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Quarter 3 Finals > Peds > Flashcards

Peds Flashcards

1
Q

Cerebral Palsy

A

Non-progressive
d/t brain injury
4 types: Spastic*, ataxia, dyskinetic, mixed

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2
Q

Hydrocephalus

A

Increased volume of CSF –> ventricular dilation and increased ICP

2 types: obstructive vs non-obstructive

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3
Q

Hydrocephalus sx

A

Bradycardia
HTN
HA, behavior change, papilledema, spasticity

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4
Q

Hydrocephalus dx

A

Newborn: Ultrasound
Children: MRI/ CT

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5
Q

Hydrocephalus tx

A

Neurosurgeon –> Shunt

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6
Q

Microcephaly

A

> 2SD below mean OR
<5th%

If sx: delay milestone, seizure, Early fontanelle closure, Prominent suture

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7
Q

Macrocephaly

A

> 2SD above mean OR

>97th%

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8
Q

Rate of growth of Macrocephaly hints at Etiology

A

Rapid: increased ICP
Catch up: Premie, neuro intact
Normal: Familial

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9
Q

Chari malformation Type 1

A

Type 1: cerebellum disp caudally, Syringomyelia- fluid filled cyst in spinal cord “cape like sensory loss”

sx onset teen or adult

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10
Q

Chair malformation type 2

NEED SURGERY

A

all sx of type 1 + Myelomeningocele

Sx earlier (Prenatal or AT BIRTH)

dysphagia, apneic spells

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11
Q

Spina Bifida
Closed: occulta
Open: Meningocele, myelomeningocele

A

Risk factors:

Low folate, fever, genetics, poor managed DM, obesity

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12
Q

Spina bifida Occulta

A

Hairy patch
Dimple
Dark spot

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13
Q

Spina bifida meningocele

A

Outpoutching of spinal FLUID and MENINGES

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14
Q

Spina bifida myelomeningocele

A

Outpouching of SPINAL CORD and MENINGES

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15
Q

Spina bifida myelomeningocele (THE WORST)

A

Sensory loss, paralysis, Incontinence (urinary and bowel)

Often also has: Chairi II and Hydrocephalus

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16
Q

NF1

A 
Autosomal Dominant
Macrocephalus, seizures, cognitive delay
"Cafe-au-lait" spot
Axillary/inguinal freckles
Lisch nodules
Optic pathway glioma
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17
Q

Migraine

A

Focal
2-72 hrs
Pulse/throbbing
Associated sx: N/V, photophobia, maybe aura

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18
Q

Tension HA

A

Diffuse, can last up to 7 days
Constant pressure
Not worse w activity
maybe photophobia

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19
Q

Pseudomotor Cerebri

A

Idiopathic intracranial HTN (increased ICP but no mass or hydrocephalus)

OBESE TEEN GIRL

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20
Q

Pseudomotor Cerebri classic sx

OBESE TEEN GIRL

A

HA and Papilledema

Also: pulsatile tinnitus, neck stiff

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21
Q

Pseudomotor Cerebri Dx

A

LP would show increased opening pressure

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22
Q

Tx for Pseudomotor Cerebri

intracranial HTN

A

Acetazolamide

Topiramate, weight loss

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23
Q

Absence seizure

A 
Considered generalized (both hemispheres)
Sudden impaired consciousness w/o loss of tone

Provoked by hyperventilation

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24
Q

Abscense seizure

A

often gone by age 10
Dx: EEG

lasting 10 sec, may have up to 10/day

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25
Q

Absecne seizure tx

A

Ethosuximide

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26
Q

Febrile Seizure dx

A

EEG not indicated!! not necessary

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27
Q

Febrile Seizure dx, IF lasting LONGER than 5 min

A

IV Benzos

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28
Q

Guillian Barre

C. Jejuni

A

Acute flaccid paralysis

Ascending symmetric weakness

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29
Q

Dx of Guillian Barre

A

EMG/NCV
CSF has increased protein, normal WBC
Spinal MRI (with AND without contrast): enhanced nerve roots and cauda equina

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30
Q

Tx of Guillian Barre

A

IVIG or plasma exchange

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31
Q

Botulism

A 
Honey
Ach 
<6 mo usually
Descending weakness
Constipation, hypotonia
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32
Q

Dx of Botulism

A

Stool sample, EMG/NCV

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33
Q

Tx of Botulism

A

Immunoglobulin-

BIG-IV or BabyBIG

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34
Q

Duchenne MD

A

X. link recessive
MORE SEVERE FORM
earlier onset, death by 18YO
“Gower sign”

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35
Q

Dx of Duchenne MD

A

Increased muscle enzymes

genetic testing

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36
Q

Tx of Duchenne MD

A

Glucocorticoids

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37
Q

Becker MD

A

sx onset later
less severe, BUT
Cardiomyopathy may be more severe

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38
Q

Chiari Malformation Type 1

A

Neck pain

If syingomyelia: cape like sensory loss, loss of abd reflex

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39
Q

Dx of Chiari

A

MRI

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40
Q

Tx of Pseudomotor cerebri

A

Acetazolamide

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41
Q

Epilepsy

A

> 2 unprovoked, more than 24 hrs apart

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42
Q

Most common generalized seizure

A

Tonic and Clonic

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43
Q

Absence

A

provoked by Hyperventilation

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44
Q

tx for Abscence seizure

A

Ethosuximide

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45
Q

Croup (viral)

A

Parainfluenza: most common
Barking cough “Seal”
Hoarse, Stridor

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46
Q

Steeple sign on CXR

A

Croup

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47
Q

Croup

A

Mild: no stridor
Mod: stridor, some retractions
Severe: stridor, retractions, AND agitation

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48
Q

Stridor

A

inspiratory squeaking

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49
Q

Tx of Croup

A

Mild: Supportive, maybe steroid
Moderate: Steroid, Epi
Severe: ED

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50
Q

Epiglottitis

A

EMERGENCY
Usually bacterial: Hib
Vaccine available

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51
Q

Triad:

Dysphagia, drooling, distress

A

Epiglottitis

and “Hot potato voice”

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52
Q

Thumb sign on CXR

A

Epiglotitties

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53
Q

Epiglottitis tx

A

3rd gen Cephalosporin (Ceftriaxone)

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54
Q

If you suspect Aspiration from foreign body,

A

PROMPT Bronchoscopy should be performed

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55
Q

Tracheomalacia

A

Floppy trachea- abn collapse d/t inadequate supporting cartilage

56
Q

Cause of floppy trachea “tracheomalaica”

A

Craniofacial abn
Genetic
Conn tissue disorder

57
Q

Tracheomalacia

A

Harsh, barking cough
EXPIRATION worse

Most improve 6-12 mo
CPAP if severe

58
Q

Triad:
Paroxysmal cough
INSPIRATORY whoop
Post-tussive emesis

A

Pertussis

59
Q

Gold standard Pertussis dx

A

Nasal culture OR PCR from nasopharyngeal swab

60
Q

Tx of Pertussis

A

Macrolides (Azithro, Clarithro)

Bactrim is backup

61
Q

Bronchiolitis (viral)

A

Lower respiratory infection

62
Q

Bronchiolitis (viral)

A

RSV most common

Leading cause of hospitalization in infants and young children

63
Q

Bronchiolitis
non severe vs
moder-severe

A

non severe: f/u in 2 days

mod-severe: hospitalize and supportive (bronchodilator)

64
Q

RSV Broncholitis

A

Pariticularly severe
Worse with RF: <6 mo, premie, 2nd hand smoke, immunocompromised, severe asthma

Can have PNA or Apnea with it

65
Q

RSV Broncholitis tx or prevention

A

RSV Prophylaxis- Palivizumab

FOR HIGH RISK CHILDREN <2YO

66
Q

Round PNA on CXR are usually caused by:

A

Staph or Strep

67
Q

Atypical PNA are usually ____ on CXR

A

Diffuse

68
Q

Tx for bacterial PNA

A

Amoxicillin

69
Q

Tx for Atypical PNA

A

Macrolide (Azithro) or Doxy

70
Q

Cystic Fibrosis

A

CFTR gene
Cl transport faulty –> thick mucus

newborn screen

71
Q

Diagnostic test for Cystic Fibrosis

A

Sweat chloride >60

72
Q

Bronchiectasis

A

Abn dilation and distortion of bronchial tree –> COPD

73
Q

Cause of Bronchiectasis

A

Cystic Fibrosis is most common cause in children

chronic cough w purulent sputum
crackles, rhonch, digital CLUBBING, increased AP diameter

74
Q

CF causes

A

Bronchiectasis

Obstructive pattern on PFT
CXR: “Tram track” “ring shadows”

75
Q

Infant Resp Distress Synd

A

“Hyaline membrane dz”
Deficient surfactant
Alveolar collapse

Cause: Prematurity, genetic disorders

76
Q

Infant Respiratory Distress Synd

A

Sx start almost immediately after birth

Tachypnea, retractions, flaring, EXPIRATORY grunting, cyanosis

77
Q

Tx for Infant Respiratory Distress Synd

A

PRENATAL steroids
Exogenous surfactant
CPAP w O2

78
Q

CXR shows “Ground glass appearance” and Air bronchograms

A

Infant Respiratory Distress Syndrome

79
Q

Bronchodilator test for Asthma

Reversible IF:

A

> 12% or

>200 mL after use

80
Q

Ratio in asthma is

A

DECREASED

81
Q

Stepwise approach for Asthma

A

SABA
ICS
LABA (with a steroid)
LTRA

82
Q

Risk factors for Obstructive sleep apnea

A

Adenotonsilar hypertrophy

Obesity

83
Q

Dx and Tx of Obs sleep apnea

A

Polysomnography
PE
Focused sleep hx

Tx: Adenotonsillectomy, CPAP

84
Q

Highest risk for Type 1 DM

A

White (non hispanic)

85
Q

Two peaks of Type 1 DM in childhood

A

4-6 and

10-14 YO

86
Q

Gene that increases risk of DM Type I in peds

A

HLA-DR3
HLA-DR4
(in whites)

87
Q

Environmental risk factors for type 1 DM

A

Viral infection
Further from equator
Diet (cows milk early, not breastfeeding, solid foods too early)
Higher socioeconomic status

88
Q

Type 1 DM clinical presentation

A

3Ds + weight loss and fatigue

89
Q

Type 1 DM diagnosis

A

Classic
DKA
Silent (incidental) discovery

90
Q

Glucose control as you age

A

Can be more strict as you get older

<5 YO: 80-200
6-11: 70-180
>12: 70-150

91
Q

Syringe insulin method

A

Good: cheaper, less training

Risk: higher risk for Hypoglycemia

92
Q

Overweight

A

85-95th percentile

93
Q

Obese

A

> 95th percentile

94
Q

Exercise recommendation for kiddos

A

30-60 min per day

95
Q

Screen time for kiddos

A

<2 hours of non-academic per day

96
Q

Sx of Type 2 DM

A

Thirsty, Polyuria
Visual disturbance
Frequent infections

Peds: No sx, fatigue, irritable, difficulty concentrating

97
Q

Signs of Type 2 DM

A

Acanthosis Nigricans (posterior neck, axilla, abdomen, thigh, elbow space)

98
Q

Who to screen for Type 2 DM

A

> 10 YO, overweight/obese, AND 2 of the following risk factors

99
Q

The 4 risk factors for Type 2 DM for screening

A

Type 2 in first or second deg relative
High risk ethnic
Insulin resistance signs
Maternal hx of DM/gestational Dm

100
Q

How often to repeat type 2 DM screening

A

every 3 years

101
Q

When to use Insulin

A

Ketosis
Severe hyperglycemia
Mixed Type 1 and 2

Recommended when plasma glucose >250 or A1C > 9%

102
Q

After starting new DM med, how often do we monitor A1C?

A

3 months

103
Q

How often to measure blood glucose if on insulin?

A

3x/day

104
Q

Comorbidities to monitor if Type 2 DM

A

HTN

Hyperlipidemia

105
Q

Med to treat HTN if pt (over 13 YO) has Type 2 DM

A

ACE-I or ARB (first line)

Thiazide, CCB (2nd line)

106
Q

Lipid goals for teens w Type 2 DM

A

LDL <100
Trig <150
HDL >35

107
Q

When to use Statin to tx Type 2 DM teen with Hyperlipidemia?

A

LDL >130
pt is >10YO
Obesity/other CVD risk factors are present

AND if you have already tried non-pharm therapy for 6 mo with no luck

108
Q

Short stature

A

2 or more SD below mean
OR
<2.3 %

109
Q

Skeletal age: most widely used system to test

A

Greulich-Pyle Atlas method

left hand wrist X ray compared
use age and gender

110
Q

“Normal” causes of short stature

A

Familial

Constitutional delay of growth

111
Q

Pathologic causes of short stature

A 
GH deficient
Turner
Prader willi
Noonan 
Achondroplasia
112
Q

How would I check my parental mean height?

A

Subtract 5” from my dad, and average w my mom

113
Q

How would Jared check his parental mean height?

A

Add 5” to mothers, then mean with dad

114
Q

Tx for GH deficiency

A

Recombinant Human GH is 1st line tx

115
Q

Tx for GH deficiency

A

rhGH 1st line
Must tx prior to epiph plate closure
Daily SubQ injections

116
Q

Side effects of Recomb Human GH replacement

A

Pseudotumor cerebri
Hyperglycemia
Gynecomastia

117
Q

Turner Syndrome

A

45 X0
Loss of all or part of X chromo
SHORT STATURE

Shield shaped thorax, low hairline, underdeveloped gonads, amenorrhea

118
Q

Noonan syndrome

A

SHORT stature
Auto-Dominant
CHD (heart)
Variable gene mutations

Triangle head, curly wooly hair, neck webbing

119
Q

Prader Willi

A

Chromosome 15
Obesity
SHORT stature

120
Q

Achondroplasia

A

Auto-DOMINANT
FGFR3 gene
*Most common bone dysplasia in humans

121
Q

Achondroplasia

A

Disproportionate with Rhizomelic short- long bones are short

122
Q

Autosomal Dominant causes of short stature

A

Noonan

Achondroplasia

123
Q

What are IGF-1 levels in Turner, Noonan, Prader willi, Achondroplasia?

A

Normal, even though they are short

124
Q

Complications assoc with Achondroplasia

A

Rhizomelic shortening
Macrocephaly
Brachydactylyl
Obestiy

125
Q

Tall stature

A

Gigantism, GH excess b4 epiphyseal closing

126
Q

GH excess Gigantism dx

A

Serum IGF-1
GH suppression test
MRI

127
Q

GH suppression test

A

(give glucose, if GH does not fall in response= abnormal)

128
Q

Tx for GH excess

A

Octreotide*
Bromocriptine
Surgery/radiation

129
Q

Precocious puberty

A

Girls: before 8
Boys: before 9

130
Q

Central precocious puberty

A

Gonadotropin dependent

Elevated LH and FSH

131
Q

Peripheral precocious puberty

A

Testes are the problem

Elevated gonadal steroids, but low LH and FSH

132
Q

Central/ gonadotropin dependent Precociosu

A

Girls > boys
MRI brain/ Pit

Tx: GnRH agonist

133
Q

Peripheral precocious puberty

gonadotropin-indep

A 
Rare
50% cases in boys
Cause: steroids
Congenital
Mccune Albright

Tx: underlying

134
Q

21 a hydroxylase deficiency

A

Too much Androgens (virulizing)

Not enough Aldosterone or Cortisol

135
Q

Klinefelters

A

most common cause of primary testicular failure

Gynecomastia

136
Q

Tx for 21 a hydroxylase deficiency

High Androgen
Low Cortisol and Aldosterone

A

GnRH analog

Hydrocortisone
Fludrocortisone

Quarter 3 Finals (10 decks)

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