfarct
Osteomylitis (salmonella)
Avascular necrosis
87
Bruton's agammaglobulinemia (XLA)
X-linked; b-cell deficiency (humoral)
Recurrent "normal" infections: sinus, ears, pneumonia
All Ig are deficient; flow cytometry: no B cells
BTK gene
Treat with scheduled IVIG
88
Hyper-IgM
Low IgA and IgG (IgM normal to high); no class-switching
| IVIG
89
Selective IgA deficiency
Most common primary immunodeficiency
Mucosal barriers
Anaphylactic reaction after blood transfusion (to foreign IgA)
90
Common variable immunodeficiency
Looks like XLA but less severe
Deficient in at least 2 of 3 Ig
Scheduled IVIG
91
DiGeorge (22q11)
Absent thymus, micrognathia, wide spaced eyes, low set ears
Defect in cellular immunity (thymus); fungal and pneumocystis; watch Ca
TMP/SMX, IVIG and bone marrow transplant
92
Wiskott-Aldrich
Combined humoral and cellular defect
X-linked
"Normal" infections, thrombocytopenia, eczema, elevated IgE and IgA
IVIG, splenectomy, bone marrow transplant
93
Ataxia-Telangiectasia
Telangiectasia+ataxia, poor DNA repair, lymphoma and leukemia
Sinopulmonary infections and no IgA
94
SCID
Causes by absent adenosine deaminase
Essentially AIDS
IVIG and bone marrow transplant
95
Chronic granulomatous disease
Cant kill catalase +
Chronic skin or organ abscesses
Elevated IgM and IgG, elevated WBC (just not doing shit)
Negative nitro blue test -> no respiratory burst
TMP/SMX and itraconazole, bone marrow transplant
96
Leukocyte adhesion deficiency
```
Neutrphils cant get out of blood vessel
No pus but massive leukocytosis and fever
Seen at body/environment junctions
Delayed separation of cord
Bone marrow transplant
```
97
Chediak-Higashi
Indscriminate lysosomal fusion
Albinism, neuropathy and neutropenia
Giant granules in neutrophils
Infections of mucous membranes and skin
98
Hyper-IgE (Job) Syndrome
Elevated IgE and peripheral eosinophilia
"Cold" abscesses (staph, h.flu, strep pneumo)
Eczema, retained primary teeth, fractures, post-infection pneumatoceles
99
C1 esterase deficiency
```
Herediatry angioedema (defect of C1 inhibitor)
Treat with FFP
```
100
Gonococcal neonatal conjunctivitis
Swelling, profuse purulent drainage, corneal edema/ulcer
| Single IM cephalosporin
101
Chlamydial neonatal conjunctivitis
Mild swelling, water/serosanguinous/purulent drainage
| PO macrolide
102
Spondylolisthesis in adolescents
Due to growth spurts/ increased lordosis
Pain with extension (athletes with repetitive extension and rotation at higher risk)
Palpable step-off
103
Diamon-Blackfan anemia
Congenital erythroid aplasia
Craniofacial abnormalities, triphalangeal thumbs, increased risk of malignancy
Macrocytic anemia and reticylocytopenia
Treat with steroids and RBC transfusions
104
GB
```
Diagnose clinically: ascending paralysis & decreased reflexes
CSF: increased fluid, nml leukocytes
Abnml electromyogrpahy
Monitor respiratory function
IVIG if needed
```
105
Treat acute vs chronic ITP
Acute: observe/GC, IVIG or anti-D
Chronic: splenectomy
106
Kid with undiagnosed CF
Recurrent pulmonary infections
Greasy, loose stools (pancreatic insufficiency)
Bleeding (no ADEK)
107
ALL
Most common childhood cancer
Lymphadenopathy/hepatosplenomegaly/ pallor/petechia
Lymphoblasts on biopsy
108
Burkitt lymphoma
B cells, EBV
Mass on mandible or abdomen
"starry sky"
109
CLL
Lymphadenopathy
Adults
Smudge cells
110
Hodgkin lymphoma
Germinal center of B cells
| Fever, lymphadenopathy, mediastinal mass
111
Multiple myeloma
Plasma cells
Adults
rouleaux RBCs
112
Scarlet fever
"strawberry tongue"
Exudative pharyngitis
Sandpaper rash that spares palms and soles
113
Complications of Kawasaki
Coronary artery aneurysm, MI
| *do an echo on everyone
114
Central precocious puberty
```
Early 2nd sex (<8 and 9yo)
Advanced bone age
High basal LH OR low basal, high with GnRH stim
Caused by early activation of HPG axis
MRI for hypothalamic or pituitary tumor
Treat with GnRH therapy
```
115
Peripheral precocious puberty
Early 2nd sex (<8 and 9yo)
Advanced bone age
Low basal LH AND low LH with GnRH stim
Caused by gonadal or adrenal release of hormones
116
Cause of cough in croup
Inflammation -> edema and narrowing of proximal trachea (tracheolaryngitis)
117
Turner's associations
Coarctation of aorta, bicuspid aortic valve (eventual insufficiency), horseshoe kidney, streak ovaries (not enough estrogen -> osteoporosis)
118
Neonatal polycythemia
>65% hematocrit
Presents: Ruddy skin, hypoglycemia, hyperbilirubinemia, irritable
Hydrate
119
Todd paralysis
Self-limited, focal after a seizure
| Hemiparesis or hemiplegia
120
Duchenne MD
X-r; onset 2-3yo
Weak, grower, calf pseudohypertrophy
Scoliosis and cardiomyopathy
121
Becker MD
X-r; onset 5-15yo
Milder than Duchenne
Cardiomyopathy
122
Myotonic MD
AD CTG expansion of DMPK gene; onset 12-30yo
Facial weakness, hand grip myotonia, dysphagia
Arrhythmias, cataracts, balding, testicular atrophy
123
Recurrent pulmonary and GI infections; no lymphoid tissue (tonsils/lymph nodes)
XLA (abnormal B cell maturation)
| Defect in tyrosine kinase
124
Severe, recurrent viral, fungal and bacterial infections with failure to thrive
SCID
| Adenosine deaminase deficiency (impaired T cells)
125
Recurrent skin and pulmonary infections
CGD (oxidative burst)
| Organisms will be catalase-positive
126
Eczema, microthrobocytopenia (petechia, purpura, bleeding), recurrent infections
WAS (X-r)
| Impaired cytoskeleton changes in leukocytes and platelets
127
Transient tachypnea of the newborn
Inadequate alveolar clearance, mild pulmonary edema
Starts shortly after birth, resolves by day2
CXR: b/l perihilar linear streaking
128
Respiratory distress syndrome
Surfactant deficiency: alveolar collapse/atelectasis
Respiratory distress and cyanosis
CXR: diffuse, reticulogranular appearance, low lung volume, air bronchograms
Grunting, nasal flaring, retractions
129
Persistent pulmonary HTN
Pulmonary vascular resistance -> RtL shunt
Cyanosis
Clear lungs and decreased pulmonary vascularity
130
Bronchopulmonary dysplasia
Initial RDS with persistent low O2
| CXR: hazy with decreased lung volumes
131
Kawasaki
Fever >5days plus >4 of:
B/l conjunctivitis, mucositis (strawberry tongue), cervical lymphadenopathy, rash (erythematous and polymorphous), erythema/edema of hands and feet
Treat with ASA and IVIG
132
Congential adrenal hyperplasia
21-hydroxylase deficiency
Decreased 11-deoxycorticosterone (aldosterone precursor): salt wasting (hypotension, hyponatremia, hyperkalemia)
Decreased 11-deoxycortisol (cortisol precursor): hypoglycemia
Increased testosterone: Virilization and ambiguous females
Elevated 17-hydroxyprogesterone is diagnostic
133
Acute weight loss in children to fluid loss
1 kg acute weight loss = 1L fluid loss
134
Common comorbid disorders with Tourettes?
OCD and ADHD
135
NF1
AD
| Cafe-au-lait, clustered freckles, Lisch nodules (hamartomas of the iris), neurofibromas, optic gliomas
136
Osteoid osteoma
Bone forming tumor in adolescent boys
Proximal femur, pain at night, improves with NSAIDs
XR: small, round lucency
Monitor
137
Hirschsprung
Failure of NCC migration; chronically contracted
Associated with Down
Positive squirt sign
138
Thiamine deficiency in kids
Beriberi
| Cardiomegaly, neuropathy
139
Ascorbic acid deficiency in kids
Scurvy
| Ecchymoses, petechia, bleeding gums, hyperkeratosis, arthralgia, impaired wound healing
140
Hypervitaminosis A
Anorexia, pruritus, lack of weight gain, irritability, tender swelling of bones, alopecia, fissuring of mouth, hepatomegaly
141
Neuroblastoma
Neural crest cells
Kids <2, abdominal mass, periorbital ecchymoses, spinal cord compression (dumbbell tumor), opsoclonus-myoclonus
Horner's syndrome
Small, round blue cells
142
Eczema herpeticum
HSV1; vesicular rash with "punched-out" erosions and hemorrhagic crusting
143
Murmur of VSD
Holosystolic at lower left sternal border
144
Prader-Willi
Paternal deletion
| Hypotonic, weak suck, obese, hypogonadism, narrow tea/almond eyes/down turned mouth
145
Treatment of impetigo
Limited: topical abx (mupirocin)
Extensive: oral (cephalexin, dicloxacillin, clinda)
146
Painless hematochezia in a kid
Meckel diverticulum
Viteeline duct
T-99m scan
147
Beckwith-Wiedemann Syndrome
Macrosomia, hemihyperplasia, omphalocele, macroglossia
148
Heavy menstral bleeding in otherwise normal teenager
vWD
149
Clinical presentation of H-S purpura
Purpura, arhtritis/arthralgias, abdominal pain/intussusception, Renal disease
150
Homocystinuria
Looks like Marfans but:
| Intellectual disability, CVA/thrombosis, fair complexion, megaloblastic anemia
151
Laryngomalacia
Inspiratory stridor worse in supine position
| Most common cause of stridor in infants
152
Choanal atresia
```
Blockage of posterior nasal aperture
Cyclic cyanosis (worse during feeding)
```
153
Gaucher
Hepatosplenomegaly, FtT, delayed puberty, anemia, bone pain
154
Congenital VZV
cortical atrophy
155
Congenital HSV
Temporal lobe hemorrhage
156
Periventricular calcifications
CMV; saliva
157
Diffuse parenchymal/intracerebral calcifications
Toxo
158
Hereditary spherocytosis
Triad: hemolytic anemia, splenomegaly and jaundice
159
Physiologic jaundice of the newborn
Day 2-4
| Indirect hyperbili
160
Hemolytic disease of the newborn
Within 72hrs
Splenomegaly
ABO incompatibility
161
Target cells + MCV <65
Thalassemia (decreased globin chains)
